Children in Pain

REL-ACU-0-CE276-60

1.00

Online Course

2019-05-01

2022-11-11

Discuss how a child’s developmental stage affects his or her perception, understanding, and response to pain.; Outline the pharmacological and nonpharmacological interventions that can be used to prevent or relieve pain in children.; Recognize barriers and myths surrounding pediatric pain and its management.

Misconceptions and Myths

Through a Child’s Eyes

Cognitive Abilities of Children Related to Pain

Infants

Nonverbal
Display physiological and facial signs of pain
Have a pain memory
By 12 to 17 months, 45% have one word to express pain
By 18 to 23 months, 81% now have one word to express pain
Toddlers

Simple words for pain (“owie”). Toddlers less than 30 months tended to say “ow” or “ouch”; those older than 30 months used more complex words, such as “hurt” or “sore”
Parental presence very important during painful procedures
Beginning sense of control/autonomy
Generally, can’t provide ratings for intensity of pain
Look to parents for their behavioral cues on how to react
Preschoolers

Concrete language to express pain
Can point to pain location
By age 5 may be able to point to FACES pain scale to rate pain
By kindergarten can use more complex descriptors, such as burning or stabbing.
May not understand reason for painful procedure
May believe pain is a punishment
Have ability to fantasize and use imagination (magical thinking) which can be a tool to help decrease pain
Fear loss of body integrity
Band-Aid can be important
May try to delay interventions as a way to have sense of control
School-Aged Children

Self-report is more reliable indicator of pain location and intensity
By ages 7 to 11, can relate pain to an injury and have a begin to express emotional pain
Begin to understand reason for painful procedure, but fear loss of body integrity
Can better use own coping techniques for painful interventions
Adolescents

Feelings of embarrassment or loss of control may not allow them to express pain
Better able to use coping techniques for procedures, particularly with practice
Better understanding of the reason for the painful procedure
Able to link complex topics, such as pain and suffering
Beginnings of omnipotent feelings; may believe they cannot be harmed
Expressions of Pain

Age-Appropriate Assessment Tools

Preterm and Neonates: Behavioral Tools Are Needed
Neonatal Infant Pain Scale. NIPS evaluates facial expression, cry and breathing pattern, arms, legs, and state of arousal.
Premature Infant Pain Profile. PIPP evaluates gestational age, behavioral state, heart rate, oxygen saturation, eye squeeze, brow bulge and nasolabial furrow.
CRIES. This tool evaluates crying, oxygen saturation, heart rate, blood pressure, expression, sleeplessness.
Faces, Legs Activity, Cry, Consolability. FLACC evaluates children ages 3 months to 7 years. This behavior tool looks at the child’s general behavior to reach a total pain score from 0 to 10.
Children 3 Years and Older

OUCHER. This tool shows photos of faces from no hurt to biggest hurt. Includes numerical 0 to 100 scale.
FACES. This tool uses faces (cartoon to realistic) denoting pain from no pain to intense pain.
COMFORT Scale. Evaluates alertness, calmness or agitation, respiratory response, physical movement, heart rate, blood pressure, muscle tone, and facial tension.
Children’s Hospital of Eastern Ontario Pain Scale. CHEOPS is for children ages 1 to 7 and has been used on children ranging from 4 months to 17 years.
Children 5 to 7 Years Old

Body Outline. The child marks the location of pain on a simple drawing of a body; may use color.
Visual Analogue Scale. VAS is a simple horizontal line that indicates no pain to worst pain. Child marks line where he or she feels pain level is.
Poker Chip Tool. Four poker chips are given to child, and child picks 0 for no pain and 4 for most pain.
Adolescents

May use some of the previous scales, such as VAS or even FACES. Adolescents may like a numeric scale in which 0 is no pain and 10 is the worst pain imaginable. He or she is then asked to indicate a number between 0 and 10 for the current pain.
Taking Action Against Pain

Medicinal Management of Pain

Tolerance 
Physical dependence 
Addiction: as defined by the American Society of Addiction Medicine is: 
Mild Pain

Moderate Pain

Treatments for Use as Pain Increases

Morphine

Hydromorphone

Fentanyl

Meperidine

The target audience for this course is: Intermediate level Occupational Therapists; Nurses; Physicians; in the following settings: Acute Care Facility.

Asynchronous/Online Distance Learning; please see certificate details for specifics on delivery format.
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