Making heel pricks less painful.

A mechanical lancet, the Autolet, was compared with a manual heel prick in 36 newborn infants undergoing routine blood sampling for the Guthrie test and hypothyroid screening. Each method was equally effective in obtaining satisfactory blood samples but the Autolet was considerably less painful.     

When choosing injectable penicillin for the treatment of group A beta-hemolytic streptococcal pharyngitis, there is a less painful choice

OBJECTIVE: To determine whether injection of patients with Bicillin CR is less painful than injection with Bicillin LA. To discover if Bicillin CR with the addition of procaine, which doubles the volume, causes the injection to be less painful. DESIGN: An experimental, double-blinded crossover design was used for this study. SETTING: University children's and women's tertiary care emergency Department (ED) with an annual pediatric census of 22,000. PARTICIPANTS: A convenience sample was enrolled from the student body of a large university and house staff, and employees of a 152 bed children's and women's hospital in southern Alabama. The sample size was limited to 50 participants, all of whom completed the study. METHODS: Each participant received two penicillin injections, one Bicillin CR and one Bicillin LA, and rated the pain of the injection immediately after the injection, 1 hour after the injection and 12 hours after the injection. A visual analogue scale was the tool used for measuring the pain. The penicillin injections were randomized using a random number generator. RESULTS: For each of the three periods, comparisons of pain were made between the Bicillin CR versus Bicillin LA injections. Bicillin LA pain score values were consistently higher for all but the 12-hour comparison. These differences were statistically significant (P < 0.008-0.002). CONCLUSIONS: Injection of Bicillin CR with the addition of procaine to the benzathine penicillin G is statistically significantly less painful than the injection of Bicillin LA without the addition of procaine to the benzathine penicillin G, even though the Bicillin LA is one-half the volume of the Bicillin CR due to the addition of procaine to the Bicillin CR.     

A painful limp

We describe a healthy 18-month-old child who developed a painful limp, without a history of trauma or fever. The initial laboratory investigations showed normal results but the radiological findings were suggestive of scurvy. Diagnosis was confirmed by blood tests and by a rapid recovery following replacement therapy.     

Acute painful joints

Musculoskeletal pain affects up to 20% of children at any one time, by far the majority of whom have minor or benign disorders. Deciding which patients have significant pathology is key. We consider the presentation of joint pain in four clinical settings: a child who is unwell with fever; a child who is well with mechanical joint symptoms or following trauma; a child with acute joint pain as part of a chronic condition; and a child with hip specific pathologies. This approach can help to formulate a differential diagnosis, guide appropriate investigations and institute effective treatment.     

Ultrasonography of the painful hip

A total number of 204 patients presenting with an acutely or subacutely painful hip joint were investigated in two prospective studies. Intraarticular fluid collections were detected in 104 patients. The joint effusions showed different echopatterns depending on etiology and duration of disease. Additional diagnostic criteria such as synovial hypertrophy and thickening of the articular capsule allowed the distinction between transient synovitis and septic arthritis. Bony changes were encountered in 40 patients with osteomyelitis, slipping femoral epiphysis or Perthes-Calvé disease. Ultrasonography is recommended as method of choice in detecting, excluding and differentiating of joint effusions.     

Convective burn from use of hairdryer for heel warming prior to the heel prick test - a case report

Background  

Blood sampling through heel lancing is the most common invasive painful procedure performed on newborn infants.