When the child is nonverbal.

Nurses regularly assess patients’ pain. It’s a much more difficult task when the patient is unable to articulate what they’re feeling or even where they hurt. How much more difficult is it when the patient is a nonverbal child with a complex medical history?

In this month’s AJN, Brenna Quinn and colleagues share their research on pain in these children. They define “children with medical complexity” as “those having a cognitive-chronological age mismatch, profound developmental delays, limited or no verbal abilities, and multisystem diagnoses, and who are completely dependent on others for care.” These kids tend to experience pain more frequently (often, daily or weekly), and are more likely to be hospitalized than are neurotypical children.

A ‘wide range of pain-associated behaviors.’

While it is often harder to assess pain in children than in adults, most children have a narrow range of “pain behaviors” that are easily identifiable. This isn’t true of children with medical complexity; some may even seem, from their expressions, to be laughing when they are in pain.

“More than 40 pain assessment tools have been developed for use in infants and children who cannot provide self-report. Despite the availability of these tools, the evaluation of pain in children with medical complexity remains challenging, in part because a wide range of pain-associated behaviors exists.”

Working closely with those who know the children best.

When managing pain in children with medical complexity, the people who know them best can usually distinguish their everyday behaviors from those that indicate pain. Nurses, then, need to work especially closely with parents to manage pain in this group of children.

Read “Pain in Nonverbal Children with Medical Complexity: A Two-Year Retrospective Study” to learn more about:

  • signs and symptoms that parents find worrisome
  • common sources of pain in children with medical complexity
  • and best pain assessment practices in this population