Background & Aims

Many children perceive seeking emergency services as a painful and frightening experience. Pain perception during medical procedures can be significantly influenced by fear, which can lead to adverse physiological consequences. The use of measures of pain and fear can serve as a crucial tool to develop more targeted interventions and improve medical care. The Faces Pain Scale and Children’s Fear Scale are frequently used scales for self-report of pain and fear in children, given their low cognitive complexity and relative immunity to external influences in terms of explanation and interpretation. However, both scales have limitations in their use with young children and emergency medical care. This study aims to evaluate and adapt the FPS-R and CFS scales with preschoolers in pediatric emergency department (PED).

Methods

In a multicenter pilot study across four Chilean Pediatric Emergency Departments (PED), 100 preschool children (ages 4 to 5) and one parent per child participated. Preschoolers responded to self-report scales of pain (FPS-R) and fear (CFS), and both caregivers and healthcare personnel rated the same levels perceived by the child with a visual numerical scale. Descriptive statistics were analyzed with absolute frequency and percentages to estimate the prevalence of pain and fear according to what was reported by the children. Agreement between adult observers (health personnel and caregiver) was measured using Cohen’s Kappa. Correlation analysis was carried out between the values of the health personnel, caregiver and child. Additionally, the study compared responses between 4-year-old and 5-year-old children were compared using the chi-square statistic.

Results

The study involved 51% girls, 49% boys, with 90% female caregivers. Education varied (55% secondary, 20% technical, 24% university). Socioeconomic distribution: 45% vulnerable, 34% lower middle class, 21% upper middle class. Eighty-two percent of preschoolers reported pain (31% mild, 26% moderate, 23% severe). Responses to pain and fear faces were similar in 4- and 5-year-olds. On FPS-R, four faces had high response rates, mainly pointing to the second side (31%). In CFS, four faces showed higher response rates, mainly the 1st (54%). Intermediate faces had low responses (3-6%). Chi-square results showed no significant association between age and pain (?2(5)=6.840, p=0.233) or fear (?2=1.926, df=4, p=0.749). Mild to moderate correlations were found between pain and fear reported by health personnel (r=0.32-0.22), caregivers (r=0.51-0.58), and children. For adult pain assessment, Kappa coefficient was -0.008 (p=0.802), and for fear levels, it was 0.175 (p<0.001).

Conclusions

Pain is highly prevalent in preschoolers visiting PED (82%), while fear occurs in a lower proportion (56%). Both the FPS-R and CFS scales showed ease in responding to extreme levels of pain and fear, while difficulty for intermediate levels. The distribution of pain and fear measures does not vary significantly with age. Aligning with recent literature, a simplified scale adapted to preschoolers’ developmental level is recommended. Using a 4-sided scale for pain and fear, where the first indicates the absence of pain and fear, and the next 3 represent mild, intermediate, and high levels of the same constructs, is suggested. There’s a significant association between adult-perceived pain and preschoolers, especially with caregivers. However, health personnel reports might underestimate children’s pain.

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Presenting Author

Mariela Bustamante Fernandez

Poster Authors

Mariela Bustamante Fernandez

PhD

Universidad de Chile. Master in Health Psychology and Doctoral Candidate in Psychology Pontificia Universidad Católica de Chile

Lead Author

Valeska Tapia

MD

Universidad de Chile

Lead Author

Sofía Hidalgo Vilche

BS

Universidad de Chile. Psychology Student, Universidad de Chile

Lead Author

José Iván Rossel

PhD

Universidad de Chile. Master in Clinical Psychology,Universidad de Chile

Lead Author

Scarlett Caroca

BNSc

Universidad de Chile. Bachelor in Medicine, Universidad de Chile

Lead Author

Gabriela Ruiz

BNSc

Universidad de Chile. Medical Student, Universidad de Chile

Lead Author

Topics

  • Pain in Special Populations: Infants/Children