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User can click on icon to access the healthcare worker resources page.",{"edges":549},[550,553,556,558,561,564,567,570,573,575,578,581,584,587,589,591,593,595,597,600,603,606,609,611,613,615,618,620,623,626,628,630,632,635,638,640,643,646,648,650,653,656,659,662,665,667,669,671],{"node":551},{"name":552},"Procedural Anxiety and Fear",{"node":554},{"name":555},"Measles",{"node":557},{"name":172},{"node":559},{"name":560},"Agitation",{"node":562},{"name":563},"Anxiety",{"node":565},{"name":566},"Iron Deficiency Anemia",{"node":568},{"name":569},"Influenza",{"node":571},{"name":572},"Advanced Life Support",{"node":574},{"name":53},{"node":576},{"name":577},"Migraine",{"node":579},{"name":580},"Abdominal Pain",{"node":582},{"name":583},"Pneumonia (Community Acquired)",{"node":585},{"name":586},"Chronic Pain",{"node":588},{"name":61},{"node":590},{"name":69},{"node":592},{"name":76},{"node":594},{"name":83},{"node":596},{"name":90},{"node":598},{"name":599},"COVID-19",{"node":601},{"name":602},"Cannabis",{"node":604},{"name":605},"Developmental and Intellectual Disabilities",{"node":607},{"name":608},"Child Abuse",{"node":610},{"name":97},{"node":612},{"name":104},{"node":614},{"name":111},{"node":616},{"name":617},"Critically Ill Neonate",{"node":619},{"name":119},{"node":621},{"name":622},"Eating Disorders",{"node":624},{"name":625},"Febrile Seizures",{"node":627},{"name":126},{"node":629},{"name":133},{"node":631},{"name":141},{"node":633},{"name":634},"Hand Foot and Mouth",{"node":636},{"name":637},"High Flow Nasal Cannula",{"node":639},{"name":148},{"node":641},{"name":642},"Meningitis",{"node":644},{"name":645},"Mental Health Self Assessment Tool",{"node":647},{"name":156},{"node":649},{"name":164},{"node":651},{"name":652},"Procedural Pain",{"node":654},{"name":655},"Procedural Sedation",{"node":657},{"name":658},"Sepsis",{"node":660},{"name":661},"Severe Head Injury",{"node":663},{"name":664},"Sickle Cell Disease",{"node":666},{"name":180},{"node":668},{"name":188},{"node":670},{"name":196},{"node":672},{"name":673},"Visiting the Emergency Department",{"debug":675,"queryAnalyzer":676},[],{"keys":677,"keysLength":678,"keysCount":679,"skippedKeys":680,"skippedKeysSize":681,"skippedKeysCount":681,"skippedTypes":682},"6d6b3d1b2eca580f2aae3985d71dc00ef8fba31240f69e3257cf81d43dbf639a graphql:Query list:menuitem list:audience list:topic cG9zdDoxODY4 cG9zdDo0ODU5 cG9zdDoxNjQ= cG9zdDo5NDc= cG9zdDoxNjA= cG9zdDo0NzAz cG9zdDoxNjE= cG9zdDoxNjM= cG9zdDoyMDE= cG9zdDoyMDI= cG9zdDoyMDM= cG9zdDoyMDU= cG9zdDoyMDY= cG9zdDoyMDg= cG9zdDoyNzkx cG9zdDoyMDk= cG9zdDoyMTA= cG9zdDoyNzky cG9zdDoyMTE= cG9zdDoyNzk2 cG9zdDoyNzkz cG9zdDo0NzA0 cG9zdDoyNzk3 cG9zdDoyNzk0 cG9zdDoyNzk1 cG9zdDoxOTE= cG9zdDoxOTI= cG9zdDoxOTY= cG9zdDoxOTU= cG9zdDoxOTQ= cG9zdDoxOTM= cG9zdDoxMjY= cG9zdDoxMjU= cG9zdDoxOTc= cG9zdDoxOTg= cG9zdDoxOTk= cG9zdDoyMDA= dGVybToxMDg= dGVybToyMA== dGVybTo0ODE= dGVybTo0NzY= dGVybTo0Njk= dGVybTo0NDc= dGVybTo0NTQ= dGVybTo0NTg= dGVybTo0NjE= dGVybTo0NjM= dGVybTo0NjQ= dGVybTo0NzE= dGVybTo0NzI= dGVybTo0MzI= dGVybTo0MzQ= dGVybToyMg== dGVybToyNQ== dGVybToyNw== dGVybToyOA== dGVybTozMA== dGVybTozNQ== dGVybTozMQ== dGVybTozMg== dGVybTo1OQ== dGVybTozMw== dGVybTozNA== dGVybTozNw== dGVybTozNg== dGVybTozOA== dGVybTo0MjE= dGVybToxMTQ= dGVybTo0MA== dGVybTo0MQ== dGVybTo0Mg== dGVybTo2MQ== dGVybToxMTA= dGVybTo0NA== dGVybTo0Ng== dGVybToxMDU= dGVybTo0Nw== dGVybTo0OA== dGVybTo1MQ== dGVybTo1Mg== dGVybTo1NA== dGVybTo1NQ== dGVybTo1Ng== dGVybTo1Nw== dGVybTo1OA== dGVybTo2MA== dGVybToxMDM= cG9zdDoyMzc3 cG9zdDoyMzc1",1274,94,"",0,[],{"data":684,"extensions":1051},{"topics":685},{"edges":686},[687,696,702,709,717,725,733,739,745,751,759,765,773,778,786,794,802,810,818,825,833,841,849,857,865,873,881,889,897,905,913,921,928,936,943,951,959,967,974,981,989,997,1005,1013,1021,1028,1035,1043],{"cursor":688,"node":689},"YXJyYXljb25uZWN0aW9uOjQ4MQ==",{"name":552,"slug":690,"description":691,"translations":692},"procedural-fear-and-anxiety","Anxiety and fears about medical procedures are common in children/youth: two-thirds report needle fear and 10% report needle phobia. Addressing this anxiety/fear is critical, as up to half of children seen in the Emergency Department undergo painful procedures (e.g., IVs, blood tests, catheterizations, wound repair). Procedural pain is complex, involving both physical pain and anxiety/fear. Inadequate management of either increases future anxiety and can lead to healthcare avoidance that persists into adulthood. Managing both improves procedural success and optimizes future care. ",[693],{"languageCode":694,"slug":695},"fr","peur-et-anxiete-procedurale",{"cursor":697,"node":698},"YXJyYXljb25uZWN0aW9uOjQ3Ng==",{"name":555,"slug":699,"description":700,"translations":701},"measles","Measles is a single stranded, enveloped RNA virus belonging to the Morbillivirus genus in the Paramyxoviridae family. The virus can cause a measles infection which starts in the respiratory epithelium of the nasopharynx. Measles is highly contagious.\r\n\r\nMore information coming soon. ",[],{"cursor":703,"node":704},"YXJyYXljb25uZWN0aW9uOjQ2OQ==",{"name":172,"slug":705,"description":171,"translations":706},"respiratory-distress",[707],{"languageCode":694,"slug":708},"detresse-respiratoire-fr",{"cursor":710,"node":711},"YXJyYXljb25uZWN0aW9uOjQ0Nw==",{"name":560,"slug":712,"description":713,"translations":714},"agitation","A clinical tool to guide decision-making when caring for agitated pediatric patients in emergency settings.",[715],{"languageCode":694,"slug":716},"prise-en-charge-du-patient-agite",{"cursor":718,"node":719},"YXJyYXljb25uZWN0aW9uOjQ1NA==",{"name":563,"slug":720,"description":721,"translations":722},"anxiety","Anxiety is a normal emotional and physiological response to uncomfortable, novel or frightening situations. During an emergency department (ED) visit, anxiety can be experienced by any child or adolescent as well as by their caregivers. It may be the primary reason for the visit or develop during assessments, procedures, or investigations. \r\nHow individuals experience anxiety during an ED visit can vary. Approaches to recognize, assess and manage anxiety need to be patient- and family-centred.\r\n",[723],{"languageCode":694,"slug":724},"anxiete",{"cursor":726,"node":727},"YXJyYXljb25uZWN0aW9uOjQ1OA==",{"name":566,"slug":728,"description":729,"translations":730},"iron-deficiency-anemia","Iron deficiency anemia (IDA) is most commonly found in toddlers and adolescents. A primary diagnosis should be identified to explain insufficient intake or excessive loss of iron. The treatment for IDA is supplemental iron. Blood transfusion is restricted to emergency management of patients with hemodynamic instability. ",[731],{"languageCode":694,"slug":732},"iron-deficiency-anemia-fr",{"cursor":734,"node":735},"YXJyYXljb25uZWN0aW9uOjQ2MQ==",{"name":569,"slug":736,"description":737,"translations":738},"influenza","Resources to support informed decision-making in the care of pediatric patients with influenza in emergency settings.",[],{"cursor":740,"node":741},"YXJyYXljb25uZWN0aW9uOjQ2Mw==",{"name":572,"slug":742,"description":743,"translations":744},"advanced-life-support","Pediatric Advanced Life Support (PALS) is a set of clinical guidelines and techniques used to provide emergency care to infants and children experiencing life-threatening medical conditions, such as cardiac arrest, respiratory failure, or shock. It focuses on rapid assessment, early intervention, and the use of advanced airway management, medications, and defibrillation to stabilize and resuscitate pediatric patients. ",[],{"cursor":746,"node":747},"YXJyYXljb25uZWN0aW9uOjQ2NA==",{"name":53,"slug":748,"description":749,"translations":750},"education-session","The tool provides access to all the  TREKK and University of Manitoba's virtual education session videos.",[],{"cursor":752,"node":753},"YXJyYXljb25uZWN0aW9uOjQ3MQ==",{"name":577,"slug":754,"description":755,"translations":756},"migraine","Migraine accounts for up to 30% of pediatric Emergency Department (ED) visits for headache and results in frequent ED revisits. The average age of onset is 7 years in boys and 9 years in girls. Migraine is more common in girls by adolescence. Evidence for ED management of acute migraine attacks in children and adolescents is limited, resulting in significant practice variation.",[757],{"languageCode":694,"slug":758},"migraine-fr",{"cursor":760,"node":761},"YXJyYXljb25uZWN0aW9uOjQ3Mg==",{"name":580,"slug":762,"description":763,"translations":764},"abdominal-pain","Abdominal pain is a common complaint in children, often leading to visits to the emergency department (ED). It can be caused by various conditions, ranging from mild issues like constipation or gas to more serious concerns such as infections or gastrointestinal conditions. Children may experience abdominal pain differently, with younger children having difficulty describing their discomfort. Recognizing, assessing, and managing abdominal pain requires a patient- and family-centred approach to address both the physical and emotional aspects of care.",[],{"cursor":766,"node":767},"YXJyYXljb25uZWN0aW9uOjQzMg==",{"name":583,"slug":768,"description":769,"translations":770},"pneumonia","Viruses are the leading cause of pneumonia in healthy young children, followed by bacteria and rarely, other organisms. These resources focus on uncomplicated community acquired pneumonia (CAP).",[771],{"languageCode":694,"slug":772},"pneumonie",{"cursor":774,"node":775},"YXJyYXljb25uZWN0aW9uOjQzNA==",{"name":586,"slug":776,"description":14,"translations":777},"chronic-pain",[],{"cursor":779,"node":780},"YXJyYXljb25uZWN0aW9uOjIy",{"name":61,"slug":781,"description":782,"translations":783},"aom","Acute Otitis Media (AOM) is common in children under 5 years of age and is often a self-limited illness lasting several days. The mainstay of AOM management is symptom/pain control. In some cases, AOM can be more prolonged or severe and requires antibiotic treatment.",[784],{"languageCode":694,"slug":785},"aom-fr",{"cursor":787,"node":788},"YXJyYXljb25uZWN0aW9uOjI1",{"name":69,"slug":789,"description":790,"translations":791},"anaphylaxis","Anaphylaxis is a serious systemic hypersensitivity reaction that is rapid in onset and can be fatal. The highest incidence of anaphylaxis is in children and youth. The three principal triggers of anaphylaxis are foods, insect stings, and drugs. In Canada, there is an Emergency Department (ED) visit for food allergy approximately every 10 minutes, and up to 80% of anaphylactic reactions in children are triggered by foods such as peanuts, tree nuts, and milk.",[792],{"languageCode":694,"slug":793},"anaphylaxis-fr",{"cursor":795,"node":796},"YXJyYXljb25uZWN0aW9uOjI3",{"name":76,"slug":797,"description":798,"translations":799},"asthma","Approximately one-third of children with asthma presenting to the emergency department (ED) have moderate respiratory distress, and less than 5% will have a severe exacerbation. There are some differences between provincial asthma pathways with regards to PRAM scores and treatment. ",[800],{"languageCode":694,"slug":801},"asthme",{"cursor":803,"node":804},"YXJyYXljb25uZWN0aW9uOjI4",{"name":83,"slug":805,"description":806,"translations":807},"bronchiolitis","Bronchiolitis is a common viral illness. It is most commonly caused by respiratory syncytial virus and typically occurs over the late fall and winter months. Children less than 2 years of age are most commonly affected, with the largest burden of illness being in children less than 12 months of age.",[808],{"languageCode":694,"slug":809},"bronchiolitis-fr",{"cursor":811,"node":812},"YXJyYXljb25uZWN0aW9uOjMw",{"name":90,"slug":813,"description":814,"translations":815},"burns","Burns are a leading cause of unintentional injury and death in children, with the vast majority of cases occurring in the home. Regardless of the burn depth or extent, these injuries can have significant long-term functional, aesthetic, and psychological consequences for the child.",[816],{"languageCode":694,"slug":817},"burns-fr",{"cursor":819,"node":820},"YXJyYXljb25uZWN0aW9uOjM1",{"name":599,"slug":821,"description":14,"translations":822},"covid-19",[823],{"languageCode":694,"slug":824},"covid-19-fr",{"cursor":826,"node":827},"YXJyYXljb25uZWN0aW9uOjMx",{"name":602,"slug":828,"description":829,"translations":830},"cannabis-intoxication","Cannabis contains two well known components, Delta-9 Tetrahydrocannabinol (Δ-9-THC) and Cannabidiol (CBD). The psychoactive properties of cannabis are typically attributed to Δ-9-THC, which is present in variable concentrations dependent on the strain, and absorbed at variable rates dependent on the mode of ingestion. Acute intoxication is rare from cannabidiol (CBD) products unless given in excess or with high THC:CBD ratio. Since Canadian legalization of cannabis for adults, there has been an increasing rate of hospitalization for cannabis exposures in children 14 years and younger.",[831],{"languageCode":694,"slug":832},"cannabis-intoxication-fr",{"cursor":834,"node":835},"YXJyYXljb25uZWN0aW9uOjMy",{"name":605,"slug":836,"description":837,"translations":838},"developmental-and-intellectual-disabilities","Children and youth with developmental or intellectual delays/disorders (DD) use Emergency Department (ED) 1.8 times more frequently than the general pediatric population. This population of patients includes those with autism spectrum disorder (ASD), fetal alcohol spectrum disorder (FASD), or other conditions. This document provides recommendations for the medical approach to these patients to assist in optimizing care.",[839],{"languageCode":694,"slug":840},"caring-for-children-with-developmental-and-intellectual-disabilities-fr",{"cursor":842,"node":843},"YXJyYXljb25uZWN0aW9uOjU5",{"name":608,"slug":844,"description":845,"translations":846},"child-abuse","Children under 3 years of age are at highest risk for serious injuries from abuse. Being alert to findings that suggest abuse will improve early recognition and prevent recurrent, escalating abuse. The extent of the workup performed in the emergency department will vary based on geography, acuity of injury, and services available. Early consultation with a Pediatric Referral Centre or child protection team is recommended.",[847],{"languageCode":694,"slug":848},"child-abuse-fr",{"cursor":850,"node":851},"YXJyYXljb25uZWN0aW9uOjMz",{"name":97,"slug":852,"description":853,"translations":854},"concussion","Concussion is a traumatic brain injury resulting from acceleration/deceleration forces from a direct blow to the head, face, neck or elsewhere on the body with an 'impulsive' force transmitted to the head. Loss of consciousness and amnesia are not required to make the diagnosis.",[855],{"languageCode":694,"slug":856},"concussion-fr",{"cursor":858,"node":859},"YXJyYXljb25uZWN0aW9uOjM0",{"name":104,"slug":860,"description":861,"translations":862},"constipation","Children with functional constipation (FC) often present to the ED with impaction or colicky abdominal pain. The prevalence of FC in infants and toddlers is approximately 20%. While organic causes are responsible for less than 5% of constipation in children, FC may mimic surgical causes of abdominal pain, such as appendicitis, intussusception and bowel obstruction, thus a careful assessment is required before making this diagnosis.",[863],{"languageCode":694,"slug":864},"constipation-fr",{"cursor":866,"node":867},"YXJyYXljb25uZWN0aW9uOjM3",{"name":111,"slug":868,"description":869,"translations":870},"croup","Croup is the most common cause of upper airway obstruction in children. It is characterized by acute onset of barky cough +/- stridor. The typical age of presentation is between 6 months and 5 years with a peak around 2 years. Consider other causes of upper airway obstruction such as bacterial tracheitis, epiglottitis and retropharyngeal abscess in children presenting with severe symptoms and a transient or lack of response to croup treatment.",[871],{"languageCode":694,"slug":872},"croup-fr",{"cursor":874,"node":875},"YXJyYXljb25uZWN0aW9uOjM2",{"name":617,"slug":876,"description":877,"translations":878},"critically-ill-neonate","A clinical tool to guide decision-making when caring for critically ill pediatric patients in emergency settings. \r\nUse in infants 0-28 days. At birth, refer to NRP guidelines. Not intended for preterm infants less than 37 weeks",[879],{"languageCode":694,"slug":880},"critically-ill-neonate-fr",{"cursor":882,"node":883},"YXJyYXljb25uZWN0aW9uOjM4",{"name":119,"slug":884,"description":885,"translations":886},"dka","Diabetic ketoacidosis is a complication of new or existing pediatric diabetes and may be complicated by cerebral injury. Due to this risk, it is treated differently than adult DKA. Health care providers must follow a published pediatric-specific protocol when treating pediatric DKA. Early communication with the diabetes specialist at your pediatric referral site is a key element of the management of these patients. \r\n\r\nKey highlights include dehydration is a key component of DKA pathophysiology; all patients with DKA should receive a 20 ml/kg IV bolus of normal saline or Ringer's lactate over 20 minutes at the initiation of treatment, which can be repeated if the patient remains hypoperfused; ongoing fluids in DKA should be weight-based and account for the significant fluid deficit, with an increased maximum of 500 ml/hr; and every patient in DKA is at risk of cerebral injury before and during treatment, especially if DKA is more severe. Assess every patient with DKA for signs of cerebral injury and follow the TREKK DKA algorithm. \r\n\r\nIn June 2023, TREKK’s DKA resources have been updated to reflect the 2022 International Society for Pediatric and Adolescent Diabetes (ISPAD) guidelines.",[887],{"languageCode":694,"slug":888},"dka-fr",{"cursor":890,"node":891},"YXJyYXljb25uZWN0aW9uOjQyMQ==",{"name":622,"slug":892,"description":893,"translations":894},"eating-disorders","Eating disorders are complex biopsychosocial disorders with significant medical sequelae and a high mortality rate. They exist across diverse populations regardless of age, race, ethnicity, gender, sexual orientation, body habitus, and socioeconomic background. Over the past several years, eating disorder diagnoses have increased globally.",[895],{"languageCode":694,"slug":896},"troubles-alimentaires",{"cursor":898,"node":899},"YXJyYXljb25uZWN0aW9uOjExNA==",{"name":625,"slug":900,"description":901,"translations":902},"febrile-seizures","A febrile seizure is a convulsion accompanied by a fever or illness. The child usually has muscle twitching, jerking or stiffness for a few minutes. The child usually loses consciousness and it is common for the child’s eyes to roll upward. Most children are sleepy afterward and are not responsive to your voice.\r\n\r\nFebrile seizures are common. Between 2-5% of children will have at least one febrile seizure when they are between 6 months and 5 years old. This video will help you to understand what is happening to your child and will help prepare you for your medical visit.",[903],{"languageCode":694,"slug":904},"febrile-seizures-fr",{"cursor":906,"node":907},"YXJyYXljb25uZWN0aW9uOjQw",{"name":126,"slug":908,"description":909,"translations":910},"fever","Neonates (less than or equal to 28 days of age) and young infants (29-60 days of age) with fever account for a significant number of emergency department (ED) visits. At this age, there is an increased risk of urinary tract infections and invasive bacterial infections (IBIs), specifically bacteremia and bacterial meningitis. Most febrile young infants have self-limited viral illnesses, however up to 2-3% harbour life-threatening IBIs. Clinical examination can be unreliable in determining the source or severity of infection. The difficulty lies in differentiating the infant with IBIs from those without, while minimizing the risks of over-investigations. Additionally, infants with IBIs are at risk of poor outcomes if not diagnosed and treated promptly.",[911],{"languageCode":694,"slug":912},"fever-fr",{"cursor":914,"node":915},"YXJyYXljb25uZWN0aW9uOjQx",{"name":133,"slug":916,"description":917,"translations":918},"fractures","Children break bones more easily than adults - so pediatric fractures are very common. There are several unique features of the pediatric musculoskeletal system that need to be considered in management decisions of all of these injuries - growth plates, plasticity, callus formation, remodeling potential, and partial breaks are some of the key ones. Recognition and appropriate management of pediatric fractures by ED providers is critical. While some common minor wrist and ankle fractures can be treated with a less conservative approach encouraging an early return to activities, other fractures if not treated properly can result in long term functional problems for the child and/or be a sign of child maltreatment.",[919],{"languageCode":694,"slug":920},"fractures-fr",{"cursor":922,"node":923},"YXJyYXljb25uZWN0aW9uOjQy",{"name":141,"slug":924,"description":140,"translations":925},"gastroenteritis",[926],{"languageCode":694,"slug":927},"gastroenteritis-fr",{"cursor":929,"node":930},"YXJyYXljb25uZWN0aW9uOjYx",{"name":634,"slug":931,"description":932,"translations":933},"hand-foot-mouth","Hand-foot-mouth disease or coxsackie is a common viral illness that most children get at some point that can cause symptoms including fever, rash, spots in the mouth and decreased feeding. This short video will help you to understand what to expect when your child has coxsackie and how you can care for them.",[934],{"languageCode":694,"slug":935},"hand-foot-mouth-fr",{"cursor":937,"node":938},"YXJyYXljb25uZWN0aW9uOjExMA==",{"name":637,"slug":939,"description":14,"translations":940},"high-flow-nasal-cannula",[941],{"languageCode":694,"slug":942},"high-flow-nasal-cannula-fr",{"cursor":944,"node":945},"YXJyYXljb25uZWN0aW9uOjQ0",{"name":148,"slug":946,"description":947,"translations":948},"intussusception","Intussusception is invagination of the intestine into an adjacent segment, most commonly involving the ileocecal valve. This process occludes blood supply to the bowel and can progress from tissue ischemia to necrosis/perforation. It is most likely to be idiopathic, but can be caused by a variety of pathological lead points.",[949],{"languageCode":694,"slug":950},"intussusception-fr",{"cursor":952,"node":953},"YXJyYXljb25uZWN0aW9uOjQ2",{"name":642,"slug":954,"description":955,"translations":956},"meningitis","Most cases of childhood meningitis are caused by an enterovirus. Bacterial meningitis is less common, with 90% of cases occurring in children less than 5 years of age. Bacterial meningitis has a mortality rate of 20% in infants and 2% in children; neurologic sequalae occur in approximately one-third of children who survive their infection. Early diagnosis and treatment of bacterial meningitis is associated with better outcomes. Viral meningitis is a diagnosis of exclusion.",[957],{"languageCode":694,"slug":958},"meningitis-fr",{"cursor":960,"node":961},"YXJyYXljb25uZWN0aW9uOjEwNQ==",{"name":645,"slug":962,"description":963,"translations":964},"mental-health-self-assessment-tool","On this page, you will find evidence-based tools and information surrounding pediatric mental health concerns. The information provided on TREKK.ca is designed to complement, not replace, the relationship between a patient and their own physician or healthcare provider.",[965],{"languageCode":694,"slug":966},"mental-health-self-assessment-tool-fr",{"cursor":968,"node":969},"YXJyYXljb25uZWN0aW9uOjQ3",{"name":156,"slug":970,"description":155,"translations":971},"multisystem-trauma",[972],{"languageCode":694,"slug":973},"multisystem-trauma-fr",{"cursor":975,"node":976},"YXJyYXljb25uZWN0aW9uOjQ4",{"name":164,"slug":977,"description":163,"translations":978},"pain-treatment",[979],{"languageCode":694,"slug":980},"pain-treatment-fr",{"cursor":982,"node":983},"YXJyYXljb25uZWN0aW9uOjUx",{"name":652,"slug":984,"description":985,"translations":986},"procedural-pain","Common medical procedures used to assess and treat children can cause significant pain and distress. Untreated pain has short-term (pain and distress for the child, caregivers, and healthcare providers; prolonged procedure time; slower healing) and long-term consequences (increased sensitivity to pain; avoidance of healthcare settings; needle phobia, higher levels of anxiety before a procedure). Timely and effective multi-modal pain care improves procedure success rates, prevents the need for repeated attempts, improves patient flow, and improves patient and caregiver satisfaction. Before initiating any procedure: consider whether it is truly necessary, batch procedures together, optimize pain management, and engage caregivers in planning/decision-making. ",[987],{"languageCode":694,"slug":988},"procedural-pain-fr",{"cursor":990,"node":991},"YXJyYXljb25uZWN0aW9uOjUy",{"name":655,"slug":992,"description":993,"translations":994},"procedural-sedation","A brief summary of current knowledge needed to perform safe and effective procedural sedation in children.",[995],{"languageCode":694,"slug":996},"procedural-sedation-fr",{"cursor":998,"node":999},"YXJyYXljb25uZWN0aW9uOjU0",{"name":658,"slug":1000,"description":1001,"translations":1002},"sepsis","Sepsis is a systemic response to infection; it is a leading cause of morbidity and mortality worldwide. Early recognition, aggressive resuscitation (fluids, metabolic correction, antibiotics) and escalation of care (vasoactive medications) are key to improving patient outcomes.",[1003],{"languageCode":694,"slug":1004},"sepsis-fr",{"cursor":1006,"node":1007},"YXJyYXljb25uZWN0aW9uOjU1",{"name":661,"slug":1008,"description":1009,"translations":1010},"severe-head-injury","Head trauma is considered severe in a child with a Glasgow Coma Scale (GCS) score of ≤ 8. These children often have intracranial injury identified on neuroimaging and all have suffered traumatic brain injury (TBI). Injury is the leading cause of death in children >1 year of age, and TBI is the most significant cause of death and disability across all ages.",[1011],{"languageCode":694,"slug":1012},"severe-head-injury-fr",{"cursor":1014,"node":1015},"YXJyYXljb25uZWN0aW9uOjU2",{"name":664,"slug":1016,"description":1017,"translations":1018},"scd","Sickle cell disease (SCD) is a genetic disorder of hemoglobin, in which sickling of red blood cells results in hemolysis and vasoocclusion. Newborn screening has led to early identification of SCD in many regions across Canada. While homozygous SCD (HbSS) is the most severe, other sickling syndromes (e.g., HbSC) may present similarly.",[1019],{"languageCode":694,"slug":1020},"scd-fr",{"cursor":1022,"node":1023},"YXJyYXljb25uZWN0aW9uOjU3",{"name":180,"slug":1024,"description":179,"translations":1025},"status-epilepticus",[1026],{"languageCode":694,"slug":1027},"status-epilepticus-fr",{"cursor":1029,"node":1030},"YXJyYXljb25uZWN0aW9uOjU4",{"name":188,"slug":1031,"description":187,"translations":1032},"suicidal-risk-screening-assessment",[1033],{"languageCode":694,"slug":1034},"suicidal-risk-screening-assessment-fr",{"cursor":1036,"node":1037},"YXJyYXljb25uZWN0aW9uOjYw",{"name":196,"slug":1038,"description":1039,"translations":1040},"uti","UTI is among the most common serious bacterial infections seen in infants and children. UTI with fever is indicative of an upper tract infection/pyelonephritis, as opposed to afebrile cystitis. It is important to diagnose and empirically treat febrile UTIs in infants and children, as delayed treatment may increase the risk of bacteremia. There are a number of risk factors associated with increased rates of UTI in young children such as age, gender and height of fever. ",[1041],{"languageCode":694,"slug":1042},"uti-fr",{"cursor":1044,"node":1045},"YXJyYXljb25uZWN0aW9uOjEwMw==",{"name":673,"slug":1046,"description":1047,"translations":1048},"visiting-ed","The Emergency Department (ED) is a place where people go for immediate care.\r\nVisiting the ED can be scary and overwhelming, especially when you don’t know what to expect. We hope these resources helps reduce stress and helps you prepare.\r\n",[1049],{"languageCode":694,"slug":1050},"visiting-ed-fr",{"debug":1052,"queryAnalyzer":1053},[],{"keys":1054,"keysLength":1055,"keysCount":1056,"skippedKeys":680,"skippedKeysSize":681,"skippedKeysCount":681,"skippedTypes":1057},"9ba504182e5375d8ee802ccd07f58575ad4f11b79a3c746ac62c55429115da0f graphql:Query list:topic dGVybTo0ODE= dGVybTo0NzY= dGVybTo0Njk= dGVybTo0NDc= dGVybTo0NTQ= dGVybTo0NTg= dGVybTo0NjE= dGVybTo0NjM= dGVybTo0NjQ= dGVybTo0NzE= dGVybTo0NzI= dGVybTo0MzI= dGVybTo0MzQ= dGVybToyMg== dGVybToyNQ== dGVybToyNw== dGVybToyOA== dGVybTozMA== dGVybTozNQ== dGVybTozMQ== dGVybTozMg== dGVybTo1OQ== dGVybTozMw== dGVybTozNA== dGVybTozNw== dGVybTozNg== dGVybTozOA== dGVybTo0MjE= dGVybToxMTQ= dGVybTo0MA== dGVybTo0MQ== dGVybTo0Mg== dGVybTo2MQ== dGVybToxMTA= dGVybTo0NA== dGVybTo0Ng== dGVybToxMDU= dGVybTo0Nw== dGVybTo0OA== dGVybTo1MQ== dGVybTo1Mg== dGVybTo1NA== dGVybTo1NQ== dGVybTo1Ng== dGVybTo1Nw== dGVybTo1OA== dGVybTo2MA== dGVybToxMDM=",713,51,[],{"data":1059,"extensions":1153},{"footer_1":1060,"footer_2":1078,"footer_3":1105,"footer_privacy":1118,"social":1125,"footer":1139},{"edges":1061},[1062,1067,1072],{"cursor":1063,"node":1064},"YXJyYXljb25uZWN0aW9uOjE2Ng==",{"label":29,"uri":31,"target":14,"menu":1065},{"node":1066},{"name":12},{"cursor":1068,"node":1069},"YXJyYXljb25uZWN0aW9uOjIwMzg=",{"label":36,"uri":38,"target":14,"menu":1070},{"node":1071},{"name":12},{"cursor":1073,"node":1074},"YXJyYXljb25uZWN0aW9uOjE2OA==",{"label":1075,"uri":13,"target":14,"menu":1076},"All Topics",{"node":1077},{"name":12},{"edges":1079},[1080,1085,1090,1095,1100],{"cursor":1081,"node":1082},"YXJyYXljb25uZWN0aW9uOjE2OQ==",{"label":441,"uri":435,"target":14,"menu":1083},{"node":1084},{"name":448},{"cursor":1086,"node":1087},"YXJyYXljb25uZWN0aW9uOjE3MA==",{"label":448,"uri":481,"target":14,"menu":1088},{"node":1089},{"name":448},{"cursor":1091,"node":1092},"YXJyYXljb25uZWN0aW9uOjE3MQ==",{"label":455,"uri":487,"target":14,"menu":1093},{"node":1094},{"name":448},{"cursor":1096,"node":1097},"YXJyYXljb25uZWN0aW9uOjE3Mg==",{"label":462,"uri":493,"target":14,"menu":1098},{"node":1099},{"name":448},{"cursor":1101,"node":1102},"YXJyYXljb25uZWN0aW9uOjIxMjk=",{"label":469,"uri":499,"target":14,"menu":1103},{"node":1104},{"name":448},{"edges":1106},[1107,1113],{"cursor":1108,"node":1109},"YXJyYXljb25uZWN0aW9uOjE3NA==",{"label":506,"uri":507,"target":14,"menu":1110},{"node":1111},{"name":1112},"Info",{"cursor":1114,"node":1115},"YXJyYXljb25uZWN0aW9uOjE3Mw==",{"label":510,"uri":511,"target":14,"menu":1116},{"node":1117},{"name":1112},{"edges":1119},[1120],{"cursor":1121,"node":1122},"YXJyYXljb25uZWN0aW9uOjE3NQ==",{"label":1123,"uri":1124,"target":14},"Terms of Use","/terms-of-use/",{"edges":1126},[1127,1130,1133,1136],{"cursor":1128,"node":1129},"YXJyYXljb25uZWN0aW9uOjE5Nw==",{"label":516,"url":517,"target":14},{"cursor":1131,"node":1132},"YXJyYXljb25uZWN0aW9uOjE5OA==",{"label":520,"url":521,"target":14},{"cursor":1134,"node":1135},"YXJyYXljb25uZWN0aW9uOjE5OQ==",{"label":524,"url":525,"target":14},{"cursor":1137,"node":1138},"YXJyYXljb25uZWN0aW9uOjIwMA==",{"label":528,"url":529,"target":14},{"optionsTheme":1140},{"newsletterTitle":1141,"newsletterTitleFr":1142,"newsletterDescription":1143,"newsletterDescriptionFr":1144,"newsletterUrl":1145,"newsletterUrlFr":1149,"landAcknowledgement":1151,"landAcknowledgementFr":1152},"Subscribe to our Newsletter","Abonnez-vous à notre bulletin d'information","When you subscribe to this e-update, new issues will be sent to your email address the moment they are published.","Lorsque vous vous abonnez à cette mise à jour électronique, les nouveaux numéros seront envoyés à votre adresse e-mail dès leur publication.",{"title":1146,"url":1147,"target":1148},"Subscribe","https://trekk.us16.list-manage.com/subscribe?u=31840b6f27d1074425db8898a&id=2c90e9e1a9","_blank",{"title":1150,"url":1147,"target":1148},"S'inscrire","\u003Cp>TREKK acknowledges that our network is situated on the unceded and ancestral territories of diverse Indigenous Peoples across Turtle Island. \u003C/p>\n\u003Cp>From coast to coast to coast, we respect and acknowledge Inuit, Métis, and First Nations Peoples as the traditional stewards of the lands we work and live on. For those of us who are settlers, we recognize that processes of colonization continue to impact Indigenous Peoples today. TREKK is committed to working toward cultural safety, decolonization, and reconciliation.\u003C/p>\n","\u003Cp>TREKK reconnaît que notre réseau est situé sur les territoires non cédés et ancestraux de divers peuples autochtones de l'Île de la Tortue.\u003C/p>\n\u003Cp>D’un océan à l’autre, nous respectons et reconnaissons les Inuits, les Métis et les Premières Nations en tant que gardiens traditionnels des terres sur lesquelles nous travaillons et vivons. Pour ceux d’entre nous qui sont des colons, nous reconnaissons que les processus de colonisation continuent d’avoir un impact sur les peuples autochtones aujourd’hui. TREKK s’engage à œuvrer en faveur de la sécurité culturelle, de la décolonisation et de la réconciliation.\u003C/p>\n",{"debug":1154,"queryAnalyzer":1155},[],{"keys":1156,"keysLength":1157,"keysCount":1158,"skippedKeys":680,"skippedKeysSize":681,"skippedKeysCount":681,"skippedTypes":1159},"d9a1e4a4227d63ecc282d2b69b4b64d07ba73e19765e9d47f113fdada604cd45 graphql:Query list:menuitem cG9zdDoxNjY= cG9zdDoyMDM4 cG9zdDoxNjg= cG9zdDoxNjk= cG9zdDoxNzA= cG9zdDoxNzE= cG9zdDoxNzI= cG9zdDoyMTI5 cG9zdDoxNzQ= cG9zdDoxNzM= cG9zdDoxNzU= cG9zdDoxOTc= cG9zdDoxOTg= cG9zdDoxOTk= cG9zdDoyMDA= YWNmX29wdGlvbnNfcGFnZTp0aGVtZS1zZXR0aW5ncw== dGVybTo3Ng== dGVybTo3Nw== dGVybTo3OA==",371,22,[],{"data":1161,"extensions":1276},{"resource":1162},{"title":1163,"databaseId":1164,"excerpt":680,"uri":1165,"language":1166,"translations":1168,"ptResources":1205},"Bottom Line Recommendations: Migraine",4421,"/resources/bottom-line-recommendations-migraine/",{"code":1167},"en",[1169],{"slug":1170,"uri":1171,"title":1172,"languageCode":694,"ptResources":1173},"recommandations-de-base-migraine","/fr/resources/recommandations-de-base-migraine/","Recommandations de base : Migraine",{"mainTitle":577,"subTitle":14,"media":1174,"pdf":1175,"link":1182,"videos":14,"sections":1184},"PDF",{"cursor":1176,"node":1177},"YXJyYXljb25uZWN0aW9uOjQ1NDY=",{"fileSize":1178,"mediaItemUrl":1179,"translations":1180},385260,"https://cms.trekk.ca/wp-content/uploads/2025/04/2025_05_14-Migraine-BLR_v1.0-Final-FR.pdf",[1181],{"languageCode":694,"mediaItemUrl":1179},{"title":680,"target":680,"url":1183},"https://trekk.ca/topic/migraine",[1185,1187,1188,1190,1191,1192,1193,1197,1198,1199,1200,1201,1202,1203,1204],{"__typename":1186},"PtResourcesSectionsContentLayout",{"__typename":1186},{"__typename":1189},"PtResourcesSectionsTableLayout",{"__typename":1186},{"__typename":1186},{"__typename":1186},{"__typename":1194,"title":14,"type":1195,"rawImageUrl":1196,"rawImageAlt":680,"image":14},"PtResourcesSectionsMediaLayout","Image","https://cms.trekk.ca/wp-content/uploads/2025/04/2025_05_14-Migraine-BLR_v1FR.jpeg",{"__typename":1186},{"__typename":1186},{"__typename":1186},{"__typename":1189},{"__typename":1186},{"__typename":1186},{"__typename":1186},{"__typename":1186},{"publish":1206,"description":1207,"eyebrow":1208,"mainTitle":577,"subTitle":14,"lastUpdated":14,"developed":1209,"developedBy":1210,"developedByCopy":14,"underReview":1206,"englishOnlyFlag":1206,"multipleLanguages":1206,"mainImage":14,"media":1174,"pdf":1211,"link":1216,"videos":14,"footnote":14,"sections":1217,"audience":1259,"topic":1264,"type":1269},false,"\u003Cp>Migraine accounts for up to 30% of pediatric Emergency Department (ED) visits for headache and results in frequent ED revisits. The average age of onset is 7 years in boys and 9 years in girls. Migraine is more common in girls by adolescence. Evidence for ED management of acute migraine attacks in children and adolescents is limited, resulting in significant practice variation.\u003C/p>\n\u003Cp>These Bottom Line Recommendations focus on the ED management of acute migraine attacks in children and adolescents. Refer to \u003Ca href=\"https://trekk.ca/resources/medication-dosing-recommendations-migraine/\">TREKK’s Medication Dosing Recommendations\u003C/a>: Migraine in children aged 6 years and older for additional information.\u003C/p>\n","Bottom Line Recommendations: Summary of Pediatric Emergency Care Information for Healthcare Providers","2025-05-14T00:00:00+00:00","Dr. Sarah Rogers (CHEO) & Dr. Garth Meckler (BC Children's)",{"cursor":1212,"node":1213},"YXJyYXljb25uZWN0aW9uOjQ1MzQ=",{"fileSize":1214,"mediaItemUrl":1215},340603,"https://cms.trekk.ca/wp-content/uploads/2025/04/2025_05_09-Migraine-BLR_v1.1_final-1.pdf",{"title":680,"target":680,"url":1183},[1218,1221,1223,1225,1227,1230,1232,1238,1240,1243,1245,1247,1250,1253,1256],{"__typename":1186,"title":1219,"subTitle":1206,"content":1220},"Summary","\u003Cp>\u003Cstrong>Migraine accounts for up to 30% of pediatric Emergency Department (ED) visits for headache and results in frequent ED revisits. The average age of onset is 7 years in boys and 9 years in girls. Migraine is more common in girls by adolescence. Evidence for ED management of acute migraine attacks in children and adolescents is limited, resulting in significant practice variation. This document focuses on the ED management of acute migraine attacks in children and adolescents.\u003C/strong>\u003C/p>\n",{"__typename":1186,"title":1222,"subTitle":1206,"content":14},"Diagnosis",{"__typename":1189,"title":14,"table":1224},"{\"table_options\":{\"ca\":\"\",\"ct\":\"ed\",\"tb\":\"full\",\"uh\":\"y\",\"uf\":\"y\",\"sc\":\"n\",\"st\":\"\",\"cols\":1,\"rows\":1,\"changed\":true},\"table_param\":{\"plugin_version\":\"1.7.2\",\"field_name\":\"table\",\"field_key\":\"field_69af09ef3dd2a\"},\"columns\":[{\"c\":\"\",\"o\":[]}],\"caption\":\"\",\"tbody\":[{\"c\":[{\"c\":\"\u003Cp>A. At least five attacks fulfilling criteria B-D (if fewer than 5 attacks, diagnosis of \\u201cprobable migraine\\u201d)\u003C\\/p>\u003Cp>B. Headache attacks lasting 2-72 hours (untreated or unsuccessfully \u003Cem>treated\u003C\\/em>)\u003C\\/p>\u003Cp>C. Headache has at least two of the following four characteristics:\u003C\\/p>\u003Cul>\u003Cli style=\\\"list-style-type: none;\\\">\u003Cul>\u003Cli>Unilateral location or bilateral frontotemporal location*\u003C\\/li>\u003Cli>Pulsating quality\u003C\\/li>\u003Cli>Moderate or severe pain intensity\u003C\\/li>\u003Cli>Aggravation by or causing avoidance of routine physical activity (e.g., walking or climbing stairs)\u003C\\/li>\u003C\\/ul>\u003C\\/li>\u003C\\/ul>\u003Cp>D. During headache at least one of the following:\u003C\\/p>\u003Cul>\u003Cli style=\\\"list-style-type: none;\\\">\u003Cul>\u003Cli>Nausea and\\/or vomiting\u003C\\/li>\u003Cli>Photophobia and phonophobia\u003C\\/li>\u003C\\/ul>\u003C\\/li>\u003C\\/ul>\u003Cp>E. Not better accounted for by another International Classification of Headache Disorders diagnosis.\u003C\\/p>\",\"o\":[]}],\"o\":[]}],\"tfoot\":[{\"c\":[{\"c\":\"\",\"o\":[]}],\"o\":[]}],\"thead\":[{\"c\":[{\"c\":\"\u003Cp>\u003Cstrong>International Headache Society Criteria for Migraine without Aura in Children and Adolescents\u003C\\/strong>\u003Csup>\u003Ca href=\\\"https:\\/\\/pubmed.ncbi.nlm.nih.gov\\/29368949\\/\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">1\u003C\\/a>\u003C\\/sup>\u003C\\/p>\",\"o\":[]}],\"o\":[]}]}",{"__typename":1186,"title":14,"subTitle":1206,"content":1226},"\u003Cp>*Pediatric migraine is more often bilateral than in adults. Unilateral pain more commonly emerges in later adolescence or early adulthood.\u003C/p>\n\u003Cul>\n\u003Cli>Migraine with aura is treated the same as migraine without aura.\u003C/li>\n\u003C/ul>\n",{"__typename":1186,"title":1228,"subTitle":1206,"content":1229},"Management","\u003Cul>\n\u003Cli>Place the patient in a dark, quiet room with sunglasses and a stretcher, if possible. Ask about patient-specific needs and comfort measures.\u003C/li>\n\u003Cli>Needle-free therapies may be tried before parenteral/procedure-based therapies, despite limited evidence.\u003C/li>\n\u003Cli>Discuss goals of treatment with patient/caregiver. The goal of treatment is not to \u003Cem>eliminate\u003C/em> pain, but to see an \u003Cem>improvement\u003C/em> in pain score that is tolerable with continued rest at home after discharge.\u003C/li>\n\u003Cli>Only 6 randomized controlled trials (RCTs) address migraine management in the pediatric ED.\u003Csup>\u003Ca href=\"https://pubmed.ncbi.nlm.nih.gov/14747817/\" target=\"_blank\" rel=\"noopener\">2\u003C/a>,\u003Ca href=\"https://www.neurology.org/doi/10.1212/WNL.0000000000205849#:~:text=Conclusions%3A,for%20youth%20with%20status%20migrainosus.\" target=\"_blank\" rel=\"noopener\">7\u003C/a>\u003C/sup> Most data that informs other treatment comes from adult evidence, case series, or observational studies outside of the ED. See a summary of the relevant RCTs below (Page 3).\u003C/li>\n\u003Cli>Opioids are \u003Cstrong>NOT\u003C/strong> recommended for the treatment of acute headache in children and adolescents.\u003C/li>\n\u003Cli>There is \u003Cstrong>no evidence\u003C/strong> to support the use of:\n\u003Cul>\n\u003Cli>Diphenhydramine (Benadryl™) to \u003Cem>prevent\u003C/em> acute dystonic reactions when using metoclopramide (Maxeran™). These reactions are rare and should only be \u003Cem>treated\u003C/em> with diphenhydramine, if they occur.\u003Csup>\u003Ca href=\"https://pubmed.ncbi.nlm.nih.gov/32098684/\" target=\"_blank\" rel=\"noopener\">8\u003C/a>\u003C/sup>\u003C/li>\n\u003Cli>Magnesium sulfate for treating migraine in children and adolescents.\u003C/li>\n\u003C/ul>\n\u003C/li>\n\u003Cli>There is no pediatric data to support the routine use of steroids for prevention of rebound headache in pediatric migraine attacks. A large adult systemic review supports its use,\u003Csup>\u003Ca href=\"https://pubmed.ncbi.nlm.nih.gov/25576463/\">9\u003C/a> \u003C/sup>but there are no pediatric trials.\u003C/li>\n\u003Cli>The treatment algorithm on Page 2 is recommended based on current evidence and reflects a common approach to migraine attacks used in Pediatric Referral Centres across \u003Cem>Canada\u003C/em>.\u003C/li>\n\u003C/ul>\n",{"__typename":1186,"title":1231,"subTitle":1206,"content":14},"Treatment Algorithm for Acute Migraine Attacks in the ED",{"__typename":1194,"title":14,"type":1195,"video":14,"rawImageUrl":1233,"rawImageAlt":680,"image":1234},"https://cms.trekk.ca/wp-content/uploads/2025/04/2025_05_09-Migraine-BLR_v1.jpeg",{"cursor":1235,"node":1236},"YXJyYXljb25uZWN0aW9uOjUxOTQ=",{"sourceUrl":1237,"altText":680},"https://cdn.trekk.ca/wp-content/uploads/2025/04/2025_05_09-Migraine-BLR_v1.jpeg?strip=all",{"__typename":1186,"title":14,"subTitle":1206,"content":1239},"\u003Cp>Refer to \u003Ca href=\"https://trekk.ca/resources/medication-dosing-recommendations-migraine/\" target=\"_blank\" rel=\"noopener\">TREKK’s Medication Dosing Recommendations\u003C/a>: Migraine in children aged 6 years and older.\u003C/p>\n",{"__typename":1186,"title":1241,"subTitle":1206,"content":1242},"Patient Disposition","\u003Cul>\n\u003Cli>Discharge home if treatment has provided \u003Cem>improvement\u003C/em> in pain and the patient/caregiver feel they can manage symptoms at home. Provide discharge instructions about treatment at home and reasons to return to the ED. Avoid driving during acute migraine.\u003C/li>\n\u003Cli>Consider admission/discuss with Pediatrics/Pediatric Referral Centre if ongoing severe headache and significant functional limitation prohibiting discharge home.\u003C/li>\n\u003Cli>Counsel health hygiene using the following mnemonic:\n\u003Cul>\n\u003Cli>“SMART” = sleep, meals, activity, relaxation (+/- Cognitive Behavioural Therapy), trigger avoidance\u003C/li>\n\u003C/ul>\n\u003C/li>\n\u003Cli>Use shared decision-making with patient/caregiver regarding initiation of nutraceutical prophylaxis based on frequency and impact of headaches.\n\u003Cul>\n\u003Cli>Nutraceuticals for migraine prevention: \u003Ca href=\"https://www.cheo.on.ca/en/resources-and-support/p6153.aspx#\">cheo.on.ca/en/resources-and-support/p6153.aspx#\u003C/a>\u003C/li>\n\u003C/ul>\n\u003C/li>\n\u003Cli>Recommend using a headache diary app (e.g., Migraine Buddy, Migraine Tracker, Canadian Migraine Tracker).\u003C/li>\n\u003Cli>Provide a \u003Ca href=\"https://www.childrenscolorado.org/globalassets/community/school-nurse/migraines-and-headaches/headache-action-plan.pdf\" target=\"_blank\" rel=\"noopener\">Migraine Action Plan\u003C/a>.\u003C/li>\n\u003C/ul>\n",{"__typename":1186,"title":1244,"subTitle":1206,"content":14},"Evidence Summary",{"__typename":1189,"title":14,"table":1246},"{\"table_options\":{\"ca\":\"\",\"ct\":\"ed\",\"tb\":\"full\",\"uh\":\"y\",\"uf\":\"y\",\"sc\":\"n\",\"st\":\"\",\"cols\":2,\"rows\":6,\"changed\":true},\"table_param\":{\"plugin_version\":\"1.7.2\",\"field_name\":\"table\",\"field_key\":\"field_69af09ef3dd2a\"},\"columns\":[{\"c\":\"\",\"o\":[]},{\"c\":\"\",\"o\":[]}],\"caption\":\"\",\"tbody\":[{\"c\":[{\"c\":\"\u003Cp>Brousseau et al. (2004)\u003Ca href=\\\"https:\\/\\/pubmed.ncbi.nlm.nih.gov\\/14747817\\/\\\">2\u003C\\/a>\u003C\\/p>\u003Cp>\u003Cem>Note: Prochlorperazine is\u003C\\/em> \u003Cem>not available in\u003C\\/em> \u003Cem>Canada\u003C\\/em>\u003C\\/p>\",\"o\":[]},{\"c\":\"\u003Cul>\u003Cli>Double blind crossover RCT conducted in 2 pediatric EDs for patients aged (2004)2 5-18 (n=62) comparing IV ketorolac and prochlorperazine\u003C\\/li>\u003Cli>\u003Cstrong>Conclusion\u003C\\/strong>: Initial treatment with IV prochlorperazine was found to meet defined criteria for treatment success in 84.4% of patients, in contrast to 55.2% in those who received IV ketorolac  (difference of 30% between agents, 95% confidence interval 8-52%).\u003C\\/li>\u003C\\/ul>\",\"o\":[]}],\"o\":[]},{\"c\":[{\"c\":\"\u003Cp>Richer et al. (2014)\u003Csup>\u003Ca href=\\\"https:\\/\\/pubmed.ncbi.nlm.nih.gov\\/25168404\\/\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">3\u003C\\/a>\u003C\\/sup>\u003C\\/p>\",\"o\":[]},{\"c\":\"\u003Cul>\u003Cli>Single blind parallel arm RCT conducted in 1 pediatric ED (n=47) looking at effect of bolus 10 mL\\/kg IV 0.9% NaCl for children aged 5-17 years with or without expectation of concurrent medication\u003C\\/li>\u003Cli>\u003Cstrong>Conclusion\u003C\\/strong>: There was no meaningful decrease in pain scores with IV fluid alone.\u003C\\/li>\u003C\\/ul>\",\"o\":[]}],\"o\":[]},{\"c\":[{\"c\":\"\u003Cp>Sheridan et al. (2018)\u003Csup>\u003Ca href=\\\"https:\\/\\/pubmed.ncbi.nlm.nih.gov\\/29456086\\/\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">4\u003C\\/a>\u003C\\/sup>\u003C\\/p>\",\"o\":[]},{\"c\":\"\u003Cul>\u003Cli>Pragmatic RCT in 2 pediatric EDs (n=66) comparing efficacy of low-dose propofol to standard therapy (ketorolac, metoclopramide, IV fluid)\u003C\\/li>\u003Cli>\u003Cstrong>Conclusion\u003C\\/strong>: Low-dose propofol did not achieve better pain reduction than standard therapy but was associated with significantly fewer rebound headaches.\u003C\\/li>\u003C\\/ul>\",\"o\":[]}],\"o\":[]},{\"c\":[{\"c\":\"\u003Cp>Richer et al. (2022)\u003Csup>\u003Ca href=\\\"https:\\/\\/pubmed.ncbi.nlm.nih.gov\\/35670115\\/\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">5\u003C\\/a>\u003C\\/sup>\u003C\\/p>\",\"o\":[]},{\"c\":\"\u003Cul>\u003Cli>Double blind RCT of children aged 5-17 (n=53) assessing efficacy and safety of IV metoclopramide compared to combination with IV ketorolac\u003C\\/li>\u003Cli>\u003Cstrong>Conclusion\u003C\\/strong>: The approach of combining IV metoclopramide with ketorolac failed to improve pain scores in children presenting for acute treatment of migraine headache.\u003C\\/li>\u003C\\/ul>\",\"o\":[]}],\"o\":[]},{\"c\":[{\"c\":\"\u003Cp>Tsze et al. (2022)\u003Csup>\u003Ca href=\\\"https:\\/\\/pubmed.ncbi.nlm.nih.gov\\/34822214\\/\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">6\u003C\\/a>\u003C\\/sup>\u003C\\/p>\",\"o\":[]},{\"c\":\"\u003Cul>\u003Cli>Double blind RCT non-inferiority trial of children aged 8-17 (n=59) comparing IV and intranasal ketorolac\u003C\\/li>\u003Cli>\u003Cstrong>Conclusion\u003C\\/strong>: intranasal ketorolac was non-inferior to IV ketorolac for reducing migraine headache pain in the emergency department.\u003C\\/li>\u003C\\/ul>\",\"o\":[]}],\"o\":[]},{\"c\":[{\"c\":\"\u003Cp>Szperka et al. (2024)\u003Csup>\u003Ca href=\\\"https:\\/\\/www.neurology.org\\/doi\\/10.1212\\/WNL.0000000000205849#:~:text=Conclusions%3A,for%20youth%20with%20status%20migrainosus.\\\" target=\\\"_blank\\\" rel=\\\"noopener\\\">7\u003C\\/a>\u003C\\/sup>\u003C\\/p>\",\"o\":[]},{\"c\":\"\u003Cul>\u003Cli>Double blind RCT of participants aged 10-21 (n=58) testing efficacy of greater occipital nerve blocks with lidocaine in children and adolescents with acute migraine refractory to standard therapies\u003C\\/li>\u003Cli>\u003Cstrong>Conclusion:\u003C\\/strong> Greater occipital nerve injections with lidocaine resulted in a significant \u003Cem>improvement\u003C\\/em> in pain scores compared to placebo.\u003C\\/li>\u003C\\/ul>\",\"o\":[]}],\"o\":[]}],\"tfoot\":[{\"c\":[{\"c\":\"\",\"o\":{\"cs\":2}}],\"o\":[]}],\"thead\":[{\"c\":[{\"c\":\"\u003Cp>\u003Cstrong>Randomized Control Trials \u003C\\/strong>\u003C\\/p>\",\"o\":[]},{\"c\":\"\u003Cp style=\\\"text-align: center;\\\">\u003Cstrong>Summary\u003C\\/strong>\u003C\\/p>\",\"o\":[]}],\"o\":[]}]}",{"__typename":1186,"title":1248,"subTitle":1206,"content":1249},"Development Team","\u003Cp>Thank you to the following \u003Cstrong>content experts\u003C/strong> who led the development of the Migraine Bottom Line Recommendations and Medication Dosing Table:\u003C/p>\n\u003Cp>\u003Cstrong>Sarah Rogers, MD, FRCPC\u003C/strong>; \u003Cem>Pediatric Emergency Medicine Fellow, Children’s Hospital of Eastern Ontario, University of Ottawa\u003C/em>\u003C/p>\n\u003Cp>\u003Cstrong> Garth Meckler, MD, MSHS\u003C/strong>; \u003Cem>Associate Professor, Department of Pediatrics, University of British Columbia; BC Children’s Hospital,  Division Head, Division of Pediatric Emergency Medicine, BC Children’s Hospital \u003C/em>\u003C/p>\n\u003Cp>Thank you to the \u003Ca href=\"https://trekk.ca/team?tab=2\">TREKK Editorial Committee\u003C/a>, editor Dr. Sarah Reid (\u003Ca href=\"https://www.cheo.on.ca/en/index.aspx\">CHEO\u003C/a>), \u003Ca href=\"https://www.chrim.ca/\">CHRIM\u003C/a> Parent and Youth Advisory Committee, and  who provided editorial support and expertise in the development of this resource. Thank you as well to Megan Bale-Nick, TREKK  Project Coordinator (\u003Ca href=\"https://umanitoba.ca/\">University of Manitoba\u003C/a>) who coordinated the development process.\u003C/p>\n",{"__typename":1186,"title":1251,"subTitle":1206,"content":1252},"Key References","\u003Cp>(as cited in the Migraine Bottom Line Recommendations):\u003C/p>\n\u003Col>\n\u003Cli>Headache Classification Committee of the International Headache Society (IHS) \u003Ca href=\"https://pubmed.ncbi.nlm.nih.gov/29368949/\">The International Classification of  Headache Disorders\u003C/a>, 3rd edition. Cephalalgia. 2018 Jan;38(1):1-211.\u003C/li>\n\u003Cli>Brousseau DC, Duffy SJ, Anderson AC, Linakis JG. \u003Ca href=\"https://pubmed.ncbi.nlm.nih.gov/14747817/\">Treatment of pediatric migraine headaches: a randomized, double-blind trial of prochlorperazine versus ketorolac.\u003C/a> Ann Emerg Med. 2004 Feb;43(2):256–62.\u003C/li>\n\u003Cli>Richer L, Craig W, Rowe B. \u003Ca href=\"https://pubmed.ncbi.nlm.nih.gov/25168404/\">Randomized controlled trial of treatment expectation and intravenous fluid in pediatric  migraine.\u003C/a> Headache. 2014 Oct;54(9):1496–505.\u003C/li>\n\u003Cli>Sheridan DC, Hansen ML, Lin AL, Fu R, Meckler GD. \u003Ca href=\"https://pubmed.ncbi.nlm.nih.gov/29456086/\">Low-Dose Propofol for Pediatric Migraine: A Prospective,  Randomized Controlled Trial.\u003C/a> J Emerg Med. 2018 May;54(5):600–6.\u003C/li>\n\u003Cli>Richer LP, Ali S, Johnson DW, Rosychuk RJ, Newton AS, Rowe BH. \u003Ca href=\"https://pubmed.ncbi.nlm.nih.gov/35670115/\">A randomized trial of ketorolac and metoclopramide  for migraine in the emergency department.\u003C/a> Headache. 2022 Jun;62(6):681–9.\u003C/li>\n\u003Cli>Tsze DS, Lubell TR, Carter RC, Chernick LS, DePeter KC, McLaren SH, et al. \u003Ca href=\"https://pubmed.ncbi.nlm.nih.gov/34822214/\">Intranasal ketorolac versus intravenous  ketorolac for treatment of migraine headaches in children: A randomized clinical trial.\u003C/a> Academic Emergency Medicine.  2022;29(4):465–75.\u003C/li>\n\u003Cli>Szperka C, de Prado BM, Hsu J, Gelfand A, Haagen D, Kellier D, et al. \u003Ca href=\"https://www.neurology.org/doi/10.1212/WNL.0000000000205849#:%7E:text=Conclusions%3A,for%20youth%20with%20status%20migrainosus.\">Randomized Controlled Trial of Lidocaine Occipital  Nerve Blocks to Treat Status Migrainosus in Children/Adolescents\u003C/a> (S22.009). Neurology. 2024 Apr 14;102(17_supplement_1):5487.\u003C/li>\n\u003Cli>Kirkpatrick L, Sogawa Y, Cleves C. \u003Ca href=\"https://pubmed.ncbi.nlm.nih.gov/32098684/\">Acute dystonic reactions in children treated for headache with prochlorperazine or meto-clopramide.\u003C/a> Pediatr Neurol. 2020;106:63-64.\u003C/li>\n\u003Cli>Woldeamanuel YW, Rapoport AM, Cowan RP. \u003Ca href=\"https://pubmed.ncbi.nlm.nih.gov/25576463/\">The place of corticosteroids in migraine attack management: A 65-year  systematic review with pooled analysis and critical appraisal.\u003C/a> Cephalalgia. 2015 Oct;35(11):996–1024.\u003C/li>\n\u003C/ol>\n",{"__typename":1186,"title":1254,"subTitle":1206,"content":1255},"Evidence Repository","\u003Cp>For a complete list of the evidence that informed the creation of the Migraine Bottom Line Recommendations see the Evidence Repository \u003Ca href=\"https://trekk.ca/resources/evidence-repository-migraine/\">here\u003C/a>.\u003C/p>\n",{"__typename":1186,"title":1257,"subTitle":1206,"content":1258},"Disclaimer","\u003Cp>The purpose of this document is to provide healthcare professionals with key facts and recommendations for the diagnosis and treatment of community acquired pneumonia in children in the emergency department. The TREKK Network is not liable for any damages, claims, liabilities, costs or obligations arising from the use of this document including loss or damages arising from any claims made by a third party. \u003Cstrong>THIS DOCUMENT IS SUBJECT TO FULL DISCLAIMER HERE:\u003C/strong> \u003Ca href=\"https://trekk.ca/terms-of-use\">trekk.ca/terms-of-use\u003C/a>\u003C/p>\n",{"edges":1260},[1261],{"cursor":541,"node":1262},{"name":29,"link":32,"slug":1263},"healthcare-providers",{"edges":1265},[1266],{"cursor":752,"node":1267},{"name":577,"link":1268,"slug":754},"https://cms.trekk.ca/topic/migraine/",{"edges":1270},[1271],{"cursor":1272,"node":1273},"YXJyYXljb25uZWN0aW9uOjEz",{"name":1274,"slug":1275},"Bottom Line Recommendations","bottom-line-recommendations",{"debug":1277,"queryAnalyzer":1278},[],{"keys":1279,"keysLength":1280,"keysCount":1281,"skippedKeys":680,"skippedKeysSize":681,"skippedKeysCount":681,"skippedTypes":1282},"4eafac0dda04198769ee29b46a885f000a14d2e4346fe90d1c324dbdc1a293ae graphql:Query cG9zdDo0NDIx cG9zdDo0NDk3 cG9zdDo0NTQ2 cG9zdDo0NTM0 cG9zdDo1MTk0 dGVybToyMA== dGVybTo0NzE= dGVybToxMw== cG9zdDo0NTQ1",195,11,[],1789499024845]