Clinical updates: Children and young people & intellectual disabilities


Chair: Owen Doody, Ireland
Principles of pain assessment in infants, children and young people
Mats Eriksson, Sweden
It is only the last 50 years that pain in infants, children and adolescents has been recognized as a significant problem in health care. The initial reasons for any pain management were not mainly humane, but instead to enable medical interventions such as surgery and
diagnostic procedures without “fuss”. For example, until late 80’s, heart surgery was performed on newborn infants with only muscle relaxants, to prevent them from moving.

Today both science and clinical practice have come further. Children are considered having their own value as stated in the UN Declaration on the Right of the Child and we know much about what causes pain, what the consequences of pain are, how we should identify and assess pain, and how we should prevent and treat pain.

And yet, it is known that pediatric pain is still under-diagnosed and undertreated. The reasons for this are partly limited resources but also wrong routines and wrong attitudes. This lecture will build on the latest evidence on how to provide family- and child-centered care and pain management and on principles that can guide this work.
Managing pain in infants, children and adolescents
Mats Eriksson, Sweden

Pain occur in infants, children and young people, both from medical conditions and from procedures in health care. This pain can have negative consequences on short and long term.

Most guidelines on pain management states that pain assessment is the basis for an adequate pain management. Pain can be assessed with self-report or by observing behavioural or physiological signals. Often these signals are combined into pain scales.

The pain experience and thereby the pain assessment depends on many contextual factors like the patients physical, emotional and psychological status, previous pain experience and support from external factors and persons.

This lecture will discuss principles for pain assessment in different ages and suggest strategies for implementing pain assessment as a clinical routine.
Assessing and managing pain in those with intellectual disabilities
Owen Doody, Ireland & Maria Bailey, Ireland
Overtime advances in research has improved our understanding of pain and people with ID to reflect a more person centered approach. However, pain misconceptions are often held with regards to people with ID as pain may be communicated as a behavioural expressions that may be variable and idiosyncratic. People with ID may have associated medical or physical conditions and associated factors increasing their risk of pain disorders and are thereby at a higher risk of experiencing pain and/or having more frequent or severe pain. The experience of pain is compounded if an individual cannot voice their discomfort, as is frequently the case for those with ID. Thus pain is often not recognised or managed well for people ID and the evidence suggests the pain relief is inadequate. Assessing pain can be complex and complicated by the presence of multiple disabilities and the existence of various levels of functioning and behavioral repertoires. Thereby there is a need for a variety of methods and measurements of pain that are matched to the ability of the person being assessed and pain should be assessed using a variety of modalities including self-report, behavior observation, physiological measures and communication abilities. When pain is suspected, treatment with analgesia and observe to see if behaviour improves. If behaviour improves, pain is then the likely cause and analgesia administration continues until the cause can be identified and treated. Non-pharmacological treatments can enhance pain management regimes and while the evidence base is difficult to prove, the subjective nature of pain often leads to the subjective nature of pain management. Pain is often difficult to treat and frequently requires ongoing assessment, review and titration and/or trial of drugs before a satisfactory outcome can be achieved and pain management interventions will vary according to pain etiology, personal characteristics and preference.

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