• S Coffman, Y Alvarez, M Pyngolil, R Petit, C Hall, and M Smyth.
• Broward General Medical Center, Ft. Lauderdale, FL 33316, USA.
• Heart Lung. 1997 May 1;26(3):221-8.

ObjectivesTo describe how nurses assess and manage pain in critically ill children.DesignDescriptive, comparative research design, with use of the Indicators of Pain in Critically Ill Children assessment tool.SettingTwelve-bed pediatric intensive care unit in a metropolitan general hospital with a level II pediatric trauma center.ParticipantsTwenty-four pediatric intensive care unit nurses who conducted 112 assessments of 25 critically ill children.ResultsPain indicators selected most frequently by nurses included cardiovascular and respiratory changes (increased heart rate, respiratory rate, and blood pressure), followed by behavioral indicators (irritable/fussy, verbalizing pain, crying), and neuromuscular responses (tenseness/rigidity, squirming, drawing up legs). The average number of pain indicators selected during each medication event was 5.3. More indicators were selected for trauma, surgery, and younger patients; fewer indicators were selected for patients receiving ventilation treatment.ConclusionPain assessment of critically ill children includes unique indicators, as compared to less sick children, and must take into account the child's decreased ability to communicate pain.

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