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Children experience pain to at least the same level as adults. Multiple studies have shown that neonates and infants perceive pain and have memory of these painful experiences. Frequently, children are underprescribed and underdosed for opioid and nonopioid analgesics due to excessive concerns of respiratory depression and/or poor understanding of the need for pain medications in children. Few data are available to guide the dosing of many pain medications, and the majority of pain medications available on the market today are unlabeled for use in pediatric patients.

Birnie  KA,  et al: Hospitalized children continue to report undertreated and preventable pain. Pain Res Manag 2014 Jul–Aug;19(4):198–204. Epub 2014 May 7
[PubMed: 24809068]
Taddio  A, Katz  J: The effects of early pain experience in neonates on pain responses in infancy and childhood. Pediatr Drugs 2005;7:245–257
[PubMed: 16118561] .


Standardizing pain measurements require the use of appropriate pain scales. At most institutions, pain scales are stratified by age (Table 32–1) and are used throughout the institution from operating room to medical floor to clinic, creating a common language around a patient’s pain. Pain assessment by scales has become the “5th vital sign” in hospital settings and is documented at least as frequently as heart rate and blood pressure at many pediatric centers around the world. There are many pain scales available, all of which have advantages and disadvantages (eg, Figures 32–1 and 32–2, and Table 32–2). It is less important what type of scale is used, but that they are used on a consistent and continuous basis.

Figure 32–1.

Bieri Faces Pain Scale, revised. (Reproduced with permission from Hicks CL, von Baeyer CL, Spafford PA, et al: The Faces Pain Scale–Revised: toward a common metric in pediatric pain measurement. Pain 2001 Aug;93(2):173–183.)

Figure 32–2.

Wong-Baker Pain Scale. Wong-Baker FACES Foundation (2019). Wong-Baker FACES® Pain Rating Scale. Retrieved [Date] with permission from Originally published in Whaley & Wong’s Nursing Care of Infants and Children. © Elsevier Inc.

Table 32–1.Pain scales—description and age-appropriate use.

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