■ Infants: Grimacing, frowning, startled expression, flinching, highpitched, harsh cry, generalized, total-body response, extremities may thrash about, tremors, increased HR and BP, ↓ oxygen saturation.
■ Toddler: Guarding, may touch or rub the area, generalized restlessness, loud cry, increased HR and BP, may verbalize with words such as, “owie” or “boo-boo.”
■ Preschooler: May perceive pain as punishment, may deny pain to avoid treatment, may be able to describe location and intensity, may exhibit crying and kicking, or may be withdrawn.
■ School-aged: Fear of bodily harm and mutilation, awareness of death, able to describe pain, may exhibit stiff body posture, may withdraw, and may attempt to delay procedures.
■ Adolescent: Perceives pain at a physical, emotional, and mental level, is able to describe pain, may exhibit increased muscle tension, may be withdrawn, and may show decreased motor activity.
Interventions for Pain
Nonopioid Analgesics:■ Acetaminophen (Tylenol): 10–15 mg/kg PO q4h, max 5 doses/day.
■ Ibuprofen (Advil): (> 2y) 7.5 mg/kg PO qid, max 30 mg/kg/day.
■ Naproxen (Naprosyn): (> 2 y) 5 mg/kg PO bid, max 2 doses.
Opioid Analgesics:
■ Codeine: (> 1 y) 0.5 mg/kg (15 mg/m2) PO, IM, SC q 4–6h, max 4 doses/day. Note: Not recommended for IV use. Infants may receive SC or IM codeine at same dose.
■ Meperidine (Demerol): 1.1–1.8 mg/kg PO, IM, SC q 3–4h prn. Max 50–100 mg/dose.
■ Morphine: 0.1–0.2 mg/kg IV, IM, or SC prn, max 15 mg/dose.
■ Sublimaze (Fentanyl): (> 2 y) 2–3 mcg/kg IV.
Nonpharmacological Interventions:
■ Distraction: Music, TV, games, dolls, stuffed animals, art, etc.
■ Minimize environmental stimuli: Noises, bright lights, etc.
■ Provide comfort: Positioning, rest, and relaxation.
■ Cutaneous stimulation: Massage, heat or cold therapy.
■ Guided imagery: Guide the child to either a make-believe place or someplace they have visited in the past (e.g., Disneyland). Encourage the child to describe this place.
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