physiologic measurements Examples of such combination scales unique to neonatal population are the Neonatal Infant Pain Scale, Neonatal Pain Agitation and Sedation Scale, and the Pain Assessment Tool TABLE 129.1 POSSIBLE REASONS FOR INADEQUATE PAIN CONTROL IN EMERGENCY DEPARTMENT Inability of young children to talk Misconception that infants cannot feel pain Misconception that children will not remember pain Misconception that children will get addicted to opioids Fear of respiratory depression and hypotension Unfamiliarity with analgesics and dosages Other conditions taking priority Self-report pain scales are the best indicators of pain and are the reference standard for assessing pain in children Standard self-report assessment tools, such as visual analog scales (VASs), are more reliable indicators of pain when completed by the patient rather than by observers Young children (between ages and years) can reliably use picture scales with faces in different phases of happiness and crying The Wong–Baker FACES Pain Rating Scale ( Fig 129.2 ) is one example of this type of ordinal scale For older children and adults, a VAS consists of a 10-cm horizontal line with end points marked as “no pain” (0) to “worst possible pain” (10) The VAS has been further enhanced for children by allowing them to use multiple modalities for pain rating such as allowing the child to determine changes in height, thickness, and color as the pain intensity increases, and to capitalize on the child’s ability to discriminate his or her pain using at least one of these dimensions