Statistics from Altmetric.com
Editor,—We welcome the study by Lewindon et al that looked at the effect of an oral sucrose solution on infant distress following immunisation.1 The authors are correct in their use of the term distress rather than pain as this is a more appropriate description of the behaviour observed. We note that there was a significant reduction in crying time, suggesting that oral sucrose reduces distress following immunisation.
We are, however, concerned about the use of the Oucher scale with infants. The Oucher scale is a self report tool that has been validated for use by children between the ages of 3 and 12 years who can speak.2 It is used as a measure of pain intensity. The child points to the facial expression or number that reflects the intensity of pain they are experiencing. The Oucher has not been validated for use by adults who try and match the face of the infant to a photograph on the scale.
Pain assessment in young children and infants is difficult3 4 but possible with the appropriate use of pain assessment tools. It is, however, crucial that a tool appropriate for the age group and the type of pain is chosen. It is also essential that any pain assessment scale is used in the correct manner.4
Dr Lewindon comments:
The comments by Choonara and Beyer as experts in the field of pain assessment in young children are well taken. In our study, the parents and the nurse were given the Oucher scale and specifically asked, “to rate your infant’s level of distress during the immunisations on a scale of 0–100, 0 being no distress, 100 being the worst possible distress”. It is this visual analogue rating that was subjected to analysis. Parents, in particular, found the pictures of facial expressions helpful in understanding their task but they were not asked to specifically match the face of the infant to the photographs.