Wednesday, April 23rd, 2014
Children who suffer from appendicitis may not be facing inevitable surgery, if a new study touting the safety and effectiveness of an antibiotic treatment becomes mainstream practice. More from Reuters:
Forgoing surgery to remove the appendix may not be an option for all kids, researchers say, but just three of 30 children who tried the antibiotics-only route ended up needing surgery.
“In this group of patients with uncomplicated appendicitis – in the people we studied, non-operative management with antibiotics alone appears to be a reasonable alternative,” Dr. Peter Minneci told Reuters Health.
He is the study’s lead author, from Nationwide Children’s Hospital in Columbus, Ohio.
Appendicitis is when the appendix, a small tube-shaped extension of the colon, becomes inflamed and filled with puss. The appendix may burst without treatment and cause a widespread infection.
Although the cause of appendicitis is not known, Minneci said it may often occur when a piece of feces blocks the appendix and allows bacteria to proliferate. Other inflamed tissues may also block the appendix and cause the condition.
“It used to be that people would operate on appendixes in the middle of the night,” he said. “Then we found that it was safe to give them antibiotics and operate on them in the morning.”
Doctors began noticing that some of the children were feeling better in the morning after the initial treatment of antibiotics.
“They were hungry and they didn’t have pain anymore,” Minneci said.
To see whether antibiotics alone might be enough to treat appendicitis, he and his colleagues enrolled 77 children and teens brought to the emergency room at Nationwide Children’s Hospital from October 2012 to October 2013.
All the participants had been diagnosed with uncomplicated acute appendicitis. Their appendixes had not burst, were not overly swollen and imaging did not show a hard piece of stool blocking the organ.
Those uncomplicated cases represent about one in five appendicitis cases at the hospital, the researchers note in the Journal of the American College of Surgeons.
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Image: Child in hospital, via Shutterstock
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Thursday, November 3rd, 2011
Children who have appendectomies or broken limbs are not given adequate narcotic pain medication, which leads to more hospital re-admissions than necessary, a new study in the Journal of Pediatric Surgery has found.
Thirteen percent of kids under age 18 who had had appendectomies reported pain that lingered for months, CNN.com reports. “Children are not being given enough pain medication, and they’re suffering needlessly,” Dr. Zeev Kain, senior author of the study and a pediatric anesthesiologist at the University of California, Irvine, told CNN.
The issue is two-f0ld, researchers found, a combination of doctors being reticent to send powerful pain medications home with parents, and parents who are nervous about giving their children the painkillers. But the study’s authors say that if doctors educate parents and write short-term prescriptions, and if parents carefully follow their doctors’ instructions about proper use of the drugs, their children can experience significant pain relief with minimal risk.
CNN offers advice for parents on how to manage post-surgical pain in children:
Pediatric pain experts have these tips for parents:
1. Ask your doctor about pain medication before your child leaves the hospital
If you think your child is in pain or will be in pain once you return home from the hospital, ask about pain medication.
“And if your child was on something for pain in the hospital, ask why they’re not continuing it when they go home,” Petitti advises.
2. Ask your doctor when to give the medication
Ask if you should give your child medication before the pain starts or only if they’re in pain, or if you should give the medication before your child tries to do a physical activity such as walking.
“You need to be really aggressive in terms of asking questions,” Kain advises.
3. Fill out your child’s prescription before you get home
When you arrive home with a sick child after a surgery or visit to the ER, it’s often tough to leave that child to go get the medication. Kain advises filling the prescription on the way home or at the hospital pharmacy if your hospital has one.
4. Recognize when your child is in pain
Once you get home, remember that a child won’t always cry, scream, or complain when they’re in pain, pediatric pain experts say. Some children in pain become quiet and withdrawn or have trouble eating or sleeping.
Unfortunately, both parents and doctors sometimes miss the pain in the quiet kids.
A 2008 study titled “The Squeaky Wheel Gets the Grease” showed that a day after having a broken limb treated in the emergency room, 20% of children received no pain medication, and 44% received only one dose. The children who were most likely to get medication were those who were loud and cried a lot.
Children in certain ethnic groups may be less likely to say they’re in pain because their culture places a high value on appearing stoic. Some studies have shown that Hispanics, for example, are less likely to talk about pain and ask for medicine.
5. Think about other ways to address the pain besides drugs
Alternative methods such as aromatherapy, acupuncture and music can be extremely helpful for kids in pain, Kain says.
Another technique is particularly powerful: distraction.
“You should definitely acknowledge your child’s pain by saying something like ‘Poor baby, I know it hurts to move, but then you should quickly move on to a solution,” Kain says. “You can say ‘let’s go for a drive’ or ‘let’s read a book’ or ‘let’s plan your birthday party together.’ Don’t just let your child lie there miserably on the sofa.”
(image via: http://www.123rf.com/)
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