Treatment of Pain in Children. Pain Scales.

    

    Nonsteroidal anti-inflammatory agents (NSAIDs) are widely used for treatment of mild to moderate pain in children. These agents are particularly useful for supplementation of analgesia with regional/local anesthesia techniques. 

Agents used commonly in children are:

  • Paracetamol, used orally or rectally in a dose of 10–15 mg/kg, maximum dose should not exceed 60 mg/kg/day. IV dose should be given according to postgestational age, 28–32 weeks 10 mg/kg, 32–36 weeks 12.5 mg/kg and ≥36 weeks 15 mg/kg.
  • Ibuprofen in dosage of 5–10 mg/kg,maximum dose 40 mg/kg/day 
  • Diclofenac in dosage of 1–2 mg/kg; maximum daily dose 3 mg/kg.  Diclofenac is  available  as  suppositories  in  strengths  of  12.5  mg,  25  mg,  50  mg  and  100 mg. However, suppositories are not recommended for children less than 12 months old. Ibuprofen and diclofenac are not recommended in infants less than 12 months of age and one must look out for gastrointestinal, hematological and renal side effects whenever these agents are used.

    A modified scale with happy/sad facial drawings combined with a verbal or observer (nurse) scoring system has been used by many workers in children as young as 3 years: 


    A combination of vocalization, facial expression and body movement has been used by various workers to formulate objective pain rating scales for assessment of pain in infants and toddlers. 
    AIIMS Pain Discomfort Score also known as the ‘AIIMS Pain Scale’ is a comprehensive scale using both subjective and objective criteria:



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