Postoperative pain assessment methods in infants and young children: a review.

Abstract

Pain assessment in a pediatric postoperative setting has always been challenging, due to the lack of insight about pain mechanisms in newborns, infants and young children. Several research works about this subject were conducted over the years, and such studies contradict what was postulated for many years and demonstrate that infants do indeed feel pain stimuli, even more so than older children or adults. For this reason, it is important for health care providers to be familiar with the best pediatric pain assessment tools available at the moment, accordingly to age, cognitive development and context of the pain (in this case, a postoperative setting). Therefore, this paper will focus on the diverse available scales and parameters used at the present time, as well as their advantages and limitations. Furthermore, some recent developed technologies are briefly mentioned, some of which could in the future translate a solution for this problem. At the present time there is no gold standard for pain assessment in all clinical settings and pediatric age groups. Self-report, behavioural and physiological scales can be used for such propose, although none of these methods has proven to be superior or demonstrated excellent accuracy. Moreover, further research is needed in order to achieve the discovery and validation of an objective and easy to use pain assessment instrument, that could be implemented as a gold standard for worldwide use. The question about the best pain assessment method for infants and young children remains unanswered, being necessary to adapt the pain assessment process to each specific child and context.