Understanding someone's pain through pain assessment is the first step to pain management.

You can assess pain in children by:

• Observing their behaviour and reactions, or
• Asking them to tell you about their pain.

There are various pain tools to help assess pain. The choice of tool is based on the child's age and their ability to self-assess.

Learn more about pain assessment:

• BC Children's Hospital Family Resource Pain Guide - Pain Assessment
• Tools for measuring pain (SickKids Hospital)

When communicating with someone in pain, we want to provide a supportive partnership and messages that are simple, accurate, and focuses on coping. Children and youth require special considerations when it comes to communication during healthcare encounters.

Relationship and rapport: Children and youth are supported by voices they know, people they trust, and environments that feel safe.

Words and terminology: Medical jargon can be confusing. Use words that are simple and age appropriate.

Non-verbal cues: We communicate just as much verbally as we do non-verbally. Adults can provide emotional and physical comfort through tone of voice, body language, and facial expression.

One voice

• One voice should be heard during the procedure
• Need for parental involvement
• Educate patient before the procedure about what is going to happen
• Validate the child's feelings
• Offer the most comfortable, non-threatening position
• Individualize your game plan
• Choose appropriate distraction to be used
• Eliminate unnecessary staff not actively involved with the procedure

One Voice Website

The words we choose have a significant impact on the person in pain. Below are some examples that you can use to communicate with your child:

When your child is undergoing a procedure:

"Some kids say it feels like ______ (use soft language such as pressure, uncomfortable, pinch) I'm not sure what it will feel like for you, you can tell me what it felt like when we're done. If we use the strategies we talked about, it won't bother you so much."

Remind the child/youth what their job is and acknowledge successes "You are doing such a great job keeping your arm still, let's keep taking those deep breaths."

Provide encouragement, validate feelings, and redirect to positive coping behaviours:

“I know you were feeling uncomfortable but you did a great job of staying focused on your game, taking deep breaths, and squeezing your stuffed animal."

Here at BC Children's Hospital, we are making comfort a priority by offering the Comfort Protocol (PDF) - an approach to support infants, children, youth and families with procedures.

There are five approaches (PDF) that BC Children's Hospital uses to promote comfort and reduce pain when possible.

• Preparation (PDF) is helping the person and family/caregivers understand what is happening. Preparation helps reduce stress before a procedure and improves outcomes. Check out the Help Your Child Manage Medical & Surgical Procedures (PDF) handout for suggestions that can help you and your child manage stress before, during and after their procedure.
• Communication provides information non-verbally and verbally, considering tone of voice, body language, and volume. Communication can influence comfort because what you say is as important as how you say it.
• Comfort Positions (PDF) are secure hugging holds that can reduce stress and ensure safety during a painful procedure. Check out how our animal friends show some examples in our Paw-sitions for comfort handout (PDF).
• Alternate Focus (PDF) (distraction) works by engaging the person in a task or activity that can redirect their attention during a procedure. The person chooses what they want to focus on, examples are: focusing on the procedure, stress ball, bubbles, books, or electronic devices.
• Medication (PDF) is used in combination with the approaches listed above to optimize comfort and reduce pain when needed.

View our one-page summary of how and why we promote comfort. (PDF)

The use of opioids is not uncommon at BC Children's Hospital. We are committed to helping all persons and caregivers understand how to safely and effectively manage pain with the use of opioids when needed.

Opioids are a class of medications that are mainly used to treat moderate to severe pain. When used appropriately, opioids can be a safe and effective way to treat short-term or long-term pain.

How to use and store this medication

• Always follow the directions on the medication label unless your healthcare provider has told you to take the opioid differently.
• Never share your medication with others.
• Store medication at room temperature, away from heat, moisture, and direct light.
• Store the medication out of reach of children and pets.
• Return unused or expired medication to a pharmacy. Your pharmacy can dispose of it in a safe way.

Safety measures

• Ask your healthcare provider before taking any other medication, including non-prescription medications, vitamins, and herbal products.
• Opioids can be sedating. Do not participate in potentially dangerous activities until you know how this medication will affect you.
• Do not stop taking this medication suddenly without talking with your healthcare provider.
• If you miss a dose of your medication, take the dose as soon as you remember or skip the missed dose if it is almost time for your next dose. Do not take any extra medication to make up for a missed dose.

Side effects

• Opioids have possible side effects that you should be aware of. Not all side effects happen to all people, and many people do not have any side effects.
• Less serious side effects often improve during your first few days taking the opioid. These include:
• Dizziness, light-headedness, or drowsiness: try moving slowly when you sit or stand
• Nausea or vomiting: try taking medication with a bit of food
• Constipation: try increasing fluids, fruits and vegetables, foods with fibre, and laxatives if you need them
• Dry mouth: try chewing gum, or sucking on ice chips
• Nervousness or restlessness: avoid caffeinated drinks
• Blurred or double vision
• Nightmares or unusual dreams
• Difficulty with urination
• If these side effects continue, or cause distress, talk with your healthcare provider or pharmacist.

Call 911 and get help now if your child experiences:

• Difficulty or slow breathing
• Seizure
• Confusion or hallucinations
• Severe dizziness
  
• Severe drowsiness
• Difficulty walking or weakness

Learn more about opioids and medication:

• BC Children's Hospital Family Resource Pain Guide - Medications
• Opioid Medicines - Information for patients and families/ Health Canada (PDF)
• Stollery Children's Hospital - So you have been prescribed an opioid? (PDF)

At BC Children's Hospital, we have specialized teams that provide pain services for the‎ children and families of British Columbia. The Pain Services include the Acute Pain Service (APS) and the Complex Pain Service (CPS).

When in the hospital, your child can access the APS if managing their pain becomes hard to manage. The CPS is a team of healthcare professionals that helps those with chronic and complex pain.

Learn more about the Acute Pain Service

Learn more about the Complex Pain Service

Learn more about Canuck Place Children's Hospice

Certified child life specialists at BC Children's Hospital make hospitalization a more positive experience for persons and caregivers through play, therapeutic interventions, preparation, and creative arts.

Find out more about their role facilitating comfort at the hospital and how to get them involved.

Learn more about Child Life Services

Needle poke procedures, whether it be for a blood draw or an intravenous (IV), are common at the hospital and can often create stress or fear for many persons and caregivers. We want to help and encourage you to take a look at the following resources to help you prepare for a needle poke.

To prepare for a needle poke procedure, please see:

• It Doesn't Have to Hurt Video
• BC Children's Hospital Family Resource Pain Guide - Acute Pain (scroll down to Needle Poke Procedures)
• Child Life Services (select Resources and scroll down to Bloodwork)

When coming to the hospital for a surgery or procedure, assessing and managing your pain is important. These pages can provide you with information on preparing for a surgery or procedure and what to do after.

• BC Children's Hospital Family Resource Pain Guide - Acute Pain
• BC Children's Procedures and Surgical Services
• BC Children's Anesthesia‎
• BC Children's Pre-Anesthesia Clinic

If you are coming in for a procedure or surgery and currently manage pain please request a consultation with APS from your primary sub-specialty team. For example: If your child is scheduled for an orthopedic procedure, contact the orthopedic clinic and ask for a consultation with APS.

There are various comfort strategies that can be provided for infants at home. The following have been shown to be useful in decreasing infant pain:

• Skin-to-skin contact: Infant is placed naked (except for a diaper) on mother's or family member's chest and covered with a blanket.
• Breastfeeding: If you are breastfeeding your infant, your infant may seek to breastfeed more often if they are experiencing pain.
• Non-nutritive sucking: If unable to initiate breastfeeding you may encourage infant to suck on their clean finger or a soother.
• Swaddling: Safely swaddle infant in a blanket to provide comfort. Watch this video for hip safe swaddling tips.
• Sensory stimulation: Rocking, holding, singing, touching.

Pain strategies can be combined to optimize better pain relief, for example, skin-to-skin contact together with breastfeeding and/or non-nutritive sucking.

Medication: If medication is prescribed, always follow the directions on the medication label unless your healthcare provider has told you to take it differently. Provide over-the-counter medication as the pharmacist or healthcare provider has instructed.

Providing support at home will be different for each child. Below are some strategies that can be used together to decrease the pain experience:

• Ask your child regularly if they are comfortable
• Don't wait to treat pain. If medication is prescribed, always follow the directions on the medication label unless your healthcare provider has told you to take it differently. Provide over-the-counter medication as the pharmacist or healthcare provider has instructed.
• Provide comfort approaches.
• Provide a calm and relaxed environment.
• Offer activity that your child enjoys.
• Gradually increase activity to normal levels as instructed by your healthcare team and as your child feels more comfortable.
• Offer pain management approaches such as: use of heat and cold compress, deep breathing, and relaxation techniques (e.g. music and distraction).

For more information, please visit:

• BC Children's Hospital Family Resource Pain Guide - Comfort Approaches
• Pain Relief: Comfort Kit (SickKids Hospital)
• Guide to Chronic Pain in Students

Providing support at home will be different for each youth. It's important to let your youth know that you are there to support them. Collaborate with your youth and make decisions together to manage their pain.

• Ask your youth regularly if they are comfortable.
• Don't wait to treat pain. If medication is prescribed, ensure your youth follows the directions on the medication label unless your healthcare provider has told you to take it differently. Encourage your youth to take over-the-counter medication as the pharmacist or healthcare provider has instructed.
• Encourage your youth to express when they are in pain so that you can support them with coping strategies and ways to self manage their pain.
• Promote a calm and relaxed environment and encourage youth to get enough rest.
• Encourage youth to engage in activities and routines that they enjoy.
• Let your youth know that their pain is real and you believe them.
• Encourage and facilitate pain management approaches such as: use of heat and cold compress, deep breathing, and relaxation techniques (e.g. music and distraction).

Please share these pain tools with your youth:

• Pain Took Kit for Youth (PDF)
• My Care Path
• Pain BC Toolbox (PDF)
• Guide to Chronic Pain in Students (PDF)

If your child's pain gets worse, or if recommended medicine doses and timing does not help, these options may help:

• Phone your BC Children's healthcare provider supporting your child's follow up care. Please use the phone number you received at time of discharge.
• Phone your family doctor or nurse practitioner (NP).
• If you have any questions about the medicines, selecting the appropriate product(s), the doses or how to measure, a pharmacist can assist you.
• If you cannot reach any of the above, call HealthLink BC (8-1-1) to speak to a registered nurse. Tell them your child's current pain medicine is not working.