Paediatric pain problems
Pain is an aversive and complex multidimensional phenomenon. In involves aversive sensations, negative affect, cognitions about the significance of the aversive experience, behavioural and interpersonal responses associated with the aversive experience often referred to as pain behaviour, and pain may also involve a physiological dimension such as tissue damage or muscle tension (McGrath et al., 1985). The development of the child's concept of pain is affected by both cognitive maturation and the child's experience of pain (McGrath, 1995). Prior to eighteen months children can indicate that they are in pain by crying or simple verbalizations but are unable to conceptualize or verbalize different levels of pain intensity. Rating scales rather than selfreport scales are probably the best way to assess changes in pain levels in children at this stage of development (McGrath et al., 1985). Children of eighteen months can verbalize the fact that pain hurts. They can localize pain in their own bodies and they can identify pain in others. They can understand that their experience of pain may be alleviated by asking for medicine or receiving hugs and kisses from carers. They may also try to alleviate pain in others by offering to hug them. At about two years more elaborate descriptions of pain occur and children can more clearly attribute pain to external causes. By three or four years of age children can differentiate between differing intensities and qualities of pain and verbalize these. By three years children are also aware that specific strategies such as distraction may be used to cope with pain. So children at this age may be aware that playing when they have hurt themselves may make them feel better by distracting them from the pain. Between five and seven years children become more proficient at distinguishing between differing levels of pain intensity and may be able to use face scales to indicate fluctuations in pain experiences (Bieri et al., 1990). On face scales, children indicate the intensity of their pain by selecting a face from an array of faces expressing a variety of levels of pain, which most closely reflects their own experience of pain. Between
the ages of seven and ten years children can explain why pain hurts and once they reach adolescence they can explain the adaptive value of pain for protecting people from harm.