Pain perception in children is complex, and is often difficult to assess. In addition, pain management in children is not always optimized in various healthcare settings, including emergency departments. A review of pain assessment scales that can be used in children across all ages, and a discussion of the importance of pain in control and distraction techniques during painful procedures are presented. Age specific nonpharmacological interventions used to manage pain in children are most effective when adapted to the developmental level of the child. Distraction techniques are often provided by nurses, parents or child life specialists and help in pain alleviation during procedures. 1. Introduction For pediatric patients presenting to the emergency department, medical procedures are often painful, unexpected, and heightened by situational stress and anxiety leading to an overall unpleasant experience. Although the principles of pain evaluation and management apply across the human lifespan, infants and children present unique challenges that necessitate consideration of the child’s age, developmental level, cognitive and communication skills, previous pain experiences, and associated beliefs [1]. According to the International Association for the Study of Pain, “Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage”. Perception of pain in pediatrics is complex, and entails physiological, psychological, behavioral, and developmental factors [1]. However, in spite of its frequency, pain in infants, children, and adolescent is often underestimated and under treated [2]. It has also been shown that infants and children, who experience pain in early life, show long-term changes in terms of pain perception and related behaviors [2]. Health care professionals in this setting have a responsibility to reduce pain and anxiety as much as possible while maintaining patient safety. Pain in infants and children can be difficult to assess which has led to the creation of numerous age-specific pain management tools and scores. Health care workers need to be able to detect the symptoms and signs of pain in different age groups and determine whether these symptoms are caused by pain or other factors [1]. It is difficult for health care professionals to foresee which measurement systems apply to accurately measure pain in the pediatric population [1]. Health care professionals often prefer practical methods, which reliably track the child’s pain experience and pain control over time whereas researchers tend to focus on
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