COSMIN database

The challenges of pain measurement in critically ill young children: a comprehensive review

Ramelet, A. S., Abu-Saad, H. H., Rees, N., and McDonald, S.
This article addresses the issues in measuring pain in critically ill children, provides a comprehensive review of the pain measures for children aged between 0 and 3 years, and discusses their applicability to this group of children. When children are critically ill, pain can only exacerbate the stress response that already exists, to the extent that homeostasis cannot be maintained. Severity of illness is thus likely to affect physiologic and behavioural pain responses that would normally be demonstrated in healthy children. The problem of differentiating pain from other constructs adds to the complexity of assessing pain in non-verbal children. A pain measure to be useful clinically must be adapted to the developmental age of the target population. Search of electronic databases and other electronic sources was supplemented by hand review of relevant journals to identify published and unpublished pain measures for use in children aged between 0 and 3 years. Twenty eight pain measures were identified in the literature; 11 for neonates only, 11 for children aged between 0 and 3 years, and six for children more than 12 months. These measures vary in relation to their psychometric properties, clinical utility and the context in which the study was performed. These measures may not be suitable for the critically ill young child, because the items included were derived from observations of healthy or moderately sick children, and may not reflect pain behaviour in those who are critically ill. It is therefore recommended to develop new pain scales for this population of compromised children.
Aust Crit Care
1036-7314 (Print)
Publication year:
Symptom status:
Physical state
Children (0-18)
Certain conditions originating in the perinatal period and related symptoms
Certain infections and parasitic diseases and related symptoms
Congenital malformations, deformations and chromosomal abnormalities and related symptoms
Diseases of and symptoms related to the blood and blood-forming organs and certain disorders involving the immune mechanism
Diseases of and symptoms related to the circulatory system
Diseases of and symptoms related to the digestive system
Diseases of and symptoms related to the genitourinary system
Diseases of and symptoms related to the musculoskeletal system and connective tissue
Diseases of and symptoms related to the nervous system
Diseases of and symptoms related to the respiratory system
Diseases of and symptoms related to the skin and subcutaneous tissue
Endocrine, nutritional and metabolic diseases and related symptoms
External causes of morbidity and mortality
Injury, poisoning and certain other consequences of external causes
Neoplasms and related symptoms
Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified
PRO / non-PRO:
Non-patient Reported Outcome
Type of measurement instrument:
6 - Clinical rating scales
7 - Observations
9 - Laboratory tests
BPS - Behavioural Pain Scale
CFCS - Child Facial Coding System
CHEOPS - The Children’s Hospital of Eastern Ontario Pain Scale
CHIPPS - Children’s and Infants’ Postoperative Pain Scale
COMFORT Scale    
DAN - Douleur Aigue du Nouveau-né
DSVNI - The Distress Scale for Ventilated Newborn Infants (DSVNI)
EDIN - Échelle Douleur Inconfort Nouveau-Né (= Neonatal Pain and Discomfort Scale)   
FLACC - Faces, Legs, Activity, Cry and Consolability Scale
IBCS - Infant Body Coding System
LIDS - Liverpool Infant Distress Scale
mdodified MBPS Modified Behavioral Pain Scale
MIPS - Modified Infant Pain Scale
NAPI - Nursing Assessment of Pain Intensity
NFCS - Neonatal Facial Coding System   
NIPS - Neonatal Infant Pain Scale   
N-PASS - Neonatal Pain, Agitation, & Sedation Scale   
OPS - Objective Pain Scale
PAIN - Pain Assessment Inventory for Neonates
PAT - Pain Assessment Tool
PEPPS - Preverbal, Early Verbal Pediatric Pain Scale
PIPP - Premature Infant Pain Profile   
POCIS - Pain Observation Scale for Young Children
POPS - Postoperative Pain Score
RIPS - Riley Infant Pain Scale
SUN - Scale for Use in Newborns
TPPPS - Toddler Pre-Schooler Postoperative Pain Scale