Cues parents use to assess postoperative pain in their children

Objective: Very little is known about the cues parents use to assess pain in their children. This study has described the cues (verbal and nonverbal) parents reported using to determine how their children felt following surgery. Design and Subjects: The subjects were 176 parents of children undergoing short-stay or day surgery. Using pain diaries, parents were asked to provide written responses to the question 'Did your child give you any clues on how they were feeling?' for the day of surgery and 2 days after their children's surgery. Parents also provided ratings of their children's pain five times per day using a visual analogue scale. Setting: The study was conducted at a tertiary care children's hospital. Results and Conclusions: Parents frequently cited using verbal report and appetite as cues to how their children were feeling. A variety of other cue types were also reported by parents, including activity level, sleep quality, visible/audible discomfort, and physiological observations. Cue types were not significantly related to the child's gender, and only one cue type was significantly related to the child's age (appetite was used more often for older children than younger children). The presence or absence of illness behavior cues (e.g., protective behavior, visible/audible discomfort) as well as disruptions to normal behavior pattern cues (e.g., sleep, level of activity) was related, in the expected direction, to the pain intensity ratings. This study provides insights into the cues parents use to assess pain in their children and serves as a foundation for future studies on parents' assessment of children's pain.