[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Nursing](https://durgical.com/en/nursing/) › [Paediatric nursing](https://durgical.com/en/nursing/areas/pediatric/) › Pain in children: procedural and postoperative pain, sucrose, topical anaesthesia, distraction and reassessment

# 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.

Updated Nov 13, 2026

## Key points

- Self-report is the gold standard; illustrated faces scales work from about 3–4 years; behaviour scales for infants and non-verbal children.
- Infants: breastfeeding or a sweet solution, skin-to-skin contact, holding by the caregiver.
- Under 6 years: distraction with toys, video, music or conversation reduces vaccination pain.
- Topical anaesthetic cream needs about 30–60 minutes to work: plan it ahead, per protocol.
- No aspiration in intramuscular injections; give the most painful injection last.
- Reassess with the same tool after each intervention and record the score.

## 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.

[Add to my cards (5)](https://durgical.app/estudiar/?add=/en/nursing/pain-in-children-procedural-and-postoperative-pain-sucrose-topical-anaesthesia-d/)

## Elsewhere in DurgiPedia

- [Pain assessment and pain scales](https://durgical.com/en/clinical-exam/pain-assessment-and-pain-scales/)
- [The psychology of pain: gate control and the biopsychosocial model](https://durgical.com/en/behavioral-science/the-psychology-of-pain-gate-control-and-the-biopsychosocial-model/)

## Connections

## Related 3

- [Pain assessment scales: numeric, visual analogue, faces, behavioural (FLACC) and in dementia](https://durgical.com/en/nursing/pain-assessment-scales-numeric-visual-analogue-faces-behavioural-and-in-dementia/)
- [Non-drug pain relief: what nurses do](https://durgical.com/en/nursing/non-drug-pain-relief-what-nurses-do/)
- [Patient-controlled and epidural analgesia: the nursing checks](https://durgical.com/en/nursing/patient-controlled-and-epidural-analgesia-the-nursing-checks/)

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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)](https://www.who.int/publications/i/item/WER9039) (World Health Organization, 2015); [Pain management during neonatal blood sampling: an overview of systematic reviews (Paediatric & Neonatal Pain 8(3))](https://pmc.ncbi.nlm.nih.gov/articles/PMC13551344/) (Paediatric & Neonatal Pain (open access, CC BY 4.0, PMC13551344), 2026); [Vaccine Administration (General Best Practices for Immunization)](https://www.cdc.gov/vaccines/hcp/imz-best-practices/vaccine-administration.html) (Centers for Disease Control and Prevention, 2024); [Pain assessment tools for infants, children, and adolescents with cancer: a scoping review (Pediatrics International 68:e70433)](https://pmc.ncbi.nlm.nih.gov/articles/PMC13172940/) (Pediatrics International (open access, PMC13172940), 2026).

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Representative model, for educational purposes only.

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Source: https://durgical.com/en/nursing/pain-in-children-procedural-and-postoperative-pain-sucrose-topical-anaesthesia-d/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/nursing/pain-in-children-procedural-and-postoperative-pain-sucrose-topical-anaesthesia-d/