Pain Assessment

After an operation it is important to regularly assess whether your child seems in pain. As a rule, your child’s behavior will change if he/she is in pain and children can sometimes find it difficult to express that they are in pain. Pain is not always expressed with words, screaming or crying. There are different pain estimation scales that can facilitate evaluation of a child’s pain. Children might not admit to pain because they don’t like taking medicine, which they may perceive as “bitter” and “a lot of medicine” to take several times per day.

Changed behavior due to pain can manifest itself in the child being whiny, worried/tense or apathetic/inactive. But other behaviors can also occur, such as being hyperactive, crying easily, just wanting to sleep or not wanting to eat and drink. You are the one who knows your child best, so it is important that you are aware of different behavior in your child. It gives you important clues as to whether your child experiences pain. Other factors that can affect and intensify the pain include fear and worry. The younger the child is, the harder it is to understand the connection between cause and effect.

Different pain estimation instruments are one tool for evaluating pain.

Children from the age of 3 can estimate their pain with the help of a face scale (see image). At school age (from approx. 7 years) when the child can understand to grade his/her pain, then the child can use a scale with numbers (see image). At hospital, different pain estimation scales are used, and they can also be good tools to use at home.

When the child estimates his/her pain below “4” on the face scale or the scale with numbers at all occasions during the day, this indicates that you can begin reducing the dose of medicine. Stop the medicine if the child continues estimating below “4” the day after you have reduced the medicine. If your child is affected by pain despite regular intake of recommended doses of medicine, then contact your doctor.

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The face scale Faces Pain Scale-Revised (FPS-R) for children from the age of 3 is intended to measure how the child feels, not what their face looks like. Explain to the child that the faces show how painful something can be. The face farthest to the left shows no pain. The faces show more and more pain, the one to the right shows a lot of pain.
Example of numeric verbal scale for children over 7 years of age, grade the pain by choosing a number between “0” (no pain) and “10” (worst pain imaginable).