Newborn Pain Assessment

[darynash]

How often does your facility require that you do pain assessments on well newborns?

[MemphisOBRNC, BSN, RN]

Though we don't have a written policy, we do a pain assessment q shift and as needed, like when a circumcision is done.

[BittyBabyGrower, MSN, RN]

All kids get a pain score at least once a shift, more frequently if procedures are being done.

[VickyRN, MSN, DNP, RN]

At our clinical facility (a magnet-status regional teaching hospital), we perform pain assessments with each set of vital signs (pain is considered the 5th vital sign) and PRN.

We use the following pediatric pain scales for infants/ neonates:

P.A.T. (Pain Assessment Tool) - for use in infants through 9 months of age

Parameters: Posture/ Tone, Sleep Pattern, Facial Expression, Cry or "Silent Cry," Skin Color, Respirations, Heart Rate, Oxygen Saturation, Blood Pressure, Caregiver "Perception"

Score

Score 5-10 = Comfort intervention and reassess

Score > 10 = Consider medication and reassess

FLACC Behavioral Pain Assessment Scale - for use in infants > 9 months, toddlers, pre-schoolers, and children unable to understand the concept of the 0-10 scale or the Faces Scale.

Parameters: Face, Legs, Activity, Cry, Consolability

Score 0-5 = Comfort measures and reassess

Score > 5 = Pharmacologic interventions

PEPPS - Preverbal, Early Verbal Pediatric Pain Scale - used in infants > 9 months, toddlers, pre-schoolers, and children unable to understand the concept of the 0-10 scale of the Faces Scale

Parameters: Heart Rate, Facial, Cry (Audible/ Visual), Consolability/ State of Restfulness, Body Posture, Sociability, Sucking/ Feeding

Score 0 = Comfort Zone

Score 1-9 = Nonpharmacologic Interventions

Score >9 = Use clinical judgment to determine nonpharmacologic and/or pharmacologic interventions

COMFORT Pain Scale - used for the intubated, non-paralyzed patient

Parameters: Alertness, Calmness/ Agitation, Respiratory Response, Physical Movement, Blood Pressure (MAP) Baseline, Heart Rate Baseline, Muscle Tone, Facial Tension

Score 20-26 = Comfort measures and reassess

Score > 26 = Pharmacologic interventions

Hope this helps :)

[Elvish, BSN, DNP, RN, NP]

Qshift or when they have a painful procedure done such as circ, injections, or heelsticks.

[SmilingBluEyes]

We are required to do this with our shift assessments, so at least qshift, or more often as needed.

[RNmommy]

Q shift and with painful interventions. We use NIPS.

[33-weeker]

We use NIPS as '5th vital sign' (with all vitals) and with any procedures (circ, blood draw, etc.).

[rn/writer, RN]

We use NIPS q shift, with painful procedures (and 24 hours post-circ), AND with any sign of protracted fussiness or inconsolability. A kiddo can have a whopper bellyache from swallowed fluid, formula intolerance, inadequate burping, etc. A baby that is hard to comfort or can't be comforted needs a thorough eval, including assessment for possible withdrawal issues.

Worst case would be something like testicular or intestinal torsion or other problems that are equally distressing and difficult to spot in a routine newborn exam.

Inconsolability (beyond mere fussiness) should set off alarm bells and initiate further investigation.

[RainDreamer, BSN, RN]

q 4 hours, or more often as needed .... and we use NPAT

[SteveNNP, MSN, NP]

Q2-3-4, (whenever we do VS and/or feeds) with procedures, etc. We use the NPASS scale.