Assessing toddlers and preschoolers (age one to four)

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Learn about how pain is assessed in toddlers and preschoolers. At this age, children can usually indicate the amount, type, and location of pain.

Toddlers are capable of expressing the intensity of their pain. Even children who cannot yet speak or who have limited speech can usually indicate the amount, type, and location of the pain. If possible, a child should be asked about and encouraged to express their pain using words they understand, such as "boo-boo," "owie," and "hurt." Getting and interpreting a useful response may take patience and skill, since children may not relate to a stranger in the hospital environment.

Children of this age are developing a sense of self and are able to have memories of painful incidents. This may heighten the child’s sense of fear and anxiety. The sight of blood, for example, even coming from a minor injury, may be quite alarming to a child and this emotional state will influence their reaction to the pain.

At the same time, this increased understanding of themselves and their surroundings provides an opportunity for helping children cope with pain that is not possible with infants. Parents should acknowledge the child’s pain and explain what is happening. For a child in pain, knowledge and understanding increases their sense of control. This can help them effectively cope with pain. Explaining to a child what is going on and why will also help prevent the child from forming negative beliefs about pain and its causes. Children of this age may believe that pain is a form of punishment for something bad they have done. Additionally, children of this age often engage in "magical thinking," which may lead to negative beliefs about pain.

Behavioural clues indicating pain

As with younger children, toddlers and preschoolers may guard, protect, or tug on a limb or other area of the body to indicate pain. For example, young children are often seen tugging on their ear if they have an ear infection or earache. Parents should also watch for other unusual changes in behaviour, such as negative reactions to normally enjoyable activities or refusing a favourite toy or food.

Last updated: September 15th 2009