PAIN ASSESSMENT: CHILD Chapter 21 PAIN ASSESSMENT: CHILD Alyson Davies

Introduction This presentation explores the misconceptions regarding children’s pain, touches on their ‘pain vocabulary’ and examines pain assessment techniques. Part 1 – Child Pain Assessment Overview Part 2 – Children’s Pain Vocabulary Part 3 – Children’s Coping Strategies, Parental Input and HCP Assessment of Pain

PART 1: Child Pain Assessment Overview

Misconceptions Regarding Children’s Pain Many myths persist about children’s pain (Twycross 1998, Collier 1997). These influence the assessment process in a negative manner. Assessment should be grounded on a sound evidence base, underpinned by research. Evidence based assessment ensures: The delivery of good quality care Belief in the child’s pain experience

Why Assess Children’s Pain? Unrelieved pain has a number of undesirable consequences (Eland 1990). Knowing the amount of pain experienced is the first step towards offering appropriate treatment (Jacob & Puntillo 1999). Accurate assessment leads to effective management (Carter 1994). Without assessing pain, it is impossible to plan appropriate interventions and evaluate their effectiveness (Collier 1997; Wong & Baker 1988).

Assessing the Child’s Pain To assist in assessing the child’s pain, a comprehensive pain history must be taken. This should be carried out with the child and parents. Children can describe their pain experiences. Parents can provide a fuller history of previous experiences.

Multi-Dimensional Perspective Pain assessment should be holistic and multidimensional It should incorporate the following factors: Cognitive Physiological Sensory Behavioural Affective Socio-cultural Environmental

Pain Assessment Tools Many Pain Assessment Tools exist These facilitate accurate assessment of the pain experience Children as young as three years old can use the tools with assistance to describe their pain

PART 2: Children’s Pain Vocabulary

Children’s Pain Vocabulary Children can describe the location, intensity and effects of their pain. Children will use a rich variety of words to describe their pain. Their vocabulary is specific to their cognitive level and experiences. Assessment of their vocabulary is vital to ensure clear communication about the pain experience.

Ross & Ross 1984: 70% of sample provided excellent descriptors of pain. Gaffney & Dunn 1986: Definitions progressed from concrete to abstract. Concrete 5-7yrs: Defined by location, physical properties Semi abstract 8-10yrs: Defined in relation to feelings, sensations Abstract 11yrs+: Defined in psychological, physiological terms

Children’s Pain Vocabulary Hester et al 1992: Hospitalized children under 6 years old use concrete words. School aged 6-10 years old understand ‘hurt’. Adolescents understand ‘pain’. La Fleur & Raway 1999: School aged child and adolescents understand ‘pain’, ‘hurt’, ‘ache’ by 15 years old. Socialized into their use by 8 years old.

PART 3: Children’s Coping Strategies, Parental Input and HCP Assessment of Pain

Children’s Coping Strategies Cognitive Distraction Relaxation Guided imagery Positive self- talk Thoughts stopping Behavioural Hiding away Fighting it Making it good

Parental Influences The assessment should be family centred. Parents are ‘the experts’ on their children and have a wealth of knowledge. Parents can use PAT effectively following initial ‘training’.

Factors Influencing HCP’s Assessment of Pain Medical diagnosis Child’s characteristics: age, development Culture of child: expression and coping Personal knowledge: attitudes, beliefs Parents’ role and involvement Work related features: workload, environment

Conclusion Assessment of a child’s pain is a complex, multi-factorial experience. It should be current in time and place for that child. Children must be listened to and believed. Children and families must be viewed as partners in care. The assessment must be individual and holistic. Effective management is dependant on effective assessment.