Why primary caregivers fail to report pediatric pain: A qualitative study

In many East Asian hospital settings where family members are closely involved in bedside care, caregivers play a crucial role in recognizing and reporting children's pain during hospitalization. Yet they often fail to inform healthcare providers, leading to inadequate interventions and prolonged suffering. While previous studies focused on whether pain is reported, the psychological mechanisms underlying non-reporting remain poorly understood, limiting the development of effective support strategies.

To explore why primary caregivers failed to report pediatric pain to healthcare providers, focusing on their decision-making process and influencing factors.

Qualitative descriptive study.

Multiple medical and surgical wards of a tertiary pediatric hospital in Chongqing, China.

Seventeen primary caregivers who observed their child in pain but did not report it to healthcare providers were purposively recruited.

Semi-structured interviews were conducted between January and March 2025. Data were analyzed using directed content analysis guided by Protection Motivation Theory.

Five themes and 17 subthemes were identified, revealing that caregivers' failure to report pediatric pain is a dynamic process shaped by attention activation, threat appraisal, coping appraisal, individual factors, and environmental factors. The process often begins with attentional filtering, where pain cues are overlooked due to competing demands or perceived normality. Once attention is activated, caregivers engage in threat and coping appraisals, which may involve underestimating the threat of pain, valuing pain tolerance, doubting reporting efficacy, holding strong self-management beliefs, or anticipating costs. These dual-path appraisals are influenced by personal traits and prior experiences, along with environmental factors like verbal persuasion, observational learning, and healthcare constraints, with some directly impeding communication. Together, these elements interact to suppress reporting, often accompanied by alternative soothing strategies.

Caregivers' failure to report pediatric pain is not a simple omission but a result of complex cognitive and contextual processes. Attentional disengagement and biased appraisals, shaped by personal beliefs and environmental cues, jointly suppress reporting behaviors. Understanding these mechanisms offers a foundation for targeted interventions that enhance caregiver awareness, reshape pain perceptions, and promote supportive communication in pediatric care.

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