Is this infant in pain? Caveats from the clinical setting

Abstract

0 ne of the more striking asymmetries in the context of pediatric are of pain experience is the difference between a parent’s and a physician’s opinion about whether an infant is experiencing pain in response to a procedure. Few parents watching an infant receive an immunization or undergoing a heel stick would hesitate to confirm that their infant is in pain. In sharp contrast, however, Schechter and Allen” ascertained that, for many physicians, pain experience “similar to adults” does not occur in infants. All physicians surveyed believed that the pain was similar only after children reached age 12. Only 50% felt that pain in infants under 1 month of age was similar. Of the three groups of physicians surveyed (family practitioners, pediatricians, and pediatric surgeons), surgeons were the least convinced, with only 30% believing that infants under 1 month felt pain similar to adults. In his focus article describing recent work on the facial expression of pain, Dr. Craig articulately describes another important asymmetry, namely, the difference between the emphasis placed on verbal self-report and the relative neglect of facial activity as both a sign and a measure of pain experience. While the significance of his argument is not limited to the assessment of pain in infants, it will no doubt strike a particularly salient chord in pediatric clinicians for whom assessing pain in the absence of verbal self-report is a daily occurrence. Dr. Craig confirms a number of important points, including that facial expression in infants can be coded objectively, that such coding has been used successfully in a variety of studies involving noxious stimuli, and that facial expression is an important (maybe the most