Can we screen young children for their ability to provide accurate self-reports of pain?

Abstract

No validated screening tasks exist to distinguish children who can accurately use self-report pain measures from those who cannot. Children aged 3–7 years (n = 108), each with a parent, provided data before and after day surgery. Parents rated how well they thought their child could understand the Faces Pain Scale-Revised (FPS-R), and children completed 4 screening tasks in counterbalanced order, such as rating pain in vignettes and selecting a middle-sized cup. Parents and children used the FPS-R to rate the children’s pain intensity. Children’s FPS-R ratings were scored for accuracy based on the extent to which they conformed to expected pain trajectories (eg, pain increasing following surgery, decreasing following analgesia), and based on parent-child agreement. On average, parents rated the youngest age at which children could understand the FPS-R as 4.4 years (95% confidence interval 4.1–4.5). The youngest children provided inaccurate high pain ratings before surgery, but they became indistinguishable from the oldest in the accuracy of their pain ratings for the remainder of the 3-day study period, suggesting that direct experience with pain or with the rating task may improve accuracy. Although children’s performance on the screening tasks was significantly associated with self-report accuracy, no prediction was strong enough for clinical use (all r’s < 0.30). We failed to identify a screening tool that was better than chronological age in identifying which children could accurately self-report pain using the FPS-R. Future research should explore other screening tasks, training methods, and simplified approaches to pain assessment for young children. The ability to use self-report pain scales usually develops from age 3 to 7 years, but no valid screening method exists to identify this achievement.