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Analgesia

Analgesia is important and often necessary to enable the child to be further assessed, and before the diagnosis is clear.

Important points;

  • Many drugs used in adults are not licensed for use in children.
  • The doses are calculated by age / weight and body surface area (BSA) of the child.
  • Formulations are variable - young children may prefer liquid medicines / syrup BUT do be aware of the alternative of SUGAR FREE options, if available, to reduce the risk of caries if there is likely to be prolonged use of NSAIDS. 
  • NSAIDS are not disease modifying but are useful in the short term for symptom relief.
  • Aspirin is very useful to treat the arthritis of Acute Rheumatic Fever 
  • High Dose Aspirin is important to treat Kawasaki Disease and helps to reduce aneurysm formation.

NSAIDs act by inhibiting enzymes (cyclo-oxygenase-1 (COX-1) and COX-2) involved in prostaglandin synthesis resulting in analgesic, anti-inflammatory, and antipyretic effects.

There are two broad groups of NSAIDs—the older, traditional, non-selective NSAIDs (e.g. ibuprofen, naproxen, aspirin) that inhibit both COX-1 and COX-2 and the newer, selective COX-2 inhibitors that predominantly inhibit COX-2 (e.g. celecoxib). The clinical effects of NSAIDs depend largely on their selectivity for these enzymes. The non-selective group acting widely resulting in varying degrees of analgesic, anti-inflammatory and anti-pyretic and anti-platelet effects, where as the selective group has less gastrointestinal tract side effects.

NSAIDS may provide some symptom relief initially from their anti-inflammatory effect although they are not disease modifying and do not prevent joint damage in Juvenile Idiopathic Arthritis. Aspirin is very useful to treat the arthritis of Acute Rheumatic Fever and children often respond to a single dose !
High Dose Aspirin is important to treat Kawasaki Disease and helps to reduce aneurysm formation.

The photograph below shows caries from chronic use of NSAIDS in syrup form 

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