Acute Episodic Pain | 1. Has a painful or stressful procedure been performed within the last hour or more? | 8/8 |
2. What was the nature of the nociceptive/stressful event or situation? for example, surgery, birth trauma, suctioning skin trauma, respiratory support | 8/8 |
3. What is the infant’s baseline behavioural state (within the last hour)? | 8/8 |
4. What is the infant’s post-menstrual age? | 7/8 |
5. What is the infant’s disease state or condition? for example, neurologically impaired, severity of critical illness, etc. | 8/8 |
6. What are external factors (environmental stimuli such as alarms) that may influence the infant’s stress levels? | 8/8 |
7. Has sufficient pharmacological and non-pharmacological pain relief been provided either before, during, and/or after the nociceptive/stressful stimuli or event? | 8/8 |
8. What other pharmacological agents are being used? for example, muscle relaxants, sedatives, inotropes | 8/8 |
9. What is the infant’s overall reactions (motor, behavioural, and physiological changes) to the painful/stressful event or situation? | 8/8 |
10. Does the infant use self-regulating/comforting behaviours? for example, flexed positioning, sucking, bringing hands together | 7/8 |
11. What tool has been used to assess the infant’s pain and what is their score on the pain assessment tool? | 7/8 |
12. What are the parents’/guardians’ impressions of the infant’s pain? | 8/8 |
13. What are the clinician’s and their colleague’s impressions of the infant’s pain? | 7/8 |
14. What are the internal (clinician’s psychological state, experience, cultural biases) and external (environmental stimuli such as alarms) factors that may affect the assessment of pain? | 8/8 |
Chronic Pain | | |
1. What is the infant’s medical history including any possible painful disease states and previous interventions and ventilation? for example, necrotising enterocolitis, epidermolysis bullosa, major surgery, mechanical ventilation | 8/8 |
2. Were there any recently performed painful/stressful events or procedures? | 8/8 |
3. How competent is the infant in coping with painful/stressful episodes (self-regulating behaviours), and daily care-taking procedures (life in general)? | 8/8 |
4. Does the infant show impaired growth (length, weight, head circumference), and is not meeting expectations? | 7/8 |
5. How is the infant’s sleep-wake cycle, levels of restlessness, general motor behaviour and physiology? for example, heart rate, blood pressure, respiratory rate, ventilator asynchrony | 8/8 |
6. How arousable is the infant to smell, touch, and sound, and what is their reaction to non-nociceptive stimuli (eg, feeding, environmental stimuli) and nociceptive stimuli? Do they have negative reactions to positive stimuli such as skin-to-skin or feeding? | 8/8 |
7. Is the infant consolable by a parent or caregiver? | 7/8 |
8. How effective are pharmacological and non-pharmacological pain relief within typical dosing regimens (as per site-specific protocols), based on blood serum levels of concentration? | 8/8 |
9. What are the parents’/caregivers’/clinician’s impression of the infant’s pain? | 7/8 |
10. What tool is used to regularly assess the infant’s non-acute pain and what is the score on the pain assessment tool? | 8/8 |
11. Are there markers of stress such as cortisol levels? | 7/8 |
12. Does the infant display age-appropriate developmental behaviours such as playing, following with eyes, vocalising? | 7/8 |