Pediatrics : Non-communicating children’s pain checklist: 3 years and older

    • Non-communicating children’s pain checklist: 3 years and older
      • Behavior are observed for 10 min
      • Six subcategories are each scored on a scale 0 to 3
        • 0: Not at all
        • 1: Just a little
        • 2: Fairly often
        • 3: Very often
      • Subcategories
        • Vocal
        • Social
        • Facial
        • Activity
        • Body and limbs
        • Physiological
      • Cutoff scores
        • 11 or higher indicates moderate to severe pain
        • 6 to 10 indicates mild pain
    • IM injections are not recommended for pain control in children
    • Intranasal medications are not recommended for children younger than 18 years
    • Rectal medications have variable absorption rates, and children dislike them
    • Intradermal medications are used for skin anesthesia prior to procedure
    • Children’s responses to pain at various ages
      • Newborn and young infant
        • Uses crying
        • Reveals facial appearance of pain (brows lowered and drawn together, eyes tightly closed, and mouth open and squarish)
        • Exhibits generalized body response of rigidity or thrashing, possibly with local reflex withdrawal from what is causing the pain
        • Shows no relationship between what is causing the pain and subsequent response
      • Older Infant
        • Uses crying
        • Shows a localized body response with deliberate withdrawal from what is causing the pain
        • Reveals expression of pain or anger
        • Demonstrates a physical struggle, especially pushing away from what is causing the pain
      • Young Child
        • Uses crying and screaming
        • Uses verbal expressions, such as “Ow,” “Ouch,” or “It hurts”
        • Uses thrashing of arms and legs to combat pain
        • Attempts to push what is causing the pain away before it is applied
        • Displays lack of cooperation; need for physical restraint
        • Begs for the procedure to end
        • Clings to parent, nurse, or other significant person
        • Requests physical comfort, such as hugs or other forms emotional support
        • Becomes restless and irritable with ongoing pain
        • Worries about the anticipation of the actual painful procedure
      • School-Age Child
        • Demonstrates behaviors of the young child, especially during actual painful procedure, but less before the procedure
        • Exhibits time-wasting behavior, such as “Wait a minute” or “I’m not ready”
        • Displays muscular rigidity, such as clenched fists, white knuckles, gritted teeth, contracted limbs, body stiffness, closed eyes, wrinkled forehead
      • Adolescent
        • Less vocal with less physical resistance
        • More verbal in expressions, such as “It hurts” or “You’re hurting me”
        • Displays increased muscle tension and body control
    • Patient-centered care
      • Nursing care
        • Reassess the child’s pain level frequently
        • Use nonpharmacological, pharmacological, or both approaches to manage pain
        • Ask parent or caregiver to reassess the child’s pain level
        • Ask the parent or caregiver their satisfaction of the pain management
        • Assess the child for adverse reactions to pain medications
        • Review laboratory reports
        • Assess the child’s physical functioning following pain management intervention
        • Assess for negative effects or distress the child might experience related to pain (anxiety, withdrawal, sleep disruption, fear, depression, or unhappiness)
      • Atraumatic measures
        • Use a treatment room for painful procedures
        • Avoid procedures in “safe places” (the playroom or the child’s bed)
        • Use developmentally appropriate terminology when explaining procedures
        • Offer choices to the child
        • Allow parents to stay with the child during painful procedures
        • Use play therapy to explain procedure on a doll or toy


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