Hospital Pediatrics

Posted on November 14, 2012 0

Hospice Pediatrics

By Lisa M. Browder, ICA, CR, RA

I'll be honest - pediatric care makes me a little nervous. Most of the available literature on pediatrics deals with common childhood issues. Although other hospices are using essential oils effectively for symptom management with their pediatric patients, there is no information-sharing network to allow us to work together, or even to know that others doing similar work exist. So I use the available literature on aromatherapy and childcare and then apply my own sleuthing technique: I quiz the nurses for relevant information on symptoms and their likely causes, determine whether it is an acute issue or an ongoing challenge, sort through essential oils that would be helpful, eliminate the ones I think might be too strong for the child's age and/or disease process, figure out what delivery method would be most effective and vary the dilution rate as necessary. These youngest hospice patients are rarely able to tell me how I am doing, so my assessment of success or failure has a different standard; it relies on nursing reports and visual cues such as a resolving skin issue, an unfurrowed brow, deeper sleep patterns; relief from constipation, or cessation of whimpering or crying.

Our pediatric program manager identified the top five pediatric diagnoses as holoprosencephaly, neurodegenerative disorders, severe cerebral palsy, hypoxic ischemic encephalopathy and chromosomal anomalies. Even pronouncing them is a challenge; they just sound scary. However, I have learned these formidable-sounding diagnoses have some common treatable symptoms, like constipation, irritability, skin issues and muscular aches.

With holoprosencephaly, the lobes of the brain have failed to develop. These little ones suffer from mobility issues, seizures, visual and hearing disturbances, irritability, agitation and contractures. Our program manager says holoproscencephaly babies appear to be born more often to diabetic mothers. These babies do extremely well with specially-blended crèmes for muscular aches and pains and agitation; each applied topically by our massage therapist. Additionally, in the acute-care units we diffuse lavender (Lavandula augustifolia) at bedside.

Neurodegenerative disorders are particularly thorny and there are enough of them that many do not even have names. These children are normal at birth but somewhere between 5 and 10 years old begin to "reverse," a condition distinguished by sudden tripping, falling and/or balance issues. They go on to develop spasticity and contractures. Many of these are older pediatric patients, so they may take a lot of pharmaceutical medications which can cause serious constipation. My formula to relieve this includes lavender, rosemary (Rosmarinus officinalis ct verbenone), ginger (Zingiber officinale), fennel (Foeniculum vulgare) and black pepper (Piper nigrum).

Some of these children do well with a combination of essential oils and massage. Others will not tolerate touch. Since it is unpredictable, we usually send in the massage therapist with a topical crème to see how the child responds. One of our patients, a 17-year-old, only liked his head touched, so the massage therapist did cranial work with him. Another, a 9-year-old with Batten disease (a fatal, inherited disorder of the nervous system), responded extremely well to both massage and reflexology and particularly loved the aromatherapy blends created for him. He was constantly restless and had frequent seizure activity. When the inhaler stick created for his breathing was held up to his nose, his movements ceased and he would inhale, deeply and audibly. The inhaler contained lavender, eucalyptus radiata, chamomile (Anthemis nobilis), myrtle (Myrtus communis) and peppermint (Mentha x piperita).

Severe cerebral palsy is frequently accompanied by other diagnoses so there may be multiple symptoms to sort out. These children show a loss of mobility and lose the ability to speak. Their muscle control is affected and they often have scoliosis and contractures. They benefit from a combination of massage and essential oils. We use a topical blend of lavender, rosemary, juniper (Juniperus communis), black pepper, fennel and peppermint. These patients may not be able to speak, but the essential oils still affect emotional centers so we frequently see a softening of facial features accompanied by soft sounds that the mothers identify as pleasure reactions.

Hypoxic ischemic encephalopathy is due to a lack of oxygen to the brain and most commonly occurs during the birth process. The affected part of the brain dies, dissolves and becomes fluid on the brain. Vision and hearing are affected and these babies suffer from contractures and spasticity. We worked with a 27-week-old baby that would only allow our massage therapist (not even his mother) to touch his feet. She used a lavender crème applied topically to help him relax.

Then there are the babies born with chromosomal anomalies such as Trisomy 18 or Trisomy 13. These diseases involve an extra copy of a numbered chromosome rather than the normal two sets and the extra material interferes with normal development. According to the National Institute of Health, these children may have clenched hands, crossed legs, low-set ears, mental retardation and sometimes a cleft lip or palate. They will frequently have clenched fingers and, as our nurse told me, they "usually just require a relaxing environment." They are good candidates for a bedside diffuser and/or hand massage with a lavender crème.

I was recently asked to blend something for one of our patients with an unidentified skin issue. Tiny blister-like raised areas appear, open up, scab over and eventually disappear. The child does not appear uncomfortable and no pattern has emerged to identify a possible source. Even a dermatologist has been unable to identify the issue. I made a .5 percent formulation in grape seed oil (Vitis vinifera) of sweet orange (Citrus sinensis), tea tree (Melaleuca alternifolia) and Roman chamomile and suggested massaging a small amount into the affected areas after his bath. I chose the tea tree for its antifungal/antibacterial/anti-infectious properties, chamomile for inflammation, and sweet orange primarily for aroma. There has been a marked improvement, with the spots healing rapidly. One of the nurses told me, "It looks like someone vacuumed his skin."

The majority of my blends are between .5-1 percent but I have also used a 2 percent constipation blend and a 3 percent blend for dry/patchy skin. There have been no negative results reported. To the contrary, many of the stronger blends have been the most successful and in the shortest amount of time. So although some of the diagnoses in pediatric hospice sound daunting, my experience has been nothing but positive. These smallest of our patients with their life-limiting illnesses respond exceedingly well (and quickly) to essential oils.

Lisa Browder is a certified reflexologist, Reiki practitioner and Registered Aromatherapist. She is the Complementary Therapies Manager at Nathan Adelson Hospice in Las Vegas. Lisa is a Professional Member of NAHA, and is NAHA Regional Director for Nevada. She is the owner of Scentsibility. Visit her new web-site at: www.scentsibility.net

To purchase Lisa's NAHA Teleconference Presentation on Hospice and Essential Oils, visit the NAHA website: www.naha.org and click on link to Teleconference recordings.

Note: Articles appearing in the NAHA e-newsletters, e-journals and other published materials fall under the NAHA publishing rights and are published with the author's permission. Copying, reposting or publishing these articles without written permission from NAHA constitues an infridgment of copyright law. You are welcome to post a link to the NAHA Blog which includes past articles.

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