Potentially unrecognised pain in children: Population‐based birth cohort study at 7 years of age

Aim To estimate agreement in the point prevalence of any pain, high‐intensity pain and pain in two or more sites according to parental and child report. Methods We conducted a prospective study of 5639 children from a Portuguese birth cohort – Generation XXI, where parents and 7‐year‐old children answered the same questions at the same time. We assessed the accuracy of parental report, considering children's self‐report as the gold standard. Results At 7 years of age, 499 children (8.8% (95% confidence interval (CI) 8.1–9.6)) reported having pain at the time of the interview. Of those, 44.1% had high‐intensity pain (3.9% (95% CI 3.4–4.4) of the whole sample) and 12.4% reported pain in two or more sites (1.1% (95% CI 0.8–1.4) of the whole sample). In this community setting, pain prevalence and intensity were lower when collected from parents. Parental report had sensitivity below 20% and specificity above 95% but its positive predictive value was at most 25%. Conclusion Our findings support that, outside acute care, parents have a specific but not sensitive report of children's pain at the age of 7 years. Their report seemed useful to exclude major complaints but limited to screen children's pain. This limitation was higher for more severe pain, that is two or more sites or high‐intensity pain. Children should be asked directly about pain to avoid under‐estimating paediatric pain.