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Appendix F Using the QUESTT approach to assess the child

The ‘Q’ in QUESTT: Question the child and parent/caregiver.

  • By 18 months, most children have a word to describe pain for example, a ‘hurt’ or an ‘eina’.
  • Pain intensity can be described by children with a cognitive age of 4 years old.
  • The gold standard for reporting pain is self-reporting as it is subjective and individual to the child.
  • Parents understand and know their child therefore they will be able to recognise subtle behavioural changes.
  • Parents may be more motivated to recognise pain in their child in order to help alleviate it.

Use the following acronym to ask questions about the pain:

P: Precipitating, palliating, provoking factors:

  • What causes the pain?
  • What makes the pain better?
  • What makes the pain worse?

Q: Quality, quantity:

  • What does the pain feel like?
  • Is it sharp, stabbing, burning, and/or stinging?

R: Radiation, related factors:

  • Where is the pain?
  • Is it in one place or does the pain move? If so, where does it move to?

SS: Severity, site:

  • How severe is the pain at the site?
  • Score the intensity using pain rating scales (see appendix G).

TT: Time course, treatment:

  • When did it start?
  • Is it there all the time?
  • Is it mainly at night or in the day?
  • Is the pain worse when you move?
  • How long does the pain last?

The ‘U’ in QUESTT: Use pain rating scales.

See appendix G for more information on age appropriate pain rating scales.

The ‘E’ in QUESTT: Evaluate behaviour and physiological changes.

Age Acute pain Chronic pain
Newborns Crying and moaning Apathy
Muscle rigidity Lack of interest in surrounding
Flexion and flailing Irritability
Diaphoresis (perspiring a lot) Changes in sleeping and eating patterns
Irritability
Guarding
Reflex withdrawal to painful procedures
Toddlers and pre-schoolers Crying, screaming and vocalizing hurt Moody
Facial expression: eye squeeze, brow bulge, open mouth, taut tongue, chin quivering, grimacing Unruly behaviour
Thrashing of arms and legs Decreased play
Pushes away, withdraws limbs Change in appetite
Clings to parent/caregiver Change in sleep pattern
Restless and irritable
School-aged children Crying School refusal
Muscle rigidity, clenched fists, white knuckles, clenched teeth, closed eyes Declining school performance
Stalling techniques when anticipating a painful procedure Decreased socialisation
Anxiety and depression
Disturbed sleep
Adolescents Verbalisation of pain Depression and anxiety
Muscle tension Low self-esteem
Loss of appetite Decreased socialisation
Insomnia or hypersomnia Drug and/or alcohol abuse
Insomnia or hypersomnia

The ‘S’ in QUESTT: Secure parent or caregiver’s involvement.

The ‘T’ in QUESTT: Take the cause of the pain into account.

The ‘T’ in QUESTT: Take action and evaluate the results.