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In this enlightening episode of Pediatrics Now, Host Holly Wayment introduces us to a founder of pediatric palliative care. This talk, by renowned Harvard pediatrician, Dr. Julie Hauer, highlights the complex world of managing chronic pain in children with severe neurological impairment. Featuring real-life case studies, Dr. Hauer guides us through the intricacies of identifying and treating chronic pain in these specific pediatric cases and attempts to shed more light on the often underrepresented field of pediatric palliative care.

A substantial portion of the conversation revolves around the significance and interpretation of behavioral changes, and the importance of observations in diagnosing pain in neurologically impaired children. We delve into comprehensive screening methods and effective interventions that can contribute to helping the child attain a calmer state.

Steering the conversation beyond known problems, this episode introduces the concept of neuropain, a type of affliction where inflammation and injury of tissues can lead to pain, and discusses how to tackle associated chronic issues via a combination of pharmacological and complementary methods such as music and massage therapy.

Additionally, Dr. Hauer discusses the various tried and tested drugs and their uses for managing neuropathic pain in children, emphasizing the necessity of expertise in handling such medications. She also sheds light on indicators of escalation despite treatment, and shares possible countermeasures.

With a strong commitment to improving the lives of neurologically impaired children, this discussion emphasizes the dire need for an integrated, multipronged approach, taking into account all possible sources of pain, the role of various drugs, constant monitoring, communication with the family, and adjustment of treatments as necessary. This comprehensive episode serves as a much-needed guide to healthcare professionals who strive to provide the best care to this special pediatric population.

Presenter: Julie Hauer, MD, FAAP, FAAHPM

Overview:
Chronic Pain in Children with Neurological Impairment: A Multisource Framework

Objectives:
To increase awareness and education for pediatric providers

Julie Hauer, MD, FAAP, FAAHPM is faculty at Boston Children’s Hospital. Her clinical expertise is focused on the rare population of children with severe neurological impairment (SNI) who have multiple co-morbidities that impact health and quality of life, resulting in complex medical care and decision-making. Her expertise includes symptom treatment, including pain, feeding intolerance, and dyspnea during acute on chronic respiratory illness. Her work has included innovative symptom treatment protocols targeting the mechanisms of pain generation specific to this population. She has written a book on the medical and palliative care needs of such individuals, with a second book to be published by Oxford University Press.

Financial Disclosures: Julie Hauer, MD, FAAP, FAAHPM has no financial relationships with ineligible companies to disclosure.

The Pediatric Grand Rounds Planning Committee (Deepak Kamat MD, PhD, Daniel Ranch, MD and Elizabeth Hanson, MD) has no financial relationships with ineligible companies to disclose. Planning Committee member Steven Seidner, MD has disclosed he receives funding from Draeger Medical for the Clinical Study to Evaluate the Safety and Effectiveness of the Infinity Acute Care System Workstation Neonatal Care Babylog VN500 Device in High-Frequency Oscillatory Ventilation (HFOV) Mode in Extremely Low Birth Weight (ELBW) Neonates for which he is a co-principal investigator.

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Chronic Pain in Children with Neurological Impairment: A Multisource Framework, Grand Rounds Episode!