Pediatric pain management

[mekat]

I gave my 30lb 8 year old (stunted growth from chromosomal abnormalities) 4mls of of acetaminophen with Codeine (generic). After it kicked in he indicated his pain was a 6 on a 10 scale and was still very moody crying at the slightest little thing. Due to his distress I topped off the dose with an extra 2mls (GI said max dose was 6mls). After the extra kicked in his pain indicated on the scale was a 4 out of 10 still a little clingy but not hysterical like before. Is a 4 out of a 10 with maxed out medication okay or do I need to ask for something stronger when the GI office opens tomorrow?

Quick explanation of why he is in pain. - He is in chronic pain because the pediatric surgeon and GI are dragging their feet scheduling a corrective surgery. He has a fistula connecting his rectal stump and sigmoid colon as well as severe colitis all around the areas of the fisula opening on both ends.

[luvsviola]

In my book, 4 out of 10 maxed out is not ok. I'd call. Kiddo has a right to be pain free, and the doctors need to be responsive to that. They need to give you a plan that takes severe pain away. Hope you get some answers soon!

[aries416]

Poor kid! I would want him as comfortable as possible. I'd call in and see if he can get something more for the pain.

[kaia.aline]

Poor baby! I'd call for better pain management options

[mekat]

Thanks, calling them was definitely the right thing to do. Today he was having crying fits and it took two maximum doses of acetaminophen with Codeine to get through the afternoon and evening. They called in Rx of Lortab. I'm not sure how that compares strength wise to a acetaminophen with Codeine. He has dealt with gastric pain before and we have always had a Rx regimen for it but his pain management needs are starting to go to a whole new level and I am now in unfamiliar territory. I think I will also max out his daily Kristalose meds (gentle laxative, similar in function to Miralax). Hopefully making his fecal output more liquid will reduce irritation to the Colitis. I noticing the more firm the more pain he has in his lower bowels.

[luvsviola]

Poor little guy!

[UnderTheStars]

I'm glad you called, but I'm sorry your little guy is having to deal with that level of pain. Is this new level of pain something that might push the doctors into more action?

[Brayjjanna]

Ive always wondered this except my 3.5 year old cant tell us. He's basically screamed most of his life. The first 2 years was 24/7. Now it's half the time. They say there is nothing else we can give him to help his pain or whatever is causing the discomfort. He arches and flails to the point you can't hold him. Sadly tynelol with codeine at his allowed full dose does nothing.

Hugs mama!

[mekat]

Originally Posted by Brayjjanna Ive always wondered this except my 3.5 year old cant tell us. He's basically screamed most of his life. The first 2 years was 24/7. Now it's half the time. They say there is nothing else we can give him to help his pain or whatever is causing the discomfort. He arches and flails to the point you can't hold him. Sadly tynelol with codeine at his allowed full dose does nothing. Hugs mama!

I'm sorry they haven't done more for him.

My son is completely nonverbal he does use AAC but is not always reliable. He is a fairly reliable pointer though. I at first tried the traditional black and white pain scale but because of his vision impairment he had difficulty reading it so I found this pain scale on the internet that used bright colors to rate pain and he can read and point quickly to where he is on the pain scale. Here is the one we used; It is called a Visual Analog Scale.

It sounds horrible but when he first was Rxed the Coedine I started to refuse to administer pain medication unless he indicated in some way he was in pain. We started out simple "you want mommy point to me or if you are in pain and need something to make it go away point to the medicine bottle." It resulted in a few tantrums during pain bouts but I felt it was important to teach him he has to communicate his pain.

We are slowly progressing and refining his pain communication. Now he is good at pointing up if he has pain in the bony area of his chest (reflux) or pointing downwards if he has pain in the soft area of his belly(lower GI pain). The analog scale was something we only just started to do in the last few weeks so now I have his input into how severe it is instead of just observing and rating it myself based on what I see. Although I will say when his pain is off the charts severe his communication regresses severely and I can only get a point at the Rx bottle response.

Any way this is what has worked for us, every special needs child is different and what works for us might not work for you. It was a long process of over a year just to get him to communicate that much and I am still working out ways to refine the communication technique.

[Brayjjanna]

Originally Posted by mekat I'm sorry they haven't done more for him. My son is completely nonverbal he does use AAC but is not always reliable. He is a fairly reliable pointer though. I at first tried the traditional black and white pain scale but because of his vision impairment he had difficulty reading it so I found this pain scale on the internet that used bright colors to rate pain and he can read and point quickly to where he is on the pain scale. Here is the one we used; It is called a Visual Analog Scale. It sounds horrible but when he first was Rxed the Coedine I started to refuse to administer pain medication unless he indicated in some way he was in pain. We started out simple "you want mommy point to me or if you are in pain and need something to make it go away point to the medicine bottle." It resulted in a few tantrums during pain bouts but I felt it was important to teach him he has to communicate his pain. We are slowly progressing and refining his pain communication. Now he is good at pointing up if he has pain in the bony area of his chest (reflux) or pointing downwards if he has pain in the soft area of his belly(lower GI pain). The analog scale was something we only just started to do in the last few weeks so now I have his input into how severe it is instead of just observing and rating it myself based on what I see. Although I will say when his pain is off the charts severe his communication regresses severely and I can only get a point at the Rx bottle response. Any way this is what has worked for us, every special needs child is different and what works for us might not work for you. It was a long process of over a year just to get him to communicate that much and I am still working out ways to refine the communication technique.

Thanks. He has no motor ability and we have found no way to communicate. It's always a guessing game. His doctors say there is nothing they can do to help and its because his brain damage is so severe. He's missing most areas in his brain.