2.3 Pain Assessment

At the end of this session you will be able to:

1. undertake a comprehensive assessment of a child presenting to you with pain

In addition you will be able to:

2. Identify appropriate tools to use within your practice (setting) and for children of different ages/cognitive needs

3. Consider effective strategies for working with and involving parents in the care of their child’s pain.

Pain Assessment

Involving parents in pain assessment is an important and influential element of care (Woodgate & Kristjanson, 1996) and they have been shown to assess children’s pain accurately (e.g., Benestad et al., 1996). However some studies have found that parents underestimate their child’s pain (St-Laurent-Gagnon et al., 1999).

Simons et al.’s (2001) phenomenological study identified that parents often felt that their involvement in their child’s pain management was often limited, passive and superficial. Simons et al. propose that nurses need to carefully negotiate with parents to establish their role and level of contribution to their child’s pain management.

These tools involve observation of behavioural pain indicators, physiological measures and the child’s (or parents) verbal report of the nature and intensity of their pain.  A higher degree of difficulty exists when assessing pain in non-verbal populations, such as infants and cognitively and/or physically impaired children (Hunt et al., 2003; Carter et al., 2002; Houlihan, 2004).

One easy way of remembering the key elements for pain assessment and management is the ABCDE for Pain Management and Assessment (Jacox et al.1992)

Assessing patients’ pain is complicated and effective management can be assisted by utilisation of an appropriate assessment tool. 

Assessment tools need to be age (cognitive level) appropriate, easy to apply in clinical practice and aid communication of the child’s pain.

There are now many different pain assessment tools available to use. Tools have been developed for

• different age groups (including infants, toddlers, young children, adolescents);

• different ethnic, cultural and language groups

• children with different diagnoses or needs (including palliative care, post-operative care, cognitive impairment);

• use as self-report instruments by the children,

• use as assessment tools by nurses and other health care professionals

• use as assessment tools by parents and carers

There has been a veritable proliferation of tools and research studies considering their comparative clinical applicability.

For further information, see Wong on Web – Powerpoint of pain assessment in infants and children

Overall the evidence is that use of appropriate assessment tools can contribute to more effective pain management.  See Table 6 for an overview of tools.

Guidelines for Good Practice

There are a number of useful websites (for example, http://www.ich.ucl.ac.uk/cpap/ ) and guidelines are readily available to assist nurses in the recognition, assessment and management of pain in children

(e.g. Action for Sick Children pamphlets for parents; Alder Hey’s -Guidelines on the Management of Pain in Children).