Aim of Investigation Little is known about how parents identify and respond to pain in very young children. We aimed to describe the children’s behaviours that parents use to identify and assess everyday pain and illnesses.

Methods 1716 parents (94.5% mothers) of children, aged 1–5 years inclusive, completed an online survey about their youngest child’s recent pain and illness experiences. Parents were asked to select the first behavioural signs that indicated their child was hurt or unwell from a list of 15 behaviours from the modified parental postoperative pain measure (mPPPM). The national sample was regionally and ethnically representative of the British population.

Results Parents noted more distress behaviours when children were ill (9.58 + 3.94) than when children were physically injured (2.48 + 2.32), p<0.001. When ill, children had less energy, were more quiet and were more grumpy than usual. When injured, children were likely to seek physical and emotional proximity to their parents, to cry and to groan more than usual. Varimax-rotated principal components exploratory factor analyses of the mPPPM produced 7-factor solutions explaining 70% of the variance in children’s illness-related behaviours and 64% of the variance in injury-related behaviours. Significant differences in the pain and illness behaviours were found for child age, gender and experience of hospital. Younger parents reported more pain behaviours in their children than older parents and some regional differences were noted.

Conclusions These findings can assist parents and healthcare practitioners in their efforts to assess and manage young children’s acute pain.