Acute pain: How to assess in older childrenAAcute pain: How to assess in older childrenAcute pain: How to assess in older childrenEnglishPain/AnaesthesiaSchool age child (5-8 years);Pre-teen (9-12 years)NANervous systemConditions and diseases;SymptomsSchool age child (5-8 years) Pre-teen (9-12 years)Pain2019-01-25T05:00:00ZRebecca Pillai Riddell, PhD, CPsych9.6000000000000055.30000000000001116.00000000000Health (A-Z) - ConditionsHealth A-Z<p>Discover how to assess acute pain in an older child (age six to 12) at home and in medical settings.</p><h2>What causes acute pain in older children?</h2><p>In older children (ages six to 12), common causes of <a href="/Article?contentid=2982&language=English">acute pain</a> include:</p><ul><li>routine vaccinations by needle</li><li>earaches and sore throats</li><li>injuries from everyday physical activities</li><li>dental treatments such as cavity fillings</li><li>procedures such as blood work, lumbar punctures or intravenous starts</li><li>surgeries (operations)</li><li>complex health conditions such as cancer or juvenile arthritis</li></ul><h2>Key points</h2><ul><li>​In older children, common causes of acute pain include routine vaccinations, infections, surgeries and complex health conditions.</li><li>At this age, children can self-report their pain rather than have a parent or health-care professional speak for them.</li><li>In medical settings, health-care providers may still want to assess your child's pain with tools such as the Faces Pain Scale - Revised or other tools if your child cannot express their pain in words.</li><li>Help your child feel safe to report their pain so they can receive the most appropriate assessment and treatment.</li></ul><h2>Assessing acute pain at home</h2><p>Older children can usually "self-report" their pain (describe it in their own words or rate how bad it is) rather than have a parent or health-care professional speak for them.</p><p>One reason is that they can use specific pain words (such as "aching", "burning" or "stabbing") to better explain their experience and where exactly in the body their pain is coming from. Older children can also start reporting what can make their pain better or worse.</p><p>But it is important to remember that children at the younger end of this age group may be too fearful or stressed to self-report their pain accurately.<br></p><h2>Assessing acute pain in medical settings</h2><p>At this age, it is usually best for a child who can talk about their pain to self-report it in the hospital.</p><p>Most children in this age group can rate their level of pain using pain scales. Children around the age of six may use words like "small", "medium" or "a lot" to rate their pain or be able to use a picture pain scale such as the Faces Pain Scale - Revised.</p> <figure class="asset-c-100"> <span class="asset-image-title">Faces Pain Scale - Revised</span> <img alt="Six faces showing increasing discomfort from left to right" src="https://assets.aboutkidshealth.ca/AKHAssets/PN_faces_scale_MISC_IMG_EN.jpg" /> <figcaption class="asset-image-caption">Faces Pain Scale - Revised. Copyright ©2001, <a href="https://www.iasp-pain.org/Education/Content.aspx?ItemNumber=1519" target="_blank">International Association for the Study of Pain</a>. Reproduced with permission.</figcaption> </figure> <p>Older children in this group can use numeric rating scales, for example by verbally rating their pain from 0 to 10, where 0 is 'no pain' and 10 is the worst or strongest pain they can imagine. With repeated use, these scales can reveal if your child's pain is changing (getting better or worse) over time.</p><p>Body diagrams can also be helpful tools for assessing an older child's pain. Older children can point at the diagram and share exactly where they are feeling pain in their body.</p> <figure class="asset-c-100"> <span class="asset-image-title">Sample body diagram</span> <img alt="Body diagram to allow child to pinpoint pain" src="https://assets.aboutkidshealth.ca/AKHAssets/SuperKidz%20pain%20assessment%20body%20diagram%20age%204-8.PNG" /> <figcaption class="asset-image-caption">Body diagram used as part of SUPER-KIDZ pain measurement tool ©2012, Stinson, J. et al. Reproduced with permission.</figcaption> </figure><h2>Factors affecting pain assessment</h2><p>A developmental disability or intellectual disability may make it difficult for your child to express their pain in words. In this case, their health-care team will use standard pain assessment tools to look at their behaviour. One such tool is the <a href="http://www.community-networks.ca/wp-content/uploads/2015/07/PainChklst_BreauNCCPC-R2004.pdf" target="_blank">NCCPC</a>, which helps make caregivers more aware if a child's behaviour may be different than usual due to pain.</p><p>Gender can affect how children express pain and how accurately their pain might be assessed. For instance, older boys may put a lot of effort into making sure they do not cry, especially if others are around. On the other hand, young girls may cry more because this behaviour is deemed more acceptable in some cultures. Or, the opposite may happen. It is important to ask a child about their pain and not make assumptions based on gender or sex.</p> <p>Cultural differences can also account for a wide variety of reactions to situations. Some cultures may express themselves freely, but others may repress their emotions or respond to pain in unexpected ways. Some children may adopt the role of a "good patient" and behave the way they believe health-care professionals want them to behave rather than express how they are feeling.</p><h2>Websites</h2><p>Faces Pain Scale-Revised<br><a href="https://www.iasp-pain.org/Education/Content.aspx?ItemNumber=1519" target="_blank">https://www.iasp-pain.org/Education/Content.aspx?ItemNumber=1519</a></p><p>Distraction toolkit<br><a href="https://ken.childrenshealthcarecanada.ca/xwiki/bin/view/Paediatric+Pain/Distraction+Toolkit" target="_blank">https://ken.childrenshealthcarecanada.ca/xwiki/bin/view/Paediatric+Pain/Distraction+Toolkit</a></p><p>Reducing the pain of vaccination in children and teens (PDF)<br><a href="https://immunize.ca/sites/default/files/Resource%20and%20Product%20Uploads%20%28PDFs%29/Products%20and%20Resources/Pain%20Management/Parents/painreduction_kidsandteens_web_e.pdf" target="_blank">https://immunize.ca/sites/default/files/Resource%20and%20Product%20Uploads%20%28PDFs%29/Products%20and%20Resources/Pain%20Management/Parents/painreduction_kidsandteens_web_e.pdf</a></p><p>Managing your child's pain from braces<br><a href="https://blog.1stfamilydental.com/reducing-braces-pain/" target="_blank">https://blog.1stfamilydental.com/reducing-braces-pain/</a></p><p>Managing your child's pain from sports injuries<br><a href="https://www.stanfordchildrens.org/en/topic/default?id=tackling-kids-sports-injuries-1-4288" target="_blank">https://www.stanfordchildrens.org/en/topic/default?id=tackling-kids-sports-injuries-1-4288</a></p><p>Preparing your child with cancer for painful procedures<br><a href="https://www.cancer.net/navigating-cancer-care/children/preparing-your-child-medical-procedures" target="_blank">https://www.cancer.net/navigating-cancer-care/children/preparing-your-child-medical-procedures</a></p><p>Managing needle pain for your child with cancer<br><a href="https://cancerkn.com/tips-manage-childs-needle-pain/" target="_blank">https://cancerkn.com/tips-manage-childs-needle-pain/</a></p><h2>Videos</h2><p>Pain management at SickKids (2 mins 49 secs)<br><a href="https://www.youtube.com/watch?v=_9_OQFo2APA" target="_blank">https://www.youtube.com/watch?v=_9_OQFo2APA</a></p><p>Reducing the pain of vaccination in children (Centre for Pediatric Pain Research) (2 mins 18 secs)<br><a href="https://www.youtube.com/watch?v=KgBwVSYqfps" target="_blank">https://www.youtube.com/watch?v=KgBwVSYqfps</a></p><p>Reducing the pain of vaccination in children (Dr. Taddio) (20 mins 52 secs)<br><a href="https://www.youtube.com/watch?time_continue=2&v=TGGDLhmqH8I" target="_blank">https://www.youtube.com/watch?time_continue=2&v=TGGDLhmqH8I</a></p><p>Learning how to manage pain from medical procedures (Stanford Children's Health) (12 mins 58 secs)<br><a href="https://www.youtube.com/watch?v=UbK9FFoAcvs&feature=youtu.be" target="_blank">https://you.tube/UbK9FFoAcvs</a></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>Gold, J.I., Mahrer, N.E. (2017) Is Virtual Reality Ready for Prime Time in the Medical Space? A Randomized Control Trial of Pediatric Virtual Reality for Acute Procedural Pain Management. <em>Journal of Pediatric Psychology</em>, 2017; <a href="https://academic.oup.com/jpepsy/article/43/3/266/4558507" target="_blank">https://doi.org/10.1093/jpepsy/jsx129</a></p><p>Hicks, C.L., von Baeyer, C.L., Spafford, P., van Korlaar, I., Goodenough, B. (2001). The Faces Pain Scale ­- Revised: Toward a common metric in pediatric pain measurement. <em>Pain</em> 2001;93:173-183.</p><p>McMurtry, C.M., Chambers, C.T., McGrath, P.J., & Asp, E. (2010). When "don't worry" communicates fear: Children's perceptions of parental reassurance and distraction during a painful medical procedure. Pain, 150(1), 52-58.</p><p>Uman, L.S., Birnie, K.A., Noel, M., Parker, J.A., Chambers, C.T., McGrath, P.J., Kisely, S.R. (2013) Psychological interventions for needle-related procedural pain and distress in children and adolescents. <em>Cochrane Database of Systematic Reviews. </em><a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD005179.pub3/full" target="_blank">https://doi.org/10.1002/14651858.CD005179.pub3</a></p><p>Taddio, A., McMurtry, C.M., Shah, V., Pillai Riddell. R. et al. Reducing pain during vaccine injections: clinical practice guideline. CMAJ 2015. <a href="http://www.cmaj.ca/content/187/13/975" target="_blank">https://doi.org/10.1503/cmaj.150391</a></p><p>von Baeyer, C.L. (2009). Children's self-report of pain intensity: what we know, where we are headed. Pain Research and Management, 14(1), 39-45.</p>

 

 

 

 

Acute pain: How to assess in older children3638.00000000000Acute pain: How to assess in older childrenAcute pain: How to assess in older childrenAEnglishPain/AnaesthesiaSchool age child (5-8 years);Pre-teen (9-12 years)NANervous systemConditions and diseases;SymptomsSchool age child (5-8 years) Pre-teen (9-12 years)Pain2019-01-25T05:00:00ZRebecca Pillai Riddell, PhD, CPsych9.6000000000000055.30000000000001116.00000000000Health (A-Z) - ConditionsHealth A-Z<p>Discover how to assess acute pain in an older child (age six to 12) at home and in medical settings.</p><h2>What causes acute pain in older children?</h2><p>In older children (ages six to 12), common causes of <a href="/Article?contentid=2982&language=English">acute pain</a> include:</p><ul><li>routine vaccinations by needle</li><li>earaches and sore throats</li><li>injuries from everyday physical activities</li><li>dental treatments such as cavity fillings</li><li>procedures such as blood work, lumbar punctures or intravenous starts</li><li>surgeries (operations)</li><li>complex health conditions such as cancer or juvenile arthritis</li></ul><h2>Key points</h2><ul><li>​In older children, common causes of acute pain include routine vaccinations, infections, surgeries and complex health conditions.</li><li>At this age, children can self-report their pain rather than have a parent or health-care professional speak for them.</li><li>In medical settings, health-care providers may still want to assess your child's pain with tools such as the Faces Pain Scale - Revised or other tools if your child cannot express their pain in words.</li><li>Help your child feel safe to report their pain so they can receive the most appropriate assessment and treatment.</li></ul><h2>Assessing acute pain at home</h2><p>Older children can usually "self-report" their pain (describe it in their own words or rate how bad it is) rather than have a parent or health-care professional speak for them.</p><p>One reason is that they can use specific pain words (such as "aching", "burning" or "stabbing") to better explain their experience and where exactly in the body their pain is coming from. Older children can also start reporting what can make their pain better or worse.</p><p>But it is important to remember that children at the younger end of this age group may be too fearful or stressed to self-report their pain accurately.<br></p><h2>Assessing acute pain in medical settings</h2><p>At this age, it is usually best for a child who can talk about their pain to self-report it in the hospital.</p><p>Most children in this age group can rate their level of pain using pain scales. Children around the age of six may use words like "small", "medium" or "a lot" to rate their pain or be able to use a picture pain scale such as the Faces Pain Scale - Revised.</p> <figure class="asset-c-100"> <span class="asset-image-title">Faces Pain Scale - Revised</span> <img alt="Six faces showing increasing discomfort from left to right" src="https://assets.aboutkidshealth.ca/AKHAssets/PN_faces_scale_MISC_IMG_EN.jpg" /> <figcaption class="asset-image-caption">Faces Pain Scale - Revised. Copyright ©2001, <a href="https://www.iasp-pain.org/Education/Content.aspx?ItemNumber=1519" target="_blank">International Association for the Study of Pain</a>. Reproduced with permission.</figcaption> </figure> <p>Older children in this group can use numeric rating scales, for example by verbally rating their pain from 0 to 10, where 0 is 'no pain' and 10 is the worst or strongest pain they can imagine. With repeated use, these scales can reveal if your child's pain is changing (getting better or worse) over time.</p><p>Body diagrams can also be helpful tools for assessing an older child's pain. Older children can point at the diagram and share exactly where they are feeling pain in their body.</p> <figure class="asset-c-100"> <span class="asset-image-title">Sample body diagram</span> <img alt="Body diagram to allow child to pinpoint pain" src="https://assets.aboutkidshealth.ca/AKHAssets/SuperKidz%20pain%20assessment%20body%20diagram%20age%204-8.PNG" /> <figcaption class="asset-image-caption">Body diagram used as part of SUPER-KIDZ pain measurement tool ©2012, Stinson, J. et al. Reproduced with permission.</figcaption> </figure><h2>Factors affecting pain assessment</h2><p>A developmental disability or intellectual disability may make it difficult for your child to express their pain in words. In this case, their health-care team will use standard pain assessment tools to look at their behaviour. One such tool is the <a href="http://www.community-networks.ca/wp-content/uploads/2015/07/PainChklst_BreauNCCPC-R2004.pdf" target="_blank">NCCPC</a>, which helps make caregivers more aware if a child's behaviour may be different than usual due to pain.</p><p>Gender can affect how children express pain and how accurately their pain might be assessed. For instance, older boys may put a lot of effort into making sure they do not cry, especially if others are around. On the other hand, young girls may cry more because this behaviour is deemed more acceptable in some cultures. Or, the opposite may happen. It is important to ask a child about their pain and not make assumptions based on gender or sex.</p> <p>Cultural differences can also account for a wide variety of reactions to situations. Some cultures may express themselves freely, but others may repress their emotions or respond to pain in unexpected ways. Some children may adopt the role of a "good patient" and behave the way they believe health-care professionals want them to behave rather than express how they are feeling.</p><h2>How you can help health-care professionals understand your child's pain</h2><p>No matter how old your child, it is important to ask about their pain and help them feel safe to truthfully express how much pain they are feeling. Your child's self-report is essential for health-care providers to give the most accurate assessment and recommend the most appropriate treatment.</p><p>If your child cannot speak for themselves, it is also important that you tell the health-care team how you know if your child is in pain.</p><h2>Websites</h2><p>Faces Pain Scale-Revised<br><a href="https://www.iasp-pain.org/Education/Content.aspx?ItemNumber=1519" target="_blank">https://www.iasp-pain.org/Education/Content.aspx?ItemNumber=1519</a></p><p>Distraction toolkit<br><a href="https://ken.childrenshealthcarecanada.ca/xwiki/bin/view/Paediatric+Pain/Distraction+Toolkit" target="_blank">https://ken.childrenshealthcarecanada.ca/xwiki/bin/view/Paediatric+Pain/Distraction+Toolkit</a></p><p>Reducing the pain of vaccination in children and teens (PDF)<br><a href="https://immunize.ca/sites/default/files/Resource%20and%20Product%20Uploads%20%28PDFs%29/Products%20and%20Resources/Pain%20Management/Parents/painreduction_kidsandteens_web_e.pdf" target="_blank">https://immunize.ca/sites/default/files/Resource%20and%20Product%20Uploads%20%28PDFs%29/Products%20and%20Resources/Pain%20Management/Parents/painreduction_kidsandteens_web_e.pdf</a></p><p>Managing your child's pain from braces<br><a href="https://blog.1stfamilydental.com/reducing-braces-pain/" target="_blank">https://blog.1stfamilydental.com/reducing-braces-pain/</a></p><p>Managing your child's pain from sports injuries<br><a href="https://www.stanfordchildrens.org/en/topic/default?id=tackling-kids-sports-injuries-1-4288" target="_blank">https://www.stanfordchildrens.org/en/topic/default?id=tackling-kids-sports-injuries-1-4288</a></p><p>Preparing your child with cancer for painful procedures<br><a href="https://www.cancer.net/navigating-cancer-care/children/preparing-your-child-medical-procedures" target="_blank">https://www.cancer.net/navigating-cancer-care/children/preparing-your-child-medical-procedures</a></p><p>Managing needle pain for your child with cancer<br><a href="https://cancerkn.com/tips-manage-childs-needle-pain/" target="_blank">https://cancerkn.com/tips-manage-childs-needle-pain/</a></p><h2>Videos</h2><p>Pain management at SickKids (2 mins 49 secs)<br><a href="https://www.youtube.com/watch?v=_9_OQFo2APA" target="_blank">https://www.youtube.com/watch?v=_9_OQFo2APA</a></p><p>Reducing the pain of vaccination in children (Centre for Pediatric Pain Research) (2 mins 18 secs)<br><a href="https://www.youtube.com/watch?v=KgBwVSYqfps" target="_blank">https://www.youtube.com/watch?v=KgBwVSYqfps</a></p><p>Reducing the pain of vaccination in children (Dr. Taddio) (20 mins 52 secs)<br><a href="https://www.youtube.com/watch?time_continue=2&v=TGGDLhmqH8I" target="_blank">https://www.youtube.com/watch?time_continue=2&v=TGGDLhmqH8I</a></p><p>Learning how to manage pain from medical procedures (Stanford Children's Health) (12 mins 58 secs)<br><a href="https://www.youtube.com/watch?v=UbK9FFoAcvs&feature=youtu.be" target="_blank">https://you.tube/UbK9FFoAcvs</a></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>Gold, J.I., Mahrer, N.E. (2017) Is Virtual Reality Ready for Prime Time in the Medical Space? A Randomized Control Trial of Pediatric Virtual Reality for Acute Procedural Pain Management. <em>Journal of Pediatric Psychology</em>, 2017; <a href="https://academic.oup.com/jpepsy/article/43/3/266/4558507" target="_blank">https://doi.org/10.1093/jpepsy/jsx129</a></p><p>Hicks, C.L., von Baeyer, C.L., Spafford, P., van Korlaar, I., Goodenough, B. (2001). The Faces Pain Scale ­- Revised: Toward a common metric in pediatric pain measurement. <em>Pain</em> 2001;93:173-183.</p><p>McMurtry, C.M., Chambers, C.T., McGrath, P.J., & Asp, E. (2010). When "don't worry" communicates fear: Children's perceptions of parental reassurance and distraction during a painful medical procedure. Pain, 150(1), 52-58.</p><p>Uman, L.S., Birnie, K.A., Noel, M., Parker, J.A., Chambers, C.T., McGrath, P.J., Kisely, S.R. (2013) Psychological interventions for needle-related procedural pain and distress in children and adolescents. <em>Cochrane Database of Systematic Reviews. </em><a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD005179.pub3/full" target="_blank">https://doi.org/10.1002/14651858.CD005179.pub3</a></p><p>Taddio, A., McMurtry, C.M., Shah, V., Pillai Riddell. R. et al. Reducing pain during vaccine injections: clinical practice guideline. CMAJ 2015. <a href="http://www.cmaj.ca/content/187/13/975" target="_blank">https://doi.org/10.1503/cmaj.150391</a></p><p>von Baeyer, C.L. (2009). Children's self-report of pain intensity: what we know, where we are headed. Pain Research and Management, 14(1), 39-45.</p>https://assets.aboutkidshealth.ca/AKHAssets/anorexia_treatment_options.jpgAcute pain: How to assess in older childrenFalse