This document provides guidance on assessing pain in pediatric patients from birth through adolescence. It notes that neonates as young as 24 weeks feel pain and their nervous systems may experience greater pain intensity initially. It recommends using age-appropriate pain assessment tools such as the Neonatal Pain Scale for infants, CHEOPS scale for ages 1-7, visual analog scale for ages 2-4, numeric rating scale for ages 7-11, and same methods as adults for adolescents 11+. Non-verbal children can be assessed using the FLACC scale. Hospitals should standardize pain scales for consistency across age groups.

1. PEDIATRIC PAIN ASSESSMENT

2. PAIN ASSESSMENT
Get detailed assessment
History of primary illness
Description of pain
Experience with pain medications
Use of non-pharmacologic approaches
Parent personal experience with pain meds
Social & spiritual factors

3. PAIN ASSESSMENT TOOLS:
SCALES DO NOT ALWAYS REPRESENT MULTIDIMENSIONAL ASPECT OF
PAIN

4. BIRTH - 2 YEARS
Pain Perception
Neonates as young as 24-
weeks feel pain
Ascending nerve tracts
develop earlier than the pain
inhibiting nerve tracts meaning
that neonates may experience
a greater intensity of pain than
older children
Neonates exposed to repeated
painful stimuli show increasing
sensitivity
Neonatal/Infant Pain Scale
(NIPS)

5. BIRTH - 2 YEARS (CONTINUED)
Cognition
No “understanding” of pain and unable to provide a
self-report
12 to 18 months, beginning of reasoning and
language (1- or 2-word statements)
Major cognitive processing through senses (eyes,
ears, hands)
CHEOPS (1-7 years)
Looks at types of pain behavior: cry, facial, verbal,
torso, touch and legs.

6. 2 - 4 YEARS
CNS fully developed
Development of
autonomy continues
Significant language
development
Limited logic and
reasoning
Self-centered thought
process
Visual analog (Wong-
Baker Faces)

7. 7 - 11 YEARS
Logic and reasoning
far more developed
Imagination and
creativity
Finalism and concept
of death
Number pain scale
(scale 1-10)

8. Adolescents (11+ years)
Cognitively adults
Same pain assessment methods as adults
Abstract thinking and understanding hypothetical
situations
Emotional needs
Include them in the process
Respect their privacy
Respect their pain reports

9. FACES SCALE
Bieri, 1990

10. NON-VERBAL CHILDREN
FLACC Scale

11. Pain Assessment
Hospitals should use a standard pain scale for the
various age groups to allow continuity.
Self report scores (e.g. numerical rating scale) can
mislead. A score of 4 may denote severe pain to
one adolescent while 8 may be severe to another.
Pain can be worsened by anxiety, depression and
spiritual crisis. We must consider this in our
assessment.

12. References
Bieri D, Reeve RA, Champion GD, Addicoat L, Ziegler JB. The
Faces Pain Scale for the self-assessment of the severity of
pain experienced by children: development, initial validation,
and preliminary investigation for ratio scale properties. Pain.
1990; 41(2):139-50.
Friedrichsdorf SJ, Kang TI. The management of pain in
children with life-limiting illnesses. Pediatric clinics of North
America. 2007; 54: 645-672.
Tomlinson D, Baeyer CL, Stinson JN, Sung L.A systematic
review of Faces scales for the self-report of pain intensity in
children. Pediatrics. 2010; 126: e1168.