**4.4 Unaided systems**

During pain assessments of communication vulnerable children, clinicians or researchers can also ask the child pain-related questions providing them three options: "Yes", "No", "Not sure". Communication vulnerable children often have clear yes/no responses (e.g. head nodding to indicate "Yes"). Should communication vulnerable children have no typical yes/no responses, the clinician can ask the child to blink their eyes ("Yes"), close their eyes ("No"), or to look away to indicate that they are not sure what to answer. In this case, the clinician should refrain from asking more than one close-ended question at a time (e.g. "Does it hurt?" and "Do you hurt in your [*body part*]?"). The clinician should rather ask only one question (e.g. "Does it hurt?") to ensure that the child can give an appropriate response.

**151**

*Supporting Communication Vulnerable Children to Communicate Their Pain*

Appropriate pain management relies on the ability to accurately assess pain. For children, a common method to communicate pain is the use of pain scales [13]. Pain scales that are often used in clinical and research practice typically depict faces, colours or numeric grading [13]. An example of faces pain scales that are built on how children communicate their feeling(s) in a facial expression is the Faces Pain Scale-Revised (FPS-R) [78]. Colours and numeric grading are typically used in analogue scales that are based on increments to indicate pain severity, and these allow children to show that a somewhat larger or smaller pain is experienced (examples are the Colour Analogue Scale (CAS) [79]; and the Numeric Rating Scale (NRS) [80]). In a systematic review by Birnie et al. [23] on recommendations for the selection of children's self-report rating scales for pain intensity, the FPS-R, CAS and NRS were recommended for self-report of acute pain. However, though these self-report scales are freely available, clinicians and researchers should keep in mind that they may not be effective for everyone [13]. For example, while some of these scales may not need expressive language, receptive language skills are crucial, as children are expected to comprehend and know the meaning of words such as

This chapter aimed to address communication vulnerable children's experiences

of pain and their need for alternative ways to express their pain so as to receive appropriate pain treatment. The concept of communication vulnerability was explained framed in the context of the adapted social communication model of pain for communication vulnerable children. According to this model, there are many ways in which communication vulnerable children can encode (B) their pain experience (A). The model also emphasises the need for observers (C) to be open to other communication modes that children may use to communicate their pain. The discussion centred on the pain experiences of communication vulnerable children such as children with Down syndrome, with intellectual disabilities, autism or cerebral palsy, as well as of children in intensive care settings who experience temporary communication vulnerability. The chapter concludes with suggestions on how AAC strategies can be used to support communication vulnerable children

The author would like to thank and acknowledge Prof Stefan Nilsson from Gothenburg University and Prof Juan Bornman from the Centre for AAC, University of Pretoria for their valuable comments to improve the content of this manuscript. The author would further like to thank Ms Olivia Loots for the draw-

The funding from the National Research Foundation in South Africa to this

*DOI: http://dx.doi.org/10.5772/intechopen.93588*

"hurt" or "pain" when using these scales [26].

**4.5 Pain scales**

**5. Conclusion**

in communicating their pain.

project is also acknowledged.

**Conflict of interest**

ings as portrayed in the three figures in this chapter.

The author declares no conflict of interest.

**Acknowledgements**

*Supporting Communication Vulnerable Children to Communicate Their Pain DOI: http://dx.doi.org/10.5772/intechopen.93588*

#### **4.5 Pain scales**

*Pain Management - Practices, Novel Therapies and Bioactives*

is instructed to use their eyes to look at a picture or word on the display and then glance at the communication partner (observer), who will then verbally confirm the

During pain assessments of communication vulnerable children, clinicians or researchers can also ask the child pain-related questions providing them three options: "Yes", "No", "Not sure". Communication vulnerable children often have clear yes/no responses (e.g. head nodding to indicate "Yes"). Should communication vulnerable children have no typical yes/no responses, the clinician can ask the child to blink their eyes ("Yes"), close their eyes ("No"), or to look away to indicate that they are not sure what to answer. In this case, the clinician should refrain from asking more than one close-ended question at a time (e.g. "Does it hurt?" and "Do you hurt in your [*body part*]?"). The clinician should rather ask only one question (e.g. "Does it hurt?") to ensure that the child can give an

child's selection [15]. **Figure 3** is an example of an eye-gaze flipchart display.

**150**

**4.4 Unaided systems**

**Figure 3.** *Eye gaze flip chart.*

**Figure 2.**

*Visual schedule of a needle procedure.*

appropriate response.

Appropriate pain management relies on the ability to accurately assess pain. For children, a common method to communicate pain is the use of pain scales [13]. Pain scales that are often used in clinical and research practice typically depict faces, colours or numeric grading [13]. An example of faces pain scales that are built on how children communicate their feeling(s) in a facial expression is the Faces Pain Scale-Revised (FPS-R) [78]. Colours and numeric grading are typically used in analogue scales that are based on increments to indicate pain severity, and these allow children to show that a somewhat larger or smaller pain is experienced (examples are the Colour Analogue Scale (CAS) [79]; and the Numeric Rating Scale (NRS) [80]). In a systematic review by Birnie et al. [23] on recommendations for the selection of children's self-report rating scales for pain intensity, the FPS-R, CAS and NRS were recommended for self-report of acute pain. However, though these self-report scales are freely available, clinicians and researchers should keep in mind that they may not be effective for everyone [13]. For example, while some of these scales may not need expressive language, receptive language skills are crucial, as children are expected to comprehend and know the meaning of words such as "hurt" or "pain" when using these scales [26].
