Pediatric pain assessment

1. PEDIATRICPAINASSESSMENT

2. PAINASSESSMENT
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

3. P
A
INASSESSMENTTOOLS:
S
CALES DO NOT ALWAYS REPRESENT MULTIDIMENSIONAL ASPECT OF
PAIN

4. 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)

5. 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, verba l,
torso, touch and legs.

6. 2 -4 YEARS

CNS fully developed

Development of
autonomy continues

Significant language development development

Limited logic and
reasoning

Self-centered thought
process

Visual analog (Wong-
Baker Faces)

7. 7 -11 YEARS
Logic and reasoning
far more developed

Imagination and creativity creativity

Finalism and concept
of death

Number pain scale
(scale 1-10)

8. 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

9. FACESSCALE Bieri, 1990 Bieri, 1990

10. NON-VERBALCHILDREN

FLACC Scale

11. 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.

12. References
Bieri D, Reeve RA, Champion GD, Addicoat L, Ziegler JB. The
Faces Pain Scale for the self-assessment of the sev erity of
pain experienced by children: development, initial validation,
and preliminary investigation for ratio scale prope rties. 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.