Accurately Measuring Pain in Children

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While most children can identify pain as early as age 3, “it is not until age 5, on average, that they are able to accurately describe concrete causes, perceptions, and intensity of pain,” the authors wrote. “This may in part be due to constraints in the development of explicit memory, which is influenced by language ability and especially by social interaction. For example, children learn partly by social referencing (looking to others present, especially parents) to assess whether a painful event is trivial or highly threatening.”

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The investigators also note that the ability of children to accurately rank levels of pain changes with their past experience; children who have been hospitalized or who have recovered from surgery tend to report pain more accurately than children who have not.

In order to accurately measure level of pain in children, the researchers therefore suggest taking cognitive ability level into account.

Possible methods might include:

  • using a simplified pain faces scale;
  • reducing the number of possible responses on the scale;
  • using symbols that are easy for young children to understand;
  • explaining the magnitude on the scale and establishing connections between the scale points and corresponding pain intensity;
  • using age-appropriate terms to describe the pain such as “ouch,” “ow,” or “hurt”; and
  • asking parents for reports of a child’s past pain experiences to determine his or her understanding of different pain levels.


Chan JY, von Baeyer CL. Cognitive developmental influences on the ability of preschool-age children to self-report their pain intensity. Pain. 2016; doi:10.1097/j.pain.0000000000000476. In press.