Pain

Introduction

Young children or children who are sick cannot always tell us exactly what they are feeling. This can be quite upsetting for parents who may feel confused about what their child is experiencing. Parents know their child’s usual reactions and behaviours, but sometimes pain and fear may change these reactions.

Many things affect a child’s experience of pain, including their:

• age
• beliefs and understanding about the cause of the pain
• beliefs in his/her ability to cope
• previous experiences with pain and how they have seen other people deal with pain
• learned responses to pain.

Acute pain

The term "acute pain" refers to pain that is not long-lasting. The pain may be caused by an operation, injury, illness, or medical procedure. Depending on what has caused the pain, the pain may last a few seconds (e.g. a needle) through to a few weeks or months (e.g. following an injury). Some pain from an operation is normal and is a part of the healing process. 

Acute pain can be reduced by medications that can be given a number of ways. You can also help your child with acute pain by using other strategies such as relaxation and distraction techniques.

Persistent or chronic pain

Persistent or chronic pain is any pain that lasts for a longer period of time, beyond the expected time of healing. This pain can be persistent (continuing), or come and go at different times. Not all persistent pain has an identifiable cause; however most persistent pain is treated the same whether there is an identifiable cause that does not have specific treatment or no cause has been found which may include medication, movement and/or using non-medicine strategies for managing the pain.

Knowing if your child is in pain

It is not always easy to know how much pain your child is feeling, but listening to what they say and watching what they do can help you assess it.

Things that can show that your child is in pain include:

• crying
• facial changes or pulling a face such as a grimace or frown
• changes in sleeping or eating patterns
• becoming quiet and/or withdrawn
• screaming
• refusing to move
• overall change in their function.

Remember that changes in a child’s behaviour can also happen if they are scared or anxious. 

Some children may tell us they are sore or hurting but may find it hard to say how much.

There are a variety of pain scales used for children depending on their age and their cognitive level. For children aged 4-7 can use a scale such as the "Faces Pain Scale – Revised" or the FLACC. The Faces scale is recommended for children 4-7 years, to use you ask your child to point to the face that shows how much hurt they are feeling from "no pain" on the left through to "very much pain" on the right.

You can tell staff which number face your child has pointed to and that will help them to know how your child is feeling. The FLACC is mostly used for children aged 1-4 years, each category, requires a score of either 0, 1, or 2 and add them up for a score out of 10. This number will help you to explain your child’s pain to staff, or the nursing staff will perform the FLACC assessment. There is a modified FLACC for children with intellectual difficulties which nursing staff will also perform the assessment on.