Nurses are guided to use pain tools for assessing pain. Appropriate tools exist for all ages of children, as well as accounting for diverse communicative abilities and impairments such as brain injury. Use of pain tools, and good documentation of pain management, is part of providing best practice, high-quality care. Clinical audit, based on compliance with the Royal College of Nursing guideline for pain assessment, measured current and changing practice at a 70-bed national specialist centre for children with brain injury. Compliance was initially poor. Changes in practice were supported by evidence-based measures, including a written guideline, classroom teaching, visits to practice areas, sharing of audit results, reminders and a special interest group. Over 3 years, the audits showed an increase of child-specific pain tools available in children's care files from 9% to 83%; assessment of pain using a pain tool, when indicated, increased from 0 to 30%. Documentation of interventions to relieve pain increased from 51% to 80% and reassessment of pain following an intervention increased from 15% to 63%. This article will resonate with any organisation trying to embed systematic pain assessment into routine practice.

Improved identification of children with an increased likelihood of death can support appropriate provision of integrated palliative care. This systematic review aims to consider immobility and the associated likelihood of death in children with disabilities, living in high-income countries. Two reviewers independently searched MEDLINE, Embase, Cochrane Library, OpenGrey and Science Citation Index (1990–2016) for studies that reported hazard ratios (HRs) and relative risk for the likelihood of death related to impaired mobility. Nine papers were included. Three studies reported functioning using the Gross Motor Function Classification Scale (GMFCS) and the remaining studies reported measures of functioning unique to the study. The strongest single prognostic factor for the likelihood of death was ‘lack of sitting ability at 24 months’, HR 44.4 (confidence interval (CI) 6.1–320.8) followed by GMFCS V HR 16.3 (CI 5.6–47.2) and 11.4 (CI 3.76–35.57) and ‘not able to cruise by 24 months’, HR 14.4 (CI 3.5–59.2). Immobility is associated with an increased risk of dying over study periods, but different referent groups make clinical interpretation challenging. Overall, the quality of evidence is moderate. The findings suggest that immobility can support identification of children who may benefit from integrated palliative care.