- Say to the child:"I want to talk with you about the hurt you
may be having right now."
- Align the chips horizontally in front of the child on the bedside
table, a clipboard, or other firm surface.
- Tell the child,"These are pieces of hurt." Beginning at the
chip nearest the child's left side and ending at the one nearest the
right side, point to the chips and say,"This (first chip) is a
little bit of hurt and this (fourth chip) is the most hurt you
could ever have."
For a young child or for any child who may not fully comprehend the
instructions, clarify by saying, "That means this (one)is
just a little hurt, this (two)is a little more hurt, this
(three) is more yet, and this (four) is the most hurt you could
- Do not give children an option for zero hurt. Research with the
Poker Chip Tool has verified that children without pain will so indicate
by responses such as, "I don't have any."
- Ask the child, "How many pieces of hurt do you have right
- After initial use of the Poker Chip Tool, some children
internalize the concept "pieces of hurt". If a child gives a response
such as "I have one right now", before you ask or before you
lay out the poker chips, proceed with instruction # 5.
- Record the number of chips on the Pain Flow Sheet.
- Clarify the child's answer by words such as, "Oh, you have a little
hurt? Tell me about the hurt."
- Tell the parent:"Estas fichas de poker son una manera de
medir dolor. Usamos cuatro fichas rojas."
- Say to the child: "Las fichas son como pedazos de dolor: una
ficha (pedazo) es un poquito de dolor, mientras cuatro fichas (pedazos)
significa el dolor máximo que tu puedes sentir.
?Cuántos pedazos de dolor tienes?"
 Developed in 1975 by Nancy O.
Hester, University of Colorado Health Sciences Center, Denver, CO.
 Spanish instructions by Jordan-Marsh, M., Hall, D.,
Yoder, L., Watson, R., McFarlane-Sosa, G., & Garcia, M. (1990). The
Harbor-UCLA Medical Center Humor Project for Children. Los Angeles:
Harbor-UCLA Medical Center.