Acute pain: How to assess in infants and toddlersAAcute pain: How to assess in infants and toddlersAcute pain: How to assess in infants and toddlersEnglishPain/AnaesthesiaNewborn (0-28 days);Baby (1-12 months);Toddler (13-24 months)NANervous systemSymptomsAdult (19+) CaregiversPain2019-01-25T05:00:00Z10.500000000000042.50000000000001136.00000000000Health (A-Z) - ConditionsHealth A-Z<p>Find out how your infant's or toddler's acute pain is assessed at home and in medical settings.</p><h2>What causes acute pain in infants and toddlers?</h2><p>In infants and toddlers, common causes of acute pain include:</p><ul><li>teething</li><li>a bump or fall</li><li>ear infections</li><li>vaccinations by needle</li><li>heel lances to obtain a blood sample</li><li>procedures such as inserting a catheter (thin tube) or doing a lumbar puncture</li></ul><p>​As a rule, anything that causes pain in older children or adults (such as inserting a needle or catheter) will also cause pain in your infant or toddler. So if your young child is having a procedure that you would find painful, they are likely experiencing at least as much pain as you would experience.</p><p>Indeed, certain procedures may be more painful for young children because their brains cannot yet help them cope with pain, for example by using distraction. Never discount your young child's pain-related distress even if they have an injury or procedure that you would not find painful.</p><h2>​Key points</h2><ul><li>In infants and toddlers, common causes of acute pain include teething, bumps or falls, and vaccinations by needle.</li><li>Signs of acute pain in this age group include irritability, whimpering, sudden changes to facial expression and flailing of arms or legs.<br></li><li>In medical settings, health-care providers assess pain by using standard tools and checking your baby's heart and breathing rate, and their oxygen levels.</li><li>Always feel free to share your own opinion and any concerns about your child's pain with the health-care team.</li></ul><h2>Assessing acute pain at home </h2><p>Because your young child cannot speak yet, you can only tell how much pain they are experiencing through the painful situation and their behaviour. In this case, the context means thinking about whether the procedure would be painful for an older child or could be painful for a young child even if not painful for someone older. Based on this information, you would then watch for any changes in your child's behaviour.</p><p>Behavioural signs of acute pain include:</p><ul><li>irritability</li><li>sharp changes in facial expressions (for example grimacing with eyes shut and brow bulging)</li><li>crying or whimpering</li><li>flailing or thrashing arms or legs</li><li>changes in their feeding, playing and/or sleeping routines</li><li>rigidness or limpness</li><li>changes in breathing</li><li>changes in how they interact with people and things around them</li></ul><h2>Assessing acute pain in medical settings</h2><p>In the hospital, your child's health-care team uses a range of tools to determine how much pain an infant is feeling. </p><p>In the NICU setting, one of the most common tools for assessing pain in infants is the <a href="https://www.semanticscholar.org/paper/The-premature-infant-pain-profile-revised-%28PIPP-R%29:-Stevens-Gibbins/76e49d44432665d7dffd5a9a7a2fdd55466f7f32/figure/0" target="_blank">Premature Infant Pain Profile-Revised (PIPP-R)</a>. This tool rates many of the behaviours that a child might display at home as well as physiological signs (signs inside the body), such as your infant's:</p><ul><li>heart rate<br></li><li>oxygen saturation (how much oxygen is in their blood)<br></li><li>breathing rate</li></ul><p>For older infants and children aged up to two, health-care providers usually use the <a href="http://www.olchc.ie/Healthcare-Professionals/Nursing-Practice-Guidelines/Pain-FLACC-Behavioural-Pain-Assessment-Scale-2015.pdf" target="_blank">Faces, Legs, Activity, Cry and Consolability (FLACC) scale</a>. This tool looks at several of the behaviours described above.</p> <p>In medical settings, your child's health-care team plays an important role in clarifying the level and cause of pain, but feel free to share your opinions and concerns about your infant's pain with them.</p><h2>Websites</h2><p>Comforting Your Baby in Intensive Care<br> <a href="http://familynursing.ucsf.edu/comforting-your-baby-intensive-care" target="_blank">http://familynursing.ucsf.edu/comforting-your-baby-intensive-care</a></p><h2>Videos</h2><p><a href="https://www.youtube.com/watch?v=9OgCQKOnn-I" target="_blank">Bringin' up Baby: Soothing the Pain</a> (3 mins 50 secs)<br>Psychological and physical strategies for parents to reduce vaccination pain in healthy infants</p><p><a href="https://www.youtube.com/watch?v=5Oqa1Fag5eQ" target="_blank">Reduce the pain of vaccination in babies</a> (13 mins 08 secs)<br> Tips for parents on helping healthy infants get through vaccinations</p><p><a href="https://www.youtube.com/watch?v=-Y49FOGtmwo" target="_blank">Easing your baby's pain: A mother's story</a> (3 mins 07 secs)<br> Three ways to instantly reduce your infant's pain in the NICU</p><p><a href="https://www.youtube.com/watch?v=3nqN9c3FWn8" target="_blank">The Power of a Parent's Touch</a> (2 mins 40 secs)<br> How breastfeeding and skin-to-skin contact can help when an infant is experiencing a painful procedure</p><p>Content developed by Rebecca Pillai Riddell, PhD, CPsych, OUCH Lab, York University, Toronto, in collaboration with:<br>Lorraine Bird, MScN, CNS, Fiona Campbell, BSc, MD, FRCA, Bonnie Stevens, RN, PhD, FAAN, FCAHS, Anna Taddio, BScPhm, PhD<br> Hospital for Sick Children</p> <h3>References</h3><p>Anand, K.J.S. (2012). Assessment of neonatal pain. In J. A. Garcia-Prats & M. S. Kim (Eds.), UpToDate. UpToDate: Waltham, MA.</p><p>International Association for the Study of Pain (2010) Fact Sheet on Mechanisms of Acute Pain.  <a href="https://s3.amazonaws.com/rdcms-iasp/files/production/public/Content/ContentFolders/GlobalYearAgainstPain2/AcutePainFactSheets/3-Mechanisms.pdf" target="_blank">https://s3.amazonaws.com/rdcms-iasp/files/production/public/Content/ContentFolders/GlobalYearAgainstPain2/AcutePainFactSheets/3-Mechanisms.pdf</a> [Accessed March 29, 2018]</p><p>Mathew, P.J., & Mathew, J.L. (2003). Assessment and management of pain in infants. Postgraduate Medical Journal, 79(934), 438-443.</p><p>McGrath, P.J. (1985). CHEOPS: a behavioral scale for rating postoperative pain in children. Adv Pain Res Ther, 9, 395.</p><p>Merkel, S., Voepel-Lewis, T., & Malviya, S. (2002). Pain Assessment in Infants and Young Children: The FLACC Scale: A behavioral tool to measure pain in young children. AJN The American Journal of Nursing, 102(10), 55-58.</p><p>Ohlsson, A., & Shah, P.S. (2015). Paracetamol (acetaminophen) for prevention or treatment of pain in newborns. Cochrane Database Syst Rev, 6(6).</p><p>Pillai Riddell, R., Lisi, D., Campbell, L. (2013).  Pain Assessment in Neonates. In Encyclopedia of Pain, 2<sup>nd</sup> edition.</p><p>Pillai Riddell, R.R, Racine, N.M., Gennis H.G., Turcotte, K., Uman, L.S., Horton, R.E., Ahola Kohut, S., Hillgrove Stuart, J., Stevens, B., & Lisi, D.M. (2015). Non-pharmacological management of infant and young child procedural pain. Cochrane Database of Systematic Reviews, Issue 12. Art. No.: CD006275</p><p>Pillai Riddell, R., O'Neill, M., Campbell, L., Taddio, A., Greenberg, S., Garfield, H. (2018). The ABCDs of Pain Management: A Double-Blind Randomized Controlled Trial for a Brief Educational Video for Parents of Young Children undergoing Vaccination. <em>Journal of Pediatric Psychology.</em> Volume 43, Issue 3, 1 April 2018, Pages 224-233, <a href="https://doi.org/10.1093/jpepsy/jsx122" target="_blank">https://doi.org/10.1093/jpepsy/jsx122</a></p><p>Pillai Riddell, R.R., Racine, N.M., Gennis, H.G., Turcotte, K., Uman, L.S., Horton, R.E., ... & Lisi, D.M. (2015). Non‐pharmacological management of infant and young child procedural pain. The Cochrane Library.</p><p>Stevens, B., Yamada, J., Campbell-Yeo, M. Gibbins, S., Harrison D., Dionne, K., Taddio, A., McNar C Willan, A., Ballantyne, M., Widger, K., Sidani, S., Estabrooks, C., Synnes, A., Squires J., Victor, C., and Riahi, S. (2018). The minimally effective dose of sucrose for procedural pain relief in neonates: a randomized controlled trial. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5824554/" target="_blank">BMC Pediatr</a>. 2018; 18: 85.</p><p>Stevens, B.J., Gibbins, S., Yamada, J., Dionne, K., Lee, G., Johnston, C., & Taddio, A. (2014). The premature infant pain profile-revised (PIPP-R): initial validation and feasibility. The Clinical journal of pain, 30(3), 238-243. </p><p>Stevens, B.J., Abbott, L.K., Yamada, J., Harrison, D., Stinson, J., Taddio, A., & Campbell, F. (2011). Epidemiology and management of painful procedures in children in Canadian hospitals. <em>Canadian Medical Association Journal</em>, <em>183</em>(7), E403-E410.</p><p>Stevens, B., Yamada, J., Lee, G.Y., & Ohlsson, A. (2013). Sucrose for analgesia in newborn infants undergoing painful procedures. Cochrane Database Syst Rev, 1(1).</p><p>Taddio, A., McMurtry, C.M., Shah, V., Riddell, R.P., Chambers, C.T., Noel, M., & Lang, E. (2015). Reducing pain during vaccine injections: clinical practice guideline. <em>Canadian Medical Association Journal</em>, <em>187</em>(13), 975-982.</p>
Douleur aiguë : Comment l’évaluer chez les nourrissons et les tout-petitsDDouleur aiguë : Comment l’évaluer chez les nourrissons et les tout-petitsAcute pain: How to assess in infants and toddlersFrenchPain/AnaesthesiaNewborn (0-28 days);Baby (1-12 months);Toddler (13-24 months)NANervous systemSymptomsAdult (19+) CaregiversPain2019-01-25T05:00:00ZHealth (A-Z) - ConditionsHealth A-Z<p>Découvrez comment la douleur aiguë de votre nourrisson ou tout-petit est évaluée à la maison et en milieu médical.</p><h2>Qu’est-ce qui cause la douleur aiguë chez les nourrissons et les tout-petits?</h2><p>Chez les nourrissons et les tout-petits, les causes courantes de douleur aiguë comprennent notamment :</p><ul><li>la poussée dentaire;</li><li>les chocs ou chutes;</li><li>les otites;</li><li>les injections de vaccins;</li><li>les ponctions du talon pour prélever un échantillon de sang;</li><li>les interventions telles que l’insertion d’un cathéter (tube mince) ou une ponction lombaire.</li></ul><p>​En règle générale, toute source de douleur chez des enfants plus âgés ou des adultes (comme l’insertion d’une aiguille ou d’un cathéter) sera aussi source de douleur pour votre nourrisson ou tout-petit. Ainsi, si votre jeune enfant subit une intervention que vous trouveriez douloureuse, son niveau de douleur sera vraisemblablement similaire, voire supérieur au vôtre.</p><p>En effet, il se peut que certaines interventions soient plus douloureuses pour les jeunes enfants, car leurs cerveaux ne peuvent pas encore les aider à tolérer la douleur, par exemple par la distraction. Ne sous-estimez en aucune circonstance l’angoisse de votre jeune enfant par rapport à la douleur, même s’il a une blessure ou une intervention que vous ne trouveriez pas douloureuse.</p><h2>À retenir​</h2><ul><li>Chez les nourrissons et les tout-petits, les causes courantes de douleur aiguë sont notamment la poussée dentaire, les chocs ou les chutes, et les injections de vaccins.</li><li>Les signes de douleur aiguë dans ce groupe d’âge comprennent l’irritabilité, les gémissements, les changements soudains dans l’expression du visage, et les gesticulations des bras ou des jambes.</li><li>En milieu médical, les fournisseurs de soins de santé évaluent la douleur en utilisant des outils standards et en contrôlant la fréquence cardiaque et le rythme respiratoire de votre bébé ainsi que ses niveaux d’oxygène.</li><li>N’hésitez pas à faire part de votre opinion et de vos préoccupations concernant la douleur de votre enfant à l’équipe de soins de santé.<br></li></ul><h2>Évaluation de la douleur aiguë à la maison</h2><p>Comme votre jeune enfant ne peut pas encore parler, les seuls indicateurs de son niveau de douleur sont la situation douloureuse dans laquelle il se trouve et son comportement. Dans ce cas, le contexte implique de réfléchir afin de déterminer si l’intervention serait douloureuse pour un enfant plus âgé ou pourrait être douloureuse pour un jeune enfant, même si elle ne l’est pas pour une personne plus âgée. D’après ces renseignements, vous devriez alors surveiller tout changement dans le comportement de votre enfant.</p><p>Voici les signes comportementaux d’une douleur aiguë :</p><ul><li>irritabilité;</li><li>changements brutaux dans l’expression du visage (par exemple, une grimace avec les yeux fermés et les sourcils bombés);</li><li>pleurs ou gémissements;</li><li>gesticulations ou agitation des bras ou des jambes;</li><li>changements dans l’alimentation, la façon de jouer, la structure du sommeil;</li><li>rigidité ou mollesse;</li><li>changements dans la respiration;</li><li>changements dans le mode d’interaction avec les personnes et les objets environnants.</li></ul><h2>Évaluation de la douleur aiguë en milieu médical</h2><p>À l’hôpital, l’équipe de soins de santé de votre enfant utilise un éventail d’outils visant à déterminer le degré de douleur éprouvé par un nourrisson.</p><p>Dans les unités néonatales de soins intensifs (UNSI), l’un des outils les plus courants pour l’évaluation de la douleur chez les nourrissons est le <a href="https://www.semanticscholar.org/paper/The-premature-infant-pain-profile-revised-%28PIPP-R%29:-Stevens-Gibbins/76e49d44432665d7dffd5a9a7a2fdd55466f7f32/figure/0" target="_blank">profil de douleur du bébé prématuré révisé (PIPP-R)</a>. Cet outil note bon nombre des comportements qu’un enfant pourrait présenter à la maison ainsi que les signes physiologiques (signes à l’intérieur du corps), notamment :</p><ul><li>la fréquence cardiaque de votre nourrisson;<br></li><li>sa saturation en oxygène (le taux d’oxygène dans son sang);</li><li>sa fréquence cardiaque.<br></li></ul><p>Pour les nourrissons et les enfants jusqu’à deux ans, les fournisseurs de soins de santé utilisent généralement <a href="http://www.olchc.ie/Healthcare-Professionals/Nursing-Practice-Guidelines/Pain-FLACC-Revised-June-2017.pdf" target="_blank">l’échelle FLACC (visage, jambes, activité, pleurs et consolabilité)</a>. Cet outil examine plusieurs des comportements décrits ci-dessus.</p><p>En milieu médical, l’équipe de soins de santé de votre enfant joue un rôle important dans la précision du niveau et de l’origine de la douleur, mais n’hésitez pas à lui faire part de votre opinion et de vos préoccupations concernant la douleur de votre enfant.</p><h2>Sites Web</h2><p> Réconforter votre bébé dans une unité de soins intensifs (Comforting Your Baby in Intensive Care, en anglais)<br> <a href="http://familynursing.ucsf.edu/comforting-your-baby-intensive-care" target="_blank">http://familynursing.ucsf.edu/comforting-your-baby-intensive-care<br></a></p><h2>Vidéos<br></h2><p> <a href="https://www.youtube.com/watch?v=9OgCQKOnn-I" target="_blank">Éducation d’un bébé : soulagement de la douleur</a> (3 min. 50 s.)<br> Stratégies psychologiques et physiques pour les parents en vue de réduire la douleur liée à la vaccination chez les nourrissons en bonne santé</p><p> <a href="https://www.youtube.com/watch?v=5Oqa1Fag5eQ" target="_blank">Réduction de la douleur liée à la vaccination chez les bébés</a> (13 min. 8 s.)<br> Conseils pour les parents afin d’aider des nourrissons en bonne santé à traverser l’épreuve de la vaccination</p><p> <a href="https://www.youtube.com/watch?v=-Y49FOGtmwo" target="_blank">Soulagement de la douleur de votre bébé : l’histoire d’une mère</a> (3 min. 7 s.)<br> Trois façons de réduire instantanément la douleur de votre nourrisson à l’UNSI</p><p> <a href="https://www.youtube.com/watch?v=3nqN9c3FWn8" target="_blank">Le pouvoir du toucher d’un parent</a> (2 min. 40 s.)<br> Les bienfaits de l’allaitement et du contact peau contre peau pour aider un nourrisson subissant une intervention douloureuse</p><p>Ce contenu a été développé par Rebecca Pillai Riddell, PhD, CPsych, OUCH Lab, York University, Toronto, en collaboration avec : Lorraine Bird, MScN, CNS, Fiona Campbell, BSc, MD, FRCA, Bonnie Stevens, RN, PhD, FAAN, FCAHS, Anna Tadio, BScPhm, PhD L’hôpital pour enfants de Toronto (Canada), The Hospital for Sick Children</p><h3>Références</h3><p>Anand, K.J.S. (2012). Assessment of neonatal pain. Dans J. A. Garcia-Prats & M. S. Kim (Eds.), UpToDate. UpToDate: Waltham, MA.</p><p>International Association for the Study of Pain (2010) Fact Sheet on Mechanisms of Acute Pain. <a href="https://s3.amazonaws.com/rdcms-iasp/files/production/public/Content/ContentFolders/GlobalYearAgainstPain2/AcutePainFactSheets/3-Mechanisms.pdf" target="_blank">https://s3.amazonaws.com/rdcms-iasp/files/production/public/Content/ContentFolders/GlobalYearAgainstPain2/AcutePainFactSheets/3-Mechanisms.pdf</a> [consulté le 29 mars 2018]</p><p>Mathew, P.J. et Mathew, J.L. (2003). Assessment and management of pain in infants. Postgraduate Medical Journal, 79(934), 438-443.</p><p>McGrath, P.J. (1985). CHEOPS: a behavioral scale for rating postoperative pain in children. Adv Pain Res Ther, 9, 395.</p><p>Merkel, S., Voepel-Lewis, T. et Malviya, S. (2002). Pain Assessment in Infants and Young Children: The FLACC Scale: A behavioral tool to measure pain in young children. AJN The American Journal of Nursing, 102(10), 55-58.</p><p>Ohlsson, A. et Shah, P.S. (2015). Paracetamol (acetaminophen) for prevention or treatment of pain in newborns. Cochrane Database Syst Rev, 6(6).</p><p>Pillai Riddell, R., Lisi, D., Campbell, L. (2013). Pain Assessment in Neonates. Dans Encyclopedia of Pain, 2<sup>e</sup> édition.</p><p>Pillai Riddell, R.R, Racine, N.M., Gennis H.G., Turcotte, K., Uman, L.S., Horton, R.E., Ahola Kohut, S., Hillgrove Stuart, J., Stevens, B. et Lisi, D.M. (2015). Non-pharmacological management of infant and young child procedural pain. Cochrane Database of Systematic Reviews, numéro 12. Art. n<sup>o</sup> : CD006275</p><p>Pillai Riddell, R., O'Neill, M., Campbell, L., Taddio, A., Greenberg, S., Garfield, H. (2018). The ABCDs of Pain Management: A Double-Blind Randomized Controlled Trial for a Brief Educational Video for Parents of Young Children undergoing Vaccination. <em>Journal of Pediatric Psychology.</em> Volume 43, numéro 3, 1<sup>er</sup> avril 2018, pages 224-233, <a href="https://doi.org/10.1093/jpepsy/jsx122" target="_blank">https://doi.org/10.1093/jpepsy/jsx122</a></p><p>Pillai Riddell, R.R., Racine, N.M., Gennis, H.G., Turcotte, K., Uman, L.S., Horton, R.E., ... et Lisi, D.M. (2015). Non‐pharmacological management of infant and young child procedural pain. The Cochrane Library.<br></p><p>Stevens, B., Yamada, J., Campbell-Yeo, M. Gibbins, S., Harrison D., Dionne, K., Taddio, A., McNar C Willan, A., Ballantyne, M., Widger, K., Sidani, S., Estabrooks, C., Synnes, A., Squires J., Victor, C. et Riahi, S. (2018). The minimally effective dose of sucrose for procedural pain relief in neonates: a randomized controlled trial. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5824554/" target="_blank">BMC Pediatr</a>. 2018; 18: 85.</p><p>Stevens, B.J., Gibbins, S., Yamada, J., Dionne, K., Lee, G., Johnston, C. et Taddio, A. (2014). The premature infant pain profile-revised (PIPP-R): initial validation and feasibility. The Clinical journal of pain, 30(3), 238-243.</p><p>Stevens, B.J., Abbott, L.K., Yamada, J., Harrison, D., Stinson, J., Taddio, A. et Campbell, F. (2011). Epidemiology and management of painful procedures in children in Canadian hospitals. <em>Journal de l'Association médicale canadienne</em>, 183(7), E403-E410.</p><p>Stevens, B., Yamada, J., Lee, G.Y. et Ohlsson, A. (2013). Sucrose for analgesia in newborn infants undergoing painful procedures. Cochrane Database Syst Rev, 1(1).</p><p>Taddio, A., McMurtry, C.M., Shah, V., Riddell, R.P., Chambers, C.T., Noel, M. et Lang, E. (2015). Reducing pain during vaccine injections: clinical practice guideline. <em>Journal de l'Association médicale canadienne</em>, 187(13), 975-982.</p>

 

 

 

 

Acute pain: How to assess in infants and toddlers3634.00000000000Acute pain: How to assess in infants and toddlersAcute pain: How to assess in infants and toddlersAEnglishPain/AnaesthesiaNewborn (0-28 days);Baby (1-12 months);Toddler (13-24 months)NANervous systemSymptomsAdult (19+) CaregiversPain2019-01-25T05:00:00Z10.500000000000042.50000000000001136.00000000000Health (A-Z) - ConditionsHealth A-Z<p>Find out how your infant's or toddler's acute pain is assessed at home and in medical settings.</p><h2>What causes acute pain in infants and toddlers?</h2><p>In infants and toddlers, common causes of acute pain include:</p><ul><li>teething</li><li>a bump or fall</li><li>ear infections</li><li>vaccinations by needle</li><li>heel lances to obtain a blood sample</li><li>procedures such as inserting a catheter (thin tube) or doing a lumbar puncture</li></ul><p>​As a rule, anything that causes pain in older children or adults (such as inserting a needle or catheter) will also cause pain in your infant or toddler. So if your young child is having a procedure that you would find painful, they are likely experiencing at least as much pain as you would experience.</p><p>Indeed, certain procedures may be more painful for young children because their brains cannot yet help them cope with pain, for example by using distraction. Never discount your young child's pain-related distress even if they have an injury or procedure that you would not find painful.</p><h2>​Key points</h2><ul><li>In infants and toddlers, common causes of acute pain include teething, bumps or falls, and vaccinations by needle.</li><li>Signs of acute pain in this age group include irritability, whimpering, sudden changes to facial expression and flailing of arms or legs.<br></li><li>In medical settings, health-care providers assess pain by using standard tools and checking your baby's heart and breathing rate, and their oxygen levels.</li><li>Always feel free to share your own opinion and any concerns about your child's pain with the health-care team.</li></ul><h2>Assessing acute pain at home </h2><p>Because your young child cannot speak yet, you can only tell how much pain they are experiencing through the painful situation and their behaviour. In this case, the context means thinking about whether the procedure would be painful for an older child or could be painful for a young child even if not painful for someone older. Based on this information, you would then watch for any changes in your child's behaviour.</p><p>Behavioural signs of acute pain include:</p><ul><li>irritability</li><li>sharp changes in facial expressions (for example grimacing with eyes shut and brow bulging)</li><li>crying or whimpering</li><li>flailing or thrashing arms or legs</li><li>changes in their feeding, playing and/or sleeping routines</li><li>rigidness or limpness</li><li>changes in breathing</li><li>changes in how they interact with people and things around them</li></ul><h2>Assessing acute pain in medical settings</h2><p>In the hospital, your child's health-care team uses a range of tools to determine how much pain an infant is feeling. </p><p>In the NICU setting, one of the most common tools for assessing pain in infants is the <a href="https://www.semanticscholar.org/paper/The-premature-infant-pain-profile-revised-%28PIPP-R%29:-Stevens-Gibbins/76e49d44432665d7dffd5a9a7a2fdd55466f7f32/figure/0" target="_blank">Premature Infant Pain Profile-Revised (PIPP-R)</a>. This tool rates many of the behaviours that a child might display at home as well as physiological signs (signs inside the body), such as your infant's:</p><ul><li>heart rate<br></li><li>oxygen saturation (how much oxygen is in their blood)<br></li><li>breathing rate</li></ul><p>For older infants and children aged up to two, health-care providers usually use the <a href="http://www.olchc.ie/Healthcare-Professionals/Nursing-Practice-Guidelines/Pain-FLACC-Behavioural-Pain-Assessment-Scale-2015.pdf" target="_blank">Faces, Legs, Activity, Cry and Consolability (FLACC) scale</a>. This tool looks at several of the behaviours described above.</p> <p>In medical settings, your child's health-care team plays an important role in clarifying the level and cause of pain, but feel free to share your opinions and concerns about your infant's pain with them.</p><h2>Websites</h2><p>Comforting Your Baby in Intensive Care<br> <a href="http://familynursing.ucsf.edu/comforting-your-baby-intensive-care" target="_blank">http://familynursing.ucsf.edu/comforting-your-baby-intensive-care</a></p><h2>Videos</h2><p><a href="https://www.youtube.com/watch?v=9OgCQKOnn-I" target="_blank">Bringin' up Baby: Soothing the Pain</a> (3 mins 50 secs)<br>Psychological and physical strategies for parents to reduce vaccination pain in healthy infants</p><p><a href="https://www.youtube.com/watch?v=5Oqa1Fag5eQ" target="_blank">Reduce the pain of vaccination in babies</a> (13 mins 08 secs)<br> Tips for parents on helping healthy infants get through vaccinations</p><p><a href="https://www.youtube.com/watch?v=-Y49FOGtmwo" target="_blank">Easing your baby's pain: A mother's story</a> (3 mins 07 secs)<br> Three ways to instantly reduce your infant's pain in the NICU</p><p><a href="https://www.youtube.com/watch?v=3nqN9c3FWn8" target="_blank">The Power of a Parent's Touch</a> (2 mins 40 secs)<br> How breastfeeding and skin-to-skin contact can help when an infant is experiencing a painful procedure</p><p>Content developed by Rebecca Pillai Riddell, PhD, CPsych, OUCH Lab, York University, Toronto, in collaboration with:<br>Lorraine Bird, MScN, CNS, Fiona Campbell, BSc, MD, FRCA, Bonnie Stevens, RN, PhD, FAAN, FCAHS, Anna Taddio, BScPhm, PhD<br> Hospital for Sick Children</p> <h3>References</h3><p>Anand, K.J.S. (2012). Assessment of neonatal pain. In J. A. Garcia-Prats & M. S. Kim (Eds.), UpToDate. UpToDate: Waltham, MA.</p><p>International Association for the Study of Pain (2010) Fact Sheet on Mechanisms of Acute Pain.  <a href="https://s3.amazonaws.com/rdcms-iasp/files/production/public/Content/ContentFolders/GlobalYearAgainstPain2/AcutePainFactSheets/3-Mechanisms.pdf" target="_blank">https://s3.amazonaws.com/rdcms-iasp/files/production/public/Content/ContentFolders/GlobalYearAgainstPain2/AcutePainFactSheets/3-Mechanisms.pdf</a> [Accessed March 29, 2018]</p><p>Mathew, P.J., & Mathew, J.L. (2003). Assessment and management of pain in infants. Postgraduate Medical Journal, 79(934), 438-443.</p><p>McGrath, P.J. (1985). CHEOPS: a behavioral scale for rating postoperative pain in children. Adv Pain Res Ther, 9, 395.</p><p>Merkel, S., Voepel-Lewis, T., & Malviya, S. (2002). Pain Assessment in Infants and Young Children: The FLACC Scale: A behavioral tool to measure pain in young children. AJN The American Journal of Nursing, 102(10), 55-58.</p><p>Ohlsson, A., & Shah, P.S. (2015). Paracetamol (acetaminophen) for prevention or treatment of pain in newborns. Cochrane Database Syst Rev, 6(6).</p><p>Pillai Riddell, R., Lisi, D., Campbell, L. (2013).  Pain Assessment in Neonates. In Encyclopedia of Pain, 2<sup>nd</sup> edition.</p><p>Pillai Riddell, R.R, Racine, N.M., Gennis H.G., Turcotte, K., Uman, L.S., Horton, R.E., Ahola Kohut, S., Hillgrove Stuart, J., Stevens, B., & Lisi, D.M. (2015). Non-pharmacological management of infant and young child procedural pain. Cochrane Database of Systematic Reviews, Issue 12. Art. No.: CD006275</p><p>Pillai Riddell, R., O'Neill, M., Campbell, L., Taddio, A., Greenberg, S., Garfield, H. (2018). The ABCDs of Pain Management: A Double-Blind Randomized Controlled Trial for a Brief Educational Video for Parents of Young Children undergoing Vaccination. <em>Journal of Pediatric Psychology.</em> Volume 43, Issue 3, 1 April 2018, Pages 224-233, <a href="https://doi.org/10.1093/jpepsy/jsx122" target="_blank">https://doi.org/10.1093/jpepsy/jsx122</a></p><p>Pillai Riddell, R.R., Racine, N.M., Gennis, H.G., Turcotte, K., Uman, L.S., Horton, R.E., ... & Lisi, D.M. (2015). Non‐pharmacological management of infant and young child procedural pain. The Cochrane Library.</p><p>Stevens, B., Yamada, J., Campbell-Yeo, M. Gibbins, S., Harrison D., Dionne, K., Taddio, A., McNar C Willan, A., Ballantyne, M., Widger, K., Sidani, S., Estabrooks, C., Synnes, A., Squires J., Victor, C., and Riahi, S. (2018). The minimally effective dose of sucrose for procedural pain relief in neonates: a randomized controlled trial. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5824554/" target="_blank">BMC Pediatr</a>. 2018; 18: 85.</p><p>Stevens, B.J., Gibbins, S., Yamada, J., Dionne, K., Lee, G., Johnston, C., & Taddio, A. (2014). The premature infant pain profile-revised (PIPP-R): initial validation and feasibility. The Clinical journal of pain, 30(3), 238-243. </p><p>Stevens, B.J., Abbott, L.K., Yamada, J., Harrison, D., Stinson, J., Taddio, A., & Campbell, F. (2011). Epidemiology and management of painful procedures in children in Canadian hospitals. <em>Canadian Medical Association Journal</em>, <em>183</em>(7), E403-E410.</p><p>Stevens, B., Yamada, J., Lee, G.Y., & Ohlsson, A. (2013). Sucrose for analgesia in newborn infants undergoing painful procedures. Cochrane Database Syst Rev, 1(1).</p><p>Taddio, A., McMurtry, C.M., Shah, V., Riddell, R.P., Chambers, C.T., Noel, M., & Lang, E. (2015). Reducing pain during vaccine injections: clinical practice guideline. <em>Canadian Medical Association Journal</em>, <em>187</em>(13), 975-982.</p>https://assets.aboutkidshealth.ca/AKHAssets/ear_infections_sore_throat_babies.jpgAcute pain: How to assess in infants and toddlersFalseAcute pain: Infants and toddlers Find out how acute pain is identified and assessed, at home and in medical settings, in children not old enough to speak.