None of the more than 15 different methods of measuring pain levels in newborns and children under four produces a useful, reliable result. A new method, based on research in the Netherlands by the NWO's Medical Sciences Council, looks set to change this situation. Using the new pain observation scale will make it possible to evaluate pain effectively in children aged up to four.
Pain slows down recovery, interferes with sleep and appetite, prevents children playing and going to school, and impedes proper development. A more effective way of evaluating pain can improve the way young children are cared for when they are ill.
The new method, called APocis, allows doctors and nurses to record seven types of behaviour which are related to pain. Staff observe the child unobtrusively, noting a score for whether it is crying, how it breathes (panting, holding its breath or breathing regularly), the way it moves its arms and fingers (in the case of pain, cramped, clenched fists, wild movements), how it moves its legs (kicking, legs drawn up), the posture of the back and body (cramped, twisted, trembling) and the facial expression (grimace, wrinkled up nose, frown). The total scale gives a measure of the pain: no pain (0), mild pain (1-2), pain (3-4) or severe pain (5-7).
The method is intended to be carried out initially every half hour after a painful medical intervention, for example tonsillectomy. On the basis of the scores, a nurse can determine to what extent it is necessary to treat the pain with medication. A test involving 300 toddlers after medical intervention (ranging from the painless insertion of ear tubes to the painful removal of tonsils and adenoids) has shown that the scale is reliable and valid and that it is easy to use to evaluate acute or chronic pain. Some sixty Dutch hospitals with a paediatric pain group are to receive the set, which includes an instructional video.