The physician, registered nurse (RN), licensed practical nurse (LPN) is responsible for assessment of pain. Unlicensed assistive personnel (UAP) may obtain subjective reports of pain. When measurement is obtained by the UAP, any variance from baseline is reported to the licensed caregiver.

Each healthcare institution should identify standardized assessment tools appropriate for use in each age group or patient group (e.g., use an appropriate tool for infants, young children, school age/adolescents, for cognitively impaired children, nonverbal due to clinical condition). Select from these tools when choosing a method of pain assessment for an individual child; if the preferred tool is not effective, try one of the others. After identifying a tool that works for the child, use this consistently unless the situation changes (e.g., the child is comatose and can no longer use a self-report tool) (see Chapter 7).

Assess pain level within the first hour of admission to an acute care setting or during an outpatient contact to obtain baseline data regarding the comfort status of the child.

For a child who has chronic pain, frequency of pain assessments are based on child’s condition but are performed at least monthly.

Assess pain level every 8 to 12 hours in an acutely ill child and more frequently as clinically indicated. Pain assessment is an ongoing process; each caregiver performs a comprehensive pain assessment when initially assuming care of the child. After the initial assessment, if the child’s status changes; if the child demonstrates signs of pain or is subjected to a presumably painful event; or if there is change in infusion rates of sedation, analgesic medication, or anesthetic medication, perform another comprehensive pain assessment.

Assess pain level before and after pain interventions within 1 hour of any intervention for an acutely ill child (time interval is dependent on the specific intervention) to assess response to treatment regimes.