Children’s Fear During Procedural Pain: Preliminary Investigation of the Children’s Fear Scale C. Meghan McMurtry University of Guelph, Guelph, Ontario Melanie Noel, Christine T. Chambers, and Patrick J. McGrath Dalhousie University and IWK Health Centre, Halifax, Nova Scotia Many children consider getting a needle to be one of their most feared and painful experiences. Differentiating between a child’s experience of fear and pain is critical to appropriate intervention. There is no gold standard one-item self-report measure of fear for use with children. Objective: To conduct an initial investigation of the psychometric properties of the Children’s Fear Scale (CFS; based on the adult Faces Anxiety Scale) with young school-age children. Method: Children and their parents were filmed during venipuncture and completed pain and fear ratings immediately after the procedure (n = 100) and 2 weeks later (n = 48). Behavioral coding of the procedures was conducted. Results: Support was found for interrater reliability (Time 1: r s = .51, p  .001) and test–retest reliability (r s = .76, p  .001) of the CFS for measuring children’s fear during venipuncture. Assessment of construct validity revealed high concurrent convergent validity with another self-report measure of fear (Time 1: r s = .73, p  .001) and moderate discriminant validity (e.g., Time 1: r s =-.30, p  .005 with child coping behavior; r s = .41, p  .001 with child distress behavior). Conclusions: The CFS holds promise for measuring pain-related fear in children. In addition to further investigation into the psychometric properties of the CFS during acute pain with a wider age range, future research could validate this measure in other contexts. The utility of a one-item measure of fear extends beyond the field of pediatric pain to other contexts including intervention for anxiety disorders and children in hospital. Keywords: fear, anxiety, children, measurement, pain Fear is a negative emotion that is thought to arise as an alarm to a dangerous and/or life threatening situation (Albano, Causey, & Carter, 2000). 1 Fear in children is common, can represent norma- tive developmental processes, and may be induced by experiences such as separation from parents, a growling dog, or going to school (e.g., see: Gullone, 2000). Medical fears have been identified as a common subcategory of fear in children (e.g., Ollendick, 1983) and, unlike other types of fear, may increase with age (Gullone, 2000). Needle fears appear to be particularly prevalent: many children consider getting a needle to be one of their most feared and painful experiences (Broome & Hellier, 1987; Hart & Bossert, 1994). Fear can increase pain perception (Rhudy & Meagher, 2003). The bidirectional relationships between children’s fear prior to needles and their fear and pain during needles are difficult to disentangle. However, differentiating between a child’s experience of fear and pain is critical to appropriate intervention (Chambers, Hardial, Craig, Court, & Montgomery, 2005). A recent consensus document recommended the measurement of children’s emotional This article was published Online First August 1, 2011. C. Meghan McMurtry, Department of Psychology, University of Guelph, Guelph, Ontario; Melanie Noel, Centre for Pediatric Pain Research and Department of Psychology, Dalhousie University and IWK Health Centre, Halifax, Nova Scotia; Christine T. Chambers, Centre for Pediatric Pain Research and Departments of Psychology and Pediatrics, Dalhousie University and IWK Health Centre; Patrick J. McGrath, Centre for Pedi- atric Pain Research and Departments of Psychology, Pediatrics, and Psy- chiatry, Dalhousie University and IWK Health Centre. This research was conducted at the IWK Health Centre during Mc- Murtry’s PhD training. At the time of the research, McMurtry was sup- ported by a CIHR CGS Doctoral Research Award. The project was supported by an IWK Health Centre Category A Research Grant awarded to McMurtry and colleagues and a CIHR operating grant awarded to CT Chambers. Noel was supported by a CIHR CGS Doctoral Research Award, a Nova Scotia Health Research Foundation Doctoral Student Research Award, an honorary Killam Predoctoral Scholarship, and a Pain in Child Health (PICH) stipend. CT Chambers and McGrath are supported by Canada Research Chairs. Portions of this article were presented at the International Symposium on Pediatric Pain, Acapulco, Mexico, March 2010. As described in the Method section, the manuscript contains data that was collected as part of a larger study. We thank Sharon McKinley and colleagues who graciously provided the images of the Faces Anxiety Scale for our use in this research. Thank you to Dr. Carl von Baeyer for his thoughtful and engaging discussions on self-report of fear in children earlier in this project. We are also grateful to the families who participated in this research and the Core Lab staff. Correspondence concerning this article should be addressed to C. Meghan McMurtry, Department of Psychology, MacKinnon Extension, 87 Trent Lane, University of Guelph, Guelph, Ontario, N1G 2W1. E-mail: cmcmurtr@uoguelph.ca 1 Anxiety is also a negative emotion but differs in that it is apprehen- sively directed toward a future negative event. A full theoretical discussion of the differences between anxiety and fear is beyond the scope of this paper (see: Albano et al., 2000). Health Psychology © 2011 American Psychological Association 2011, Vol. 30, No. 6, 780 –788 0278-6133/11/$12.00 DOI: 10.1037/a0024817 780