Become an EPEC-Pediatrics Trainer: Chicago, IL (March 12-13, 2016 in conjunction with AAHPM/HPNA conference)


The Education in Palliative and End-of-life Care (EPEC) -Pediatrics curriculum features state-of-the-art knowledge in pain and symptom management, as well as training in the skills required to address key domains for pediatric palliative care. The curriculum is designed to give pediatric health care providers the knowledge and skills needed to provide excellent palliative care to their patients and their families. Based on the well-established and proven training methods of EPEC, this curriculum features a high impact, widely disseminated approach that utilizes a train-the-trainer model.  With knowledge gained through the EPEC-Pediatrics Curriculum, physicians and advanced practice registered nurses (APRNs) as well as other health care professionals will be equipped to become trainers who will educate local interdisciplinary teams that provide care to children with serious illness, including cancer and hematological conditions, thus optimizing pediatric palliative care outreach.

Registration & more info: 

Discounts offered for teams from a single institution bringing an interdisciplinary team to the conference, practitioners from safety net hospitals, low to moderate income countries.  Please contact with requests and for more details.

  • Education in Palliative and End-of-life Care (EPEC – Pediatrics) a comprehensive curriculum designed to address the needs of seriously ill children, their families, and pediatric oncology providers and other pediatric clinicians.
  • Funded by the National Institutes of Health / National Cancer Institute. (NIH Grant Number: 1 R25 CA151000-01) with $ 1.6 million from 2010-2016,
  • Collaborates with a team of 35 national and international leaders in the field of pediatric pain medicine and palliative care.

The recently finished curriculum now comprises 24 core palliative care modules, delivered in a combination of distance online learning and in-person conference sessions. These “Train-the-Trainer” modules provide the “trainers” (pediatric hematologists/oncologists or other pediatric specialists incl. nurse practitioners) with all PowerPoint presentations, trigger-tape videos and a teaching handbook for each module to teach interdisciplinary teams.

Existing EPEC-Pediatric modules:

  1.    Multimodal Analgesia: Acute Pain Management
  2.    Opioid Selection and Opioid Rotation
  3.    Neuropathic Pain Management and Adjuvant Analgesia
  4.    Procedural Pain Management Strategies
  5.    Chronic/Complex Pain Management
  6.    Management of Gastrointestinal Symptoms
  7.    Management of Respiratory Symptoms
  8.    Management of Emotional and Behavioral Symptoms
  9.    Management of Neurological Symptoms
  10. Management of Refractory Distress
  11. Preparation for Imminent Death
  12. Integrative Medicine
  13. Introducing Quality Improvement in PPC
  14. What is Pediatric Palliative Care and Why Does it Matter: An Overview
  15. Child Development
  16. Family Centered Care
  17. Grief and Bereavement
  18. Professional Care for Professionals
  19. Team Collaboration and Effectiveness
  20. Communication & Planning
  21. Ethical & Legal Considerations
  22. Teaching with EPEC-Pediatrics in the Face-to-Face Setting
  23. Teaching Pain & Symptom Management
  24. Methadone


Stefan Friedrichsdorf*, MD, FAAP, Principal Investigator; Children’s Hospitals and Clinics of Minnesota and the University of Minnesota School of Medicine, Minneapolis, MN

Joanne Wolfe*, MD, MPH, Site Principal Investigator, Dana-Farber Cancer Institute and Children’s Hospital, Boston, MA

Joshua Hauser*, MD, Buehler Center on Aging, Health and Society and Northwestern Feinberg School of Medicine, Chicago, IL

Stacy Remke*, LICSW, ACHP-SW, Co- Investigator, Children’s Hospitals and Clinics of Minnesota and the University of Minnesota School of Social Work, St. Paul, MN

Justin Baker, MD, St. Jude Children’s Research Hospital, Memphis, TN

Sarah Friebert, MD, Akron Children’s Hospital, Akron, Ohio

Ross Hayes, MD, Seattle Children’s Hospital, Seattle, WA

Stephen Liben, MD, McGill University, Montreal, Quebec

Kaci Osenga, MD, Children’s Hospitals and Clinics of Minnesota, Minneapolis, MN

Kathy Perko, MS, PNP, Oregon Health and Science University, Portland OR


EPEC-Pediatrics Train-the-Trainer Conference Participants’ Comments:

  • “This is the best conference I’ve ever been to. I love that I’m learning a skill”
  •  “This was a wonderful experience – so grateful for your good work in creating this curriculum!  So looking forward to disseminating content at my site.”
  • “Most useful part of ASPHO!  Very helpful and practical.”
  • “Speakers are very dynamic in different ways. Their styles complemented one another and was a huge strength of the program. They are true teacher’s teachers, like the docs that all docs go to.”
  •  “This was well done and communicated, meaningful lessons for effective communication / teaching”
  • “Excellent use of humor and engaging audience”
  • “Good use of mixed methods – lecture, case-based, interactive – Best lecture in a long time!”
  • “Wonderful!  Amazing speaker – more time with him”
  • “The movement back and forth between the lecture and the teaching points was excellent”
  • “Outstanding – multimodal approach and presenter passion made this great”
  • “Really kept everyone’s attention – great example of effective teaching!”
  • “Excellent and engaging; wonderful role modeling for teaching”
  • “It was great to see you put into practice the techniques you were teaching and to see how to make a lecture interactive.”
  • “Extremely informative. Valuable resources including teaching methods and information”
  • “This presentation was engaging and effective.  I especially liked the intersection of appropriate humor to make larger point”
  • “It was very helpful to be very open about ‘here is the hook’ and to show different examples, and ‘here is how to develop/practice a skill’ and do examples.”
  • “Really great teaching methods ‘ like the hooks and ice breakers and concrete instructions on methods”
  • “Enjoyable, interesting, engaging and useful for practice!”

Position available: Pediatric Psychologist, PhD in our interdisciplinary pain clinic (Minneapolis, MN)

Children’s Hospitals and Clinics of Minnesota is one of the largest freestanding pediatric health care systems in the United States, with more than 4,800 employees, 385 staffed beds (50% of those in intensive care) at its two hospitals in St. Paul and Minneapolis and more than a dozen primary and specialty clinics throughout the Twin Cities (3.5 million inhabitants in the metro area). An independent, not-for-profit health care system, Children’s of Minnesota provides care through more than 14,500 inpatient admissions, 19,300 surgical cases, 8,800 home visits, and more than 95,000 emergency room and 410,000 other outpatient visits every year.

Please join us as Pediatric Psychologist, PhD in our interdisciplinary pain clinic

We are seeking a full-time Clinical Pediatric Psychologist with medical/hospital experience to join our expanding Department of Pain Medicine, Palliative Care, and Integrative Medicine. Specifically, we are looking for a pediatric psychologist to work in our interdisciplinary chronic pain clinic, including assessments of and treatment to children and adolescents with chronic and complex pain (such as CRPS, headaches/migraines, functional abdominal pain, musculoskeletal pain).  Our interdisciplinary pain clinic consists of pediatricians/nurse practitioners, physical therapists, social worker/family therapists, and two psychologists. In addition to outpatient chronic pain services, other responsibilities  include providing consultation to our larger Pain and Palliative Care team across inpatient, outpatient and home settings. Opportunities exist for collaboration in research and educational activities (such as the annual pediatric pain master class) and program development.

About our department: Our interdisciplinary team consists of 36 team members, who work in close collaboration with all pediatric subspecialties in the care of children with acute, chronic, and complex pain in the inpatient and outpatient settings. In addition, we provide palliative and hospice care to children and their families through a continuum of care across home, clinic, and inpatient settings. Integrative Medicine provides and teaches integrative, non-pharmacological therapies (such as massage, acupressure, biofeedback, aromatherapy, self-hypnosis) to provide care that promotes optimal health and supports the highest level of functioning in all individual child’s activities. Please access the following link for a full description of our department:

The department was a 2013 recipient of the “Clinical Centers of Excellence in Pain Management Award” by the American Pain Society. Please watch our chronic pain clinic team in action (in the previous clinic space): In 2015 we opened a unique, one-of-a-kind 10,000 square foot “Healing Environment” Pain, Palliative and Integrative Medicine Clinic and the candidates’ office would be located there: and

Qualifications include: a doctorate in psychology from an accredited graduate program; clinical internship at an APA-approved program; and licensed or license-eligible in Minnesota. Experience  with cognitive-behavioral therapy, biofeedback, and working in an interdisciplinary pediatric clinic setting is desired.  We are hoping to fill the position within the next few weeks or months, but would wait until next summer for an outstanding candidate. We offer an attractive salary and flexible benefits package.  Minority candidates are encouraged to apply.

For consideration, please send letter of introduction, curriculum vitae, and names of references to: Ryan Berreth, Administrator of Physician and APP Recruitment,, (612) 813-8125. We invite you to explore our website at for additional information about Children’s.


For clinical questions, feel free to contact the pediatric psychologist Kavita Desai, PhD, LP or the director of the program Stefan J. Friedrichsdorf, MD, FAAP

 Children’s Hospitals and Clinics is an Equal Opportunity Employer

“Children’s Comfort Promise: Doing everything possible to treat and prevent pain.”

Eliminating Needle Pain in children:






Link to brochure: Pain Clinic Grand Opening

Media Coverage:

Kare11 Minneapolis/St.Paul (NBC): Innovative kids’ pain clinic opens in Twin Cities (Jan 15, 2015)

WCCO 4 News At 6: Children’s Hospital in Minneapolis officially opened a pain clinic unlike any other in the country, reports Susan-Elizabeth Littlefield (Jan. 15, 2015)

Star Tribune: Clinic taps into the senses to relax and soothe hurting children. (Jan 19, 2015)

Children’s new Pain, Palliative & Integrative Medicine Clinic opens new doors

Minneapolis /St. Paul Business Journal: Children’s Hospitals opens expanded pain therapy clinic (Jan 15, 2015):

Minneapolis/St.Paul Magazine: Horst Rechelbacher’s legacy: $ 3.1 Million New Healing Environment Pain, Palliative & Integrative Medicine Clinic at Children’s of MN (Oct 2014)

Kiran Stordalen and late Horst Rechelbacher discuss integrative medicine with Dr. Stefan Friedichsdorf and their generous gift to create the Kiran Stordalen and Horst Rechelbacher Pediatric Pain, Palliative and Integrative Medicine Clinic at Children’s Hospitals and Clinics of Minnesota. (Oct 2014)

CBS: Horst Rechelbacher and Kiran Stordalen give $1.5M to Children’s Hospitals and Clinics of Minnesota for new pain, palliative and integrative medicine clinic (Oct 2014)



9th Annual Pediatric Pain Master Class: June 11-17, 2016 Registration will open December 2015: Contact if you would like to be added to mailing list


8th Annual Pediatric Pain Master Class: June 20-26, 2015 in Minneapolis, MN (USA): Download here the complete brochure and agenda:  2015 Pain Master Class Brochure

Course Description: The Pediatric Pain Master Class offers State of the Art education in pain management for the pediatric patient from a holistic and interdisciplinary perspective. The program features a faculty of internationally recognized experts, who will cover pharmacological, medical, psychosocial and integrative therapies in the management of children’s acute, procedural, and complex/chronic pain. Pain assessment and management of somatic, visceral, neuropathic, psychosocial and spiritual pain as well as end-of-life management of pain and distressing symptoms will be explored in depth using lectures, workshops, and a small-group approach.
2015 Registration closed now: 


SCHOLARSHIP for 9th Pediatric Pain Master Class plus 1-week Practicum

June 6-17, 2016 for physicians from low-moderate income countries: Guidelines available at: 

(Click to download): Application Guidelines for 2016

Past Scholars include:

2015: Rakesh Sharma, MD, from Shimla, Indira Gandhi Medical College, Shimla; India

2015: Issrang Nuchprayoon, MD, Chulalongkorn University, Bangkok; Thailand

2014: Wendy Cristhyna Gómez García, MD, Dr. Robert Reid Cabral Children’s Hospital, Dominican Republic 


2014: Cornelius Kondwani Huwa, MD. Queen Elizabeth Central Hospital, Palliative Care Support Trust, Malawi

2013: Mercedes BernadaMD. Professional Faculty, Department of Pediatrics, Central Hospital Pereira Rossell, Uruguay

2013: Catherine Segbefia, MD. Clinical Tutor, Department of Child Health, University of Ghana School of Medicine, Ghana

2012: Juan Carlos Irola Moya, MD. Pediatric Palliative Care Physician, National Children’s Hospital, Costa Rica

2012: Julius X. Scott, MD, Associate Professor, Pediatric Hematology/Oncology, Sri Ramachandra Medical University, India

2012: Damte Shimelis, MD, Department of Pediatrics and Child Health, Addis Ababa University, School of Medicine, Ethiopia

2011: María Carolina Kamel, MD, Medical Supervisor Pediatrics & Assoc. Clinical Officer, Miguel Pérez Carreño Hospital, Venezuela

2011: Anna Sonkin, MD, Attending Pediatric Physician, Moscow Scientific-Practical Center for Pediatric Cranio-Facial Surgery/Neuropathology, Russia

2010: Linge Gowda, MD, Professor and Head, Kidwai Memorial Institute of Oncology, Bangalore, India

2010: Jinxiang Li, MD, Department of Palliative Medicine, The West China Fourth Hospital of Sichuan University, China

2009: Michelle Meiring, MD, Pediatric Physician, Bigshoes Paediatric Palliative Care Services, Capetown, South Africa

2009: Thao Tran, MD, Pediatric Physician, Pham Ngoc Thach University of Medicine Children’s Hospital, Vietnam


8th Annual Pediatric Pain Master Class – Selected Participant Comments

  • Stefan and his team’s PMC is probably the most intensive educational course I’ve ever done – it is a stunningly thorough coverage of the field of pediatric pain medicine, both broad & deep. The use of interactive feedback, and instant access to a plethora of resources electronically, and experiential aspects (as well as the excellent food, and the two social & one clinical visit provided a welcome balance to the early starts and long days. It truly is an amazing course. Thank you! Paul Vroegop, MD, Auckland, New Zealand
  • This course has invigorated me to become a leader of institutional change at my hospital – it’s time to make children’s comfort a given. Whether using nitrous oxide, topical anesthetics, distraction or advocating for 3 P approach in chronic pain and regional anesthesia at the end of life, comfort possibilities are endless if we just make them a priority. Katherine O’Connor, MD, Bronx, NY
  • Amazing & practical course, packed with entertaining speakers and real-world advice. Really game-changing. Molly Williams, FRACP, Melbourne VIC, Australia
  • This class has opened my eyes to pediatric pain and has made me realize that pain does not have to be a frustrating process and can change. This course should be a must for every pediatric provider to be able to continue to shift thinking in pediatric pain management. The concept of no needless pain/comfort promise is a concept that should absolutely be implemented in every children’s hospital and doctors office in the country (and world!). It has been empowering to want to make a change. J.D. USA
  • Wow, what an amazing course, truly integrated approach. I have learnt so much and it has been a brilliant experience. This seven day course had been a unique experience, the blend of lecturers really works well. You have a fantastic clinic and a really amazing team of people you work with. I will be recommending this amazing course to my colleagues back in the UK. Thank You. Julie Bayliss, Rn, RSCN, BSC Med, London, UK
  • The Pain Master Class was an amazing opportunity to not only (greatly) increase my knowledge on pediatric pain management, but also change my attitude on chronic and procedural pain. The many skills I learned at this course will directly translate to improved patient care. Melissa Acquazzino, MD, Milwaukee, WI
  • As an Emergency Physician I am an expert at managing acute pain, but have had challenging experiences with chronic pain and palliative care patients. Following this course I will bring increased enthusiasm and confidence to my interactions with these patients as I start to use some of my skills and knowledge I have gained. And I will go forward and strive to increase my advocacy for optimal pain management for all infants, children and young people. Jocelyn Neutze, MD, Auckland, New Zealand
  • The pain master class should be required education for every provider who sees a substantial number of pediatric patients with acute and chronic pain, and every provider who want to take a greater leadership role in pediatric pain/palliative care at their institution.
  • A comprehensive and wide ranging course on pediatric pain & palliative care. The speakers are world renowned in their field & are able to distil the clinically relevant aspects of their field. Highly recommended.
  • This was one of the most effective and enjoyable learning activites I have participated in. The approach was multi-modal, multi-faceted & modeled was taught (attitude, skill, knowledge). The time & money spent was the best use of those resources thus far in my career. Anyone who cares for children will benefit from the knowledge, resources, collegiality, networking & inspiration that this course provides. Christine Zawistowski, MD, New York, NY
  • I appreciate the chance to attend this wonderful conference. […] I noticed Japanese are indifferent to pediatric pain. I’m trying to eliminate the needless pain from now on. Yuko Cho, MD, PhD, Sapporo, Japan
  • This class has transformed the way I view pain in pediatrics. It has given me so many tips and methods to help any pediatric patient cope with the variety of things that happen in a hospital and I am really looking forward to making a positive change at my hospital.
  • Thank you for such a fantastic learning opportunity. This dynamic course has provided practical training and methods that I will be able to use immediately to improve the care that I give to children. Wonderful teachers and speakers. So refreshing to be with company of like-minded colleagues and innovative leaders in the field. M.B., Chicago, IL
  • Dear Stefan, Thank you and your team so much for this amazing course. You really found, addressed and taught the sweet spot of holistic, child-centered pain management. Besides this, I appreciated that you provided teaching methodology and skills as well as the implementation lectures. It was an exciting experience meeting you and your team and all the other excellent speakers and the colleagues from all over the world. It will be skill-changing for sure. Thank You. Kathrin Knochel, MD, Munic, Germany
  • Starting a career in palliative care- this course provided the knowledge base confidence to get started. Karen-Rose Wilson, MD, Calgary, Aleberta, Canada
  • This has been a fantastic course. It has provided both inspiration to strive for better pain management program for children and a solid foundation via confident, evidence-based manner. Any reservations about developing comprehensive pain program for pediatrics at my institution have been entirely removed through my participation in this course. Bradd Henker, MD, Coon Rapids, MI
  • This week was a feast for the mind, body and spirit – a very comprehensive overview of the field of Pain Management in children. Kaylani Raghavan, MD, MBBC, DCH, Hartford, CT
  • The Pain Master Class is a one of a kind course that raises the bar on pain management. The course focuses on pediatric pain management, palliative care and integrative medicine with international leaders in the field lending their expertise to this endeavor. As someone with extensive training in pain management already – I still felt that this course was extremely valuable to my practice. Alexander J. Madonis, MD, Los Angeles, CA
  • In the 16 years that I practiced pediatric oncology, and the 7 years of pediatric palliative medicine & hospice, I have never attended a conference that so fundamentally changed the way I think about how to care for / treat children that even remotely compares to this one. Bob Bash, MD, Tampa/St. Petersburg, FL
  • It was an extremely useful course. I will go back to my hospital with a more profound knowledge of all aspects of pediatric pain. Thank you! Join Verlooy, MD, Antwerp, Belgium
  • A well organized course with high content value. The presentation were par excellance and kept everyone glued. Created an opportunity to learn extensively in the field of pain management and the recent advances in the field. Rakesh Sharma, MD, India

7th Annual Pediatric Pain Master Class – Selected Participant Comments

  • This was an amazing class. I learned so much that is directly applicable to my own practice, both to the whole program and individual patients. I am inspired and rejuvenated to return to work. Mary Beth Chrismaeich, MD, St. Louis, MO
  • Stefan is a wonderful and innovative teacher, but even beyond that he really does bring the best people on the planet to teach the various domains in the course. Caitlin Neri, MD, MPH, Boston, MA
  • I loved all the resources provided. The fabulous networking activities were a great touch to make it even more special. Thank you! I will recommend this conference to my colleagues. Life changing! Anonymously
  • The lectures and experimental activities are based on equal parts compassion and evidence best practice… Sarah Fehr, RN, MSN
  • The lessons are largely practical and applicable even in my setting in Malawi. This will change the way pain is managed and viewed in children in Malawi. Cornelius Huwa, MD, Blantyre, Malawi (Africa)
  • I have gained knowledge and skills that I will start using Monday morning…My patients and their families are no doubt better off as a result of me taking this master class. Dr. N.P., Mesa, AZ
  • It is not often in our professional career that we have the fortune to experience a comprehensive course by worldwide experts in one location. Rebekah Holpira
  • Thanks for helping instill confidence in my management and my ability to affect change in pain management within my own institution. Mona Reed, MD
  • The days are long, but the learning is immense and relevant, fun and immediately usable. After a long day, you leave the course feeling energized and ready to begin again in the morning. Anonymously
  • Our days were filled with superb speakers who were all masters of their craft, simple to complex material was effectively communicated with innovative learning strategies and resources were provided to prepare us to be change agent for our return home. Debra Davis, APRN
  • Phenomenal, comprehensive, evidence-based, well-organized course … everything needed to start a pain program or to enhance / grow an existing program. S.D., NY, USA
  • I feel significantly more competent to care for my patients…This course has the highest proportion of truly excellent presenters of any course/meeting I have attended. Robert J. Brown, MD, Los Angeles, CA






Here is a list of current

US Pediatric Palliative Care Physician Fellowship Programs

Thanks to Joanne Wolfe, Boston, in compiling this information !!!

(1) Akron Children’s Hospital Pediatric Palliative Medicine Fellowship (2 slots) Contact: Cathy Kelly-Langen, MD – or 330-543-3343



(2) Children’s Healthcare of Atlanta and Emory University School of Medicine (Pediatric Track) Contact: Jeffrey C Klick, MD –



(3) Children’s Hospital of Philadelphia (2 slots)  Contact:  Jennifer K. Hwang, MD MHS



(4) Children’s of Alabama Palliative & Supportive Care Team/University of Alabama at Birmingham (Pediatric Track, not dedicated position)  Contact: Michael Barnett, MD MS  or (205) 975-8197



(5) Cincinnati Children’s Hospital Hospice & Palliative Care Fellowship (2 slots)

Contact: Marybeth Sullivan, fellowship coordinator

Contact: Norb Weidner, MD  Director



(6) Jefferson Medical College Program – Wilmington DE

Nemours/duPont Hospital for Children HPM Fellowship (Pediatric Track)

Contact: Elissa Miller, MD



(7) Harvard Palliative Care Fellowship (Pediatric Track) (2 slots)

Contact: Joanne Wolfe, MD MPH  pediatric fellowship director

Contact: James F. Fitzgerald  fellowship coordinator



(8) Kaiser Permanente Southern California Hospice and Palliative Medicine Fellowship (Pediatric Track at Children’s Hospital Los Angeles)

Contact: Susan Wang,MD or Ilanit Brook, MD (CHLA Palliative care physician)



(9) Northwestern University Palliative Medicine Fellowship (Pediatric Track, not dedicated position) Contact: Joshua Hauser, MD Contact: Joel Frader, MD



(10) University of Florida Jacksonville (Pediatric Track)

There is also an adult track – 1 position for each year.




(11) University of Michigan Ann Arbor Palliative Care Fellowship (Pediatric Track)

Applicants require funding from home institution

Contact: Terry Murphy



(12) University of Minnesota: Hospice and Palliative Medicine Fellowship (Pediatric Track)

Department of Pain Medicine, Palliative Care and Integrative Medicine, Children’s Hospitals and Clinics of Minnesota, Minneapolis/St. Paul, MN

Contact: Kris Catrine, MD , Pediatric Fellowship Director



(13) University of Mississippi / Batson Children’s Hospital, Hospice and Palliative Medicine Fellowship (Pediatric Track, 1 slot)

Contact: Rick Boyte, MD, Fellowship Director,

Contact: Daphne Secrest, Fellowship Coordinator,


(14) University of Tennessee Palliative Care Fellowship (Pediatric Track) (2 slots)

Contact:  Le Bonheur Children’s Hospital site director:  Melody Cunningham, MD:

Contact:  St Jude Children’s Research Hospital site director:  Justin Baker, MD:

Contact: Fellowship Coordinator:  Catina Price;



(15)  University of Texas Medical School at Houston Hospice and Palliative Medicine Fellowship (Pediatric Track, not dedicated position)

Contact: John Halphen, MD  Fellowship Director

Contact: Patrick Jones, MD Pediatric Track Director



(16) University of Washington Palliative Medicine Fellowship (Pediatric Track, not dedicated position)

Contact: Ross Hays, MD

Contact: Fellowship Coordinator, Betsy Zickler


A Pediatrician’s favorite Top 10 Apps for Pain Management

State of the art pain management in the 21st century demands that pharmacological management must be combined with supportive and integrative (non-pharmacological) therapies to manage a child’s pain. At our department we are using physical methods (e.g. cuddle/hug, massage, comfort positioning, heat, cold, TENS), cognitive behavioral techniques (e.g. guided imagery, hypnosis, abdominal breathing, distraction, biofeedback) as well acupressure and aromatherapy.

For “needle-pokes” (vaccinations, blood draws etc.) for instance we expect that kids are sitting upright (use sucrose in the age group 0-12 months), that we numb their skin with topical anesthesia (e.g. EMLA-patch, LMX 4% lidocaine patch, or J-tip) and use distraction, such as bubble blowing or blowing a pin wheel. Alternatives can be apps on your smartphone etc.

My personal favorite remains teaching children in self-hypnosis. However, in addition, I use in my clinical practice (inpatient, clinic and home visits) increasingly Apps on my iPhone or iPad:

My Top 10 Apps for Pain & Symptom Management in Children

 #10 Chalkboard: Drawing on a realistic chalkboard with different color chalk – much more fun than it sounds. [$ 1.99]

 #9 Talking Tom: This is a cat that repeats everything you say in a funny voice. You can then record and share videos and send them by eMail / YouTube / Facebook. Kids really enjoy that they can make Tom the cat say funny stuff… [free]

# 8 Simply Being: Provides relaxation, stress relief and benefits of meditation without prior experience. It allows the child/teenager to choose from 4 meditation times and gives them the option to listen to the guided meditation with or without music or nature sounds. Kids can also listen to the music or nature sounds alone. More for older children and teenagers. [$ 0.99]

 #7 Drums:  As the name implies, this is a drum kit. Great for kids with too much [or too little] energy. Rock on! [$ 0.99]!/id311549739?mt=8

# 6 Tesla Toy: Tesla Toy is a fun interactive “particle toy”. When the fingers touch the screen they generate what looks like a powerful electrical field that makes the thousands of particles react beautifully. 
Kids (& adults) are often mesmerized by this app for a long time. [$ 1.99]

#5 Fruit Ninja: A “juicy” action game with squishy, splatty and satisfying fruit carnage! [$ 0.99]

 #4 Koi Pond: One is gazing into a pond of crystal clear water with fish, turtles and more. Kids run their fingers across the cool surface of the pond and water ripples away from their touch.
The koi fish, disturbed, dart away… only to quickly forget and swim close once more… [$ 0.99]

#3 Easy Bake Treats: This is a highly recommended app. It let’s children make, bake, decorate, eat and share virtual cakes, cupcakes, cookies, cake pops and pizza. They pick their mix, fill the pan with batter and water, mix it all together and slide the pan into the virtual oven to cook.  Then they can add candles to their cakes and cupcakes too! Candles can be lit and re-lit for even more fun! 
Once they’ve baked and decorated their treats, kids can show off and share their delicious virtual creations with family and friends via email or Facebook. Highly addictive – kids can spend a very long time on this! [free]!/id462795218?mt=8

#2 The Healing Buddies Comfort Kit™ app provides an interactive, virtual way for kids and teens to engage with the latest in integrative medicine techniques and activities to assist in the management of symptoms they may be experiencing. 
Kids and families are increasingly interested in options to improve health and wellness that involve taking fewer pills and that involve supporting their body’s natural, internal healing systems. -combining kid-friendly activities and pre-recorded audio exercises and instructions that teach self-care skills. The Healing Buddies Comfort Kit™ (mobile app for iPad, iPhone and iPod Touch platforms) offers an interactive, virtual way for kids and teens at home, in a doctor’s office, or in the hospital, to learn and immediately benefit from self-care techniques to manage common symptoms like pain, worries, nausea, fatigue and trouble sleeping. 

The Healing Buddies Comfort Kit™ contains several integrative medicine techniques adapted for use by children and teens that are quick and effective for symptom control so kids can get back to doing what they like to do–and need to do each day. The techniques included in this mobile app are designed by leaders in the field of Pediatric Integrative Medicine (Physicians, Nurses, Psychologists and Child Life Specialists) and have been tested for years in several leading Children’s Hospitals and Clinics. The app leads kids through these various techniques and activities, plus, the Healing Buddies™ make it a fun and engaging experience.

Techniques that kids will learn that are included in the Healing Buddies Comfort Kit™ include:

-Mental Imagery/Visualization: in this technique kids/teens will learn to use the power of their imagination to effect changes in physical and emotional activity.

-Relaxation Exercises: with these breathing and muscle control techniques, kids/teens will learn to calm down and balance the body and the nervous system which helps to reduce symptoms of pain and nausea, improves sleep and can have a powerful effect on controlling & even eliminating worries

-Acupressure: acupressure is part of the ancient Chinese medical system and involves applying pressure to “special points” on the body which in turn releases helpful chemicals and induces nervous system changes that can help to reduce pain, nausea, and anxiety

-Aromatherapy: aromatherapy, which involves smelling oils made from plants, has been around in most cultures for thousands of years. Smelling certain kinds of scented oils offers another tool for kids/teens to use to control unwanted symptoms/feelings

-Positive Self-Talk: this involves learning to be a “self-coach” and harnesses the power of positive thinking. [Disclaimer:

The creation of the mobile app has been a collaborative effort of my department at the Children’s Hospitals and Clinics of Minnesota with Ridgeview Medical Center and DesignWise Medical.]

 and the winner is…

#1 Balloonimals:  Absolutely groovy – kids love it! My favorite app to distract a child in pain or discomfort. Beautifully rendered balloon animals spring to life when you blow into the microphone on your iPhone/iPad or swipe with your iPod Touch. Watch the balloon inflate and then give your phone a shake to start constructing your Balloon animal. With each shake, your animal takes greater shape until… Voila! Your Balloon animal appears and is ready to play. Pet your “Balloonimal” to see what tricks it can do.


Also, check out the brand-new “Pain Squad” from SickKids in Toronto:

Apps, which just did not make the list (but I still like them a lot): Art of Glow, Sand Garden, Build a Zoo, Naturespace, SkyView and Disney’s Small World

And…a groovy App just out in October 2014: Pain Squad Mobile App

The Hospital for Sick Children (SickKids) in Toronto needed to find a way to encourage their young cancer patients to complete daily reports on their pain. With a little back-up from Canada’s top police dramas, our innovative mobile app made this overwhelming task easy and fun.




Stefan J. Friedrichsdorf, MD, FAAP Medical Director | Department of Pain Medicine, Palliative Care & Integrative Medicine | Children’s Hospitals and Clinics of Minnesota

Twitter: @NoNeedlessPain