Ametop (Amethocaine referred to as “magic cream”) as a local anaesthetic prior to venepuncture or lumbar puncture can be used from 1 month of age. Oral sucrose (see “from the literature” section below) works well as a soother in these young babies as does breastfeeding during the procedure (admittedly not very practical for lumbar puncture) so, in practice, we do not tend to use Ametop until they are a bit older. It also takes 40 minutes to work properly and most babies who need intervention need it fairly fast. Ametop can be systemically absorbed so should not be used on broken or inflamed skin. There is also a fast-acting vapocoolant spray (Cryogesic) available for numbing older children’s skin prior to venepuncture. You need to spray the area until a thin snow film forms and insert the needle straight away. Very young children probably can’t tell the difference between severe cold and pain so it’s not worth using it in infants. Be guided by the nurses.

Children should not be left in pain while waiting to see someone in the Emergency Department. There is a comprehensive pain guideline on our intranet and we have recently added intranasal diamorphine for fast relief of pain from fractured long bones, burns and sickle cell crises. You will find paediatric guidelines under “Women and Children’s Services” when you click on the “Departments” tab on the intranet’s front page. Do ask if you need advice.

From the July 2010 Emergency Department edition of Paediatric Pearls