Faces scales have become the most popular approach to eliciting children's self-reports of pain, although different formats are available. The present study examined: (a) the potential for bias in children's self-reported ratings of clinical pain when using scales with smiling rather than neutral 'no pain' faces; (b) levels of agreement between child and parent reports of pain using different faces scales; and (c) preferences for scales by children and parents. Participants were 75 children between the ages of 5 and 12 years undergoing venepuncture, and their parents. Following venepuncture, children and parents independently rated the child's pain using five different randomly presented faces scales and indicated which of the scales they preferred and why. Children's ratings across scales were very highly correlated; however, they rated significantly more pain when using scales with a smiling rather than a neutral 'no pain' face. Girls reported significantly greater levels of pain than boys, regardless of scale type. There were no age differences in children's pain reports. Parents' ratings across scales were also highly correlated; however, parents also had higher pain ratings using scales with smiling 'no pain' faces. The level of agreement between child and parent reports of pain was low and did not vary as a function of the scale type used; parents overestimated their children's pain using all five scales. Children and parents preferred scales that they perceived to be happy and cartoon-like. The results of this study indicate that subtle variations in the format of faces scales do influence children's and parents' ratings of pain in clinical settings.
BACKGROUND: Despite recent progress in understanding memory of pain in adults, the validity of the assumption that these findings extend to children has not been established. Because treatment often is evaluated on the basis of pain recall, it is crucial that the accuracy of pain memories in children be established.OBJECTIVES: To examine children's ability to recall pain intensity and contextual details associated with a novel painful experience. Furthermore, children's memories were compared with those of their parents.SUBJECTS AND METHODS: Twenty-three parent-child dyads were recruited from a sample participating in an earlier study investigating children's responses to the cold pressor test and parents' characterization of the children's responses. Children (age five to 12 years) and parents independently had rated the child's pain using a seven-point Faces Pain Scale. Approximately one year later, they were asked to recall the experience and rate the pain again. Memory for contextual details associated with the event also was assessed through a series of open-ended questions.RESULTS: A 2 (rater) × 2 (time period) repeated measures ANOVA examined the reliability of ratings and differences between parent and child ratings of pain, both recorded at the time of the cold pressor and recalled one year later. There were no significant differences in ratings over time or between parent and child.CONCLUSIONS: The findings indicate that children's memories of a novel painful experience can be consistent over a long interval. Moreover, parents' ratings also reflect good recall and can be in agreement with those of their children.
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