Relationship of cues to assessed infant pain level

Cues that 46 pediatric nurses with a BS in Nursing reported as key to their pain assessments of 88 videotaped infants, ages 0 to 12 months, are identified. Frequencies with which these cues were used for infants of different ages and the relationships between key cues and assessed levels of pain are described. Greater pain was strongly associated with tears, stiff posture, guarding, and fisting. Greater pain was moderately associated with inadequate type or dosage of analgesia, more recent surgery, inconsolability, difficult to distract, does not focus on surroundings, frown, grimace, wrinkled face, flushed face, pain cry, and increased arousal in response to touch of sore area. Internurse variability in cue use was sizable. Most of the often-used cues had weak or no association with assessed pain level. Only consolability, pain cry, grimace, and stiff posture were frequently used and correlated > .51 with assessed level of pain.