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Systematic Review of Self-Report Measures of Pain Intensity in 3- and 4-Year-Old Children: Bridging a Period of Rapid Cognitive Development

  • Carl L. von Baeyer
    Correspondence
    Address reprint requests to Carl L. von Baeyer, PhD, Department of Pediatrics and Child Health, University of Manitoba, CE-208 Childrens Hospital, 840 Sherbrook St, Health Sciences Centre, Winnipeg, Manitoba R3A 1S1, Canada.
    Affiliations
    Department of Clinical Health Psychology, and Department of Pediatrics and Child Health, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
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  • Tiina Jaaniste
    Affiliations
    Department of Pain and Palliative Care, Sydney Children's Hospital, Randwick, New South Wales, Australia

    School of Women's and Children's Health, University of New South Wales, Kensington, New South Wales, Australia
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  • Henry L.T. Vo
    Affiliations
    Department of Pain and Palliative Care, Sydney Children's Hospital, Randwick, New South Wales, Australia

    School of Women's and Children's Health, University of New South Wales, Kensington, New South Wales, Australia
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  • Georgie Brunsdon
    Affiliations
    Department of Pain and Palliative Care, Sydney Children's Hospital, Randwick, New South Wales, Australia
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  • Hsuan-Chih Lao
    Affiliations
    School of Women's and Children's Health, University of New South Wales, Kensington, New South Wales, Australia

    Department of Anesthesiology and Pain Management Center, MacKay Children's Hospital, Taipei City, Taiwan
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  • G. David Champion
    Affiliations
    Department of Pain and Palliative Care, Sydney Children's Hospital, Randwick, New South Wales, Australia

    School of Women's and Children's Health, University of New South Wales, Kensington, New South Wales, Australia
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      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.

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      References

        • Besenski L.
        • Forsyth S.
        • von Baeyer C.
        Screening young children for their ability to use self-report pain scales.
        Pediatric Pain Letter. 2007; 9: 1-6
        • Beyer J.E.
        • Aradine C.R.
        Content validity of an instrument to measure young children’s perceptions of the intensity of their pain.
        J Pediatr Nurs. 1986; 1: 386-395
        • Bosenberg A.
        • Thomas J.
        • Lopez T.
        • Kokinsky E.
        • Larsson L.E.
        Validation of a six-graded faces scale for evaluation of postoperative pain in children.
        Paediatr Anaesth. 2003; 13: 708-713
        • Chan J.Y.
        • von Baeyer C.L.
        Cognitive developmental influences on the ability of preschool-aged children to self-report their pain intensity.
        Pain. 2016; 157: 997-1001
        • Clemente I.
        Pain in cultural and communicative contexts.
        in: McGrath P.J. Stevens B.J. Walker S.M. Zempsky W.T. Oxford Textbook of Paediatric Pain. Oxford University Press, Oxford, United Kingdom2013: 102-110
        • Decruynaere C.
        • Thonnard J.L.
        • Plaghki L.
        How many response levels do children distinguish on faces scales for pain assessment?.
        Eur J Pain. 2009; 13: 641-648
        • Emmott A.
        • West N.
        • Zhou G.
        • Dunsmuir D.
        • Montgomery C.J.
        • Lauder G.R.
        • von Baeyer C.L.
        Validity of simplified versus standard self-report measures of pain intensity in preschool-aged children undergoing venipuncture.
        J Pain. 2017; 18: 564-573
        • Huguet A.
        • Stinson J.N.
        • McGrath P.J.
        Measurement of self-reported pain intensity in children and adolescents.
        J Psychosom Res. 2010; 68: 329-336
        • Jaaniste T.
        • Noel M.
        • von Baeyer C.
        Young children’s ability to report on past, future, and hypothetical pain states: A cognitive-developmental perspective.
        Pain. 2016; 157: 2399-2409
        • Jones C.M.
        • Heidmann J.
        • Gerrish A.C.
        Children’s ratings of dental injection and treatment pain, and the influence of the time taken to administer the injection.
        Int J Paediatr Dent. 1995; 5: 81-85
        • Latimer M.
        • Finley G.A.
        • Rudderham S.
        • Inglis S.
        • Francis J.
        • Young S.
        • Hutt-MacLeod D.
        Expression of pain among Mi’kmaq children in one Atlantic Canadian community: A qualitative study.
        CMAJ Open. 2014; 2: E133-E138
        • Lehmann H.P.
        • Bendebba M.
        • DeAngelis C.
        The consistency of young children’s assessment of remembered painful events.
        J Dev Behav Pediatr. 1990; 11: 128-134
        • Moher D.
        • Liberati A.
        • Tetzlaff J.
        • Altman D.G.
        Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement.
        PLoS Med. 2009; 6: e1000097
        • Peterson C.
        • Noel M.
        ‘I was just screeching!’: Comparing child and parent derived measures of distress.
        Stress Health. 2012; 28: 279-288
        • Ruskin D.
        • Amaria K.
        • Warnock F.
        • McGrath P.
        Assessment of pain in infants, children, and adolescents.
        in: Turk D. Melzack R. Handbook of Pain Assessment. Guilford Press, New York, NY2011: 213-241
        • Stanford E.A.
        • Chambers C.T.
        • Craig K.D.
        The role of developmental factors in predicting young children’s use of a self-report scale for pain.
        Pain. 2006; 120: 16-23
        • Stinson J.N.
        • Kavanagh T.
        • Yamada J.
        • Gill N.
        • Stevens B.
        Systematic review of the psychometric properties, interpretability and feasibility of self-report pain intensity measures for use in clinical trials in children and adolescents.
        Pain. 2006; 125: 143-157
        • St-Laurent-Gagnon T.
        • Bernard-Bonnin A.C.
        • Villeneuve E.
        Pain evaluation in preschool children and by their parents.
        Acta Paediatr. 1999; 88: 422-427
        • Thirion J.
        • O’Riordan M.A.
        • Stormorken A.
        Revisiting the Pieces of Hurt pain assessment tool – do the pieces matter?.
        Pediatric Pain Letter. 2015; 17: 1-4
        • Tomlinson D.
        • von Baeyer C.L.
        • Stinson J.N.
        • Sung L.
        A systematic review of faces scales for the self-report of pain intensity in children.
        Pediatrics. 2010; 126: e1168-e1198
        • Tsze D.S.
        • von Baeyer C.L.
        • Bulloch B.
        • Dayan P.S.
        Validation of self-report pain scales in children.
        Pediatrics. 2013; 132: e971-e979
        • von Baeyer C.L.
        Children’s self-reports of pain intensity: Scale selection, limitations and interpretation.
        Pain Res Manag. 2006; 11: 157-162
        • von Baeyer C.L.
        Self-report: The primary source in assessment after infancy.
        in: McGrath P.J. Stevens B.S. Walker S.M. Zempsky W.T. Oxford Textbook of Paediatric Pain. Oxford University Press, Oxford, United Kingdom2014: 370-378
        • von Baeyer C.L.
        • Chambers C.T.
        • Forsyth S.J.
        • Eisen S.
        • Parker J.A.
        Developmental data supporting simplification of self-report pain scales for preschool-age children.
        J Pain. 2013; 14: 1116-1121
        • von Baeyer C.L.
        • Forsyth S.J.
        • Stanford E.A.
        • Watson M.
        • Chambers C.T.
        Response biases in preschool children’s ratings of pain in hypothetical situations.
        Eur J Pain. 2009; 13: 209-213
        • von Baeyer C.L.
        • Uman L.S.
        • Chambers C.T.
        • Gouthro A.
        Can we screen young children for their ability to provide accurate self-reports of pain?.
        Pain. 2011; 152: 1327-1333
        • Willis M.H.
        • Merkel S.I.
        • Voepel-Lewis T.
        • Malviya S.
        FLACC Behavioral Pain Assessment Scale: A comparison with the child’s self-report.
        Pediatr Nurs. 2003; 29: 195-198
        • Yeh C.H.
        Development and validation of the Asian version of the Oucher: A pain intensity scale for children.
        J Pain. 2005; 6: 526-534