Course: Pediatric Nursing
Topic: Pain Management in Children
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Module Goals
Learners will be able to:
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Pain
MedlinePlus, 2018
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Types of Pain
Ernstmeyer & Christman, 2021
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Factors Affecting Pain
Biological
Ernstmeyer & Christman, 2021
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Factors Affecting Pain
Physiological
Ernstmeyer & Christman, 2021
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Factors Affecting Pain
Social
Ernstmeyer & Christman, 2021
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Children and Pain
Ernstmeyer & Christman, 2021
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Piagetian Stages of Cognitive Development and the Experience of Pain
Sensorimotor children (birth to about 2 years old)
Emerson & Bursch, 2020
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Piagetian Stages of Cognitive Development and the Experience of Pain (Continued)
Preoperational children (about 2–7 years old)
Emerson & Bursch, 2020
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Piagetian Stages of Cognitive Development and the Experience of Pain (Continued)
Concrete operational children (about 7–11 years old)
Emerson & Bursch, 2020
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Piagetian Stages of Cognitive Development and the Experience of Pain (Continued)
Formal operational children (11+ years old)
Emerson & Bursch, 2020
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Critical Thinking Question
Reflect on the factors (biological, physiological, social) that affect the perception of pain.
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The QUESTT Principle of Pain Assessment
Bettercare, 2020
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The QUESTT Principle of Pain Assessment
The ‘Q’ in QUESTT: Question the child and parent/caregiver
Bettercare, 2020
Queensland Government, 2021
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The QUESTT Principle of Pain Assessment
The ‘U’ in QUESTT: Use pain rating scales
Bettercare, 2020
Queensland Government, 2021
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The QUESTT Principle of Pain Assessment
The ‘E’ in QUESTT: Evaluate behavior and physiological changes
Bettercare, 2020
Queensland Government, 2021
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The QUESTT Principle of Pain Assessment
The ‘S’ in QUESTT: Secure parent or caregiver involvement
Bettercare, 2020
Queensland Government, 2021
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The QUESTT Principle of Pain Assessment
The ‘T’ in QUESTT: Take the cause of the pain into account
Bettercare, 2020
Queensland Government, 2021
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The QUESTT Principle of Pain Assessment
The ‘T’ in QUESTT: Take action and evaluate the results
Bettercare, 2020
Queensland Government, 2021
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Take Action and Evaluate Results
Queensland Government, 2021
Pain | 0 | 1-3 | 4-7 | 8-10 |
Action | No action required |
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|
|
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Critical Thinking Question
Imagine you are the nurse taking care of a 5-year-old who fell from a tree and presents with swelling and a deformity of the right forearm.
Use the QUESTT principle to simulate a pain assessment for this child.
Think about what questions you would ask or actions you would take for each letter of the acronym.
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Pain Assessment Tools
Gai et al, 2020
Tool | Target population | Scoring System | Scale |
Pain word scale | 3–7 years old, or older children who are unable to use the NRS | Ask the child to quantify the severity of pain using words such as “none”, “a little”, “medium”, “a lot” | Descriptive words |
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Pain Assessment Tools
Gai et al, 2020
Tool | Target population | Scoring System | Scale |
Numeric Rating Scale (NRS) | 7 years and older | Ask the client to assign a number to their pain, with 0 being no pain and 10 the worst pain ever | 0–10 Mild= 0–3, Moderate= 4–6 Severe= 7–10 |
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Pain Assessment Tools
Gai et al, 2020
Tool | Target population | Scoring System | Scale |
Faces Pain Scale—Revised (FPS-R) | 5–12 years old | Picture-based scale where child selects 1 of 6 faces to represent their pain experience | 0–10 Mild= 0–3, Moderate= 4–6 Severe= 7–10 |
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Pain Assessment Tools
The Wong-Baker FACES Pain Rating Scale as cited in Ernstmeyer & Christman, 2021
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Pain Assessment Tools: The FLACC Scale
Gai et al, 2020
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Pain Assessment Tools
Gai et al, 2020
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The FLACC Scale
Ernstmeyer & Christman, 2021
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Pain Assessment Tools
Gai et al, 2020
Tool | Target population | Scoring System | Scale |
Premature Infant Pain Profile (PIPP-R) | Preterm and term infants | Combines 5 items (3 behavioral—brow bulge, eye squeeze, nasolabial furrow; 2 physiologic—heart rate, oxygen saturation) with gestational age | 0–21 (mild: 0–6, moderate: 7–13, severe: 13–21) |
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Pain Assessment Tools for Children
Physiological Pain Assessment Tool: Changes in blood pressure and heart rate may indicate severity of pain experienced through an objective lens.
Behavioral Pain Assessment Tool: Facial, verbal expressions, muscle tone response.
Pande, 2020
Chu, 2017
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Factors Affecting Pain Assessment
Emotional Factors: What child feels about pain
Presence of stress and anxiety
Fear, frustrations, underlying anxiety and depression issues
Behavioral Factors
Reaction may vary with age, expectations, emotions and belief system: anger, fear, denial and anxiety
About Kids Health, 2009
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Factors Affecting Pain Assessment
Cognitive factors:
What examiner, parents, and child understand and believe about pain
Psychological factors:
A child’s emotions affect how they behave and respond to pain
About Kids Health, 2009
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Barriers to effective Pain Assessment
Barriers of parents or children may include:
Better Care, 2020
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Barriers to Effective Pain Assessment
Barriers of professionals may include:
Better Care, 2020
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Case Study
A nurse is taking care of a 10-month-old infant after surgery for a cleft lip and palate repair. The nurse notes that the infant is withdrawn and appears restless and tense, frequently shifting to different positions. The infant occasionally frowns and has been quietly whimpering since waking up. Neither the mother or the nurse have been able to console or distract the infant.
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Principles of Pain Management in Children
Better Care, 2020
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Non-Pharmacological Pain Management in Children
For Newborns:
(etter Care, 2020
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Non-Pharmacological Pain Management in Children (Continued)
Pain in babies and older children
Better Care, 2020
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Pharmacological Pain Management in Children
Use the World Health Organization (WHO) broad principles of analgesic use:
Better Care, 2020
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Pain Management in Children
The original World Health Organization (WHO) pain ladder as cited in Better Care, 2020
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Pain Management in Children: By The Ladder
Better Care, 2020
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General Approach to Pain Management in Children
Better Care, 2020
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Nurses Role in Pain Management of Children
Maryland.gov, n.d.
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Nurses Role in Pain Management of Children
Maryland.gov, n.d.
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What Would the Nurse Do?
A nurse is caring for an 8-year-old child admitted for a sickle cell crisis. When the nurse assesses the child, they are agitated and tearful, reporting pain of 8/10 on the numeric rating scale.
The nurse checks the child’s chart and sees that there is an order for 150 mg of oral acetaminophen every 4 hrs PRN (as needed). The last dose was administered 5 hrs ago.
According to the WHO principles of analgesic use, what should the nurse do in this situation?
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Red Flags
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Cultural Considerations
Religion, culture, beliefs, and ethnic customs can influence how families understand and use health concepts:
AHRQ, 2020
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Cultural Considerations (Continued)
Religion, culture, beliefs, and ethnic customs can influence how families understand and use health concepts:
AHRQ, 2020
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Cultural Considerations: Examples
Wandner et al., 2012
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References:
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References:
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References:
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References:
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Please go to
to provide feedback on your experience.
Thank you, and come back soon!
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