UBC Reports | Vol. 51 | No. 1 | Jan. 10, 2005

E I E I Ouch!

Psychology student examines how children express pain

By Erica Smishek

Scraped knees, bumps and bruises, tummy aches, immunizations -- in an average child’s early years, pain is a daily reality. For sick kids, that pain can be chronic and even more intense.

Yet young children between three and six years of age may not have the verbal skills to efficiently communicate the type of pain or the magnitude of discomfort they are experiencing.

“A three- or four-year old may not even understand what the word ‘pain’ means,” says UBC psychology graduate student Elizabeth Job.

Job, under the supervision of professor emeritus Ken Craig and former UBC pediatrics assistant professor Christine Chambers, has examined ways children use everyday language to describe pain, as well as their ability to accurately convey their level of pain, through methods that include pointing to a series of pain faces developed as a rating scale, called the Faces Pain Scale Revised. The research will increase understanding of how developmental factors -- such as language and numerical reasoning -- influence children’s ability to accurately express pain with these scales.

Ultimately the research could lead to more effective pain assessment and treatment for children.

“Kids do a lot of things when they’re in pain,” says Job, who completed the research at the UBC Psychology department and the B.C. Research Institute for Children’s and Women’s Health. “They have characteristic facial expressions, they have characteristic body expressions. But few studies have considered how children develop vocabularies to express pain. This is a novel area in the field of pediatric pain assessment.”

Results of one study that used the Child Language Data Exchange System (CHILDES) database, a large language development database found the pain word strings most frequently used by a sample of children aged 12 to 108 months were “hurt,” “ouch” and “ow” while “ache”, “boo-boo”, “pain” and “sore” occurred very infrequently. Researchers also found that the earliest age of emergence for a pain word string (“ouch”) was 17 months while the latest age of emergence for a word string (“pain”) was 72 months.

In another study involving coding videotapes of 58 children aged four to six years receiving a routine immunization, 27 children used words to express the pain they experienced due to the injection; the remaining 31 did not use words. By far the most common utterance for those using words was an interjection – “ow!” Other utterances included declarative sentences (“It doesn’t hurt”), exclamatory sentences (“I didn’t cry!”), and interrogative sentences (“Is that done?”).

Researchers found that older children were less likely to use words to express their pain. Job says the studies reflect the need for clinicians to become informed of factors, such as language development, that impact on pediatric pain assessment. Only when clinicians carefully account for the role developmental factors play in the pain assessment process will they be best able to appropriately diagnose and treat pediatric pain.