Pain Assessment and Management in Children
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| Young Infant (Response to Pain) | rigidity or thrashing w/ local reflex w/drawal; loud crying; eyebrows lowered & drawn together, eyes tightly closed & mouth open & squarish; no association demonstrated between approaching stimulus & subsequent pain
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| Older Infant (Response to Pain) | body response w/ deliberate w/drawal of stimulated area; loud crying; facial expression of pain or anger; physical resistance, especially pushing the stimulus away after its applied
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| Young Child (Response to Pain) | loud crying, screaming; say "Ow"; thrashing of arms & legs; attempt to push away stimulus b4 its applied; lack of cooperation, need physical restraint; request termination of procedure; clings to parent; requests emotional support such as hugs; restless
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| School-Age Child (Response to Pain) | may see all the behaviors of a young child, especially during actual painful procedure but less in the anticipatory period; stalling behavior such as Im not ready; muscular rigidity, such as clenched fists, white knuckles, gritted teeth, contracted limbs
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| Adolescent (Response to Pain) | less vocal protest; less motor activity; more verbal expressions, such as "it hurts"; increased muscle tension & body control
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| distress behaviors | such as vocalization, facial expression, and body movement, have been associated w/ pain
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| FLACC Pain Assessment Tool | most commonly used behavioral pain measure; is an interval scale that includes five categories of behavior: facial expression (F); leg movement (L); activity (A); cry (C); & consolability (C); it measures pain by quantifying pain behaviors w/ scores 0-10
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| Children's Hospital of Eastern Ontario Pain Scale (CHEOPS) | which was developed in collaboration w/ experienced recovery room nurses who were queried as to what behaviors they most frequently observed to determine whether a child is in pain
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| Toddler-Preschooler Postoperative Pain Scale (TPPPS) | which is an observational scale developed for measuring postoperative pain in children ages 1 to 5 years
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| Parent's Postoperative Pain Rating Scale (PPPRS) | which is a scale that parents may use to rate their children's pain by noting changes in the frequency of a number of behaviors
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| FACES pain scales | provide a series of facial expressions depicting gradations of pain
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| Adolescent Pediatric Pain Tool (APPT) | is a multidimensional pain instrument pain instrument for children & adolescents that is used to assess three dimension of pain: location, intensity, & quality
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| CRIES | pain assessment tool used by nurses who work w/ premature & full term infants in the NICU, which is an acronym for the tool's physiologic & behavioral indicators of pain: crying, requiring increased O2, increased VS, expression, & sleeplessness
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| Premature Infant Pain Profile (PIPP) | unique bc it has been developed specifically for preterm infants; the category "gestational age at time of observation" gives a higher pain score to infants w/ lower gestational age
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| Neonatal Pain, Agitation, and Sedation Scale (NPASS) | originally developed to measure pain or sedation in preterm infants after surgery; it measures 5 criteria in two dimensions (pain & sedation) & may be used in neonates as young as 23 weeks of gestation up to infants who are 100 days old
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| Non-communicating Children's Pain Checklist | is a pain measurement tool specifically designed for children w/ cognitive impairments; the scale discriminates between periods of pain & calm & can predict behavior during subsequent episodes
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| Pain Indicator for Communicatively Impaired Children (PICIC) | distinguishes between pain & nonpain in communicatively impaired children w/ life threatening illnesses
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| Oucher Pain Scale | consists of a 0 to 10 numeric scale for older children and six-picture photographic scale for younger children
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| containment | achieved through positioning & blanket rolls; it provides a nest that enhances the infant's feelings of security & decreases stress
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| facilitate tucking | which is holding the infant's extremities flexed & contained close to the trunk, during heel lance procedures has been demonstrated to decrease HR, decrease crying time, & promote stability in the sleep wake cycles after the lance
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| kangaroo care | skin-to-skin holding of infants dressed only in diapers against their mother's or father's chest
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| nonopioids | a combination (acetaminophen w/ codeine) works better in some cases bc it acts at the peripheral nervous system
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| opioids | acts at the CNS
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| coanalgesics | or adjuvant analgesics, may be used alone or w/ opioids to control pain symptoms & opioid side effects
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| preemptive analgesia | involves administration of medications before the child experience the pain or before surgery is performed so that the sensory activation & changes in the pain pathways of the peripheral & CNS can be controlled
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| multimodal or balanced analgesia | a combination of medications that is used for postoperative pain & may include NSAIDs, local anesthetics, nonopioids, and opioid analgesics to achieve optimum relief & minimize side effects
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| headache diary | can allow child to record the time of onset, activities before the onset, any worries or concerns as far back as 24 hrs before the onset, the severity and duration of pain, pain meds taken, & activity pattern during headache episodes
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