Gender Bias in Pediatric Pain Assessment

Abstract

Objective: Observer rating of pain is central to diagnosis and treatment in healthcare, especially in pediatrics. However, there are few studies examining potential biases in observer ratings of pediatric pain. Cohen et al. (2014) reported that adult participants rated a video of a child undergoing a needle stick as experiencing more pain when the child was described as a boy as compared to a girl, suggesting a possible gender bias. To confirm, clarify, and extend this finding, we conducted a replication experiment and follow-up study examining the role of explicit gender stereotypes in shaping such asymmetric judgments. Method: In an independent, pre-registered, direct replication and extension study with open data and materials (osf.io/6tj58), we showed participants the same video from Cohen et al. (2014), with the child described as a boy or a girl depending on condition. We then asked adults to rate how much pain the child experienced and displayed, how typical the child was in these respects, and how much they agreed with explicit gender stereotypes concerning pain response in boys versus girls. Results: Similar to Cohen et al. (2014), but with a larger and more demographically diverse sample, we found that the ‘boy’ was rated as experiencing more pain than the ‘girl’ despite identical clinical circumstances and identical pain behavior cross conditions. Controlling for explicit gender stereotypes eliminated the effect. Conclusions: Explicit gender stereotypes—e.g., that boys are more ‘stoic’ or girls are more emotive—may bias adult assessment of children’s pain.

Sex Differences in the Outcomes of Mild Traumatic Brain Injury in Children Presenting to the Emergency Department

“…While no study has directly examined how parent ratings of post-concussive symptoms are influenced by children's sex, one study found that adults were more likely to rate boys as experiencing higher levels of pain than girls despite the sexes reporting identical pain ratings (Earp et al 2019). The researchers emphasize that while the adult raters were not parents of the target child and cannot emulate the parent-child relationship, healthcare providers need to be aware of potential gender biases in judgements concerning children's health experiences (Earp et al 2019). Another study found only moderate agreement between child and parent ratings of both somatic and cognitive symptoms (Hajek et al, 2011).…”

Unraveling the long‐term links among adolescent peer victimization and somatic symptoms: A 5‐year multi‐informant cohort study

“…Somatization forms part of the internalizing cluster, alongside depression and anxiety (American Psychiatric Association, ), suggesting that somatic symptoms are psychiatric in nature and can be viewed as the physical expression of psychological distress. Somatic symptoms are nonetheless experienced as physical pain, and gender bias in the assessment of pain begins in early childhood (Earp et al, ). Fundamentally, this suggests that girls are not only more likely to experience frequent somatic symptoms, but are also more likely to have the severity of their symptoms minimized.…”

Youngsters' perceptions of the experience of pain and utilisation of over‐the‐counter pain medication as needed in community: A qualitative study

“…In this study, girls perceive the communication of pain as normal when they have pain, while boys perceive that the noncommunication of pain reflects personal strength. This difference between the perceptions of pain communication may also be explained by the fact that boys start to be conscious of the beliefs linked to masculinity, following exposition to explicit sexist stereotypes such as those which state that boys would be more robust and the girls more sensible (Earp et al, 2019). Finally, when these perceptions in line with the pain communication are not taken into account, pain will be ill‐expressed, ill‐interpreted, and thus mismanaged.…”