Assessing the pain of a child with disabilities or impairments, whether developmental, cognitive, or physical, presents special challenges. Depending on the severity and type of a child’s disability, self-assessments may not be possible. Moreover, a child’s ability to understand pain itself and the necessity for procedures, some of which may be painful, may be seriously limited. How a child with disabilities comes to understand pain varies greatly. As with all assessments, the child’s individuality needs to be taken into account.
Pain assessment for these children can be very difficult for the child, parent, and caregivers, but several assessment tools have been developed that can provide a picture of the amount and type of pain a child with disabilities is feeling. In general, these tools are based on physiological measures and observed behaviour.
Some of the behaviours that indicate pain include whether the child is cranky, seeking comfort, and gesturing to a part of the body that hurts. Caregivers will also look for changes in the child’s eyes, the child’s activity level, and whether the child is crying or gasping. Parents can provide valuable information as to whether the child is reacting as he normally would. For example, does he find music enjoyable? Are his eating and sleeping patterns changed from what is normal for their child?
These tools have many similarities with the measures for assessing nonverbal younger children, but the indicators may be different due to the disabled child’s altered pain pathways and subsequent reaction to painful events. In recent years, much has been learned about assessing pain in children with disabilities, and new assessment tools continue to be developed and refined.