Traditionally, pediatric pain has been inadequately treated, partly because of the difficulty in assessing pain in young children. Since the most reliable indicator of the existence and intensity of acute pain is self-report (Acute Pain Management, 1992), several instruments have been developed to help children describe how much they are hurting. The use of facial expressions, such as the Wong-Baker FACES Pain Rating Scale, has provided a simple method for measuring pain in children as young as 3 years of age (Wong and Baker, 1988). Although instructions accompany the FACES some health professionals use a variety of instructions, including minimal explanation. It is believed that the easier the scale is to use, the more likely people will use it and children will understand it. Therefore, a form of abbreviated word instructions was tested that included two to three descriptive words from the original instructions placed under each facial expression: FACE 0: no hurt; FACE 1: hurts little bit; FACE 2: hurts little more; FACE 3: hurts even more; FACE 4: hurts whole lot; FACE 5: hurts worst.
A convenience sample was comprised of 148 children ages 4 to 5 years who received an injected vaccine. There were 56 four-year-old and 92 five-year-old subjects. Of the total sample 58 were males. Before data collection, the tester randomly assigned prospective subjects to Group 1 (n=80; mean age 59.8 months) to receive the original instructions or to Group 2 (n=68; mean age 61.7 months) to receive the abbreviated word instructions. Before and after the injection, the child was asked, "Which face shows how much hurt you have now?"
The results of analysis of variance (ANOVA) indicated that age and sex had no significant influence on pain rating scores. T-tests were performed on the mean pre-injection scores, the mean post-injection scores, and the mean post- minus the pre-injection scores for the two groups. All differences in the corresponding mean values were found to be insignificant. The analysis indicated that the Wong-Baker FACES Pain Rating Scale with words under the faces provided sufficiently clear instruction for 4- to 5-year-old children to use the scale successfully for rating pain intensity. The mean post-injection score was significantly higher that the mean pre-injection score based on 95% confidence intervals for Group 1 (1.132 to 2.018) and for Group 2 (1.204 to 2.267). These values indicated that there were significant differences between the mean pre-injection pain score and mean post-injection pain score in both groups, thus supporting the construct validity of the scale. The use of the simple word instructions that accompany the FACES is encouraged.
Click here to see a pain assessment record.
View original and revised instructions.
See Chapter 26 of Nursing Care of Infants and Children, 5th and 6th editions.
See Chapter 21 of Essentials of Pediatric Nursing, 5th edition.
March 15, 2002