Menu Search Donate
Child Health Guideline Identifier

Pain - paediatric pain assessment

This document is only valid for the day on which it is accessed. Please read our disclaimer.



  • 'An unpleasant sensory and emotional experience associated with actual or potential tissue damage.'
  • 'Pain is always subjective. Each individual learns the application of the word through experiences related to injury in early life.' (IASP, 1979)

Rationale for formal pain assessment

Pain assessment is essential:

  • To detect pain
  • To evaluate the effectiveness of our pain management interventions

Pain assessment and management algorithm

Pain assessment algorithm

Pain measurement

Pain is difficult to measure accurately and reliably in children and there is no single method of pain assessment that has been validated for children of all ages.

As pain is a subjective experience, self-reporting techniques are acknowledged as the most accurate indicators of pain1.

This is not always achievable because of a child's:

  • Cognitive ability
  • Developmental age 
  • Clinical condition

To help determine the presence and level of pain the following should be observed in conjunction with self-reports:

  • Behavioural signs
  • Physiological signs

Parent/Carer involvement

Parent(s)/carers are a valuable resource when assessing a child's pain, particularly when a child has special needs. Ensure the parent(s)/carers are involved in the assessment process where appropriate.

Pain assessment tools

Use the recommended Starship Hospital Pain Assessment Tools, following the instructions on the reverse of the tools.

The tools used are the:

  • Numerical rating scale for children 5 years and above
  • The Faces Pain Scale Revised for children aged 3 years and above
  • The Revised FLACC for infants, non-verbal children and children up to the age of 7 years.

The appropriate tool for the patient should be kept in their bedside notes during admission to allow for ease of assessment and personalised scoring.

Frequency of assessment

Assessments should be performed:

  • Hourly, if a child is receiving an analgesia infusion, patient/nurse controlled analgesia, a regional or an epidural infusion
  • At least hourly immediately after surgery, decreasing in frequency as the observations decrease
  • If a child complains of pain
  • Following administration of analgesia
  • When a procedure is carried out that would normally cause pain or discomfort
  • At least once a shift for all patients to establish if they have any pain


For in-patients, assessments should be recorded on the Paediatric Early Warning Score (PEWS) chart. In other areas, pain assessments should be recorded on the appropriately designated documentation.


  1. Broome M E & Huth M M, (2003). Nursing Management of the Child in Pain. In: Schechter N L, Berde C B & Yaster M, (eds). Pain in Infants, Children and Adolescents, 2nd Edition, Lippincott, Williams and Wilkins. Philadelphia
  2. Department of Health (2003). Getting the Right Start: National Service Framework for Children. Standard for Hospital Services, DOH, London
  3. Hicks CL, von Baeyer CL, Spafford P, von Korlaar, I & Goodenough B(2001)The Faces Pain Scale - Revised : Towards a commom metric in pediatric paim measurement, PAIN, 93: 173 -183
  4. Malviya S, Vopel-Lewis T, Burke C, Merke S & Tait A(2006)The revised FLACC observational pain tool: improved reliability and validity for pain assessment in children with cognitive impairment, Pedaitric Anaesthesia, 16: 258 - 265

Did you find this information helpful?

Document Control

  • Date last published: 23 December 2016
  • Document type: Clinical Guideline
  • Services responsible: Paediatric Pain Service
  • Author(s): Paediatric Pain Nurse Specialists
  • Owner: Paediatric Pain Service
  • Editor: Greg Williams
  • Review frequency: 2 years

More From Starship