Pediatric emergency department: Focus on pain control, teamwork, mental health

At the 2024 American Academy of Pediatrics National Conference & Exhibition, John Loiselle, MD, FAAP, Chief of Emergency Medicine at Nemours Children’s Hospital of Delaware, discussed critical aspects of pediatric emergency care.

"When evaluating younger children, you have to be very careful with your physical exam and not jump right into the area that's hurt or causing the pain," Loiselle explained. Observing a child’s spontaneous movements and behaviors before initiating a hands-on exam can provide valuable insights. "I spend a lot of time focusing on the observation part of the evaluation," he said, adding that this approach helps "get a much better examination" and ensures that the child is more cooperative. By taking a slower, more measured approach and offering pain control when necessary, physicians can often pinpoint the source of pain more accurately.

Loiselle also highlighted the importance of coordination among emergency departments to improve the consistency and quality of care. "We are focused on working together and coordinating our care with other emergency departments," he said. This collaboration involves developing and implementing consistent clinical pathways, which help streamline patient care across different healthcare settings, ensuring that children receive the same high level of treatment no matter where they are seen.

Another key area Loiselle discussed was the expanding role of technology in emergency medicine. "Ultrasound is getting bigger and bigger and bigger in the emergency department," he noted.

Beyond physical health, Loiselle addressed a growing concern for emergency departments: the surge in mental health issues among pediatric patients. "We're also just seeing a huge rise in mental health issues that is directly impacting the emergency department," he explained. Managing and treating mental health crises in children is expected to be a significant challenge over the next 5 to 10 years. "How we manage those patients, care for those patients, [and] treat those patients is going to be... a very big part of care in the emergency department," Loiselle concluded.

His insights underscored the evolving nature of pediatric emergency medicine, with increasing collaboration, technological advances, and the rising prominence of mental health care shaping the future of the field.