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Agreement between child and parent reports of pain
C T Chambers1, G J Reid, K D Craig
1Department of Psychology, IWK-Grace Health Centre and Dalhousie University, Halifax, Nova Scotia, Canada.
Insights
Parents often underestimate their child's pain after surgery. While correlations appear strong, actual agreement is poor, potentially leading to inadequate pain management for children.
Area of Science:
- Pediatric Pain Management
- Child Psychology
- Clinical Assessment
Background:
- Parents are primary informants for pediatric pain in research and clinical settings.
- Established parent-child agreement on pain ratings is lacking.
- Accurate pain assessment is crucial for effective treatment.
Purpose of the Study:
- To investigate the agreement between child- and parent-reported pain intensity.
- To evaluate parent-child concordance following minor surgical procedures.
- To identify potential discrepancies in pain perception and reporting.
Main Methods:
- Study conducted at a tertiary care children's hospital.
- 110 children (aged 7-12 years) and their parents participated.
- Pain intensity was rated independently using a 7-point Faces Pain Scale over three days post-surgery.
Main Results:
- High correlations between child and parent pain ratings were observed.
- Kappa statistics revealed poor to fair agreement beyond chance.
- Parents tended to underestimate children's pain, especially on the first two days post-surgery.
- Agreement improved to fair/good when pain was categorized as low or clinically significant.
- Parental sensitivity in identifying significant pain was low.
Conclusions:
- Correlations overestimate the strength of parent-child pain rating agreement.
- Parents' underestimation of pediatric pain can lead to insufficient pain control.
- Improved assessment methods are needed to capture children's true pain experiences.
Objective:
Parents are often the primary source of information regarding their children's 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.
Setting:
Tertiary care children's hospital.
Participants:
A total of 110 children (56.4% male) aged 7-12 years undergoing surgery and their parents.
Outcome Measures:
Parents and children independently rated pain intensity by using a 7-point Faces Pain Scale on the day of the child's surgery and the following 2 days.
Results:
Correlations (both Pearson's 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 children's pain on the day of surgery and the following day, but not on the second day following surgery. When children's 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.
Conclusions:
Correlations 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 child's pain may contribute to inadequate pain control.