| Paediatric patient cohort | Appropriate pain assessment tools |
| Neonates & premature infants |
PIPP: 28-40 weeks N-PASS: 23 weeks - 100 days CRIES: 32-60 weeks |
| Pre-verbal children | FLACC: 2months - 7yrs (Up to 19yrs in those with cognitive impairment) |
| Non-verbal children | FLACC: 2months - 7yrs Comfort: 0-18yrs in those sedated/intubated NCCPC-PV: 3-18yrs inc. cognitive impairments |
| Verbal children (<8yrs) | FACES Pain Scale Revised: 4-18yrs Wong-Baker FACES Pain Scale: >3yrs Oucher: 3-18yrs Pieces of hurt: 3-18yrs |
| Verbal children (>8yrs) | FACES Pain Scale Revised: 4-18yrs Numeric rating scale: ≥8yrs Visual analogue scale: ≥8yrs |
Assessing Paediatric Pain
Assessing Paediatric Pain
The curriculum asks us to possess 'the ability to assess and manage acute pain for special groups to include children, infants'.
Anecdotally this is a frequent SBA/MTF question, though doesn't appear to have been the sole basis for a CRQ (yet).
Resources
- Systematic, routine pain assessment using standardised, validated measures is the foundation of effective pain management
- Assessment tools tend to be based on either:
- Self-reporting
- Observed behaviours
- Self-reporting is the 'gold standard' as it is a direct measure of pain, however no one tool is appropriate for use across all children or cases
- In general, self-reporting tools are suitable for patients >5yrs
- They are not always exact, but when used properly are the most accurate method of pain assessment
Wong-Baker Faces Pain Rating Scale and the Faces Pain Scale-Revised (FPS-R)
- The Wong-Baker scale uses six hand-drawn faces which represent pain intensity
- A change of one face at a time is considered clinically significant
- It is suitable for those 3 - 18yrs old
- The Faces Pain Scale-Revised scale uses cartoon faces which are numbered 0 - 10
- Suitable for those 4-12yrs old
Poker chip tool
- Appropriate for those 4-17yrs
- Used to represent pain intensity
- The child chooses the number of chips that represent the pain they're experiencing
- One chip indicates 'a little hurt'
- Four chips indicate 'the most hurt a child could have'
Visual analogue scale
- Can be used in those >8yrs, but is more reliable in those >12yrs old
FLACC
- The Face - Legs - Activity - Cry - Consolability scale is used for children 2 months-7yrs old
- It incorporates five categories of pain behaviours
- It is a simple framework for quantifying pain behaviours in children who may not verbalise the presence or severity of pain
| Criteria | Score 0 | Score 1 | Score 2 |
| Face | No particular expression/smile | Occasional grimace/frown Withdrawn, uninterested |
Quivering chin Clenched jaw |
| Legs | Normal or relaxed | Uneasy, restless or tense | Kicking Drawing legs up |
| Activity | Lying quietly in a normal position Moves easily |
Squirming, shifting back & forth Tense |
Arched, rigid Jerking |
| Cry | No cry (asleep or awake) | Moans, whimpers Occasional complaints |
Steady crying Screaming, sobbing Frequent complaints |
| Consolability | Content, relaxed | Reassured by talking/hugging/touch Distractible |
Difficult to console or comfort |
Procedure Behaviour Checklist (PBCL)
- Appropriate in children 3 - 18yrs
- Used to observe pain and anxiety during medical procedures
- Assesses six behaviours
- Behaviours are rated on a 1 - 5 scale based on their occurrence and intensity
Children's Hospital of Eastern Ontario Pain Scale (CHEOPS)
- Appropriate for those 1 - 12yrs
- It is an observational measure of post-operative pain in children
- Assesses six behaviours
- Each behaviour is rated on a 0 - 3 scale based on intensity
COMFORT scale
- Used for those 0 - 18yrs in intensive care environment
- Assesses eight domains indicative of pain
- Each dimension is scored 1 - 5 and the scores added to yield a measure of sedation, yielding a possible total score between 9 and 45
- A score of 17 - 26 is thought to represent adequate sedation and analgesia
Premature Infant Pain Profile (PIPP)
- Seven indicators of pain are scored on a four-point scale