Chapter 39: Pain Management for Children

A central focus involves developmental pain assessment, recognizing that children communicate pain differently across developmental stages. Neonates and infants demonstrate pain through behavioral cues like facial grimacing, distinctive cry patterns, and physiologic changes in heart rate and breathing, while older children develop increasing verbal and cognitive capacity to self-report. The chapter details multiple validated assessment instruments matched to developmental ability, including the Neonatal Pain Assessment Scale and CRIES scale for newborns, the Facial Action Coding System for nonverbal toddlers and preschoolers, and self-report scales such as the faces scale and numeric rating approaches for school-age children and adolescents. Management strategy emphasizes multimodal analgesia, combining both pharmacologic and nonpharmacologic methods. Nonpharmacologic techniques encompass environmental modifications, cognitive distraction, imagery techniques, physical comfort measures like swaddling and skin-to-skin contact, and oral glucose solutions for infants. Pharmacologic management follows a sequential approach, beginning with acetaminophen and nonsteroidal anti-inflammatory agents for mild discomfort, progressing to opioid medications for moderate to severe pain, while avoiding contraindicated agents due to serious adverse effects. The chapter addresses advanced delivery systems including patient-controlled devices and neuraxial anesthesia with accompanying safety monitoring and reversal agent protocols. Finally, procedural pain management incorporates topical anesthetic preparations and sedation protocols with specific attention to airway management and vital sign monitoring.