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Pediatric pain management in an adult critical care unit
1Department of Anesthesia, Children's Hospital Medical Center of Cincinnati, Ohio, USA.
Insights
Pediatric critical care faces challenges with limited specialized centers. This study reviews pain assessment tools, including self-report and behavioral methods like CHEOPS and FLACC, for children in adult units.
Area of Science:
- Pediatric Critical Care
- Pain Management
- Trauma Care
Background:
- Limited availability of dedicated pediatric trauma centers necessitates treating children in adult critical care units.
- Effective pain assessment is crucial for managing pain in pediatric patients, especially those in critical care settings.
- Challenges exist in assessing pain in children, particularly those who are nonverbal or unable to self-report.
Purpose of the Study:
- To review current pain assessment strategies for children treated in adult critical care units.
- To highlight the importance of appropriate pain assessment tools for pediatric patients.
- To provide recommendations for nonpharmacological pain management interventions.
Main Methods:
- Review of existing literature on pediatric pain assessment tools.
- Discussion of self-report measures (e.g., OUCHER) for verbal children.
- Examination of behavioral assessment tools (e.g., Children's Hospital of Eastern Ontario Pain Scale [CHEOPS], Face, Legs, Activity, Cry, Consolability [FLACC] scale) for nonverbal children.
Main Results:
- Self-report is the preferred method for pain assessment when feasible.
- Behavioral scales like CHEOPS and FLACC are valuable for nonverbal pediatric patients.
- The OUCHER scale can be used for children as young as three years old.
- Nonpharmacological interventions are effective and can be integrated into daily nursing care.
Conclusions:
- Accurate pain assessment in children within adult critical care units requires utilizing appropriate tools based on the child's ability to self-report.
- A combination of self-report and behavioral assessment methods ensures comprehensive pain evaluation.
- Implementing accessible nonpharmacological approaches can significantly improve pain management for pediatric patients in critical care.
Abstract:
Many children every year will be treated in "adult" critical care units because of the limited pediatric trauma centers currently available. Assessment is an integral part of all pain management. Ideally, self-report is the gold standard for assessing pain; however, some children may not have the ability to use these tools. Nonverbal children may be assessed with behavioral tools such as the CHEOPS or FLACC. In children as young as 3 years old, the self-report tool called an OUCHER can be administered to assess their pain. Easy to apply nonpharmacological approaches are discussed with recommendations for nurses to incorporate into their daily care.