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Background: Relief of pain and suffering is an important responsibility of nurses caring for children, and intravenous cannula insertions is the most common sources of pain in hospitalized children. Distraction is recommended to help in minimizing the discomfort of painful procedures. The aim of the study is to examine the effects of pressing a soft ball on children's behavioral response and pain level during and after intravenous catheter insertion. Methods: Research design Quasi-experimental design was used. Setting: The study was conducted at surgical ward at pediatric hospital, Zagazig university hospitals. Sample: A convenient sample of 100 children aged 4–10 years. Tools: Four tools were used to collect the study data: (I): Demographic data (child's age, gender, birth order and cause of surgery). (II): Vital signs sheet (heart rate and respiratory rate) measured before and after intravenous cannula insertion in both intervention and control groups. (III): Behavioral response scale "FLACC" included five criteria (Face, Legs, Activity, Cry, Consolability). (IV): Wong–Baker FACES Pain Rating Scale (WBFPS) to assess children's pain. Findings: After performing the procedure 46% of intervention group experienced moderate pain, compared to 56% of the control group. Statistically significant correlation between children behavioral response and pain score in both intervention and control groups (P = 0.001, P = 0.01) respectively. Highly statistically significant correlation between respiratory rate after intervention and children face rating scale in intervention group (P < 0.001). Conclusion: the study concluded that pressing a soft ball is an effective and easily accessible technique to decrease pain during IVCI in children between 4 years and 10 years. Practice implication: The results have implication for how health care professionals should implement distraction techniques to relieve children's pain during painful invasive procedures such as IVCI. [ABSTRACT FROM AUTHOR]

Objective: Oxytocin induction is a commonly used intervention during childbirth worldwide. This study aimed to compare the pain and stress levels of newborns born to mothers who administered synthetic oxytocin at birth with those who did not. Methods: This quasi-experimental study included 164 participants and their newborns who were delivered vaginally in a public hospital. The data were collected using an Information Form, a Neonatal Follow-Up Form, and the Assessment of Neonatal Pain and Stress Scale (ALPS-Neo). Results: In the study, there were no differences between the two groups in terms of the participants' and newborns' demographic characteristics (p >.05). During and after drying, before, during, and after the first injection, and before, during, and after blood glucose measurement, the mean ALPS-Neo scores were higher in the oxytocin induction group, with the difference being statistically significant (p <.001). Conclusion: Although the data presented here are observational, the findings indicate that infants born to participants who underwent oxytocin induction exhibit more intense pain and stress responses. The pain-stress scores of newborns born to participants who underwent oxytocin induction were higher than those of newborns whose mothers did not receive oxytocin induction. [ABSTRACT FROM AUTHOR]

This article explores the definition of pain according to the International Association for the Study of Pain (IASP) and its relevance to fetuses, neonates, and infants. The authors argue that the current definition does not adequately address pain experiences in early life. They discuss the debate surrounding fetal pain and the development of pain perception in fetuses and neonates. The article also examines the impact of pain on neurodevelopment and the challenges of providing pain relief in the neonatal period. The authors suggest that a more comprehensive understanding of pain in early life is necessary. They propose that pain in perinatal and neonatal pediatric therapy should be analyzed from sociological, ethical, theological, and medical perspectives. The concept of fetal pain raises questions about maternal autonomy and pregnancy. The article also emphasizes the importance of considering the prenatal experience in shaping individuals. The author states that they have no financial support or conflicts of interest. The views expressed in the article are solely those of the authors and do not necessarily represent the views of their affiliated organizations or the publisher. [Extracted from the article]

Copyright of Revista Española de Quimioterapia is the property of Sociedad Espanola de Quimioterapia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Abdominal surgeries are considered to be one of the most painful surgical procedures which defined as surgery pertaining to the content of the abdominal cavity. Massage therapy is a technique that promotes the manual mobilization of several structures from both muscle and subcutaneous tissue, The study was aimed to determine the effect of massage therapy on sleep disturbances and pain control for children post abdominal surgeries. Subjects and method: Purposive sampling of 60 children post abdominal surgeries participated in the present study divided into two equal groups study and control group. The study was conducted at the Pediatric Surgical Department of Tanta University Hospital. Four tools were used for data collection: structured interview schedule for socio-demographic characteristics of the children, sleep diaries, assessment for sleep disturbances scale for children, physiological measurement, pain assessment by using numerical rating scale, and FLACC behavioral pain assessment scale. The results showed children in the study group significantly improved of sleep disturbances and physiological measurement decreased pain level after implementing massage therapy postoperatively Conclusions: The difference was statistically significant after implementing massage therapy in the study group than control group. The study recommended that ongoing in-service education programs must be designed and implemented for nurses about massage therapy. Future studies are suggested with increased sample sizes, a longer interventional period duration, and an objective measure of sleep. [ABSTRACT FROM AUTHOR]

Copyright of Gümüshane Üniversitesi Saglik Bilimleri Dergisi is the property of Gumushane University, Faculty of Health Sciences and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Lejun Gao,1,&ast; Huaixin Mu,2,&ast; Yun Lin,1 Qingping Wen,1,3 Peng Gao1 1Department of Anesthesiology, First Affiliated Hospital of Dalian Medical University, Dalian, People’s Republic of China; 2Emergency Department, Shenyang Children’s Hospital, Shenyang, People’s Republic of China; 3Department of Anesthesiology, Dalian Medical University, Dalian, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Peng Gao; Qingping Wen, Department of Anesthesiology, First Affiliated Hospital of Dalian Medical University, NO. 222 Zhongshan Road, Dalian, 116011, People’s Republic of China, Tel/Fax +86 411 86110440, Email dalianpeople@163.com; dmuwqp@163.comAbstract: Postoperative pain is one of the most prevalent complications following surgery, and more than 47% of surgical patients endure postoperative discomfort worldwide. In Africa, due to resource shortages and other issues, postoperative pain is substantially more common when compared to developed countries. Severe postoperative pain has many negative effects, including possibly death, which can burden both individuals and society as a whole. Therefore, effectively controlling postoperative pain is becoming increasingly important. To enhance the effectiveness of future pain management, a thorough analysis of the current reasons for inadequate postoperative pain management is necessary. In this article, the present situations of occurring postoperative pain, children’s postoperative pain, and pain management in Africa are reviewed, based on relevant and recent literature. In particular, the reasons for inadequate postoperative pain management in Africa are detailed in this article from five perspectives: the inadequate assessment of postoperative pain, the knowledge gap among medical professionals, the patients’ misconceptions, the scarcity of resources, and the lack of medications. Additionally, we offer appropriate solutions following various factors.Keywords: Africa, postoperative pain, pain management, analgesia, pain in children, pain assessment

Prior to 2020, pain management in the Washtenaw/Livingston County Medical Control Authority (W/L MCA) Emergency Medical Service (EMS) system in Southeast Michigan was limited to morphine, fentanyl, ketorolac, and acetaminophen. Based on the increasing evidence describing its safety and efficacy, ketamine was added to local protocols for pain management. This study aimed to evaluate differences in pain management and adverse effects of ketamine and opioid administration. Data from pediatric patients who received ketamine or an opioid in the W/L MCA EMS system from October 2019 to March 2021 were analyzed. The primary outcome was the difference in pain score, and the secondary outcome was adverse effects observed after analgesic administration. The decrease in pain scores was greater among ketamine patients (mean: 5.2) compared to opioid patients (mean: 2.9), p < 0.001. The prevalence of adverse effects was higher among patients in the ketamine group (28.6%) compared to patients in the opioid group (2.4%, p < 0.001). Of 14 patients who received ketamine, one 17-year-old male experienced mild anxiety (7.1%), two teenage females experienced mild dissociation (14.3%), and one 20-year-old female experienced mild nausea (7.1%). Overall, ketamine is a safe and effective option compared to opioids for pediatric patients experiencing moderate to severe prehospital pain. [ABSTRACT FROM AUTHOR]

BACKGROUND AND OBJECTIVES: Blood cultures (BCxs) are often obtained in the initial evaluation of children with fever and acute lower extremity pain; however, their yield in this population is unknown. We aim to describe the prevalence of bacteremia among children presenting to the emergency department (ED) with fever and acute lower extremity pain and identify predictors of bacteremia. METHODS: Cross-sectional review of children aged 1 to 18 years presenting to the ED with fever and acute lower extremity pain between 2010 and 2020. We excluded patients with trauma within the previous 24 hours, orthopedic comorbidity, immunocompromised status, or antibiotic pretreatment. We identified our cohort using a Natural Language Processing-assisted model with manual review and abstracted clinical data. Our primary outcome was a BCx positive for a pathogen. RESULTS: We screened 478 979 ED notes and identified 689 patients who met inclusion criteria. Median age was 5.3 years (interquartile range 2.7-8.8); 39.5% were female. BCxs were obtained from 75.9% (523/689) of patients, of which 510 were available for review. BCxs were positive in 70/510 (13.7%; 95% CI, confidence interval [CI], 10.9-17.0) of children and in 70/689 (10.2%; 95% CI, 8.0-12.7%) of the entire cohort. The most common pathogens were methicillin-susceptible Staphylococcus aureus (71.6%) and methicillin-resistant Staphylococcus aureus (15.7%). Predictors of bacteremia include C-reactive protein ≥3 mg/dL (odds ratio, 4.5; 95% CI, 2.1-9.6) and localizing examination findings (odds ratio, 3.3; 95% CI, 1.4-7.9). CONCLUSIONS: The prevalence of bacteremia among children presenting to the ED with fever and acute lower extremity pain is high. Routine BCx should be considered in the initial evaluation of this population. [ABSTRACT FROM AUTHOR]

To examine whether children experience less fear or pain using a child‐centered intervention and if there were differences between the intervention group and the control group regarding heart rate, time required for the procedure, success rate for the cannula insertion, and patient satisfaction. A controlled single‐center case study of observational design, with one control and one intervention group. Child self‐reported fear or pain levels did not reveal any differences for those receiving the intervention compared with controls. However, according to a behavioral observation measure with the Procedure Behavior Check List, effects of the intervention were lower distress in relation to fear and pain during the cannula insertion. The time it took to perform the cannula insertion also decreased significantly in the intervention group. More children in the intervention group reported that they were satisfied with the needle procedure compared with the children in the control group. The child‐centered intervention provides reduced observed distress related to fear and pain in children undergoing a cannula insertion and reduced total time by more than 50%. This study found that child involvement in care strengthen their ability to manage a needle procedure. [ABSTRACT FROM AUTHOR]

Background: Pain and physical health domains included in Patient-Reported Outcomes Measurement Information System® (PROMIS®) can be administered as short forms (SF) or as computer adaptive tests (CAT). CAT is ideal in many settings but cannot be administered without specialized technology. We compared SF and CAT to identify items for customized SFs to improve the SF performance for children with sickle cell disease (SCD). Methods: Eligible children 8–17 years old were administered CATs for 5 domains of physical health and 2 domains of pain, followed by any items on the corresponding SF that were not included in the CAT assessments. We describe the range of scores on the CAT and SFs, including the percentage of participants with floor or ceiling effects using the SF. The agreement and correlation between CAT and SF scores were assessed using Bland–Altman plots. Items frequently offered on CAT that had variable responses and were not already present on SF are recommended as additional items for customized SFs. Results: Among 90 children with SCD, there were strong correlations between CAT and SF scores (Concordance Correlation Coefficient > 0.8) however, the SFs for fatigue, mobility, strength impact, pain behavior, and pain interference had substantial floor/ceiling effects. Fatigue, mobility, physical stress experience, and pain behavior domains had items that were frequently offered on CAT, variable responses, and were not present on the SF. Conclusions: Adding items to the SFs for the fatigue, mobility, physical stress experience, and pain behavior domains may improve these domains' SFs performance for children with SCD. [ABSTRACT FROM AUTHOR]

Introduction: Along with the pharmacological measures, any complementary therapy is also an important factor for a best outcome as complementary therapy can work in tandem with standard medical management without causing any adverse effect. Reiki is a form of energy healing touch therapy. So along with routine medical measures, some complementary therapy can also be adopted to cope with invasive procedures. However, there is a lack of solid scientific evidence about the clinical benefits of complementary therapy in paediatric patients; especially Reiki Therapy. Hence the study aimed to find the effectiveness of reiki therapy among children undergoing surgery. Materials and Methods: A Quasi experimental pre-test post-test control group research design was adopted for the study. It was conducted among children aged between 6-12 years who undergone elective surgery in Yenepoya Medical College Hospital, Mangaluru. The study participants were recruited using non probability purposive sampling technique. The sample size was 84, allocated 42 each in intervention and control group. Anxiety was assessed one day before surgery, on the day of surgery, 12 hours after surgery, 24 hours after surgery and 48 hours after surgery using the tool modified Yale Pre operative Anxiety Scale. Post operative pain was assessed on 12 hours after surgery, 24 hours after surgery and 48 hours after the surgery using Wong Baker Faces Pain rating scale. The intervention group received reiki therapy two times a day (with a gap of 5 hours in between) on one day before surgery, on the day of surgery, 12 hours after surgery, 24 hours after surgery and 48 hours after surgery, whereas the control group children received the routine care. The obtained data were analyzed using descriptive and inferential statistics. Results: When comparing the post operative pain scores within the intervention and control groups, mean pre- to post-test score showed a significant difference in the intervention group (p<0.05), whereas in control group there is no significant difference found. Within the intervention and control groups, the comparison of the anxiety score showed there is a significant difference in the intervention group (p<0.05), where as in control group there is no significant difference found when comparing the mean pre- to post-test score (p>0.05). Effectiveness of Reiki Therapy between the group showed there is no significant difference when comparing post operative pain between the intervention and control group(p>0.05), while, in case of anxiety between the intervention and control group, there is a significant difference found in the mean post-test scores (p<0.05) for most of the outcome. Conclusion: This study concluded that Reiki therapy is effective in controlling anxiety among children undergoing surgery. It can be implemented in clinical setting for planned surgeries as a preparation to the children to cope with anxiety. [ABSTRACT FROM AUTHOR]

Recurrent pain can be a significant disruption in the activities of daily life, and is not only a health problem in adults but also in children and adolescents. This study analyzed the prevalence of recurrent pain in the current sample (n = 1516; 11–17 years (meanage = 14.4 ± 2.0 years); 50.8% female) of a nationwide study in Germany, evaluated the association of participants' device-based physical activity (PA) with the prevalence of recurrent pain, and assessed whether children and adolescents who reported pain for the last three months accumulated less PA than those who did not. A higher prevalence was found in girls for recurrent headaches (42.2% vs. 28.7%), abdominal pain (28.2% vs. 20.1%), and back pain (26.9% vs. 19.5%). We found higher odds for recurrent headaches in girls (OR = 1.54) and in participants that did not reach at least 60 min of moderate to vigorous PA (MVPA) per day (OR = 2.06). Girls who reported recurrent headaches accumulated 4.7 min less MVPA per day than those without. The prevalence of pain remains at a high level in the German youth and underscores the need for interventions to improve the health situations of children and adolescents. [ABSTRACT FROM AUTHOR]

Background: Virtual reality (VR) is used as a distraction measure during painful clinical procedures associated with the use of needles. These procedures include vaccinations, blood draws, or the administration of medications, which can cause children to feel increased levels of pain and fear. Objective: The objective of this study was to collect and analyze the current evidence regarding the effectiveness of VR as a tool to distract children from pain and fear during needle procedures as compared to that of standard techniques. Methods: A systematic review and meta-analysis was performed. We included randomized clinical trials (RCTs) or quasi-RCTs with participants younger than 21 years who underwent needle procedures in which the main distraction measure used was VR and where the main outcome measure was pain. The databases searched included the PubMed, Web of Science, Scopus, PsycINFO, CINAHL, and Cochrane libraries. In this systematic review, the studies were analyzed by applying the Critical Appraisal Skills Program guide in Spanish and the Jadad scale. In the meta-analysis, the effect size of the studies was analyzed based on the results for pain and fear in children. Results: From 665 unique search results, 21 studies were included in this systematic review, most of which reported low methodological quality. The study sample cohorts ranged from a minimum of 15 participants to a maximum of 220 participants. Ten studies were included in the meta-analysis. The global effect of using VR as a distraction measure was a significant reduction in pain (inverse variance [IV] -2.37, 95% CI -3.20 to -1.54; Z=5.58; P<.001) and fear (IV -1.26, 95% CI -1.89 to -0.63; Z=3.92; P<.001) in children in the experimental groups. Conclusions: The quality of the studies was mostly low. The main limitations were the impossibility of blinding the participants and health care personnel to the VR intervention. Nonetheless, the use of VR as a distraction measure was effective in reducing pain and fear in children during procedures involving needles. [ABSTRACT FROM AUTHOR]

In the neonatal intensive care unit, preterm infants undergo many painful procedures. Although these can impair their neurodevelopment if not properly managed, only half of the painful procedures are optimally handled. This cross-sectional study aimed to evaluate nurses' perceptions of preterm infants' pain, to evaluate nurses' pain assessment and management practices, as well as to identify the individual and contextual factors that influence nurses' assessments and interventions for pain management. Secondary analyses, including a mixed-model analysis, were performed with data from a larger study (n = 202 nurses). Nurses were found to have attitudes and perceptions in favor of preterm infants' pain management, although they reported using few standardized instruments to assess pain. Nurses stated that they widely used sucrose, non-nutritive sucking, and positioning as pain management interventions, while skin-to-skin contact was rarely practiced. Nurses' attitudes and perceptions influenced their pain assessment practices, which predicted their implementation of interventions. Several contextual (country, level of care, and work shift) and individual factors (age, level of education, had a preterm infant, perceptions of family-centered care, and skin-to-skin contact) also predicted nurses' pain assessment and management practices. [ABSTRACT FROM AUTHOR]

Children's needle-related distress is strongly related to parental verbal behaviors. Yet, empirical data supporting theorized contributors to parent behaviors in this context remain limited. This is the first study to collectively measure biological (heart rate variability; HRV), psychological (catastrophizing, anxiety), and social (child behaviors) contributors to parent verbal behaviors throughout pediatric venipuncture. HRV was used as a measure of emotion regulation capacity and examined as a moderator in the associations between parent psychological factors and their behaviors, and between child and parent behaviors. Sixty-one children aged 7 to 12 years who presented at an outpatient blood lab for venipuncture and a parent participated. Parent baseline HRV, state catastrophizing, and anxiety were measured prior to venipuncture. The procedure was video-recorded for later coding of pairs' verbal behaviors. Strong associations emerged between child behaviors and parent behaviors. Baseline HRV moderated the association between parent catastrophizing and behavior. Social factors remain a strong influence related to parent behaviors. Psychologically, parent negative cognitions differentially related to parent behaviors based on their emotion regulation capacity. Biologically, low baseline HRV may increase the risk that certain parents engage in a constellation of behaviors that simultaneously direct their child's attention toward the procedure and inadvertently communicate parental worry, fear, or concern. [ABSTRACT FROM AUTHOR]

Exposure to repetitive pain during the neonatal period has been shown to have important short and long-term effects on the neurodevelopment of the premature neonate and can contribute to experienced prolonged pain. A uniform taxonomy of neonatal prolonged pain is still lacking to this day which contributes to suboptimal prolonged pain management in neonatal intensive care units. Accordingly, a scoping review exploring the state of knowledge about prolonged pain in preterm neonates hospitalised in the neonatal intensive care unit will contribute to the developing field of neonatal prolonged pain and provide recommendations for clinical prolonged pain management. To determine the scope, extent, and nature of the available literature on prolonged pain in premature neonates hospitalised in neonatal intensive care units. Scoping review. An electronic search was conducted from inception to November 2023 in the databases of CINAHL, PubMed, Medline, Web of Science, GeryLit.org and Grey Source Index. Included studies discussed concepts related to neonatal prolonged pain such as definitions of prolonged pain, indicators of prolonged pain, contexts that result in prolonged pain, prolonged pain evaluation tools, consequences of prolonged pain and interventions for prolonged pain management. Key concepts of neonatal prolonged pain were identified in the 86 included articles of this scoping review such as definitions (n = 26), indicators (n = 39), contexts (n = 49), scales (n = 56), consequences of prolonged pain (n = 30) and possible interventions for prolonged pain management (n = 22). Whilst a consensus on a definition has yet to be achieved, no proximate event was shown to cause prolonged pain and a time criterion was identified by authors as being relevant in defining prolonged pain. Interestingly, the context of hospitalisation was identified as being the most indicative of prolonged pain in premature neonates and should guide its evaluation and management, whilst only limited pain management interventions and consequences were discussed. The findings of this scoping review contribute to the foundation of growing knowledge in neonatal prolonged pain and shed light on the ambiguity that currently exists on this topic in the scientific literature. This review summarises knowledge of key concepts necessary for a better understanding of prolonged pain and stresses the importance of considering contexts of hospitalisation for prolonged pain evaluation and management in neonatal intensive care units, with the objective of improving developmental outcomes of premature neonates. A scoping review reveals that the contexts of prolonged pain in premature neonates hospitalised in the neonatal intensive care unit are essential in guiding its evaluation and management. [ABSTRACT FROM AUTHOR]

The communication of pain in individuals with co‐morbid Autism Spectrum Disorder and intellectual disability (ASD‐ID) is largely unexplored. The communication deficits associated with ASD‐ID can result in nonverbal behavior such as self‐injurious behavior, aggression, irritability, and reduced activity as a means to communicate that pain is present. The objective of this study was to determine whether a behavioral‐based educational intervention could increase the pain‐related communication of children with ASD‐ID who experience pain frequently. Specifically, the study aimed to determine if children with ASD‐ID can label the location of their pain or quantify pain severity and request pain relief. The sample included three children with ASD‐ID who experienced pain frequently. The intervention utilized educational materials and behavioral reinforcements and the intervention was conducted using a series of case studies. Pain was assessed daily by caregivers using the Non‐Communicating Children's Pain Checklist—Postoperative (NCCPC‐PV) and the ability of the individual to identify and express pain was recorded using the Wong Baker FACES Pain (WBFPS) Scale. Challenging behavior was recorded based on frequency count. The results indicated that all participants displayed the ability to independently respond to a question about how they were feeling by vocalizing the location of pain or indicating their level of pain on the WBFPS and requesting pain relief. The results suggest a role for behavioral‐based educational interventions to promote communication of pain in people with ASD‐ID. [ABSTRACT FROM AUTHOR]

Aim: This study was conducted to determine the knowledge level and opinions of parents regarding circumcision. Materials and Methods: This descriptive style study was conducted with 258 individuals who were the parents of male patients being treated in the pediatric surgery department of a university hospital. The data of the study were collected through a questionnaire which was designed in line with the literature and given through a face-to-face interviewing method. The data were analyzed by using descriptive statistics with the SPSS 21.0 package program for Windows. Results: A total of 84.9% of the parents were the mothers of the children. A total of 70.2% of the parents stated that they had had their child circumcised by a physician in a hospital setting. Regarding the purpose of circumcision, a total of 27.5% of the parents stated medical and emergency requirements while 25.6% of them stated cultural factors. A total of 23.3% of the parents stated that their children did not want to be circumcised while 57.4% stated that they had made decision to circumcise together with their spouse. A total of 54.3% of the parents mentioned that their children experienced pain after circumcision. It was determined that the parents had a moderate level of knowledge regarding the benefits of circumcision, however, most of them had no idea about the practices of circumcision. Conclusion: Parents emphasized the cultural and medical factors as being the most important factors in the decision to circumcise their child. Parents have a lack of knowledge of circumcision practice, its benefits, and post-circumcision care. Training with the aim of increasing the knowledge of parents regarding circumcision should be planned. Qualitative and quantitative studies on the subject are recommended to be conducted in different regions and with large populations. [ABSTRACT FROM AUTHOR]

Spinal pain in adults is a significant burden, from an individual and societal perspective. According to epidemiologic data, spinal pain is commonly found in children and adolescents, where evidence emerging over the past decade has demonstrated that spinal pain in adults can, in many cases, be traced back to childhood or adolescence. Nevertheless, very little focus has been on how to best manage spinal pain in younger age groups. The purpose of this article is to put the focus on spinal pain in children and adolescents and highlight how and where these problems emerge and how they are commonly dealt with. We will draw on findings from the relevant literature from adults to highlight potential common pathways that can be used in the management of spinal pain in children and adolescents. The overall focus is on how healthcare professionals can best support children and adolescents and their caregivers in making sense of spinal pain (when present) and support them in the self-management of the condition. [ABSTRACT FROM AUTHOR]

Evolving treatment paradigms have led to increased survival rates for children diagnosed with a brain tumor, and this has increasingly shifted clinical and research focus to morbidity and quality of life among survivors. Among unfavorable outcomes, survivors of pediatric brain tumors are at risk for academic failure and low educational attainment, which may then contribute to lower health related quality of life, lower income and vocational status, and a greater likelihood of dependence on others in adulthood. Several specific risk factors for lower educational performance and attainment have been investigated. These are typically examined in isolation from one another which clouds understanding of the full range and potential interplay of contributors to educational difficulties. This review integrates and summarizes what is known about the direct and indirect barriers to educational success and performance (i.e., educational pain points) to enhance clinician knowledge of factors to consider when working with pediatric brain tumor survivors. Specific barriers to educational success include neurocognitive difficulties, school absences, psychosocial challenges, challenges to knowledge and communication, and physical and sensory difficulties. Finally, we discuss the current state of educational interventions and supports and offer recommendations for future research to improve educational outcomes for pediatric brain tumor survivors. [ABSTRACT FROM AUTHOR]

Cancer is one of the main causes of death in children, however, the techniques and interventions applied allow the cure of 80% of diagnosed cases. The aim of this review was to determine the benefits of a health and physical activity promotion programme to reduce pain and fatigue symptoms in children and adolescents with cancer. The databases PubMed, Embase, Scopus, Cochrane, Web of Science and PEDro were searched between December 2020 and January 2021 to elaborate this review, using the keywords child, cancer, exercise, fatigue and pain. The review was preregistered in PROSPERO (ID CRD42021262183). Six studies, out of 937 identified at baseline, were finally included in the review: four randomised controlled trials and two quasi-experimental studies. The total sample size of all the included studies was of 474 participants with very different types of cancer and evolution, and outcome variables were pain, fatigue, physical activity level, self-efficacy and quality of life. A health and physical activity promotion programme seems to improve fatigue in paediatric cancer patients and survivors, but no significant results were found related to pain. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To enhance your knowledge of the anatomy, physiology and development of the five senses • To increase your awareness of the common childhood conditions that can affect sensory function • To count towards revalidation as part of your 35 hours of CPD, or you may wish to write a reflective account (UK readers) • To contribute towards your professional development and local registration renewal requirements (non-UK readers) This article, the 11th in the Biological basis of child health series, focuses on the senses. There are five basic senses in humans: hearing, sight, touch, smell and taste. Several congenital and acquired conditions can affect the senses and may have significant negative effects on a child's development and ability to communicate with others. This article explores each of the five senses, discussing their anatomy, physiology and embryological development, as well as common conditions affecting sensory function in children. It aims to provide children's nurses with an understanding of the role of the senses in supporting children to make sense of the world, and how knowledge of this can be linked to clinical practice. [ABSTRACT FROM AUTHOR]

History of the present illness: A four-year-old female presented to our pediatric rheumatology clinic with chief complaint of periodic fevers and abdominal pain. Fevers began 4 months prior to presentation following a documented streptococcal pharyngeal infection, with a maximum temperature of 104F. They occurred every 1-2 weeks and would then last 4-6 hours. Fevers were followed by severe abdominal pain that prevented eating. She did not have associated emesis, diarrhea, or constipation. [ABSTRACT FROM AUTHOR]

Youth with chronic headache disorders often experience sensitivities to light and sound that trigger or exacerbate their headaches and contribute to functional disability. At present, there are no known validated measures for assessing these sensitivities and their impact on functioning in youth with chronic headaches. This pilot study sought to develop and assess the feasibility of measures of headache-related light and sounds sensitivities in youth with chronic headache disorders. The initial item pools were generated via an intensive literature review, an informal quality improvement project, and a panel of experts in chronic pain. Then, youth (n = 20) presenting for clinical evaluation of headaches completed the revised items as well as assessments of the measures’ feasibility and items’ understandability. A subset (n = 2) completed formal cognitive interviews as well. The resulting 20-item Headache-Related Light Sensitivity Inventory (HALSI) and 18-item Headache-Related Sound Sensitivity Inventory (HASSI) for youth assess headache-related sensory sensitivities, as well as related emotional and behavioral responses. Through the iterative incorporation of feedback, these measures appear to be feasible to administer and understandable tools for assessing light and sound sensitivity in youth with chronic headache disorders. Once they are empirically validated, they have the potential to serve as important tools for understanding the patient experience, developing interventions, and assessing treatment response. [ABSTRACT FROM AUTHOR]

Background: Although chronic pain is common in children with cerebral palsy (CP), little is known about short-term pain fluctuations and their impact on children's well-being. High-quality cohort studies are needed to understand the clinical course of pain in this population. We aimed to determine the feasibility of conducting a multicentre cohort study. In this pilot study we assessed: 1) study processes, 2) resource and 3) management indicators including recruitment and follow-up rates, data completeness, participant characteristics, and successes and barriers in the study conduct.Methods: A multi-centre pilot cohort study was conducted with 10 Canadian children/youth with CP attending one of two children's rehabilitation centers. We collected self-reported pain intensity (Faces Pain Scale-Revised [FPS-R], Numeric Rating Scale [NRS]); pain interference (PROMIS PI); pain location (pain diagram); physical and psychological well-being (KIDSCREEN-27), sleep characteristics, preceding months' interventions, and some clinical characteristics at baseline. Average pain intensity was reported weekly for five weeks. Well-being, sleep and interventions were measured at baseline and again at five weeks. We used feasibility indicators to evaluate:1) study processes (e.g. recruitment, attrition rates); 2) resources (e.g. data completion, budgetary challenges); and 3) management (e.g. data optimization, variability of participants and pain scores).Results: Between March and May 2019, 24 children and their parents/guardians were contacted and 20 met eligibility criteria. Of those, 10 agreed to in-person screening (50%) and were subsequently enrolled. The follow-up rate was 90% and self-reported missing data was minimal. Ninety percent of participants chose e-questionnaire follow-ups versus mailed paper questionnaires. Sixty percent required reminders to complete e-follow-ups. Participants were aged 8-17 years, five were female, GMFCS levels I-IV (none with level V), 90% had spastic CP and 80% reported having pain in the preceding week. Pain intensity (FPS-R) between participants ranged from 0-8/10 at baseline and 0-6/10 across all four weekly follow-ups.Conclusions: This pilot study demonstrates the feasibility of conducting a multicentre cohort study to identify short-term pain trajectories and measure their association with well-being in children and youth with CP. Additional strategies to improve recruitment and accessibility for those with GMFCS levels V should be implemented in future studies. [ABSTRACT FROM AUTHOR]

Effective communication with children about pain is important and has the potential to mediate the short‐ and longer‐term effects of pain on children. Most communication studies relating to children's pain have focused on language children use to describe everyday pain experiences. However, little is known regarding how health professionals, particularly nurses, communicate with children in healthcare settings about pain. This study aimed to explore how nurses talk to children and their parents about pain and what factors influence nurses' use of language and non‐verbal communication. A cross‐sectional mixed‐methods (predominantly qualitative) survey ("pain talk") was conducted, comprising qualitative items about pain communication and four vignettes portraying hypothetical cases of children representing typical child pain scenarios. Participants were recruited via email, social media, newsletters, established networks, and personal contacts. A total of 141 registered (68.1%) or in‐training nurses across 11 countries with experience of managing children's pain completed the survey. Textual survey responses were analyzed using conventional qualitative content analysis. Qualitative content analysis generated a meta‐theme "Being confident and knowing how to do 'pain talk'" and four main themes that described the functions, purpose, and delivery of "pain talk": (a) "contextualizing and assessing," (b) "empowering, explaining, and educating," (c) "supporting, affirming, and confirming," and (d) "protecting, distracting, and restoring." "Pain talk" was a triadic collaborative communication process that required nurses to feel confident about their role and skills. This process involved nurses talking to children and parents about pain and creating engagement opportunities for children and parents. "Pain talk" aimed to promote the agency of the child and parent and their engagement in discussions and decision‐making, using information, support, and comfort. Nurses shaped their "pain talk" to the specific context of the child's pain, previous experiences, and current concerns to minimize potential distress and adverse effects and to promote optimal pain management. [ABSTRACT FROM AUTHOR]

The advent of increasingly sophisticated medical technology, surgical interventions, and supportive healthcare measures is raising survival probabilities for babies born premature and/or with life‐threatening health conditions. In the United States, this trend is associated with greater numbers of neonatal surgeries and higher admission rates into neonatal intensive care units (NICU) for newborns at all birth weights. Following surgery, current pain management in NICU relies primarily on narcotics (opioids) such as morphine and fentanyl (about 100 times more potent than morphine) that lead to a number of complications, including prolonged stays in NICU for opioid withdrawal. In this paper, we review current practices and challenges for pain assessment and treatment in NICU and outline ongoing efforts using Artificial Intelligence (AI) to support pain‐ and opioid‐sparing approaches for newborns in the future. A major focus for these next‐generation approaches to NICU‐based pain management is proactive pain mitigation (avoidance) aimed at preventing harm to neonates from both postsurgical pain and opioid withdrawal. AI‐based frameworks can use single or multiple combinations of continuous objective variables, that is, facial and body movements, crying frequencies, and physiological data (vital signs), to make high‐confidence predictions about time‐to‐pain onset following postsurgical sedation. Such predictions would create a therapeutic window prior to pain onset for mitigation with non‐narcotic pharmaceutical and nonpharmaceutical interventions. These emerging AI‐based strategies have the potential to minimize or avoid damage to the neonate's body and psyche from postsurgical pain and opioid withdrawal. [ABSTRACT FROM AUTHOR]

In 2020, the International Association for the Study of Pain (IASP) revised the definition of pain, providing an update to IASP's original definition in place since 1979. The origins of the field of pediatric pain, born in part in the 1980s from the advocacy of Jill Lawson, mother to Jeffrey Lawson who experienced gross inadequacies in pain care as a premature infant, emphasize the critical need to listen to and act with the voice of people living with pain and their families and caregivers. Furthermore, the field of pediatric pain emerged in the mid‐1980s marking this revised definition of pain as the first opportunity within which the experience and science of pain in childhood has been considered. This invited commentary offers two lived experience reactions to the revised IASP definition of pain, from the perspective of one's own experience with pain during childhood and as parents and family members. Together, they highlight that the value of a revised definition must be judged on its ability to directly benefit children experiencing pain and their families. Their skeptical hope reflects their lived experience backed by empirical evidence demonstrating continued inequities and inadequacies in preventing and managing pediatric pain. We must mobilize together to ensure change in culture, knowledge, and behavior. With the combined efforts of researchers, healthcare professionals, and policymakers, in partnership with diverse people with lived experience, we can ensure that more effective action is taken to rapidly improve pain for children and their families. [ABSTRACT FROM AUTHOR]

Pain is a universal experience, but it has been challenging to adequately define. The revised definition of pain recently published by the International Association for the Study of Pain addressed important shortcomings of the previous version; however, it remains narrow in its focus on sensory and emotional features of pain, failing to capture the substantial roles of cognitive and social core components of the experience and their importance to advances in pain management. This paper reviews evidence and theoretical models for the significant role social and cognitive factors play in pain experience and we argue that without explicit recognition of these core components in the definition, significant nuances are lost at a cost to understanding and clinical management of pain. A focus on sensory and emotional features perpetuates biomedical interventions and research, whereas recognition of cognitive and social features supports a multidimensional model of pain, advances in interdisciplinary care, and the benefits of cognitive behavioral therapy and self‐management interventions. We also explore the six Key Notes that accompany the new definition of pain, discuss their application to the understanding of pain in childhood, and, in doing so, further explore social and cognitive implications. Considerations are also described for assessment and treatment of pain in pediatric populations. [ABSTRACT FROM AUTHOR]

Telehealth has emerged as a promising healthcare delivery modality due to its ability to ameliorate traditional access-level barriers to treatment. In response to the onset of the novel coronavirus (COVID-19) pandemic, multidisciplinary pain clinics either rapidly built telehealth infrastructure from the ground up or ramped up existing services. As the use of telehealth increases, it is critical to develop data collection frameworks that guide implementation. This applied review provides a theoretically-based approach to capitalize on existing data sources and collect novel data to inform virtually delivered care in the context of pediatric pain care. Reviewed multisource data are (1) healthcare administrative data; (2) electronic chart review; (3) clinical health registries; and (4) stakeholder feedback. Preliminary telehealth data from an interdisciplinary pediatric chronic pain management clinic (PPMC) serving youth ages 8–17 years are presented to illustrate how relevant implementation outcomes can be extracted from multisource data. Multiple implementation outcomes were assessed, including telehealth adoption rates, patient clinical symptoms, and mixed-method patient-report telehealth satisfaction. This manuscript provides an applied roadmap to leverage existing data sources and incorporate stakeholder feedback to guide the implementation of telehealth in pediatric chronic pain settings through and beyond COVID-19. Strengths and limitations of the modeled data collection approach are discussed within the broader context of implementation science. [ABSTRACT FROM AUTHOR]

Associations between poor sleep and pain may be amplified for children who also have depressive or anxious symptoms. This study examined associations between child sleep at eight years and recurrent pain at nine years along with the moderating role of internalizing symptoms. Families were from a community-based, ongoing longitudinal study (N = 632 children). At eight and nine years, twins (49.2% female, 56.7% non-Latinx European American, 28.8% Latinx) and caregivers participated in assessments focused on child sleep and pain, respectively. Approximately 53% of children had pain in at least one location at least monthly. Internalizing symptoms at age eight were positively associated with number of pain sites at age nine. Lower sleep efficiencies were associated with more pain sites for children with higher levels of internalizing symptoms. Later midpoint times were associated with more pain sites for children with lower levels of internalizing symptoms. Interventions focused on improving children's pain outcomes may consider targeting sleep behaviors and mental health. [ABSTRACT FROM AUTHOR]

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Effective parent functioning is a key predictor of functional outcomes for children with persistent pain. It is therefore important to identify factors that support or limit functioning in parents of these children. Child and parent attachment and child sensory processing patterns have been identified as risk-factors for parent functioning in healthy samples. Our study extends current research by examining whether parent and child attachment patterns and child sensory processing patterns are related to parent functioning in families of children with persistent pain. Using a cross-sectional design, data was collected at a tertiary pain management clinic from 98 parent-child dyads (i.e., a child or adolescent with persistent pain and one parent). Standardized questionnaires were used to assess parent and child attachment patterns, child sensory processing patterns, child pain intensity, and eight domains of parent functioning. Regression analyses revealed that parent attachment avoidance was significantly related to poorer overall parent functioning and three functioning domains: depression, partner relationship, and leisure. Child attachment avoidance was related to higher parental strain and the use of fewer protective parenting behaviors. Parent and child attachment anxiety and child sensory processing patterns were not significantly related to parent functioning. Findings suggest that parent and child attachment avoidance warrant further consideration with regards to parent functioning in clinical settings where children present with persistent pain. This may aid in identifying parents who are at-risk of poorer functioning and could guide the use of attachment-informed interventions for families of children with persistent pain. Highlights: Parent attachment avoidance was related to poorer overall parent functioning, higher levels of depression, poorer leisure functioning, and poorer partner relationship in parents of children with persistent pain. Parents of avoidantly attached children reported higher levels of parental strain and used fewer protective parenting behaviors (e.g., they were less likely to encourage the child to avoid painful activities). Child sensory processing patterns were not directly related to parent functioning in families of children with persistent pain. Parents' attachment patterns warrant consideration when evaluating or supporting parent functioning in families of children with persistent pain. Clinicians should consider using attachment-informed clinical reasoning when evaluating the use of parenting behaviors, particularly for children with avoidant attachment patterns. [ABSTRACT FROM AUTHOR]

Spinal pain is common in adolescence, and overweight in children and adolescence is an increasing public health problem globally. Since musculoskeletal pain is a known barrier for physical activity which potentially can lead to overweight, the primary objective of this study was to determine if self-reported lifetime spinal pain in 2010 was associated with being overweight or obese in 2012 in a cohort of 1080 normal-weighted Danish children, aged 11–13 years at baseline. Overweight was based on body mass index measured by trained staff. Spinal pain was self-reported by questionnaires during school hours. Estimates were adjusted for relevant covariates. The 2-year incidence rate of overweight was 5.3% (95% CI 3.98–7.58) for children with spinal pain at baseline versus 1.6% (95% CI 0.19–5.45) for children without. There was stepwise and statistically significant increased risk of overweight with increasing frequency of pain and for having pain in more than one part of the spine. Despite the short follow-up time where only 40 children developed overweight, these results indicate that spinal pain might increase the risk of subsequent overweight. [ABSTRACT FROM AUTHOR]

Pediatric chronic pain is a challenging problem for children and their families, although it is still under-recognized and under-treated. The aim of this study was to investigate whether a pain neuroscience education program for children (PNE4Kids) delivered to healthy children aged 8 to 12 years old and attended by their parents would result in improved parental knowledge about pain neurophysiology, decreased parental pain catastrophizing about their own pain and their children's, decreased parental pain vigilance and awareness, and decreased fear of pain in children. Twentyseven healthy child--parent dyads received a 45 min PNE4Kids session. Demographic data were collected, and the Neurophysiology of Pain Questionnaire (NPQ), Fear of Pain Questionnaire--Parent Proxy Report (FOPQ-P), Pain Catastrophizing Scale (PCS), Pain Catastrophizing Scale for Parents (PCS-P), and the Pain Vigilance and Awareness Questionnaire (PVAQ) were completed by the parents before and after the PNE4Kids session. Twenty-six dyads completed study participation. In response to the PNE4Kids session, significant short-term (1 week) improvements were shown in the NPQ (p < 0.001) and the FOPQ-P (p = 0.002). Parents' level of pain knowledge and children's fear of pain, reported by their parents, improved after a 45 min PNE4Kids session. Thus, PNE4Kids should likewise be further investigated in healthy child--parent dyads as it might be useful to target parental and children's pain cognitions at a young age. [ABSTRACT FROM AUTHOR]

Neuroblastoma (NB) is the most common extracranial, solid, pediatric malignancy and, despite the constant progress of treatment and development of innovative therapies, remains a complex, challenging disease causing major morbidity and mortality in children. There is significant variability in the management of neuroblastoma, partially due to the heterogeneity of the clinical and biological behavior, and partially secondary to the different approaches between treating institutions. Anesthesia takes an integral part in the multidisciplinary care of patients with NB, from diagnosis to surgery and pain control. This paper aims to review and discuss the critical steps of the perioperative and operative management of children undergoing surgery for neuroblastoma. Anesthesia and analgesia largely depend on tumor location, surgical approach, and extension of the surgical dissection. Attention should be paid to the physio-pathological changes on cardiovascular, gastrointestinal, and immune systems induced by the tumor or by chemotherapy. At the time of surgery meticulous patient preparation needs to be carried out to optimize intraoperative monitoring and minimize the risk of complications. The cross-sectional role of anesthesia in cancer care requires effective communication between all members of the multidisciplinary team. [ABSTRACT FROM AUTHOR]

Specialization training for physiotherapists, occupational therapists, and sports therapists involved in pediatric pain is scarce and curricula are rarely published. The objectives of this study are twofold: firstly, to perform a scoping review to derive important contents for a pediatric pain education curriculum for specialized pain therapists. Secondly, to conduct a survey on specific contents in curricula currently used by pain experts and to obtain their evaluation regarding the importance of such contents for a specialized curriculum. The review substantiated the importance of a specific curriculum in pediatric pain education, but provided little information on adequate contents. In the survey, 45 experts in pediatric pain education confirmed that specific curricula and specialized contents for pediatric pain education are missing. Their answers give a well-defined picture of the specifics needed in the interaction with a pediatric population. The most important items they classified were e.g., the biopsychosocial framework and the impact of pediatric pain on daily life. Those expert ratings were in line with the recommendations of pediatric pain management guidelines. Further curriculum work in an interdisciplinary, international network is highly recommended. [ABSTRACT FROM AUTHOR]