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Updated: Aug 16, 2026
An Experimental Paradigm for the Prediction of Post-Operative Pain (PPOP)
Published on: January 27, 2010
Children and their parents' assessment of postoperative surgical pain: Agree or disagree?
Olivia Kaminsky1, Michelle A Fortier2, Brooke N Jenkins3
1University of California-Irvine School of Medicine, USA, 1001 Health Sciences Rd., Irvine, CA, USA.
Insights
Parents often overestimate their child's pain after tonsillectomy and adenoidectomy (T&A) surgery, leading to increased analgesic administration. Standardized pain assessment and tailored regimens are crucial for effective postoperative care.
Area of Science:
- Pediatric Surgery
- Pain Management
- Psychology
Background:
- Postoperative pain assessment in children is complex, involving subjective reporting by the child and interpretation by the parent.
- Discrepancies between child and parent pain ratings can influence treatment decisions and adherence.
Purpose of the Study:
- To compare postoperative pain scores between children and their parents after tonsillectomy and adenoidectomy (T&A).
- To identify predictors of parent-child disagreement in pain assessment.
- To determine the impact of this disagreement on analgesic administration.
Main Methods:
- Prospective longitudinal study of children undergoing outpatient T&A and their parents across 4 tertiary hospitals.
- Assessment of baseline psychological factors (parental anxiety, coping, child temperament, medication attitudes).
- Postoperative pain ratings by children and parents on days 1-3 using validated scales; parent logs of analgesic use.
Main Results:
- A significant proportion of parent-child pairs (30-36%) disagreed on pain ratings post-T&A.
- Parents most frequently overestimated their child's pain (24-26% across days 1-3).
- Overestimating parents administered higher doses of ibuprofen and oxycodone; hospital site predicted disagreement.
Conclusions:
- Parents tend to overestimate their child's pain post-T&A, potentially leading to increased analgesic use.
- Standardized child pain assessment methods are needed.
- Tailored postoperative analgesic regimens are recommended for children undergoing T&A.
Objective:
The purpose of this study is to compare postoperative pain scores between children undergoing tonsillectomy and adenoidectomy (T&A) surgery and their parents, identify potential predictors for this disagreement, and determine possible impact on analgesic administration.
Methods:
This is a prospective longitudinal study conducted with children undergoing outpatient T&A in 4 major tertiary hospitals and their parents. Children and their parents were enrolled prior to surgery and completed baseline psychological instruments assessing parental anxiety (STAI), parental coping style (MBSS), child temperament (EAS) and parental medication administration attitude questionnaire (MAQ). Postoperatively, parents and children completed at-home pain severity ratings (Faces Pain Scale-Revised, children; Numeric Rating Scale, parents) on postoperative recovery days 1, 2, and 3, reflecting an overall pain level for the past 24 h. Parents also completed a log of analgesic administration. Based on postoperative pain scores, parent-child dyads were classified as overestimators (i.e., parents rated their child's pain higher than children rated their own pain), in agreement (i.e., rating in agreement), or underestimators (i.e., parents rated their child's pain lower than children rated their own pain).
Results:
A significant proportion of parent-child pairs disagreed on pain ratings on postoperative days 1-3 (30.05%-35.95%). Of those pairs in disagreement, the majority of parents overestimated their child's pain on all three postoperative days, specifically such that a total of 24-26% parents overestimated their child's pain on postoperative days 1, 2, and 3. Repeated measures ANOVA demonstrated that parents in the overestimator group administered higher, though still within safe limits, amounts of ibuprofen and oxycodone (mg/day) than did the underestimator or agreement groups. Multiple regression models showed hospital site as the only independent predictor for postoperative pain rating disagreement between children and parents.
Conclusions:
Since parents overestimate their child's postoperative pain and may administer more analgesics to their child, it is essential to develop a standardized method of child pain assessment and a tailored recommended postoperative analgesic regimen amongst medical providers for children undergoing T&A.
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