Highlights
- •Most studies of 3- and 4-year-olds’ pain ratings aggregate data with older children.
- •Most 3-year-olds cannot reliably and validly use self-report pain intensity scales.
- •Many 4-year-olds can provide meaningful scores using self-report pain intensity scales.
- •Pain scales with fewer response options are more suitable for young children.
Abstract
Claims are made for the validity of some self-report pain scales for 3- and 4-year-old
children, but little is known about their ability to use such tools. This systematic
review identified self-report pain intensity measures used with 3- and/or 4- year-old
participants (3-4yo) and considered their reliability and validity within this age
span. The search protocol identified research articles that included 3-4yo, reported
use of any pain scale, and included self-reported pain intensity ratings. A total
of 1,590 articles were screened and 617 articles met inclusion criteria. Of the included
studies, 98% aggregated self-report data for 3-4yo with data for older children, leading
to overestimates of the reliability and validity of self-report in the younger age
group. In the 14 studies that provided nonaggregated data for 3-4yo, there was no
evidence for 3-year-old and weak evidence for 4-year-old children being able to use
published self-report pain intensity tools in a valid or reliable way. Preschool-age
children have been reported to do better with fewer than the 6 response options offered
on published faces scales. Simplified tools are being developed for young children;
however, more research is needed before these are adopted.
Perspective
Some self-report pain scales have been promoted for use with 3- and 4-year-old children,
but this is on the basis of studies that aggregated data for younger and older children,
resulting in overestimates of reliability and validity for the preschool-age children.
Scales with fewer response options show promise, at least for 4-year-old children.
Key words
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Article info
Publication history
Published online: March 24, 2017
Footnotes
T.J. is supported by the Sydney Children's Hospital Foundation.
The authors have no conflicts of interest to declare.
Identification
Copyright
© 2017 by the American Pain Society
