Cerebral Irritation (Constant Screaming)

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Niamh's Journey

What is Cerebral Irritation?

Cover the Possibility of Real Pain

Try the usual pain relief (Paracetamol, Ibuprofen, Codeine, Morphine, etc) which should relieve discomfort, if pain is from an origin that is not the brain.

We used Buprenorphine skin patches on Niamh which are a slow release opiod (changed weekly) that deliver a controlled amount of a morphine like chemical into the body without the need for a IV or sub-cutaneous line. This meant she continually had background pain relief to cover most causes of day to day pain.

When Niamh was experiencing Cerebral Irritation, even high doses of additional morphine failed to relieve this distress.

Cover the Possibility of other causes of Distress

Think through the problems that your child experiences and tick off one by one, that these could not be the cause of their distress.

Try the basics like distraction, change of positioning, nappy, start/stop feed, play as well as addressing all their medical complications.

When Niamh was experiencing Cerebral Irritation, all the above were addressed but failed to relieve this distress.

Sedation

It is reported that combination of pain relief and sedation are the only effective way of treating this phenomenon.
As pain relief will usually have been administered first, the addition of an anti-anxiety and sedative drug should give the child short term relief.

Midazolam, Chloral Hydrate (Exixir), Clonidine (Dixarit) and Phenobarbitone have worked for children that we know. However the relief is often only effective for the length of the sedation and if the child wakes up and remains distressed then sedation may have to be repeated.

Our Feeling as Parents

Our underlying feeling was that the constant screaming was caused by gastric discomfort of some sort.

Although daily changes to feeding rates and feed types did not show any obvious improvement we did notice that during periods of acute illness (pneumonia etc) when Niamh was not fed for several days as she was on IV fluids - then this screaming would stop.

We also noticed some improvement in the screaming when feeding was via a gastro-jejunal tube - with feed entering through the jejunal port and the gastro (stomach) post was left to vent/drain freely.

As a Symptom of MPEI

Almost all the children in our support group have experienced inconsolable screaming like this at some stage.

On average it seems to start anytime after the age of 15 months and strangely seems to have disappeared in all our children by the age of 3.