How Much Pain is Our Kid Feeling? Well, How Much Can We Afford?

When a sick kid is too young to speak, doctors naturally ask a parent or other caretaker how much it hurts. Only half of the answer, according to this study in this month’s Journal of Pain, is based on symptoms. The rest arises from the adult’s own life experience, including social class: Given a list of earache symptoms, parents at a clinic were asked to rate how much a hypothetical one-year-old would be suffering. College graduates’ estimates were distinctly higher than those of people who didn’t get beyond high school.

Nader Shaikh and colleagues at the University of Pittsburgh also report finding a link between pain perception and type of insurance: About a fifth of the parents who completed their questions had private insurance, while the rest used public programs. Those with the private coverage perceived more pain from the same symptoms. Both education level and insurance status, as the authors write, are often-used proxies for class status.

Everyone’s answers, on a scale from no-pain 0 to unbearable 100, clumped around the same numbers, making all parents look alike. So the researchers log-transformed the data to expose the differences among them. Which means these transformed numbers (college grads’ average estimate, 39.8; no-college parents’, 21.5), represent a slight, not colossal, distinction. Still, the authors write, it’s significant.

It wasn’t a large or broadly representative study (only 59 parents, 41 of whom were African-American and only 13 of whom had graduated college) had their answers tallied. But it’s enough, the authors say, to suggest that simply asking about a sick child’s pain may not be enough. Doctors, when they ask parents for their gut feelings about what their child has suffered, might want to consider what else that gut has been through in life.

Shaikh, N., Kearney, D., Colborn, D., Balentine, T., Feng, W., Lin, Y., & Hoberman, A. (2010). How Do Parents of Preverbal Children With Acute Otitis Media Determine How Much Ear Pain Their Child Is Having? The Journal of Pain, 11 (12), 1291-1294 DOI: 10.1016/j.jpain.2010.03.017