Paediatric Pain Management
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Paediatric Pain Management
Understanding the child’s perspective on pain.
Katrina Shapland
Occupational Therapy Student.
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Try and imagine a time when you were in hospital/in pain as a child:
How did you feel?
What did you do to cope?
What did people around you do?
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Ward-groupGoals of ward group
Provide opportunity for children to enact hospital procedures through play
Facilitate social interaction
Provide normalcy - play is the primary occupation of childhood.
Allow projection of feelings and experiences onto the teddy to further sense of mastery and control.
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Ward group - 2FW
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Number of children per caseload identified to benefit from OT services verses number of referrals.
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Medical Play
• http://www.youtube.com/watch?v=Go8N5i3lCWI
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Play!
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What is pain? Pain is whatever the
experiencing person says it is, existing wherever they
say it does.
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Evidence shows that pain is an inherently subjective, multifactorial experience.
For this reason it is impossible to treat pain on a physical level and expect it to disappear.
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PEO(Person, Environment, Occupation)
EnvironmentOccupation
Person
Occupational performance
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Piaget’s developmental stages
Cognitive Stage of Development
Key Feature Impact on perception of pain
Preoperational2 - 7 yrs.
EgocentrismProcess of ‘getting better’ in response
to pain (2, 4)
Concrete Operational7 – 11 yrs.
ConservationAble to describe psychological feelings
of pain (3)
Table 1 ref: Piaget, 1932
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What does the literature say - 2-
4years?
Getting better: (a) ‘hide away,’ (b) ‘fight it’, (c) ‘make it good’.
More frequent the pain, the more frequently these strategies were used.
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Strategies: 2-4 years
Explaining the procedure just before it happens
Introduction of medical equipment prior to procedure through play (e.g. X-ray machine = space ship!).
Distraction: blowing bubbles, puppets, toys.
Reflecting on hospital experiences through play with other children.
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What does the literature say - 7-11
years?Taking medicine and other curative actions
Resting and cognitive control strategies e.g. distraction
Decrease in parental support - view themselves as active agents in pain relief.
Non-observable components of pain.
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What does the literature say - specific
conditions?Specific conditions develop their own pain patterns - specific strategies to target these.
For example: Tonsillectomy
Visual Analogue Scale O = no pain 10= extreme pain
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Assessing pain• Situations that caused pain to all
children in hospital were procedures connected with treatment.
• Children described pain as physiological, and psychological feelings of pain.
• Research indicates school-aged children’s ability to describe their own pain.
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Looking to the future:
• Assessments- to gauge pain perception before and after medical play
• Extending play for older children.
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Future research
• Influence of individual’s personal experience on the concept of pain.
• Influence of socio-cultural factors
• Specialised pain intervention strategies
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Thank you for your time.
Any questions?
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References
• Tonsillectomy picture: 200214425-001_XS.jpg retrieved from http://www.livestrong.com/tonsillectomies/
• Baum, C. M, & Christiansen, C. H. (2005). Person-environment-occupation-performance: An occupation-based framework for practice. In C. H. Christiansen, C. M. Baum, and J. Bass-Haugen (Eds.), Occupational therapy: Performance, participation, and well-being (3rd ed.). Thorofare, NJ: SLACK Incorporated.
• (Paediatric Pain Management: A Multi-Disciplinary Approach - By Alison Twycross, Anthony Moriarty, Tracy Betts 1998 )
• Piaget, J. (1932). The moral judgment of the child. London: Routledge & Kegan Paul.
• reference: 1995 Young children's behavioural responses to acute pain: strategies for getting better.http://www.ncbi.nlm.nih.gov/pubmed/7593943
• reference: 1997 ["It feels like a hedgehog quill sticking in my foot...". School-aged children's experience of pain in the hospital].http://www.ncbi.nlm.nih.gov/pubmed/9429343 )
• reference: 1996 "Getting better from my hurts": toward a model of the young child's pain experience. http://www.ncbi.nlm.nih.gov/pubmed/8772041)
• Idvall, E., Holm, C., Runeson, I. (2005). Pain experiences and non-pharmacological strategies for pain management after tonsillectomy: a qualitative interview study of children and parents. Journal of Child Health Care, 9(3), 196-207.
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