Psychosocial management of fear of needles in children

Abstract

with a prefactor VIII infusion activity of 25% and a 2 h postinfusion activity of 71% after receiving 50 u kg )1 . The Bethesda titre for the inhibitor was 0.9 units at this time. The most recent factor activity has dropped to 19% at 9 months. The patient has not had any bleeds post-transplantation, however. Conclusions: 1. An inhibitor patient on long-term immune tolerance underwent successful orthotopic liver transplantation with initial normalization of factor VIII activity. 2. Beginning 2 months after OLT and continuing to the present, factor VIII activity gradually decreased associated with detection of a low titre recurrent factor VIII inhibitor. Synthesis of factor VIII by the donor liver is not sufficient for total suppression of the long-standing inhibitor.Background: Recent studies have shown that children with severe haemophilia could have moderately reduced bone density compared with gender-and age-matched control subjects. Patients with more established changes resulting from haemophilic joint disease exhibited the lowest bone mineral density. The reason for this includes factors such as lack of weight-bearing physical activity, lower height and weight reached by these patients, muscle atrophy and hepatitis C seropositivity. A lower peak bone density reached during late adolescence and young adulthood predisposes to the development of osteoporosis in the later years. Objective: While Vitamin D and calcium supplementation has been recommended by many authors for haemophiliacs, there are no studies looking at Vitamin D levels in these patients. The aim of this study was to evaluate for the prevalence of Vitamin D deficiency and the need for supplementation in the haemophiliac patients in our centre. Methods: The 25-hydroxy Vitamin D3 (25-OH D3), calcium, phosphorus and PTH levels were measured in patients between the ages of 1-18 years during their regular visits to the haemophilia centre. A 25-OH D3 level of >30ng mL )1 is considered as adequate, levels of 21-29 ng mL )1 indicates a relative insufficiency and a level <20ng mL )1 is defined by most experts as being absolutely Vitamin D deficient. Results: Of the 33 patients, 21 of them were Vitamin D deficient (63.6%). Calcium, phosphorus and PTH levels did not correlate with Vitamin D levels.Conclusions: Vitamin D deficiency is highly prevalent in patients with haemophilia in our centre, and given their propensity to develop osteopenia, Vitamin D supplementation is essential in this group of patients. As the calcium, phosphorus and PTH level do not correlate with Vitamin D levels, evaluation of Vitamin D deficiency needs the measurement of serum 25-hydroxy D3 level. The reasons for a deficiency of Vitamin D in these patients, the amount of supplementation needed and the effect of supplementation of Vitamin D on attaining the peak bone mass density of these patients need to be explored further. Vitamin D status in patients with haemophilia (25-OH D3 level)

Specialist hospital treatment and care as reported by children with intellectual disabilities and a cleft lip and/or palate, their parents and healthcare professionals

“…Additional ways of managing GA induction are soft lighting and distraction (Courtman & Mumby, ), sensory solutions (e.g. guided imagery and relaxation) (Fung, ) in addition to music, computer games and hypnotherapy; restraint should only be considered after exhausting other approaches (Christiansen & Chambers, ). These examples pre‐date the current research so it is apparent that HCPs in this research were unaware of this good practice.…”

Needle Fear and Threat in Children

“…The psychological ways of minimizing pain include hypnosis (20), use of microneedles (6), postural techniques (21), or distraction methods (22).…”

Needle Fear and Threat in Children

“…The psychological ways of minimizing pain include hypnosis (20), use of microneedles (6), postural techniques (21), or distraction methods (22).…”