Pediatrician最新文献

This paper describes methods of assessment and pharmacologic management for chronic or persistent pain in children. This report will be a clinical one, derived from the experiences of a pediatric oncologist (P.M.Z.) and a pediatric pain consultant (L.K.Z.). Case reports will illustrate clinical assessment and management strategies.

A review of infant pain assessment and management is presented. Included are physiological (cardiovascular and hormonal) and behavioral (facial expression and cry analysis) approaches to measurement. Management of pain in infants includes pharmacological (namely opiate) approaches and nonpharmacological techniques.

The mouth is a uniquely sensitive repository of nutritional information reflecting past and present nutritional insults with a speed and to a degree unmatched by almost any other body site. Changes in the structural integrity of the teeth provide a history of exposure to deficiencies of vitamin A, vitamin C, vitamin D and iodine and to an excess of fluorides during the years of tooth formation. Changes in the structural integrity of the oral mucosa may signal ongoing deficiencies of riboflavin, niacin, folic acid, vitamin B6, vitamin B12, biotin, vitamin C, vitamin K, iron and protein calories. The evidence is readily accessible and painlessly procured. The clinician alert to and familiar with the stomatological reactions to prolonged deprivation of many of the essential nutrients is in a privileged position for the early diagnosis and effective management of the nutritional deficiency states.

Pediatric victims of AIDS virus infection continue to increase. The major source of transmission is by birth from an HIV-positive mother. Recognition is often difficult because of the varied and misleading signs and symptoms. Only a few studies describe oral manifestations in children and adolescents. The most common oral findings include candidiasis, parotid salivary gland enlargement and herpetic infections. Oral involvement may reflect early signs and symptoms of HIV-related immunosuppression.

Bite mark evidence has been admitted in a vast number of cases in courts throughout the United States, as well as other countries. Because there is variation in the dentition of humans, if bite marks are noted in a victim, it is possible in many cases to determine the identity of the perpetrator depending on the quality of the bite mark, its age, lack of distortion and documentation. In other cases, facial injuries, including damage to the frenum and teeth in addition to the face, may point to nonaccidental injury if the history corroborates this condition.

This paper provides an overview to the assessment and management of chronic and recurrent pain in children with chronic diseases. Relevant clinical research studies are cited, and practical guidelines are provided for the differential assessment and management issues inherent in the comprehensive care of chronic and recurrent pain in children and adolescents with hemophilia, juvenile rheumatoid arthritis, sickle cell disease, and cancer.

During the last 2 decades, a vast amount of information has been obtained about the sensory system responsible for pain perception, with the result that there have been dramatic changes in the understanding of how pain is experienced and how pain can be modified. However, recent advances in the management of pain have been confined almost exclusively to adults. Consequently, our understanding about pain perception in infants, children and adolescents, our knowledge about the prevalence of different pain problems for children and data about the effectiveness of various pharmacological and nonpharmacological pain control methods are limited. This article explores the issue of the undertreatment of acute, recurrent, chronic and cancer pain in infants and children.

Recurrent headache is a frequent problem in children and adolescents. With a careful history and physical examination few errors in diagnosis will be made. Fortunately, few headaches are of pathological origin. The most common headaches are migraine and muscle contraction headaches. For many sufferers, a few simple suggestions and proper use of analgesics will provide effective management. The best documented treatments for more difficult headaches are stress management therapies. Recently stress management treatments that can be administered by professionals not trained in psychology have made these approaches more accessible.

This paper examines the consequences of our attitudes toward children's pain and suffering, both on that pain and suffering and on children's response to treatment. Examples are offered for alternative ways we can cope with suffering children. Attention is paid to the importance of self-awareness on the part of clinicians, and of its relevance to good clinical care.