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Babies and young children cannot tell their doctors and nurses that they are having pain, or if their pain medicine is working. So, measuring scales have been created to help child caretakers tell how the children are feeling.

Cincinnati Children's Hospital Medical Center, uses these pain scales:

• For babies, the Neonatal Infant Pain Scale (NIPS) is used to assess pain levels. NIPS is a set of behaviors doctors and nurses can look for to see if a baby is having pain. This scale is used in the NICU.
• The FLACC (Face, Legs, Activity, Cry, Consolability) is used to assess pain levels on children from birth and older including developmentally delayed patients; excluding patients who are paralyzed or have spasticity. It is an observational scale that is used in patients who cannot report their pain.
• For children three to seven years old, the Oucher can be used. The Oucher shows pictures of young children who are comfortable or in different degrees of pain. The child points to the picture of the face he / she feels most like.
• For older children and adults, a scale of 0 to 10 is used (the Numeric Rating Scale). Zero means no pain and 10 is the worst pain they can imagine.
• For unconscious children on a ventilator, the COMFORT scale is used to help determine if they are as comfortable as possible.
• Your child will be asked how he / she feels. If your child is too young or disabled to answer, you will be asked how you think your child is feeling. As the parent, your opinion on your child's comfort is very important.

Pain has many causes including illness, surgery, tests and injury. Sometimes, no cause for pain can be found.

Children describe their pain in many ways. Words such as achy, sharp, dull, electrical, burning, throbbing, pressure, or stabbing can help your child's doctor find the right medicine to treat the pain.

Older children will say they hurt, but sometimes they cannot describe their pain clearly. Younger children may cry or hold very still and try not to move. They may have a poor appetite, or be irritable, or cranky. They may not be able to sleep well, or they may want to sleep a lot.

Children in pain usually do not do the things they would be doing if they were not in pain. They may choose not to play, read, talk with you, or watch TV.

Why is treating pain important?

Treating pain is more than just making a nasty sensation feel better. Pain can affect your child's ability to breathe well, move around or even eat normally. Pain can affect activity, sleep and energy levels as well as alter moods and make it hard for you to talk with your child. Pain, management can help get your child home sooner by speeding up the healing process.

How is pain treated?

Pain is treated in many different ways. The treatments chosen for your child will depend on your child's circumstances, cause of pain, and medical and psychological condition. (See also Medical Pain, Inpatient Surgical Pain, Outpatient Surgical Pain and Cancer Pain.)

It is very important to understand that pain treatment is an ongoing process. Your child's nurse or doctor will ask you and your child how well the treatment is working and if any side effects need to be addressed.

Your child will continue to be checked for pain and possible side effects, and treatment will be changed as needed. At Cincinnati Children's, the hospital staff wants to make sure that pain is being relieved as best as possible, with minimum side effects.

Call your child's doctor if the pain is not being relieved by the treatments prescribed, or if you think your child is having a side effect from a treatment.

Your child's doctor or nurse will explain how the medicines and other pain treatments work. They will help you use each of them to make your child as comfortable as possible.

Some pain can be expected after surgery. Talk with your child's surgeon or anesthesiologist about how pain is going to be controlled afterwards. The pain of an injury or illness cannot be planned for, but can be treated quickly after the safety of the child is assured.

• Pain, Pain, Go Away: Helping Children with Pain, a Web site created to help parents understand pain in children