Infant Pain and Stress Assessment; An Integrative Review

Open Access
McInnis, Molly Kathleen
Area of Honors:
Bachelor of Science
Document Type:
Thesis Supervisors:
  • Kim Kopenhaver Haidet, Thesis Supervisor
  • Donna M. Fick, Honors Advisor
  • infants
  • pain
  • stress
  • assessment tools
Accurate infant pain and stress assessment is paramount to the appropriate management of pain and stress states. PURPOSE: To analyze recent validation research concerning infant pain tools and to make recommendations to clinicians and researchers regarding the use of these tools. DESIGN AND METHODS: An integrated review of the literature was conducted in October 2009 using the PubMed database with the search terms measures of stress and pain scales. Results were limited to validation studies published between 2005-2009 using neonatal samples. SUBJECTS: 13 pain instruments within 19 studies were reviewed. Tools were assessed according to study design and psychometrics available. RESULTS: Of the 13 tools reviewed, 7 used strictly behavioral cues and 6 used multidimensional cues. The 19 studies were conducted internationally and were observational or quasi-experimental in design. Full term, preterm, and mixed age samples were used, and the tools were tested for a wide range of psychometrics, including content, construct, and criterion validity, interrater and intrarater reliability, and internal consistency. Several studies conducted nurse reports of feasibility. DISCUSSION: Several pain/stress tools emerged as the most suitable for research and clinical practices, as well as for the purpose of assessing procedural and prolonged pain. Several studies tested for the difference between pain and stress. It is important that future validation studies for infant pain include more accurate reporting of descriptive statistics, tool psychometrics, rater training on the use of the tool, and the gestational age and postnatal age of infant subjects.