The Journal of Pain
Volume 10, Issue 2 , Pages 214-220, February 2009

Does the Neonatal Facial Coding System Differentiate Between Infants Experiencing Pain-Related and Non-Pain-Related Distress?

  • Sara Ahola Kohut

      Affiliations

    • Department of Psychology, Faculty of Health, York University, Toronto, Ontario, Canada
    • Corresponding Author InformationAddress reprint requests to Ms Sara Ahola, York University, 4700 Keele Street, Toronto, Ontario, Canada M3J 1P3
    • ,
  • Rebecca Pillai Riddell

      Affiliations

    • Department of Psychology, Faculty of Health, York University, Toronto, Ontario, Canada
    • Hospital for Sick Children, Toronto, Ontario, Canada

Received 9 May 2008; received in revised form 20 August 2008; accepted 29 August 2008. published online 11 December 2008.

Abstract 

The Neonatal Facial Coding System (NFCS) is widely accepted as a measure of infant pain-related distress in known pain-specific contexts. It has clearly shown the ability to distinguish between facial reactivity in no-pain and pain-related situations. The primary purpose of this study was to explore whether NFCS differentiates between pain-related and non-pain-related distress. Two groups of 35 infants (1 group was distressed before injection whereas the other group was not distressed before injection) were coded using NFCS before and after an immunization procedure. Within-group analyses of infants who were distressed before immunization suggested that NFCS was not able to discriminate between pain-related and non-pain-related distress. However, between-group analyses showed NFCS discriminated between potential gradations of distress in infants after immunization. Results suggest that NFCS has the ability to discriminate between intensities of distress but not between pain–related and non-pain-related distress.

Perspective

Adding to the NFCS validity literature, this study suggests that while able to distinguish between no-distress and pain-related distress, facial actions of NFCS may not distinguish between pain-related and non-pain-related distress expressions. However, NFCS was able to discern infants presumed to have higher pain-related distress due to experiencing pre-needle distress.

Key words: Infant pain, pain expression, facial coding, Neonatal Facial Coding System

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 Supported by Canadian Institutes of Health Research and in part by research start-up funds provided by York University.

PII: S1526-5900(08)00735-9

doi:10.1016/j.jpain.2008.08.010

The Journal of Pain
Volume 10, Issue 2 , Pages 214-220, February 2009

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