Neonatal Pain Assessment

Original Editor - REDISHA JAKIBANJAR Top Contributors - Redisha Jakibanjar and Kim Jackson


The International Association for the Study of Pain (IASP) defines pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.”[1][2][3]

Pain can be classified as nociceptive and neuropathic on the basis of pathology, nonmalignant and malignant on the basis of etiology, acute and chronic on the basis of duration and on the basis of location, it can be classified by body sites. [3]

Pain is now considered as the fifth vital sign hence it should be noted at any time. [3]

Neonatal Pain

Neonates have 30-40% lower pain threshold than the adult and other age group and they have lower pain tolerance. [2]

Premature infants are more sensitive to pain stimuli than full-term infants because of immature sensory processing and inhibition controls. It leads to lower thresholds for excitation and sensitization, thereby potentially maximizing the central effects of tissue-damaging inputs.[2]

Pain Assessment in Neonates

Pain assessment is the path for pain management. For the assessment of pain, a standardized and validated outcome tool is necessary. Self-report is the best method for pain assessment as pain is subjective. But, in the case of neonates, they couldn’t communicate. So, observational and behavioral tools are the best substitutions.[2][3]

A Conceptual Framework For The Measurement of Neonatal Pain

Neonatal pain assessment conceptual framework

Assessment Tools

Some of the outcome tools used in the assessment are[2][3]:

  • CRIES pain rating scale
  • FLACC assessment tool
  • Behavioral pain score
  • COMFORT neo


  1. Cohen M, Quintner J, van Rysewyk S. Reconsidering the International Association for the Study of Pain definition of pain. Pain reports. 2018 Mar;3(2).
  2. 2.0 2.1 2.2 2.3 2.4 2.5 Cong X, McGrath JM, Cusson RM, Zhang D. Pain assessment and measurement in neonates: an updated review. Advances in Neonatal Care. 2013 Dec 1;13(6):379-95.
  3. 3.0 3.1 3.2 3.3 3.4 Kahsay H. Assessment and treatment of pain in pediatric patients. Current Pediatric Research. 2017.