Measuring Pain in Children

How is pain diagnosed?

Pain is not a symptom that is visible like a rash or palpable like a lump. The medical team usually won’t know the patient is in pain unless the patient tells them or, in very young patients, parents have observed behavior that makes them suspect their child is in pain.

Patients and parents must be honest about pain symptoms, so the causes and appropriate treatment may be determined.

The medical team will ask questions about how pain affects the patient’s daily life – such as the ability to go to school, play with friends, and participate in favorite activities.

These questions are known as a functional assessment of pain. The team may ask questions such as

• Does pain interfere with normal daily activities?
• Do you find it hard to concentrate on normal activities such as reading, playing with friends, watching TV, playing video games, or talking with someone?
• Is the pain so intense that it causes you to limit or avoid physical activity? 
• Is it difficult to concentrate on anything except the pain?

Doctors will also determine the intensity of pain using a 0-10 scale. The way patients report their pain score depends on their age. 

Patients younger than 4

In young patients, the FLACC scale is commonly used. It relies on parent observations.

Patients 4 to 7 years old

The FACES® Pain Rating Scale-Revised uses facial expressions to help young children rate their pain on the 0-10 scale. The faces show how much something can hurt. The face on the far left (0) shows no pain. The faces show more and more pain as the number go up. A 10 scale means the pain is very intense. Patients are asked to point to the face that shows how much they hurt right now.

Patients 8 and older

Older children, teens, and young adults can rate their pain using a simple 0-10 numerical score – 0 for no pain and 10 for intense pain.

In addition to a pain score, the doctor will classify the type of pain.

Physical pain is either

• Tissue-related (nociceptive): Pain related to disease, surgery or side effects of treatment, such as mouth sores. The pain can be in the bone, joint, muscle, skin, or connective tissue. It is usually described as aching or throbbing.
• Nerve-related (neuropathic): Pain resulting from nerve damage or inflammation. It is often described as burning, tingling, or piercing. It follows the path of the injured nerve from surgery such as phantom limb pain, chemotherapy-induced nerve damage such as vincristine side effects, or radiation therapy.

Doctors may also encourage patients and families to keep a diary or journal, so they can note any patterns such as times of day pain is more likely to occur or after what types of activities (or lack of activity.)

Pain may also have causes and members of the care team can explore these issues with the patient family. A chaplain or social worker may be called to assist the family.

Accurate, in-depth assessment of pain is important because it helps the medical team develop the best possible pain management plan.