No need to ask a small child to rate his pain on a scale of 1 to 10. He is unable to do so until he is 5 years old.
“Ouch”, “I’m in pain! These words come very early in a child’s vocabulary. But identifying pain does not necessarily mean being able to assess its intensity. The methods currently proposed are not adapted to the cognitive capacities of toddlers, underline two Canadian researchers in the specialized journal Bread. “Using a scale to estimate the intensity of pain is a complex mental process that is often difficult for children under 5 or 6 years old,” explain Jenny Yun-Chen Chan and Carl von Baeyer.
The understanding of pain evolves in stages: from 18 months, children are able to express it in words and designate its origin. But it is only from 3 years old that the precise vocabulary develops and around 5 years old that the causes, perception and intensity are assimilated.
Before this age, suffering is perceived in an “idiosyncratic” way. The use of symbols or scales is therefore not possible.
A difficult hierarchy
Yet this is what is required of preschool children. They are placed in front of tokens or symbols supposed to allow them to quantify their pain. But as the two authors explain, the child may have difficulty making a connection between the object and the suffering it is supposed to represent. This ability is only developed after 5 years.
Another problem is that 2-3 year olds are able to compare two objects. But they may not necessarily be able to establish hierarchies among themselves, especially in unusual situations.
Not to mention that, often, children turn to their parents when it comes to assessing the impact of a painful event, whether it is benign or threatening.
The researchers therefore propose to simplify the evaluation tool, by not proposing more than 3 possible answers and by taking into account the child’s experience on the feelings of pain in the past.
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