Pediatric Pain

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Pediatric Pain Assessment
Pediatric Pain Assessment
Susan Harp, RN Division of Pediatric Anesthesia
and Pain Management
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Goals of Pain Assessment
Provide accurate information to determine
which actions could be taken to alleviate the
pain, and, on an ongoing basis evaluate the
effectiveness of these actions. Judith
Beyer and Nancy Wells, PEDIATRIC CLINICS OF
NORTH AMERICA,1989
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Pain Assessment

• Location
• Characteristics
• Onset / Duration
• Frequency
• Quality
• Intensity / Severity
• Precipitating Factors

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Assessment Tools

• Self-Report The Gold Standard
• Observational Scales
• Physiologic Parameters
• Parent Report
• Nurse Report

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Self-Report

• Description of Pain- type of pain- intensity of
  pain
• Pain Scale Ratings

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Observations

• Vocalization / verbalization
• Facial Expression
• Body Language
• Emotional State

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Physiologic Parameters

• Heart rate
• Respiratory rate
• Blood pressure

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Parent Vs. Nurse Report

• Varying results in studies comparing parent,
  nurse, and self-report
• May be especially useful in cognitively impaired
  children

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Special Situations

• Cognitively impaired
• Cerebral palsy with normal cognitive level
• Hearing or vision impaired
• Non-English speaking
• Intubated / paralyzed patients

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Developmental Factors

• Newborns and small children unable to give
  self-report
• However, avoidance behavior has been shown by at
  least 6 months of age
• Consistency of facial and cry response has been
  shown in neonates and infants
• Children 3-5 yrs are able to use some self-report
  measures, localize pain

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Assessment in Neonates

• Neonatal Infant Pain Scale (NIPS)
• Objective Pain Scale (OPS)
• Cries
• Parent Report
• Nurse Report
• Physiologic Measures

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Neonatal Infant Pain Scale (NIPS)

• Facial Expression - relaxed, grimace
• Cry - no cry, whimper, vigorous
• Breathing patterns - relaxed, changed
• Arms - relaxed, flexed/extended
• Legs - relaxed, flexed/extended
• State of Arousal - sleeping/awake, fussy

Lawrence J, et. al
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Objective Pain Scale (OPS)

• Blood pressure - 10, 10-20, 20-30 preop
• Crying - not crying, crying /- response to TLC
• Moving - none, restless, thrashing
• Agitation - calm, mild, hysterical

Broadman LH, Hannalah RS, et.al
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Objective Pain Scale (OPS)

• Verbal Eval / Body Language- asleep/states no
  pain- mild pain (cannot localize)- moderate
  pain (localizes)

Broadman LH, Hannalah RS, et.al
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Assessment in Infants and Children lt 3 Years

• OPS
• CHEOPS
• Parent Report
• Nurse Report
• Physiologic Measures

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Childrens Hospital of Eastern Ontario Pain Scale
(CHEOPS)

• Cry - None, Moaning, Crying, Screaming
• Facial - Composed, Grimace, Smiling
• Verbal - None, Other, Pain, Both, Positive
• Torso - Neutral, Shifting, Tense,
  Shivering, Upright, Restrained
• Touch - None, Reach, Touch, Grab, Restrained
• Legs - Neutral, Squirming, Drawn-up, Standing,
  Restrained

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Assessment in Children 3-6 Yrs

• Faces Scale
• Oucher Scale
• Poker Chip Tool
• Visual Analogue Scale (VAS)
• Observation Tools
• Parent Report
• Nurse Report

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FACES Rating Scale
Adapted from Wong/Baker FACES Rating Scales Wong,
D and Whaley, L Clinical Handbook of Pediatric
Nursing ed.2, p. 373, St. Louis, 1986, The C.V.
Mosby Company.
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OUCHER!
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Numerical Rating Scale
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Assessment in Children gt 6-7 Yrs

• Self-Report- VAS- Numerical Ranking Scale
• Observational Scales
• Parent Report
• Nurse Report

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Golden Rule of Pain Assessment

• Dont forget to ask the patient !!!

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Pain Assessment in Children
Pain is whatever the patient says it is.
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Facts About Children Pain

• Infants do feel pain
• Children do not tolerate pain better than adults
• Children can tell you where they hurt
• Children do not always tell The truth about pain

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Facts About Children Pain

• Children do not become accustomed to pain or
  painful procedures
• Behavioral manifestations of pain may not reflect
  pain intensity
• Narcotics are no more dangerous for children
  than adults

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