It’s up to adults to accurately interpret a child’s pain — without bias.
Pain is relative, and thus, it’s one of the hardest things for doctors to measure. Think about it: Having a sore throat is obviously not as bad as being in labor, but when you’re in the midst of a severe sore throat, it sure feels like a 10 out of 10 on the pain scale, right?
Things get really tricky when you’re talking about kids’ pain. Children, especially young ones, can’t always verbalize their pain accurately. The words you learn as you age—like searing, throbbing, aching, or stabbing—are just summed up by young kids as “hurting” or even just “ow.” Therefore, children have to rely on adults to interpret their pain accurately.
Here’s the problem: Some kids’ pain might be taken more seriously than others'. New research adds to the evidence that there may be a gender bias at work when it comes to pain assessment. That is, adults may take boys’ pain more seriously than girls’ pain.
About the Study
A 2019 study from The Journal of Pediatric Psychology showed a video of a young child in gender-neutral clothing (athletic shorts and a T-shirt) to a diverse population of adults. In the video, the child gets their finger pricked for a blood test, and reacts with pain.
Here’s where it gets fun: Some of the participants were asked to assess Samuel’s pain, and others were asked to assess Samantha’s pain. Despite watching the exact same clip—with the same display of pain by “Sam”—the adults interpreted the pain as more severe when they thought they were observing a boy.
What Are the Consequences?
The adults’ tendency to interpret the boys’ pain as more severe could reflect the stereotype that boys are more stoic and that girls are more emotional. In other words, when they saw “Samantha” react to the finger prick, they interpreted her pain as just dramatic, and when they saw “Samuel” react, his sudden loss of stoicism led them to believe his pain was serious.
Sure, in this video, it’s just a finger prick, which you know is not life-threatening. However, if this gender bias is true in other circumstances, it can affect whether adults believe their kid’s pain, as well as how accurately doctors diagnose their young patients.
For example, endometriosis affects many women, and the painful symptoms can begin when girls are going through puberty. Many teenage girls may complain of severe abdominal pain, but for years, their parents and doctors may brush it off as “just cramps.”
On average, it takes an average of 3 to 11 years from onset of symptoms to accurate diagnosis of endometriosis, according to the American College of Obstetricians and Gynecologists. During this time, young women may experience severe reduction in their quality of life, progressive severity of their disease, and a financial burden from constant medical visits.
And in some cases, an accurate diagnosis based on pain assessment can be life-saving. For example, a child experiencing symptoms of appendicitis needs immediate medical attention.
Learned biases are hard to break, but even just identifying your own biases can help make more informed interpretations.
Causes of acute abdominal pain in children and adolescents. Waltham, MA: UpToDate, 2019. (Accessed on September 12, 2019 at https://www.uptodate.com/contents/causes-of-acute-abdominal-pain-in-children-and-adolescents.)
Earp BD, Monrad JT, LaFrance M, Bargh JA, Cohen LL, Richeson JA. Gender bias in pediatric pain assessment. J Pediatr Psychol. 2019 May;44(4):403-14.Endometriosis fact sheet. American College of Obstetricians and Gynecologists. (Accessed on September 12, 1019 at https://www.acog.org/about_acog/news_room/~/media/newsroom/millionwomanmarchendometriosisfactsheet.pdf.)