title: Home management of sickle cell-related pain in children and adolescents: natural history and impact on school attendance.
abstract: Some children and adolescents with sickle cell disease experience frequent painful episodes. To gain information about the natural history of the pain and its impact on sleep and school attendance, we developed a home-based diary system. Eighteen children and adolescents completed 4756 diary days, with an average compliance of 75%. Pain was reported on 30% of days and was managed at home nine-tenths of the time. Girls reported more days with pain than did boys, and age was positively correlated with the length of the painful episodes. The pain affected school attendance and sleep. Patients were absent from school on 21% of 3186 school days, with half of the absenteeisms on days with reported pain. Of the pain-associated absenteeisms, two-thirds occurred when pain was managed at home, and one-third when patients were hospitalized. The average consecutive number of school days missed was 2.7. These findings have implications for developmentally critical activities.
authors.affiliation: Pain Management Service, Division of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA 19104 USA Division of Hematology, Children's Hospital of Philadelphia, Philadelphia, PA 19104 USA Unit for Experimental Psychiatry, Institute of Pennsylvania Hospital, Philadelphia, PA 19139 USA Department of Psychology in Psychiatry, Institute of Pennsylvania Hospital, Philadelphia, PA 19139 USA University of Pennsylvania School of Medicine, Philadelphia, PA 19104 USA.
authors.forename: Barbara S
authors.initials: BS
authors.lastname: Shapiro
authors.forename: David F
authors.initials: DF
authors.lastname: Dinges
authors.forename: Emily Carota
authors.initials: EC
authors.lastname: Orne
authors.forename: Nancy
authors.initials: N
authors.lastname: Bauer
authors.forename: Linnette B
authors.initials: LB
authors.lastname: Reilly
authors.forename: Wayne G
authors.initials: WG
authors.lastname: Whitehouse
authors.forename: Kwaku
authors.initials: K
authors.lastname: Ohene-Frempong
authors.forename: Martin T
authors.initials: MT
authors.lastname: Orne
mesh_terms: D000041:Absenteeism; D000293:Adolescent; D000367:Age Factors; D000755:Anemia, Sickle Cell / Q000150:complications* / Q000503:physiopathology; D002648:Child; D005260:Female; D006701:Home Nursing; D006760:Hospitalization; D006801:Humans; D008297:Male; D008499:Medical Records; D010146:Pain / Q000209:etiology / Q000503:physiopathology; D059408:Pain Management; D012189:Retrospective Studies; D012574:Schools; D012890:Sleep / Q000502:physiology