UBC Reports | Vol.
51 | No. 1 | Jan.
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
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
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.