The Royal College of Emergency Medicine (RCEM) uses several measures to assess pain in pediatric patients.
Components:
(1) Wong-Baker FACES pain rating scale with 4 levels
(2) ladder scale (VAS scale from 0 to 10; no pain 0; mild pain 1-3; moderate 4-6; severe 7-10)
(3) behavioral
(4) injury example
|
Pain Level
|
Behavior
|
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none
|
normal activity; happy; no decrease movement
|
|
mild
|
rubbing affected area; decreased movement; neutral expression; able to play or talk normally
|
|
moderate
|
protective of affected area; decreased movement; quiet; complaining of pain; consolable crying; grimaces when affected part moved or touched
|
|
severe
|
no movement or defensive of affected part; looking frightened; very quiet; restless or unsettled; complaining of lots of pain; inconsolable crying
|
|
Pain Level
|
Example
|
|
none
|
bump on head
|
|
mild
|
abrasion; small laceration; sprain of ankle or knee; sore throat; fracture of finger or clavicle
|
|
moderate
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small burn or scald; fingertip injury; fracture forearm, elbow or ankle; appendicitis
|
|
severe
|
large burn; fracture of long bone; appendicitis; sickle crisis
|
James et al found the ladder (VAS scale) to be problematic in children, with poor inter-rater agreement.
