Longer-lasting pain: How to assess in infants and toddlersLLonger-lasting pain: How to assess in infants and toddlersLonger-lasting pain: How to assess in infants and toddersEnglishPain/AnaesthesiaBaby (1-12 months);Toddler (13-24 months)NANervous systemSymptoms;Conditions and diseasesCaregivers Adult (19+)Pain2019-01-25T05:00:00Z10.300000000000046.4000000000000918.000000000000Health (A-Z) - ConditionsHealth A-Z<p>Infants and toddlers can experience longer-lasting pain from certain conditions and repeated procedures. Find out how to assess longer-lasting pain in infants and toddlers at home and in medical settings.</p><p>In children, teens and adults, chronic (long-term) pain:</p><ul><li>lasts longer than expected (more than three months)</li><li>can be continuous (never goes away) or recurring (comes and goes)</li><li>persists even after regular healing times for injuries and illness have passed</li></ul><p>The definition of chronic pain may not be appropriate for infants, especially those who may be less than three months old but have experienced pain for a large portion of their young lives.</p><p>Experts are still debating an exact definition of chronic pain in infants. Some experts believe that chronic pain (as defined in older children and adults) may not be possible for infants, as they do not experience the nervous system changes we see in older people with chronic pain. As a result, the term "longer-lasting pain" is used for infants instead.</p><h2>How does longer-lasting pain develop in infancy?</h2><p>Most health-care professionals working with hospitalized infants agree that infants can experience:</p><ul><li>long-lasting pain from certain diseases and conditions (such as staphylococcal-scalded skin syndrome)</li><li>continuous pain from repeated invasive medical procedures</li></ul><table class="akh-table"><tbody><tr><td> <strong>The pain from one short painful procedure (acute pain) is different from ongoing pain (from certain diseases and conditions) or repetitive pain from many painful procedures in the hospital.</strong></td></tr></tbody></table><p>Infants in the hospital who have several painful procedures a day (like heel lances, lumbar punctures, arterial line insertions) for many days in a row need more attention than healthy infants who, for instance, have pain from routine vaccinations.</p><p>Generally speaking, infants who have severe, persistent pain are either in hospital or in a highly medically-supported environment at home.</p><h2>Key points</h2><ul><li>Infants can experience longer-lasting pain from certain diseases and conditions, and continuous pain from repeated medical procedures.</li><li>Some infants can be hyper-reactive to pain, for instance crying when held, flailing their arms and legs, and tightly closing their eyes.</li><li>Other infants can be hypo-reactive to pain, for example going limp, not showing interest in caregivers or having a blank face.</li><li>There is no standard tool for assessing chronic pain in infants. Instead, health-care providers assess a child's behaviour and certain vital signs such as heart rate and breathing.</li></ul><h2>Assessing pain at home</h2><p>Because your infant cannot speak yet, they can only tell you if they are in pain – and how much pain – through their behaviour.</p><p>Typically, infants who are suspected to have longer-lasting pain tend to display two patterns of behaviour:</p><ul><li>hyper-reactive (reacting very strongly to painful stimulation)</li><li>hypo-reactive (reacting very little to painful stimulation)</li></ul><h3>Hyper-reactive behaviours</h3><p>Infants who are hyper-reactive tend to:</p><ul><li>cry when handled before the painful procedure</li><li>flail their arms and legs a lot</li><li>lose their breath for a short time</li><li>tightly shut their eyes or have a bulging brow</li><li>stretch their mouth wide open</li></ul><h3>Hypo-reactive behaviours</h3><p>Infants who are hypo-reactive tend to:</p><ul><li>go limp</li><li>offer no reaction to the painful procedure</li><li>show less interest in interacting with caregivers</li><li>have a blank face</li></ul><p>Because of these different responses, it is important to observe changes in your infant's behaviours for clues that they might be experiencing pain.</p><h2>Assessing pain in medical settings</h2><p>When your infant is in the hospital, your child's health-care team uses a range of tools to determine how much pain your child is feeling during an acute painful event (such as a heel lance).</p><p>The most common tools measure typical behaviours of a child in acute pain, such as:</p><ul><li>crying</li><li>facial expressions</li><li>body movements</li></ul><p>They also measure physiological signs (signs inside the body) such as your infant's:</p><ul><li>heart rate</li><li>oxygen saturation (how much oxygen is in their blood)</li><li>breathing rate</li></ul><p>Because there is no widely accepted definition of longer-lasting pain in infants, there is no single standard tool for measuring it. Indeed, physiological signs may not be helpful for assessing longer-lasting pain. However, in the NICU setting, the <a href="https://comfortassessment.com/web/files/4114/2919/4117/COMFORT_Neo_scale___final_version_April_2015.pdf" target="_blank">COMFORTneo scale</a> and the <a href="https://assets.aboutkidshealth.ca/AKHAssets/EDIN%20scale%20to%20assess%20prolonged%20pain%20in%20infants.jpg" target="_blank">EDIN scale</a> both offer promising assessments, as they focus on patterns of behaviour over time, rather than immediate reactions to something painful.</p><h2>Websites</h2><p>Comforting your baby in intensive care (in-depth PDF)<br><a href="http://familynursing.ucsf.edu/sites/familynursing.ucsf.edu/files/wysiwyg/Comfy%20PDF%20ENGLISH%20Dec%2017.pdf" target="_blank">http://familynursing.ucsf.edu/sites/familynursing.ucsf.edu/files/wysiwyg/Comfy%20PDF%20ENGLISH%20Dec%2017.pdf</a></p><h2>Videos</h2><p>It Doesn't Have to Hurt: The Power of a Parent's Touch<br><a href="https://www.youtube.com/watch?v=OlAItP-06hM" target="_blank">https://www.youtube.com/watch?v=OlAItP-06hM</a></p><p>Dr. Marsha Campbell Yeo: What's the power of a parent's touch?<br><a href="https://www.youtube.com/watch?v=XXzkAUV9ICE&t=132s">https://www.youtube.com/watch?v=XXzkAUV9ICE&t=132s</a></p><p>Reduce your infant's pain during newborn blood tests<br><a href="https://www.youtube.com/watch?v=L43y0H6XEH4&list=PLlZczt8t4Ac8cW3pbuRKJAEs3SoC5y8MB" target="_blank">https://www.youtube.com/watch?v=L43y0H6XEH4&list=PLlZczt8t4Ac8cW3pbuRKJAEs3SoC5y8MB</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, Danielle Ruskin, PhD, CPsych, Bonnie Stevens, RN, PhD, FAAN, FCAHS<br> Hospital for Sick Children</p><h3>References</h3><p>Debillion, T., Zupan, V., Ravault, N., Magny, J.F., Dehan, M. Development and initial validation of the EDIN scale, a new tool for assessing prolonged pain in preterm infants. Arch. Dis Child. Fetal 2001, 85, F36–F41.</p><p>DiLorenzo, M., Pillai Riddell, R., & Holsti, L. (2016). Beyond acute pain: understanding chronic pain in infancy. Children, 3(4), 26.</p><p>Pillai Riddell, R.R., Stevens, B.J., McKeever, P. et al. Chronic pain in hospitalized infants: health professionals' perspectives. J Pain. 2009;10:1217–1225.</p><p>Van Dijk, M., Roofthooft, D.W., Anand, K.J., Guldemond, F., de Graaf, J., Simons, S., de Jager, Y., van Goudoever, J.B., Tibboel, D. Taking up the challenge of measuring prolonged pain in (premature) neonates: The COMFORTneo scale seems promising. Clin. J. Pain 2009, 25, 607–616.</p><p>Van Ganzewinkel, C.J., Anand, K.J., Kramer, B.W., Andriessen, P. Chronic pain in the newborn: Toward a definition. Clin. J. Pain 2014, 30, 970–977.</p>

 

 

 

 

Longer-lasting pain: How to assess in infants and toddlers3644.00000000000Longer-lasting pain: How to assess in infants and toddlersLonger-lasting pain: How to assess in infants and toddersLEnglishPain/AnaesthesiaBaby (1-12 months);Toddler (13-24 months)NANervous systemSymptoms;Conditions and diseasesCaregivers Adult (19+)Pain2019-01-25T05:00:00Z10.300000000000046.4000000000000918.000000000000Health (A-Z) - ConditionsHealth A-Z<p>Infants and toddlers can experience longer-lasting pain from certain conditions and repeated procedures. Find out how to assess longer-lasting pain in infants and toddlers at home and in medical settings.</p><p>In children, teens and adults, chronic (long-term) pain:</p><ul><li>lasts longer than expected (more than three months)</li><li>can be continuous (never goes away) or recurring (comes and goes)</li><li>persists even after regular healing times for injuries and illness have passed</li></ul><p>The definition of chronic pain may not be appropriate for infants, especially those who may be less than three months old but have experienced pain for a large portion of their young lives.</p><p>Experts are still debating an exact definition of chronic pain in infants. Some experts believe that chronic pain (as defined in older children and adults) may not be possible for infants, as they do not experience the nervous system changes we see in older people with chronic pain. As a result, the term "longer-lasting pain" is used for infants instead.</p><h2>How does longer-lasting pain develop in infancy?</h2><p>Most health-care professionals working with hospitalized infants agree that infants can experience:</p><ul><li>long-lasting pain from certain diseases and conditions (such as staphylococcal-scalded skin syndrome)</li><li>continuous pain from repeated invasive medical procedures</li></ul><table class="akh-table"><tbody><tr><td> <strong>The pain from one short painful procedure (acute pain) is different from ongoing pain (from certain diseases and conditions) or repetitive pain from many painful procedures in the hospital.</strong></td></tr></tbody></table><p>Infants in the hospital who have several painful procedures a day (like heel lances, lumbar punctures, arterial line insertions) for many days in a row need more attention than healthy infants who, for instance, have pain from routine vaccinations.</p><p>Generally speaking, infants who have severe, persistent pain are either in hospital or in a highly medically-supported environment at home.</p><h2>Key points</h2><ul><li>Infants can experience longer-lasting pain from certain diseases and conditions, and continuous pain from repeated medical procedures.</li><li>Some infants can be hyper-reactive to pain, for instance crying when held, flailing their arms and legs, and tightly closing their eyes.</li><li>Other infants can be hypo-reactive to pain, for example going limp, not showing interest in caregivers or having a blank face.</li><li>There is no standard tool for assessing chronic pain in infants. Instead, health-care providers assess a child's behaviour and certain vital signs such as heart rate and breathing.</li></ul><h2>Assessing pain at home</h2><p>Because your infant cannot speak yet, they can only tell you if they are in pain – and how much pain – through their behaviour.</p><p>Typically, infants who are suspected to have longer-lasting pain tend to display two patterns of behaviour:</p><ul><li>hyper-reactive (reacting very strongly to painful stimulation)</li><li>hypo-reactive (reacting very little to painful stimulation)</li></ul><h3>Hyper-reactive behaviours</h3><p>Infants who are hyper-reactive tend to:</p><ul><li>cry when handled before the painful procedure</li><li>flail their arms and legs a lot</li><li>lose their breath for a short time</li><li>tightly shut their eyes or have a bulging brow</li><li>stretch their mouth wide open</li></ul><h3>Hypo-reactive behaviours</h3><p>Infants who are hypo-reactive tend to:</p><ul><li>go limp</li><li>offer no reaction to the painful procedure</li><li>show less interest in interacting with caregivers</li><li>have a blank face</li></ul><p>Because of these different responses, it is important to observe changes in your infant's behaviours for clues that they might be experiencing pain.</p><h2>Assessing pain in medical settings</h2><p>When your infant is in the hospital, your child's health-care team uses a range of tools to determine how much pain your child is feeling during an acute painful event (such as a heel lance).</p><p>The most common tools measure typical behaviours of a child in acute pain, such as:</p><ul><li>crying</li><li>facial expressions</li><li>body movements</li></ul><p>They also measure physiological signs (signs inside the body) such as your infant's:</p><ul><li>heart rate</li><li>oxygen saturation (how much oxygen is in their blood)</li><li>breathing rate</li></ul><p>Because there is no widely accepted definition of longer-lasting pain in infants, there is no single standard tool for measuring it. Indeed, physiological signs may not be helpful for assessing longer-lasting pain. However, in the NICU setting, the <a href="https://comfortassessment.com/web/files/4114/2919/4117/COMFORT_Neo_scale___final_version_April_2015.pdf" target="_blank">COMFORTneo scale</a> and the <a href="https://assets.aboutkidshealth.ca/AKHAssets/EDIN%20scale%20to%20assess%20prolonged%20pain%20in%20infants.jpg" target="_blank">EDIN scale</a> both offer promising assessments, as they focus on patterns of behaviour over time, rather than immediate reactions to something painful.</p><h2>Websites</h2><p>Comforting your baby in intensive care (in-depth PDF)<br><a href="http://familynursing.ucsf.edu/sites/familynursing.ucsf.edu/files/wysiwyg/Comfy%20PDF%20ENGLISH%20Dec%2017.pdf" target="_blank">http://familynursing.ucsf.edu/sites/familynursing.ucsf.edu/files/wysiwyg/Comfy%20PDF%20ENGLISH%20Dec%2017.pdf</a></p><h2>Videos</h2><p>It Doesn't Have to Hurt: The Power of a Parent's Touch<br><a href="https://www.youtube.com/watch?v=OlAItP-06hM" target="_blank">https://www.youtube.com/watch?v=OlAItP-06hM</a></p><p>Dr. Marsha Campbell Yeo: What's the power of a parent's touch?<br><a href="https://www.youtube.com/watch?v=XXzkAUV9ICE&t=132s">https://www.youtube.com/watch?v=XXzkAUV9ICE&t=132s</a></p><p>Reduce your infant's pain during newborn blood tests<br><a href="https://www.youtube.com/watch?v=L43y0H6XEH4&list=PLlZczt8t4Ac8cW3pbuRKJAEs3SoC5y8MB" target="_blank">https://www.youtube.com/watch?v=L43y0H6XEH4&list=PLlZczt8t4Ac8cW3pbuRKJAEs3SoC5y8MB</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, Danielle Ruskin, PhD, CPsych, Bonnie Stevens, RN, PhD, FAAN, FCAHS<br> Hospital for Sick Children</p><h3>References</h3><p>Debillion, T., Zupan, V., Ravault, N., Magny, J.F., Dehan, M. Development and initial validation of the EDIN scale, a new tool for assessing prolonged pain in preterm infants. Arch. Dis Child. Fetal 2001, 85, F36–F41.</p><p>DiLorenzo, M., Pillai Riddell, R., & Holsti, L. (2016). Beyond acute pain: understanding chronic pain in infancy. Children, 3(4), 26.</p><p>Pillai Riddell, R.R., Stevens, B.J., McKeever, P. et al. Chronic pain in hospitalized infants: health professionals' perspectives. J Pain. 2009;10:1217–1225.</p><p>Van Dijk, M., Roofthooft, D.W., Anand, K.J., Guldemond, F., de Graaf, J., Simons, S., de Jager, Y., van Goudoever, J.B., Tibboel, D. Taking up the challenge of measuring prolonged pain in (premature) neonates: The COMFORTneo scale seems promising. Clin. J. Pain 2009, 25, 607–616.</p><p>Van Ganzewinkel, C.J., Anand, K.J., Kramer, B.W., Andriessen, P. Chronic pain in the newborn: Toward a definition. Clin. J. Pain 2014, 30, 970–977.</p>https://assets.aboutkidshealth.ca/AKHAssets/Lung_problems_babies.jpgLonger-lasting pain: How to assess in infants and toddlersFalse