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 Table of Contents  
Year : 2021  |  Volume : 11  |  Issue : 3  |  Page : 285-287

Scales for assessment of pain in infants, neonates and children

1 Department of Anaesthesia and Critical Care, IFH Hospital, Goma, Democratic Republic of the Congo
2 Department of Paediatrics, Military Hospital Jammu, Jammu and Kashmir, India
3 Department of Psychiatry, Level III IFH Hospital, Goma, Democratic Republic of the Congo
4 Department of Radiodiagnosis and Imaging, Alchemist Ojas Hospital, Panchkula, Haryana, India

Date of Submission18-Jul-2021
Date of Decision21-Jul-2021
Date of Acceptance23-Jul-2021
Date of Web Publication04-Sep-2021

Correspondence Address:
Shibu Sasidharan
Department of Anaesthesia and Critical Care, Level III IFH Hospital, Goma
Democratic Republic of the Congo
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/aihb.aihb_109_21

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How to cite this article:
Sasidharan S, Dhillon GK, Dhillon HS, Manalikuzhiyil B. Scales for assessment of pain in infants, neonates and children. Adv Hum Biol 2021;11:285-7

How to cite this URL:
Sasidharan S, Dhillon GK, Dhillon HS, Manalikuzhiyil B. Scales for assessment of pain in infants, neonates and children. Adv Hum Biol [serial online] 2021 [cited 2021 Dec 7];11:285-7. Available from: https://www.aihbonline.com/text.asp?2021/11/3/285/325572

It is a humanitarian and ethical imperative for doctors to provide pain relief to a patient in pain. In clinical practice, pain is considered the 5th vital sign.[1] Assessment of pain is the cornerstone for effective pain management. Some studies have reported that doctors and nurses underestimated the pain intensity of their patients.[2] Another study found that the pain intensity scores between doctors and nurses had a weak correlation.[3] A French study stated that there are systematic differences in the assessment of the intensity of pain between patients themselves and physicians.[4] In Germany, a study revealed that half the postoperative patients who were operated on were not asked about their pain status in the first 24 h post-operative period.[5]

Pain is an unpleasant, subjective, sensory and emotional experience originating from actual or potential tissue damage. The objective assessment of pain is difficult in the adult population and more so in the paediatric population. However, as per recommendations regarding the treatment of pain, it must be precisely detected, located, quantified and reevaluated; categorised into acute or chronic along with an attempt to determine underlying pathophysiology.[6]

The assessment of pain in children is challenging as it depends on age and cognitive development. The gold standard for children older than 06 years of age is self-reported pain scales (provided normal cognitive development), while behavioural pain scales are used for younger children (<06 years).[7] The different types of pain scales are validated as per specific context depending on the types of pain; acute, prolonged or chronic. New-borns have anatomic and physiologic substrates to perceive painful stimuli. However, they cannot verbalise it, which shifts the onus of the clinicians to decipher the same. The correlates of pain in newborns and younger children are mainly nonverbal facial expressions and physiological variables (Facial expression, crying, controllability, eye squeeze, body movements, withdrawal movements, tachycardia, tachypnoea, reduced oxygen saturation, intermittent moans, interrupted sleep and state of arousal) [Table 1].
Table 1: Pain assessment scales for new-borns and infants

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  Pain Assessment Scales for New-Borns and Infants Top

The methods used for the assessment of painful events can be divided into three categories: measurement of physiological responses of pain, observations of behaviors related to pain, and verbal or written descriptions of pain and/or associated variables. There are measures of pain intensity (one-dimensional) and measures of multiple dimensions of pain (multidimensional). The one-dimensional tools are designed to measure the presence or absence of pain and have been frequently used in hospitals and/or clinics to obtain fast, noninvasive, valid information on pain and analgesia. As for the multidimensional tools, they are used to assess sensory, affective and evaluative components that are reflected in the language used to describe the painful experience.

  Pain Assessment Scales for Children Top

The standard self-assessment scales are reliable after age 6 years after attaining appropriate cognitive and language skills because they require. However, between 4 and 6 years, children can locate and verbalise the painful site. The various scales available are the Visual analogue scale, Numerical rating scale, verbal rating scale, face pain scale [Table 2]. All these scales require optimal communication skills, in the absence of which behaviour scales are utilised.
Table 2: Behavior scales for children (>4 years of age)

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The above tables will serve as a quick reference for practising paediatricians, anesthesiologists and pain physicians to objectively quantify pain.

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Conflicts of interest

There are no conflicts of interest.[19]

  References Top

Morone NE, Weiner DK. Pain as the fifth vital sign: Exposing the vital need for pain education. Clin Ther 2013;35:1728-32.  Back to cited text no. 1
McCaffery M, Ferrell BR. Nurses' assessment of pain intensity and choice of analgesic dose. Contemp Nurse 1994;3:68-74.  Back to cited text no. 2
Drayer RA, Henderson J, Reidenberg M. Barriers to better pain control in hospitalized patients. J Pain Symptom Manage 1999;17:434-40.  Back to cited text no. 3
Chibnall JT, Tait RC. Comment on Marquie L. et al. Pain rating by patients and physicians: Evidence of systematic pain miscalibration (Pain 2003;102:289-96). Pain 2004;107:193.  Back to cited text no. 4
McCracken LM, Gross RT, Eccleston C. Multimethod assessment of treatment process in chronic low back pain: Comparison of reported pain-related anxiety with directly measured physical capacity. Behav Res Ther 2002;40:585-94.  Back to cited text no. 5
American Academy of Pediatrics. Committee on Psychosocial Aspects of Child and Family Health; Task Force on Pain in Infants, Children, and Adolescents. The assessment and management of acute pain in infants, children, and adolescents. Pediatrics 2001;108:793-7.  Back to cited text no. 6
Sasidharan S, Sharma A, Lahareesh BL, Singh V, Babitha M, Dhillon H, et al. Venturing into the unknown − Managing rare syndromes. Alexandria J Pediatr 2021;34:96.  Back to cited text no. 7
Beltramini A, Milojevic K, Pateron D. Pain assessment in new-borns, infants, and children. Pediatr Ann 2017;46:e387-95.  Back to cited text no. 8
Hudson-Barr D, Capper-Michel B, Lambert S, Palermo TM, Morbeto K, Lombardo S. Validation of the Pain Assessment in Neonates (PAIN) Scale with the Neonatal Infant Pain Scale (NIPS). Neonatal Netw 2002;21:15-21.  Back to cited text no. 9
Zabalia M, Jacquet D. Effet du contexte sur la conception de la douleur chez l'enfant. Douleurs Eval Diagnostic Trait 2004;5:203-7.  Back to cited text no. 10
Grunau RE, Oberlander T, Holsti L, Whitfield MF. Bedside application of the neonatal facial coding system in pain assessment of premature neonates. Pain 1998;76:277-86.  Back to cited text no. 11
Stevens BJ, Gibbins S, Yamada J, Dionne K, Lee G, Johnston C, et al. The premature infant pain profile-revised (PIPP-R): Initial validation and feasibility. Clin J Pain 2014;30:238-43.  Back to cited text no. 12
Krechel SW, Bildner J. CRIES: A new neonatal postoperative pain measurement score. Initial testing of validity and reliability. Paediatr Anaesth 1995;5:53-61.  Back to cited text no. 13
Children and Infants Postoperative Pain Scale. Available from: https://scholar.google.com/scholar?hl=en and as_sdt=0%2C5 and q=Children+and+Infants+Postoperative+Pain+Scale+and btnG=. [Last accessed on 2021 Jul 18].  Back to cited text no. 14
Freund D, Bolick BN. CE: Assessing a child's pain. Am J Nurs 2019;119:34-41.  Back to cited text no. 15
Breau LM, McGrath PJ, Camfield CS, Finley GA. Psychometric properties of the non-communicating children's pain checklist-revised. Pain 2002;99:349-57.  Back to cited text no. 16
von Baeyer CL, Chambers CT, Eakins DM. Development of a 10-item short form of the parents' postoperative pain measure: The PPPM-SF. Pain 2011;12:401-6.  Back to cited text no. 17
Voepel-Lewis T, Zanotti J, Dammeyer JA, Merkel S. Reliability and validity of the face, legs, activity, cry, consolability behavioral tool in assessing acute pain in critically ill patients. Am J Crit Care 2010;19:55-61.  Back to cited text no. 18
Shamim F, Ullah H, Khan FA. Postoperative pain assessment using four behavioral scales in Pakistani children undergoing elective surgery. Saudi J Anaesth 2015;9:174-8.  Back to cited text no. 19


  [Table 1], [Table 2]


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