1. Paediatric Pain Management Understanding the child’s perspective on pain. Katrina Shapland Occupational Therapy Student.

2. Try and imagine a time when you were in hospital/in pain as a child: How did you feel? What did you do to cope? What did people around you do?

3. Ward-group Goals of ward group Provide opportunity for children to enact hospital procedures through play Facilitate social interaction Provide normalcy - play is the primary occupation of childhood. Allow projection of feelings and experiences onto the teddy to further sense of mastery and control.

4. Ward group - 2FW

5. Number of children per caseload identified to benefit from OT services verses number of referrals.

6. Medical Play http://www.youtube.co m/watch?v=Go8N5i3lC WIhttp://www.youtube.co m/watch?v=Go8N5i3lC WI

7. Play! -

8. What is pain? Pain is whatever the experiencing person says it is, existing wherever they say it does.

9. Evidence shows that pain is an inherently subjective, multifactorial experience. For this reason it is impossible to treat pain on a physical level and expect it to disappear.

10. PEO (Person, Environment, Occupation) Environment Occupation Person Occupational performance

11. Piaget’s developmental stages Cognitive Stage of Development Key FeatureImpact on perception of pain Preoperational Preoperational 2 - 7 yrs. Egocentrism Process of ‘getting better’ in response to pain (2, 4) Concrete Operational Concrete Operational 7 – 11 yrs. Conservation Able to describe psychological feelings of pain (3) Table 1 ref: Piaget, 1932

12. What does the literature say - 2-4years? Getting better: (a) ‘hide away,’ (b) ‘fight it’, (c) ‘make it good’. More frequent the pain, the more frequently these strategies were used.

13. Strategies: 2-4 years Explaining the procedure just before it happens Introduction of medical equipment prior to procedure through play (e.g. X-ray machine = space ship!). Distraction: blowing bubbles, puppets, toys. Reflecting on hospital experiences through play with other children.

14. What does the literature say - 7-11 years? Taking medicine and other curative actions Resting and cognitive control strategies e.g. distraction Decrease in parental support - view themselves as active agents in pain relief. Non-observable components of pain.

15. What does the literature say - specific conditions? Specific conditions develop their own pain patterns - specific strategies to target these. For example: Tonsillectomy Visual Analogue Scale O = no pain 10= extreme pain

16. Assessing pain Situations that caused pain to all children in hospital were procedures connected with treatment. Children described pain as physiological, and psychological feelings of pain. Research indicates school-aged children’s ability to describe their own pain.

17. Looking to the future: Assessments- to gauge pain perception before and after medical play Extending play for older children.

18. Future research Influence of individual’s personal experience on the concept of pain. Influence of socio-cultural factors Specialised pain intervention strategies

19. Thank you for your time. Any questions?

20. 20 References Tonsillectomy picture: 200214425-001_XS.jpg retrieved from http://www.livestrong.com/tonsillectomies/200214425-001_XS.jpghttp://www.livestrong.com/tonsillectomies/ Baum, C. M, & Christiansen, C. H. (2005). Person-environment-occupation-performance: An occupation- based framework for practice. In C. H. Christiansen, C. M. Baum, and J. Bass-Haugen (Eds.), Occupational therapy: Performance, participation, and well-being (3rd ed.). Thorofare, NJ: SLACK Incorporated. (Paediatric Pain Management: A Multi-Disciplinary Approach - By Alison Twycross, Anthony Moriarty, Tracy Betts 1998 ) Piaget, J. (1932). The moral judgment of the child. London: Routledge & Kegan Paul.The moral judgment of the child reference: 1995 Young children's behavioural responses to acute pain: strategies for getting better.http://www.ncbi.nlm.nih.gov/pubmed/7593943 www.ncbi.nlm.nih.gov/pubmed/7593943 reference: 1997 ["It feels like a hedgehog quill sticking in my foot...". School-aged children's experience of pain in the hospital].http://www.ncbi.nlm.nih.gov/pubmed/9429343 )www.ncbi.nlm.nih.gov/pubmed/9429343 reference: 1996 "Getting better from my hurts": toward a model of the young child's pain experience. http://www.ncbi.nlm.nih.gov/pubmed/8772041) http://www.ncbi.nlm.nih.gov/pubmed/8772041 Idvall, E., Holm, C., Runeson, I. (2005). Pain experiences and non-pharmacological strategies for pain management after tonsillectomy: a qualitative interview study of children and parents. Journal of Child Health Care, 9(3), 196-207. 20