title: Evaluating pain induced by venipuncture in pediatric patients with developmental delay.
abstract: OBJECTIVE
  Little attention has been paid to the assessment of pain in children with developmental delay. The aim of this study was to explore several methods for assessing pain during venipuncture in this population of children, using classic and modified scales to evaluate the children's response to simplified tools.
  
  
  METHODS
  Sixteen children with mild or moderate developmental delay were evaluated using three standard self-rating scales (Visual Analog Scale [VAS], Eland Scale, and Faces Scale) and three modified methods (Cube Test, Modified Eland Scale, and Modified Faces Scale), recording subjective self-ratings and behavioral expressions of pain during a venipuncture procedure, apart from the initial fear. The children's pain and reaction time were assessed by an outside observer, while their pain and fear were also evaluated by the parents.
  
  
  RESULTS
  The VAS was used without difficulty by all the children and revealed a good consistency with the Cube Test. The parents' and neutral observer's indirect pain assessment was also consistent with the child's evaluations. The Eland Scale proved difficult to use, especially for Down's syndrome children, while its modified version was easier. Results emerging from the original and modified Faces Scales were inconsistent. Frightened children attributed higher pain scores, demonstrating that negative emotions exacerbate the experience of pain in developmentally delayed children. The patients showed a limited capacity for verbal and behavioral expression in reaction to the painful stimulus (especially the Down's cases).
  
  
  CONCLUSIONS
  These findings support the conviction that even developmentally delayed children can use self-rating methods effectively. This sector demands further, more extensive study, including the development of simplified tools, to ensure an adequate pain assessment and optimal antalgic approach to this particular pediatric population.
authors.affiliation: Department of Pediatrics, University of Padua, Italy. irene@pediatria.unipd.it
authors.forename: Franca
authors.initials: F
authors.lastname: Benini
authors.forename: Manuela
authors.initials: M
authors.lastname: Trapanotto
authors.forename: Daniela
authors.initials: D
authors.lastname: Gobber
authors.forename: Caterina
authors.initials: C
authors.lastname: Agosto
authors.forename: Giovanna
authors.initials: G
authors.lastname: Carli
authors.forename: Paola
authors.initials: P
authors.lastname: Drigo
authors.forename: Jo
authors.initials: J
authors.lastname: Eland
authors.forename: Franco
authors.initials: F
authors.lastname: Zacchello
mesh_terms: D000293:Adolescent; D002648:Child; D002658:Developmental Disabilities / Q000150:complications / Q000628:therapy*; D005069:Evaluation Studies as Topic; D005149:Facial Expression; D005239:Fear / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D015588:Observer Variation; D010146:Pain / Q000209:etiology* / Q000523:psychology; D010147:Pain Measurement; D018962:Phlebotomy / Q000009:adverse effects*; D012647:Self-Assessment; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires