There are four main ways in which we recognise that a child is in pain:
• A description from the child or parent.
• Behavioural changes such as crying, guarding of the injured part, facial grimacing.
• Physiological changes such as pallor, tachycardia and tachypnoea, which are observed by the clinician.
• An expectation of pain because of the pathophysiology involved, e.g. fracture, burn or other significant trauma.
The purpose of pain assessment is to establish, as far as possible, the degree of pain experienced by the child so as to select the right level of pain relief. Additionally, reassessment using the same pain tool will indicate whether the pain management has been successful or whether further analgesia is required. The ideal pain assessment tool would be simple and quick to use, have been validated and would give reliable reproducible results which took account of both patient and observer data. To date, no pain tool fulfils all these criteria. The following are two pain scales for older and for younger children and a combination of these is shown in Figure F.1.
Figure F.1. Continued pain scale
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