title: "Ow!": spontaneous verbal pain expression among young children during immunization.
abstract: OBJECTIVE
  Although self-reports are a commonly used means of assessing pain in clinical settings, little is understood about the nature of children's spontaneous verbal expressions of pain. The purpose of this study was to describe verbalizations of pain among children receiving a preschool immunization and to examine how pain verbalizations correspond to children's facial expressions and self-reports of pain intensity.
  
  
  METHODS
  Fifty-eight children between the ages of 4 years 8 months and 6 years 3 months (67% female) were videotaped while receiving their routine preschool immunization. Global ratings of facial expression and detailed transcription and coding of pain verbalizations were undertaken. Children provided self-reports of pain using a 7-point faces pain scale.
  
  
  RESULTS
  Fifty-three percent of children used verbalizations spontaneously to express their pain. The modal verbalization was the interjection "Ow!," which expressed negative affect and was specific to the experience of pain. Older children were less likely to use verbalizations to express their pain. Children who used verbalizations to express pain displayed greater facial reactions to pain and rated their pain experience as being more intense than children who did not use words to express their pain.
  
  
  CONCLUSIONS
  Results indicate that many young children do not spontaneously use verbalizations to express pain from immunization. When 5-year-olds use verbalizations to express pain, the verbalizations are most often brief statements that express negative affect and directly pertain to pain. Knowledge of how children verbalize pain may lead to an improved ability to assess and manage pediatric pain.
authors.affiliation: Department of Psychology, University of British Columbia, Vancouver, British Columbia, Canada. eajob@interchange.ubc.ca
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Stanford
authors.forename: Christine T
authors.initials: CT
authors.lastname: Chambers
authors.forename: Kenneth D
authors.initials: KD
authors.lastname: Craig
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: McGrath
authors.forename: Keri-Leigh
authors.initials: KL
authors.lastname: Cassidy
mesh_terms: D002648:Child; D002675:Child, Preschool; D005149:Facial Expression; D005260:Female; D006801:Humans; D007114:Immunization / Q000009:adverse effects* / Q000523:psychology; D008297:Male; D010146:Pain / Q000209:etiology*; D010147:Pain Measurement / Q000523:psychology*; D015203:Reproducibility of Results; D014705:Verbal Behavior