How parents gauge level of ear pain in preverbal children

Levels of pain severity from ear aches observed and reported by parents of preverbal children can be influenced as much by socioeconomic status and other non-clinical factors as symptoms unless physicians ask about specific observable symptoms, according to research in The Journal of Pain, published by the American Pain Society.

Researchers at the University of Pittsburgh studied 69 parents of preverbal children to determine the information parents use to gauge the severity of ear pain, also known as otalgia. Since ear pain is the most useful symptom for diagnosing acute otitis media infections, physicians rely on parental assessment of pain when deciding to prescribe antibiotics. The subjects were asked to comment on hypothetical cases in which various symptoms were present. Several observable symptoms of ear arches were chosen, including: fussiness, ear tugging, eating less, fever, sleeping difficulty and playing less. Specifically the parents were asked: "We are trying to find out how parents can tell when their child is in pain. Below are eight descriptions of what a one-year-old with an ear infection might have. If you were the parent of this child, how would you rate the pain level?"

Although no symptom dominated the parental assessments, ear tugging and fussiness were those most frequently influencing parental pain perceptions. But the researchers reported that overall pain levels described by parents may depend not only on observed symptoms but other child and parental factors. Most notably, maternal education and insurance status, which indicate higher socioeconomic status, appear to influence pain assessments. Because pain ultimately is a subjective determination, the authors concluded it is likely to be influenced by biological, psychological and social factors. In the study, observable behaviors accounted for only 50 percent of the pain levels.

To guide physicians in diagnosing ear infections, the study suggests that asking parents to report individual symptoms and pain behavior (rather than describing overall pain levels) is less subject to bias and variability from non-clinical factors. Therefore, asking about observable behaviors, such as ear tugging and fussiness, should follow a general question about ear pain and give physicians better insights on specific symptoms from which to base possible treatments.