Pain in children: procedural and postoperative pain, sucrose, topical anaesthesia, distraction and reassessment
- Safe practice
Assess pain with a tool that fits the child's age, prevent procedural pain with simple measures, give prescribed relief and check again afterwards.
What it is
Children feel pain like adults but may not be able to report it, so the nurse chooses the assessment method by age and ability: self-report when the child can give it, behaviour-based tools for infants and children who cannot. Procedural pain can be reduced with low-cost measures: breastfeeding or a sweet solution in infants, holding by the caregiver, distraction, honest neutral language and, where available, a topical anaesthetic. After surgery and after every measure, pain is checked again with the same tool. Analgesics are given only as prescribed and per protocol; this page gives no doses.
What it requires
- Sweet solutions probably reduce pain from heel pricks and venipuncture in newborns; side effects were rare and minor.
- Skin-to-skin contact likely reduces pain scores and crying after heel pricks.
- Topical anaesthetics are effective but slow; WHO does not recommend them for routine programme use because of cost and time.
- Warming the vaccine, rubbing the site and giving oral analgesics beforehand are not recommended for vaccination pain.
- Behaviour tools named in reviews include FLACC and COMFORT; faces scales include FPS-R. Use the version validated in the institution.
Components
- Assessment: an age-suited tool, the parent's report, and a regular reassessment time.
- Non-drug measures: positioning, breastfeeding or sweet solution, skin-to-skin, distraction, relaxation.
- Drug measures as prescribed: topical anaesthetic, analgesics, sedation per protocol.
- Technique: no aspiration, painful injections last, procedures in a treatment room.
How it is applied (and why)
- Choose the tool by age and ability: self-report if possible, a behaviour scale if not — the wrong tool misses pain.
- Ask the parent what is normal for the child and how they show pain — parents notice changes staff may not.
- Before a needle, plan the topical anaesthetic early if prescribed — it needs time on the skin.
- For infants, breastfeed or give a sweet solution as the protocol says, or hold skin to skin — these blunt the pain response.
- Hold the young child on the caregiver's lap and distract with toys, songs or bubbles — attention away from pain lowers it.
- Use neutral words ('here I go') and avoid 'it will only hurt a bit' — fear and broken trust increase pain.
- Inject without aspiration and leave the most painful injection for last — both reduce pain.
- After surgery, score pain at the interval set by the protocol and give prescribed analgesia as ordered — regular scores show when relief is needed.
- Reassess with the same tool after every measure and record it — only the score shows if relief worked.
In nursing practice
- Behaviour tools rate what a child does (face, movement, crying, consolability) when the child cannot report pain.
- Child and parent reports can differ; parent input adds to, but does not replace, the child's report.
- For adolescents, distraction did not reduce vaccination pain; give information, control and the general measures.
- Topical anaesthetics are not used in infants under 12 months who take drugs that can cause methaemoglobinaemia.
- For patient- or nurse-controlled analgesia and epidurals, follow the linked page and the institution's protocol.
Common mistakes
- Using an adult numeric scale with a child too young to use it.
- Not reassessing after giving analgesia or a non-drug measure.
- Believing that repeated procedures make children tolerant of pain.
- Applying the topical anaesthetic too late to work.
- Rubbing the injection site or warming the vaccine, which do not help.
Test yourself
Think of the answer, then tap the question to see it.
What is the gold standard of pain assessment in a child who can talk?
The child's own report, using a tool suited to age, such as a faces scale from about 3–4 years.
Which simple measures reduce needle pain in infants?
Breastfeeding or a sweet solution, skin-to-skin contact and holding by the caregiver.
Why plan a topical anaesthetic ahead?
It needs about 30–60 minutes on the skin to work.
In which order are several injections given in one visit?
In order of increasing painfulness, so the most painful one is given last.
What must follow every pain intervention?
Reassessment with the same tool, recorded in the chart.
Elsewhere in DurgiPedia
Connections
Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order.
Sources: Reducing pain at the time of vaccination: WHO position paper, September 2015 (Weekly Epidemiological Record 90(39):505–516) (World Health Organization, 2015); Pain management during neonatal blood sampling: an overview of systematic reviews (Paediatric & Neonatal Pain 8(3)) (Paediatric & Neonatal Pain (open access, CC BY 4.0, PMC13551344), 2026); Vaccine Administration (General Best Practices for Immunization) (Centers for Disease Control and Prevention, 2024); Pain assessment tools for infants, children, and adolescents with cancer: a scoping review (Pediatrics International 68:e70433) (Pediatrics International (open access, PMC13172940), 2026).
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Representative model, for educational purposes only.