Table 2. Challenges in assessing pediatric pain are numerous but there are strategies to help clinicians more reliably measure this pain, allowing for enhanced treatment.

Potential pitfall: Patient is…	Countermeasures	Comments
Preverbal, nonverbal	Using nociceptive stimuli, ascertain facial expressions, movements, or sounds that correlate with pain	Facial expressions, movements, postures, and verbalizations may correlate to pain intensities
Cognitively impaired
Distressed with an unknown cause	Consider separation anxiety, fear, hunger, discomfort	Differential diagnosis
Refusing to talk about suspected pain	May fear that admitting pain will lead to injection or other unpleasant treatment	Rely on other signs (facial expressions, movements, sounds) to assess pain. Build trust with the child
	May fear that admitting pain will prolong the hospital stay
	May have a culturally inspired or familial attitude that complaining about pain is a sign of weakness or not being “brave”	Encourage the child to talk about the pain in a noncomplaining “brave” way
Unable to describe the pain	Suggest terms (“burning” or “deep” or “cramps”) and ask about pain locations	“Normalize” the discussion of pain so the patient does not feel that he/she is an extreme case