A qualitative exploration of the phenomenology of pain in children to inform pain assessment methods

Abstract

Background Pain is a common experience associated with healthcare for children, who often recall it as the worst part of hospitalisation. Several factors make assessment of pain more challenging in children. Families have previously identified the development of improved tools to assess pain in children as a key priority. We therefore sough to investigate the nature of this experience from the perspective of children and their parents to inform the development of such tools. Methods To explore the phenomenology of children’s acute pain to inform improved assessment, we conducted a qualitative study with combined (children aged ≥4 and parents) semi-structured interviews of families with children aged 0–16 years at a tertiary paediatric hospital in Western Australia. The interviews were analysed using the Framework Method. Results We recruited 27 families, stratified across <6 years, 6–11 years, and 12 + years child age groups. Children and parents demonstrated a range of insights and a wide diversity of ideas about pain. The key themes were: pain is a familiar part of normal life that serves an important function; children communicate pain with others, both verbally and non-verbally; children relate pain to a range of other sensory experiences, with some common experiences identified such as the colour red representing pain; existing pain scales are difficult for children due to limited experiences of extremes of pain; and pain scales could be improved by using more familiar or attractive content or technology. Conclusions Children demonstrated diverse experiences of pain and sensory associations. These findings can inform the development of paediatric pain assessment methodology. The novelty and adaptability offered by digital platforms may assist in creating individualised and engaging pain assessment tools.