Understanding pain perception of toddlers is an important part of pain management in toddlers. Toddlers are children between the ages of 12 and 36 months. These children are not considered infants, but are not yet fully verbal or at the preschool stage of development.
According to Piaget, these children are very concrete and lack abstract cognitive abilities. By the age of 3 years, children can localize their pain but cannot identify intensity or quality.
Toddlers typically do not understand the short-term nature of a painful stimulus (Peterson as cited in Christiano & Tarbell, 1998), may view an invasive procedure as a punishment (Harbeck & Peterson as cited in Christiano & Tarbell, 1998) and have a limited range of coping skills to prevent or mitigate pain (Reissland as cited in Christiano & Tarbell, 1998).
Toddlers are likely to experience anticipatory anxiety (Katz et al. as cited in Christiano & Tarbell, 1998), appraise invasive procedures as assaultive and threatening (Rudolph, Dennig, & Weisz, as cited in Christiano & Tarbell, 1998), and not engage in deliberate coping mechanisms (Reissland as cited in Christiano & Tarbell, 1998).
It is likely because of these various developmental factors that toddlers are seen to exhibit higher levels of distress and pain before and during procedures than older children (Fanurik, Koh, & Schmitz, 2000). For this reason, practitioners often have trouble assessing actual levels of distress and pain. Often, this difficulty leads to either overuse of pharmacological methods of pain management, and sometimes to the total absence of pain management.
