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  • The Review Course in Family Medicine

TOP 10: Pediatric Pain Pearls - Best Practices You Should Know

Here are 10 best practice tips for assessing and managing pain in young patients.


DON'T MISS: #8 and #9 contain great SAMP pearls, and be sure to think of #10 during your SOOs!


  1. Use a developmentally appropriate pain assessment tool, with the verbal Numeric Rating Scale-11 (NRS-11), the Faces Pain Scale-Revised (FPS-R) being most highly recommended.

  2. Whenever possible allow children to self-report pain as it is a subjective experience modulated by emotions, developmental factors, and culture.

  3. Observational tools can aid in assessment. For infants, use the Neonatal Infant Pain Scale (NIPS) or the Face, Legs, Activity, Cry, Consolability (FLACC) scale. The FLACC can also be used in toddlers and older children.

  4. When evaluating chronic pain, assess how pain is impacting global functioning and social participation (i.e. school, play, family).

  5. Aim to manage pain early, as it does not affect diagnostic accuracy and allows for easier testing and examination.

  6. Reassess pain following interventions using the same tool as the first encounter. For chronic pain, the primary goal is symptom resolution and functional improvement.

  7. For management, combine OTC analgesia with physical and psychological strategies. Ibuprofen has a similar safety profile to acetaminophen and is effective for MSK pain.

  8. Use opioids sparingly with appropriate dosing and careful monitoring. Codeine should never be used under 18yrs old.

  9. Intranasal (IN) fentanyl is an effective analgesic in the acute setting. There is also evidence for IN Ketamine for traumatic limb injuries.

  10. Chronic pain is best managed by an individualized approach, which combines treatment modalities (psychological, occupational, pharmacological) and empowers the child and caregiver to actively engage in therapy.

References: Trottier ED, Ali S, Doré-Bergeron MJ, et al; Canadian Paediatric Society, Acute Care

Committee, Hospital Paediatrics Section, Paediatric Emergency Medicine Section. Best

practices in pain assessment and management for children.










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