Assessment Toolkit

Last modified by Lisa Stromquist on 2017/09/15 15:49

Welcome to the toolkit about pain assessment that can be used to help better treat and prevent pain for children ages 0-18 years of age. 


“Pain is a common reason to seek care for a child whether its ear pain from an inflection or musculoskeletal pain from an injury. Inadequate treatment of painful conditions is a significant problem, and ample evidence exists that children are far less likely than adults to receive analgesic medication for their pain.”                                                                                                                                                              (Drendel, Kelly & Ali, Pediatr Emerg Care.2011)

The treatment of pain, regardless of cause, starts with a pain assessment. The purpose of this toolbox is to make using pain assessment techniques in clinical practice easier to use. The contents, which have been provided by your clinical colleagues from around the country, can help you move pain assessment into your regular practice, help create a policy for use in your organization, support clinical education in assessment, and provide clinical and family resources to make pain assessment and tools easier to use. Use as many of the resources as you need and modify them to fit your organizational context. 


In this kit you’ll find:

  • An overview of pain assessment tools to use with different populations, such as neonates, infants and toddlers
  • A Clinical pain assessment flow chart, to help you decide when and how to incorporate a pain assessment and treatment into your practice
  • An example of a hospital policy for the use of pain assessment. This policy can be used to create your own organizational policy based on your needs and context.
  • Clinical PowerPoint developed by your clinical colleagues to support education about using pain assessment techniques and pain assessment tools, including case studies of interventions used based on real life examples from the ER. This slide deck can be modified and delivered for your needs and context but please acknowledge the original authors and the CAPHC Pain CoP for their contributions.
  • Background articles outlining the research evidence to support using pain assessment for acute procedural pain 

Please note, examples of policies are provided for reference purposes, only. We encourage all users of the toolkit who wish to adopt a similar policy at their institution to review, adapt, and modify the examples, as needed. The providers of these examples do not endorse their use outside of the institution for which it was originally created.

If you have any comments, questions or additions for the box, please contact CAPHC at 

Thank you for supporting the CAPHC Pain Community of Practice’s mission to improve health outcomes for infants and children by reducing pain experienced during medical procedures, healthcare interventions and chronic conditions, disease or disability. 

Pain Assessment Tools 
Paediatric Pain Assessment Tools (Includes a variety of self report and observational pain scales)
PEDIADOL La douleur de l'enfant - French Resource Website

Self Report Scales
Faces Pain Scale -Revised (FPS - R) English, age 4 and older
Faces Pain Scale - Revised (FPS - R)French, age 4 and older
VAS Scale (Visual Analog Scale 2015) - English, age 7 to adult

Observational Scales
FLACC Scale - English, 2 months to 7 years
FLACC Scale - French, 2 months to 7 years
EVENDOL - English, birth to 7 years
EVENDOL - French, birth to 7 years

Body Maps for the assessment of the location of paediatric pain
von Baeyer CL, Lin V, Seidman LC, Tsao JC, Zeltzer LK. Pain charts (body maps or manikins) in assessment of location of pediatric pain. Pain Management, 2011;1(1):61-68.
Clinician ResourcesClinical Pain Assessment Flowchart - For emergency departments
Hospital PolicyExample from Holland Bloorview Children's Rehabilitation Hospital
Clinical PowerPoint When Owies Need More than a Band-aid… Managing Pain in the Emergency Department - PPT to download

When Owies Need More than a Band-aid... Managing Pain in the Emergency Department - PDF
Background Articles

Complete list of Background Articles 

Ali, S., Drendel, A. L., Kircher, J., & Beno, S. (2010). Pain Management of Musculoskeletal Injuries in Children Current State and Future Directions. Pediatric Emergency Care, 26(7), 518-528.

Drendel, A. L., Kelly B. T., & Ali, S. 2011). Pain Assessment in Children: Overcoming Challenges and Optimizing Care. . Pediatric Emergency Care, 27(8), 773-781

Fein, J. A., Zempsky W. T., Cravero J. P., & THE COMMITTEE ON PEDIATRIC EMERGENCY MEDICINE AND SECTION ON ANESTHESIOLOGY AND PAIN MEDICINE. (2012). Relief of Pain and Anxiety in Pediatric Patients in Emergency Medical Systems, Pediatrics, 130, e1391

Krauss, B. S, Calligaris, L.,  Green, S. M.,  & Barbi, E. (2015). Current concepts in management of pain in children in the emergency department. The Lancet, 387(10013), 83-92.

Stinson, J. N., Kavanagh, T.,Yamada, J., Gill, N., & Stevens B. (2006). Systematic review of the psychometric properties, interpretability and feasibility of self-report pain intensity measures for use in clinical trials in children and adolescents. Journal of Pain, 125, 143-157

Tomlinson, D.,  von Baeyer, C. L., Stinson, J. N., & Sung, L. (2010). A Systematic Review of Faces Scales for the Self-report of Pain Intensity in Children. Pediatrics, 126, e1168. DOI: 10.1542/peds.2010-1609

von Baeyer, C. L ., & Spagrud, L. J. (2007) Systematic review of observational (behavioral) measures of pain for children and adolescents aged 3 to 18 years. Journal of Pain, 127, 140-150 


Clinical Practice Guidelines

 Assessment and Management of Pain Third Edition, Registered Nurses Association of Ontario (RNAO) December 2013 (link to pdf)
The recognition and assessment of acute pain in children Update of full guideline, September 2009 Royal College of Nursing (link to pdf)

Created by Lisa Stromquist on 2015/12/03 19:08