Tuesday, February 16, 2016

'How much does it hurt?' For preschoolers, cognitive development can limit ability to rate pain

February 3, 2016
Wolters Kluwer Health
'Rate your pain on a scale of zero to ten' -- for most adults and older children, it's a simple concept. But preschool-aged children generally lack the cognitive skills needed to make reliable pain ratings, say experts.

"Rate your pain on a scale of zero to ten"--for most adults and older children, it's a simple concept. But preschool-aged children generally lack the cognitive skills needed to make reliable pain ratings, according to an article in PAIN®, the official publication of the International Association for the Study of Pain (IASP). The journal is published by Wolters Kluwer.
"Using a scale to estimate and report pain intensity is a complex mental process and is often challenging for children under the age of five or six," write Jenny Yun-Chen Chan of University of Minnesota-Twin Cities and Carl L. von Baeyer of University of Manitoba, Winnipeg. They discuss cognitive (intellectual) development issues affecting children's ability to rate their pain, and discuss modifications for more developmentally appropriate pain assessments in the preschool age group.
For Kids Under Five, Pain Intensity Ratings Aren't So Simple
Asking patients to rate pain intensity is a routine part of everyday healthcare, and in research evaluating the impact of pain and the effectiveness of pain treatments. But in both settings, pain ratings are less often obtained in preschool-aged children.
That's because children younger than five may "report their pain in idiosyncratic ways that appear inappropriate for the context," Chan and von Baeyer write. Factors like memory of pain and knowledge of magnitude and symbolic processing limit preschoolers' ability to make pain self-assessments.
Words used to describe pain--such as "ow" or "hurt"--emerge as early as 18 months of age, and toddlers can point to a part of their body that hurts. By three years, most children have basic pain vocabulary. But it's not until age five that most children can "accurately describe concrete causes, perceptions, and intensity of pain," according to the authors.
That partly reflects the cognitive process of "explicit memory," which is influenced by language ability and social interactions. For example, children look to their parents to assess whether a painful event is trivial or threatening. Past pain experience also plays a role--preschoolers who have undergone surgery make pain intensity ratings more similar to those of older children.
"Knowledge of magnitude"--especially the understanding of magnitude relations--is also important for pain ratings. Two- and three-year-olds can compare and label two objects but they may have trouble with intermediate rankings, especially in unfamiliar situations.
Young children are sometimes asked to use symbols to denote their pain--for example, pointing to pictures of faces or using poker chips as "pieces of hurt." But for two- and three-year-olds, it may be difficult to distinguish between the object itself and the hurt it is supposed to represent. As with numerical scales, the typical five-year-old has the skills to use these alternative tools while most three-year-olds do not.
Chan and von Baeyer propose some modifications for simplifying self-report pain scales for preschoolers, based on cognitive developmental research--for example, using tools with no more than three response options and considering the child's past pain experiences. The authors also note that pain intensity ratings are just one method for assessing one aspect of pain. They add, "Thus it is important, perhaps especially so with young children, to incorporate multiple methods, such as observation and parent report, and to assess multiple aspects of pain to better understand patients' experience and provide appropriate treatment."

Story Source:
The above post is reprinted from materials provided by Wolters Kluwer HealthNote: Materials may be edited for content and length.

Journal Reference:
  1. Jenny Yun-Chen Chan, Carl L von Baeyer. Cognitive developmental influences on the ability of preschool-age children to self-report their pain intensityPAIN, 2015; 1 DOI: 10.1097/j.pain.0000000000000476

Thursday, February 4, 2016

Daycare teacher Belia Fuentes interacts with infants and toddlers at Buena Vista center in Watsonville. The children are playing with traditional stacking toys.
If parents want to help their babies learn to talk, they need to ditch the chattering electronic toys and bring back the books and blocks.
That’s the conclusion of Anna V. Sosa, an associate professor at Northern Arizona University, who conducted an experiment to determine whether the type of toy used during parent-child play influenced the quantity and quality of communications.
Sosa gave parents simple board books, traditional toys such as blocks, puzzles and shape sorters, and battery-operated toys such as a talking farm and a baby laptop and cell phone. Sosa then asked the parents to play with their child at home for 15 minutes at a time, twice a day, for three days. During each playtime, the parents used one type of toy or book. The children, who ranged in age from 10 to 16 months, wore a vest with a recorder to record their interactions. At this age, the infants typically relied on baby talk, such as “gah,” or single words.
Both parents and babies were much more likely to verbally interact with each other while looking at a board book or playing with traditional toys than with electronic toys. The study, “Association of the Type of Toy Used During Play With the Quantity and Quality of Parent-Infant Communication,” involved 26 parents and their babies and was published in JAMA Pediatrics in December.
The responsiveness of the caregiver, Sosa said, “is the No. 1 thing that seems to influence language development — are they tuned in to that child.”
The more parents talk to their children, the larger those children’s vocabularies, which can affect their achievement in school, researchers have found. Children from high-income, well-educated families can hear up to 30 million more words by the age of 3 than children in low-income, less-educated households. This research finding has been dubbed The Thirty Million Word Gap.
Although the parents in Sosa’s study were fairly homogeneous – mostly white, well-educated mothers – there were substantial differences in how much they talked to their babies, Sosa said. The babies wore the recorders for up to 16 hours during the day, making it possible for Sosa and her assistants to note those differences.
“We had parents who were super talkative and parents who over the course of the three days weren’t talking very much,” Sosa said. “We analyzed the results of the more chatty and less chatty parents.”
The less chatty parents talked a lot less, but in all cases, the books and traditional toys inspired the most verbal interactions.
“I was surprised at how consistent the results were,” Sosa said.
recent study found that reading books aloud provides exposure to a wider vocabulary than simply talking to children. In the Sosa study, books also were best at encouraging the most words and more content-specific words, even though the board books given to the parents were mostly pictures with few words.
“They weren’t story books,” Sosa said. “But even with a limited number of words, they provided some sort of script that encouraged parents to talk.”
“For families where reading books is not a preferred activity or the child is too active and doesn’t want to sit and look at a book, traditional toys may be a valuable alternative for parent-infant playtime,” said Anna V. Sosa, an associate professor at Northern Arizona University.
Though not as stimulating as books, traditional toys were also substantially better than electronic toys in encouraging more talking and content-specific words from the adults.
“For families where reading books is not a preferred activity or the child is too active and doesn’t want to sit and look at a book, traditional toys may be a valuable alternative for parent-infant playtime,” Sosa said.
Overall, the results “provide a basis for discouraging the purchase of electronic toys for babies that are promoted as educational and are often quite expensive,” she said.
Electronic toys may work as entertainment to keep babies occupied while parents are busy, “but there is no evidence that kids this young can learn language that way,” Sosa said.