Pain Assessment in Infants & Children
Starting at about 18 months of age, children have acquired words for pain, and 3- or 4-year-old children may be able to report pain, indicate its location, and describe its characteristics. If self-report is possible, it is the preferred strategy for information-gathering about pain. Progress has been made in creating and validating self-report scales and in understanding the developmental and socioenvironmental influences on pain report, but research in this area is needed.10 Self-report pain scales developed for young children include the Poker Chip Scale, Wong-Baker Faces Scale and the Oucher Scale.11-13 The Oucher Scale (www.oucher.org) which is available in different ethnic versions, permits children to rate their pain intensity by matching it to photographs of other children's faces depicting increasing levels of pain. The Poker Chip Scale asks children to quantify their pain in "pieces of hurt," with more poker chips representing more pain. Body outlines allow young children to point to the location of their pain. As school age children learn the proportionality of numbers and colors, they can generally use the same scales as adults (i.e.,Visual Analog Scale, Numeric Rating Scale) without difficulty.
Interpreting pain scales can be difficult in young children since their ratings are based on prior experiences of pain. Thus, when young children use the upper end of a scale to rate their pain, they are indicating its severity relative to their prior pain experience.14 For young children, an injury or procedure might be the strongest pain they have experienced whereas older children and adults may rate the same injury as less painful, because they have experienced a more diverse array of pain.
Several questionnaires have been developed for children with chronic or persistent pain. These include, among others, the Varni-Thompson Pediatric Pain Questionnaire, and the Children’s Comprehensive Pain Questionnaire.15,16