Elephants dancing in my head: a developmental approach to children's concepts of specific pains.

The present study produced an empirically derived, developmental continuum of children's understanding of specific pains. Subjects of 5 age groups: preschool (ages 3-4), first grade (ages 6-7), third grade (ages 8-10), sixth grade (ages 11-12) and college freshmen (ages 18-23) were interviewed with open-ended questions. The subjects were questioned extensively about 3 specific types of pain: an injury (skinned knee), a medical intervention (injection), and an illness (headache). Subjects were asked to describe each pain, tell why the pain hurt, and state the value of the pain. Their answers were then categorized and the categories ordered developmentally by experts in pediatric pain who were unaware of the children's ages. Then children's specific answers were given developmental scores. Multivariate analyses revealed that older children had more complex and precise understandings of pain, and this pattern differed by type of pain and by aspect of pain being considered. The subjects were also asked to report the frequency of their own pains and their parents' pain; parental and self-reported pains were closely related.