Table 4.

Dropped Items and issues discovered in cognitive debriefing

Item Dropped	Reason(s)
I clenched my teeth (B)	3/6 did not associate this behavior with pain (tended to associate with anger instead).
My face looked sad (B)	One child said her face doesn’t only look sad when she’s in pain. 4/6 preferred “it showed on my face” (broader meaning).
I had to bend over when I was walking (B)	3/6 did not understand or like this item.
I asked people to not bother me (B)	2/6 preferred “I asked people to let me be by myself.”
I squirmed (B)	Children had difficulty understanding how squirming was related to pain—felt only little kids squirmed.
I drew my knees up to my chest (B)	Children denied doing this behavior or felt that doing this behavior would cause more pain.
I walked careful (B)	2/6 had difficulty understanding this item or reported walking carefully was not related to pain.
I bit my lips (B)	4/6 denied doing this behavior when in pain.
I thrashed (B)	4/6 did not know the meaning of the word “thrashed.”
I held my body where it hurt (B)	4/6 preferred “I protected the part of my body that hurt.” Children did not endorse the item or noted that it’s not always possible to hold your body where it hurts (i.e., back).
I refused to walk (B)	4/6 did not like this item—felt that it’s impossible to “refuse” to walk.
I crawled (B)	All 6 children reviewing this item denied crawling when in pain. They reported that crawling is for babies or could make pain worse.
Heavy (S)	Several children had trouble relating this word to pain.
Pressing (S)	2/6 could not understand the meaning of this word.
Freezing (S)	5/6 did not like this word to describe pain—could not understand how “freezing” is related to pain, felt it was too extreme of a word choice.
Piercing (S)	4/6 did not know the meaning of the word and/or felt the word was not a good descriptor of pain.
Cutting (S)	3/6 did not know the meaning of the word and/or felt the word was not a good descriptor of pain.
Gnawing (S)	All 6 children reviewing this item felt it was a difficult word to understand/not a good descriptor of pain.
Penetrating (S)	4/6 did not understand this word/would not use this word to describe pain.
Searing (S)	5/6 did not know the meaning of the word and/or would not use the word to describe their pain.
Scalding (S)	3/6 did not know the meaning of the word and/or would not use the word to describe their pain.
Suffocating (S)	5/6 did not feel this word was a good descriptor of pain.
Oppressive (A)	5/6 did not know the meaning of the word “oppressive.”
Scary (A)	4/6 felt that pain could not be “scary.”
Terrifying (A)	Children had similar issues as with “scary.”
Vicious (A)	5/6 did not understand the meaning of the word and/or felt it was not a good descriptor for pain. Several children related the word to villains, dog attacks, etc. rather than pain.
Punishing (A)	3/6 related this item to being punished (grounded, hit) by a person rather than pain.

(S)=pain quality sensory item; (A)=pain quality affective item; (B)=behavior item