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Introduction: Research related to parent-led neonatal pain management is increasing, as is the clinical implementation. Skin-to-skin contact, breastfeeding and parents’ vocalizations are examples of pain reducing methods that give parents an opportunity to protect their infant from harm while alleviating their anxiety and developing their parenting skills. Methods: In this paper we will provide a narrative review and describe the current research about parent-led neonatal pain management. Based on this we will discuss clinical challenges, implementation strategies and implications for future research. Results: Parents express great readiness to embrace opportunities to increase their self-efficacy in their ability to address infant pain. Parent-led pain- reducing methods are effective, feasible, cost-effective, culturally sensitive, and can be individualized and tailored to both the parent’s and infant’s needs. Both barriers and facilitators of parent-led pain care have been studied in research highlighting structural, organizational, educational, and intra- and interpersonal aspects. For example, health care professionals’ attitudes and beliefs on parent-led methods, and their concern that parental presence during a procedure increases staff anxiety. On the other hand, the presence of a local pain champion whose duty is to facilitate the adoption of pain control measures and actively promote parent-professional collaboration, is crucial for culture change in neonatal pain management and nurses have a key role in this change. The knowledge-to-practice gap in parent-led management of infants’ procedure-related pain highlight the need for broader educational applications and collaborative professional, parental and research initiatives to facilitate practice change. Conclusion: Parent-led neonatal pain management is more than simply a humane and compassionate thing to do. The inclusion of parent-led pain care has been scientifically proven to be one of the most effect

Bakgrund: Smärta hos barn i samband med procedurer i sjukvården är ett vanligt problem som sjuksköterskan hanterar. Hos barn är smärta tydligt kopplat till rädsla och otrygghet. Syfte: Att kartlägga icke-farmakologiska metoder för att hantera procedursmärta hos barn. Metod: En litteraturstudie med systematisk ansats som studerar kvantitativa studier. Resultat: Tio vetenskapliga studier på ämnet icke-farmakologiska metoder att hantera procedursmärta hos barn i åldern 2–10 år inkluderades i analysen. Smärthanteringsmetoderna kategoriserades under rubrikerna aktiva distraktionsmetoder, passiva distraktionsmetoder och fysikaliska metoder. De aktiva distraktionsmetoderna att barnet blåser såpbubblor eller spelar spel på surfplatta/smartphone eller virtual reality och användning av de fysikaliska metoderna vibration kombinerat med kyla i den medicintekniska produkten Buzzy, visade god evidens. Vidare forskning på ämnet passiv distraktion med sjukhusclowner och effekten av utformningen på sjuksköterskors arbetskläder är önskvärt. Aktiv distraktion visade lovande resultat och vidare kartläggning rekommenderas. Slutsats: Hantering av procedursmärta bör inkludera barns lek med såpbubblor, spel på surfplatta/smartphone, lek med distraktionskort samt de fysikaliska metoderna vibration och kyla., Background: Pain in children associated with procedures in healthcare is a common problem that nurses deal with. In children, pain is clearly linked to fear and insecurity. Aim: To map non-pharmacological methods to manage procedural pain in children. Method: A literature study with a systematic approach that studies quantitative studies. Results: Ten scientific studies on the topic of non-pharmacological methods of managing procedural pain in children aged 2–10 years were included in the analysis. The pain management methods were categorized under the headings active distraction methods, passive distraction methods and physical methods. The active distraction methods of the child blowing soap bubbles or playing games on a tablet/smartphone or virtual reality and using the physical methods vibration combined with cold in the medical device Buzzy, showed good evidence. Further research on the topic of passive distraction with hospital clowns and the effect of the design on nurses' work clothes is desirable. Active distraction showed promising results and further survey is recommended. Conclusion: Management of procedural pain should include children's play with soap bubbles, tablet/smartphone games, distraction card play, and the physical methods of vibration and cold.

Bakgrund Barns smärta utgörs av många olika dimensioner, och har länge varit ett eftersatt område som har präglats av myter och missuppfattningar. Barn som uppsöker sjukvården och som genomgår smärtsamma procedurer är särskilt utsatta då kommunikationen med ett barn måste anpassas i samband med vårdbesöket. Sjuksköterskan bör förstå komplexiteten kring att behandla smärta hos ett barn och vilka faktorer som utgör en smärtupplevelse samt vad smärta innebär. Barn är inte små vuxna och detta är av stor vikt för en sjuksköterska att förstå i samband med omvårdnaden när ett barn behöver uppsöka sjukvården. Syfte Syftet var att undersöka icke-farmakologiska omvårdnadsåtgärder vid procedursmärta hos barn. Metod Detta arbete redovisas med hjälp av en icke-systematiska litteraturöversikt där resultatet baserats utifrån 16 originalartiklar med kvantitativ ansats. Artiklarna som inkluderades inhämtades från databaserna CINAHL och PubMed med hjälp av sökord i olika kombinationer som var relevanta för att besvara syftet. Artiklarnas kvalitet granskades sedan med hjälp av en kvalitétsgranskningsmall. En integrerad dataanalys användes för att sammanställa resultatet. Resultat I resultatsammanställningen identifierades två huvudkategorier samt fem underkategorier för att strukturera upp samt för att kunna besvara syftet. Att barns smärta är komplex och flerdimensionell tyder på att ett personcentrerat förhållningssätt är av stor vikt och att anpassningar bör göras utifrån ålder och barnets mognadsgrad när det kommer till vilka icke-farmakologiska åtgärder som bör användas under procedurer. Att ta hjälp av rätt verktyg leder till en minskad smärtupplevelse samt minskar även oro och ångest som barn upplever när de genomgår en smärtsam procedur. Slutsats Denna litteraturöversikt visar på värdefulla metoder och distraktionstekniker som sjuksköterskor kan och bör använda sig av för att minska procedursmärta, ångest och oro hos barn. Att barn får möjlighet att bli distraherade under proc, Background Children's pain consists of many different dimensions and has long been a neglected area that has been characterized by myths. Children seeking medical care and undergoing painful procedures are particularly vulnerable as communication with a child must be adapted. The nurse should understand the complexity of treating pain in a child and what factors make up a pain experience and what pain means. Children are not small adults, and this is of great importance for a nurse to understand in connection with the care when a child needs to seek medical care. Aim The aim was to investigate non-pharmacological nursing interventions for procedural pain in children. Method This work is presented using a non-systematic literature review where the results are based on 16 original articles with quantitative approach. The articles used were retrieved from the databases CINAHL and PubMed using keywords in various combinations. The quality of the articles was then reviewed using a quality review template. An integrated data analysis was used to compile the results. Results In the summary of results, two main categories were identified and five subcategories to give the result a structure to answer the purpose of the study. Children's pain is complex and multidimensional suggests that a person-centered approach is of great importance and that adjustments should be made based on the age and maturity of the child when it comes to which non-pharmacological measures should be used during procedures. Conclusions This literature review demonstrates valuable methods and distraction techniques that nurses can and should use to reduce procedural pain, anxiety and worry in children. That children could be distracted during procedures, regardless of the technology used, is valuable for the overall experience and future care encounters.

Att smärtlindra sederade intensivvårdspatienter vid procedurer är något som intensivvårdssjuksköterskor utför dagligen på sina arbetsplatser. Att behandla smärta är viktigt för patientens välmående samtidigt som att bedöma smärta hos en sederad patient upplevs svårare än att bedöma smärta hos en vaken patient. Syfte: Studiens syfte är att beskriva intensivvårdssjuksköterskors erfarenheter av att smärtlindra sederade intensivvårdspatienter vid procedurrelaterad smärta. Metod: En kvalitativ intervjustudie med ett induktivt förhållningssätt. Nio legitimerade sjuksköterskor med specialistutbildning inom intenssivsjukvård intervjuades till studien. Intervjuerna analyserades med kvalitativ innehållsanalys. Urval: Inklusionskriterierna var legitimerad sjuksköterska med specialistutbildning inom intensivsjukvård och en arbetslivserfarenhet av minst tre år vid en intensivvårdsavdelning samt en vilja att berätta sina erfarenheter. Resultat: Analysprocessen gav fyra kategorier: Utmaningen att bedöma smärta, Att förebygga smärta inför procedurer, Att smärtlindra den sederade patienten vid procedurer, Samarbete och kommunikation. Slutsats: Intensivvårdssjuksköterskor använder sig av observation av patienten och sina tidigare erfarenheter för att tolka och bedöma smärta hos patienten. Studien betonar även vikten av att samarbeta i teamet runt patienten för att förebygga smärta vid olika procedurer., Presentation skett via Zoom 9/6

Bakgrund: Nålrelaterade procedurer är vanligt förekommande inom barnsjukvården och är något som orsakar lidande för barn. Om detta lidande inte förebyggs eller lindras adekvat kan det leda till stickrädsla. Sjuksköterskan har en skyldighet att vidta omvårdnadsåtgärder utefter barnets behov och därför är det viktigt att sjuksköterskan besitter kunskap om vilka omvårdnadsåtgärder som lindrar lidande hos barn vid venprovtagning och insättning av perifer venkateter (PVK-sättning). Syfte: Att beskriva omvårdnadsåtgärder som lindrar lidande hos barn vid venprovtagning och PVK-sättning. Metod: Litteraturstudien baserades på 14 kvantitativa originalartiklar som har kvalitetsgranskats. Resultatet har därefter analyserats genom att identifiera data, organisera data i olika kategorier samt summera och analysera detta, vilket resulterade i tre huvudkategorier: fysisk distraktion, aktiv distraktion och passiv distraktion. Resultat: Litteraturstudiens resultat visade att fysisk distraktion hade en lindrande effekt på smärta, oro och rädsla i samband med venprovtagning och PVK-sättning i ett flertal av studierna. Likaså hade aktiva och passiva distraktionsmetoder en betydande positiv effekt hos barnen i samband med procedurerna. Slutsats: Med hänsyn till distraktionsmetodernas påvisade effekt bör sjuksköterskan individanpassa omvårdnadsåtgärder och använda sig av dessa distraktionsmetoder i samband med venprovtagning och PVK-sättning., Background: Needle related procedures are common in pediatric healthcare and causes suffering to the child. If this suffering is not adequately prevented or treated, a fear of needles could be developed. The nurse is responsible to take nursing measures according to the child's needs. Thus, it is important that the nurse has knowledge of which nursing measures that relieves suffering in children during venipuncture and intravenous insertion (IV-insertion). Aim: To describe nursing measures that relieve suffering in children during venipuncture or IV-insertion. Method: The literature study was based on 14 original quantitative articles. The articles were quality reviewed and then analyzed. The analysis consisted of identifying data, organizing and categorizing data and then summarizing and analyzing the result. The result was presented in three main categories: physical distraction, active distraction and passive distraction. Result: It was found that physical distraction had a relieving effect on pain, anxiety and fear during and after the venipuncture and IV-insertion in several studies. Likewise, active and passive distraction methods had a positive effect on the children during and after the procedure. Conclusion: Considering the effect of the distraction methods, the nurse should individualize the nursing measures during venipuncture and IV-insertion.

Diplomová práce na téma "Hodnocení bolesti v souvislosti s převazy chronických ran pacientů hospitalizovaných v geriatrickém centru" se zabývá v první kapitole stručně problematikou bolesti. Druhá kapitola je zaměřena na procedurální bolest a třetí kapitola se věnuje nehojícím se ránám, hodnocení bolesti v souvislosti s nehojící se ránou a její léčbou. Poslední kapitola je zaměřená na kompetence všeobecných sester v péči o nehojící se rány. Hlavním cílem výzkumné části je zjistit, jak pacienti s chronickou ránou vnímají bolest v souvislosti s převazy. Výzkumná část je zpracována pomocí záznamových archů jejich analýzou a interpretací., The diploma thesis on the topic "Assessment of pain in connection with dressings of chronic wounds of patients hospitalized in a geriatric center" deals briefly with the issue of pain in the first chapter. The second chapter is focused on procedural pain and the third chapter is devoted to non-healing wounds, assessment of pain related to non-healing wounds and its treatment. The last chapter is focused on the competence of general nurses in the care of non-healing wounds. The main goal of the research part is to find out how patients with a chronic wound perceive pain in connection with dressings. The research part is processed using record sheets by their analysis and interpretation., Fakulta zdravotnických studií, Student/ka úspěšně obhájil/a diplomovou práci, odpověděl/a na doplňující otázky oponenta., Dokončená práce s úspěšnou obhajobou

Diplomová práce je zaměřena na hodnocení zdravotnické pomůcky Buzzy během odběru krve u dětských klientů z pohledu jejich zákonných zástupců a zdravotnických pracovníků. Teoretická část pojednává všeobecně o odběrech krve, procedurální bolesti a hodnocení bolesti u dětských klientů. Výzkumná část analyzuje výsledky smíšeného výzkumu na základě nestandardizovaného dotazníku a strukturovaných rozhovorů., The diploma thesis focuses on the evaluation of the buzzy medical device during blood collection in pediatric clients from the perspective of their legal representatives and health care professionals. the theoretical part discusses in general about blood collection, procedural pain and pain assessment in pediatric clients. the research section analyses the results of a mixed-methods study based on a non-standardised questionnaire and structured interviews., Fakulta zdravotnických studií, Student/ka úspěšně obhájil/a diplomovou práci, odpověděl/a na doplňující otázky oponenta., Dokončená práce s úspěšnou obhajobou

OBJECTIVE: Whether parental presence during their children's painful medical procedures is advantageous with regard to child's pain-related outcomes is questionable. Research regarding this topic is equivocal and additional questions, such as whether levels of parental involvement may play a role as well, remain to be assessed. The purpose of this systematic review is to summarize and critically appraise the literature regarding the impact of parental presence versus absence during their children's painful medical procedures on the child's pain-related outcomes.METHODS: The review protocol was registered on Prospero (ID CRD42018116614). A systematic search in PubMed, Web of Science, and PsycArticles resulted in 22 eligible studies incorporating 2157 participants. Studies were considered eligible if they included children (≤ 18 years old) undergoing a painful medical procedure and compared parental presence and/or involvement with parental absence during the procedure.RESULTS: The children's pain-related outcomes included self-reported pain intensity, self-reported fear, anxiety and distress, observed pain-related behavior, and physiological parameters. Overall, evidence points in the direction of beneficial effects of parental presence versus absence with regard to children's self-reported pain intensity and physiological parameters, whereas mixed findings were recorded for children's self-reported fears, anxiety and distress, and observed pain-related behaviors.CONCLUSIONS: : In order to provide clear recommendations on how to involve the parent during the procedure, as well as for which type of children and parents parental presence has the best effects, further research is needed, as indicated in this review.

Background: Burns and related procedures are painful and distressing for children, exposing them to acute and chronic sequelae that can negatively affect their physiological, psychological, and social functions. Non-pharmacological interventions such as distraction techniques are beneficial adjuncts to pharmacological agents for procedural pain, state anxiety, and itch in children with burns but have limitations (e.g. lack of research on burn-related itch, tailoring, and consensus on optimal treatment). Hypnotherapy is a non-pharmacological intervention that can be tailored for varied settings and populations with evidence of benefit for itch and superior effectiveness in comparison to other non-pharmacological interventions for children’s procedural pain and state anxiety. Thus, children with burns can benefit from hypnotherapy as an adjunct to pharmacological agents. Yet, in paediatric burns, rigorous studies of effectiveness are limited and no studies have been identified that screen for hypnotic suggestibility, an important predictor of hypnotherapy outcomes. Considering potential barriers to the delivery of hypnotherapy in paediatric burns, the proposed study will examine the feasibility and acceptability of hypnotic suggestibility screening followed by hypnotherapy for procedural pain, state anxiety, and itch in children with acute burns. Methods: An observational mixed-methods feasibility and acceptability study will be conducted over 15 weeks. Eligible children (N = 30) aged 4 to 16 years presenting to a paediatric burns outpatient centre in a metropolitan children’s hospital in Australia with acute burns requiring dressing changes will be included. Eligible parents of children (N = up to 30) and clinicians who perform dressing changes (N = up to 20) will also be included. Child participants screened as having medium to high suggestibility as assessed by behavioural measures will receive hypnotherapy during dressing changes. A process evaluation will targ

Neugeborene werden nach der Geburt schmerzhaften Interventionen ausgesetzt, die langfristige Folgen haben können. Um Schmerzen bei Neugeborenen zu lindern und mögliche Langzeitfolgen zu minimieren, gibt es diverse nichtmedikamentöse Methoden. Doch welche sind wirksam und können zur Anwendung im Hebammenalltag empfohlen werden? Mithilfe einer Literaturrecherche in den Datenbanken «Pubmed» und «CINAHL» konnten fünf randomisierte kontrollierte Studien gefunden werden, die den Ein- und Ausschlusskriterien entsprachen und anschliessend kritisch gewürdigt wurden. Die nichtmedikamentösen Methoden Stillen, Pucken, nicht-nutritives Saugen (NNS), Hautkontakt und Sucrose sind wirksam zur Linderung von Schmerzen während kapillären Blutentnahmen an der Ferse. Die Wirksamkeit von Musiktherapie ist umstritten und scheint von der Art der Musik und dem Gestationsalter beeinflusst zu werden. Für tiefere Fersenstiche ist die Anwendung von NNS oder eine Kombination von NNS und Pucken zusätzlich zur Sucrose wirksamer als Sucrose allein. Aufgrund der Wirksamkeit dieser Methoden kann eine evidenzbasierte Empfehlung zur situationsangepassten Anwendung in der Praxis ausgesprochen werden. Dabei sind Stillen und Hautkontakt besonders zu empfehlen, da sie kostengünstig, umweltschonend, sicher und einfach in der Anwendung sind und einen Einbezug der Eltern zulassen.

Children's heightened attention to pain and parental narrative style have been linked to the development of negatively-biased pain memories in children (i.e., recalling higher levels of pain and fear than initially reported, which robustly predicts maladaptive pain outcomes). However, the interplay between child attention bias and parental narrative style remains to be assessed. This study aims to fill this gap using enhanced paradigms assessing children's cognitive biases for cues signaling actual pain. Healthy school children (N = 63; 9-15 years old) received painful heat stimuli while performing a spatial cueing task measuring attention bias to cues signaling actual pain. Parent-child interaction upon completion of the painful task, was coded for parental narrative style (i.e., elaboration, repetition and evaluation). Children's pain-related memories were elicited two weeks later. Findings indicated that children showed an attention bias to cues signaling pain. Furthermore, children who were hypervigilant to pain cues benefitted from parents elaborating more about the pain experience, while children who avoided pain cues developed more negatively-biased pain memories if parents had a more elaborative style compared to a more evaluative parental style. In conclusion, this study suggests that optimal ways to talk about children's pain depend upon child characteristics (i.e., children's attention bias to pain).

Bakalářská práce na téma "Buzzy očima dítěte" se zabývá problematikou procedurální bolesti a její možnou eliminací s konkrétním zaměřením na distrakční metodu Buzzy. Cílem je zjistit s jakým efektem Buzzy pracuje, jestli má smysl jeho použití v rámci procedurální bolesti a jaká je reakce dětí na tuto distrakční metodu. Praktická část je zpracována pomocí polostrukturovaných rozhovorů a pozorováním a uvádí efekt Buzzyho především z pohledu dětí., The bachelor´s thesis to the topic "Buzzy by the children´s eyes" deals with the issue of procedural pain and its possible elimination with a specific focus on the distractive method Buzzy. The aim is to find out what effect Buzzy works with, whether it makes sense to use it in procedural pain and what is the reaction of children to this distractive method. The practical part is processed with semi-structured interviews and observations and presents the effect of Buzzy, especially from the perspective of children., Fakulta zdravotnických studií, Student/ka úspěšně obhájil/a bakalářskou práci, odpověděl/a na doplňující otázky oponenta., Dokončená práce s úspěšnou obhajobou

AIM: To investigate the feasibility, and perform a pilot study, of a randomised clinical trial, investigating whether children experience less pain, fear and/or distress when they receive oral ibuprofen vs placebo before a needle is inserted in a subcutaneously implanted intravenous port. METHODS: Twenty-three children were included consecutively and randomised to either oral ibuprofen (n = 12) 7.5 mg/kg body weight or placebo (n = 11). The child's pain, fear and distress were reported by parents, nurses and the children (if ≥7 years of age). Feasibility criteria were defined as (a) ≥4 children included/month, (b) ≥80% of eligible patients agreed to participate, (c) >90% treated according to protocol, (d) <5% missing data, (e) s-cortisol samples analysed in ≥90% of the children. RESULTS: All feasibility criteria were met except recruitment and consent. Parents, nurses and children reported no trend of benefit of oral ibuprofen with regard to pain, fear and distress compared with placebo. CONCLUSION: The study failed to meet important feasibility criteria and was closed due to low recruitment rate and absence of trend of effect. From this data, we cannot state that ibuprofen is not helpful in needle procedures but that it seems unlikely.

63 p. : il.-- Bibliogr.: p. 23-28, Durante muchos años el dolor en el neonato tanto a término como prematuro ha sido tratado de manera insuficiente por parte de los profesionales de la salud. Sin embargo, en la actualidad el abordaje del dolor es considerado un componente esencial de la atención en las UCIN. Los RN ingresados en las UCIN son sometidos diariamente a procedimientos invasivos como la punción del talón, venopunción o sondaje nasogástrico, entre otros. Se ha demostrado que el dolor tiene consecuencias tanto a corto como a largo plazo, pudiendo influir en el posterior desarrollo de los RN o presentar hiperalgesia, es decir, una respuesta exagerada al dolor, a futuro. A lo largo de los últimos años, se han desarrollado medidas no farmacológicas que ayudan a controlar o disminuir la sensación dolorosa y evitar las consecuencias de un abordaje insuficiente de este. Entre ellas se encuentran: la administración de soluciones orales dulces, la succión no nutritiva, la lactancia materna, la música, el método canguro, la contención o la combinación de varias. Estas estrategias no farmacológicas no solo permiten a la enfermería un manejo efectivo del dolor, sino que aumentan la autonomía de los profesionales al ser el alivio y manejo del dolor una actuación competente a la disciplina enfermera.

Introduction &objectives: Introduction: Itch and pain are acknowledged problems for individuals with RDEB. PEBLES is a prospective register study to record detailed information about what happens to an individual with RDEB and how it affects them over time, including itch and pain. To report preliminary findings regarding itch and pain reported by individuals with RDEB. Materials &methods: Methods: Individuals recruited to PEBLES were reviewed annually for those 10 years and older and 6-monthly for those under 10 years. All participants reported background and procedural pain (dressing changes) on a 10cm visual analogue scale (VAS) and indicated the number of nights their sleep was disturbed by pain. Participants aged 8 years and above also completed the Leuven Itch Scale (version 1.0). The study was ethically approved by the UK Research Ethics Committee and Health Research Authority. Result(s): Data regarding itch and pain at initial review were available for 38 adults (79%) and 10 children (21%). Of these, 31 (65%) completed four reviews spanning 2-4 years. Participants with RDEB generalised severe (RDEB-GS) reported the greatest number of nights sleep disturbed by pain: only 19% had undisturbed sleep compared to 39% of individuals with RDEB generalised intermediate (RDEB-GI) and 29% with RDEB-other. Participants in all subtypes reported significant background pain (median 4.3, IQR 2.9,6.0) with greater procedural pain (median 6.0, IQR 4.0,7.6); background and procedural pain levels were greatest for participants with RDEB-GS. Individuals with RDEB-GS (n=36) experienced more frequent itch, greater severity and distress, but shortest duration. More than half of all individuals reported consequences of itching such as skin damage, disturbed routine, difficulty falling asleep, being woken up by itchd mood and loss of concentration. Reduced quality of life was a common consequence of itch in RDEB-GS not other subtypes. Nearly half (44%) were not using treatment for it

OBJECTIVE: Inadequately treated pain and distress elicited by medical procedures can put children at higher risk of acute and chronic biopsychosocial sequelae. Children can benefit from hypnotherapy, a psychologically tailored intervention, as an adjunct to pharmacological agents to address the multiple components of pain and distress. Despite providing evidence on the effectiveness and potential superiority of hypnotherapy to other psychological interventions, research on hypnotherapy for pediatric procedural pain and distress has been predominantly limited to oncology and needle procedures. Plus, there is a lack of reporting of intervention manuals, factors influencing hypnotic responding, pain unpleasantness outcomes, theoretical frameworks, adverse events, as well as barriers and facilitators to the feasibility of delivering the intervention and study procedures. The proposed review aims to map the range and nature of the evidence on hypnotherapy for procedural pain and distress in children to identify gaps in literature and areas requiring further investigation. METHODS: This review will follow the Arksey and O'Malley (2005) methodology and incorporate additional scoping review recommendations by the Joanna Briggs Institute and Preferred Reporting Items for Systematic reviews and Meta-Analyses. Relevant studies will be identified through searching published literature databases (PubMed, Cochrane Library, PsycINFO, Embase, CINAHL, Scopus and Web of Science) and grey literature in addition to hand-searching of reference lists and key journals. Two authors will independently screen titles and abstracts of search results followed by full-texts review against eligibility criteria. CONCLUSION: Findings are anticipated to guide future research and inform the development of tailored hypnotic interventions in children.

Objective: Whether parental presence during their children's painful medical procedures is advantageous with regard to child's pain-related outcomes is questionable. Research regarding this topic is equivocal and additional questions, such as whether levels of parental involvement may play a role as well, remain to be assessed. The purpose of this systematic review is to summarize and critically appraise the literature regarding the impact of parental presence versus absence during their children's painful medical procedures on the child's pain-related outcomes. Methods: The review protocol was registered on Prospero (ID CRD42018116614). A systematic search in PubMed, Web of Science, and PsycArticles resulted in 22 eligible studies incorporating 2157 participants. Studies were considered eligible if they included children (≤ 18 years old) undergoing a painful medical procedure and compared parental presence and/or involvement with parental absence during the procedure. Results: The children's pain-related outcomes included self-reported pain intensity, self-reported fear, anxiety and distress, observed pain-related behavior, and physiological parameters. Overall, evidence points in the direction of beneficial effects of parental presence versus absence with regard to children's self-reported pain intensity and physiological parameters, whereas mixed findings were recorded for children's self-reported fears, anxiety and distress, and observed pain-related behaviors. Conclusions: : In order to provide clear recommendations on how to involve the parent during the procedure, as well as for which type of children and parents parental presence has the best effects, further research is needed, as indicated in this review.

Tato bakalářská práce se zabývá procedurální bolestí během výkonů v intervenční radiodiagnostice. V teoretické části se zabývá bolestí, typy bolestí, charakterem a terapií bolesti. Dále jsou popsána vyšetření v intervenční radiodiagnostice a jejich principy. Průzkumná část obsahuje dotazníkové šetření, které se týká procedurální bolesti při angiografických výkonech., This bachelor thesis deals with procedural pain during interventional radiology. The theoretical part deals with pain, types of pain, character and therapy of pain. Examinations in interventional radiodiagnostics and their principles are also described. The practical part contains a questionnaire survey, which concerns procedural pain in angiography., Fakulta zdravotnických studií, Doplňující otázky pro obhajobu závěrečné práce: 1. Jak souvisí bolest s úzkostí a strachem? 2. Co můžete dělat pro snížení úzkosti a strachu u pacienta před výkonem? 3. Jaké nefarmakologické metody snižování bolesti kromě vlídného chování můžete využívat? Co byste doporučila, aby radiologičtí asistenti v této souvislosti uměli, v čem by se měli vzdělávat? Obhajoba bakalářské práce s prezentací výborná minus., Dokončená práce s úspěšnou obhajobou

Background: Children with cancer often undergo long treatment trajectories involving repeated needle procedures that potentially cause pain and distress. As part of a comprehensive effort to develop clinical practice guidelines (CPGs) to address pain prevention and management in children with cancer, we aimed to provide recommendations on the pharmacological and psychological management of procedure-related pain and distress. Methods: Of the international inter-disciplinary CPG development panel (44 individuals), two working groups including 13 healthcare professionals focused on procedural pain and distress. Grading of Recommendations Assessment, Development and Evaluation methodology was used, including the use of systematic literature reviews to inform recommendations and the use of evidence to decision frameworks. At an in-person meeting in February 2018, the guideline panel discussed these frameworks and formulated recommendations which were then discussed with a patient-parent panel consisting of 4 survivors and 5 parents. Results: The systematic reviews led to the inclusion of 48 randomised controlled trials (total number of participants = 2271). Quality of evidence supporting the recommendations ranged from very low to moderate. Strong recommendations were made for the use of topical anesthetics in all needle procedures, for offering deep sedation (DS)/general anesthesia (GA) to all children undergoing lumbar puncture, for the use of DS/GA in major procedures in children of all ages, for the use of hypnosis in all needle procedures and for the use of active distraction in all needle procedures. Conclusion: In this CPG, an evidence-based approach to manage procedure-related pain and distress in children with cancer is presented. As children with cancer often undergo repeated needle procedures during treatment, prevention and alleviation of procedure-related pain and distress is of the utmost importance to increase quality of life in these children and their f

Purpose: To develop an evidence-based decision aid for parents of children with cancer and to help guide them in the use ofcomplementary and alternative medicine (CAM) for cancer care. Methods: This study had a mixed research design. The needs of parents were investigated by survey and focus group. Asystematic review and meta-analysis were performed on the effectiveness of CAM using Grading of RecommendationsAssessment, Development and Evaluation (GRADE). Clinical experts were interviewed and a decision aid on CAM treatmentfor pain was developed. Results: Parents emphasized the importance of reliable information on CAM, focusing primarily on communication and a broadspectrum of complaints related to cancer treatment. The decision aid on CAM for pain included five modalities based on 11randomized control trials (RCTs): hypnotherapy, mind-body techniques, massage, healing touch, and music therapy. Metaanalysis could be performed on hypnotherapy, which significantly reduced cancer-related procedural pain compared withstandard care (MD, − 1.37; 95% CI, − 1.60, − 1.15; P < 0.00001) and attention control (MD, − 1.13; 95% CI, − 1.34, − 0.94;P < 0.00001), and massage, demonstrating no effect on pain compared with standard care (MD, − 0.77; 95% CI, − 1.82, 0.28;P = 0.15). Research evidence and supplementary information from clinical practice and patient were incorporated in a websitebased decision aid. Conclusions: An evidence-based decision aid was developed to support parents of children with cancer in making decisions aboutCAM for pain management. Next steps will be to expand the website to include additional childhood cancer-related complaintsand to evaluate its use in practice, This article is distributed under the terms of the CreativeCommons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/)

Bakgrund: Procedurrelaterad smärta är vanligt förekommande hos barn inom barnsjukvården. Procedurer kan skapa oro och ångest hos barnet och sjuksköterskan bör erbjuda adekvat smärtlindring och använda en distraktionsmetod som kan hjälpa barnet att hantera smärtan. Syfte: Att beskriva sjuksköterskors erfarenheter av att använda VR-glasögon som distraktion på barn i samband med procedursmärta. Metod: Studien är en kvalitativ fokusgruppsintervjustudie med induktiv ansats. Ett ändamålsenligt urval gjordes och 13 sjuksköterskor som arbetar på barnkliniker i södra Sverige inkluderades. Intervjuerna analyserades efter en kvalitativ manifest innehållsanalys utifrån Graneheim och Lundmans modell. Resultat: Sjuksköterskorna ansåg att VR-glasögon fungerade som distraktionsmetod vid smärtsamma procedurer på barn, dock hade en del barn behov av kontroll och andra var inte mogna för att använda dem. Denna distraktionsmetod kunde underlätta för sjuksköterskornas arbete men det fanns även svårigheter så som att det var tidskrävande och att den tekniska utrustningen kunde krångla. Slutsats: I denna studie ansåg sjuksköterskorna att VR-glasögon oftast är en bra distraktionsmetod för barn som genomgår procedurrelaterad smärta. Har sjuksköterskan kunskap om dess för- och nackdelar kan de fungera som ett redskap för att barnet ska uppleva hälsa trots procedurrelaterad smärta., Background: Procedural related pain is common for children in pediatric care. Procedures can make the child anxious and the nurse should offer adequate pain relief and use a distraction method that can help the child cope with the pain. Aim: To describe nurses’ experiences of using VR-headsets as a distraction for children with procedural pain. Method: This study is a qualitative focus group interview study with inductive approach. An appropriate selection was selected and 13 nurses working in pediatric clinics in southern Sweden were included. The interviews were analyzed according to a qualitative manifest content using the model of Graneheim and Lundman. Result: The nurses thought that VR-headsets served as a distraction for children during painful procedures, but some children needed to be in control of the situation and others were not mature enough to use them. This method of distraction could simplify the nurses’ work, but there are also difficulties such as time consuming and some technology issues. Conclusion: In this study the nurses thought that VR-headsets work as a good distraction for children undergoing procedural pain. If the nurse has knowledge of the advantages and disadvantages, they can serve as a tool for the child to experience health despite procedural pain.

Bakgrund: Enligt barnkonventionen har barn som vistas inom hälso- och sjukvården rätt till delaktighet i sin vård genom anpassad information samt att få att uttrycka sina åsikter i alla frågor som rör dem. Insättning av perifer venkateter och blodprovstagning är smärtsamma procedurer som barn utsätts för inom barnsjukvården. Inför dessa procedurer är det viktigt att barn får goda förberedelser. Syfte: Studiens syfte var att undersöka och beskriva barns erfarenheter av delaktighet inför och under insättning av perifer venkateter och blodprovstagning. Metod: Studien genomfördes som en kvantitativ enkätstudie. Enkäterna besvarades av 47 barn i åldrarna åtta till arton år, som hade genomgått insättning av perifer venkateter alternativt lämnat venösa eller kapillära blodprov på Falu lasarett eller Akademiska barnsjukhuset i Uppsala. Resultat: Tjugoen procent av barnen fick inte lokalbedövning och 20% blev aldrig tillfrågade om önskemål i samband med smärtsamma procedurer. De barn som uppgav att personalen inte hade berättat hur de smärtsamma procedurerna skulle gå till hade lägre ålder i median jämfört med de barn som personalen berättade för (9 år versus 14 år, p=0,006). Ju högre barnen skattade att de förstått informationen de fått på en tiogradig skala desto högre skattade de att de kunde säga stopp om något var för påfrestande eller gjorde för ont i samband med smärtsamma procedurer (r=,430, p=0,004). Slutsats: Alla barn ska tillfrågas om önskemål och erbjudas lokalbedövning inför smärtsamma procedurer. Sjukvårdspersonal ska ge barn anpassad information oavsett ålder vilket främjar barns möjlighet att säga stopp om de upplever proceduren som för påfrestande. Sjukvårdspersonal måste visa extra lyhördhet gentemot barn med lägre ålder., Background: According to the Convention on the Rights of the Child, children receiving healthcare have the right to personalized information and to have their opinions expressed on all issues that concern them. Peripheral intravenous cannulation and blood sampling are painful procedures that children are subjected to in pediatric care, and prior to these procedures it is important that children receive good preparation. Objective: The aim of the study was to investigate and describe children’s experiences of participation before and during peripheral intravenous cannulation and blood sampling. Method: The study was a quantitative survey. The questionnaires were answered by 47 children aged eight to eighteen years, who had experienced peripheral intravenous cannulation or venous/capillary blood test at the hospital in Falun or at the Children’s Hospital in Uppsala. Results: Twenty-one percent of the children did not receive local anesthesia and 20% were never asked for their preferences in connection with painful procedures. The children who stated that they were not informed by the healthcare professionals regarding the painful procedures were of younger age compared to the children that were informed (9 years versus 14 years, p=0,006). The higher the children rated on a 10-degree scale that they understood the information, the higher they also rated that they could tell the healthcare professionals to stop if the painful procedures was too demanding or too painful (r=,430, p=0,004). Conclusion: All children should be asked for their preferences and be offered local anesthesia for painful procedures. Healthcare professionals should provide the children with appropriate information regardless of the age of the child, which promotes the child’s ability to tell the healthcare professionals to stop if they experience the procedures as too demanding. Healthcare professionals should be more aware when caring for younger children.

Bakgrund: När barn besöker sjukhus är det vanligt att nålrelaterade procedurer genomförs. Barn kan uppleva procedurerna obehagliga och smärtsamma. Det finns olika metoder för att minskaobehaget och smärtan, exempelvis med hjälp av trygghetsfaktorer, distraktionsmetoder och lokalsmärtlindring. Syfte: Syftet med studien var att studera effekter av omvårdnadsåtgärder i samband mednålprocedurer för att lindra procedurrelaterad smärta hos barn. Metod: En litteraturstudie där åtta kvantitativa experimentella studier med kontrollgruppundersöktes. Sökningar gjordes i databaserna Cinahl och Pubmed. Effektmåttet beskrevs medCohen’s d. Resultat: Samtliga åtta studier visade god effekt gällande distraktionsmetoder. Såpbubblor,distraktionskort samt kyla kombinerat med vibration hade hög effekt medan lokalbedövandekräm och föräldrars närvaro hade medelhög effekt. Konklusion: Ett effektivt sätt att förebygga smärta var med lokalbedövande kräm, kyla kombineratmed vibration samt distraktionsmetoder. Föräldrars närvaro och sjuksköterskans information införproceduren underlättade situationen., Background: Children visiting hospital are often undergoing various procedures including needles. Children may experience the procedures as painful and unpleasant. There are differenttypes of measures to relieve the pain and discomfort. With topical anesthesia, safety factors anddistraction methods the pain can be relief. Aim: The aim of the study was to investigate the effects of nursing measures in relation withneedle procedures to relieve procedural pain in children. Methods: A literature study in which eight quantitative experimental studies with a controlgroupwere examined. Searches were performed in Cinahl and Pubmed. The power measure wasdescribed with Cohen’s d. Results: All eight studies showed a good effect regarding distraction methods. Soap bubbles,distractioncards and cold combined with vibration had a high effect, while local anesthetic creamand parents' presence had a medium effect. Conclusion: An effective way to reduce procedural pain was to use local anesthetic cream, coldcombined with vibration and distraction methods. Parents’ presence and information from the nursebefore the procedure facilitated the situation.

Pain experiences can negatively impact children and adolescents, leading to trauma symptoms and nonadherence to important health behaviors. Developmentally-tailored communication strategies may mitigate this risk. This article reviews cognitive and linguistic developmental factors, within the familial and cultural context, that are important to consider when communicating with youth about acute, procedural, and/or chronic pain. Youth undergoing acute or procedural pain benefit from pain education, truthful information about the procedure, and advance preparation. The use of analogies may be particularly helpful for patient understanding of chronic pain development, maintenance, and treatment. Youth with developmental disabilities may express pain differently than their normative peers, requiring adaptation of communication strategies. Developmentally-tailored pain communication is an important tool for caregivers and healthcare providers that may foster adaptive functioning in youth who experience pain.

Bakalářská práce se zabývá problematikou bolesti u dětských pacientů. Konkrétně je zaměřena na eliminaci procedurální bolesti, s cílem zjistit způsoby odvádění pozornosti dětí v přípravě na bolestivý výkon v nemocnici a v přednemocniční péči. Praktická část je zpracována prostřednictvím polostrukturovaných rozhovorů a uvádí zkušenosti odborníků z praxe v této oblasti péče., The bachelor thesis deals with the issue of pain in children's patients. Specifically, it is the elimination of procedural pain in children. The aim of the work is to determine whether it is possible to eliminate procedural pain in children under certain conditions, procedures or aids. I focus primarily on the form of the game, game aids and ways to divert attention from possible pain, etc., not on elimination with the help of pharmacotherapy. The practical part is prepared with the help of interviews with game specialists, paramedics and children's nurses., Fakulta zdravotnických studií, Hodnocení vedoucího: velmi dobře Hodnocení oponenta: velmi dobře Doplňující otázky k obhajobě: 1. Mohla byste prosím trochu lépe zformulovat stručné odpovědi na průzkumné otázky, které jste si dala? 2. Vzpomenete si na vaše osobní zkušenosti dítěte s eliminací procedurální bolesti? Myslíte si, že nějak ovlivní váš přístup k dětem vystaveným procedurální bolesti nyní ve vaší profesi? Obhajoba bakalářské práce s prezentací velmi dobrá., Dokončená práce s úspěšnou obhajobou

Objective: To assess the efficacy and safety of a virtual reality distraction for needle pain in 2 common hospital settings: the emergency department (ED) and outpatient pathology (ie, outpatient laboratory). The control was standard of care (SOC) practice. Study design: In 2 clinical trials, we randomized children aged 4-11 years undergoing venous needle procedures to virtual reality or SOC at 2 tertiary Australian hospitals. In the first study, we enrolled children in the ED requiring intravenous cannulation or venipuncture. In the second, we enrolled children in outpatient pathology requiring venipuncture. In the ED, 64 children were assigned to virtual reality and 59 to SOC. In pathology, 63 children were assigned to virtual reality and 68 to SOC; 2 children withdrew assent in the SOC arm, leaving 66. The primary endpoint was change from baseline pain between virtual reality and SOC on child-rated Faces Pain Scale-Revised. Result(s): In the ED, there was no change in pain from baseline with SOC, whereas virtual reality produced a significant reduction in pain (between-group difference, -1.78; 95% CI, -3.24 to -0.317; P = .018). In pathology, both groups experienced an increase in pain from baseline, but this was significantly less in the virtual reality group (between-group difference, -1.39; 95% CI, -2.68 to -0.11; P = .034). Across both studies, 10 participants experienced minor adverse events, equally distributed between virtual reality/SOC; none required pharmacotherapy. Conclusion(s): In children aged 4-11 years of age undergoing intravenous cannulation or venipuncture, virtual reality was efficacious in decreasing pain and was safe. Trial registration: Australia and New Zealand Clinical Trial Registry: ACTRN12617000285358pCopyright © 2019 Elsevier Inc.

Pain in newborn children should be prevented due to negative short- and long-term consequences. A good understanding of the development of the nociceptive system in newborns is necessary to enable optimal pain assessment, and most importantly to treat and prevent pain adequately in neonates. So far, preclinical juvenile animal studies have led to a tremendous amount of information regarding the development of the nociceptive system. In addition, they have made clear that the developmental stage of the nociceptive system may influence the mechanism of action of different classes of analgesics. Age specific analgesic therapy, based on post-menstrual age, should therefore be considered by incorporating information on the developmental stages of the nociceptive system in combination with knowledge from pharmacokinetic and dynamic studies in neonates.

Bakgrund: Två vanligt förekommande smärtsamma procedurer på barn i sjukvården är insättning av perifer venkateter (PVK) och behandling med lavemang (KLYX). För att lindra procedursmärta hos barn är det viktigt med en välgenomtänkt planering som gör barn och föräldrar trygga och lugna inför proceduren. Syfte: Studiens syfte var att undersöka hur föräldrar upplevde förberedelser på sjukhus inför insättning av perifer venkateter eller givande av lavemang på deras barn. Metod: Studien var en kvantitativ enkätstudie, där frågorna besvarades av 71 föräldrar med barn upp till 12 års ålder som genomgått PVK-insättning eller lavemangbehandling. Joyce Travelbees omvårdnadsteori användes som teoretiskreferensram för att beskriva vikten av information och god kommunikation i vården. Resultat: Resultatet visade att 91% av föräldrarna fick information om barnets behandling och 78% av föräldrarna var nöjda med informationen de fick inför proceduren på barnet. En större andel av barnen som fick PVK (88%) fick smärtlindring jämfört med barnen som fick KLYX (5%) (p = 0,001). Sjutton föräldrar (24%) i studien upplevde att deras barn inte hade möjlighet att stoppa proceduren om den blev för jobbig. Av föräldrarna blev 36,6% tillfrågade om sina önskemål inför barnets procedur. Slutsats: Denna enkätstudie visade att en stor andel av föräldrarna inte blev tillfrågade om sina önskemål inför proceduren som barnet skulle genomgå. Den belyser också att en grupp föräldrar upplevde att barnet vid de smärtsamma procedurerna inte kunde säga stopp om behandlingen blev för jobbig. Studien belyser vikten av att fråga föräldrar om önskemål för delaktighet i barnets vård samt att barnet måste ges möjlighet till att kunna sätta stopp om behandlingen blir för jobbig., Background: Two commonly occurring painful procedures for children in healthcare are the insertion of peripheral vein catheters (PVK) and treatment with enema (KLYX). In order to ease the pain for the children during the procedure, it is important to have a well planning that makes children and parents safe and calm before starting the procedure. Purpose: The aim of the study was to investigate how parents experienced preparations in hospitals prior to inserting peripheral vein catheters or giving enema to their children. Method: The study was a quantitative survey, which the questionnaire was answered by 71 parents with children up to 12 years of age who had experienced PVK insertion or enema treatment. Joyce Travelbees nursing theory was chosen as theoretical referencefram to describe the importance of information and good communication in healthcare. Result: The result showed that 91% of the parents got information about the child's treatment and 78% of the parents were satisfied with the information they received before the procedure for the child. A larger proportion of the children who got PVK (88%) received pain relief compared to the children who got KLYX (5%) (p = 0,001). Seventeen parents (24%) in the study found that their children hadn’t possibility to stop the procedure if it became too difficult. 36,6% of the parents were asked about their wishes before the initiating the procedure. Conclusion: This survey showed that a large proportion of the parents were not asked about their wishes before the starting the procedure which the child would undergo. It also highlights that a group of parents felt that the child hadn’t possibility to stop the procedures if the treatment becomes too painful. The study highlights the importance of asking parents about the wishes for participation in the child's care and that the child must be given the opportunity to be able to stop the treatment if it becomes too painful.

SAMMANFATTNING Bakgrund:Inom vården utsätts spädbarn för flertalet medicintekniska moment som kan ge upphov till procedursmärta. För att säkerställa att spädbarnen inte upplever procedursmärta krävs omvårdnadsåtgärder som kan minska denna typ av smärta. Omvårdnadsåtgärder som förebygger och minskar procedursmärta hos spädbarn kan vara farmakologiska och icke-farmakologiska. Procedursmärta hos spädbarn ger upphov till ett sjukdomslidande, vilket bör undvikas. Syfte:Syftet med denna litteraturstudie är att kartlägga om förebyggande farmakologiska samt icke-farmakologiska omvårdnadsåtgärder kan minska procedursmärta hos spädbarn under medicintekniska moment. Metod:För att besvara syftet gjordes en litteraturstudie med 11 kvantitativa artiklar. Resultat:De farmakologiska omvårdnadsåtgärder som minskar procedursmärta hos spädbarn är sackaros och glukos medan paracetamol är en metod som inte har denna effekt. De icke-farmakologiska omvårdnadsåtgärderna som minskar procedursmärta är bland annat amning, bekanta ljud och att linda spädbarnet. Att linda spädbarnet var även effektivt i kombination med sackaros och icke näringsrikt sugande medan icke näringsrikt sugande verkar smärtförebyggande i kombination med bröstmjölk och stödjande sammanhållning. Hud mot hud vård minskar procedursmärta både ensamt och i kombination med amning. Ingen evidens finns för att klassisk musik minskar procedursmärta hos spädbarn. Slutsats:Det finns evidens för att farmakologiska och icke-farmakologiska omvårdnadsåtgärder minskar procedursmärta hos spädbarn under medicintekniska moment. Trygghet, beröring och närhet är viktiga faktorer för förebyggande av smärta hos spädbarn och kan uppnås genom användandet av olika icke-farmakologiska metoder. Trots att användandet av smärtförebyggande omvårdnadsåtgärder minskar procedursmärta kan frånvaro av smärta och sjukdomslidande inte säkerställas., Background:Infants are exposed to several medical technical procedures that can cause procedural pain. To ensure that infants do not experience procedural pain, it is required to find nursing methods that can reduce this type of pain. Nursing methods that prevent and reduce procedural pain in infants can be pharmacological and non-pharmacological. Procedural pain in infants leads to infants suffering from disease, which should be avoided. Aim:The aim of this literature study is to chart if preventive pharmacological and non-pharmacological nursing methods can reduce procedural pain in infants during medical technical procedures. Method:To answer the aim of the study, a literature study with 11 quantitative articles were conducted. Result:The pharmacological methods that reduce procedural pain in infants are sucrose and glucose while paracetamol is a method that is not effective. The non-pharmacological methods that reduce procedural pain are for example breastfeeding, familiar auditory stimulus and swaddling. Swaddling was also effective in combination with sucrose and non-nutritive sucking while non-nutritive sucking had an preventing effect in combination with oral breastmilk and facilitated tucking. Skin-to-skin contact reduces procedural pain both alone and in combination with breastfeeding. There is no evidence that classical music reduces procedural pain in infants. Conclusion:There is evidence that pharmacological and non-pharmacological nursing methods reduce procedural pain in infants during medical technical procedures. Comfortability, physical contact and closeness are important factors in the prevention of pain in infants and can be achieved by use of various non-pharmacological methods. Although the use of pain prevention nursing methods reduces procedural pain, the absence of pain and suffering from disease can not be ensured.

Background and aim of the work: procedural pain is a significant issue for paediatric patients. In particular, needle pain is amongst the most stressful for children. Studies revealed that a large number of children do not receive adequate pain prevention during the procedures. Neglecting the prevention of needle pain can cause several psychological effects such as anxiety and phobias, and increase perceptions of pain in the future. We aimed to verify the efficacy of Buzzy System in reducing pain during venipuncture. Methods: A randomized control trial was conducted among 72 children aged 3 to 10 years undergoing venipuncture. Children were randomly assigned to The Buzzy with distraction cards group (experimental group) or to “magic gloves” group (control group). Perception of pain was measured through the Visual Analogue Scale (VAS), the Wong-Baker Scale (WBS) and the Numeric Rating Scale (NRS). Results: Sixty-four children participated in the study, 34 in the experimental group and 30 in the control group. The experimental group showed significantly lower levels of pain (p=.039; 95% CI: -2,11; -0,06) in terms of the mean=3.65±2.011; median=3, compared to the control group (mean: 4.67±2.14, median=4). Caregivers were satisfied with the Buzzy System. Conclusion: The Buzzy System combined to distraction cards showed a greater reduction of perceived pain than “magic glove” technique. This study underlines the importance of active involvement of caregivers during procedural pain in children. Pediatric nurses have an important role in empowering children and caregivers to be interactive during venipunctures.

Bakgrund: Barn som besöker vården upplever rädsla och oro inför att vårdåtgärder kan tänkas göra ont. Adekvat smärtlindring är viktig för att lindra barns fysiska och psykiska smärta samt främja god hälsa. Det finns olika sätt att lindra barns smärta, en metod är lustgasbehandling. Syfte: Syftet var att i form av ett förbättringsarbete utvärdera lustgasbehandling i samband med att barn genomgår en smärtsam procedur på en barn- och ungdomsmedicinsk klinik på ett medelstort sjukhus i södra Sverige. Metod: Förbättringsarbetet genomfördes med en kvantitativ design. Deskriptiv statistik har använts för att utvärdera lustgasens effekter och bieffekter, vidare har andra faktorer som kan påverka behandlingen utvärderats. Resultat: Lustgas har varit användbart i samband med smärtsamma procedurer, behandlingen har fungerat smärtlindrande samt varit till hjälp för barn som varit rädda. Lustgasbehandling uppskattas av både barn och deras vårdnadshavare. Slutsatser: För att lindra barns lidande och utföra god omvårdnad måste barnsjuksköterskan ha kunskap om hur barn upplever smärtsamma situationer samt hur smärta bäst lindras. Det aktuella förbättringsarbetet har bekräftat att lustgas är en metod som kan hjälpa barn i samband med flera typer av smärtsamma procedurer. Genom att kunna välja lustgas som smärtlindrande och lugnande metod kan barnets delaktighet och hälsa främjas., Background: Children receiving health care experience fear and anxiety related to possible painful procedures. Adequate pain relief is important to ease children’s physical and psychological pain and further to promote good health. There are various ways of relieving children’s pain, one method is nitrous oxide. Aim: The aim was to through an improvement work evaluate the usage of nitrous oxide in connection to children undergoing a painful procedure on a children’s and youth’s medicine ward at a medium sized hospital in south of Sweden. Method: The improvement work was conducted through a quantitative design. Descriptive statistics was used to evaluate the effects and adverse events of nitrous oxide, furthermore has other variables that may affect the treatment been evaluated. Results: Nitrous oxide has been useful when utilized in painful procedures, the treatment has served pain relieving and eased children who experienced fear. Both children and legal guardians appreciated the usage of nitrous oxide. Conclusion: A children’s nurse must possess knowledge related to children’s experience of pain and adequate pain relief in order to ease children’s suffering and administer good care. The current improvement work has confirmed nitrous oxide to be a tool that might help children in connection to several painful procedures. Through the choice of using nitrous oxide as a pain relieving and sedative method the child’s empowerment and health can be improved.

__Background:__ The availability of a safe and effective pharmacological therapy to reduce procedural pain in preterm infants is limited. The effective analgesic single dose of intravenous paracetamol in preterm infants is unknown. Comparative studies on efficacy of different paracetamol doses in preterm infants are lacking. __Objectives:__ To determine the analgesic effects of different single intravenous paracetamol doses on pain from peripherally inserted central catheter (PICC) placement in preterm infants. __Methods:__ In a blinded randomized controlled trial, the ana

Syfte: Att beskriva metoder i bemötandet av barn med smärta inom sjukvåden. Metod: En allmän litteraturstudie baserad på tio kvalitativa studier publicerade mellan 2008– 2017. Resultat: Resultatet visade att det var komplext för sjuksköterskor att finna rätt metod för att bemöta barn med smärta inom sjukvården. Dock identifierades olika metoder som kunde underlätta för sjuksköterskorna. Detta resulterade i tre huvudfynd: distraktion, delaktighet och förtroendeskap. Det krävdes både kompetens och kunskap av sjuksköterskorna att utföra dessa metoder på ett strukturerat och evidensbaserat arbetssätt. Slutsats och förslag på fortsatt forskning: Sjuksköterskan har stora möjligheter att bemöta barns smärta inom sjukvården med hjälp av olika metoder. Barn 6–12 år påverkas i stor utsträckning av det bemötande och förhållningssätt sjuksköterskan använder sig av. Ett personcentrerat, åldersanpassat och väl förberett möte skänker trygghet för barnen och minskar deras upplevelse av smärta vid olika procedurer i sjukvården. Det krävs dock mer forskning på hur sjuksköterskan ska bemöta och involvera barn på ett personcentrerat sätt i sjukvården., Aim: To describe methods in the meeting of children with pain in healthcare. Method: A general literature study based on ten qualitative studies published between 2008- 2017. Result: The results showed that it was a complex issue for nurses to find the right methods in the meeting of children with pain in the healthcare environment. However, different methods were identified that could make the work easier for the nurses. This resulted in three main findings: distraction, participation and confidence properties. Skills and knowledge from nurses were required to execute these methods in a structured and evidence-based approach. Conclusion and suggestions for further research: Nurses have great opportunities to meet children in pain through different methods. Children 6-12 years are largely influenced by the treatment and attitude from the nurses. A person-centered, age-adjusted and well-prepared meeting provides child safety and reduces their experience of pain in different healthcare procedures. However, more research is needed on how the nurse should respond and involve children in a person-centered way in the healthcare sector.

Procedursmärta är den vanligaste orsaken till smärta hos barn i sjukvården. Dagligen genomförs diagnostiska och terapeutiska procedurer på barn, som både är skrämmande och smärtsamma. Barn som upplever otillräcklig smärtlindring under medicinska procedurer har en högre nivå av rädsla och ångest inför framtida procedurer, de reagerar dessutom kraftigare på akut smärta. Att låta barn inhalera en blandning av lustgas och syrgas ger både en smärtlindring och sedering. Stor fördel är att lustgas är enkel att administrera, har en kort anslagstid och effekten avklingar snabbt när inhalationen avslutas, och ger få biverkningar. Syftet med litteraturstudien var att beskriva effekten av lustgas i samband med att barn utsätts för smärtsamma procedurer inom hälso- och sjukvården. En litteraturstudie utfördes där tio vetenskapliga studier grundlade resultetet. Vid bearbetningen identifierades tre olika teman, dessa var; Lustgas och smärta, Lustgas och biverkningar, Lustgas och fasta. I resultatet framkom att lustgassedering är en effektiv och säker metod för att uppnå smärtlindring och sedering under mindre, men smärtsamma medicinska procedurer, med få biverkningar. Allt fler barn sederas med lustgas vid olika medicinska procedurer av icke anestesiutbildade sjuksköterskor. En konklusion av resultatet var, för att sjuksköterskan ska kunna möta kraven måste systematisk utbildning och träning finnas och tydliga guidelines utarbetas och vara förankrad hos all personal. Detta måste prioriteras, förbättras och kontinuerligt uppdateras.

Bakgrund: Barn behöver ibland uppsöka sjukvård för att genomgå vårdprocedurer av olika slag. Barns reaktioner på oro och rädsla styrs av ålder, förståelse, fantasi och verklighetsuppfattning. Barn behöver därför förberedas inför obehagliga ingrepp som ska hända till exempel: smärtsamma undersökningar, venpunktion eller injektioner. Dessa undersökningar kan skapa oro och rädsla hos barn. Syfte: Syftet med studien var att beskriva olika icke farmakologiska avledande metoder och dess effekter vid procedursmärta hos barn. Samt att beskriva undersökningsgrupperna i de inkluderade artiklarna. Metod: En deskriptiv design användes för att besvara litteraturstudiens syfte och frågeställningar. Studien baserades på tretton vetenskapliga artiklar. De vetenskapliga artiklarna söktes i databaserna Cinahl och PubMed. Artiklarna var publicerade mellan åren 2006-2016. Huvudresultat: Studien påvisar att icke farmakologiska avledande metoder som till exempel: blåsa såpbubblor, titta i ett kalejdoskop, lyssna på musik eller använda ”Buzzy” har haft lindrande effekt på barns rädsla, oro och smärta. Effekterna har skattats med hjälp av olika skalor genom sjuksköterskors, forskare och föräldrars observationer. Barnen har själva fått skattat effekterna av de icke farmakologiska avledande metoderna. Slutsats: I resultatet i föreliggande studie har författarna kommit fram till att icke farmakologiska avledande metoder kan lindra barnens rädsla, oro eller smärta vid olika omvårdnadshandlingar. Författarna har även kommit fram till slutsatsen att de avledande metoderna som undersökts kan användas i det vardagliga arbetet inom barnsjukvården., Background: Children sometimes need to seek medical help in order to undergo treatment procedures of various kinds. Children's reaction to anxiety and fear are governed by age, understanding, imagination and perception of reality. Children therefore need to be prepared for unpleasant procedures that they will undergo, such as: painful examinations, venipuncture or injections. These procedures can create anxiety and fear in children. Purpose: The purpose of this study was to describe the various non - pharmacological istraction methods and its effects on procedural pain in children. And to describe the study groups in the included articles. Method: A descriptive design was used to answer the literature studies experimental purpose and questioning. The study was based on thirteen scientific articles. The papers were searched in databases Cinahl and PubMed. The articles were published between the years 2006-2016. Result: The study demonstrates that non - pharmacological distraction methods for example: playing with soap bubbles, looking through a kaleidoscope, listen to music and use a “Buzzy” have had a soothing effect on children’s fear, anxiety and pain. The effects have been estimated using different scales by nurses, researchers and parents' observations. The children themselves have been estimating the effects of the non - pharmacological distraction methods. Conclusion: In the results of the present study, the authors concluded that non-pharmacological distraction methods can ease children's fear, anxiety or pain at different nursing actions. The authors have also come to the conclusion that the distraction methods investigated can be used in everyday work in pediatric care.

Background: Most procedures in healthcare were described to cause the child pain. Anxiety was also strongly linked to pain and painful experience can generate future consequences for the child in contact with health services. Administering medication to children was considered difficult to adapt while non-pharmacological treatment is considered to be both time- and cost efficient. Purpose: To describe nurses' use of non-pharmacological treatment of procedural pain in children and to examine the included articles research group.Method: This descriptive literature studies results was based on 15 articles sought in the databases Cinahl, PsycINFO and PubMed. Eight of the included articles were qualitative studies, four were quantitative studies and three were studies with mixed approach. Main Results: Non-pharmacological treatment of procedural pain in children was considered effective when it was formed based on each unique child and occasion. The nurses described distraction as a useful method that can be performed in several ways, ranging from the child's needs. The importance of a good relationship, a working cooperation and that the nurse had the ability to get the child's confidence was described as key elements in non-pharmacology. The research group characteristics were examined and in all articles the participants profession consists in the majority of nurses. Conclusion: Non-pharmacological treatment of procedural pain should be adjusted based on the unique child and the situation. Distraction was considered by the majority of nurses to be a positive and useful non-pharmacological treatment of procedural pain in children and can be performed by both nurses and parents to reduce the child's pain and future fears., Bakgrund: Ett flertal procedurer inom vården beskrevs kunna orsaka barnet smärta. Oro var vidare starkt kopplat till smärta och en tidigare smärtsam upplevelse kan komma att generera framtida konsekvenser för barnet i kontakt med sjukvården. Administreringen utav läkemedel till barn ansågs vara svårt att anpassa samtidigt som icke-farmakologisk behandling anses vara både tids- och kostnadseffektiv. Syfte: Att beskriva sjuksköterskors användning av icke-farmakologisk behandling vid procedursmärta hos barn, samt att granska de inkluderade artiklarnas undersökningsgrupp. Metod: Denna beskrivande litteraturstudies resultat grundades på 15 artiklar eftersökta i databaserna Cinahl, PsycINFO och PubMed. Åtta av studiens inkluderade artiklar hade kvalitativ ansats, fyra hade kvantitativ ansats och tre var studier med mixad ansats. Huvudresultat: Icke-farmakologisk behandling vid procedursmärta hos barn ansågs effektivt när den formades utifrån varje unikt barn och tillfälle. Sjuksköterskorna beskrev distraktion som en användbar metod som kan utföras på flertalet sätt, allt utifrån barnets behov. Vikten av en fungerande relation, ett fungerande samarbete och att sjuksköterskan hade förmåga att få barnets förtroende beskrevs vidare som centrala delar inom icke-farmakologin. Artiklarnas beskrivning av undersökningsgrupp granskades och deltagarnas yrkeskategori utgjordes i majoritet av sjuksköterskor i samtliga fall. Slutsats: Icke-farmakologisk behandling vid procedursmärta bör anpassas utifrån det unika barnet och situationen. Distraktion ansågs av majoriteten sjuksköterskor vara en positiv och användbar icke-farmakologisk behandling vid procedursmärta hos barn och kan utföras av både sjuksköterskor och föräldrar för att minska barnets smärta och framtida rädslor.

Needle-related procedures are reported to be problematic for children. In a school-based celiac disease screening, 12-year-olds' experiences with relaxation and guided imagery (R-GI) during venipuncture were investigated. One group tried nurse-led R-GI (n = 60) and another group received standard care (SC; n = 49). A mixed method design was applied using short written narratives, facial affective scale (FAS), and visual analog scale (VAS) for pain intensity. Qualitative content analysis highlighted that diversity and contradictions when facing blood tests. FAS scores were significantly lower in the SC group before (p = 0.01), during (p = 0.01), and after (p = 0.01) venipuncture. VAS scores did not differ between the groups. The blood test was mostly experienced as unproblematic, and GI during venipuncture did not decrease pain or affect. However, the fact that a number of children scored high FAS indicates a need for effective methods to help children cope with needle-related school-based procedures.

Purpose: To investigate if nurses at neonatal units in Sweden have adopted national guidelines when neonates are exposed to intravenous catheter, capillary heel prick, venepuncture and injections, to identify the frequency of documentation of pharmacological and behavioural treatments and to compare the answers from the nurses with results from an earlier national survey completed by the chief neonatologists at the same units. Design and sample: Four nurses at a total of 44 neonatal units in Sweden, received questionnaires. A total number of 116 surveys were analysed (response rate 66%). Main outcome and results: All units had written guidelines for prevention and treatment of pain. Behavioural treatments were used in every painful procedure in the study, but only1/5 used EMLA often or always. There was a higher tendency to document the use of drugs than behavioural treatments. The chief neonatologist reported higher use of glucose than did nurses. Conclusions: Swedish national guidelines are not used consistently in some neonatal units. There is a considerably larger cohort of nurses who use behavioural treatments, rather than using drugs when painful procedures are performed. It was also evident that it was more common to document the use of drugs than behavioural treatments., Available online 13 May 2013

Bakgrund: Barn som besöker sjukhus och andra vårdinrättningar förknippar ofta vistelsen med undersökningar och behandlingar. De ofta rädda för det okända och för att inte veta vad som ska hända. Det kan bero på den annorlunda miljön och på möten med nya främmande ansikten. Om dessa procedurer också är förknippade med smärta kan barnen riskera att utveckla ökad stress och rädsla inför kommande procedurer Syfte: Syftet med litteraturstudien är att belysa sjuksköterskans möjligheter att lindra rädsla och smärta hos barn i samband med smärtsamma behandlingar och procedurer inom sjukvården Metod: En litteraturstudie baserad på 24 vetenskapliga artiklar och 2 doktorsavhandlingar. Resultat: Ur analysen av datamaterialet har två huvudteman identifierats. Resultatet visar att ”faktorer som lindrar rädsla och smärta” och ”faktorer som påverkar smärtbedömning, rädsla och smärta” är områden som har stor betydelse för barn som genomgår smärtsamma behandlingar eller procedurer inom sjukvården. Slutsats: Sjuksköterskor behöver uppmärksamma och förstå barns kognitiva utveckling, mognad och behov samt skapa kunskap om smärta och rädsla i samband med smärtsamma procedurer och behandlingar för att kunna utföra välavvägda omvårdnads- och medicinska behandlingar., Background: Children that visit hospitals and other care givers often connect their stay with medical treatments and examinations. They are also often forced into unpredictable and distressful situations of being exposed to the unknown, not knowing what will happen to them. This could be due to the unfamiliar surroundings or unknown faces they meet. If these procedures are connected to pain, the children are at risk of developing feelings of increased stress and fear in relation to future procedures. Aim: The aim of this literature review is to illuminate nurse’s possibilities to reduce fear and pain in connection to painful treatments and procedures in health care. Method: A literature review based on 24 scientific articles and 2 doctoral theses. Results: Through the analysis of the data two main themes were identified: "factors that alleviate fear and pain" and "factors affecting pain assessment, fear and pain". These themes are areas that have significant impact in children undergoing painful procedures and treatments in health care. Conclusion: Nurses need to be attentive to children’s cognitive development, maturity and needs. They also have to become better to develop knowledge about fear and pain associated with painful procedures and treatments in order to increase the quality of care within this context.

Identifying and measuring the biochemical effects of procedural pain in infants is a continuing challenge for clinicians. To address this issue we evaluated the relationship between procedural pain, ATP utilization (hypoxanthine and uric acid), and oxidative stress (MDA and allantoin) in premature infants. Through these studies we found that 1) a single heel-lance significantly increases plasma uric acid in rabbit kits, 2) tape removal increases MDA and prevents a decrease in uric acid in the plasma of premature infants, and 3) a single dose of oral sucrose before a heel-lance is sufficient to significantly increase plasma markers of ATP utilization and oxidative stress. These studies indicate that, in premature infants, ATP utilization and oxidative stress are altered by procedural pain and that oral sucrose, a common analgesia, may increase ATP breakdown. Next, we examined clinical factors that need to be considered when using the urinary concentrations of hypoxanthine, xanthine, uric acid, and allantoin to evaluate the biochemical effects of procedural pain. Specifically, we determined the effects of gestational age, weight for gestational age, and neonatal morbidity on the urinary concentration of purines and allantoin. We found infants born at earlier gestational ages had significantly higher urinary purine and allantoin concentrations compared to infants born at later gestations, after 31 weeks. Weight for gestational age also altered the urinary concentration of purines with small for gestational age infants having significantly lower urinary hypoxanthine compared to appropriate and large for gestational age infants. In addition, respiratory morbidity significantly increased urinary purines, but not allantoin, within the late preterm population. These data suggest that gestational age, weight for gestational age, and neonatal morbidity alter the urinary concentration of purine metabolites. Allantoin was also found to be significantly altered by gestational ag

Objectives: To assess pain burden in neonates during their hospitalization in China and thus provide evidence for the necessity of neonatal pain management. Patients and Methods: The Neonatal Facial Coding System was used to evaluate pain in neonates. We prospectively collected data of all painful procedures performed on 108 neonates (term, 62; preterm, 46) recruited from admission to discharge in a neonatal intensive care unit of a university-affiliated hospital in China. Results: We found that during hospitalization each preterm and term neonate was exposed to a median of 100.0 (range, 11 to 544) and 56.5 (range, 12 to 249) painful procedures, respectively. Most of the painful procedures were performed within the first 3 days. Preterm neonates, especially those born at 28 and 29 weeks' gestational age, experienced more pain than those born at 30 weeks' gestation or later (P < 0.001). Among those painful procedures, tracheal aspiration was the most frequently performed on preterm neonates, and intravenous cannulation was the most common for term neonates. Moreover, tracheal intubations and femoral venous puncture were found to be the most painful. Notably, none of the painful procedures was accompanied by analgesia. Conclusions: Neonates, particularly preterm neonates, were exposed to numerous invasive painful procedures without appropriate analgesia in hospitals in China. The potential long-term impacts of poorly treated pain in neonates call for a change in pediatric practice in China and in countries with similar practices.

Tato diplomová práce pojednává o problematice procedurální bolesti u dětí. V teoretické části se zabývá fyziologií bolesti, jejími typy, seznamuje s možnostmi hodnocení bolesti, způsoby tlumení, důsledky a také významem herního specialisty. Ve výzkumné části se vyhodnocují data týkající se procedurální bolesti spojené s odběrem krve., This thesis discusses the childern?s procedural pain. The theoretical part deals with the physiology of pain and its types, it introduces the possibilities of pain assessment, methods of control, the consequences and significance of play specialist. The research part focuses on evaluation of data concerning the procedural pain associated with blood donation., Katedra ošetřovatelství, Hodnocení vedoucího: velmi dobře mínus Hodnocení oponenta: výborně Doplňující otázky k obhajobě: Využívá se v současné době Emla nebo nějaký její ekvivalent? 2 Obhajoba diplomové práce s prezentací velmi dobrá.

Acutely and critically ill patients are exposed to many therapeutic procedures that can produce painful experiences. Tracheal suctioning (TS) and wound care procedure (WCP) are frequently performed in these patients. The purpose of this dissertation was to evaluate pain responses during both TS and WCP and to determine the efficacy of a pharmacologic treatment to prevent pain during an open WCP.The first report was a secondary data analysis of findings from a larger procedural pain study. A total of 755 patients underwent the TS procedure that was performed primarily in intensive care units (93%). Pain intensity mean (SD) scores were significantly greater during the TS procedure 3.96 (3.3) than prior to 2.14 (2.8) or after 1.98 (2.7). Few patients received analgesics prior to or during the procedure. Although mean pain intensity during TS was mild, almost the half of the patients who presented pain reported it as moderate to severe. The second study was a randomized, cross-over design with the purpose to determine whether the addition of small doses of ketamine would potentiate morphine's analgesic effects and decrease WCP pain intensity. Patients were randomized to receive morphine plus saline (MS) IV or morphine plus ketamine (MK) IV before the WCP. When the WCP was repeated, patients were crossed-over to receive the alternate treatment. Eleven patients from the Trauma Hospital of Puerto Rico participated in the study. Procedural pain intensity mean ranks during the WCP-MK was significantly less than during the WCP-MS (p = .005). Mean (SD) procedural pain intensity during the WCP-MK was 3.09 (3.27), while it was 6.82 (3.06) during the WCP-MS. However, 91% of patients had adverse effects during MK versus none during MS. In addition, mean (SD) diastolic BP was significantly higher during the WCP-MK than during WCP-MS and prior to WCP-MK, 84 (11.8), 73 (7.4), 72 (12.6), respectively. Individualized pain management must be performed by healthcare providers in order to

Syftet med denna deskriptiva kvalitativa intervjustudie var att beskriva barns upplevelser av lustgasbehandling. Urvalet består av sex barn i åldern sex till fjorton år som behandlats med lustgas vid procedursmärta, akut eller planerat, på barnsjukhusets akutmottagning eller allmänna specialistmottagning. Intervjuerna analyserades med kvalitativ innehållsanalys. Alla barnen upplevde annorlunda kroppskänslor eller abstrakta känslor som inte nödvändigtvis var obehagliga under lustgasbehandlingen. Samtidigt som flera av barnen beskrev en typ av frånvaro var de flesta medvetna om omgivningen och till viss del händelseförloppet. Vidare framkom att hörsel- och synintryck kunde förvrängas där ljud ibland förstärktes och kunde störa och påverka fokuseringen. Olika grader av smärta beskrevs. I barnens egen sammanfattning uttryckte fyra av barnen positiva upplevelser. Fem av barnen var positiva till att få lustgasbehandling igen om så behövdes medan ett barn svarade "kanske" och önskade i så fall en mindre mängd lustgas nästa gång. Behandlingen kan ytterligare utvecklas genom kombination med andra smärtstillande läkemedel., The aim of this descriptive, qualitative interview study was to describe children´s experiences of treatment with nitrous oxide. The sample consists of six children aged six to fourteen who were treated with nitrous oxide for procedural pain, acute or planned, in the emergency room or special surgery of the Children´s hospital. The interviews were analyzed by qualitative content analysis. All children experienced different feelings in the body or intangible feelings that were not necessarily unpleasant during the treatment with nitrous oxide. Although some of the children described some kind of absence, most of them were aware of the surroundings and to some part what happened during the treatment. Further it appeared that hearing and sight impressions could be distorted and sounds were sometimes amplified and could disturb and affect the focusing. Varying degrees of pain were described. In their own summary four of the children expressed positive experiences. Five of the children were positive to receive nitrous oxide in the future if needed, while one child answered "perhaps" and in that case wanted less amount of nitrous oxide next time. The treatment could be developed further by combining with other analgesics.

Objectives: To document pain expression characteristics in former preterm infants in the first year of life in whom systematic evaluation and treatment of pain was provided. Methods: Data on the Modified Behavioral Pain Scale (MBPS), Visual Analogue Scale (VAS, crying time and heart rate were collected during immunization. The effect of clinical characteristics {postconception and gestational age [PCA], surgery, ventilation, fentanyl, length of stay (LOS)} on bio-behavioral parameters was evaluated. Results: 121 procedures were recorded in 49 infants. GA was 28 (25-32) weeks. PCA was 60 (34-90) weeks. Median MBPS was 8 (2-10), median crying time 44 (0-112) s. Median pre-procedural heart rate was 144 (103-201) and increased to 184 (147-220) afterwards, resulting in a relative increase of 29 (5-99)%. Median VAS score was 7 (1-10).

L’association Sparadrap met au point depuis plus de dix ans des documents d’information destinés aux enfants et aux familles autour de la maladie, de l’hôpital et des soins douloureux, et a développé dans ce domaine une réelle expertise. Mais l’entreprise comporte des exigences précises. Il faut communiquer des messages clairs et véridiques qui aident les parents à garder leur rôle. Il faut aussi choisir entre l’exposé des pratiques les plus courantes, et la promotion des façons de faire les plus humaines.