Neonates and infants do experience pain – they may experience as much pain as older children and long-term consequences from exposure to repeated painful stimuli. Untreated pain leads to increased sensitivity to subsequent stimuli.

Assessing pain in neonates and young children.

Behavioral observational scales
They are the primary method of pain assessment for infants, children less than 3 years old, and developmentally disabled patients. Validated tools include:

CRIES

Assesses Crying, Oxygen requirement, Increased vital signs, facial Expression, Sleep.

NIPS

(Neonatal/Infants Pain Scale)
Assesses facial expression, cry, breathing pattern, arms, legs, and state of arousal

FLACC

Assesses Face, Legs, Activity, Crying, Consolability

CHEOPS

(Children’s Hospital of Eastern Ontario Scale)
Assesses cry, facial expression, verbalization, torso movement, if child touches affected site, and position of legs

Self-report
Children 3 years of age and older can rank their pain using one of several validated scales including:

Wong-Baker Faces scale

Sixcartoon faces showing increasing degrees of distress. Face 0 signifies “no hurt” and face 5 the “worst hurt you can imagine.

Bieri-Modified

Six cartoon faces starting from a neutral state and progressing to tears/crying; scored 0-10 by the child.

Visual analogue scale

Uses a 10 cm line with one end marked as no pain and the opposite end marked as the worst pain. The child is asked to make a mark on that line that is then measured in cm from the no pain end.

Parent or caregiver report

INRS (Individualized Numeric Rating Scale)

It is an adaptation of the numeric rating scale that incorporates the parents’ and/or caregiver’s descriptions of the child’s past and current responses to pain; responses are stratified on a scale from 0 to 10.

See reference and links for more information

Adapted from Walker G, Arnold R. Pediatric pain assessment scales. Palliative Care Network of Wisconsin. Fast facts and concepts #117. Internet. Accessed on January 5, 2019.