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

Share:

More Posts

Heart Attack Symptoms

Español Not all heart attacks begin with the sudden and crushing chest pain that comes when the blood flow to heart gets blocked. Heart attack

Sun Safety

Skin cancer is the most common cancer in the U.S. Too much sun can cause skin cancer. Spending time outside is a great way to

Leave Fireworks to the Experts

Summer is synonymous with barbecues, parades and fireworks. The National Safety Council advises everyone to enjoy fireworks at public displays conducted by professionals, and not