Over the last two years, the CRC has transformed our Upper Limb Orthopaedic Clinic, delivering a new, patient-centered pathway, with collaboration from orthopaedic and paediatric consultants, therapy and nursing teams, all working together.

In the Upper Limb Orthopaedic Clinic, the team’s focus is on improving upper limb function and effective tone management. This often requires the use of Botulinum toxin injections, which help to loosen the muscles, enabling better stretch and enhancing overall arm function.

The use of this injection can be very painful, especially for children and it can also provoke anxiety for many children who have needle phobias. Many of the children seen in the CRC would be waitlisted for this procedure at a local paediatric hospital where they would have access to procedural sedation to manage their anxiety and pain.

For the children, their families, and carers, bringing the child into the hospital,   coupled with the uncertainties of wait times and cancellations related to demand on acute hospital beds, posed significant challenges and increased anxieties. The CRC multidisciplinary team recognised this recurring issue and sought a more efficient solution.

It became evident the importance of being able to treat children during their clinic visits, without the need for further external admissions, and a streamlined process that would ensure timely and comprehensive care.  For all the children, including many that attend school here, it was imperative to address this issue and ensure that the CRC remained their safe space.

Seeking alternative solutions for effective pain management, the expert teams sought to establish the safe use of procedural sedation in the CRC to reduce requirement for attendance at an acute hospital.

Entonox, commonly known as nitrous oxide or laughing gas is widely utilised in maternity wards and by paramedics, to alleviate immediate pain. It is currently in use in day wards in children’s hospitals, and one of the means of sedation used for this cohort of children when they were referred for the Botulinum toxin injections in the children’s hospital.

Over the last 18 months, we have undertaken extensive work, focusing on training and education on Entonox administration to ensure the highest standards of care and safety. After thorough planning Entonox was introduced in our clinics in 2023.

For most children, this development means if Botulinum toxin is required during their therapy, the treatment can be administered on the same day, eliminating the need for further hospital appointments, and potential waiting lists, and reducing the risk of cancellations. For children, the CRC is a familiar environment with familiar staff with a calm and reassuring setting. For a child, it means reduced pain with minimal disruptions to their day and for their families and carers a more seamless and calmer experience.

The development of the use of Entonox in the CRC has been a significant leap forward in paediatric care, emphasising efficiency in a patient-led approach. It is anticipated that in time this can be rolled out to other specialist clinics.  This transformative achievement is the result of dedicated collaboration among the CRC’s multidisciplinary teams, utilising charitable funds, exemplifying the power of collective efforts in driving positive change for children with disabilities, their families, and carers.