In a comatose child with multiple injuries, which statement is true about pain?

• A. Pain cannot occur in coma
• B. Pain may occur if consciousness returns
• C. Pain requires astute nursing assessment and management
• D. Pain is best assessed by family members

Answer: (C)

Pain can be present even when a child is comatose, because nociception may occur without the ability to clearly communicate it. That means the care team must rely on careful, ongoing assessment rather than assuming there is no pain. Clinicians should use nonverbal pain scales and vigilant observation of cues such as facial expressions, body movements, agitation, and physiologic signs to detect and gauge pain intensity. Because the patient cannot tell you where or how much it hurts, this attentive nursing assessment is essential to guide timely analgesia and comfort measures. While input from family members about the child’s typical responses is valuable, it cannot replace systematic assessment by trained staff. Pain should be addressed proactively to prevent unnecessary distress and physiologic stress, even if consciousness has not yet returned.