The OSBD: eight behaviour categories7
| Category | Definition | Examples | Non-examples |
| Information seeking | Any question regarding medical procedure | “When will it stop?” “Is the needle in?” “Is the blood coming?” | “Will I get a present?” |
| Cry | Crying sound and/or onset of tears | Sobbing; booh; crying sounds; tears while they flow | Sniffling; heavy breathing |
| Scream | Loud vocal expression at high pitch | Sharp; shrill; harsh; high tones; shriek | Loud yelling but at low pitch |
| Restraint | Child must be physically held down by member of staff or parent | ||
| Verbal resistance | Any verbal expression of delay, termination, resistance; must be intelligible | “I want to go” “Stop” “No more” “Don't hurt me” “I don't like this!” “No, no!” | |
| Emotional support | Verbal or non-verbal; seeking hugs, hand holding; physical or verbal comfort by child | “Hold me” “Help me” reaching out to be held | “Mummy get me out of here” is VR not ES |
| Verbal pain | Any word, phrase or statements referring to pain or discomfort | “That hurts” “It stings” “Owww!” “Oh!” | “Will it hurt?” is IS not VR |
| Flail | Random, gross movements of arms and legs or whole body; flail in response to restraint | Pounding fists; kicking legs repeatedly and randomly; flapping of arms on self | Must be random |
ES, emotional support; IS, information seeking; OSBD, observation scale for behavioural distress; VR, verbal reponse.