Based at the University Hospitals of Leicester, we serve the educational needs of healthcare practitioners in Acute & Emergency Medicine across the East Midlands, UK
Pain in children is a distressing symptom for all involved in the care of a child, it can affect parents and healthcare workers as much (sometimes more so!) as the child themselves.
Adequate assessment and treatment of pain is a very important consideration in all children. It can be impossible to examine a child without pain relief and the response to analgesia can be very helpful in the assessment of an injured child.
We've all met the children with minor injuries who seem very distressed initially but are then tearing round the waiting room 40 minutes later after a bit of Calpol or Ibuprofen!
Pain relief is not just important for the relief of symptoms due to an injury or organic disease process.
There are a number of procedures we need to perform on a regular basis when dealing with unwell children that can be painful and the administration of appropriate pain relief strategies are key in the smooth performance of these investigations.
Approximately 50% of paediatric ED attendances are for trauma and skeletal injuries. Hands are the most commonly injured body part and the most hand injury is a fingertip injury.
Accounting for 5-10% of ED attendances research has found that as many as 20-30% of hand injuries are improperly diagnosed and managed initially.
It is important to fully understand the anatomy of both the bones and soft tissues in the hand to ensure injuries are picked up and treated expediently to avoid any adverse consequences.
Paediatric x-rays can be difficult to interpret as many abnormalities can be subtle and the situation is complicated further by the appearance of secondary ossification centres.
Doctors working in the Emergency Department should have a sound knowledge of the normal x-ray appearances across all age groups.
Assess pain in children.
Be aware of the pharmacological and non-pharmacological options for analgesia.
Know the principles of safe sedation in children.
Understand the differential diagnoses for the limping child.
Assess children presenting with hand injuries including nail bed injuries.
Recognise the common fractures and soft tissue injuries seen in children and be aware of associated injuries to look for.
Prescribe and administer entonox, oral analgesia, IV opiates and intranasal diamorphine to paediatric patients.
Examine a child systematically to localise an injury and check for neurovascular compromise.
Examine a child's joints and assess gait.
Reduce a pulled elbow and common dislocations presenting to the ED.
Complete the following before the face to face session:
Duration: 60 mins
Listen to this podcast and then read these two documents from RCEM.
Duration: 40 mins
This e-LfH module gives an good basic overview of common paediatric soft tissue and bony injuries.
Click on the picture or link below to be directed to the e-LfH site.
Duration: 60 mins
This RCEM learning module on hand injuries is very comprehensive regarding all soft tissue injuries of the hand, it's pretty much all you'll ever need to know!
Duration: 20 mins
This article gives a good summary of the differential diagnoses and clinical assessment of a child presenting with a limp.
We have written a series of interactive cases (wikis) with short answer questions to be answered by trainees prior to the face to face teaching sessions. Currently this is only available to East Midlands Trainees.
Answer one or two questions before attending the face-to-face teaching session. Add comments to answers already given if you think it's appropriate. We will also provide tutor comments. If you find good resources that answer a question why not include links in your comment.
Part of the face-to-face teaching will be spent discussing the case(s) below:
Here are some extra resources to review if you want more information:
A brief overview of septic arthritis in children.
An interactive short module based on the above article. This is not one of the free modules but can be accessed for free via Athens if you do not have a BMJ learning account.
An interesting article and box 2 on page 7 highlights the probability of abuse from several fracture types.
Once you have worked through the exercises, discussed the example cases and attended the face-to-face teaching, please complete the following form: