Improving comfort in children with severe neurological impairment

Physical discomfort is a frequent and significant problem for children with severe neurological impairment (SNI) of the central nervous system. Such children have various problems that can result in discomfort, including spasticity, muscle spasms, and autonomic dysfunction. Children with SNI also have a significant rate of pain, and pain can trigger and worsen these other problems. It can seem a daunting task to determine the primary cause of discomfort given the overlap in features seen with each problem. There is the added challenge of a non-verbal population unable to indicate symptoms. Knowledge of sources of discomfort can help guide a step-wise approach to empiric treatment. The goal of this article is to provide an evidence-based framework for approaching symptom treatment in a population vulnerable to under-recognition and under-treatment of discomfort. Interventions include integrative therapies and medications, such as gabapentinoids, tricyclic antidepressants, alpha-agonists, and opioids including methadone. Awareness of potential sources of discomfort in children with SNI and the interventions available will expand our ability to improve comfort in this vulnerable group of children.