All 4 faces pain scales were found to be adequately supported by psychometric data .
When given a choice between faces scales , children preferred the WBFPRS .
Confounding of pain intensity with affect caused by use of smiling and crying anchor faces is a disadvantage of the WBFPRS .
: For clinical use , we found no grounds to switch from 1 faces scale to another when 1 of the scales is in use .
CONTEXT : Numerous faces scales have been developed for the measurement of  pain intensity in children .
It remains unclear whether any one of the faces scales is better for a particular purpose with regard to validity , reliability , feasibility , and preference .
OBJECTIVES : To summarize and systematic ally review faces pain scales most commonly used to obtain self-report of pain intensity in children for evaluation of reliability and validity and to compare the scales for preference and utility .
Children's responses to sequential versus simultaneous immunization injections.
INTRODUCTION The purpose of this study was to compare distress behaviors and perceptions of distress in 4- to 6-year-old children who received two immunization injections simultaneously with those in children who received their immunizations sequentially .  METHOD This experimental study used a convenience sample of 46 children scheduled for pre-kindergarten examinations . The children were r and omly assigned to either a sequential injection or a simultaneous injection group . Direct observation and videotapes were made of the children 's behaviors before and after injection . Distress behaviors were analyzed with the Observation Scale of Behavioral Distress-Revised , and perceptions of distress were obtained from both children ( with the Wong-Baker Pain Rating Scale [ FACES ] ) and parents ( with the Visual Analog Scale ) . RESULTS Results of the Observation Scale of Behavioral Distress-Revised showed no significant differences in children 's distress behaviors between the two groups either before or after injection . The children 's self-reports of distress also showed no group differences . Parents ' perceptions of the children 's distress before and after injection were lower for the sequential group but were judged to be unrelated to the intervention . Given the opportunity to state a preference , however , parents preferred the simultaneous method . DISCUSSION The simultaneous procedure was not found to be associated with reduced distress behaviors ; however , parents preferred the simultaneous method
All 4 faces pain scales were found to be adequately supported by psychometric data .
When given a choice between faces scales , children preferred the WBFPRS .
Confounding of pain intensity with affect caused by use of smiling and crying anchor faces is a disadvantage of the WBFPRS .
: For clinical use , we found no grounds to switch from 1 faces scale to another when 1 of the scales is in use .
CONTEXT : Numerous faces scales have been developed for the measurement of  pain intensity in children .
It remains unclear whether any one of the faces scales is better for a particular purpose with regard to validity , reliability , feasibility , and preference .
OBJECTIVES : To summarize and systematic ally review faces pain scales most commonly used to obtain self-report of pain intensity in children for evaluation of reliability and validity and to compare the scales for preference and utility .