PEDI | Pain Assessment

Effective nursing care for a child in pain requires individualized assessment using age-appropriate tools and a multimodal management approach that combines medication with behavioral strategies.

1. Assessment: The QUESTT Principle

Accurate assessment is the foundation of pain management. The text highlights the QUESTT framework as a key guide:

• Question the child.

• Use a reliable, valid pain scale.

• Evaluate behavior and physiologic changes.

• Secure parental involvement.

• Take the cause of pain into account.

• Take action.

Choosing the Right Tool:

• Infants & Non-verbal: Rely on behavioral and physiologic indicators (facial expressions, crying, heart rate, oxygen saturation) and scales like NIPS or FLACC.

• Toddlers to Teens: Move toward self-report tools. Use FACES (ages 3+) or Numeric scales (ages 5+).

• Crucial Myth-Busting: Nurses must recognize that newborns do feel pain, and a child who is playing or sleeping may still be in significant pain.

2. Management: A Multimodal Approach

Treatment should be tailored to the child's developmental level and the intensity of the pain.

• Non-Pharmacologic: These are essential for reducing anxiety and pain perception.

◦ Cognitive/Behavioral: Distraction, relaxation, guided imagery, and positive self-talk.

◦ Biophysical: Heat/cold application, massage, and nonnutritive sucking with sucrose for infants.

• Pharmacologic: Involves the use of analgesics (opioids/non-opioids), adjuvants, and anesthetics.

3. The Nurse’s Role

Beyond administration, the nurse acts as a safety monitor and advocate.

• Procedural Pain: Minimize trauma by using topical anesthetics, therapeutic hugging, and preparing the child ahead of time.

• Monitoring: Continually assess vital signs (specifically for respiratory depression) and watch for common opioid side effects like constipation and pruritus (itching)