Examination of Pain

Question 1

Cognitive Factors Influencing the Perception of Pain in Children

Answer 1

1. Child’s understanding of source of pain
2. Child’s ability to control what happened that resulted in pain
3. Child’s expectations regarding the pain

Question 2

Behavioral Factors influencing the perception of pain

Answer 2

1. Child’s actions – crying, kicking, etc.
2. Response of parents and others to the child’s pain
3. Use of restraint: ILLEGAL
4. Implications of the pain/injury to the child’s life

Question 3

Emotional factors influencing the perception of pain

Answer 3

• Child’s ability to understand and cope with the pain
• Never assume pain is not the issue

Question 4

Clinicians and Parents frequently…

Answer 4

under report pain in children

Question 5

What does assessment of pain in children depend on?

Answer 5

age and cognitive ability

Question 6

Assessment of pain in infants, pre-verbal, or non-verbal children

Answer 6

 Neonatal/Infant Pain Scale (NIPS) - <1 year
 Face, Legs, Activity, Cry, and Consolability- 2 months – 8 years
 Revised FLACC behavior pain scale – cognitively impaired
children 4 -19 years post-operatively

Question 7

Assessment of pain for toddlers, preschool, and older children

Answer 7

 Visual Analog Scale (VAS) - 5 years and above
 Wong-Baker Pain Rating Scale – 3-18 years (very high validity)
 Face Pain Scale – 5-12 years (CHEOPS) Children’s Hospital of Eastern Ontario Pain Scale - 1 to 7 years

Question 8

QUEST principles of pain assessment

Answer 8

Question the child.
Use pain rating scales.
Evaluate behavior and physiologic changes.
Secure parents’ involvement.
Take cause of pain into account.
Take action and evaluate results.

Question 9

Pain Assessment Considerations for the child with neurological impairment

Answer 9

• Impact of the therapeutic environment
• Therapist Response: you have a responsibility to address the pain
• Ability to express pain: you need to pick up on the clues when they can’t express pain

Question 10

Signs of Distress/Pain in Neonate

Answer 10

facial expression, body
movements, crying, changes in heart rate, respiratory rate, blood pressure, oxygen saturation [SaO2], vagal tone, palmar sweating, and plasma cortisol or catecholamine levels

Question 11

Signs of Pain in Infant

Answer 11

tress signs include startles (widening of eyes), hiccups, gasping, tremors, twitching, yawning, and sneezing

Question 12

Signs of pain in a toddler (under 2 yo)

Answer 12

feeding difficulties, irritability, increased crying, grunting, breath-holding, crying that can’t be comforted, facial expressions, such as a furrowed brow, a wrinkled forehead, closed eyes, or an angry appearance, sleep changes, such as waking often or sleeping more or less than usual, body movements, such as making fists, guarding a part of the body (especially while walking), kicking, clinging to whoever holds him or her, or not moving

Question 13

Signs of pain in a child (2 years old and over)

Answer 13

acting out behaviors, including defiant speech and actions, anger problems, stomach aches or headaches, Decreased appetite, inability to control emotions, nightmares, clinginess, whining