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

2. 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

3. PART 1: Child Pain Assessment Overview

4. 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

5. 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).

6. 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.

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

8. 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

9. PART 2: Children’s Pain Vocabulary

10. 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.

11. 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

12. 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.

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

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

15. 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’.

17. 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

18. 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.