BACKGROUND: This position statement provides clinical recommendations for the assessment of pain, level of sedation, iatrogenic withdrawal syndrome and delirium in critically ill infants and children. Admission to a neonatal or paediatric intensive care unit (NICU, PICU) exposes a child to a series of painful and stressful events. Accurate assessment of the presence of pain and non-pain-related distress (adequacy of sedation, iatrogenic withdrawal syndrome and delirium) is essential to good clinical management and to monitoring the effectiveness of interventions to relieve or prevent pain and distress in the individual patient. METHODS: A multidisciplinary group of experts was recruited from the members of the European Society of Paediatric and Neonatal Intensive Care (ESPNIC). The group formulated clinical questions regarding assessment of pain and non-pain-related distress in critically ill and nonverbal children, and searched the PubMed/Medline, CINAHL and Embase databases for studies describing the psychometric properties of assessment instruments. Furthermore, level of evidence of selected studies was assigned and recommendations were formulated, and grade or recommendations were added on the basis of the level of evidence. RESULTS: An ESPNIC position statement was drafted which provides clinical recommendations on assessment of pain (n = 5), distress and/or level of sedation (n = 4), iatrogenic withdrawal syndrome (n = 3) and delirium (n = 3). These recommendations were based on the available evidence and consensus amongst the experts and other members of ESPNIC. CONCLUSIONS: This multidisciplinary ESPNIC position statement guides professionals in the assessment and reassessment of the effectiveness of treatment interventions for pain, distress, inadequate sedation, withdrawal syndrome and delirium.

Department of Intensive Care Neonatology Emma Children's Hospital Academic Medical Centre Amsterdam The Netherlands

Department of Pharmacology General University Hospital 1st Faculty of Medicine Charles University Prague Czech Republic

Division of Neonatology Department of Pediatrics Erasmus MC Sophia Children's Hospital Erasmus University Medical Centre Rotterdam The Netherlands

Institute of Higher Education and Nursing Research University of Lausanne CHUV Lausanne Switzerland

Intensive Care and Department of Pediatric Surgery Erasmus MC Sophia Children's Hospital Office Sb 2704 P O Box 2060 3000 CB Rotterdam The Netherlands

Intensive Care Unit Department of Pediatrics General Faculty Hospital 1st Faculty of Medicine Charles University Prague Prague Czech Republic

PICU and Children's Nursing Research Unit Alder Hey Children's NHS FT Liverpool UK and University of Central Lancashire Preston UK

PICU Department of Evelina London Children's Hospital Guys and St Thomas' NHS Foundation Trust London UK

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Rescue Paracetamol in Postoperative Pain Management in Extremely Low Birth Weight Neonates Following Abdominal Surgery: A Single Unit Retrospective Study

Critically Ill Pediatric Patient and SARS-CoV-2 Infection

Pain and sedation management and monitoring in pediatric intensive care units across Europe: an ESPNIC survey