Developmental data supporting simplification of self-report pain scales for preschool-age children

Claims regarding the ability of preschool-age children to provide accurate self-reports using standard pain scales are not well supported by age-specific evidence. Responses of children younger than 5 years are often idiosyncratic and subject to biases. Simplifying the task of self-report of pain would make it more developmentally appropriate for 3- to 5-year-olds. A binary question is asked: "Does it hurt?" or an equivalent. If yes, a simplified scale is presented, comprising 3 categories representing low, medium, and high pain severity. Children aged 3 to 5 years (N = 184) were recruited from preschools and day care centers. Following parental consent and child assent, children were randomly assigned to use either the Faces Pain Scale-Revised or a 3-face scale preceded by a yes-no question to rate pain in 9 picture stories from the Charleston Pediatric Pain Pictures portraying no pain, moderate pain, and severe pain. The simplified pain rating task made no difference for 5-year-olds, whose mean scores were nearly identical using the 2 approaches. However, discrimination of the 3 levels of Charleston Pediatric Pain Pictures items was significantly better in 3- and 4-year-olds with the simplified task than with the Faces Pain Scale-Revised. Simplifying the task improved preschool-age children's ability to estimate pain intensity.

Perspective: Standard self-report pain scales with 6 faces are confusing for many 3- and 4-year-olds. In basic preparatory research for future development of a preschool self-report pain scale, we simplified the task. This simplification made no difference for 5-year-olds but improved the performance of 3- and 4-year-olds.