Odynophagia - Paediatric Palliative Care
Description General and supportive measures Medication and treatment ICD-10 code: R13 DESCRIPTION Pain that arises from the oropharynx and/or pain with swallowing. Not only does it lead to irritability and discomfort but can affect intake of feeds and medication. May be an unrecognised source of pain in neurologically impaired non-verbal children. GENERAL AND SUPPORTIVE MEASURES Perform a t
General and supportive measures
ICD-10 code: R13
DESCRIPTION
Pain that arises from the oropharynx and/or pain with swallowing. Not only does it lead to irritability and discomfort but can affect intake of feeds and medication. May be an unrecognised source of pain in neurologically impaired non-verbal children.
GENERAL AND SUPPORTIVE MEASURES
Perform a thorough examination to determine and treat the underlying cause where possible:
- Uncomplicated gingivitis (see: Gingivitis, Uncomplicated).
- Necrotising periodontitis (see: Necrotising Periodontitis).
- Aphthous ulcers (see: Aphthous Ulcers).
- Herpes gingivostomatitis (see: Herpes Gingivostomatitis).
- Stevens-Johnson Syndrome (see: Stevens-Johnson Syndrome (SJS)/ Toxic Epidermal Necrosis (TEN)).
- Candidiasis oral (see: Candidiasis, Systemic and Other).
- Mucositis (secondary to chemo or radiotherapy).
Xerostomia (dry mouth) is also common in palliative care patients and can cause significant discomfort. This is especially prevalent in children who are not taking in orally, are being fed via NGT or feeding gastrostomy, cannot close their mouths and/or are receiving anti-cholinergic medications. Xerostomia is common in children with prolonged hospitalisation with poor attention to oral hygiene. In severe cases the tongue may stick to the roof of the mouth causing pain and bleeding when pried away.
Prevent xerostomia with good oral nursing care and brushing of teeth with a soft toothbrush and fluoride containing toothpaste.
Place ice-chips in mouth to prevent xerostomia and keep lips moist with white soft paraffin.
In children who are feeding orally but where pain is preventing sufficient oral intake, rehydration and/or temporary feeding via naso-gastric tube may be needed (if appropriate: see: End of life and Terminal care) while oral lesions heal.
Avoid hot, spicy or acidic food and carbonated drinks in older children still able to swallow and change to soft or puréed diet until condition improves.
Drink through a straw to bypass the mouth.
MEDICATION AND TREATMENT
- Regular washes (2–4 times a day) with chlorhexidine 0.2% mouthwash.
- Paracetamol oral (or per NGT) or PR 15 mg/kg/dose 6 hourly.
- In severe cases of mucositis, oral or even IV morphine may be necessary. (See: Pain Control.)
Standard Treatment Guidelines And Essential Medicines List For South Africa, Hospital Level, Paediatrics, 2023 Edition
Chapter: 21. Palliative Care, 21.1 Symptom Control, 21.1.1 Gastro-intestinal Symptoms, 21.1.1.1 Odynophagia