Advances in Human Biology

: 2021  |  Volume : 11  |  Issue : 3  |  Page : 285--287

Scales for assessment of pain in infants, neonates and children

Shibu Sasidharan1, Gurpreet Kaur Dhillon2, Harpreet Singh Dhillon3, Babitha Manalikuzhiyil4,  
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

Correspondence Address:
Shibu Sasidharan
Department of Anaesthesia and Critical Care, Level III IFH Hospital, Goma
Democratic Republic of the Congo

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;11:285-287

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 ];11:285-287
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Full Text

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

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

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}

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]


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