Pain, feeding and respiratory care in severe neurodisability: Viva

Branch 1: Reading the behavioural change as pain

A strong candidate states at once that a change from baseline in a non-verbal child with severe neurodisability is pain or a treatable medical source until proven otherwise. The arching, grimacing, and sleep disturbance are not his baseline dystonia; they are a signal that something hurts. The candidate names the observational pain tools, the revised FLACC, the Non-communicating Children's Pain Checklist, and the Paediatric Pain Profile, and explains that the child cannot self-report so a validated tool replaces the guess. The next step is to give prompt analgesia to settle the distress enough to examine, and then to search the head-to-toe and system list for the source. ^[1]

When the examiner pushes for the sources, the candidate lists the treatable ones by system: the musculoskeletal sources of hip subluxation and dislocation, occult fracture, scoliosis, and contractures; the gastrointestinal sources of reflux, oesophagitis, constipation with impaction, and dental abscess; the genitourinary sources of urinary tract infection and stones; and the neurological sources of dystonia and neuropathic pain. The candidate stresses that the discipline is to keep searching until a source is found, because assuming there is none is the most common and most harmful error in this population. ^[1]