Blank Children’s Hospital

Des Moines, Iowa

Pediatric Pain Management

PURPOSE:

To provide standardized documented assessments of pain in infants and children utilizing developmentally appropriate tools which are proactive, multidisciplinary and collaborative.

To integrate the child/family’s personal, cultural, spiritual and or ethical beliefs into the pain management plan.

To provide documentation of child/family explanation and education of pain management, including assessment, interventions, and expected outcomes.

POLICY:
  1. Pain assessment is one component of the initial nursing assessment and is considered the fifth vital sign. Pain assessment is ongoing, occurring with vital signs, or each new report or indication of pain. Reassessment will occur 30-60 minutes after any pain intervention. Interventions for pain will continue until the child/family indicate acceptable pain and this is congruent with the assessment.
  2. Pain assessment will include: location, intensity, frequency, triggers, character/quality, duration, effect, history and past therapies.
  3. Specific pain assessment tools will be based on the child’s age and developmental level. The tools utilized will be: PIPP, CRIES, Objective Pain Scale, Comfort Scale, Wong/Baker Face Rating Scale and/or Numeric Scale.
  4. Non-pharmacologic pain management may include:
    1. Comfort positioning
    2. Distraction
    3. Breathing and relaxation
    4. Splinting as needed
    5. Environmental adjustments – ice, warm blankets, noise and light reduction
  1. Pharmacological pain intervention may include:

a. NSAIDS
b. Analgesics
  1. c. Opioids
  2. d. Local anesthetics

IM route of medication is discouraged when alternate routes available.
  1. Special considerations are necessary for patients experiencing:

a. Head injury with loss of consciousness
    1. Decrease level of consciousness
    2. Potential need for surgery
  1. Intervention for pain will be provided within10 minutes of the initial pain scale assessment.
  2. Pain intervention should be given for all medical situations that produce pain or have the potential to produce pain.
  3. Pain medication should be administered on a regularly scheduled basis rather than PRN when pain is continuous or predictable.

PROCEDURE:

 1. Choose the appropriate pain assessment tool based on child’s age. See resource manual for tools utilized within Blank Children’s Hospital.

Assess pain on initial assessment and with each set of vital signs.

Initiate pain intervention within ten minutes of assessment. Pain interventions utilized should be suitable for patient condition/ circumstances.

Reassess pain level 30-60 minutes after pain intervention.

If pain is not at a level acceptable to the child/parent, continue with further interventions until pain level is deemed appropriate.

Document type of tool used, interventions utilized, parent education, and patient response.

REFERENCES:

McCaffery, M. & Pasero, C. (1999). Pain Clinical Manual (Second Edition). St. Louis: Mosby.

National Association of Neonatal Nurses (1999). Pain Management in Infants, Position Statement. Author: Des Plaines, Illinois.