Pain in 4- to 6-year-old children receiving intramuscular injections: A comparison of the faces pain scale with other self-report and behavioral measures

Objective: The main objective was to compare the utility of the Faces Pain Scale (Bieri et al., 1990) with three alternative self-report measures of pain intensity in children, as well as with pain ratings based on observations of the child's behavior. Design: Fifty children used 4 self-report scales to rate the severity of needle pain from routine immunization. Using videotapes, the child's pain-related behavior was coded in detailed fashion, and a subset of the sample were also rated globally by 60 registered pediatric nurses. Main Outcome Measures: Faces Pain Scale; Poker Chip Tool; Visual Analogue Toy; Verbal Rating Scale; behavioral checklist (scoring observable facial, motor, verbal and vocal reactions). Results and Conclusions: The Faces Pain Scale was simple to use, readily understood by the children, and showed a realistic distribution of scores with respect to the type of pain being measured. With the exception of verbal reactions (which were not meaningfully related to self-report), observer ratings based on detailed coding of the child's behavior correlated only poorly to moderately well with self-report scores (r = .39 to r = .58). Similarly, although confident in their judgments, the nurses' ratings showed only moderate agreement with those of the children. In estimating the child's pain, all observers appeared to appropriately weigh changes in the child's facial behavior, which showed evidence of being the most sensitive behavioral index to the intensity of short sharp (needle) pain in 4 to 6 years olds.