Childhood Pain and Baby Teething Pain in children is a common problem, but it often goes unrecognised or is under treated. Infants and children of all ages, including premature babies, are capable of feeling pain. In a typical month, an average healthy child will have about four episodes of pain related to injuries, disease or infections (eg, falls, sprains, sore throats) and one “ache”, eg, headache or stomach ache. Some children may also experience recurrent pain (headaches, stomach aches), up to three or four times a week. The younger the child is, the less likely they are to receive adequate pain relief. Social, family and cultural factors, and prior experience with medicines or of pain can also affect how a child reports pain, or how family members react to their child's self-reported pain. Initial assessment Listen carefully to a caregiver's description of their child's pain and observe the child's behaviour. Is the child: • crying, agitated, anxious, angry or frightened? • difficult to comfort or distract? • holding the sore part of their body (eg, clutching at their stomach)? • quiet, withdrawn or lying very still and not wanting to move? • refusing food and drink? • tugging on the ears (ear pain) or protecting a body area? Ask the caregiver how the child is sleeping as the only cues in very young children may be frequent awakening, irritability, or excessive, inconsolable crying. Children over three may be able to indicate how their pain makes them feel using a scale of smiley faces, where a happy face indicates no hurt and a sad face indicates it hurts the most. Always involve the pharmacist in any discussion about pain relief for a child. Treatment Pain relief does not necessarily only mean medicines like paracetamol or ibuprofen. Integrative, non-pharmacological treatments, such as distraction, abdominal breathing, heat and cold therapy, and aromatherapy all have a place in the mangement of children's pain, especially chronic or recurring pain. Baby teething Baby teeth start to erupt through the gums between the ages of six months and two-and-a-half years. This is usually painful for the baby and may cause irritability, drooling, swollen red gums and cheeks, and the child may be fussy with food or restless. All 20 baby teeth will be through by about three to four TREATMENT OPTIONS Category Examples Comments Simple analgesics Non-steroidal antiinflammatory drugs (NSAIDs) Topical oral analgesics for baby/child teething Topical anaesthetics Natural / herbal products / supplements [GENERAL SALE] eg, paracetamol – less than 20 tablets, (Panadol, Paracare, Parafast) [PHARMACY ONLY MEDICINE] eg, paracetamol – greater than 20 tablets, suspension (Pamol All Ages*, Pamol Infant Drops*, Paracare For Babies & Young Children 3 months–6 years*, Paracare For Children 6 + years & Adults*) [PHARMACY ONLY MEDICINE] eg, ibuprofen (Advil, Fenpaed, Nurofen, Nurofen for Children*, Nurofen for Children Soft Chewable Capsules 7*) [GENERAL SALE] eg, choline salicylate (Bonjela Teething Gel*, Orased Jel) [GENERAL SALE] eg, lignocaine (Soov cream) [PHARMACY ONLY MEDICINE] eg, lignocaine/prilocaine (Emla cream) Homeopathic teething medicines (eg, NaturoPharm Teethmed relief, Weleda Baby Teething powder) Kiwiherb Kid's Calm Paracetamol has very few side effects and is safe for most people to use at recommended dosages. Take care to avoid overdose. Check strength, formulation and dosage instructions on the back of the product packet. Paracetamol is not recommended for routine use before or after vaccination as it may reduce the effectiveness of childhood vaccinations to stimulate lasting immunity (infection-fighting ability). Avoid aspirin in children or adolescents under the age of 18. This is because of the risk of Reye’s syndrome. Reye’s syndrome is a rare and serious condition which most commonly occurs after viral infections which have been treated with aspirin. Symptoms include vomiting or constant nausea, drowsiness, confusion, hallucinations, agitation and seizures. Urgent medical attention is required. Ibuprofen is the NSAID least likely to cause stomach irritation. May be used in conjunction with paracetamol. Refer children on certain other medications or with some medical conditions (eg, asthma, kidney disease) to the pharmacist before selling (may not be suitable). Discontinue use if stomach upsets, increased bruising or prolonged bleeding occur. Take care to avoid overdose. Ensure children stay well hydrated. Helpful in infants and both older and younger children with localised pain caused by new teeth breaking the skin surface. Do not use in babies younger than four months and not more frequently than every three hours. Apply only a small amount directly to gums and do not exceed recommended dosages. Lignocaine can be used to relieve skin pain due to sunburn, minor scalds or burns, and cuts and grazes. Lignocaine/prilocaine creams can be used before procedures (eg, injections or taking blood samples). Apply to the skin 45–60 minutes before the procedure to allow time for the lignocaine to numb the pain response. Lignocaine creams should be used with caution in infants up to three months of age as adverse effects are more likely in this age group. Homeopathic teething medicines may help relieve the discomfort and restlessness of teething in infants and children. Contain homeopathic ingredients such as belladonna, chamomilla, conchae and magnesium carb. Kid's Calm contains chamomile and helps soothe colic and teething symptoms. Products with an asterisk have a detailed listing in the Childhood Pain & Baby Teethingsection of OTC Products, starting on page 222. Effective relief you can trust Nurofen for Childen is now available in Liquids 3 months+... Use: For the temporary relief of mild to moderate pain & fever. Nurofen for Children Liquid contains: 100 mg ibuprofen per 5 ml. Nurofen for Children Soft Chewable Capsules contains: 100 mg per capsule. Contra: Stomach ulcer, allergy to aspirin/NSAIDs, impaired renal function or heart failure, GI disorder, dehydration,3rd. trimester of pregnancy, Children < 3 months. Prec: Adults 65 years and over, asthma, the first 6 months of pregnancy, use for more than a few days at a time. Use lowest effective dose for shortest possible time. Keep to recommended dose. Excessive use may be harmful and increase the risk of heart attack, stroke and liver damage. Nurofen for Children Soft Chewable Capsules children 7 < years; Nurofen for Children Liquid Children < 12 mths. Adverse: GI ulcer, bleeding, Page 32 HEALTHCARE HANDBOOK 2017-2018 Common Disorders
CONTINUING OTC EDUCATION Helpful numbers and websites •• PlunketLine 0800 933 922 – for advice about child health and parenting. All calls are answered by a plunket nurse, 24 hours a day, 7 days a week. •• Healthline 0800 611 116 – for advice on what to do for a sick child or adult. Interpretation service available. All calls are answered by a registered nurse, 24 hours a day, 7 days a week. •• The Australian Pain Society: Pain in Childhood Special Interest Group (www.apsoc. org.au/pain-in-childhood) – aims to share and improve knowledge about pain in childhood. •• Department of Pain Medicine, Palliative Care & Integrative Medicine (http://bit. ly/1qvp0vv) – A paediatrician's top 10 Apps for pain management. years of age. Permanent teeth start to come through around six or seven years of age. It is important to begin caring for your children’s teeth as soon as they have erupted, to prevent tooth decay (see Toothache). Relieve the pain of baby teething by giving the child something cold to chew on (eg, a frozen banana wrapped in muslin, a cold teething ring), rubbing a teething gel on the gums, or giving oral pain relief (eg, paracetamol) if necessary. Advice for customers • Seek urgent medical advice if the pain does not abate or the child is in distress. • Research has identified four key ways pain relating to needles (such as during vaccination) can be reduced or eliminated. »» Numbing with topical anaesthesia »» Giving an oral sucrose solution to children aged from birth to 12 months »» Positioning the child for comfort »» Distracting the child (includes the use of electronic devices). • Chronic pain requires special management. For an excellent video for young people about chronic pain see http://bit.ly/2gEj331 • Pain relievers should not be used regularly or continuously in children, except on medical advice. • Watch for “double-ups” when using other medications (eg, paracetamol can be in both pain and cough/cold medications). Refer to PHARMACIST Urgent medical advice should be sought for children who are floppy, pale, hard to wake or unresponsive, with an unusual cry or who develop a rash or complain of a stiff neck. The following questions aim to identify children who would benefit from further input from a pharmacist. Your initial assessment or a caregiver's history may have already provided some answers. Decide if any further questions still need to be asked and refer any “yes” answers to a pharmacist. • Does the child have any other health conditions (eg, immunosuppression, diabetes)? • Does the child take any other medication, either prescribed by a doctor or bought from a shop or supermarket (including herbal/ complementary medications)? • Despite 24-hour treatment with OTC pain relievers, has the pain persisted or become worse, or is the source of the pain unknown? • Is the child crying, grizzling and tugging the ears (ear infection)? • Does the child appear floppy, pale or is hard to wake up? • Has the child had a fit (convulsion)? • Is the child young (eg, under six years)? • Has the child refused to eat for more than 24 hours or is vomiting? • Does the child have a sore throat? • Does the child feel too hot or too cold? • Do you or the caregiver feel “things are not quite right” (pain relievers can cover up symptoms of serious pain)? • Does the child have any allergies to medicines? Nurofen for Children Chewable Capsules 7+ On-the-go pain relief Provides the right dose for 7+ years No need for water, easy to chew 7 + ...and Chewable Capsules years perforation, acute renal injury, hypertension, oedema, severe skin reaction. Nurofen for Children Liquid dosage: Measure dose with syringe provided. Use lowest effective dose for shortest possible duration. Read pack for dosing details. Repeat dose every 8 hrs as nec (max 3 doses/day). Nurofen for Children Soft Chewable Capsules dosage: Children: 7 – 10 yrs (22-32kg) 2 capsules every 6 to 8 hrs (Max 8 capsules/24 hrs); 10 – 12 yrs (32 – 40 kg) 3 capsules every 6 to 8 hrs (Max 12 capsules/24 hrs). Reckitt Benckiser, Auckland. 0800 40 30 30. TAPS DA1704JD. Page 33
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