Screening young children for their ability to use self-report pain scales

Self-report has often been identified as the 'gold standard' for pain measurement (McGrath et al., 1995; McGrath et al., 1996) despite its limitations and complex interpretation (Williams et al., 2000; Hodgins, 2002; Craig & Badali, 2004). One of the limitations is associated with the use of self-report measures with young children, particularly those under 5 years of age. While it has been suggested that some children as young as 3 years old are capable of using self-report measures (Villarruel & Denyes, 1991), data are lacking on whether those children who can validly use pain scales can be identified beforehand. The cognitive and social abilities necessary to self-report pain through measures such as faces scales and visual analog scales change rapidly as children progress from preschool to early school age. Children younger than 3 years are unable to quantify pain using self-report measures, while most children older than 5 years are able to rate their pain on suitable scales (McGrath, 1990; Shields et al., 2003; Spagrud et al., 2003). If clinicians routinely ask all 3or 4-year-old children for their pain ratings, some of these ratings will be invalid (e.g. because the child misunderstands the scale). The ensuing inaccurate pain assessment could lead to suboptimal pain management. On the other hand, if clinicians avoid asking any 4-year-olds for their pain ratings, valuable information will be missed from those children who are able accurately to report their pain intensity. Therefore, screening 3to 5-year-old children for their ability to complete self-report tasks has the potential to provide a better estimate compared to chronological age (McGrath, 1990). This review summarizes past methods of screening young children for their ability to use self-report pain scales, and discusses what may make a screening tool practical and efficient in clinical use.