Analgesia

Analgesia is important and often necessary to enable a child to be examined and further assessed.

Important points:

• Many drugs used in adults are not licensed for use in children.
• The doses are calculated by age / weight and body surface area (BSA) of the child.
• Formulations are variable - young children may prefer liquid medicines / syrup.  
• Be aware of the alternative of SUGAR-FREE options, if available, to reduce the risk of dental caries if there is likely to be prolonged use of NSAIDS. 
• There are various Children's Drug Formularies available (e.g., Children's version of the British National Formulary and the Royal Children’s Hospital Paediatric Pharmacopoeia).
• Paracetamol (acetominophen) is useful as pain relief.
• NSAIDS are useful in the short term for symptom relief of arthritis rather than long term disease control.
• Naproxen, ibuprofen or aspirin are very useful to treat the arthritis of Acute Rheumatic Fever.
• High-Dose Aspirin is important to treat Kawasaki Disease and helps to reduce aneurysm formation and to prevent thrombosis.
• However, when using Aspirin in children, always be aware of the potential risk for Reye’s syndrome.

NSAIDs act by inhibiting enzymes (cyclo-oxygenase-1 [COX-1] and COX-2) involved in prostaglandin synthesis resulting in analgesic, anti-inflammatory, and anti-pyretic effects.

There are two broad groups of NSAIDs—the older, traditional, non-selective NSAIDs (e.g., ibuprofen, naproxen, aspirin) that inhibit both COX-1 and COX-2 and the newer, selective COX-2 inhibitors that predominantly inhibit COX-2 (e.g., celecoxib). The clinical effects of NSAIDs depend largely on their selectivity for these enzymes. The non-selective group acting widely resulting in varying degrees of analgesic, anti-inflammatory and anti-pyretic and anti-platelet effects. The selective group has less gastro-intestinal tract side effects.

More information about pain relief is provided in PMM-Nursing.

The photograph below shows severe dental caries. Caries risk is increased with the regular ingestion of medicines that contain sugar-based syrups. Sugar-free alternatives are available and recommended.