Never assume a sleeping or withdrawn child has no pain; children in chronic pain may guard and self-quiet.
Before you read
Test yourself first: 5 questions
Question 1 of 5
A nurse is caring for a nonverbal client with advanced dementia who appears to be in pain. Which assessment approach is most appropriate?
Answer: A. When a client cannot self-report, the nurse uses a validated behavioral observation tool such as PAINAD, which scores breathing, vocalization, facial expression, body language, and consolability. Behavioral cues become the primary indicator of pain.
Question 2 of 5
A nurse evaluates the effectiveness of a pain intervention. When should the nurse reassess pain after administering an IV opioid?
Answer: A. IV opioids reach peak effect within roughly 15 to 30 minutes, so the nurse reassesses pain about 15 to 30 minutes after IV administration. Oral analgesics are typically reassessed around 60 minutes. Reassessment confirms effectiveness and guides further action.
Question 3 of 5
A nurse is assessing a client's pain. Which statement reflects the most accurate principle of pain assessment?
Answer: A. Pain is subjective; the single most reliable indicator is the client's self-report. The nurse should accept and act on the client's report rather than judging it against objective signs.
Question 4 of 5
A hospice client has increasing pain near the end of life. The nurse's approach to pain is to:
Answer: B. In hospice/palliative care, the priority is comfort — titrate opioids/analgesics to relieve pain even if it may have side effects (the principle of double effect), and address total comfort. Withholding pain medication out of fear of addiction is inappropriate at end of life.
Question 5 of 5
A nurse is performing a dressing change on a deep partial-thickness burn. The procedure is very painful for the client. Which nursing action best addresses the pain?
Answer: A. Burn dressing changes are among the most painful procedures. The nurse should administer the prescribed analgesic, often an IV opioid, and time the dressing change to coincide with its peak effect. Nonpharmacologic measures such as distraction supplement but do not replace analgesia. Withholding pain medication or rushing the procedure without analgesia is inappropriate.
Keep the streak going with more questions like these, each with a full rationale.
What is pediatric pain assessment?
Self-report is the gold standard whenever the child can provide it. Key principle: choose the right scale for the right age, and never assume a quiet child is pain-free.
Key points to remember
- FLACC (Face, Legs, Activity, Cry, Consolability) is a behavioral scale for nonverbal children, infants, and ages roughly 2 months to 7 years.
- Wong-Baker FACES and the Faces Pain Scale-Revised are used for children about 3 years and older who can point to a face.
- The Numeric Rating Scale (0-10) is appropriate for school-age children (about 7+) who understand numbers.
- CRIES is a behavioral and physiologic scale used for neonates and preterm infants.
- Physiologic signs (tachycardia, hypertension, sweating, dilated pupils) may indicate acute pain but are unreliable for chronic pain.
- Infants in pain show high-pitched crying, facial grimacing, clenched fists, and rigid or flailing body posture.
Nursing priorities
- Select and use a developmentally appropriate, validated pain scale and use the SAME tool for reassessment.
- Accept the child's self-report as the most accurate measure of pain when available.
- Reassess pain after every intervention at the expected peak effect (about 30 minutes IV, 60 minutes oral).
- Combine pharmacologic relief with nonpharmacologic measures: distraction, swaddling, sucrose for neonates, positioning, comfort.
- Involve parents, who know the child's baseline behavior and comfort cues.
Patient teaching
- Teach parents to use the same faces or number scale at home to track relief.
- Explain that comfort measures like holding, distraction, and routine reduce a child's fear and pain.
- Reassure parents that treating pain promptly does not cause addiction and aids healing.
Red flags: report now
- Never assume a sleeping or withdrawn child has no pain; children in chronic pain may guard and self-quiet.
- Untreated or escalating pain with deteriorating vital signs requires prompt provider notification.
- Do not use an adult numeric scale on a preverbal child; mismatched tools yield invalid scores.
References
Clinical references for this topic
