The overlap with non-pain related distress Pain assessment tools include behavioral cues that can signal the presence of pain or non-pain related distress (e.g. fear, anxiety, depression, frustration, dysphoria, delirium). For example, crying, sobbing, physical tension, clinging, restlessness, and seeking or avoiding touch is observed in children exhibiting pain and non-pain related distress (von Baeyer & Spagrud, 2007). Our systematic review of instruments for scoring