Hospitals need to introduce better monitoring of the treatment of children in intensive care, according to a six month study of 96 patients at the Royal Brompton Hospital (BMJ, 5 June 1993).

Researchers looked at the use of invasive procedures including skin punctures, insertion or removal of catheters, tubes and drains, incubation, minor surgery and major dressings.

They conclude that children “may be less able than adults to limit the number of procedures performed or ensure adequate analgesia [pain relief]”.

Of the 181 procedures recorded, 50 were conducted without additional analgesia or sedation, and during 36 of these the child grimaced or cried. An adverse response occurred in 89 procedures. The average length of each was five minutes; and a relative was present during just 36 procedures.

Although only 181 procedures were recorded, the researchers were able to establish that at least an additional 318 had taken place without being monitored. They call for “routine and continual recording of invasive procedures” and for these to be given only when essential.

Each child in intensive care should have a single paediatrician to care for him or her as a “whole person”. “With unresolving illness, parents may be unable to make objective decisions about continuing intensive care and carers may focus on system failure and lose sight of the child as a whole person,” they say.

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Written by What Doctors Don't Tell You

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