The Toddler-Preschooler Postoperative Pain Scale (TPPPS) can be used to evaluate the pain experienced by a small child during and following a medical or surgical procedure.
Criteria for use:
(1) child 1-5 years old
(2) must occur during or after a potentially painful medical procedure or surgery
(3) child must be awake
Expressions of pain which are observed:
(1) verbal (3)
(2) facial (3)
(3) bodily movements (1)
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Pain Expression
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Behaviors
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verbal
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verbal pain complaint and/or cry
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scream
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groan, moan, grunt
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facial
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open mouth with lips pulled back at corners
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squint, closed eyes
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furrowed forehead, brow bulging
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bodily
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restless motor behavior and/or rubbing-touching painful area
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where:
• verbal pain complaint: any word, phrase, or statement that refers to pain, hurt or discomfort; it must be a statement and not a question.
• cry: tears in eyes and/or running down face and/or making sobbing sounds; this should not include crying initiated by separation from parents, unless the child is undergoing a potentially painful procedure.
• scream: acute, loud, high-pitched cry
• groan, moan, grunt: deep, low-pitched sounds; may be drawn out (moan) or abrupt (grunt)
• open mouth with lips pulled back at corners: open mouth with lips pulled back at corners, with a downward pull on the jaw
• squint, closed eyes: eyelids taut, stiff, closed or nearly closed with wrinkling of the skin at the lateral aspect of the eyes
• furrowed forehead: creasing or furrows above the eyebrows
• brow bulging: bulging between the eyebrows
• restless motor behavior: unrestrained motor activity with the body and/or head never still; may appear random or lack goal directions
• rubbing-touching painful area: touching, rubbing, massaging body part where the medical or surgical procedure was performed
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Scoring Behavior
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Points
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if behavior present during a 5 minute observation period
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1
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if behavior absent during a 5 minute observation period
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0
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pain score =
= SUM(number of behaviors present)
Interpretation:
• minimum score: 0
• maximum score: 7
• According to Table V (page 278), the low pain group had a mean score of < 1.17; the moderate pain group had a mean score of 1.18 - 3.00; the high pain group had a mean score of 3.01 to 5.33.
