LAUSR

Pain assessment is something that every nurse caring for children will need to undertake, yet it is something that is not always done effectively, and some children are more at risk of poor pain assessment than others. Assessing typically developing children’s pain can be challenging and children are susceptible to supoptimal pain management (Brudvik, Moutte, Baste, & Morken, 2017; Carter & Simons, 2014; Twycross, 2007). Many factors such as the child’s gender (Earp et al., 2019), whether they are preverbal (Andersen, Nakstad, Jylli, Campbell-Yeo, & Anderzen-Carlsson, 2019) and whether their pain is acute or chronic, can be influential. It is also clear that assessment is influenced by the perspective of who is undertaking the assessment, so self-report of pain by children can differ from that of their parents/carers or healthcare professionals, with healthcare professionals often underestimating pain (Brudvik et al., 2017). Assessing pain in some groups of children, such as children with special needs (Quinn, Seibold, & Hayman, 2015) or children with cerebral palsy (Riquelme, Pades Jiménez, & Montoya, 2018), can be seen as additionally challenging. Assessing the pain of children who are so profoundly cognitively impaired that they are unable to self-report their pain, as they lack the capacity to either verbally communicate or purposefully communicate their pain through other systems, is highly complex and challenging (Carter, Arnott, Simons, & Bray, 2017; Carter, Simons, Bray, & Arnott, 2016). Children with profound cognitive impairment are a heterogenous group who are at particular risk of experiencing pain (Cascella, Bimonte, Saettini, & Muzio, 2019); often experiencing a higher number of nociceptive and neuropathic pain episodes compared to their healthy peers and sometimes experiencing significant daily pain that impacts on their lives (Breau, Camfield, McGrath, & Finley, 2003; Carter & Simons, 2014; Zernikow et al., 2012). This pain arises from the interplay between their underlying condition and their range of co-morbidities; this complicates both assessment and management (Bottos & Chambers, 2006). Children with profound cognitive impairment are therefore completely reliant on their parents/carers, and on their healthcare professionals for effective assessment and management of their pain. Studies show that, despite robust and