Methods of Assessing Postoperative Pain in Infants (0-12 Months): A Scoping Review

Infants undergoing surgery experience postoperative pain beyond acute short-lasting procedural pain and have variable analgesic needs. Assessing pain in this nonverbal population presents challenges for clinicians and parents. Given the short- and long-term effects of pain and its treatment, timely and accurate assessment of pain is vital. The aim of this scoping review was to map pain assessment methods used by clinicians and parents to assess postoperative pain in infants aged 0 to 12 months and describe their psychometric properties. The review was guided by Arksey and O'Malley's (2005) five-stage framework. We searched Embase, Medline, PsycINFO, Scopus, Cochrane, CINAHL from January 2014 to March 2026 to retrieve eligible studies. Thirty-five studies (four systematic reviews, eight trials, and 23 original research studies) were included. We identified 20 different pain assessment methods used by clinicians. Postoperative pain categorization was inconsistent and lacked clear differentiation. There were inconsistencies in the duration, frequency, and documentation of pain scores. Several studies highlighted a discordance between pain scores, clinical judgment, and treatment decisions. Some tools had been used without being validated for postoperative pain or the age group studied. We found no studies of formal pain assessment methods used by parents. Observational subjectivity, the lack of current validity testing and standardization in methods, together with the multi-faceted nature of pain reflects the need for a multidimensional approach to assess pain. Research is warranted on continuous monitoring of postoperative pain in infants and family involvement in pain assessment.