PAIN IN 4-YEAR-OLD TO 6-YEAR-OLD CHILDREN RECEIVING INTRAMUSCULAR INJECTIONS - A COMPARISON OF THE FACES PAIN SCALE WITH OTHER SELF-REPORT AND BEHAVIORAL MEASURES

Objective: The main objective was to compare the utility of the Faces Pain Scale (Bieri et al., 1990) with three alternative self-report mea sures of pain intensity in children, as well as with pain ratings base d on observations of the child's behavior. Design: Fifty children used 4 self-report scales to rate the severity of needle pain from routine immunization. Using videotapes, the child's pain-related behavior was coded in detailed fashion, and a subset of the sample were also rated globally by 60 registered pediatric nurses. Main Outcome Measures: Fa ces Pain Scale; Poker Chip Tool; Visual Analogue Toy; Verbal Rating Sc ale; behavioral checklist (scoring observable facial, motor, verbal an d vocal reactions). Results and Conclusions: The Faces Pain Scale was simple to use, readily understood by the children, and showed a realis tic distribution of scores with respect to the type of pain being meas ured. With the exception of verbal reactions (which were not meaningfu lly related to self-report), observer ratings based on detailed coding of the child's behavior correlated only poorly to moderately well wit h self-report scores (r = .39 to r = .58). Similarly, although confide nt in their judgments, the nurses' ratings showed only moderate agreem ent with those of the children. In estimating the child's pain, all ob servers appeared to appropriately weigh changes in the child's facial behavior, which showed evidence of being the most sensitive behavioral index to the intensity of short sharp (needle) pain in 4 to 6 years o lds.