For acute medical and surgical pain in children Show
Introduction Aim Definition of Terms Assessment Pain Assessment Tools Physiological Indicators Key Considerations Special Considerations Companion Documents Links Education Evidence Table IntroductionPain assessment is crucial if pain management is to be effective. Nurses are in a unique position to assess pain as they have the most contact with the child and their family in hospital. Pain is the most common
symptom children experience in hospital. Acute pain (noiciception) is associated with tissue damage and an inflammatory response, it is self limiting of short duration and does not involve neural tissue. AimThe guideline specifically seeks to provide nurses with information regarding
Definition of TermsPain:
Pain assessment: is a multidimensional observational assessment of a patients’ experience of pain. Pain measurement tools: are instruments designed to measure pain. AssessmentPain assessment is a broad concept involving clinical judgment based on observation of the type, significance and context of the individual’s pain experience. Pain assessment in infants and children is also challenging due to the subjectivity and multidimensional nature of pain. The dependence on others to assess pain, limited language, comprehension and perception of pain expressed contextually. In some children it can be difficult to distinguish between pain, anxiety and distress. Assessment and documenting pain is needed in order to improve management of pain. When assessing a child’s level of pain careful consideration needs to be given to their:
Pain measurement quantifies pain intensity and enables the nurse to determine the efficacy of interventions aimed at reducing pain. A pain assessment should be conducted during a patient’s admission. (link to Nursing Assessment nursing clinical guideline) Points to consider:
When to assess pain?
Pain Assessment ToolsTools used for pain assessment at RCH have been selected on their validity, reliability and usability and are recognized by pain specialists to be clinically effective in assessing acute pain. All share a common numeric and recorded as values 0-10 and documented on the clinical observation chart as the 5th vital sign. Three ways of measuring pain:
Pain Assessment Tools used at RCHThere are three main tools used for the neonate, infant and child 3-18 years these tools reflect a combination of self-report and behavioural
assessment. 1. FLACC - The acronym FLACC stands for Face,Legs, Activity, Cry and Consolability. Behavioural
How to use FLACCEach category (Face, Legs etc) is scored on a 0-2 scale, which results in a total pain score between 0 and 10. The person assessing the child should observe them briefly and then score each category according to the description supplied.
 2. Wong-Baker faces pain scale 3-18yo How to use?
3. Visual Analogue scale 8-years and older Self report How to use? Ask the child using numbers from 0 = no pain through to 10 being the worst pain
Physiological indicators
Physiological indicators in isolation cannot be used as a measurement for pain. A tool that incorporates physical, behavioural and self report is preferred when possible. Key considerations
Special ConsiderationsMulti language Wong Baker and Numeric tools are available if needed https://www.briggshealthcare.com/Wong-Baker-Faces-Pain-Rating-Scale-8-Languages Modified PAT Tool is used in the Neonatal Intensive Care Unit http://www.rch.org.au/rchcpg/hospital_clinical_guideline_index/Neonatal_Pain_Assessment/ Comfort B is used for Ventilated paediatric patients assessing both pain and sedation
http://www.rch.org.au/picu_intranet/guidelines/Nursing_management_of_the_patient_with_invasive_mechanical_ventilation_in_PICU/ Companion Documents
Further information on pain management principles and assessing pain in children can be found here:
Links
Education
Evidence TableThe evidence table for this guideline can be viewed by clicking here. Please remember to
read the disclaimer. The development of this nursing guideline was coordinated by Sueann Penrose, CNC, Children's Pain Management Service, and approved by the Nursing Clinical Effectiveness Committee. Updated August 2022. What are the management of abdominal pain?Treatment for abdominal pain in adults
Fluids – you may have fluids given into a vein to correct fluid loss and rest your bowel. Medicines – for example, you may be given something to stop you vomiting. Fasting – your doctor may ask you not to eat or drink anything until the cause of your pain is known.
What questions should I ask about abdominal pain?5 Questions to Ask If You Have Stomach Pain. Severity: Is the pain so severe that when it's present, you can't focus on or do other things?. Vomiting: Are you also vomiting? ... . Output: Okay, no one likes to talk about this, but I'm a doctor, so I have to ask. ... . Other symptoms: Are you having difficulty breathing?. How do you test for abdominal pain?Blood, urine, or stool tests.. X-ray of the abdomen.. Ultrasound of the abdomen.. Computerized tomography (CT) scan of the abdomen.. Barium enema (colon X-ray). Endoscopic procedures (inserting a tube with a tiny camera through your mouth or rectum to view areas inside your digestive tract). Electrocardiogram (ECG or EKG). What is the most common cause of acute abdominal pain?The most common causes — such as gas pains, indigestion or a pulled muscle — usually aren't serious. Other conditions may require urgent medical attention. While the location and pattern of abdominal pain can provide important clues, its time course is particularly useful when determining its cause.
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