Christine T. Chambers

A comparison of faces scales for the measurement of pediatric pain: children's and parents' ratings.

Faces scales have become the most popular approach to eliciting childrens self-reports of pain, although different formats are available. The present study examined: (a) the potential for bias in childrens self-reported ratings of clinical pain when using scales with smiling rather than neutral no pain faces; (b) levels of agreement between child and parent reports of pain using different faces scales; and (c) preferences for scales by children and parents. Participants were 75 children between the ages of 5 and 12 years undergoing venepuncture, and their parents. Following venepuncture, children and parents independently rated the childs pain using five different randomly presented faces scales and indicated which of the scales they preferred and why. Childrens ratings across scales were very highly correlated; however, they rated significantly more pain when using scales with a smiling rather than a neutral no pain face. Girls reported significantly greater levels of pain than boys, regardless of scale type. There were no age differences in childrens pain reports. Parents ratings across scales were also highly correlated; however, parents also had higher pain ratings using scales with smiling no pain faces. The level of agreement between child and parent reports of pain was low and did not vary as a function of the scale type used; parents overestimated their childrens pain using all five scales. Children and parents preferred scales that they perceived to be happy and cartoon-like. The results of this study indicate that subtle variations in the format of faces scales do influence childrens and parents ratings of pain in clinical settings.

Agreement between child and parent reports of pain

OBJECTIVEnParents are often the primary source of information regarding their childrens pain in both research and clinical practice. However, parent-child agreement on pain ratings has not been well established. The objective of the present study was to examine agreement between child- and parent-rated pain following minor surgery.nnnSETTINGnTertiary care childrens hospital.nnnPARTICIPANTSnA total of 110 children (56.4% male) aged 7-12 years undergoing surgery and their parents.nnnOUTCOME MEASURESnParents and children independently rated pain intensity by using a 7-point Faces Pain Scale on the day of the childs surgery and the following 2 days.nnnRESULTSnCorrelations (both Pearsons and intraclass correlation coefficients) indicated a highly significant relationship between child and parent ratings. However, kappa statistics indicated only poor to fair agreement beyond chance. Parents tended to underestimate their childrens pain on the day of surgery and the following day, but not on the second day following surgery. When childrens and parents pain ratings for each of the 3 days were collapsed into a no-pain/low-pain group or a clinically significant pain group, kappa statistics indicated fair to good agreement. Parents demonstrated low levels of sensitivity in identifying when their children were experiencing clinically significant pain.nnnCONCLUSIONSnCorrelations between parent and child pain reports do not accurately represent the relationship between these ratings and in fact overestimate the strength of the relationship. Parents underestimation of their childs pain may contribute to inadequate pain control.

An intrusive impact of anchors in children's faces pain scales

&NA; The numerous pain rating scales using faces depicting varying degrees of distress to elicit reports of pain from children fall into two categories; those with a neutral face as the ‘no pain’ anchor, and those with a smiling face as the ‘no pain’ anchor. This study examined the potentially biasing impact of these anchor types on childrens self‐reports of pain in response to a series of vignettes. Participants were 100 children stratified by age (5–6 years, 7–8 years, 9–12 years) and randomly assigned to one of three groups: (1) neutral scale/sensory instructions; (2) smiling scale/sensory instructions; (3) smiling scale/affective instructions. Children completed a faces scale, a VAS, and emotions ratings in response to four scenarios depicting: (1) no pain/negative emotions; (2) pain/negative emotions; (3) no pain/positive emotions; (4) pain/positive emotions. Results showed that children who used the smiling scale had significantly higher pain scores for no pain and pain/negative emotions vignettes and significantly lower faces scale scores for pain/positive vignettes than children who used the neutral faces scale. Instructions varying in focus on sensory or affective qualities of pain had no effect on childrens pain ratings. Group differences in childrens ratings with the VAS and emotions measure suggested that rating pain with a smiling faces scale may alter a childs concept of pain. Age differences indicated the younger children rated the negative emotion vignettes as more painful than the older children. These findings suggest that childrens pain ratings vary depending on the types of faces scale used, and that faces scales with smiling anchors may confound affective states with pain ratings.

The role of developmental factors in predicting young children's use of a self-report scale for pain

Abstract Accurate pain assessment is the foundation for effective pain management in children. At present, there is no clear consensus regarding the age at which young children are able to appropriately use self‐report scales for pain. This study examined young childrens ability to use the Faces Pain Scale‐Revised; (FPS‐R; [Hicks CL, von Baeyer CL, Spafford PA, van Korlaar I, Goodenough B. The Faces Pain Scale‐Revised: toward a common metric in pediatric pain measurement. Pain 2001; 93: 173–83]) for pain in response to vignettes and investigated the role of developmental factors in predicting their ability to use the scale. One hundred and twelve healthy children (3–6 years old) were assessed for their ability to accurately use a common faces scale to rate pain in hypothetical vignettes depicting pain scenarios common in childhood. Accuracy was determined by considering whether childrens judgements of pain severity matched the pain severity depicted in the various vignettes. Children were also administered measures of numerical reasoning, language, and overall cognitive development. Results indicated that 5‐ and 6‐year‐old children were significantly more accurate in their use of the FPS‐R in response to the vignettes than 4‐year‐old children, who in turn were significantly more accurate than 3‐year‐old children. However, over half of the 6‐year‐olds demonstrated difficulties using the FPS‐R in response to the vignettes. Child age was the only significant predictor of childrens ability to use the scale in response to the vignettes. Thus, a substantial number of young children experienced difficulties using the FPS‐R when rating pain in hypothetical vignettes, although the ability to use the scale did improve with age.

A normative analysis of the development of pain-related vocabulary in children

&NA; Effective verbalization of pain requires progressive cognitive development and acquisition of social communication skills. Use of self‐report in pediatric pain assessment assumes children have acquired a capacity to understand and use common words to describe pain. The current investigation documented the language most commonly used by young children to describe pain and the age of onset of use of these words. Two complementary research methodologies were employed. Study 1 used the CHILDES database, an aggregated transcript database of multiple research studies examining spontaneous speech development across childhood. Transcripts of 14 randomly selected studies, yielding a total of 245 child participants ranging in age from 1 to 9 years, were searched for seven English primary pain word‐stems: ‘ache’, ‘boo–boo’, ‘hurt’, ‘ouch’, ‘ow’, ‘pain’, and ‘sore’. Study 2 surveyed 111 parents of children aged 3 to 6 years old concerning words the children commonly used for pain. Parents rated their childrens frequency and age of first use of the seven pain word‐stems. Both studies indicated that the most frequently used word‐stems were ‘hurt’, ‘ouch’, and ‘ow’. These words first emerged in childrens vocabularies as early as 18 months of age. The word‐stem ‘pain’ was used relatively infrequently and gradually emerged in childrens vocabularies. The findings indicate that young children rely on a select number of words to describe pain, with these words appearing in childrens vocabularies at an early age. These results have implications for developmentally appropriate pain assessment in young children.

The parents' postoperative pain measure: replication and extension to 2-6-year-old children

&NA; Pain assessment is a difficult task for parents at home following childrens surgery. The purpose of the present study was to confirm the psychometric properties of a behavioural measure of postoperative pain developed to assist parents with pain assessment in children aged 7–12 years following day surgery. The study also examined the reliability and validity of the measure with children aged 2–6 years. Participants were 51 parents of children aged 7–12 years and 107 parents of children aged 2–6 years. For the 2 days following surgery, parents completed a pain diary that included global ratings of their childrens pain and the 15‐item Parents’ Postoperative Pain Measure (PPPM). The older children provided self‐reports of their pain intensity. The PPPM items showed good internal consistency on the two postoperative days for both samples (&agr;’s=0.81–0.88) and scores on the PPPM were highly correlated with childrens (for the older children) and parents’ (for the young children) global ratings of pain (rs=0.53–0.72). As global pain ratings decreased from Days 1 to 2, so did scores on the PPPM. Scores on the PPPM were successful in discriminating between children who had undergone low/moderate and high pain surgeries. The results of this study provide evidence of the reliability and validity of the PPPM as a measure of postoperative pain among children aged 2 through to 12 years.

Training highly qualified health research personnel: the pain in Child Health consortium.

The Pain in Child Health (PICH) consortium is a Strategic Training Initiative in Health Research funded by the Canadian Institutes of Health Research. The PICH represents a community of interdisciplinary researchers whose goal is to support the education of highly qualified personnel and to promote research on the prevention and relief of pediatric pain. The authors of this article report on the success of the PICH since its inception in 2002.