Providing effective analgesia and sedation for critically ill children means addressing both their physical and psychological comfort. Correctable environmental and physical factors causing discomfort should be dealt with in the first instance; these factors might include medical devices, beds, lighting, noise reduction strategies, fluid and feeding regimes, day-night orientation and maintenance of sleep structure. Factors such as these should be considered before the introduction of any pharmacological agents, and should be continually reassessed during the course of a critical care admission.

After a satisfactory level of analgesia has been achieved, additional sedative agents may be required by some children. The aims of sedation are to reduce levels of anxiety and distress in the child, and to allow for better tolerance of therapeutic or diagnostic procedures. The specific strategies employed to achieve satisfactory levels of analgesia and sedation in critically ill children will depend on whether prolonged sedation is required, as is normally needed to facilitate invasive mechanical ventilation, or if short-term sedation is required to facilitate a procedure. The requirement profile for sedative agents in critically ill children can vary considerably during the course of their admission; a young child mechanically ventilated for a week may require a gradually increasing level of “background” sedation to allow them to tolerate tracheal intubation, particularly if tolerance to sedative agents develops, and in addition they may require several episodes of controlled deepening of sedation to facilitate specific procedures.

In both cases, environmental and non-pharmacological techniques can reduce the need for pharmacological agents. Massage and relaxation techniques have been shown to be beneficial in critically ill adults1^–3 and the watching of videos has also been shown to reduce the sedation requirements of children undergoing procedures.4 The benefits of music therapy in critically ill adults have been well described and can …