Validation of the Emoji Faces Pain Scale for Evaluating Acute Procedural Pain in Children Aged 3-5 Years.

PURPOSE: To evaluate the measurement performance and clinical feasibility of the Emoji‑FPS for acute procedural pain assessment in children aged 3-5 years, compared with the Wong-Baker FACES Pain Rating Scale (WBFPS).

DESIGN

This was an observational study.

METHODS

A total of 192 children aged 3-5 years self-reported acute procedural pain using both the Emoji‑FPS and the WBFPS within 5 minutes of routine clinical procedures. Agreement between the two scales and responsiveness of Emoji-FPS were analyzed, and receiver operating characteristic analysis was used to establish pain severity cutoffs. Clinical feasibility based on observed child performance and scale preference were assessed.

RESULTS

The Emoji‑FPS showed strong agreement with the WBFPS. Clinical feasibility improved with age, with 57.69% of 3-year-old children, 75.95% of 4-year-old children, and 89.66% of 5-year-old children reporting that the scale was easy to use. Overall, 67.19% of children preferred the Emoji‑FPS.

CONCLUSIONS

The Emoji-FPS was able to effectively distinguish between mild, moderate, and severe pain in children aged 3-5 years who were able to understand the scale and complete the rating in acute procedural pain settings, and accurately reflected changes in pain before and after procedure.

CLINICAL IMPLICATIONS: The Emoji Faces Pain Scale may support procedural pain assessment in preschool-aged children and should be interpreted alongside clinical judgment.