An assessment of the psychometric properties of the Stoplight Pain Scale in a Canadian paediatric emergency department

ObjectiveThis study aimed to validate a novel, three faced, colour-coded, action-oriented tool: The Stoplight Pain Scale (SPS).MethodsA prospective observational cohort study was conducted at a Canadian paediatric emergency department from November 2014 to February 2017. Patients aged 3 to 12 years and their caregivers were asked to rate pain using the SPS and the Faces Pain Scale-Revised (FPS-R). Pain was measured just before analgesia administration, 30 minutes after analgesia administration, and immediately following a painful procedure.ResultsA total of 227 patients were included; 26.9% (61/227) were 3 to 5 years old while 73.1% (166/227) were 6 to 12 years old. Using Cohen’s κ, agreement for SPS and FPS-R was ‘fair’ for children (0.28 [95% confidence interval {CI} 0.20 to 0.36]) and ‘poor’ for caregivers (0.14 [95% CI 0.07 to 0.21]), at initial measurement. The SPS had ‘fair’ agreement between child and caregiver scores, (0.37 [95% CI 0.27 to 0.47]), compared to FPS-R which showed ‘poor’ agreement (0.20 [95% CI 0.12 to 0.29]). Absolute agreement between child and caregiver SPS scores improved with repeat exposure; 30 minutes after analgesia administration, caregivers and children had fair agreement (κ=0.38, 95% CI 0.28 to 0.48); they had moderate agreement directly following painful procedures (κ=0.46, 95% CI 0.34 to 0.59). Overall, 72.4% (139/192) of children and 60.2% (118/196) of caregivers preferred SPS over FPS-R.ConclusionThe SPS demonstrates fair agreement with FPS-R for children and fair-moderate agreement between children and caregivers; agreement improved with repeat use. The SPS is simple and easy to use; it may have a role in empowering direct child and family involvement in pain management.     

Pain management in the critically ill child

Children frequently received no treatment, or inadequate treatment, for pain and for painful procedures. The newborn and critically ill children are especially vulnerable to no treatment or under-treatment. Nerve pathways essential for the transmission and perception of pain are present and functioning by 24 weeks of gestation. The failure to provide analgesia for pain results in rewiring the nerve pathways responsible for pain transmission in the dorsal horn of the spinal cord and results in increased pain perception for future painful results. Many children would withdraw or deny their pain in an attempt to avoid yet another terrifying and painful experiences, such as the intramuscular injections. Societal fears of opioid addiction and lack of advocacy are also causal factors in the under-treatment of pediatric pain. False beliefs about addictions and proper use of acetaminophen and other analgesics resulted in the failure to provide analgesia to children. All children even the newborn and critically ill require analgesia for pain and painful procedures. Unbelieved pain interferes with sleep, leads to fatigue and a sense of helplessness, and may result in increased morbidity or mortality.     

Treatment of pitressin sensitive diabetes insipidus in children with clofibrate and carbamazepine

Four children with pitressin sensitive diabetes insipidus were treated with clofibrate and carbamazepine. Both substances significantly reduced daily urine volumes, clofibrate by 40–83%, carbamazepine by 50–70%. The combination of both substances led to a significant further reduction. Long term clinical control of diabetes insipidus was achieved with clofibrate 25–30 mg/kg/day in 2 cases, and by clofibrate 45 mg/kg/day and carbamazepine 6 mg/kg/day in one child. No side effects of the treatment were observed. In healthy adult volunteers, clofibrate inhibited diuresis effectively after acute hydration.This study was partly supported by the Deutsche Forschungsgemeinschaft (Scha 169/3) and by Fa. Rheinpharma, Heidelberg.     

Vincristine treatment for function- and life-threatening infantile hemangioma]

AIM: To evaluate the efficacy of vincristine treatment for function- and life-threatening hemangiomas. PATIENTS AND METHOD: Nine infants, eight girls and one boy, received vincristine treatment (VCR) for endangering hemangiomas. In six cases, the hemangiomas involved head and neck in a segmental unilateral or bilateral distribution (3/6 also had laryngeal and 2/6 tracheal location causing respiratory distress, 5/6 had eyelid and orbital involvement); one infant had disseminated neonatal hemangiomatosis (skin, liver, kidney); two infants had liver hemangiomas with cardiac failure. VCR was prescribed after failure of high-dosage corticosteroid treatment in six, and of both corticosteroids and interferon alpha 2b (5 months) in one; two infants received VCR as first line treatment. RESULTS: A dosage of 1 mg/m(2) IV injection was delivered, with weekly injections first, and then tapering, increasing the interval between injections, depending on the clinical response. The nine infants received from 5 to 25 injections (average: 16), for a length of treatment of 1.5-8 months (average: 5.5 months). In seven patients a clear clinical response was observed at the end of the first month of treatment, while a slow protracted response was noted in two. Transient mild side effects were present in four patients. DISCUSSION: Corticosteroid treatment, although a worldwide recognized treatment of problematic hemangiomas, cannot always control the growth of alarming hemangiomas. Interferon alpha 2a and 2b have proven a 90% effectiveness: treatment for cortico-resistant, function- and life-threatening, hemangiomas.     

Evaluation of the Use of PenNeedle? 32G Taper in Children being Treated with Growth Hormone

Pain resulting from needle injection is a serious problem for patients that self-administer medication at home. We studied impressions of needle use by comparing PenNeedle® 32G Taper (NovoFine® 32G Tip), developed to reduce the sense of fear and pain of injection, with a conventional needle, in children self-injecting GH. A total of 34 patients self-injected themselves with needles coupled with Norditropin® NordiFlex® pre-filled recombinant human GH, and impressions of use were evaluated by a series of questionnaires. Compared to the conventional needle, PenNeedle 32G Taper was slightly less painful at time of insertion according to patient responses, though the difference was not statistically significant (P=0.06). PenNeedle 32G Taper has the same inner diameter as the conventional needle, thus there was no difference in the pain felt at time of injection between these two needles. Large differences in pain perception between the two needles were not seen probably due to their similar shape and appearance and as the subjects of this study were young. Nevertheless, based on the results of post-study questionnaires, significantly more patients (68%, P=0.02) expressed a desire to use PenNeedle 32G Taper for daily injections of GH. PenNeedle 32G Taper thus appears to be a superior needle which reduces insertion-associated pain in children receiving recombinant GH and improves patient QOL.     

婴幼儿血管瘤的阶段性治疗

目的 探讨糖皮质激素及手术治疗对婴幼儿血管瘤的效果。方法 2003年7月～2006年7月对本院收治1～3个月婴儿草莓状血管瘤26例予盐酸曲安奈德注射液瘤体内注射（1mg／12cm^2，总量不超过2mg／kg），2～3周1次，共3～5次；3个月以上婴儿草莓状及海绵状血管瘤50例予手术切除，缺损较大者以皮片移植或局部皮瓣转移修复。其中创口直接缝合38例，植皮3例，以局部皮瓣转移修复9例。结果 草莓状血管瘤26例经激素注射1、2次充血减轻，4、5次瘤体均变平，边缘萎缩。手术50例，术后皮片皮瓣均成活，形态良好。结论 激素注射是控制小龄婴儿血管瘤安全、可靠、简便方法，对大龄患儿可耐受手术及麻醉则以手术切除效果为佳。     

The clinical significance of lung hypoexpansion in acute childhood asthma

Background Many children experiencing acute asthmatic episodes have chest radiographs, which may show lung hyperinflation, hypoinflation, or normal inflation. Lung hypoinflation may be a sign of respiratory fatigue and poor prognosis.Objective To compare the clinical course in children with asthma according to the degree of lung inflation on chest radiographs.Patients and methods We conducted a retrospective study during a 24-month period (from July 1999 to July 2001) of children aged 0–17 years, who presented to a pediatric emergency department or outpatient clinic with an asthma exacerbation. Chest radiographs obtained at presentation were reviewed independently by three pediatric radiologists who were blinded to the admission status of the patient. The correlation between hypoinflation and hospital admission was assessed in three age groups: 0–2 years, 3–5 years, and 6–17 years.Results Hypoinflation on chest radiographs was significantly correlated with hospital admission for children aged 6–17 years (odds ratio 16.00, 95% confidence interval 1.89–135.43). The inter-reader agreement for interpretation of these radiographs was strong, with a kappa score of 0.76. Hypoinflation was not correlated with admission in younger children.Conclusion Lung hypoinflation is associated with a greater likelihood of hospital admission in children aged 6 years or older. Therefore, hypoinflation was a poor prognostic sign and may warrant more aggressive therapy.     

Prevalence of self-reported back pain in school children: A study of sociodemographic differences

The study considers the prevalence of back pain experienced in a nationwide random sample of 2173 Icelandic school children aged 11–12 and 15–16. The study found a 20.6% prevalence of at least weekly back pain. The prevalence of back pain was significantly more frequent among the older children. No gender or class difference was found in the overall sample. Older children from rural areas have significantly more back pain than those living in the city. The need for a thorough epidemiological investigation of the association of back pain in children is emphasized.     

Daunorubicin: Results in Childhood Leukaemia

Fifty children with acute leukaemia (44 lymphatic, 6 myeloid) were treated with daunorubicin. In 3 cases, it was given in courses of daily injections; in 47, single injections were given at 7- to 14-day intervals. On the latter (intermittent) regimen, in combination with prednisolone, a good response—complete, bone marrow, or clinical remission—occurred in 22 of 27 cases (81%) of `new'' or previously untreated acute lymphoblastic leukaemia but in only 3 of 13 cases previously treated with other drugs. With acute myeloid leukaemia a good response occurred only when daunorubicin was given in combination with other cytotoxic drugs. The major side-effect was bone marrow depression with the related complications of haemorrhage and infection. Cardiotoxicity was not a problem; the cumulative total dose of daunorubicin did not exceed 26·8 mg/kg. This study indicates that intermittent dosage with 2-3 mg/kg at intervals of 7 to 14 days is as effective as, and no more toxic than, the courses of daily injections that have been commonly used.     

Effectiveness of Regular Breathing Technique (Hey-Hu) on Reduction of Intrathecal Injection Pain in Leukemic Children: A Randomized Clinical Trial

Objective

Children with chronic diseases such as leukemia are subjected to pain during various procedures. Injection pain in children is so important that it is considered as the most stressful aspect of their disease. Distraction is one of the easiest and least costly methods of non-pharmacological pain relief that has not been paid attention to by nurses. In the present study, the effectiveness of regular breathing method (Hey-Hu) in reduction of pain of intrathecal injection in leukemic children was evaluated.

Methods

This study was conducted as a single blind randomized clinical trial among 100 patients coming to a referral hospital related to Shahid Sadoughi University of Medical Sciences, Yazd, Iran. The patients were 6-15 years old children coming to oncology ward suffering from leukemia. They were selected and randomly allocated to either regular breathing group or control group in equal numbers. The pain of children was assessed by Wong pain face scale and also general behaviors of the samples were evaluated by the researcher. In Pain Rating Scale, face 0 is considered happy because there is no hurt and face 5 denotes maximum pain.

Findings

Mean pain score in the regular breathing group was significantly lesser than the control group (2.98±1.68 and 3.80±1.30, respectively; P=0.01). There was no significant difference between the two sexes but in the regular breathing group, mean pain score was significantly lower in children aged above 10 years.

Conclusion

This study showed that regular breathing can significantly reduce the pain of intrathecal injection in leukemic children, especially in those aged above 10 years. Considering the key role of nurses in a health care team, the researchers hope that the results of this study can help them learn this method and implement it in hospitalized children who undergo painful procedures.     

Conservative treatment of hemangiomas in infancy and childhood with interferon-alpha 2a

Hemangioma is the most common tumor of infancy. Most hemangiomas proliferate for 8 to 18 months and then slowly regress over the next 5 to 8 years. So far, steroids have been the established means of treatment, but there have been some reports of the use of interferon-alpha 2a (IFN-A2a) in such tumors. To evaluate the efficacy of IFN-A2a in treating giant hemangiomas in infancy and childhood, we administered it to ten patients aged 4 h to 6.5 years with life-threatening hemangiomas in various parts of the body. The dose used was 3 MU/m² body surface area subcutaneously every second day. All children had previously received corticosteroids for 2 to 5 weeks without obvious success. The results were satisfactory: five patients had total or almost total regression; the rest have had partial regression while treatment is still in progress. A flu-like syndrome with fever, rhinitis, etc. accompanied the injections in some patients. The symptoms were controlled with paracetamol as necessary. Mild, transient leukopenia occurred in some children as well, but subsided after cessation of therapy for 1 week. IFN-A2a appears to be a promising and well-tolerated element in the treatment of life-threatening hemangiomas in infancy and childhood. Accepted: 6 January 1998     

Effect of childhood obesity and obesity-related cardiovascular risk factors on glomerular and tubular protein excretion

There is increasing evidence that obesity may damage the kidney in otherwise healthy individuals. Our study investigated the effect of childhood obesity on urinary albumin and beta-2-microglobulin excretion, and the association of these with obesity-related cardiovascular risk factors. Random morning spot urine samples were collected from clinically healthy obese ( n =86; median age 12.9 years, range 8.9–17.2 years; median weight 80.6 kg, range 46.1–136.8 kg; median body mass index 30.4 kg/m², range 24.5–43.2 kg/m²) and normal weight children ( n =79; median age 13.5 years, range 10.7–14.9 years; median weight 51.0 kg, range 27.3–72.5 kg; median body mass index 18.2 kg/m², range 13.2–23.9 kg/m²). The obese children were examined for the presence of common obesity-related cardiovascular risk factors including hyperinsulinaemia, impaired glucose tolerance (IGT), dyslipidaemia, hypercholesterolaemia, and hypertension. Obese children had a significantly higher urinary albumin/creatinine ratio (U-ACR) (median 11.7 mg/g, interquartile range 12.9 mg/g versus median 9.0 mg/g, interquartile range 5.1 mg/g; P =0.003) and urinary beta-2-microglobulin/creatinine ratio (U-BMCR) (median 63.9 µg/g, interquartile range 34.7 µg/g versus median 34.6 µg/g, interquartile range 44.1 µg/g; P <0.001) than normal weight children. Among the obese children, the U-ACR was associated with fasting hyperinsulinaemia, IGT, and hypercholesterolaemia (all P <0.05), and significantly correlated with the fasting ( r =0.23, P <0.05) and 2-h ( r =0.37, P <0.001) plasma glucose levels measured during an oral glucose tolerance test. Obese children with no more than one of the features of the metabolic syndrome had significantly lower U-ACRs than obese children with two or more features (median 10.4 mg/g, interquartile range 5.8 mg/g versus median 15.3 mg/g, interquartile range 14.9 mg/g; P <0.05). Conclusion:According to our results, clinically healthy obese children have a higher degree of albuminuria and beta-2-microglobulinuria than normal weight children, indicating early renal glomerular and tubular dysfunction as a consequence of childhood obesity. The urinary albumin/creatinine ratio in the obese children was associated with certain metabolic derangements linked to obesity, and also with the clustering of features of the metabolic syndrome.     

Theophylline pharmacokinetics in children,comparing sustained release spheres (Theo-Dur sprinkle) with elixir

A new sustained release theophylline preparation (Theo-Dur Sprinkle, TDS) was given b.i.d. and a theophylline elixir t.i.d. to eight children with bronchial asthma, 4–10 years of age, in an open study with a randomized cross over design. The serum concentration curves of theophylline were compared. The individual theophylline dose was close to 20 mg/kg body weight per day. On day 3 of each regimen, blood samples were taken 11 times over 24h. There were great differences between morning concentrations of theophylline, with a range from 0.9–10.7 mg/l in children given elixir, while corresponding values for children given TDS were 4.1–19.3 mg/l. Fluctuation during a dosing interval was 276% for elixir but only 54% in the case of TDS. The morning theophylline levels on two consecutive days did not differ significantly when the children were treated with TDS. The bioavailability of theophylline from TDS was 94% (range 54%–121%). Parents prefered TDS in seven of the eight cases. TDS showed satisfactory sustained release properties but the study confirmed the need for individually tailored dosage of theophylline based on monitoring of symptoms and serum concentrations.Abbreviations TDS Theo-Dur sprinkle - HPLC a liquid chromatographic method - AUC area under concentration curve - C_max maximum-theophylline concentration - C_min minimum theophylline concentration Subsidiary of AB Astra, Sweden     

Massive digitoxin intoxication treated with digoxin-specific antibodies in a child

Summary A 20-month-old girl with massive digitoxin intoxication (initial digitoxin serum level: 629 ng/ml) was successfully treated with digoxin-specific antibody fragments (Fab). She presented with moderate signs of digitalis toxicity (somnolence, bradycardia, first-degree AV block) and improved rapidly during fractional Fab administration. Free serum-digitoxin disappeared after 6 vials of Fab (480 mg), but was measurable again on days 6 and 7. This case demonstrated that digoxin-specific antibodies, despite a 30–100 times lesser affinity for digitoxin, are effective in massive digitoxin intoxications. A rebound phenomenon may occur several days later and should be taken into consideration.     

Treatment of traumatic pancreatic pseudocysts in children: the role of percutaneous catheter drainage

Six cases of successful percutaneous catheter drainage (PCD) of pancreatic pseudocysts in children ages 3–13 years are presented. All cases involved blunt abdominal trauma and presented with abdominal pain, vomiting, epigastric tenderness without a palpable mass, and elevated serum amylase. Indications for PCD were an enlarging pseudocysts and marked abdominal pain. Catheter placement was accomplished using CT guidance 15.3±1.8 days (mean ± SEM) following injury. Two patients had transgastric PCD. None of the pseudocysts were infected. Catheters were left in place until the drainage ceased, the serum amylase approached normal, the pseudocyst resolved on ultrasound, and the asymptomatic patient tolerated enteral feedings with the catheter clamped. The mean duration of catheter drainage was 18.3±3.7 days. At the time of catheter insertion, the range of serum amylase values was 242–2810 IU/l, while discharge values were 50–147 IU/l (normal: 16–108 IU/l). The mean hospital stay was 36.2±3.8 days and the mean length of total parenteral nutrition was 27.5±4.5 days. All pseudocysts were treated successfully without complication. PCD of traumatic pancreatic pseudocysts in children was performed safely and effectively in our study. Use of this therapeutic modality allowed earlier treatment, decreased the duration of symptoms, and avoided abdominal operation. PCD may prove to be the treatment of choice for pancreatic pseudocysts in children.Presented at the 22nd Annual Meeting of the Pacific Association of Pediatric Surgeons, Portland/Sunriver, Oregon, May 24, 1989.     

Risks of jet injection of insulin in children

The aim of our study was to assess whether a non-invasive insulin injector could improve the metabolic control of ten diabetic children complaining of painful injections with syringe and needle. The cumulative study period amounted to 1347 days. Whereas a non-significant rise in insulin needs was observed (from 0.98±0.03 to 1.03±0.06 units/kg per day, mean ± sem), mean HbA1c value remained unchanged (8.9%±0.4% vs 9.0%±0.5%). Jet injections were felt as less painful than those using syringe and needle (nine out of ten cases). This advantage was hampered by side-effects in eight out of ten cases such as episodes of glycoketonuria (six out of ten cases) leading to hospitalization in three patients. Other side-effects included inability to adjust injection pressure (four out of ten cases) and technical failure requiring an exchange of injector in five cases. The four children with most serious problems were significantly younger (P=0.009) than other subjects. In conclusion, this type of injector should be discouraged in young diabetic children. For older children and adolescents, it may be an alternative to syringe and needle provided repeated detailed information and tight medical supervision is available.     

The effect of cyproterone acetate on the growth of children with central precocious puberty

We have examined the growth and skeletal maturation of 19 children (6 male, 13 female) with central precocious puberty. The aetiology in nine patients (5 male, 4 female) was secondary to a hypothalamic hamartoma. Six children (2 male, 4 female) received no treatment whereas 13 children (4 male, 9 female) were treated with cyproterone acetate in a mean dose of 68 mg/m² per day (range, 34–260) for a mean duration of 4.5 years (range, 0.8–7.9). There was no significant difference between height SDS for bone age at the beginning and end of observation in either treated or untreated groups. No significant relationship between the mean dose of cyproterone acetate used and change in height SDS for bone age could be determined. We conclude that cyproterone acetate has no beneficial effect on the growth prognosis of children with central precocious puberty.Abbreviation GnRH gonadotrophin releasing hormone     

Role of anal dilatation in treatment of idiopathic constipation in children: long-term follow-up of a double-blind randomized controlled study

Constipation in childhood is a common symptom, with an estimated incidence between 0.3% and 8%. Most of the evidence for the current management of constipation and fecal soiling in children is based on reports of nonrandomized retrospective trials. Anal dilatation has had an established role in the management of idiopathic constipation but has never been evaluated by a randomized study. A double-blind randomized controlled trial was done of children who failed to respond to medical treatment and were admitted for investigation and treatment of idiopathic constipation to Guys Hospital, London, between April 2001 and April 2003. All children had intestinal transit study on admission. They were randomized, using a computer-generated allocation in sealed envelopes, to receive no anal dilatation (control group) or anal dilatation (anal dilatation group). Anorectal manometry and endosonography were done under ketamine anesthesia followed by anal dilatation if necessary under the same anesthesia. Disimpaction of feces from the rectum was done at the end of the procedure under general anesthesia using propofol muscle relaxant to minimize stretching of anal sphincter muscles in the control group. All children had intensification of medical treatment, toilet training, and monitoring of their response to treatment during their hospital stay, which ranged from 3 to 5 days. Outcome was measured using a parents questionnaire of symptom severity at 3 and 12 months of follow-up by one of the authors, who was blinded to randomization. The symptom severity score ranged between 0 and 65 and consisted of scores for the following: delay in defecation (score range 0–10), difficulty and pain with passing stool (0–5), soiling problem (0–10), intensity of laxative treatment (0–10), childs general health (0–5), behavior related to the bowel problem (0–5), overall improvement of symptoms (0–12,) and assessment of megarectum on abdominal examination (0–8). Of 60 neurologically normal children, 31 (19 males) were randomized in the control group and 29 (18 males) in the anal dilatation group. All children had findings consistent with idiopathic constipation and positive anorectal reflex on manometry, no anal sphincter damage on endosonography, and no anal fissure on examination under anesthesia. The median age for control and anal dilatation groups was 7.97 (range 4.1–14.25) years and 7.78 (4–13.25) years, respectively. Both groups were also comparable with regard to median of duration of laxative treatment (32 months vs. 31.5 months), internal anal sphincter thickness on endosonography (0.90 mm vs. 0.80 mm), resting anal sphincter pressure on manometry (51 mmHg vs. 51 mmHg), total rectal capacity on manometry (260 mmHg vs. 260 mmHg), and total symptom severity score before admission (33 vs. 29), respectively. At 12-month follow-up, the median pre-admission symptom severity score had improved significantly, from 33 (range 12–49) in the control group and 29 (16–51) in the dilatation group to 15 (0–51, p<0.0001) and 19 (1–46, p<0.0001), respectively. There was no significant difference between the two groups with regard to symptom severity score improvement at 12-month follow-up (p<0.92). We found a significant correlation between total rectal capacity measured on manometry and symptom severity score before admission and at 12-month follow-up (r=0.30, p<0.01 and r=0.25, p<0.05, respectively). Our results indicate that anal dilatation does not contribute to the management of school-aged children with idiopathic constipation. Admission to hospital for clarification of diagnosis and intensification of medical treatment with disimpaction of stool from the rectum is beneficial.     

Fatty acid composition of phospholipids of plasma and of mononuclear blood cells in children with allergic asthma and the influence of glucocorticoids

Fatty acid (FA) composition of plasma phospholipids and phospholipids extracted from peripheral mononuclear white blood cells (MNC) was investigated in 11 allergic asthmatic children (age 8.9±4.6 years), in 10 age-matched non-allergic healthy controls and in 14 allergic and non-allergic children with an acute attack of asthma, who had received prednisolone medication for 2–4 days. In allergic asthmatics eicosapentaenoic acid (205n–3) was significantly elevated in both plasma and MNC. The relative amount of 205n–3 in MNC as well as in plasma correlated positively with increasing levels of total serum IgE (P<0.02). The pattern of the other FAs in plasma and of MNC phospholipids did not differ between allergic asthmatic and non-allergic control children. In children with an acute attack of asthma, who had been treated with glucocorticoids (2 mg prednisolone/kg body weight for 2–4 days), distinct changes of relative FA composition of phospholipids were restricted to plasma, where some very long chain FA (224n–6, 225n–6) were elevated. No significant changes in FA from MNC phospholipids could be observed after glucocorticoid treatment. These findings may indicate a possible role of 205n–3, the precursor of group 3 eicosanoids, in allergic asthmatic children.     

Diagnostic laparoscopy with planned appendectomy: an integral step in the evaluation of unexplained right lower quadrant pain

Recurrent right lower quadrant (RLQ) abdominal pain is often difficult to diagnose and treat. We reviewed our experience with diagnostic laparoscopy with planned appendectomy for children with unexplained RLQ pain. This procedure was performed when the cause of atypical RLQ pain could not be diagnosed by comprehensive medical and radiological evaluation. Outcome data was obtained at office visits and by telephone. From 1997 to 2000, 30 children (22 female) presented with unexplained RLQ pain. Ages ranged from 5 to 16 years (mean 11 years). Symptoms had been present from 6 days to 2 years (median 6 weeks). Gross and/or histological appendiceal abnormalities were found in 26 children (87%). Incidental findings included patent processus vaginalis in one and adnexal cysts in six. Two complications occurred: pelvic fluid collection and umbilical suture reaction. At initial follow-up, 29 patients (97%) were pain-free. Long-term follow-up was continued through 2002. At a median of 19 months (range 2–47 months), 25 of 28 patients (89%) reported no recurrence of their original pain. Our results confirm that the appendix is an important source of unexplained recurrent RLQ pain in children. Diagnostic laparoscopy with planned appendectomy is highly effective and should be considered an integral step in the management of these patients.