Self-report methods should be easy to administer with simple instructions for children. They should allow both verbal and nonverbal (e.g., pointing) responses. Often, children will not respond to questions verbally, especially if they are anxious or depressed or are experiencing severe pain.
Several self-report methodsifor pain intensity are available for use with children (see Attachment B or, for example, Pain Affect Faces Scale ). Although the psychometric adequacy of these methods for children with cancer has yet to be determined, reliability and validity estimates are available for other pain syndromes such as postoperative pain, procedural pain, and juvenile rheumatoid arthritis. Methods appropriate for children over the age of 4 years include the Oucher (Beyer, Villarruel, and Denyes, 1993) and the Poker Chip Tool (Hester, Foster, and Kristensen, et al., 1990). Some investigators have used cartoon faces as scales of measurement for young children with cancer who are undergoing procedures, but the construct being measured was not necessarily pain. One scale measures pain affect (McGrath, de Veber, and Hearn, 1985), whereas others measure intensity of pain, anxiety, or distress (Adams, 1990; LeBaron and Zeltzer, 1984). Children over the age of 7 years who understand the concepts of order and number may prefer an NRS (McGrath and Unruh, 1987), a horizontal word graphic rating scale (Savedra, Tesler, Holzemer, et al., 1989 [updated 1992]), or a VAS (McGrath, 1990b). A large study that included children and adolescents reported that the VAS was the least preferred of five horizontal pain scales (Tesler, Savedra, Holzemer, et al., 1989).
To determine the location of pain, children can be asked either to point to their body or use a body map (i.e., an outline). Children over the age of 4 can use crayons or colored markers to locate pain on a body map (Eland, 1989; Savedra, Tesler, Holzemer, et al., 1989 [updated 1992])(see Attachment B). The precision of the location will increase with the child's age. Children who are suffering may regress; similarly, children who are developmentally delayed or learning disabled may need assessment tools developed for younger children. If a child is unable or unwilling to provide pain ratings, parents or health care professionals can provide proxy reports. Proxy ratings, however, are inexact.
ASSESSMENT OF PAIN IN THE PATIENT WITH CANCER
Ongoing Pain Assessment
Pain in Neonates, Children, and Adolescents
Assessment
Methods for Assessing Pain
Behavioral Observation
Pain Management (Children)
Assessing the Adequacy of Pain Management Strategies (Children)
Index