Pediatric Emergency and Critical Care Working Group

Indonesian Pediatric Society

Introduction
Children admitted to the hospital have pain caused
either by the underlying disease or by the diagnostic or
therapeutic procedures.

More often than not, patients receive insufficient

analgesic treatment, even for painful procedures.

Effective management of pain in children is a major

priority for patients, parents, and health-care providers,

highlighted as a priority in the Childrens

Introduction

WHY?
The long-term negative effects of pain are becoming more
apparent
Inadequately treated pain, particularly in the neonatal period

INCREASES MORBIDITY AND MORTALITY

Pediatrics in Review Vol.24 No.10 October 2003

Introduction
Children admitted to the hospital have pain caused
either by the underlying disease or by the diagnostic or
therapeutic procedures.

More often than not, patients receive insufficient

analgesic treatment, even for painful procedures.

Effective management of pain in children is a major

priority for patients, parents, and health-care providers,

highlighted as a priority in the Childrens

Definition

As defined by the International Association for

the Study of Pain (IASP):
PAIN is "an unpleasant sensory and emotional
experience associated with actual or potential
damage, or described in terms of such
damage."

Effect of acute pain

Physiologic

Increased heart rate

Increased respiratory
rate
Increased blood
pressure
Decrease in oxygen
saturation

Effect of acute pain

Physiologic

Increased heart rate

Increased respiratory
rate
Increased blood
pressure
Decrease in oxygen
saturation

Effect of acute pain

Facial expression of
pain

Behavioural

Factors that Modify Pain Perceptions

Age
Cognition
Gender
Previous pain experience
Temperament
Cultural and family factors
Situational factors

 Pain scale on Pediatrics??

COMFORT scale anxiety or pain?

VAS visual Autonomic system?
FLAGS Autonomic system?

WBPS patient must consciousness

NIPS Neonatal Infant Pain Scale

NIPS
(1) facial expression
(2) cry
(3) breathing patterns
(4) arms
(5) legs
(6) state of arousal

Interpretation:
minimum score: 0
maximum score: 7

No particular expression or smile

Occasional grimace or frown, withdrawn, disinterested 1

FACE

LEGS
ACTIVITY

CRY

Frequent to constant quivering chin, clenched jaw

Normal position or relaxed
Uneasy, restless, tense
Kicking or legs drawn up
Lying quietly, normal position, moves easily

Squirming, shifting back and forth, tense

Arched, rigid or jerking

No cry, (awake or asleep)

Moans or whimpers; occasional complaint

Crying steadily, screams or sobs. Difficult to console.

2
0

Reassured by occasional touching, hugging or being

talked to.

Difficult to console or comfort

Content, relaxed

CONSOLE

0
1

2
0

A
C

Wong Baker Pain Scale (3 yrs and older)

Brief word instructions: Point to each face using the words to describe the
pain intensity. Ask the child
to choose face that best describes own pain and record the appropriate number.
Wongs Essentials of Pediatric Nursing, 6/e, St. Louis, 2001, P.
1301.

Crit Care Nurse 2009;29:59-66

Crit Care Nurse 2009;29:59-66

Management
Nonpharmacologic

Sensorimotor strategies for infants

Cognitive/behavioral strategies for older children
Child participation strategies

Physical strategies

Distraction
Blowing bubbles
Playing with pop-up toys
Looking through a kaleidoscope
Imagining a superhero

Suggestion
Breathing techniques
Guided imagery

Procedure related pain

Combine pharmacologic and nonpharmacologic

options when possible and appropriate

WHO step ladder

WHO step ladder

Monitoring

A cardiac / respiratory monitor is used for infants less than 7

months
Oximetry monitors for other patients during use of IV
opioids
Unstable respiratory status
History of difficult airway management
Neurologically impaired