Children and their parents’ assessment of postoperative surgical pain: Agree or disagree?

Abstract

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 hours. 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 19 demonstrated that parents in the overestimator group administered higher, though still within safe 20 limits, amounts of ibuprofen and oxycodone (mg/day) than did the underestimator or agreement 21 groups. Multiple regression models showed hospital site as the only independent predictor for 22 postoperative pain rating disagreement between children and parents. 23 2 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.

Impact of a revised postoperative care plan on pain and recovery trajectory following pediatric tonsillectomy

“…Secondly, as self‐reported pain scores were not practical, parent‐proxy pain scores were used. While parent‐proxy scores have been demonstrated to be useful, 37 they have also been associated with both underreporting 38 and overreporting 39 of pain severity. In addition, nausea is difficult to detect in young children and may only be recognized if they vomit.…”

Postoperative pain, pain management, and recovery at home after pediatric tonsil surgery

“…In the present study, caregivers' ability to recognize and assess their child's pain was moderate (K W = 0.57) [21], and the most common disagreement was caregivers underestimating the pain. On the other hand, overestimating pain by caregivers might cause problems with the use of high doses of analgesics [15]. The most serious risk is opioid overdosing.…”

“…The mean differences with 95% confidence intervals (CI) were assessed with t tests. In line with previous research [15,16], the agreement between the parent daily median NRS scores and their child's daily median scores on the FPS-R was set to < 2 points difference. Furthermore, a weighted kappa (K w ) of all child-parent pain scores during days 1-3 was calculated.…”

“…The children were divided by surgical method and age: tonsillotomy with or without adenoidectomy in those aged 4-11 years (TT ± A age 4-11), tonsillectomy with or without adenoidectomy in those aged 4-11 years (TE ± A age 4-11), and tonsillectomy with or without adenoidectomy in those aged 12-17 years (TE ± A age [12][13][14][15][16][17]. Older children (age 12-17) undergoing TT ± A were few (n = 5) and are presented only in the context of the total cohort and not analyzed as a separate group.…”

The impact of parental health mindset on postoperative recovery in children

“…Data from this study were drawn from a larger National Institutes of Health‐funded study designed to examine the impact of a healthcare provider behavioral training on children's postoperative anxiety following T&A. Several publications have resulted from the larger study, including an examination of acculturation on children's pre‐operative anxiety, 17 parent/child agreement in ratings of children's postoperative pain severity at home following T&A, 18 factors associated with patient experience following T&A, 19 and a descriptive report on clinical and behavioral recovery in children after T&A 20 . The data presented here have not previously been reported.…”