Taking into account the information above how would you assess pain in children of the following ages:

• Baby aged 6 months

Answer: use behavioural pain assessment scales validated for a child of this age, taking account of the type of pain (procedural, post-operative or disease-related pain) and the setting in which the child is being cared in (e.g. hospital, community etc.)

• Child aged 6 years

Answer: if possible use a self-report tool with the child.  If this is not possible use a behavioural pain assessment scale validated for a child of this age, taking account of the type of pain (procedural, post-operative or disease-related pain) and the setting in which the child is being cared in (e.g. hospital, community etc.)

• Adolescent aged 14 years

Answer: if possible use a self-report tool with the young person.  If not possible use a behavioural pain assessment scale validated for this age group, taking account of the type of pain (procedural, post-operative or disease-related pain) and the setting in which the child is being cared in (e.g. hospital, community etc.)

Jenny is 9 years old and has been admitted via Accident and Emergency to the ward with a facial laceration.  Angela is a newly qualified staff nurse and has been asked to assess Jenny’s current level of pain before analgesia is prescribed.  Angela accesses the online pain assessment form and finds herself presented with a bewildering array of self-report and behavioural pain assessment tools.  

Access the full RCN guideline at: 

www.rcn.org.uk/professional-development/publications/pub-003542

Answer: Although initially unsure about how to choose the correct tool she remembers that the Royal College of Nursing (RCN) (2009) clinical practice guideline on the recognition and assessment of acute pain in children, and uses this to swiftly identify the tool she needs, based on Jenny’s age, the setting where Jenny’s assessment is taking place and whether Jenny can self-report her pain. 

Taking into account the information above how would you plan the postoperative pain management for children of the following ages?

•  Baby aged 2 weeks

Answer: assess the child’s pain and ascertain if it is mild, moderate or severe.  Use age appropriate pharmacological and non-pharmacological interventions, taking account of the child’s underlying clinical condition and past medical history.  Evaluate the efficacy of the interventions employed by re-assessing the patient at an appropriate time interval.  Document all interventions employed and their efficacy.

• Child aged 7 years

Answer: assess the child’s pain and ascertain if it is mild, moderate or severe.  Use age appropriate pharmacological and non-pharmacological interventions, taking account of the child’s underlying clinical condition and past medical history.  Evaluate the efficacy of the interventions employed by re-assessing the patient at an appropriate time interval.  Document all interventions employed and their efficacy.

Karen has brought her 1-year-old child George to the community health centre for his vaccinations.  George has been very distressed during previous vaccinations and Karen is very anxious to know what can be done to limit any pain and anxiety George may experience. 

Access the full APA guidelines at:  http://onlinelibrary.wiley.com/doi/10.1111/j.1460-9592.2012.03838.x/epdf

Taking into account the information above how would you plan the procedural pain management for children of the following ages?

Baby aged 2 weeks

Child aged 8 years

Adolescent aged 13 years

Answer: Health visitor Paul has already consulted the APA (2012) guidelines on the management of medical procedures in children (section 4) and is aware of high level of evidence supporting the use of non-pharmacological strategies for managing vaccination pain.  He has also considered their guidance on procedure modification such as use of combined vaccine formulations, order of vaccines (least painful first), needle size and depth of injection. 

• Baby aged 2 weeks

Answer: Discuss the likely intensity of the pain with the health professional undertaking the procedure and choose the most appropriate pharmacological and non-pharmacological interventions for the patient, taking account of the child’s underlying clinical condition and past medical history.  Evaluate the efficacy of the interventions throughout the procedure using an age appropriate assessment tool that is validated for use in measuring pain intensity during procedures.  Be ready to suspend the procedure and re-evaluate the intervention if pain is not effectively managed.  Document the interventions used and their efficacy at the end of the procedure.

• Child aged 8 years

Answer: Discuss the likely intensity of the pain with the health professional undertaking the procedure and choose the most appropriate pharmacological and non-pharmacological interventions for the patient, taking account of the child’s underlying clinical condition and past medical history.  If appropriate discuss and agree the plan with the child and/or their family prior to the start of the procedure. Evaluate the efficacy of the interventions throughout the procedure using an age appropriate assessment tool that is validated for use in measuring pain intensity during procedures.  Be ready to suspend the procedure and re-evaluate the intervention if pain is not effectively managed.  Document the interventions used and their efficacy at the end of the procedure.

• Adolescent aged 13 years

Answer: Discuss the likely intensity of the pain with the health professional undertaking the procedure and choose the most appropriate pharmacological and non-pharmacological interventions for the patient, taking account of the child’s underlying clinical condition and past medical history.  Discuss and agree the plan with the young person and/or their family prior to the start of the procedure. Evaluate the efficacy of the interventions throughout the procedure using an age appropriate assessment tool that is validated for use in measuring pain intensity during procedures.  Be ready to suspend the procedure and re-evaluate the intervention if pain is not effectively managed.  Document the interventions used and their efficacy at the end of the procedure.