10 months ago

2017 HCHB_digital

Childhood Pain and Baby

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 • quiet, withdrawn or lying very still and not wanting to move?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. – 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 • 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

  • Page 1 and 2: HEALTHCARE HANDBOOK incorporating t
  • Page 3 and 4: 2017-2018 HEALTHCARE HANDBOOK PUBLI
  • Page 5 and 6: Index Common Disorders Acne--------
  • Page 7 and 8: Asthma and COPD CONTINUING OTC EDUC
  • Page 9 and 10: Head and scalp • Condition of hai
  • Page 16 and 17: Acne Acne is a common skin problem
  • Page 18 and 19: Allergies An allergy occurs when th
  • Page 20 and 21: Asthma and COPD Asthma New Zealand
  • Page 22 and 23: Baby Feeding Breastfeeding is best
  • Page 24 and 25: Bites and Stings Bites and stings c
  • Page 26 and 27: Bruises, Scars, Spider Veins Bruise
  • Page 28 and 29: Childhood Diseases and Immunisation
  • Page 30 and 31: Childhood Diseases and Immunisation
  • Page 32 and 33: Childhood Diseases and Immunisation
  • Page 34 and 35: Childhood Diseases and Immunisation
  • Page 38 and 39: Colds A cold is a contagious viral
  • Page 40 and 41: Cold Sores Cold sores are fluid-fil
  • Page 42 and 43: Constipation Constipation is the te
  • Page 44 and 45: Contraception & Sexual Wellbeing Co
  • Page 46 and 47: Contraception: Emergency Emergency
  • Page 48 and 49: Coughs: Dry Coughs are called dry o
  • Page 50 and 51: Coughs: Productive Coughs are consi
  • Page 52 and 53: Cuts, Abrasions and Blisters This t
  • Page 54 and 55: Cystitis [Bladder Infection] Cystit
  • Page 56 and 57: Dandruff Dandruff is a common condi
  • Page 58 and 59: Dermatitis/Eczema Dermatitis is a g
  • Page 60 and 61: Diabetes Diabetes is a condition in
  • Page 62 and 63: Diarrhoea and Vomiting Diarrhoea an
  • Page 64 and 65: Dry Skin Dry skin is skin that lack
  • Page 66 and 67: Ear Conditions Our ears allow us to
  • Page 68 and 69: Eye Conditions Almost two-thirds of
  • Page 70 and 71: Eye Conditions (continued) Type Sym
  • Page 72 and 73: Eyes: Contact Lenses Contact lenses
  • Page 74 and 75: Fever What is fever Fever is define
  • Page 76 and 77: Foot Care Common foot problems incl
  • Page 78 and 79: Fungal Infections: Superficial Supe
  • Page 80 and 81: Fungal Nail Infections (Onychomycos
  • Page 82 and 83: Gout Historically known as the “d
  • Page 84 and 85: Haemorrhoids Haemorrhoids (also cal
  • Page 86 and 87:

    Hair Loss Alopecia is the medical t

  • Page 88 and 89:

    Hay Fever Hay fever (also called in

  • Page 90 and 91:

    Hay Fever (continued) TREATMENT OPT

  • Page 92 and 93:

    Headache Headaches are common and c

  • Page 94 and 95:

    Head Lice Head lice (pediculosis ca

  • Page 96 and 97:

    Heart Health Cardiovascular (CV) di

  • Page 98 and 99:

    Indigestion, Heartburn and Gastriti

  • Page 100 and 101:

    Influenza Influenza (flu) is a comm

  • Page 102 and 103:

    Influenza (continued) TREATMENT OPT

  • Page 104 and 105:

    Iron Deficiency Iron is an essentia

  • Page 106 and 107:

    Irritable Bowel Syndrome Irritable

  • Page 108 and 109:

    Menopause Menopause - the “change

  • Page 110 and 111:

    Migraine Migraines are a type of se

  • Page 112 and 113:

    Muscular Aches, Pains and Tightness

  • Page 114 and 115:

    Nappy Rash Nappy rash is a red rash

  • Page 116 and 117:

    Oral Health Oral health disorders i

  • Page 118 and 119:

    Osteoarthritis Osteoarthritis is th

  • Page 120 and 121:

    Osteoporosis Osteoporosis (meaning

  • Page 122 and 123:

    Period Pain and Endometriosis Perio

  • Page 124 and 125:

    Poisonings Any substance that has t

  • Page 126 and 127:

    Pregnancy Tests and Supplements Hom

  • Page 128 and 129:

    Preventive Health There are certain

  • Page 130 and 131:

    Probiotics and Prebiotics Probiotic

  • Page 132 and 133:

    Psoriasis Psoriasis is a long-term

  • Page 134 and 135:

    Scabies Scabies is a very contagiou

  • Page 136 and 137:

    Shingles Shingles (herpes zoster) i

  • Page 138 and 139:

    Sinus and Nasal Problems Sinuses ar

  • Page 140 and 141:

    Sleep Problems and Snoring Sleep is

  • Page 142 and 143:

    Smoking Cessation Almost 5000 New Z

  • Page 144 and 145:

    Sore Throat Sore throats are very c

  • Page 146 and 147:

    Strains and Sprains Sprains and str

  • Page 148 and 149:

    Sun Care Sunburn Sunburn occurs fro

  • Page 150 and 151:

    Sun Care: Eye Protection Protecting

  • Page 152 and 153:

    Sweating: Excessive (Hyperhidrosis)

  • Page 154 and 155:

    Toothache Toothache is the term use

  • Page 156 and 157:

    Travel Health (including Vaccinatio

  • Page 158 and 159:

    Travel Sickness Travel, or motion,

  • Page 160 and 161:

    Urinary Incontinence Urinary incont

  • Page 162 and 163:

    Urticaria (Hives) Urticaria refers

  • Page 164 and 165:

    Vaginal Health The vagina is a clos

  • Page 166 and 167:

    Varicose Veins and Support Stocking

  • Page 168 and 169:

    Vitamins and Dietary Supplements Vi

  • Page 170 and 171:

    Warts Warts are benign (non-cancero

  • Page 172 and 173:

    Weight Loss Obesity has reached epi

  • Page 174 and 175:

    Worms Pinworms (Enterobius vermicul

  • Page 176 and 177:

    Wound Care Our skin acts as a barri

  • Page 178 and 179:

    Wound Care (continued) Wound type M

  • Page 180 and 181:


  • Page 182 and 183:

    Chapter References (continued) Diar

  • Page 184 and 185:

    Chapter References (continued) Gord

  • Page 186 and 187:

    Significant learning opportunity: W

  • Page 188 and 189:

    PharmacyToday A part of your everyd

  • Page 190 and 191:

    OTC Medicines: Interactions When se

  • Page 192 and 193:

    OTC Medicines: Interactions OTC Med

  • Page 194 and 195:

    OTC Medicines: Interactions OTC Med

  • Page 196 and 197:

    OTC Medicines: Interactions OTC Med

  • Page 198 and 199:

    OTC Medicines: Precautions OTC Medi

  • Page 200 and 201:

    OTC Medicines: Precautions OTC Medi

  • Page 202 and 203:

    OTC Medicines: Adverse Effects OTC

  • Page 204 and 205:

    Herbal Supplements: Interactions He

  • Page 206 and 207:

    Herbal Supplements: Interactions He

  • Page 208 and 209:

    Herbal Supplements: Interactions He

  • Page 210 and 211:

    Herbal Supplements: Interactions He

  • Page 212 and 213:

    Drugs in Sport Treating Athletes Me

  • Page 214 and 215:

    Drugs in Aviation AVIATION - PRECAU

  • Page 216 and 217:

    Drugs in Pregnancy Drug use in preg

  • Page 218 and 219:

    NZ Support Groups ADHD Association

  • Page 220 and 221:

    NZ Support Groups New Zealand AIDS

  • Page 222 and 223:

    HEAT or INFLAMMATION Unlike heat ru

  • Page 224 and 225:

    OTC Products Over-the-counter produ

  • Page 226 and 227:

    OTC Products Index Foot Care - Fung

  • Page 228 and 229:


  • Page 230 and 231:

    »» Childhood Pain and Baby Teethi

  • Page 232 and 233:


  • Page 234 and 235:


  • Page 236 and 237:


  • Page 238 and 239:


  • Page 240 and 241:


  • Page 242 and 243:


  • Page 244 and 245:


  • Page 246 and 247:

    »» Foot Care - Fungal Infections

  • Page 248 and 249:


  • Page 250 and 251:


  • Page 252 and 253:


  • Page 254 and 255:


  • Page 256 and 257:


  • Page 258 and 259:

    »» Irritable Bowel Syndrome GASTR

  • Page 260 and 261:


  • Page 262 and 263:


  • Page 264 and 265:


  • Page 266 and 267:

    »» Sexual Wellbeing - Contracepti

  • Page 268 and 269:


  • Page 270 and 271:


  • Page 272 and 273:


  • Page 274 and 275:


  • Page 276 and 277:


  • Page 278 and 279:

    An ENHANCED ELearning Experience As

  • Page 280 and 281:

    Product Index ANIME LUBRICANT 50ML-

  • Page 282 and 283:

    Manufacturer’s Index AFT Pharmace

  • Page 284:

    Topiramate Actavis Topiramate 25mg,

Swissmedic Annual Report 2017: achieving success through collaboration
national list of essential medicines sri lanka - World Health ...
How to deal with military prescriptions - Pharmaceutical Press
seWJe~uelewp~4~Jadue~fie4es UO~S~A~aSa)~AJasle)~lna)ewJe4d
Full colour PDF of the pages as they appeared in -
Pharmacists in sport - Royal Pharmaceutical Society
I - Presentation of the Forum and Current Agenda Areas
Industry groups unite to secure central healthcare role for ... - Info
WHO Drug Information Vol. 23, No. 1, 2009 - World Health ...
Get Out! GAY Magazine – Issue 339– October 25, 2017
Get Out! GAY Magazine – Issue 341 – November 8, 2017
Medicines management: Everybody's business - Surrey and Borders ...
the-pharmacist-tomorrows-stakeholder Whitepaper
Codeine Guidelines.indd - Pharmaceutical Society of Ireland
PHARMACY? - Royal Pharmaceutical Society
Achieving the Value of Medicines - FIP