Table 1 Management of pediatric pain in the ED and beyond: the 10 statements of the COPPER project

1. Pain is a frequent, fearful and harmful symptom in newborns, children and adolescents in all clinical conditions; it undermines health and is a source of anxiety and worry.

2. All children perceive pain; the younger the child, the higher the level of his/her perception and the consequent damage.

3. Pain must always be assessed and measured in children. Pain measurement must be carried out by validated tools adapted to age and setting; the data reported must be recorded on a medical chart.

4. Pain measurement must be always carried out at the first contact with the patient during medical examination, before discharge from the ED, whenever a child seems to be in pain or complains about pain, whenever the caregivers report the child being in pain and also in order to assess the efficacy of the planned analgesic treatment.

5. Pain must be always promptly treated using both nonpharmacological and pharmacological procedures.

6. The presence of caregivers in close contact with children is the mainstay of pain management and must be assured. The analgesic treatment recommended must always be communicated and shared with the child and/or with the relatives and caregivers using appropriate and effective communication tools.

7. All analgesic drugs must be chosen considering the type and intensity of the pain; they must be appropriately prescribed according to age, weight and clinical situation. The route of administration must be as noninvasive as possible and must be the most effective. In the event of insufficiently controlled pain, a rescue dose must be established.

8. Procedural pain must be always predicted. Any unnecessary procedure must be avoided.

9. When discharging a child treated for pain, caregivers should receive correct information regarding the management of potential recurrence and the timing of the medical check-up with general pediatrician/practitioner.

10. Pain in children with motor and/or cognitive impairment can be difficult to recognize. In these patients, pain must always be assessed and measured with specifically validated tools and must be treated according to an analgesic plan that considers the global situation of these patients, peculiarity of the causes of the pain and, if provided, of the current medication being taken.