A 3-month-old is recovering from a pyloromyotomy and shows signals of pain. Which finding is most indicative of pain in this infant?

• A. Increased respiratory rate
• B. Increased heart rate
• C. Restlessness
• D. Clenched fists

Answer: (C)

Infants express pain mainly through behavior, because they can’t verbalize it. After surgery, nonverbal cues become the clearest signal of distress. Restlessness stands out as the most specific indicator of postoperative pain in a 3-month-old: an infant who cannot settle, keeps moving, or squirms despite attempts to soothe is showing ongoing discomfort from the procedure.

While higher heart rate or faster breathing can accompany pain, these vitals are non-specific and can be influenced by many factors after surgery, such as anesthesia effects, fluid status, or fever. Clenched fists can occur with distress as well, but restlessness more consistently reflects pain in this age group and context.