💊 Pain in Children Cram
Chapter 36 · highest-yield points
1The foundation
Pain is subjective + individualized
ALL ages feel pain — even preemies
Babies can't report it — read behavior + body signs. Untreated pain harms physically, emotionally, developmentally. Cycle: assess → intervene → reassess.
2Five pain types
Acute: sudden, resolves with healing
Chronic: persistent or recurrent
Nociceptive: tissue injury/inflammation
Neuropathic: nerve injury/dysfunction
Procedural: caused by care (IV start, spinal tap)
Examples: fracture = acute · appendicitis = nociceptive · nerve injury = neuropathic · recurrent headache = chronic.
3Pain signs — babies + little kids
Neonate: grimace · high-pitched cry · stiffening
Toddler: screaming · kicking · clinging · regression
Neonates also change heart rate, breathing rate, oxygen saturation + poor feeding/sleep. Judge behavior + body signs together. Preschoolers may hide or go quiet — silence ≠ comfort.
4Pain in older kids + teens
School-age: can describe location + intensity
Teens: detailed self-report — but may minimize
School-age kids may act brave or fear that reporting = more procedures. Teens guard privacy + body image — involve them in decisions.
5The myths — all FALSE
"Newborns don't feel pain"
"Sleeping/playing = pain-free"
"Kids always report accurately"
Also false: "they forget it" (early pain changes future responses), "crying = intensity" (behavior varies), "never opioids" (opioids OK with careful monitoring).
6Assessment rules
Self-report preferred when reliable
Reassess with the SAME tool
Assess location · intensity · duration · quality. Add behavior + vital-sign changes and parent's read on baseline. Validated scale, matched to development.
7Pick the scale
PIPP-R: premature + term newborns
CRIES: newborn post-op
FLACC: young or nonverbal
r-FLACC: nonverbal + cognitive impairment
FACES: self-report, ~age 3+
Numbers 0–10: older kids + teens
FLACC = Face, Legs, Activity, Cry, Consolability — 5 × 0–2 = 0–10. CRIES = Crying, Requires oxygen, Increased vitals, Expression, Sleeplessness — also 0–10. FACES = 6 faces scored 0, 2, 4, 6, 8, 10 — check understanding first.
8Non-drug toolkit
Distraction: toys · music · games · video
Parents present · positioning · swaddling
Relaxation · guided imagery · breathing
Babies: skin-to-skin, breastfeeding, sucrose (sugar water) for short procedures. Pair comfort measures with medication — multimodal beats either alone.
9The medications
Acetaminophen: watch total dose — liver
Ibuprofen: 6 mo+ — stomach + kidneys
Opioids: moderate–severe pain
Nonopioids = mild–moderate. Naproxen: selected older kids only. On opioids monitor breathing rate/effort, sedation, oxygen + nausea, constipation. Lowest dose, shortest time.
10Safety + procedures + follow-through
Weight in KILOGRAMS · verify max doses
Oral syringe — never a kitchen spoon
Procedures: anticipate pain, topical numbing, distraction, parents present, assess before/during/after. Sedation levels: local (one spot) · regional (bigger area) · general (unconscious) · procedural sedation (calmer, still responsive — trained staff + monitoring). Reassess: same scale + comfort, sleep, feeding, side effects — change the plan if it's not working.