Barriers to pain management in infants and children are vast and include inaccuracies regarding pathological mechanisms of pain and deficient knowledge of methods of assessing pain (Srouji et?al., 2010). Despite recent advances in our understanding of children’s pain, difficulties lie in distinguishing pain from other ?sources such as anxiety and stress (Voepel-Lewis 2011). The unique challengers assessing pain in children are age, development, ?communication skills and past experiences of pain (Srouji et al., 2010). These challengers are increased when there is varying ?levels of cognitive ability, and children with cognitive impairment are at greater risk of under treatment (Clen-Lim et al., 2012). The common problem is the inability to verbally self-report their pain and the frequent exposure to pain due to association of disease pain and the high impact on quality of life (Massaro et al., 2013). Measurement of pain is essential and is assessed to ?determine the effectiveness of the treatments (Massaro et al., 2013). For children with communication difficulties a valid and reliable tool should always be used (Massaro et al., 2013). The Faces, Legs, Activity, Cry and Consolability (FLACC) behavioural tool developed by Merkel, Voepel-Lewis, Shayevitz, and Malviya (1997) was not originally designed for cognitively impaired children however has shown to be a valid and reliable tool in this population (Massaro et al., 2013).
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