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: Advanced 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.
Relias has a grievance policy in place to facilitate reports of dissatisfaction. Relias will make every effort to resolve each grievance in a mutually satisfactory manner. In order to report a complaint or grievance please contact Relias.
If you require special accommodations to complete this module, please contact Relias Support by completing the web form (https://www.relias.com/help) or by using the chat functionality.
All courses offered by Relias, LLC are developed from a foundation of diversity, inclusiveness, and a multicultural perspective. Knowledge, values and awareness related to cultural competency are infused throughout the course content.
Reference herein to any specific commercial product, process, or service by trade name, trademark, service mark, manufacturer or otherwise does not constitute or imply any endorsement, recommendation, or favoring of, or affiliation with, Relias, LLC.
All characteristics and organizations referenced in the following training are fictional. Any resemblance to any actual organizations or persons living or dead, is purely coincidental.
To earn continuing education credit for this course you must achieve a passing score of 80% on the post-test and complete the course evaluation.

If you require special accommodations to complete this module, please contact Relias Customer Support here.

Expert Reviewers, Instructors, and Staff Writers disclosures will be listed above after the individuals' biographical paragraph. All other members involved within the planning of this educational activity have declared no conflict of interest exists when planning and developing this course.