Pain evaluation in preschool children and by their parents.

The accurate assessment of pain in children constitutes a challenge for health professionals and, in the case of young children, parents are generally the main source of information. The objective of this study was to validate and to compare three pain scales in preschool children and their parents. A total of 104 children between 4 and 6 y of age and their parents participated in the study while undergoing an immunization procedure in the outpatient department of a tertiary pediatric care hospital. Three pain scales were used, the McGrath Facial Affective Scale (FAS), the Hester Poker Chip Tool (HPCT) and the Multiple Size Poker Chip Tool (MSPCT). There were 47 (45%) boys and 57 (55%) girls, with 54 (52%) 4-y-olds, 34 (33%) 5-y-olds and 16 (15%) 6-y-olds. Twenty-eight children (27%) had memories of pain experienced during a former hospitalization. Correlations were very high both in children (r = 0.78) and their parents (r = 0.96) when comparing immunization pain scores obtained from the HPCT versus the MSPCT. Correlations between McGrath's FAS and HPCT or MSPCT ranged from r = 0.34-0.43 in children and r = 0.38-0.39 in parents. There was a good correlation between parents and children during the immunization procedure on all three scales, with the highest correlation using the FAS (r = 0.76), followed by the MSPCT (r = 0.69), and the HPCT (r = 0.66). Subgroup analyses based on the criteria of age, sex and previous hospitalization showed no consistent relationship. Parents tended to underestimate their child's pain when using HPCT or MSPCT. It seems that both HPCT and MSPCT measure a similar dimension of pain, whereas the FAS addresses a different aspect of pain. Although parents play an important role in their child's pain assessment, they tend to underestimate the intensity of pain when using HPCT or MSPCT.

Paediatric palliative care in the home.

BACKGROUND: A palliative home care program for children was reviewed OBJECTIVES: To obtain a better understanding of the complications found in the home, and to ascertain the extent of the nursing support needed. DESIGN: The study was descriptive and retrospective. Data were abstracted from both medical and home care charts. SETTING: The palliative home care program for children is based in a tertiary care paediatric hospital. POPULATION: Twenty-eight children under the age of 18 years, with cancer, neurodegenerative disease and acquired immunodeficiency syndrome, needing specialized terminal nursing care at home, were included. Patients needing minimal nursing support were excluded from the review. RESULTS: Twenty-two patients died at home and two died in the hospital in accordance with the parents' wishes. Most patients had pain severe enough to need opioids (25 of 28). The more frequent complications were inconsistent pain control (43%), vomiting (39%), respiratory problems (39%), bed sores (25%) and convulsions (25%). Home care had to be discontinued for only four patients. Parents found intractable pain, convulsions and end-stage dyspnea were the more worrisome complications. The patients received an average of 14 home visits and 14 telephone calls. Telephone calls and home visits were frequent over the weekends and evenings (0 to 45, median=3). CONCLUSIONS: This report confirms the feasibility of terminal care at home for children with complex problems. Complications can be well tolerated by the parents if the medical team is readily available.

Neonatal survival and disability rate at age 18 months for infants born between 23 and 28 weeks of gestation.

OBJECTIVE: Our purpose was to determine gestational age-specific outcomes of infants born in a period of surfactant use. STUDY DESIGN: All 465 consecutive births between 23 and 28 weeks' gestation in a tertiary center from 1987 to 1992 were analyzed prospectively. At 18 months' corrected age, 217 of 254 (85%) survivors were evaluated. RESULTS: From 1987 and 1988 to 1991 and 1992 there was an increase in survival for infants born at 24 weeks (from 0% to 33% p = 0.17), 25 to 26 weeks (38% to 71%, p < 0.005), and 27 to 28 weeks (66% to 84%, p < 0.05). At each weekly interval from 24 to 28 weeks of gestation the respective incidence of normality was 44%, 71%, 57%, 76% and 72% (not significant) and the respective mean developmental quotient was 91 +/- 17, 89 +/- 25, 90 +/- 24, 96 +/- 15 and 96 +/- 14 (not significant). CONCLUSIONS: Gestational age was strongly associated with outcome in terms of survival. Overall, 70% of children followed up were developing within the normal range.

Women in pediatrics: the experience in Quebec.

OBJECTIVES: To compare the practice patterns of female pediatricians in Quebec with those of their male counterparts and to identify specific factors influencing these practice patterns. DESIGN: Matched cohort questionnaire survey. SETTING: Primary, secondary and tertiary care pediatric practices in Quebec. PARTICIPANTS: All 146 female pediatricians and 133 of the 298 male pediatricians, matched for age as well as type and site of practice; 119 (82%) of the female and 115 (86%) of the male pediatricians responded. MAIN OUTCOME MEASURES: Demographic and family data as well as detailed information about the practice profile. RESULTS: The two groups were comparable regarding demographic data, professional work and patient care. Compared with the male respondents, the female pediatricians were younger and saw more outpatients. The mean number of hours worked per week, excluding on-call duty, was 40.5 (standard deviation [SD] 12.4) for the women and 48.9 (SD 12.0) for the men (p < 0.001). The female pediatricians were more likely than their male counterparts to have spouses who were also physicians (40%) or in another profession (45%). The female pediatricians without children worked significantly fewer hours than the male pediatricians with or without children (p < 0.001). Children (p = 0.006), but not the number of children (p = 0.452), had a significant effect on the number of hours worked by the female pediatricians. CONCLUSION: The duality of the role of female physicians as mothers and professional caregivers must be considered during workload evaluations. If the same style of practice and the increase in the proportion of female pediatricians continue, about 20% more pediatricians will be needed in 10 years to accomplish the same workload.