title: Systematic Review of Self-Report Measures of Pain Intensity in 3- and 4-Year-Old Children: Bridging a Period of Rapid Cognitive Development.
abstract: Claims are made for the validity of some self-report pain scales for 3- and 4-year-old children, but little is known about their ability to use such tools. This systematic review identified self-report pain intensity measures used with 3- and/or 4- year-old participants (3-4yo) and considered their reliability and validity within this age span. The search protocol identified research articles that included 3-4yo, reported use of any pain scale, and included self-reported pain intensity ratings. A total of 1,590 articles were screened and 617 articles met inclusion criteria. Of the included studies, 98% aggregated self-report data for 3-4yo with data for older children, leading to overestimates of the reliability and validity of self-report in the younger age group. In the 14 studies that provided nonaggregated data for 3-4yo, there was no evidence for 3-year-old and weak evidence for 4-year-old children being able to use published self-report pain intensity tools in a valid or reliable way. Preschool-age children have been reported to do better with fewer than the 6 response options offered on published faces scales. Simplified tools are being developed for young children; however, more research is needed before these are adopted.
  
  
  
  Some self-report pain scales have been promoted for use with 3- and 4-year-old children, but this is on the basis of studies that aggregated data for younger and older children, resulting in overestimates of reliability and validity for the preschool-age children. Scales with fewer response options show promise, at least for 4-year-old children.
authors.affiliation: Department of Clinical Health Psychology, and Department of Pediatrics and Child Health, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada. Electronic address: carl.vonbaeyer@gmail.com.
authors.forename: Carl L
authors.initials: CL
authors.lastname: von Baeyer
authors.affiliation: Department of Pain and Palliative Care, Sydney Children's Hospital, Randwick, New South Wales, Australia; School of Women's and Children's Health, University of New South Wales, Kensington, New South Wales, Australia.
authors.forename: Tiina
authors.initials: T
authors.lastname: Jaaniste
authors.affiliation: Department of Pain and Palliative Care, Sydney Children's Hospital, Randwick, New South Wales, Australia; School of Women's and Children's Health, University of New South Wales, Kensington, New South Wales, Australia.
authors.forename: Henry L T
authors.initials: HLT
authors.lastname: Vo
authors.affiliation: Department of Pain and Palliative Care, Sydney Children's Hospital, Randwick, New South Wales, Australia.
authors.forename: Georgie
authors.initials: G
authors.lastname: Brunsdon
authors.affiliation: School of Women's and Children's Health, University of New South Wales, Kensington, New South Wales, Australia; Department of Anesthesiology and Pain Management Center, MacKay Children's Hospital, Taipei City, Taiwan.
authors.forename: Hsuan-Chih
authors.initials: HC
authors.lastname: Lao
authors.affiliation: Department of Pain and Palliative Care, Sydney Children's Hospital, Randwick, New South Wales, Australia; School of Women's and Children's Health, University of New South Wales, Kensington, New South Wales, Australia.
authors.forename: G David
authors.initials: GD
authors.lastname: Champion
mesh_terms: D002675:Child, Preschool; D003071:Cognition; D006801:Humans; D010147:Pain Measurement / Q000379:methods*; D002666:Psychology, Child; D057566:Self Report
keywords: Systematic review; assessment; child; pain; preschool; self-report