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 .
Vapocoolant spray is equally effective as EMLA cream in reducing immunization pain in school-aged children.
BACKGROUND Untreated immunization pain causes undue distress and contributes to underimmunization through physician , and possibly parental , resistance to multiple simultaneous injections . OBJECTIVE To compare the efficacies of two pain management methods in reducing immediate immunization injection pain and distress in school-aged children . DESIGN A r and omized , controlled clinical trial of eutectic mixture of local anesthetics ( EMLA ) cream and vapocoolant spray . PATIENTS Children aged 4 to 6 years and scheduled to receive diphtheria and tetanus toxoids and acellular pertussis vaccine ( DTaP ) during health supervision visits . INTERVENTIONS Enrolled children were r and omized to one of three treatment groups : 1 ) EMLA cream + distraction ; 2 ) vapocoolant spray + distraction ; or 3 ) distraction alone ( control ) . The specific pharmacologic pain control interventions consisted of EMLA cream ( 2.5 % lidocaine , 2.5 % prilocaine [ Astra Pharmaceutical Products , Inc , Westborough , MA ] $ 15 . 00/patient ; applied 60 minutes before injection ) and vapocoolant spray ( Fluori-Methane [ Gebauer Company , Clevel and , OH ] $ 0 . 50/patient ; applied via spray-saturated cotton ball for 15 seconds immediately before injection ) . MAIN OUTCOME MEASURES The blinded investigator ( BI ) measured ( by edited videotape ) cry duration and the number of pain behaviors using the Observational Scale of Behavioral Distress . Pain visual analog scales ( linear and faces scales ) were completed by the child , parent , nurse , and the BI . RESULTS Sixty-two children , aged 4.5 + /- 0.4 years ( mean + /- SD ) were r and omized . The three treatment groups had similar subject characteristics . All pain measures and cry duration were similar for EMLA and vapocoolant spray . Both EMLA and spray were significantly better than control . Results for spray vs control : cry duration ( seconds ) : 8.5 + /- 21.0 vs 38.6 + /- 50.5 ; number of pain behaviors : 1.2 + /- 1.9 vs. 3.1 + /- 2.1 ; child-scored faces scale : 2.0 + /- 2.4 vs. 4.1 + /- 2.3 ; parent-scored faces scale : 1.6 + /- 1.6 vs. 3.0 + /- 1.7 ; nurse-scored faces scale : 1.6 + /- 1.2 vs. 3.1 + /- 1.4 ; and BI-scored faces scale : 1.0 + /- 1.5 vs. 2.4 + /- 1.4 . CONCLUSIONS When combined with distraction , vapocoolant spray significantly reduces immediate injection pain compared with distraction alone , and is equally effective as , less expensive , and faster-acting than EMLA cream . As an effective , inexpensive , and convenient pain control method , vapocoolant spray may help overcome physician and parent resistance to multiple injections that leads to missed opportunities to immunize
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 .