As an ER nurse, I saw a lot of people in pain, either arriving at our door to have their pain relieved or enduring the pain of needed treatments, knowing that the interventions were necessary. In my experience, though, there’s nothing worse than seeing a child in pain, and the younger the child, the more awful it was.

You began the encounter with a sick or injured child who was already frightened by the circumstances that had caused their parents or guardians to bring them to the hospital. It’s hard to get past the frightened eyes and tears, the little ones trying to burrow into their mother’s shoulder and not wanting to be put down on a paper-covered table. And this was before even attempting any assessment.

Nurse uses Wong–Baker FACES Pain Rating Scale to help assess patient’s pain. Photo by Gerry Melendez/The State/MCT via Getty Images.

Factors to consider in assessing a child’s pain.

We were taught that “pain is what the patient says it is,” and that still seems to be true of children’s reports of pain. But there are many factors that need to be considered, such as the child’s developmental stage and understanding. So how do you determine a child’s pain?

In the May issue, the CE article by authors Freund and Bolick, “Assessing a Child’s Pain,” describes types of assessment used to measure pain intensity in children, taking into account age and special circumstances or conditions such as ventilation requirements, cognitive impairment, and developmental delay.

In addition, the authors discuss proxy pain reporting by the parent or caregiver and “how nurses can improve communication between the child, caregiver, and health care providers, thereby promoting favorable patient outcomes.”

Inadequately treated pediatric pain can have long-term effects.

The importance of assessing and treating pain in children can’t be overemphasized. The authors note:

”Inaccurate pain assessment leaves a child vulnerable to prolonged or repeated acute pain, including procedural pain, and to such associated sequelae as subsequent medical traumatic stress, more intense response to subsequent pain, and development of chronic pain, resulting in interference with sleep as well as with academic, social, household, and extracurricular activities. In comparison, children whose acute or procedural pain is sufficiently relieved may be more likely to experience the type of enhanced development seen in children who undergo ‘posttraumatic growth’ and emerge from traumatic experiences with increased resilience and a feeling that the world is a safe place.”

The article is worth a read for every nurse who encounters children in their practice. You can earn CE credit too. (And for nurses who work with acutely ill children, you might also be interested in a systematic review we published last April on recognizing delirium in young children.)