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Clinical Hub,Patient Education,Health and Nutrition Facts For You,Pain

Using Pediatric Pain Scales (7590)

Using Pediatric Pain Scales (7590) - Clinical Hub, Patient Education, Health and Nutrition Facts For You, Pain

7590

Using Pediatric Pain Scales

We care about your child’s comfort. You
are an important member of your child’s
healthcare team. You know your child best.
We want to partner with you to help control
your child’s pain. If you have questions or
concerns, please speak up and let your
child’s nurse know. While we may not be
able to make your child pain free, this is
what we can do.
ξ Assess your child’s pain. This is the
first step to understand and treat
pain. We use pain scales based on
the child’s age, ability to
communicate and preference. We
work with you and your child to
decide which one works best. The
pain scale you choose is used the
whole time your child is in the
hospital unless your child’s condition
changes.
ξ Work with you and your child to
come up with a goal for pain control.
ξ Learn what has worked before to
control your child’s pain and put that
information in your child’s plan of
care.
ξ Use medicine and non-drug methods
to control your child’s pain.
ξ Teach you about other methods you
and your child can use to control
your child’s pain.

Often a combination of medicine and
comfort methods will give the best pain
relief.
If you think medicine is needed, please let
your child’s nurse know. In the hospital a
physician must order pain medicine before a
nurse can give it to a patient. Your child’s
nurse works with you to decide what is
needed. In clinic your child’s doctor or nurse
talks with you about pain medicine plan.

You can start using some simple methods if
your child seems uncomfortable or in pain.
These methods are often able to provide
comfort and distraction that may decrease
your child’s pain. At the hospital we have
options to provide pain control without
medicine. The nurse, nursing assistant or
child life specialist can work with you to
choose the best tools for your child. They
can also give you tips about how to use the
tools that are chosen. We also have another
Health Fact for You titled Non-drug Pain
Control for Kids that gives tips based on
your child’s age. These methods can be
used with or without medicine. Pain control
research teaches us that the best pain control
happens when we combine medicines that
work in different ways, and non-drug
methods of pain control. We suggest you try
these non-drug methods with your child
when you feel they may be helpful.

At UW Health we use a few different pain
scales. We will work with you and your
child to decide which pain scale works best.
Usually, the pain scale you choose is used
the whole time your child is in the hospital.
Sometimes, if a child’s condition changes,
the pain scale used may change. For
example, if a child is admitted to the
Pediatric Intensive Care Unit and is sedated
with medicines, a different scale is used than
when that child is transferred to one of the
other units and is able to report pain.
On the next few pages are descriptions of
the pain scales and when they are used.

Neonatal Infant Pain Scale (NIPS)
At the American Family Children’s Hospital
(AFCH) the NIPS is used in children less
than one year of age. Children at this age are
not able to tell us if they are in pain. This
scale uses body language to help us to
understand if a child is in pain. A child is

evaluated and either scored a 0 or 1 in each
category based on their behavior. A total
score is calculated. Most of the time a score
greater than 3 tells us a child is likely to be
experiencing pain or discomfort. If you
notice this, you could try some of the
comfort methods listed below.
ξ Repositioning
ξ Singing or soft music
ξ Gentle stroking
ξ Rocking with the child in a rocking
chair
ξ Swaddling
ξ Holding a comfort item or blanket

Neonatal/Infant Pain Scale (NIPS)
(Recommended for children less than 1 year old) A score greater than 3 indicates pain.


Faces Legs Activity Cry Consolability
Revised Scale (FLACC-R)

The FLACC-R Scale is used for children
older than one year that cannot report their
pain. Research suggests to us that the most
accurate report of pain is from the person in
pain. But children often are not able to
report their pain. Sometimes they cannot
report their pain because they are too young
to speak or understand what is being asked.
Some children may never really understand
how to report their pain. We use the
(FLACC-R) to help us to decide if children
are having pain when they cannot tell us.
This scale has been researched and shown to
be helpful for children with developmental
delays.

A child is evaluated and either scored a 0, 1
or 2 in each category based on their
behavior. A total score is calculated. This
scale helps us to know if it is likely the child
is experiencing pain or discomfort. Often
methods to reduce pain are started when a
score of 3 or greater is identified.

If you notice other behaviors that tell you
your child is in pain, please share this
information with your child’s nurse.

If you think your child is in pain, you could
try some comfort methods listed below.

ξ Repositioning
ξ Singing or soft music
ξ Gentle stroking
ξ Rocking with your child in a rocking
chair
ξ Watching a movie
ξ Reading a book
ξ Other methods you use at home to
comfort your child








Faces Legs Activity Cry Consolability Revised Scale (FLACC-R)












Faces Pain Scale Revised (FPS-R)
We know these faces may look odd and
even scary to you. We offer you the option
to use this pain scale because it has been
studied and used in many cultures and is
found to work well.

We use this scale by telling children "These
faces show how much something can hurt.
This face [point to left-most face] shows no
pain. The faces show more and more pain
[point to each from left to right] up to this
one [point to right-most face] - it shows
very much pain. Point to the face that shows
how much you hurt [right now]." It is
important not to include a number with
talking about these faces as that can cause
confusion. These faces are used with
children who do not yet understand what the
number would represent. If they can use a
number scale appropriately, that is the scale
they should be using. Typically this scale is
used with children ages 4-8 years old. It can
be used in older children if the number scale
does not adequately describe their pain or
they have difficulty choosing a number to
represent the amount of pain they are
experiencing.

If you think your child is in pain, you could
help by using some of the non-drug methods
of pain control listed below.
ξ Repositioning
ξ Singing or soft music
ξ Gentle stroking
ξ Rocking with your child in a rocking
chair
ξ Watching a movie
ξ Reading a book
ξ Other methods you use at home to
comfort your child











Numeric Rating Scale (NRS) 0-10


The NRS is normally used for children over
eight years old. A child is asked to rate their
pain from no pain to the worst possible pain.
Sometimes a lot of ideas go into choosing
that number: fear, concern that someone will
cause more pain, belief that no one believes
them, stress of being in the hospital and
being away from loved ones. If, at any age,
you think your child cannot use this scale, it
is ok to use the Pain Faces Scale Revised.
Please talk to your child’s nurse if a pain
scale is not working so a change can be
made. The pain scale is just a tool to help us
talk with you and your child about your
child’s pain
If you think your child is in pain, you could
help by using some of the non-drug methods
of pain control listed below.
ξ Repositioning
ξ Singing or soft music
ξ Gentle stroking
ξ Rocking with your child in a rocking
chair
ξ Watching a movie
ξ Reading a book
ξ Other techniques you use at home to
comfort your child










Your health care team may have given you this information as part of your care. If so, please use it and call if you have any
questions. If this information was not given to you as part of your care, please check with your doctor. This is not medical
advice. This is not to be used for diagnosis or treatment of any medical condition. Because each person’s health needs are
different, you should talk with your doctor or others on your health care team when using this information. If you have an
emergency, please call 911. Copyright ©11/2017 University of Wisconsin Hospitals and Clinics Authority. All rights reserved.
Produced by the Department of Nursing HF#7590.