C. S. Mott Children's Hospital
after - pain management
Children often experience pain after surgery. If you identify and treat the pain successfully your child will recover faster and with fewer problems. Since some operations are more painful than others, and each child experiences pain differently, you will need to decide:
• If your child is in pain
• How severe the pain is, and
• What is needed to make your child comfortable
Pain Assessment Tools
Children of different ages show their pain in different ways. A baby may cry and draw his legs up when hurting while an older child can usually use words to describe the pain. By watching a baby’s behavior or listening to a child’s words we can determine how bad the pain is.
The following are some suggestions to help you assess your child’s pain.
For a baby, watch for pain behaviors. This pain assessment tool is called FLACC, which stands for Face, Legs, Activity, Crying, and Consolability. Each behavior is rated with a number. Number scores for each area are added up to determine an overall pain score. A low number score may indicate just a little pain. Higher numbers may mean more pain.
| 0 | 1 | 2 | |
| Face | no particular expression or smile | occasional grimace/frown, withdrawn disinterested |
frequent to constant frown, clenched jaw, quivering chin |
| Legs | normal position or relaxed | uneasy, restless, tense | kicking, or legs drawn up |
| Activity | lying quietly, normal position, moves easily |
squirming, shifting back and forth, tense |
arched, rigid, or jerking |
| Cry | no cry (awake or asleep) |
moans or whimpers, occasional complaint |
crying steadily, screams or sobs, frequent complaints |
| Consolability | content, relaxed |
reassured by occasional touching, hugging or talking to, distractible |
difficult to console or comfort |
It is helpful to use this scale to assess pain unless your child is older and is using words in a way that you can understand. Once a child can use words there are other ways to tell the amount of pain.
The row of faces can be used to help a young child describe how bad their pain is. Explain to the child that each face is for a person who feels happy because he has no pain (hurt) or sad because he has some or a lot of pain.
 |
Face 0 is very happy because he doesn’t hurt at all. |
 |
Face 2 hurts just a little bit. |
 |
Face 4 hurts a little more. |
 |
Face 6 hurts even more. |
 |
Face 8 hurts a whole lot. |
 |
Face 10 hurts as much as you can imagine, although you don’t have to be crying to feel this bad. |
Ask the child to choose the face that best describes how he is feeling.
For children about 8 years of age or older, a number scale can be used to measure the amount of pain they feel. This Pain Scale uses 0 for “no hurt at all” and 10 as “the biggest hurt you could ever have”. Show your child the scale and ask for a pain number from 0 to10. You will then have a better idea about how much pain medicine is needed.
For children able to do so it is helpful to have them indicate the location and the type of pain, such as sharp, dull, aching, or pinching. You can then determine if the quality of the pain is changing.
Anxiety and fear can make pain seem bigger to children. Asking a child about being frightened can help you sort out pain and fear. Providing distraction or assisting a child with relaxation may enhance the pain-relieving effects of medications.
Pain medicine will be recommended or prescribed for your child. Used as directed, these medicines can be given safely. Prescriptions such as Tylenol with Codeine (acetaminophen with codeine phosphate) may be needed for the first day or two, or even longer for certain operations. Non-prescription medicines such as Tylenol (Acetaminophen) or Motrin (Ibuprofen) may be recommended for less painful operations or to use as your child’s pain decreases in the days after the operation.
A good assessment of the location and intensity of pain will help you to decide if pain medicine is needed. For pain that is constant it is best to give pain medicines routinely (e.g. Every 4-6 hours) for the first day or two, or longer in some cases. Your nurse will teach you about the details of dosing and frequency.
If your child’s pain is not easily managed with the medicines prescribed the doctor should be contacted. Your child may need something stronger, or may need to return to the hospital for a checkup.
Please feel free to ask questions while you are here, or to call us later if you need help using this information. Most pain after surgery is manageable and children benefit when they feel good while recovering.
University of Michigan
C.S. Mott Hospital PACU
F3200/ Box 0222
1500 E. Medical Center Dr.
Ann Arbor, MI 48109
734-763-2513
877-368-1316
www.med.umich.edu/nursing/pacu/patient.htm
Authors: Aurora Brown, R.N. and staff at the
C.S. Mott Childrens Hospital Recovery Room
Executive Officers of the Health System
Gilbert S. Omenn, U-M Executive Vice President for
Medical Affairs, and CEO, U-M Health System; Allen
Lichter, Dean, U-M Medical School; Larry Warren,
Executive Director, U-M Hospitals and Health Centers,
and Associate Vice President, UM Health System
The Regents of the University of Michigan
David A. Brandon, Laurence B. Dietch, Daniel D.
Horning, Olivia P. Maynard, Rebecca McGowan, Andrea
Fischer Newman, S. Martin Taylor, Katherine E. White, B.
Joseph White, ex officio
The University of Michigan is an equal opportunity/affirmative
action employer. The University of Michigan
Health System is committed to Total Quality.
Funded through a grant from the FRIENDS of the
University of Michigan Hospitals.
Copyright © 2002 The Regents of the University of
Michigan, Ann Arbor, Michigan, 48109 05/02/3000.
