Management of critical care emergencies in children with autism spectrum disorder

Table 8 Pain assessment tools, guidelines for interpreting behavioral and physiological indicators of pain, and safe and effective pain management strategies for children with autism spectrum disorder¹

Protocol component	Guidelines
Pain assessment tools
Non-communicating children's pain checklist	Use to assess pain in non-verbal children. Includes categories like vocal expressions, social behavior, and body/limb movements
Face, legs, activity, cry, consolability scale	Use for children who can’t communicate their pain. Scores behaviors in five categories to determine pain level
Faces pain scale-revised	Use for children who can understand and point to facial expressions that correspond to their pain level
Visual analog scale	Use for children capable of understanding and marking a point on a line that represents their pain intensity
Behavioral indicators of pain
Vocalizations	Moaning, crying, or screaming
Facial expressions	Grimacing, frowning, or tightly closed eyes
Body movements	Restlessness, rigidity, flinching, or guarding specific areas
Changes in social behavior	Withdrawal, irritability, or aggression
Changes in routine activities	Refusal to eat, sleep disturbances, or reluctance to move
Physiological indicators of pain
Heart rate	Increased heart rate
Respiratory rate	Increased respiratory rate
Blood pressure	Elevated blood pressure
Sweating	Increased sweating (diaphoresis)
Muscle tension	Observed muscle tension or stiffness
Pain management strategies
Non-pharmacological interventions	Distraction techniques (e.g., videos, games), comfort items, relaxation techniques (e.g., deep breathing, guided imagery)
Pharmacological interventions
Acetaminophen	Use for mild to moderate pain, considering dosage adjustments for weight and age
Non-steroidal anti-inflammatory drugs (e.g., ibuprofen)	Use for mild to moderate pain and inflammation, monitoring for potential gastrointestinal or renal side effects
Opioids	Use for severe pain, with careful monitoring for side effects and potential for dependence
Local anesthetics	Use topical or local anesthetics for procedural pain management
Alternative therapies	Consider options such as physical therapy, occupational therapy, or acupuncture as adjuncts to pain management
Medication sensitivities
Allergies	Verify and document any known medication allergies or adverse reactions
Comorbid conditions	Consider the impact of comorbid conditions on medication choice and dosing
Drug interactions	Review all current medications to avoid potential drug interactions
Monitoring and reassessment
Regular monitoring	Regularly reassess pain levels using appropriate tools, and adjust management strategies as needed
Documentation	Document pain assessments, interventions, and outcomes in the child’s medical record
Family and caregiver input	Involve caregivers in the pain assessment and management process to provide additional insights and support

¹This table format provides a comprehensive approach to assessing and managing pain in children with autism spectrum disorder.