A meta-synthesis of the language of pediatric pain

This study aims to conduct a meta-synthesis to explore the language of pain in children.

We conducted a meta-synthesis, following the outline proposed by Sandelowski. Our search encompassed six electronic databases, namely PubMed, Scopus, EBSCO, Web of Science, SAGE, and Wiley. The Primary keywords used were pediatric pain, pain expression, communication, and qualitative studies. We included articles in English within the field of pediatric nursing between 1989 and 2023. Initially, 563 records were identified which reduced to 508 references after removing duplicates. Subsequently, we assessed 172 full-text articles for eligibility and 10 relevant studies were ultimately included. Quality appraisal was conducted with no study being excluded. Data were synthesized using the qualitative thematic analysis method.

The analysis of the data yielded one main theme (the language of pain) and four subthemes. The subthemes were expressive discourse (phonetic expressions, verbal expression, and symbolic expression), subtle gestures of expression (behavioral discrepancies, self-harm, face grimaces, and eye changes), embodied communication (early neonatal to infant movements, older infants movements, and somatic movement), and silent endurance (endurance due to fear of invasive procedure, worrying family, and social isolation).

From phonetic utterances to nuanced gestures, this study underscores the intricate ways children convey their pain.

These findings underscore the importance of healthcare practitioners recognizing and interpreting diverse modes of children's pain expression for accurate assessment. Implementing a holistic approach that integrates verbal, nonverbal, and embodied communication can enhance pediatric pain management practices.