Adaptation of pain scales for parent observation: are pain scales and symptoms useful in detecting pain of young children with the suspicion of acute otitis media?

Johanna M Uitti,Miia K Laine,Sanna Salanterä,Paula A Tähtinen,Aino Ruohola

doi:10.1186/s12887-018-1361-y

Abstract

BackgroundThe assessment of ear pain is challenging in young, mostly preverbal children. Our aim was to investigate whether pain scales are useful tools for parents to detect pain in their young children with the suspicion of acute otitis media (AOM), and to assess associations between 16 symptoms and the severity of pain.MethodsThis cross-sectional study included 426 children (6–35 months) with symptoms suggestive of AOM. We surveyed symptoms and pain via parental interview. As part of the interview, parents assessed their child’s pain by using two pain scales: The Faces Pain Scale-Revised (FPS-R) and the Face, Legs, Activity, Cry, Consolability (FLACC) Scale. The outcome of interest was moderate/severe pain. We used the χ2 test or Fisher’s test as applicable to compare the severity of pain between three parental pain assessment methods (the parental interview, the FPS-R and the FLACC Scale). We also used multivariable logistic regression models to study the association between the severity of pain and AOM and to study the association between symptoms and the severity of pain.ResultsIn children with AOM (n = 201), pain was assessed by parents as moderate/severe in 65% via interview; 90% with the FPS-R; and 91% with the FLACC Scale (P < 0.001). In children without AOM (n = 225), the percentages were 56, 83 and 88%, respectively (P < 0.001). Between children with and without AOM, the occurrence of moderate/severe pain did not differ with any of the pain evaluation methods. Of symptoms, ear pain reported by child and restless sleep were significantly associated with moderate/severe pain, regardless of the pain evaluation method.ConclusionsIt seems that nearly all the children with respiratory tract infection, either with or without AOM, might suffer from moderate/severe pain. Without pain scales, parents may underestimate their child’s pain. Of symptoms, ear pain reported by child and restless sleep might indicate pain in children with respiratory tract infection. We suggest that the adaptation of pain scales for parent observation is a possibility in children with respiratory tract infection which, however, requires further studies.Trial registrationwww.clinicaltrials.gov, identifier NCT00299455. Date of registration: March 3, 2006.

Highlights

The assessment of ear pain is challenging in young, mostly preverbal children
Association of individual symptoms with moderate/severe pain Among all the 426 children with the parental suspicion of acute otitis media (AOM), the associations between individual symptoms and moderate/severe pain are presented in Fig. 5a, b and c. As parents assessed their child’s pain via interview (Fig. 5a), ear pain reported by child and restless sleep had significant associations with moderate/severe pain
As parents assessed their child’s pain with the Faces Pain Scale-Revised (FPS-R) (Fig. 5b), following symptoms had significant associations with moderate/severe pain: ear pain reported by child, excessive crying, restless sleep and poor appetite

Summary

Introduction

The assessment of ear pain is challenging in young, mostly preverbal children. Our aim was to investigate whether pain scales are useful tools for parents to detect pain in their young children with the suspicion of acute otitis media (AOM), and to assess associations between 16 symptoms and the severity of pain. Ear pain is considered as the most important and specific symptom of AOM and parents perceive it as one of the greatest burden in young children with AOM [1]. Ear pain of preverbal children is suggested to emerge as various non-specific symptoms, according to The American Academy of Pediatrics AOM guideline [2]. The study of Shaikh et al [4] suggested ear rubbing and fussiness to be the most important symptoms in influencing parental perception of ear pain in preverbal children with AOM. As they stated, their results are preliminary and are based on hypothetical patient scenarios. The adaptation of pain scales for parental use to assess acute, non-procedural pain in young children in an outpatient setting has not been investigated

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