Pain tolerance varies greatly among people and in the same person over time.

A decrease in pain tolerance is evident in children, teenagers and elderly.

Infants in the first 1 to 2 days after birth are less sensitive to pain.

A full behavioural response to pain is apparent at 3 to 12 months of age.

In children, the central nervous system tracts that conduct pain are completely myelinated by 30 weeks of intra uterine life.

Cortical interconnections with the thalamus, those tracts that play a role in higher perception of pain, are complete by 24 weeks.

The descending inhibitory controllers of pain, though, are deficient in the neonate.

This leads to the likelihood that neonates, particularly preterm neonates, may be more sensitive to pain than older children and adults.

There is no easy or scientific way to tell how much pain a neonate is having.

Toddlers may become very quiet and inactive while in pain or may become very active. Parents report that ‘they aren’t acting like they normally do’.

Sometimes toddlers manifest their pain and fear by aggressive outbursts.

School-age children are more accurate in communicating about their pain.

By the age of 8 years, children can very reliably describe location of pain.

Symptom scales and self-report tools are appropriate for most children 4 years of age and older.

Children older than 8 years who understand the concept of order or number can use a VAS scale.

Luc Peeters, MSc.Ost.