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 < 5 = NO PAIN
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