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Can we screen young children for their ability to provide accurate self-reports of pain?
Carl L von Baeyer1, Lindsay S Uman, Christine T Chambers
1Department of Psychology, University of Saskatchewan, Saskatoon, SK, Canada Department of Pediatrics, University of Saskatchewan, Saskatoon, SK, Canada Department of Psychology, Dalhousie University, Halifax, NS, Canada IWK Health Centre, Halifax, NS, Canada Department of Pediatrics, Dalhousie University, Halifax, NS, Canada.
Insights
No validated screening tools accurately identify young children who can self-report pain. Chronological age was a better predictor than screening tasks for pain reporting accuracy in children aged 3-7 years.
Area of Science:
- Pediatric Pain Management
- Child Psychology
- Clinical Assessment
Background:
- Accurate pain self-reporting in children is crucial for effective treatment.
- Validated screening tools are lacking to determine if children aged 3-7 years can reliably use pain scales like the Faces Pain Scale-Revised (FPS-R).
- Understanding the developmental trajectory of pain self-report accuracy is essential.
Purpose of the Study:
- To evaluate the effectiveness of screening tasks in identifying children who can accurately use the Faces Pain Scale-Revised (FPS-R).
- To assess the relationship between performance on screening tasks and actual pain self-report accuracy.
- To determine if chronological age is a better predictor of pain reporting ability than specific screening tasks.
Main Methods:
- 108 children aged 3-7 years and their parents participated.
- Children completed four screening tasks and used the FPS-R to rate pain intensity pre- and post-day surgery.
- Parental perception of child's understanding of FPS-R and parent-child agreement were recorded.
Main Results:
- Parental estimates suggested children could understand the FPS-R around 4.4 years old.
- Younger children initially gave inaccurate high pain ratings, but accuracy improved over time, becoming similar to older children.
- Screening tasks showed a significant association with self-report accuracy, but no task was a strong enough predictor for clinical use (r < 0.30).
Conclusions:
- Chronological age was a better indicator of pain self-report accuracy than the tested screening tasks.
- Direct pain experience or task familiarity may enhance accuracy in younger children.
- Further research is needed on alternative screening methods, training, and simplified pain assessment for young children.
Abstract:
No validated screening tasks exist to distinguish children who can accurately use self-report pain measures from those who cannot. Children aged 3-7 years (n=108), each with a parent, provided data before and after day surgery. Parents rated how well they thought their child could understand the Faces Pain Scale-Revised (FPS-R), and children completed 4 screening tasks in counterbalanced order, such as rating pain in vignettes and selecting a middle-sized cup. Parents and children used the FPS-R to rate the children's pain intensity. Children's FPS-R ratings were scored for accuracy based on the extent to which they conformed to expected pain trajectories (e.g., pain increasing following surgery, decreasing following analgesia), and based on parent-child agreement. On average, parents rated the youngest age at which children could understand the FPS-R as 4.4 years (95% confidence interval 4.1-4.5). The youngest children provided inaccurate high pain ratings before surgery, but they became indistinguishable from the oldest in the accuracy of their pain ratings for the remainder of the 3-day study period, suggesting that direct experience with pain or with the rating task may improve accuracy. Although children's performance on the screening tasks was significantly associated with self-report accuracy, no prediction was strong enough for clinical use (all r's < 0.30). We failed to identify a screening tool that was better than chronological age in identifying which children could accurately self-report pain using the FPS-R. Future research should explore other screening tasks, training methods, and simplified approaches to pain assessment for young children. The ability to use self-report pain scales usually develops from age 3 to 7 years, but no valid screening method exists to identify this achievement.
