Babies and children too young to speak are unable to communicate effectively when they are in pain. It is up to the parent or physician to assess the degree of pain being experienced, and to provide appropriate levels of pain relief.
A new scale developed in the UK can help parents and health professionals assess the pain of children too young to speak or suffering from severe neurological impairment. The "Pediatric Pain Profile" (PPP) has 20 different types of pain cues. These include vocal cues, changes in posture, different movements the child might make, changes in their facial expression and mood, and changes in the way they sleep or eat.
Each of the behaviors in the scale is rated between zero and three for the extent to which it occurs within a given time frame. Because the parents' role in assessing pain in this group of children is so important, the scale has been incorporated into a record that the parent can keep at home. The Pediatric Pain Profile has been developed by researchers at the Royal College of Nursing Institute, Oxford and the Institute of Child Health, London.
The PPP tool is available for download as a PDF document at:


The Association of Pediatric Oncology Nurses (APON) offers a new course in 2003. "Foundations of Pediatric Hematology/Oncology Nursing: A Comprehensive Orientation and Review Course" includes a module on Supportive Care, a module on Pain Management, and a module on End-of-Life Care.
The course is designed to provide an overview of nursing issues involved in caring for children and adolescents with cancer and blood diseases using PowerPoint slides and CD roms. Case studies are included to provide clinical scenarios, and enhance learning. A course evaluation form and posttest are provided to assist in measuring the effectiveness of the program.
Available for purchase from APON at:


Six online lectures and seminars about pediatric pain have been developed by the Initiative for Pediatric Palliative Care (IPPC, pronounced Ipsee). IPPC is a consortium of US-based organisations that work together to improve care and quality of life of children and families. It is an initiative of the Educational Development Center's Centre for Applied Ethics and Professional Practice.

"Developmental Factors in Pain Assessment and Treatment." This lecture enhances the ability of medical professionals to apply key principles and tools in the assessment of pain in children of all developmental stages and abilities.
"Pain Assessment in the Absence of Self Report." This case-based seminar addresses pain assessment in children who are unable to report their pain verbally.
"Chronic Pain, Adolescents, and Pain Assessment." This seminar emphasizes key principles of pain assessment in adolescents with chronic or recurrent pain resulting from a long-term, potentially life-threatening condition.
"Pain Management in Children with Life-Threatening Conditions." This lecture provides an overview of the pharmacological and non-pharmacological interventions to treat pain in children.
"The Safe and Effective Use of Opioids to Manage Pain." This lecture introduces participants to the range of opioid medications commonly used in pediatrics, their routes of administration, side effects, and guidelines for dosages, titration, and equianalgesic conversion.
"Addressing Parents' Fears about Opioid Analgesia." This seminar has two parts, "Common Fears and Concerns Regarding the Use of Opioids in Children," and "Communicating with Parents About Opioid Medications." A videotape dramatization is used as a trigger for discussion in both parts.
The complete IPPC module "Relieving pain and other symptoms" is available online at:


Easing Pain & Symptom as Illness Progresses: Relief Guide for Families.
This reference manual is for families who have children who are nearing the end of their life. The manual was written by parents and medical professionals. It includes information on decision-making and communication that applies to anyone with a complex medical condition, but most of the practical information about pain management and emotional support relates to end-of-life issues.
The manual was developed by the Pediatric Palliative Care Project at Children's Hospital and Regional Medical Center in Seattle, Washington, USA as the result of a grant from Promoting Excellence in End-of-Life Care, a national program of The Robert Wood Johnson Foundation (RWJF), providing grants and technical support to improve end-of-life care in the US.
The manual has been used by hospice nurses serving families as palliative care nurse case managers.
To request a copy of this manual, email Beth McKinstry,