A systematic review to evaluate pain assessment tools for children with cognitive impairments
Authors: Billingsley, L. and Singleton, H.
Conference: Phi Mu Chapter Annual Conference 2025
Abstract:Background Pain assessment in children with cognitive impairments who cannot self-report presents a unique challenge in pediatric care. While self-reporting is the gold standard for pain assessment, it is often not feasible for children with cognitive or neurological impairments. Inaccurate pain assessment in this group can result in under-treatment, making it essential to evaluate and refine pain assessment tools used in clinical practice.
Methods A systematic review was conducted using the Population, Exposure, Outcome (PEO) framework to evaluate pain assessment tools for children with cognitive impairments. A search of the EBSCO database identified 132 studies, which were narrowed down to 62 after applying inclusion/exclusion criteria. Following further screening, three studies were selected: a systematic review, a quantitative study, and a qualitative study. These were appraised using appropriate critical appraisal tools: CASP for the systematic and qualitative studies, and MMAT for the quantitative study.
Findings The studies reviewed suggest that pain assessment tools such as the NCCPC-PV and FLACC scales are effective for assessing pain in children with cognitive impairments, but they also highlight certain limitations. While these tools generally provide reliable results, their use in clinical practice can be inconsistent. Caregiver input plays a crucial role in interpreting the child’s pain, as they offer insights into the child’s baseline behavior and can help identify changes indicative of pain. Additionally, all studies emphasize the importance of individualized assessment, as children with cognitive impairments express pain differently, and standardized tools may not capture these variations. The findings also point to a need for ongoing staff education to ensure accurate and confident use of these tools.
Conclusion The review confirms that while current pain assessment tools like NCCPC-PV and FLACC are useful, they require adaptation to each child’s unique needs. Caregiver involvement and staff training are critical in enhancing the accuracy of pain assessments in children with cognitive impairments.
Implications for Practice For pediatric nurses, this review underscores the importance of using personalized pain assessment tools and working closely with caregivers to accurately gauge pain. Continuous professional development in pain assessment is necessary to improve care and outcomes for children with cognitive impairments. Further research is needed to refine existing tools and explore their applicability across diverse clinical settings.
Source: Manual