Pediatric Pain
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Pediatric Pain Assessment. Pediatric Pain Assessment. Susan Harp, RN Division of Pediatric Anesthesia and Pain Management. Pediatric Pain Management P R O G R A M. Goals of Pain Assessment.

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Pediatric Pain Assessment

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Pediatric Pain

Assessment

Pediatric Pain

Assessment

Susan Harp, RN

Division of Pediatric Anesthesia and Pain Management


Pediatric Pain ManagementP R O G R A M

Goals of Pain Assessment

“Provide accurate information to determine which actions could be taken to alleviate the pain, and, on an ongoing basis evaluate the effectiveness of these actions.”

Judith Beyer and Nancy Wells, PEDIATRIC CLINICS OF NORTH AMERICA,1989


Pediatric Pain ManagementP R O G R A M

Pain Assessment

  • Location

  • Characteristics

  • Onset / Duration

  • Frequency

  • Quality

  • Intensity / Severity

  • Precipitating Factors


Pediatric Pain ManagementP R O G R A M

Assessment Tools

  • Self-Report “The Gold Standard”

  • Observational Scales

  • Physiologic Parameters

  • Parent Report

  • Nurse Report


Pediatric Pain ManagementP R O G R A M

Self-Report

  • Description of Pain- type of pain- intensity of pain

  • Pain Scale Ratings


Pediatric Pain ManagementP R O G R A M

Observations

  • Vocalization / verbalization

  • Facial Expression

  • Body Language

  • Emotional State


Pediatric Pain ManagementP R O G R A M

Physiologic Parameters

  • Heart rate

  • Respiratory rate

  • Blood pressure


Pediatric Pain ManagementP R O G R A M


Pediatric Pain ManagementP R O G R A M

Parent Vs. Nurse Report

  • Varying results in studies comparing parent, nurse, and self-report

  • May be especially useful in cognitively impaired children


Pediatric Pain ManagementP R O G R A M

Special Situations

  • Cognitively impaired

  • Cerebral palsy with normal cognitive level

  • Hearing or vision impaired

  • Non-English speaking

  • Intubated / paralyzed patients


Pediatric Pain ManagementP R O G R A M

Developmental Factors

  • Newborns and small children unable to give self-report

  • However, avoidance behavior has been shown by at least 6 months of age

  • Consistency of facial and cry response has been shown in neonates and infants

  • Children 3-5 yrs are able to use some self-report measures, localize pain


Pediatric Pain ManagementP R O G R A M

Assessment in Neonates

  • Neonatal Infant Pain Scale (NIPS)

  • Objective Pain Scale (OPS)

  • Cries

  • Parent Report

  • Nurse Report

  • Physiologic Measures


Pediatric Pain ManagementP R O G R A M

Neonatal Infant Pain Scale (NIPS)

  • Facial Expression - relaxed, grimace

  • Cry - no cry, whimper, vigorous

  • Breathing patterns - relaxed, changed

  • Arms - relaxed, flexed/extended

  • Legs - relaxed, flexed/extended

  • State of Arousal - sleeping/awake, fussy

Lawrence J, et. al


Pediatric Pain ManagementP R O G R A M

Objective Pain Scale (OPS)

  • Blood pressure - 10%, 10-20%, 20-30% preop

  • Crying - not crying, crying +/- response to TLC

  • Moving - none, restless, thrashing

  • Agitation - calm, mild, hysterical

Broadman LH, Hannalah RS, et.al


Pediatric Pain ManagementP R O G R A M

Objective Pain Scale (OPS)

  • Verbal Eval / Body Language- asleep/states no pain- mild pain (cannot localize)- moderate pain (localizes)

Broadman LH, Hannalah RS, et.al


Pediatric Pain ManagementP R O G R A M

Assessment in Infants and Children < 3 Years

  • OPS

  • CHEOPS

  • Parent Report

  • Nurse Report

  • Physiologic Measures


Pediatric Pain ManagementP R O G R A M

Children’s Hospital of Eastern Ontario Pain Scale (CHEOPS)

  • Cry - None, Moaning, Crying, Screaming

  • Facial - Composed, Grimace, Smiling

  • Verbal - None, Other, Pain, Both, Positive

  • Torso - Neutral, Shifting, Tense, Shivering,Upright, Restrained

  • Touch - None, Reach, Touch, Grab, Restrained

  • Legs - Neutral, Squirming, Drawn-up, Standing, Restrained


Pediatric Pain ManagementP R O G R A M

Assessment in Children 3-6 Yrs

  • Faces Scale

  • Oucher Scale

  • Poker Chip Tool

  • Visual Analogue Scale (VAS)

  • Observation Tools

  • Parent Report

  • Nurse Report


Pediatric Pain ManagementP R O G R A M

0

2

4

6

8

10

FACES Rating Scale

Adapted from Wong/Baker FACES Rating Scales

Wong, D and Whaley, L: Clinical Handbook of Pediatric Nursing

ed.2, p. 373, St. Louis, 1986, The C.V. Mosby Company.


Pediatric Pain ManagementP R O G R A M

100

90

80

70

60

50

40

30

20

10

0

OUCHER!


Pediatric Pain ManagementP R O G R A M

5

4

3

2

1


Pediatric Pain ManagementP R O G R A M

Worst

Possible

No Pain

6

0

1

2

3

4

5

7

8

9

10

Pain!!

No Pain

Numerical Rating Scale


Pediatric Pain ManagementP R O G R A M

Assessment in Children > 6-7 Yrs

  • Self-Report- VAS- Numerical Ranking Scale

  • Observational Scales

  • Parent Report

  • Nurse Report


Pediatric Pain ManagementP R O G R A M


Pediatric Pain ManagementP R O G R A M

“Golden Rule” of Pain Assessment

  • Don’t forget to ask the patient !!!


Pediatric Pain ManagementP R O G R A M

Pain Assessment in Children

“Pain is whatever the patient says it is.”


Pediatric Pain ManagementP R O G R A M

Facts About Children & Pain

  • Infants do feel pain

  • Children do not tolerate pain better than adults

  • Children can tell you where they hurt

  • Children do not always tell The truth about pain


Pediatric Pain ManagementP R O G R A M

Facts About Children & Pain

  • Children do not become accustomed to pain or painful procedures

  • Behavioral manifestations of pain may not reflect pain intensity

  • Narcotics are no more dangerous for children than adults


Pediatric Pain ManagementP R O G R A M


Pediatric Pain ManagementP R O G R A M


Pediatric Pain ManagementP R O G R A M


Pediatric Pain ManagementP R O G R A M


Pediatric Pain ManagementP R O G R A M


Pediatric Pain ManagementP R O G R A M


Pediatric Pain ManagementP R O G R A M


Pediatric Pain ManagementP R O G R A M


Pediatric Pain ManagementP R O G R A M


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