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- 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
- Non-communicating children’s pain checklist: 3 years and older
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- 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
- Newborn and young infant
- 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
- Nursing care
- Children’s responses to pain at various ages
