Despite myriad job titles and descriptions, varying roles and role responsibilities, and a wide range of practice settings, every working day each of us cares for patients with neurologic and neurosurgical disorders. Our patients require care for degenerative, congenital, vascular, traumatic, and a host of other disorders and, whatever the pathogenesis and eventual outcome, have special, individually unique needs. Some of us, though, care for the smallest, youngest, and perhaps most vulnerable patients of all-children.
Pediatric neuroscience nursing provides the usual rewards of our profession, but these patients can often teach us more about the values of love and sacrifice as well. Children try our patience, and at the same time, they tug hard on our heartstrings. Garrison Keller has said that "Nothing you do for children is ever wasted. They seem not to notice us [horizontal ellipsis] and they seldom offer their thanks, but what we do for them is never wasted." The nervous system of a child is still plastic and can "recover" from injuries or illnesses that devastate an adult; physically, they bounce back to their normal baseline quickly; and, emotionally, children often demonstrate increased self-knowledge and empathy for others as a part of their experience with illness. As we care for them, we watch them play using make-believe, games, and imagination as coping mechanisms.
In this issue, authors focus our attention on these young patients as they address both fairly common and very rare pediatric neurologic and neurosurgical disorders. They tackle assessment issues, treatment modalities, the psychosocial needs of the children and their families, and the sometimes very difficult decision making that is a part of their care.
Chan and her colleagues provide an overview of pediatric migraine and, after a brief recap of diagnostics and typical treatment approaches, introduce us to the use of Botox as a possible new means of managing headache frequency, pain intensity, and pain duration. Although debate continues over its use, in this Canadian Headache Center teenagers have been treated safely and effectively with Botox. Their work supports that of U.S. researchers who are using the drug to treat other disorders in which pain receptor activation is a key component (Singer, 2009).
Shore and her research team report on their study of the psychosocial care needs of children with new-onset epilepsy and their parents. Their results tell us that a substantial number of the study population have unmet psychosocial care needs that negatively affect both children and their families and family life. As readers, we may be able to apply their findings to children with other chronic neurologic disorders and to examine the implications for the family as a whole.
Turkelson writes about polymicrogyria, a rare neuronal migrational defect disorder. Characterized by multiple small gyri, shallow sulci, and abnormal cortical layering, children with polymicrogyria are affected with a wide variation in findings that range from minor deficits to profound neurologic dysfunction. The author discusses the collaborative management essential for optimal outcomes for these children.
In her article, Cohen reports on a study designed to compare the interrater reliability and predictive validity of the FOUR score tool and the Glasgow Coma Scale in pediatric patients. Originally designed for use in unresponsive adults and validated in that population, this study demonstrated that the assessment tool could be used reliably in children as well. As a result, the reader will have a new tool available to support best practice in the pediatric population.
Duffy explores the ethical dilemmas we and parents often face when trying to make treatment decisions for a neurologically impaired child. She argues that pediatric neurology is a specialty area in which extremely rare disorders are seen with relative frequency. She examines decision-making practices that support nurses as they advocate for the importance of parental involvement in the process.
Finally, Fumiyo and her colleagues report the results of a Japanese study focused on the mother-son dyad in cases in which the son has experienced a traumatic brain injury. The data from this qualitative study outlined the psychosocial adjustment process of mothers for 5 years following the child's injury and supported their hypothesis that both mother and son need social rehabilitation.
Whether you care for only adults, only children, or some combination of both, this issue may prompt you to think differently about what it means to care for our youngest neuroscience patients. It may also prompt you to become involved in some small way in their lives. Become a volunteer, support pediatric neuroscience research, read a bit more about pediatric disorders and pediatric nursing care, or simply, hug a child.
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