Evid Based Nurs doi:10.1136/eb-2013-101553
  • Child health
  • Mixed methods

Parents of non-verbal children with learning disability (LD) most commonly recognise their child’s pain through vocalisations, social behaviour and facial expressions

  1. Lynn M Breau
  1. Department of Psychology, Glenrose Rehabilitation Hospital, Edmonton, Alberta, Canada
  1. Correspondence to: Dr Lynn M Breau, Department of Psychology, Glenrose Rehabilitation Hospital, 10230 111 Ave., Edmonton, Alberta, Canada T5G 0B7; lynnbreau{at}

Commentary on:

Implications for practice and research

  • When parents assess pain responses, using a numerical pain rating scale, in children who are non-verbal and have a learning disability (LD), they most often equate responses to pain extremes (scoring 0 or 10 accordingly) or at the midpoint (5).

  • Children's pain responses change qualitatively with pain severity; reducing the content of current tools or developing alternative briefer tools to improve feasibility may reduce the validity of pain assessment in children who are non-verbal and have LD.


Assessing pain in children who are non-verbal and have learning disability (LD) is challenging. Yet these children experience frequent and significant pain because of complex concomitant health conditions.1 It is widely perceived that pain responses in these children are idiosyncratic and parents report that ‘knowing’ their child is an …

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