pain words

[Brian MacWhinney]

Dear Info-CHILDES,
     Here is a summary of a UBC press release about a forthcoming 
article in the journal "Pain" that summarizes the development of pain 
words in the CHILDES English database.  It seems important for doctors 
and nurses to realize how limited children's expression of pain is 
initially.
Also, they note in a separate study of innoculations that older kids 
are a bit more stoic.

--Brian MacWhinney

Scraped knees, bumps and  bruises, tummy aches, immunizations – in an 
average child’s early years, pain is a daily  reality. For sick kids, 
that pain can be chronic and even more intense. Yet young children 
between three and six years of age may not have the verbal skills to 
efficiently communicate the type of pain or the magnitude of discomfort 
they are  experiencing. “A three- or four-year old may not even 
understand what the word ‘pain’ means,” says UBC psychology graduate  
student Elizabeth Job. Job, under the supervision  of professor 
emeritus Ken Craig and former UBC pediatrics assistant professor 
Christine Chambers, has examined ways children use everyday language to 
describe pain, as well as their ability to accurately convey their 
level of pain, through methods that include pointing to a series of 
pain faces  developed as a rating scale, called the Faces Pain Scale 
Revised. The research will increase understanding of how developmental 
factors – such  as language and numerical  reasoning – influence 
children’s ability to accurately express pain with these scales. 
Ultimately the research could lead to more effective pain assessment 
and treatment for children. “Kids do a lot of things when they’re in 
pain,” says Job, who completed the research at the UBC pPsychology 
department and the B.C. Research Institute for Children’s and Women’s 
Health. “They have characteristic facial expressions, they have 
characteristic body expressions. But few studies have considered how 
children develop vocabularies to express pain. This is a novel area in 
the field of pediatric pain assessment.” Results of one study that  
used the Child Language Data Exchange System (CHILDES) database, a 
large language development database found the pain word strings most 
frequently used by a sample of children aged 12 to 108 months were 
“hurt,” “ouch” and “ow” while “ache”, “boo-boo”, “pain” and “sore” 
occurred very infrequently. Researchers also found that the earliest 
age of emergence for a pain word string (“ouch”) was 17 months while 
the latest age of  emergence for a word string (“pain”) was 72 months. 
In another study involving coding videotapes of 58  children aged four 
to six years receiving a routine immunization, 27 children used words 
to express the pain they  experienced due to the  injection; the 
remaining 31  did not use words. By far the most common utterance for 
those using words was an  interjection – “ow!” Other utterances 
included declarative sentences  (“It doesn’t hurt”), exclamatory 
sentences (“I didn’t cry!”), and interrogative  sentences (“Is that 
done?”). Researchers found that older children were less likely to use 
words to express their pain. Job says the studies reflect  the need for 
clinicians to become informed of factors, such as language development, 
that impact on pediatric pain assessment. Only when clinicians 
carefully account for the role developmental factors play in the pain 
assessment process will they be best able to  appropriately diagnose 
and treat pediatric painUBCresearcher studies the many ways kids say 
“ouch.”