Table 2.

Sample quotes describing parent reported recognition of fracture pain.

	Pain recognition	Sample quotes describing pain expression
Physical	Breath holding and gulping air	‘She was holding her breath like she was in extreme pain’ ‘Her stomach was swollen…they put it down to gulping air and being in so much pain’
	Body expression	‘Every time we moved her she screamed and she would convulse again and not in a seizure way but she would convulse so much it looked similar to a seizure’ ‘When we over stretched her she gets very wide eyed and her tremors get worse’ ‘She seemed to have spasms as soon as we touched her legs’ ‘We were moving her around she would flinch and she wouldn’t really cry out but she would sort of flinch and wince’ ‘She would wiggle, she would do a pelvic thrust to show you she is uncomfortable’
	Vocalisation	‘She was screaming in a way that we have not heard her cry before’ ‘She is very passive and quiet and it was the first time in her life and my life I ever heard her make a distinct noise’
	Eye gazing	‘Communicating with her eyes, it gives us a good indication with a begging look or a happy look. She’s almost telling you everything with her eyes’.
	Facial expressions	‘As I moved her hips she woke up with that very same wide eyed shaking expression…I had no idea it could have been her femur fractured’ ‘She doesn’t have that much movement of her forehead even when she frowns she very slightly gets a farrow in her forehead but with this her forehead was farrowing up and I’ve never seen her face so pained’
	Swelling	‘By that stage the knee had swollen and it was concerning me something had wrenched on her knee. Maybe another child’
Behavioural	Sleeping	‘Going off to sleep constantly was very new for her and I think it was that she was just in total shock and was trying to block it out’ ‘She did not sleep that night and we had to give her pain medication and a sedative to sleep’
	Change in mood	‘Very quiet and not really smiling, to me that is showing signs of discomfort’ ‘She is so happy all the time, her whole persona changed dramatically in the space of two days’