CRU RAX215DC Installation Manual - Page 4

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Assessment and treatment of pain in pediatric patients.

Assessment of pain in older children:

Self-report: The single most reliable indicator of

the existence and intensity of pain and any resultant

distress is the patient's self -report. For older children,

the use of a self-reporting scale can be helpful to staff

and empowering to the patient [24]. A self-report of

pain from a patient with limited verbal and cognitive

skills may be a simple yes/no or other vocalizations

or gestures, such as hand grasp or eye blink. When

self-report is absent or limited, explain why self-

report cannot be used and further investigation and

observation are needed [4,28]. Myriad guidelines are

coming together in using different self-report methods

in assessing pain in older children such as the Visual

Analogue Scale (VAS) (Figure 1) which is described

by a horizontal line with "no pain" at the beginning to

"worst possible pain" at the termination and patients

draw a line to show their severity of pain. It has several

benefits: it avoids imprecise descriptive terms, quick

and simple to score, and offers many determining

points. However, it can be difficult in post-operatively

or in children with neural and psychological disorder as

it needs a concentration and coordination [1,12,24,29].

Wong-Baker faces pain rating scale is the other self-

report tool mainly used to assess acute pain. Expressed

by six line-drawn faces range from no pain at one end to

worst pain at the other end and assigns by number with

word descriptors to each face to indicate the intensity

of pain [11,37].

However, many studies take a type of self-report, face

scale method for assessing pain in older children. Below

is the Faces scale, currently used by the children's hospital

at West Mead:

These faces show how much something can hurt. From no

pain to very much pain pointing to the face by the patient

him/herself to show how much he/she hurt to simplify

pain assessment (Figure 2).

Generally, most institutions approved using the pain

assessment tools as their basic instrument for diagnosis

and management of the different type of pains encountered

in pediatrics.

Curr Pediatr Res 2017 Volume 21 Issue 1

Management of Pain in Pediatrics

The management of pain in pediatrics is still

misunderstood. Explicitly, neonates and infants are not

managed for pain effectively, due to the misperception

that they are not able to sense pain as adults [16,18].

American academy of pediatrics suggested that the

lack of pain assessment and fears of adverse effects of

analgesic medications including respiratory depression

and addiction are the main barriers to the treatment

of pain in children [9]. As the underlying disease is

expected to advance a continuous adjustment of pain

therapy is required. A study in Toronto hospitals shows

that out of the total 265 children, 58.9% received a

minimum of one documented intervention of pain

management. Out of 66 children with recognized pain

(mild, moderate or severe), 55 of them received an

intervention for their pain [14]. It extends beyond pain

relief, encompassing the patient's quality of life and

ability to work productively and to enjoy recreation.

Pain management is a joint responsibility among

the members of the health care team. This includes

addressing pain status of each patient daily on inpatient

unit rounds or with each patient visit, consultation if

pain treatment is ineffective, and discharge planning for

continuing pain management needs [3,15,38].

Generally, on consideration of the above challenges

Managements of pain in pediatrics encompass the use of

pharmacological and non-pharmacological interventions

to control the patient's identified pain.

Non-Pharmacological Interventions

Non-pharmacological measures should be favored as base

line for both adults and children intervention of pain. in

conjunction with pharmacological options to help lower

levels of anxiety, pain and distress, the psychological

comfort measures such as

distraction as well as physical interventions including

the use of massage repositioning or heat and/or cold

compresses are useful Strategies [3,4,15,19,24,39].

According to the guidelines for clinical practice of

the American pain society, pain education such as the

interventions and options for pain relief during the pre-

Figure 1. Visual analogue scale [21,25]

Figure 2. Face scale assessment tool [27]

relaxation techniques and

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