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Overview
Whether the child is at home, in a clinic or clinician's office, or at the hospital, assessment of pain should occur during the course of his or her illness. Critical to assessment is open communication about pain among the child, the family, and the health care team.
An initial pain-history focuses on understanding pain from the child's and family's perspective. Central to communicating with the child about pain is determining the language the child uses for pain (e.g., hurt, owie, boo-boo) and how and to whom the child communicates pain. Other issues include past pain experiences, the child's response to pain, expectations related to pain, and preferences for assessing and treating pain. Clinicians should integrate this background information into subsequent assessments and treatment plans for the child.
A routine assessment of pain is critical to ongoing management. The frequency of assessment should be tailored to the severity of the pain, the context, and the preferences of the child and family. Frequent assessments are necessary when pain is being poorly managed or is not responding to the current treatment. Documentation of pain ratings on a chart or flowsheet, located in a visible place such as at the bedside, provides easy access for providers. The use of a flowsheet reduces the possibility of redundant questioning which can be overwhelming for the child and family and may interfere with the child's coping skills.
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