Principles & Practice of Pain Medicine > Part V. Pain Syndromes > E. Pediatric and Geriatric Pain > Chapter 53. Acute Pain Management in Infants and Children Christine D. Greco, Moris M. Aner, and Alyssa LeBel

Pain Assessment in Infants and Children

"Pain assessment is a fundamental and essential part of pain treatment. The ability to reliably assess pain facilitates the diagnosis of painful conditions and helps to evaluate efficacy of pain relief methods. The assessment of pain in infants and children, however, is one of the most difficult challenges faced by health care providers. The subjective nature of pain, cognitive and language limitations, and differences in pain expression and perception account for the difficulty in assessing pain in pediatric patients. As discussed earlier, there is growing evidence to suggest that inadequately treated pain can have both short-term and long-term consequences. For example, it is well established that full-term and preterm infants develop physiologic stress responses to pain and inadequate anesthesia that can result in greater postoperative complications.^1,15,16 Pain is most commonly assessed by asking patients about the quality, location, and severity of their pain. Self-report methods are considered to be the most reliable guides to pain assessment for most patients. However, infants and preverbal children are unable to communicate their experience of pain and must rely on caregivers to interpret signs of pain and distress. Pain assessment methods that combine self-report with other measures, such as behavioral and physiologic responses, may provide more accurate measures of pain. There can be limitations in the use of behavioral and physiologic indices for pain assessment. Distinguishing between pain and distress may be difficult in young children...."