Authors:
Lily W. Lee, PhD, RN
Rosemary White-Traut, DNSc, RN
Illinois Central College and University of
Illinois at Chicago
The purpose of this study was to explore the relationship between children's temperament and their response to pain.
Despite recent advances in understanding pain and its management, problems remain in managing children's pain effectively. It is generally recognized that children's pain perception and response vary due to interactions of developmental and social-environmental factors. However, children's individual differences in temperament has rarely been considered.
A convenience sample of 137 three to seven-year-old children scheduled for elective surgery which required preoperative blood test by venipuncture and their parents (or guardian) participated in the study. The children rated their pain with Wong-Baker Faces Pain Rating Scale (WBFPRS) before and after the venipuncture. Their pulse rate and oxygen saturation were recorded and behaviors videotaped during the blood sampling procedure. The Children's Hospital of Ontario Pain Scale (CHEOPS) and the Revised Behavioral Pain Rating Scale (RBPRS) were used to analyze their behaviors. Parents reported their child's previous pain experiences and responses, usual pain behaviors, and their own behaviors when their child experienced pain. Parents also rated their child's temperament characteristics using the Behavioral Style Questionnaire (BSQ).
The mean scores of children's self-report of pain were 0.09 (SD = 0.47, range 0-4) before and 2.45 (SD = 1.9, range 0-5) after the venipuncture (t (125) = -14.1, p < .001). Self-report of higher pain intensity correlated significantly to decreases oxygen saturation (r = .21, P <.OS), increased pulse rate (r = .26, p <.01)), and more behavioral distress (CHEOPS, r = .47, p <.OO1; RBPRS, r = .42, P <.001)). Children with lower "threshold" reported higher level of pain after the venipuncture (r = .18, p <.05), and exhibited more behavioral distress in the preparation phase of the blood sampling procedure {F (9,116) = 2.46, p <.05). "Activity," "adaptability," "approach," "intensity," "mood," and "threshold" correlated to children's previous pain responses and their usual pain behaviors. These variables were strong predictors of children's responses to the blood sampling procedure.
When caring for children in pain, nursing interventions based on thorough assessment of the individual child's temperament, usual response to pain, self-report, physiological and behavioral responses to pain, will enable nurses to manage pediatric pain more effectively.
March 15, 2002
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