The concept of Comfort: Pain in pediatric patients.

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By: Zacilah Rodriguez

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Pathophysiology and etiology of pain
 Pain is triggered by the peripheral nervous system. Sensory
receptors or nociceptors respond to pain and send a signal
along sensory neurons to the spinal cord where the signal is
transmitted to the brain for interpretation. The brain then sends a
signal back to the site of pain via motor neurons, causing the
body to respond to the painful stimuli.

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Assessment of
pain
 Wong-Baker FACES
Scale
 Behavioral scales
 Neonatal infant pain
scale
 FLACC

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Physiological
considerations
for Children in
Pain.
 Children may not be able to accurately describe their pain although, children as
young as 3 years old can give a basic description of location and intensity of pain.
 Children normally have a higher pulse and respiratory rate, as well as a lower bp in
comparison to adults therefore, sympathetic response to pain may be difficult to
assess in children.
 Changes in vital signs may not be a valid indicator of pain.
 Children tend to experience pain more intensely at the beginning of the painful
episode, but the intensity decreases quickly.
 Children do not understand the purpose of pain so this brings anxiety and stress.
 They also do not understand the means of pain relief that they are able to request.

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Children and
behavioral
responses to
pain.
The most common
responses to pain are
crying and grimacing.
Behavior that is out of
the ordinary may
indicate pain.
As the child ages
their behavioral
response may
become more
controlled.
Infants may cry
inconsolably when
experiencing pain.
School children may
exhibit restrained
crying or whimpering.
Adolescents may not
cry at all and are less
likely to admit
needing comfort.

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Newborn/Infants
Response
 Body rigidity or thrashing
 Facial expression of pain
 Cries inconsolably
 Exhibits hypersensitivity or
irritability
 Poor oral intake
 Lethargy
 Inability to sleep.
Nursing Interventions
 Offer pacifier
 Allow parents to hold the infant
 Offer distractions such as music or
a small toy.

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Toddlers
Response
 May explain pain through basic
words or gestures.
 May be verbally aggressive.
 May cry intensely.
 Exhibits physical resistance by
pushing away painful stimulus.
 Guards painful area of body.
 May see pain as punishment.
 May request emotional support from
parent.
Nursing Interventions
 Offer distractions such as toys,
books, or treats.
 Allow parent to hold the child.
 Teach the child what to expect when
encountering a painful procedure.
 Encourage parent to be calm, as
children can sense a parent’s
anxiety.

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School age child
Response
 Should be able to accurately
describe their pain.
 Attempts to be brave in
response to pain.
 May stall/postpone painful
procedures.
 May revert to earlier
development stage with
persistent or severe pain.
Nursing Interventions
 Simulate/act out the procedure
beforehand.
 Encourage a parent to be
present to provide support.
 Give the child a book to read or
an activity to do.
 Encourage cultural practices
such as prayer.

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Adolescent
Response
 May deny pain in the
presence of peers.
 Exhibits changes in sleep
patterns or appetite.
 May regress to earlier
developmental stage in the
presence of a trusted adult.
Nursing Interventions
 Discuss the clients
misconceptions about pain.
 Address the clients
symptoms of fear and anxiety.
 Focus on providing adequate
pain control based on the
client’s description of pain
intensity.

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Diagnosis
 Impaired Physical Mobility
 Fatigue
 Activity Intolerance
 Deficient knowledge
 Anxiety
 Disturbed Sleep Pattern
 Fear

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Planning
 Client will report a 50%
reduction in pain.
 Client will obtain adequate
pain relief to allow for
mobility or normal activity.

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Interventions
 Apply ordered topical anesthetics
 Pacifier with or without Sucrose
 Emotional comfort
 Pharmacologic therapy.
 Heat/ice
 Movement restriction
 Distraction
 Family support

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Evaluation
 The nurse should evaluate
behavioral signs of continued
pain.
 Evaluate the effectiveness of
pain control measures by
asking clients if they have
experienced relief and if so, to
what degree.
 Inadequate pain treatment may
lead to physiological
consequences such as
decreased growth and
development, decreased
immune function, lack of
appetite, hypertension, and
increased sensitivity to future
pain.

15. z References
Fein, J. A., Zempsky, W. T., & Cravero, J. P. (2012, November 01).
Relief of Pain and Anxiety in Pediatric Patients in Emergency Medical
Systems. Retrieved February 18, 2018, from
http://pediatrics.aappublications.org/content/130/5/e1391
The concept of comfort. (2015) In K. Trakalo, L. Horowitz, & A.
McCulloch (Eds.) . Nursing: A concept based approach to learning.
(Vol.1, pp. 153-173). Boston, MA: Pearson Education, Inc.