Paediatric Pain

Last modified by Ann Watkins on 2016/04/05 21:15



The publications, presentations, papers and documents herein are provided solely for illustration , instructional purposes and for your general information and convenience.  Appropriate, qualified professional advice is necessary in order to apply any information to a healthcare setting or organization.

Any reliance on the information is solely at the user's own risk.

The Canadian Association of Paediatric Health Centres (CAPHC) and contributing health care organizations are not responsible , nor liable for the use of the information provided


The CoP will first focus on three key areas: acute procedural pain, acute presenting pain, and chronic pain .  The initial project undertaken by the CoP of focus shall be acute procedural pain, as there is a great deal of Canadian research, tools and supports already in existence.  The biggest challenge for this area of pain measurement and treatment is implementation of guidelines and practice change (Kortteisto et al., 2010) . The areas of acute presenting pain and chronic pain will follow.  Priorities within each area of focus will be identified by the CoP eg. assessment and treatment


To improve health outcomes for infants and children by reducing pain experienced during medical procedures, healthcare interventions and chronic conditions, disease or disability.

Community goal & objectives

Over-arching Goals

  1. Develop and support the implementation and evaluation of paediatric practice guidelines for paediatric pain assessment and management
  2. Work toward solutions to barriers to practice change to implementing pain assessment and/or management strategies and products
  3. Look for collaboration points within the child and youth healthcare community and with external stakeholders & partners 
  4. Identify pockets of related projects across child and youth health service delivery and share work openly with those projects
  5. Encourage standards adoption within clinical settings
  6. Encourage Pain CoP membership from multiple clinical disciplines that assess and or manage pain in the healthcare system
  7. Advocate for national accreditation standards
  8. Evaluate the success of the CoP on a regular basis

Specific yearly goals are established and completed as per the Community Charter and workplan.


Pain: An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage. The inability to communicate verbally does not negate the possibility that an individual is experiencing pain and is in need of appropriate pain-relieving treatment. (IASP, 1979, 2011)

Acute Pain: May be defined as a pain that subsides as healing takes place i.e. has a limited duration and with a predictable end (Royal College of Nurses, 2009)

Procedure: Procedures include all medical interventions which have the potential to cause pain or to cause distress or anxiety. (Royal Children's Hospital, Melbourne)

Chronic Pain: Chronic pain in children is the result of a dynamic integration of biological processes, psychological factors, and sociocultural context considered within a developmental trajectory. (American Pain Society 2001)

Environmental Scan - Current Practice

Stories From the Floor - A Knowledge Translation Casebook on Improving Pediatric Pain Practices from the CIHR Team in children's Pain

Pain Assessment Tools

  2. Wong Baker FACES
  3. Faces Pain Scale Revised
  4. Face Legs Arms Cry Consolability (FLACC)
  5. Neonatal Infant Pain Scale (NIPS) Ages Birth to One Year
  6. Premature Infant Pain Scale (PIPP) Development and Validation

Hospital - based Guidelines

  1. WRH Paediatric Pain & Nausea Management Order Set
  2. BCCH Sucrose for Procedural Analgesia in Infants up to 12 Months of Age
  3. BCCH Topical Anesthetic Skin Refrigerant
  4. BCCH Local Anesthetic Cream Application
  5. BCCH Psychological Interventions 

Published Guidelines

  1. Bennett et al, The Recognition and Assessment of Acute Pain in Children. 2009 (link to pdf)
  2. Howard et al. Association of Paediatric Anaesthetists of Great Britain and Ireland. Good practice in postoperative and procedural pain management, 2012 (link to pdf)
  3. Lago et al. Pain Study Group of the Italian Society of Neonatology. Guidelines for procedural pain in the newborn.,2009 (link to pdf)
  4. Taddio et al Reducing the pain of childhood vaccination: an evidence-based practice guideline,2010 (link to pdf)
  5. Spence et al Australian and New Zealand Neonatal Network. Evidence-based clinical practice guideline for neonatal pain, 2010 (link to pdf)
  6. Lee GY, Yamada J, et al. Pediatric Clinical Practice Guidelines for Acute Procedural Pain: A Systematic Review PEDIATRICS Volume 133, Number 3, March 2014

Family Tools and Resources

  1. BC Children's Hospital - Procedural Sedation and Analgesia
  2. Children's Hospital of Eastern Ontario - What you need to know: PCA - Patient Controlled Analgesia
  3. Children's Hospital of Eastern Ontario - What you need to know: Reducing pain with 25% Sucrose

References and Recommended Reading:

  1. Reducing pain at the time of vaccination: WHO position paper – September 2015 
  2. This won't hurt a bit Maclean's Magazine February 4, 2013
  3. CIHR Team in Pain Webinar Series link to presentations 
  4. Epidemiology and management of painful procedures in children in Canadian hospitals (link to article)
  5. S Ali, AL Chambers, DW Johnson, et al. Paediatric pain management practice and policies across Alberta emergency departments. Paediatr Child Health 2014;19(4):190-194. (link to pdf)

Cochrane Systematic Review

  1. Sucrose for analgesia in newborn infants undergoing painful procedures, 2013 Stevens B, Yamada J, et al
  2. Psychological interventions for needle-related procedural pain and distress in children and adolescents, 2013.Uman LS, Birman KA, et alal
  3. Non-pharmacological management of infant and young child procedural pain, 2011. Pillai Riddell RR, Racine NM, et al
  4. Breastfeeding or breast milk for procedural pain in neonates, 2012.Shah PS, Herbozo C, et al.Topical anaesthetics for repair of dermal laceration, 2011.Eidelman A, Weiss JM, et al.
  5. Adjusting the pH of lidocaine for reducing pain on injection.Cepeda MS, Tzortzopoulou A, et al
  6. EMLA and amethocaine for reduction of children's pain associated with needle insertion., 2006. Lander JA, Weltman JJ, et al. Tissue adhesives for traumatic lacerations in children and adults, 2002. Farion K, Osmond M, et al.
  7. Venepuncture versus heel lance for blood sampling in term neonates Shah Vs, Ohlsson A.  
Created by Lisa Stromquist on 2012/11/29 16:22

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