Assessment and Questionnaires for Children with Pain

Introduction

To productively treat chronic pain in children, effective assessment tools are necessary.

The most reliable and accurate measure of pain in children is self-reporting, however, that is not without its challenges. Pain is shaped by developmental factors and the sociocultural, psychological and biological attributes of the child need to be understood. Utilising this biopsychosocial model helps to appreciate the child’s understanding of pain, how they describe it and how they manage their pain. These attributes are always changing and are not static as the child grows and develops.

When assessing a child’s report on their pain, Freud et al. (2019) listed four factors to take into account:

1. Level of cognitive development: depending on the age of the child determines how they perceive the cause and effect of pain. Very young infants do not understand pain, but can experience it and remember it. As they age, their understanding of pain matures.
2. Fear and prior painful experiences: Previous pain experiences can influence future or potentially painful incidents. Increased levels of fear in children correspond with higher levels of reported pain, the persistence of pain, anxiety, avoidance behaviours and disability
3. Societal expectations, stereotypical assumptions, and familial cultural norms: children learn how to experience, manage and describe pain by observing their parents’ response. Parental and caregiver responses are guided by societal stereotypes and expectations
4. Anchor effects: this refers to extremes of a scale such as:
   1. no pain vs pain
   2. Smiley face vs sad face
   3. High number vs low number
   4. Colour that depicts pain vs colour depicting no pain

The issue with anchor effects is that children can not readily understand these abstract scales leaving them to choose based on previous experiences. If they feel happy, they still could be in pain and vice versa, if they are sad, they might not be in pain. This could cause false-positive or false-negative depending on their bias towards colour or number.

Ideally, getting a history of the child from the parent and child will assist in understanding what factors might be influencing the child’s pain help create the most in-depth picture of life experiences.

Chronic Pain

Pain that occurs for longer than three months is considered chronic. The pediatric population coping with chronic pain may have interruptions in social, recreational and school activities causing functional and emotional distress. In response to chronic pain, children may develop changes in sleep, mood and anxiety. Pain questionnaires can be used to get a holistic view of the child and what they are experiencing.

Pain Questionnaires

• bulleted list
• x

or

1. numbered list