Raised intracranial pressure

• See section on raised intracranial pressure

Mucositis

• See section on mouth care

Tumour pain

• Treatment directed at the tumour (chemotherapy, radiotherapy) may relieve pain in the longer term, but there may be a time delay before pain reduces: it is therefore important to treat the pain in the meantime.
• See main pain section

Painful procedures

• If a procedure is likely to cause discomfort take preventative action!
• Explain all procedures to the child and their parent/carers to reduce anxiety
• Undertake procedures in a child friendly surroundings
• Have parents/carers or the nurse who knows the child best present.
• Use anaesthetic creams and distraction techniques as appropriate to the age of the child. Consider local or general anaesthetic where appropriate
• Benzodiazepines are often employed in small doses in conjunction with analgesia for more difficult procedures e.g. midazolam given buccally, i/v, or intranasally gives light sedation and some amnesia
  - see section on agitation for doses. Inhaled nitrous oxide has analgesic and amnesic properties (not sedating), and is useful in co- operative children over 5 yrs
• Play therapy may be very useful is distracting a child during a procedure