Chambers et al developed a scale for parents to evaluate postoperative pain in their child. This can help monitor recovery and identify a child with excessive discomfort who may require further evaluation. The authors are from Dalhousie University in Nova Scotia.


Patient selection: children 7 to 12 years of age


Items – The child:

(1) whines or complains more than usual

(2) cries more easily than usual

(3) plays less than usual

(4) does not do the things s/he normally does

(5) acts more worried than usual

(6) acts more quiet than usual

(7) has less energy than usual

(8) refuses to eat

(9) eats less than usual

(10) holds the sore part of his/her body

(11) tries not to bump the sore part of her/his body

(12) groans or moans more than usual

(13) looks more flushed than normal

(14) wants to be close to you more than usual

(15) takes medication when s/he normally refuses

Parent’s Observation








• The point assignments could be expanded to account for gradations.


total score =

= SUM(points for all 15 items)



• minimum score: 0

• maximum score: 15

• The higher the score the greater the pain behavior.

• A score >= 6 was selected as he cut-off point for clinically significant pain.



• Internal reliability: Cronbach’s alpha was 0.88 on postoperative day 1 and 0.87 on postoperative day 2 in the original study.

• The distribution for scores relative to the child-rated pain and distress was positively skewed.

• Using the cut-off point of 6, the sensitivity on day 1 was 88% with specificity of 80%. On day 2 sensitivity was 80% with specificity of 84%.


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