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AAP National Conference: What you can do to reduce kids’ pain, anxiety :

October 25, 2016

Emory Petrack, M.D., FAAP, authored a study in 1997 showing that children were less likely to receive pain medicine than adults when treated in emergency departments for long bone fractures.

“The good news is that over the past one to two decades, there has definitely been significant improvement in the way pediatricians and emergency medicine addresses pain in children,” said Dr. Petrack, chief of pediatric emergency medicine at Tufts Medical Center/Floating Hospital for Children in Boston.

“That said, it’s pretty clear that we still have a ways to go,” he added.

Dr. Petrack will discuss techniques that can be used in the hospital or office setting to lessen pain and anxiety during a session titled “Painful or Anxiety-Provoking Procedures: Easing the Experience (F4060)” from 12:45-1:30 p.m. Tuesday in Room 103 of Moscone South.

Among the procedures he will discuss are laceration repair, IV insertion, immunizations and digital nerve blocks.

“Even if it’s not necessarily a painful procedure, there are ways we can help children who might be particularly anxious in the emergency department setting,” said Dr. Petrack, a member of the AAP Section on Emergency Medicine.

When assessing patients’ anxiety, it’s important to consider their developmental stage, Dr. Petrack advised. For example, most children develop separation anxiety around 9 months of age. Therefore, if the parent leaves the room, the child’s anxiety likely will increase significantly.

“The vast majority of the time, caregivers are very important to helping the child and can and should be present,” Dr. Petrack said.

Both pharmacologic and nonpharmacologic techniques to reduce pain and anxiety will be covered during the session.

Nonpharmacologic methods include positioning the child with the caregiver, preparing the child appropriately for what’s going to happen and then distracting him or her during the procedure.

If a child needs to be restrained, the parent can be positioned in a way that helps keep the child still. For example, a mother could lie on a stretcher with the child on top of her and wrap her arms around the youngster.

“That offers tremendous comfort to the child, but it also helps restrain the child,” Dr. Petrack said.

When caring for older school-age children and teens, giving them some autonomy can help them feel in control and reduce their anxiety.

Dr. Petrack also will discuss pharmacologic modalities such as lidocaine, epinephrine, tetracaine (LET) gel for laceration repair, needle-free systems for IV insertions, glucose solution for young infants undergoing procedures or immunization, and nitrous oxide for anxiety. He will show short video clips on how to use techniques correctly.

“The underlying foundation of what I’m talking about is when we combine those two modalities, pharmacologic and nonpharmacologic, that’s when we absolutely get the most bang for the buck,” Dr. Petrack said. “And it turns out that we can more reliably and consistently have a better outcome as well.”

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