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Until comparatively recently, children too young to verbalize were also considered too young to experience pain or fear, and they often received no analgesia, even after major surgery.

However, it is now known that even neonates show a physiologic response to painful stimuli.

These children typically require sedation even when other patients who are the same age may not.

External factors have as much, if not more, influence on a child’s behavior.

The American Academy of Pediatrics (AAP) and the American Academy of Pediatric Dentistry (AAPD) have issued updated clinical guidelines on the monitoring and management of pediatric patients before, during, and after sedation for diagnostic and therapeutic procedures.



Diagnostic procedures for which emergency department (ED) sedation may be indicated include the following: Discussion about the risks, benefits, and alternatives with the parent or guardian is necessary before initiation of procedural sedation.Recommendations for duration of NPO for solid food and nonclear liquids (eg, infant formula, milk) vary by age, as follows: The physical examination focuses on the airway, especially for anatomic variations.The use of the Mallampati classification for assessment helps identify patients in whom airway management is likely to prove difficult (see the image below).Various individual internal and external factors determine how a child responds to painful procedures and thus affect the decision whether to premedicate the child.

Individualized dosing and titratable agents are often necessary.

In addition, research has shown that children often do not receive the same treatment as adults with similar painful conditions.



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