Vulnerability and Pediatric Pain

Healthcare disparities amplify vulnerabilities in infants and children. In the context of pain, vulnerable individuals are those whose pain often goes under-appreciated, -recognized, or -treated. Vulnerability to pain arises due to multiple and interacting sources including inherent vulnerability, situational vulnerability, and pathogenic vulnerability. Some groups are more vulnerable to pain than others, which will be the focus of this article: sick and preterm newborns, and children with intellectual disabilities and complex communication needs, including children with cerebral palsy. In this conceptual review, we highlight vulnerabilities to pain in these vulnerable populations and identify how we have obligations to minimize harm experienced by sick and preterm newborns, and children with developmental disabilities. Although pain is a universal experience, not everyone has equal and fair access to the necessary services for adequate pain management. This is particularly the case for sick and preterm babies who are exposed to large numbers of painful procedures during their hospitalization, and individuals with intellectual disability and complex communication needs, who have limited language and/or speech capacity to self-report pain. Therefore, explicit reflection on vulnerability reinforces a collective responsibility to provide effective assessment and management of pain in particularly vulnerable pediatric populations.