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PEDIATRIC PAIN ASSESSMENT
PAIN ASSESSMENT
� Get detailed assessment
� History of primary illness
� Description of pain
� Experience with pain medications
� Use of non-pharmacologic approaches
� Parent personal experience with pain meds
� Social & spiritual factors
PAIN ASSESSMENT TOOLS: SCALES DO NOT ALWAYS REPRESENT MULTIDIMENSIONAL ASPECT OF
PAIN
BIRTH - 2 YEARS
Pain Perception� Neonates as young as 24-
weeks feel pain
� Ascending nerve tracts develop earlier than the pain inhibiting nerve tracts meaning that neonates may experience a greater intensity of pain than that neonates may experience a greater intensity of pain than older children
� Neonates exposed to repeated painful stimuli show increasing sensitivity
� Neonatal/Infant Pain Scale (NIPS)
BIRTH - 2 YEARS (CONTINUED)
Cognition
� No “understanding” of pain and unable to provide a self-report
� 12 to 18 months, beginning of reasoning and language (1- or 2-word statements) language (1- or 2-word statements)
� Major cognitive processing through senses (eyes, ears, hands)
� CHEOPS (1-7 years)� Looks at types of pain behavior: cry, facial, verbal,
torso, touch and legs.
2 - 4 YEARS
� CNS fully developed
� Development of autonomy continues
� Significant language developmentdevelopment
� Limited logic and reasoning
� Self-centered thought process
� Visual analog (Wong-Baker Faces)
7 - 11 YEARS
�Logic and reasoning
far more developed
� Imagination and
creativitycreativity
�Finalism and concept
of death
�Number pain scale
(scale 1-10)
Adolescents (11+ years)Adolescents (11+ years)
� Cognitively adults� Same pain assessment methods as adults
� Abstract thinking and understanding hypothetical situations
� Emotional needs� Include them in the process
� Respect their privacy
� Respect their pain reports
FACES SCALE
Bieri, 1990Bieri, 1990
NON-VERBAL CHILDREN
� FLACC Scale
Pain Assessment
� Hospitals should use a standard pain scale for the
various age groups to allow continuity.
� Self report scores (e.g. numerical rating scale) can
mislead. A score of 4 may denote severe pain to mislead. A score of 4 may denote severe pain to
one adolescent while 8 may be severe to another.
� Pain can be worsened by anxiety, depression and
spiritual crisis. We must consider this in our
assessment.
References
� Bieri D, Reeve RA, Champion GD, Addicoat L, Ziegler JB. The Faces Pain Scale for the self-assessment of the severity of pain experienced by children: development, initial validation, and preliminary investigation for ratio scale properties. Pain. 1990; 41(2):139-50.
� Friedrichsdorf SJ, Kang TI. The management of pain in � Friedrichsdorf SJ, Kang TI. The management of pain in children with life-limiting illnesses. Pediatric clinics of North
America. 2007; 54: 645-672.
� Tomlinson D, Baeyer CL, Stinson JN, Sung L.A systematic review of Faces scales for the self-report of pain intensity in
children. Pediatrics. 2010; 126: e1168.