Paediatric Pain Assessment in the Emergency Department
Overview
Pain is common in children presenting to the ED and is frequently under‑recognised and undertreated. A pragmatic, reproducible approach at triage and throughout care improves timeliness of analgesia, reduces distress and supports procedural planning.
Use an age‑appropriate validated tool, record the score at triage and after interventions, and combine self‑report (when possible) with behavioural observation and parental/carer input.
The RCEM composite 4‑category tool (No / Mild / Moderate / Severe) is an ED‑friendly default because it integrates faces, behaviour and injury examples and maps easily to analgesic choices.
Core principles
- Assess and document pain at triage with an age‑appropriate tool; re‑score after each intervention and record the response.
- Use a simple 4‑category system (No / Mild / Moderate / Severe) to guide initial analgesia and escalation.
- Tailor assessment to age, developmental level and communication ability; use validated behavioural tools and parental report for non‑verbal or developmentally impaired children.
- Apply condition‑specific guidance where relevant (e.g., analgesia within 30 minutes for acute sickle cell painful episodes) (NICE CG143).
- Observe prescribing safety guidance (notably MHRA restrictions on codeine) and document counselling for parents/carers.
The RCEM 4‑category paediatric pain assessment (practical ED tool)
Use this composite tool at triage and for ongoing monitoring unless local policy specifies another validated instrument.