David, age 15 months, is recovering from surgery to remove Wilms’ tumor. Which findings best indicate that the child is free from pain?
A. Increased heart rate
B. Decreased urine output
C. Increased interest in play
D. Decreased appetite
Correct Answer: C. Increased interest in play
One of the most valuable clues to pain is a behavior change. A toddler who is pain-free likes to play. In toddlers, verbal skills remain limited and quite inconsistent. Pain-related behaviors are still the main indicator for assessments in this age group. Nonverbal behaviors, such as facial expression, limb movement, grasping, holding, and crying, are considered more reliable and objective measures of pain than self-reports.
Option A: An increased heart rate may indicate increased pain. Uncontrolled pain may elevate blood pressure, pulse rate, adrenaline, and cortisol serum levels by simultaneously stimulating the sympathetic-autonomic nervous system and release of adrenal hormones.
Option B: Decreased urine output may signify dehydration. The body’s initial responses to dehydration are thirst to increase water intake and decreased urine output to try to conserve water loss. The urine will become concentrated and more yellow in color. As the level of water loss increases, more symptoms can become apparent.
Option D: A child in pain is less likely to consume food or fluids. Some behaviors are contrary to other proposed behaviors in a study, for example, reduction of activity or quiet versus jerking, arching back, or kicking. Others are very broad, for example, having disturbed sleep, eating less than usual, being irritable, and playing less than usual. While these behaviors may arouse suspicion concerning the presence of pain, they are nonspecific and associated with a wide diversity of non-painful conditions.