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Pediatric Pain Assessment & Caregiver Perception

January 17, 2019
Being aware of gender stereotypes when assessing for pain may change the way patient cases are managed.

with Tina L. Doshi, MD, MHS

A recent replication and extension study out of Yale University1 further examined potential biases in adult observer ratings of children’s pain

Published in the Journal of Pediatric Psychology, Earp, et al, expanded on a 2014 study by Cohen, et al,2 which found that adults rated a child undergoing a finger-prick as feeling more pain when the child was described as a boy as compared to a girl. Earp’s team replicated the findings of the original study in a larger, more diverse participant population and found that this effect was eliminated after controlling for the participants’ explicit gender stereotypes (eg, boy are more stoic, while girls are more expressive).

Source: 123RFThe way adults perceive pain in boys versus girls may impact their care.

Specifically, adults were asked to watch a video (the same used in Cohen2) of the finger-prick with the child described as a boy or a girl depending on condition. Subjects were then asked to rate:

  • how much pain the child experienced and displayed
  • how typical the child was in these respects
  • how much they agreed with explicit gender stereotypes concerning pain response in boys versus girls.

PPM spoke to Tina L. Doshi, MD, MHS, about the findings and potential application in pediatric pain assessment. Dr. Doshi is a neuropathic pain researcher and an assistant professor of anesthesiology and critical care medicine in the Division of Pain Medicine at Johns Hopkins University School of Medicine in Baltimore.

 “Pain is a widely variable, deeply personal, individual experience, yet we as providers must rely on our own assessments of patient pain to provide accurate diagnosis and appropriate management,” she said.  “This challenge is particularly apparent in the pediatric population, where patients are less likely to be able to articulate their pain. Healthcare providers are therefore more likely to rely on third-party assessments from adult caregivers and also more likely to draw on their own judgments about the pediatric patient experience.  Consequently, adult perceptions of pediatric pain can have a significant influence over the care of children.”

“At first glance, it may be discouraging to find that adults across a wide range of ages, genders, ethnicities, and parental statuses hold explicit gender stereotypes about pain responses, and that these stereotypes color their perceptions of the pediatric pain experience based on the child’s gender,” added Dr. Doshi. “ However, this study also presents an opportunity to improve the way we assess and care for our pediatric patients, regardless of gender.  We must identify, challenge, and deconstruct gender stereotypes about pain, both among our patients’ caregivers and within ourselves.  In doing so, we can better define and validate the highly individual, unique experience of patient pain, which is a critical component of caring for our patients, particularly among one of our most vulnerable populations: children.”


Last updated on: January 24, 2019
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