Pain evaluation in preschool children and by their parents

The accurate assessment of pain in children constitutes a challenge for hea lth professionals and, in the case of young children, parents are generally the main source of information. The objective of this study was to validat e and to compare three pain scales in preschool children and their parents. A total of 104 children between 4 and 6 y of age and their parents partici pated in the study while undergoing an immunization procedure in the outpat ient department of a tertiary pediatric care hospital. Three pain scales we re used, the McGrath Facial Affective Scale (FAS), the Hester Poker Chip To ol (HPCT) and the Multiple Size Poker Chip Tool (MSPCT). There were 47 (45% ) boys and 57 (55%) girls, with 54 (52%) 4-y-olds, 34 (33%) 5-y-olds and 16 (15%) 6-y-olds. Twenty-eight children (27%) had memories of pain experienc ed during a former hospitalization. Correlations were very high both in chi ldren (r = 0.78) and their parents (r = 0.96) when comparing immunization p ain scores obtained from the HPCT versus the MSPCT. Correlations between Mc Grath's FAS and HPCT or MSPCT ranged from r = 0.34-0.43 in children and r = 0.38-0.39 in parents. There was a good correlation between parents and chi ldren during the immunization procedure on all three scales, with the highe st correlation using the FAS (r = 0.76), followed by the MSPCT (r = 0.69), and the HPCT (r = 0.66). Subgroup analyses based on the criteria of age, se x and previous hospitalization showed no consistent relationship. Parents t ended to underestimate their child's pain when using HPCT or MSPCT. It seem s that both HPCT and MSPCT measure a similar dimension of pain, whereas the FAS addresses a different aspect of pain. Although parents play an importa nt role in their child's pain assessment, they tend to underestimate the in tensity of pain when using HPCT or MSPCT.