EIIC: Emergency Medical Services for Children | Innovation and Improvement Center

Pediatric Pain Management Toolbox

Pain is an extremely complex and individualized phenomenon for each of us. But for children, both the assessment and management of pediatric pain can be a real challenge for health care providers. Recognizing characteristic indicators of pediatric pain, use of pain measurement scales, and pain management (both pharmacological and non-pharmacologic measures of treatment) are important when caring for the children. Additionally, the immediate and long-term consequences for children when pain is unrecognized and untreated are important considerations. This tool box provides key resources and information for the emergency care provider to better understand, assess, and relieve children’s pain in the prehospital and emergency department settings.

Healthcare Provider Resources

EMSC National Resource Center

Prehospital Pain Management in Children
Developed by the University of Texas Southwestern through an EMSC Targeted Issue grant, this podcast focuses on the key elements of pain psychology, pain assessment, and pain management interventions for injured children experiencing pain.

American Academy of Pediatrics

Relief of Pain and Anxiety in Pediatric Patients in Emergency Medical Systems
This Clinical Report from the American Academy of Pediatrics (AAP) provides information to optimize pain relief and stress reduction for children requiring emergency care. (November 2004)
Prevention and Management of Pain and Stress in the Neonate
In this updated policy statement, the AAP recommends safe and effective interventions for preventing and relieving pain in neonates. (November 2006)
The Assessment and Management of Acute Pain in Infants, Children, and Adolescents
This 2001 statement, developed in conjunction with the American Pain Society (APS), underscores the responsibility of pediatricians to take a leadership and advocacy role to ensure humane and competent treatment of pain and suffering in all infants, children, and adolescents. (September 2001)

American Medical Association

Pediatric Pain Management
Recognizing that knowledge about pediatric pain management is not always translated effectively into clinical practice, the American Medical Association developed this educational module to: (1) describe developmentally appropriate strategies and tools for assessing pain in children, and (2) provide education on the utilization of pharmacologic and non-pharmacologic treatments for pain in children. (September 2009)

Centre for Pediatric Pain Research

Pediatric Pain – Science Helping Children. Canada’s Centre for Pediatric Pain Research maintains this comprehensive listing of online pain resources. The site contains a variety of links for professionals and researchers, in addition to those directly affected by pediatric pain. (Accessed June 2013)

Pain Associates in Nursing

Oucher Pain Scale
Designed to help assess pediatric pain levels, this resource presents photographs of children making pained expressions of varying intensity, corresponding to a 10-point scale. Choosing a face and a number helps children ages 1-12 communicate their discomfort level to the doctor or nurse providing care. Additional information on how to use the Oucher Scale is also available. (Accessed June 2013)

University of Rochester

Pediatric Pain Reference Cards
The University of Rochester’s Pediatric Subcommittee developed this comprehensive resource to aid in the assessment of pain in children of varying ages, describe pharmacologic and non-pharmacologic management strategies, and provide dosing information for common analgesics and sedatives. (November 2005)

Example Practices

Illinois EMSC

Illinois EMSC is a collaborative program between the Illinois Department of Public Health and Loyola Medical Center. The goal of the program is to ensure that appropriate emergency medical care is available for ill and injured children at every point along the continuum of care. Recognizing that pain management is a fundamental component of quality emergency care for children, the program has developed the educational modules and slide shows detailed below.

Pediatric Pain Management in the Emergency Department: Online Educational Module
This module provides an overview of the essential components of pediatric pain management. It addresses pain management standards, barriers and misconceptions, physiologic pain response in children, pharmacologic and non-pharmacologic management of pediatric pain, healthcare professional educational recommendations, patient/family education, and quality improvement activities. The module is designed for online use by an individual for educational credit as well as for off-line use in a group setting for nurses, physicians, and prehospital providers. (Accessed June 2013) Note that continuing education credits are available.
Pediatric Pain Management in the Emergency Department: An Executive Summary
In 2005, 121 emergency departments (ED) actively participated in the EMSC regional CQI program. These EDs were surveyed regarding pediatric pain management using a web-based application. Of the 121 facilities, 93 (77%) completed the survey. In addition, the respondents conducted 792 medical record reviews on pediatric patients age 0-15 years who presented to the ED with extremity fracture(s). After data submission, participants were provided with web-based reports that allowed comparison of their results to their region, to similar sized facilities, and to the rest of the state. For this executive summary, responses from the 2005 web-based application were compared to their responses to paper-based surveys from 2002 and 2003. In addition, comparisons were made among facilities by grouping their responses according to their EMS Regions. (2006)

Children’s Hospitals and Clinics of Minnesota

The Children’s Hospitals and Clinics of Minnesota’s Palliative Care & Hospice Program is a model for pain management across the entire continuum of pediatric patient care. The program aims to provide seamless inpatient, home, and hospice care for children experiencing acute or chronic pain, or living with life-limiting medical conditions. A multidisciplinary team – including the child’s physician, family members, specialty-care providers, nurses, social workers, child life specialists, chaplains, and volunteers – works together to address the child’s pain and provide coping mechanisms for the family. Components and aspects of the program include (each assessed May 2016):

Mattel Children’s Hospital at UCLA

Mattel Children’s Hospital at the University of California – Los Angeles (UCLA) has developed a Pediatric Pain Program, an interdisciplinary program that includes research, clinical service, and education. It is based within a mind-body framework that takes into account the complex interaction between physiology, emotions, cognitions, and the environment in all aspects of clinical evaluation and treatment, as well as in research.

The research program has three areas of focus: 1) pain and other symptoms, 2) young adult survivors of childhood cancer and the pediatric cancer experience in general, and 3) complementary and alternative medicine.The clinical program is designed to evaluate and treat infants, children, adolescents, and young adults who have complex chronic pain or other ongoing symptoms. Treatments typically integrate more traditional medicine with other complementary and alternative medicine clinical services.

The pain educational program typically has several post-doctoral research fellows, as well as graduate, undergraduate, and medical students engaged in research projects. Electives are offered for residents from different training backgrounds to enhance their education in treating pain. (Accessed February 2015)

Family and Caregiver Resources


How Do I Know My Child Has Pain?
This section of the AboutKidsHealth website aims to help parents and caregivers identify and cope with children’s pain. The site provides information on recognizing pain, helping children describe pain, and pain management strategies – both physical and psychological. (March 2010)
Pain Assessment
This section of the AboutKidsHealth website supplies information on components of pain assessment in children. The site includes lists of questions that caregivers should ask hurting children, as well as any observers, to better understand the intensity and type of pain. (September 2009)
About Pain
This site explains the physiological basis for pain – including neurological components – and describes the connection between pain and emotion in children of varying ages. (June 2013)

Cincinnati Children’s Hospital

Manejo del Dolor (Pain Management)
This resource helps Spanish speaking families to understand the causes of pediatric pain, as well as common mechanisms for measuring and treating children experiencing pain and stress. (September 2009)


Why Do I Have Pain?
Through this online resource, children have the opportunity to learn the physical causes of pain in their bodies, as well as why people experience pain. (Accessed June 2013)

University of Iowa Children’s Hospital

Helping Your Child with Pain Control
Parents bring special knowledge of their children’s needs to the health care team and are very important partners in their children’s pain management. This resource assists parents and caregivers in working with healthcare providers to hela nameentify and manage their children’s pain. (March 2008)

University of Michigan Health System

Pain and Your Child or Teen
Designed specifically for parents and caregivers, this website helps adults understand the definitions and causes of pain in children and adolescents. It includes links to resources for measuring and managing pain, learning about pain medication and non-drug treatments, and exploring specific types of pain. Alternative pain management strategies, such as breathing techniques, massage, distraction, and virtual reality, are discussed. (Accessed June 2013)