Self-reports can be used reliably for developmentally normal children over the age of four years. The pictorial FACES pain scale, which can be used for children age three years and up, demonstrates six cartoon facial expressions from no distress to extreme distress (Fig 130-1): Face 0: happy, no hurt; Face 1: hurts a little bit;
Face 2: hurts a little more; Face 3: hurts even more; Face 4: hurts whole lot; Face 5: hurts as much as you can imagine. It is useful in the ED setting as the scale is compact, can be purchased in the form of a pin or badge, and can pinned to a coat, making it always available. The Oucher pain scale is a photographic serial representation of children demonstrating the facial appearance of increasing intensity of pain. There are a number of versions of this assessment tool depicting various ethnic/racial groups. There are some limitations to its utility in the ED in that the photographic depiction cards are awkwardly large and are prone to being misplaced or removed. Numeric scales can be used with children age five years and older provided that they can count and have a concept of the relative magnitude of numbers. They also have the advantage of not requiring special photographic images. The Visual Analogue Scale (VAS) is a 0 to 10 numeric scale, which requires a degree of abstract thought, can be used in children age 7 years and older. The VAS and numeric scales are easy to use in the ED, and require no specific equipment.
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