303: Pain Assessment in Non-Verbal Children With Neurocognitive Impairment: Current Tools and Challenges

Topic: Clinical Science
Subtopic: Non-specific to any diagnosis, Assessment and Measurement of Pain/Nociception, Pain in Special Populations , Pain in special populations (e.g. neonates, children, teens, elderly, neurodegenerative diseases)

Background and Aims: Pain in children with communication or neurocognitive impairment remains a complex and frequently under-recognized clinical challenge. Accurate assessment is essential for effective management but is often hindered by non-verbal presentation, developmental variability, and the influence of sedation or illness. This review aims to explore commonly used observational pain assessment tools and highlight their clinical strengths, limitations, and applicability in non-verbal pediatric populations.

Methods: This review examines commonly used observational pain assessment tools for non-verbal children, focusing on their development, clinical application, and limitations. Particular attention is given to the Face, Legs, Activity, Cry, and Consolability scale and the Non-Communicating Children’s Pain Checklist. Literature describing validation, adaptation for children with cognitive impairment, and use in postoperative or critical care settings was explored to understand their clinical relevance.

Results: Both tools demonstrate strong clinical utility and reliability in identifying behavioral indicators of pain. The revised behavioral descriptors of the Face, Legs, Activity, Cry, and Consolability scale improved applicability for children with communication barriers, while the Non-Communicating Children’s Pain Checklist offers broader behavioral domains tailored to significant cognitive impairment. Despite effectiveness, both tools require trained observers and familiarity to ensure accurate interpretation.

Conclusions: Validated observational tools support improved pain recognition in non-verbal pediatric populations; however, individualized assessment remains essential. Differences between available instruments highlight the need for clinical judgment, appropriate training, and context-based tool selection. Enhanced awareness of assessment limitations may improve pain management strategies, particularly for children with profound neurocognitive impairment or critical illness.

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Presenting Author: Roaa Shaban
Submitting Author: Roaa Shaban

Senior Author: Roaa Shaban

IASP 2026 Global Year theme of Neuropathic Pain: No