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Children’s Sensations as Interactional Phenomena: AConversation Analysis of Children’s Expressions of Painand DiscomfortLaura Jenkinsa & Alexa Hepburna

a Loughborough University, Loughborough, UKAccepted author version posted online: 14 Jun 2015.

To cite this article: Laura Jenkins & Alexa Hepburn (2015): Children’s Sensations as Interactional Phenomena: A ConversationAnalysis of Children’s Expressions of Pain and Discomfort, Qualitative Research in Psychology

To link to this article: http://dx.doi.org/10.1080/14780887.2015.1054534

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<LRH>L. Jenkins and A. Hepburn</LRH> <RRH>Children’s Sensations as Interactional Phenomena</RRH>

<AQ>Suggested right running header okay?</AQ>

<CT>Children’s Sensations as Interactional Phenomena: A Conversation Analysis of Children’s

Expressions of Pain and Discomfort</CT> LAURA JENKINS AND ALEXA HEPBURN <CAF1>Loughborough University, Loughborough, UK</CAF1>

Laura Jenkins and Alexa Hepburn <CFN1>Correspondence: Laura Jenkins, Discourse and Rhetoric Group, Department of

Social Sciences, Loughborough University, Loughborough, Leicestershire, LE11 3TU, UK.

Email: L. Jenkins@sheffield.ac.uk</CFN1>

Abstract <AB>Psychological research has typically studied pain by using participant indirect reports.

The current study starts to build an alternative and complementary approach by directly

studying pain expressions and displays, and the way they operate in interaction. It will focus

on children’s pain expressions in a corpus of 71 video recordings of British English speaking

family mealtimes. We distinguish four relevant components of pain expressions: (a) lexical

formulations; (b) prosodic features of crying and upset; (c) pain cries; and (d) embodied

actions. Analysis shows how pain expressions are built as if they represent an internal

private state, and yet are treated as having an interactional function in the management of

getting children to eat. We will conclude by sketching some directions for an interactional

study of pain.</AB>

<KW>Keywords: children; pain; family mealtimes; health; conversation analysis; discursive psychology<KW>

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1. Psychological literature on pain The purpose of this introduction is to draw on the extensive existing literature on

pain in ways that highlight how pain has typically been conceptualised, assessed and

studied. We will describe the complexities that arise when pain is treated as an

internal experience with an observable behavioural expression. In contrast, the

discursive studies that we describe have taken an interactional approach to a range

of phenomena that, like pain, have traditionally been considered to be a measurable

internal emotion or sensation with an outward expression. In this paper we adopt a

similar discursive psychological perspective, in which we attend to the ways that

children’s expressions of pain and discomfort are situated and co-constructed in

stretches of interaction, and given their epistemological and ontological status by the

manner of their delivery and by the orientations of the participants in that

interaction.

1.1 Definitions of pain

Pain is a basic human experience, yet complexities, including individual differences,

pain without physiological cause and the interplay of what would traditionally be

treated as its ‘emotional’ and ‘cognitive’ components has meant that it has remained

a challenging and often intractable research topic for psychologists (Morris, 1991;

Rapoff and Lindsey, 2000). Early theories conceptualised pain as a purely sensory

experience determined by neurological signals responding to tissue damage,

focussing almost exclusively on physiologic processes (Sullivan et al, 2001). This is

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reflected in definitions of pain such as a “highly unpleasant physical sensation

caused by illness or injury” (Oxford English Dictionary, 2011). However definitions

have developed to include components of psychological and physiological factors

that interact and mediate the pain experience (Schneider and Karoly, 1983;

Lewandowski, 2004; Melzack, 1999, Lumley et al, 2011), with pain described as ‘an

unpleasant sensory and emotional experience associated with actual or potential

tissue damage, or described in terms of such damage’ (IASP, 2012).

1.2 Measuring children’s pain

On the basis of this dominant conceptualisation of pain as a universal internal

physical and emotional experience, it is treated as something accessible and

measurable through self-report measures. Indeed, self-report measures of pain are

regarded as the primary source for assessing children’s pain (Hadjistavropoulos and

Craig, 2002; Huguet, Stinson, and McGrath, 2010). They take the form of

standardised scales which quantify the nature and intensity of pain using words,

numbers or images such as faces (Stinson et al, 2006). Qualitative measures such as

interviews and story-telling are also used with the aim of more broadly capturing the

pain experience (Doorbar and McClarey, 1999; Lawton, 2003), and can incorporate a

wide range of methodological approaches including interviews in which children

were asked to complete sentences and pictures.

By asking children about their pain, a large literature has built a picture of the types

of factors that influence the severity and nature of a child’s pain. For example, age:

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Hay et al (2009) reported that younger children reported significantly more pain

than older children during nasendoscopy, although there was a weak (insignificant)

correlation between reported pain, observed pain and the child’s age, and other

studies have failed to support age related differences (e.g. Carr, Lemanek, and

Armstrong, 1998; Chambers et al., 1999; Goodenough, van Dongen, Brouwer, Abu-

Saad, and Champion, 1999). A gender difference in reported pain is more strongly

supported, with a consistent finding that girls report more pain than boys (e.g. Carr

et al., 1998; Chambers et al., 1999).

Self-reports have also been used in experimental studies that induce an unpleasant

sensation in children, for example, using a cold pressor device which subjects the

hand to ice-cooled water (Sullivan et al, 2001; Sullivan et al, 2006; Sullivan, Adams

and Sullivan, 2004; Vervoort, Goubert, Eccleston, et al., 2008; Vervoort et al., 2011).

By manipulating the nature of a parental response, Chambers, Craig and Bennett

(2002) found that, in girls, more pain intensity was reported when mothers were

trained to provide reassurance and empathy (pain-promotion) compared to the

condition in which the mother provided coping strategies or humour (pain-

reduction). However the effect did not impact measures of facial activity. This

highlights a key differentiation between the pain experience and its expression, in

particular the importance of the communicative context.

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1.3 Communicative aspects of pain

Facial activity is one aspect of the communicative aspects of pain that have until

more recently been excluded from conceptualisations of pain. Sullivan (2008)

criticises models of pain which are limited to sensory and experiential dimensions of

the pain system, arguing that pain behaviours are integral components of the pain

system. He argues that the differences between persons with and without pain are

not restricted to the domain of “experience”; persons in pain also ‘‘act’’ differently,

such as displaying facial expressions like grimaces or frowns, emitting utterances

such as moans or sighs, holding or guarding body parts affected by pain, and so

forth. Hadjistavropoulos and Craig (2002) describe a framework of pain in which

real or potential tissue damage is processed by the brain, experienced as pain, and

then encoded behaviourally to be decoded by others. In this way, pain

communication is treated as multidimensional nonverbal and verbal behaviour

which is a visible and public manifestation of a private and subjective experience

(Hadjistavropoulos and Craig, 2002).

Some of the studies we described above included a measure of pain behaviour. One

of the ways in which children’s pain communication has been measured in its own

right is using checklists which record the presence and intensity of vocal and physical

behaviours (Von Baeyer and Spagrud, 2007; Vervoort, Caes, Trost, Sullivan,

Vangronsveld and Goubert, 2011). However, in addition to omitting information

about prosody and delivery, they (like the studies described above) focus on

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expressions outside of conversational sequences. They lose detail relating to the

sequential placement of facial expressions, bodily movements and verbalisations,

and do not explicitly examine the interaction with the other people present.

The minority of studies that have taken expressions of pain in interaction as their

focus often employ a version of a coding system known as the Child—Adult Medical

Procedure Interaction Scale Revised (CAMPIS-R). This involves coding parents’

utterances as pain or non-related talk, and coding units of the child’s utterances as

pain talk or ‘other’ (Vervoort, Caes, Trost, et al., 2011). The analytic approach here

tends to focus on statistical associations between coded utterances rather than trying

to capture the organization of specific pain related practices (Spagrud et al., 2008;

Vervoort et al., 2011). Often the mechanisms connecting one utterance to the next

are left unexplained. Vervoort et al., (2011) note that finer-grained analyses may be

necessary to elucidate distinct qualities of a child’s pain and parents’ responses, but

they themselves do not attempt such an analysis.

We have described conceptualisations of pain, and self-report and behavioural

measures of children’s pain, which rely on a referential theory of language in which a

child’s words and embodied gestures are representative of these internal objects. The

distinction between the pain experience and the pain expression is potentially

problematic; there is an on-going issue with whether the reported, measured or

observed pain properly represents the ‘actual’ pain experience. On this basis the

credibility of the different measures of pain, and issues to do with exaggerated or

feigned pain in children is the focus of much research (e.g. Craig et al., 2010;

Hadjistavropoulos and Craig, 2002).

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1.2 Discursive Psychology and interactional analysis of emotion and pain

In developing his well-known critique of the idea of a private language argument,

Wittgenstein (1953) emphasised that rather than seeing the word pain as a term

referring to an inner state, we need to understand its operation in a ‘language game’.

This highlights the pivotal role of practices in talk, offering the grounds for a non-

cognitive psychology that Discursive Psychology (hereon DP) has built upon. The

focus moves from pain as a putative underlying state or experience to how pain is

displayed, how it becomes part of particular actions in talk, and how it is responded

to. A key feature of this discursive approach to psychology is its study of human

actions in social interaction. Psychologists have typically bypassed this approach in

favour of specifying and modelling putative underlying experience or competence.

Contemporary DP draws heavily on the analytic methods of conversation analysis to

provide a social and interactional understanding of traditionally psychological

phenomena (Hepburn and Wiggins, 2007). DP takes phenomena that are typically

(in psychology and in simplified abstract versions of common sense) considered to

be private states and experiences, such as emotions, attitudes, physical sensations

and mental states, and seeks to explore how they are conceptualized, handled and

managed in talk as part of a wide range of interactional business (Edwards, 1997;

Edwards and Potter, 2005). The philosopher Wittgenstein argued that if pain is

considered to be a label attached to a sensation, it will never be possible to explain

how pain words get attached to pain sensations (Sullivan, 1995). Instead, DP studies

episodes in which people talk as if they have inner thoughts and feelings as a specific

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practice, a way of talking which can be useful, rather than evidence of a theory of the

relationship between mind and language (Edwards and Potter, 2005).

In studying expressions of pain and discomfort, we are not necessarily studying its

lexical features, but rather what Goffman (1978) described as ‘response cries’ -

exclamatory interjections which are not full-fledged words (like ‘oops’). These

expressions are seen as a natural overflowing, a flooding up of previously contained

feeling, a bursting of normal restraints, a case of being caught off-guard. Our study

sits against a backdrop of a range of interactional studies which build on Goffman’s

work, taking occurrences of what might be considered expressions of emotion, e.g.

outrage, laughter, surprise, crying and pain, and considered their interactional

function. Goodwin and Goodwin (2000), for example, described the sequential and

intonational characteristics of displays of emotion in ongoing interactions with

children and someone with severe aphasia. They identified both embodied actions

and elevated pitch as key indicators required to make sense of heightened emotion

and ‘outrage’ and noted the sequential placement of response cries as a critical factor

in allowing recipients to make sense of one another.

This sort of detailed analysis of displays of putative inner states provides for insights

into their interactional function. For example, Wilkinson and Kitzinger (2006)

demonstrate how surprise is socially organised and collaboratively produced. A

speaker designs some talk to elicit surprise, and the recipient produces a surprise

token. The visceral nature of surprise is challenged not only by the organised

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character of these sequences, but also by the finding that surprise tokens can be

recycled (produced on more than one occasion in response to the same source) and

delayed. Similarly, Wiggins’ (2012) examination of displays of disgust shows that

regardless of their putative status as emotions, they work as assessments of food and

eating practices in everyday interaction.

In a study of displays of upset, Hepburn (2004) drew on and developed Jefferson’s

(1985) work that highlighted the need for careful transcription of laughter and

applied it to crying. Such careful description has underpinned the explication of the

social organization of extreme upset and the way its different features can be heard

and responded to, for example, the regular actions that are parts of the disruptive

role of crying (e.g. apologies) and some of the standard ways in which crying is

responded to (e.g. with sympathetic or empathic constructions, Hepburn and Potter,

2007, 2010). More broadly, this research has started to unpack the complex

interactional choreography involved in laughing and crying, and highlighted the

need for a depth of descriptive engagement beyond that which has been common in

psychology.

The work most related to the current study is Heath’s (1989) research on how adult

patients’ expressions of unpleasant physical sensations are embedded in the social

organisation of interaction in General Practitioner consultations. He described the

tension patients face in being obliged to provide reasonable grounds for seeking help

whilst being required to take an analytic or objective stance towards the difficulties.

Actual expressions of pain are interactionally organised, sensitive to and advance the

local framework of action and diagnostic activity. When pain is inflicted by the

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practitioner as part of the examination, the cry of pain is not addressed in its own

right and does not elicit sympathy; rather it is managed within the framework of

diagnostic activity, and treated as the basis for subsequent enquiries (Heath, 1989).

What is interesting about Heath’s work is the notion that expressions of pain might

serve an interactional function in medical settings, rather than simply representing a

visceral eruption of inner sensation.

We will also be contributing to an increasing body of family mealtime research which

provides greater understanding of the nature of family interaction and behaviour

management (e.g. Craven and Potter, 2010; Hepburn and Potter, 2011), and also to

studies that examine aspects of food such as taste, evaluating food, and negotiating

how much children eat (Butler and Fitzgerald, 2010; Hepburn and Wiggins, 2007;

Wiggins and Potter, 2003). Relevant to the current study, Wiggins (2002), Hepburn

and Wiggins (2005) and Laurier and Wiggins (2011) describe how the ostensibly

private states of hunger and satisfaction are constructed and delicately managed as

part of activities such as getting children to eat, evaluating food and finishing a meal.

As our analysis will show, these are particularly relevant to episodes in which

children express pain during mealtimes.

1.3 Ontological status of pain

We began our introduction with a discussion of the traditional model of pain in

which it is treated as an internal and private sensation, with an observable and

communicative expression. The relationship between the sensation and its

expression has been highlighted as problematic (see also Craig, et al., 2010), with

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measures of reported pain and expressed pain proving inconsistent (e.g. Hay et al.,

2009; Chambers, Craig and Bennett, 2002). We have identified the way that existing

analysis of expressions of pain fail to consider the sequential and prosodic features of

talk that would reveal the way expressions are interactionally designed.

Our description of the way talk about emotions serve interactional functions does

not make claims about the nature of the inner states themselves. Rather, it considers

references to and displays of things that are putatively considered to be emotions

and physical sensations, as interesting social phenomena, doing specific

interactional jobs (such as evaluating food, or responding to news) (Potter and

Hepburn, 2007) and making relevant different types of response (Goffman, 1978).

In this paper, we adopt an approach exemplified in other DP studies (see Heath,

1989; Wiggins, 2012). We will examine children’s utterances recognisable by the

recipients (parents) as physical sensation or pain relevant, and consider how we can

analyse them in a way that reveals the nature of these expressions as a social

practice, without making claims about their ontological status as actual sensations.

This approach to pain has only previously been applied to adults in medical settings

(Heath, 1989), and our analysis is unique in examining children’s expressions of

bodily experience in everyday settings.

1 4. Aim

The broader project here is to take phenomena that are typically considered to be

private states and experiences, such as emotions, physical sensations and mental

states, and to explore how they are conceptualized, handled and managed in talk as

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part of a wide range of interactional business (Edwards and Potter, 1992, Edwards,

1997). In doing so, we draw heavily on the methods and body of findings of

conversation analysis and discursive psychology.

As there is no foundational descriptive work in the study of children’s expression of

bodily sensation, we will focus on the documentation of the features of children’s

expressions, noting also where they occur and some of the ways in which they are

responded to. In this paper we will describe the features of expressions of everyday

pain communicated by children during mealtimes, and explain the function of these

reported experiences in interaction. This will consider both vocal and non-vocal

elements, as well as propositional formulations – ‘my x hurts’ – and non-

propositional forms – ‘ow’. We will describe four distinct components of children’s

expressions of pain and physical experience, and briefly consider the way these

different elements also represent an interactional function in the management of

children’s food consumption.

While a more intensive analysis of the interactional uptake of these expressions is

explored elsewhere (Jenkins, 2015), in this paper we will consider the

methodological challenges posed by this approach to researching pain as an

observable or dialogical phenomenon

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2. Method

2.1 Data

The analysis in this paper is based on a corpus of video recordings of family

mealtimes involving three British English speaking families in the UK with children

aged 15 months to nine years. At least one child in each family suffers from a long

term health condition; all were recruited through local support groups. The health

concerns include allergy, type I diabetes and a chronic heart condition. Each family

was given a camera and filmed 15-17 meals. The research was funded by the

Economic and Social Research Council, and full ethical approval was given by

Loughborough University Ethics Committee.

In addition, this analysis draws on recordings of mealtimes in two families with no

chronic health concerns1. In total five families recorded 71 mealtimes, totalling 32

hours of data. Each family included a heterosexual married couple and two children

under ten years old. The general focus centred on the way body and health issues

become live in everyday family interaction.

1 The additional two mealtimes were drawn from an archive of recordings held by the Discourse and Rhetoric Group (DARG) archive at Loughborough University. The aim was to have material which captured everyday interaction between parents and children. We are particularly grateful to Alexandra Kent (Loughborough University) for allowing us to use an extract of her data from the Amberton family (pseudonym).

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2.2 Analysis

The analysis will apply a conversation analytic approach to a collection of episodes in

which children express bodily sensations, by producing cries, and/or referring to

parts of their bodies with adjectives (such as ‘hurt’, ‘stings’, ‘ache’, ‘cold’, or

‘different’). Whilst collecting examples, we did not attempt to differentiate between

pain and unpleasant sensations, that is, to make a judgement about the valence or

severity of the child’s expression. Instead, we considered this analytic consideration

to belong to participants’ as part of the ongoing interaction. Many of these

expressions relate to acute experiences rather than chronic sensations, and are

initiated both by children with and without long term conditions. The data was

transcribed in basic orthographic form, and expressions of physical sensation that

initiated a new action were selected on the basis that they were more prevalent in the

data, and represented a distinct set of phenomena in which we could identify

common themes in relation to how they were formulated and delivered.

In total, 33 expressions of bodily sensation which initiated new sequences were

produced by children. These were found in 20 mealtimes across all five families. The

selected extracts were transcribed with the conventions developed by Gail Jefferson

and supplemented by Hepburn in relation to distress and upset (Hepburn, 2004;

Jefferson, 2004).

Table 2 Transcription conventions

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The conversation analytic approach we are using sets out to understand the

elementary structures, patterns, norms and expectations that govern interaction

(Schegloff, 1992; 2005). Essentially it involves examining in detail the video extracts

alongside the transcripts, focusing on each turn at talk within the episode in order

elucidate actions done in and by talk and their uptake (Drew, 2003). The analysis

investigates how turns at talk are constructed to perform actions or manage activity

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(Drew 2005; Schegloff, 1986), in order to examine the nature of children’s displays

of experiencing a physical sensation in family mealtimes. For a more in depth

description of CA’s analytic assumptions and method see Drew (2005), Heritage

(1984), and Schegloff (2007).

2. Analytical description of expressions of pain Children’s expressions of pain can be built out of several basic elements, including

lexicalised formulations, pain cries, features of upset, and non-verbal embodied

components. In the first analytic section we will describe some of the features of

children’s expressions that appear to have a communicative role; in the second

analytic section we will sketch some of the interactional functions of these reports of

bodily sensation.

This section sets out for the first time a description of the various features of

children’s pain expressions in a way that provides a foundation for a detailed

interactional analysis of these sequences.

3.1. Lexical Formulations

To begin we consider the lexicalised formulations that children produce. These

assertions are formulated as announcements and contain an explicit description of a

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sensation. The most prevalent type of formulation in our data is an expression of

pain in the form of “My X hurts”.

We will build up from a number of very basic observations about these assertions.

Most basically, they are produced in the present tense, conveying information about

the bodily sensation the child is presently experiencing. They provide a location in

the body (head, tummy, bottom or teeth), and indicate the nature of an experience

(predominantly ‘hurting’). Like announcement turns (Schegloff, 2007), these

formulations are designed as assertions or declaratives, and connected with this,

they contain an indication that the reported condition is current, such that the

interlocutor would not be aware of it (Maynard, 1997; Schegloff, 1995). These design

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features function to give the verbal formulations a sense of doing some sort of

‘telling’ of a current event not otherwise accessible to the recipient (Schegloff, 1995).

These claims are unmarked and claim unmediated access to the experience. They

contain no features that either strengthen or weaken the child’s epistemic rights to

remark on the matter (Heritage and Raymond, 2005). They also claim ownership of

the pain by using the possessive pronoun ‘my’. These latter points seem obvious and

simple but together they point to one of the central features of pain – it is something

that sits squarely within the experiencer’s domain. In common with upset, it raises

difficult and sometimes urgent problems of access and evaluation for recipients

(Hepburn and Potter, 2012). Careful attention to pain cries is therefore a crucial skill

for parents and healthcare providers.

3.2 Features of upset and pain cries

Many of the fragments above contain prosodic features associated with upset and

crying. Most commonly these include elevated pitch, tremulous or creaky delivery

and changes in volume.

3.2.1 Elevated Pitch

Hepburn (2004) noted that elevated pitch accompanies distress, and the link

between heightened emotion and pitch is borne out by interactional studies of

prosody (e.g. Couper-Kuhlen and Selting, 1996). Similarly, elevated pitch is a

common element in our corpus of children’s expressions of pain. The shift in pitch

may mark the whole formulation as higher than surrounding talk, as in fragment 1,

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or the pitch may mark a specific word as in fragment 4, with the word ‘tooth’ or in 5,

with the turn initial ‘it’.

3.2.2 Tremulous and/or creaky delivery

Another feature of upset that can be embedded in the delivery of these expressions is

tremulous voice, marked in the transcript by tildes ~. The whole turn may be

delivered in a tremulous voice (as in fragment 1) or the characteristic vocal quality

may mark a single word – ‘hurts’ in the following extract:

Formulations may also be delivered with a characteristic creakiness. This seems to

be one of the most robust elements of expressions of pain and discomfort. This

feature is marked by hash signs as in fragment 5 above2. It is less characteristic of

upset in adult helpline talk (Hepburn, 2004), though not an uncommon feature.

Creaky voice, or laryngealization, has also been tracked in studies of prosody, and its

communicative function in responsive turns has been shown to be related to lack of

2 We note that Gail Jefferson used the asterisk * to mark creaky delivery, but then, as discussed in Jefferson (2004), started to use the asterisk for other sounds, and stopped tracking creaky delivery. Given its ubiquity in expressions involving bodily discomfort that we have encountered, and the potential for confusion with other uses of the asterisk, we felt the hash sign provided a useful alternative. This is supported by Hepburn and Bolden (2012).

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affiliation (e.g. Pittam, 1987; Grivičić & Nilep, 2004) or to mark turn endings

(Ogden, 2001). This squares with our sense of creaky delivery as something that

requires less effort to produce; it seems to be a by-product of not fully opening one’s

throat and engaging vocal chords.

3.2.3 Volume and aspiration

A change in volume may also mark an expression of pain or bodily sensation.

Extremely quiet volume may also have a ‘breathy’ quality described as whispering.

This is marked by double degree signs as in fragment 2 above. Whispering can occur

when a child is trying to talk through crying or pain. The whispers may mark

particular words or the whole turn.

Alternatively, and perhaps more commonly in children, a marked increase in volume

can display the sudden onset of the expressed experience, and display significant

levels of discomfort, as in fragment 4.

Many of these features, for example elevated pitch, tremulous delivery, and

increased aspirationare characteristic features of talking through upset (Hepburn,

2004). Others, such as increases in volume and creaky delivery, are not uncommon

in displays of upset, but not characteristic (Hepburn and Potter, 2012). One feature

of these expressions that is not commonly found in the delivery of crying talk in adult

helpline talk is the patterns of stretching marked by colons.

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3.2.4 Stretching

Stretching occurs in all fragments 1-5 above, often featuring in several of the words

in the formulation. One function may be to extend the interactional space which the

turn holds in order to secure attention. In addition stretching neatly conveys and

underlines the on-going nature of the suffering.

Sequences in which children express pain may, as in the following extract, also

involve perhaps the most characteristic feature of crying; sobbing.

In this mealtime Isabelle has already delivered a pain cry, and here produces in-

breaths and outbreaths with characteristics of sobbing, differing volume to the

surrounding talk and voiced vowels produced with tremulous voice. Rather than

being embedded in the formulations, the sobs are separate, preceding and following

the talk. The distinct (rather than embedded) nature of sobs is also a feature of the

second type of non-verbal component to children’s expressions of pain; pain cries.

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Rather than being embedded in a verbal formulation, pain cries are separate

utterances often delivered in sequences in which pain is expressed. They may contain

(in English) a recognised form such as utterances of ‘ouch’ (extract 8) ‘ah’ (extract

9a) and ‘ow’ or ‘owa’ (extracts 10b, 11 and 12). But pain cries can also be more diffuse

in the form of stretched utterances with creaky voice and rising intonation (extract

9b) and aspiration (extract 10a).

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Heath (1989) suggested that pain cries in medical encounters allow speakers to draw

a sharp intake of breath, as if it simultaneously serves the physical need for oxygen.

They may be preceded or followed by laboured in-breaths and outbreaths, or be

infused with breathiness as is a feature of some of the more discrete moans.

Interestingly, if pain cries are produced in the same turn as a lexical formulation,

they tend to come in turn-initial, or be delivered in their own turn. We have no

examples where pain cries are produced subsequent to a lexical assertion, e.g. in the

form of ‘my X hurts ouch’. This may relate to their role in conveying information

about the severity of the pain being experienced to which the sufferer has primary

access (Heritage, 2012). Further interesting parallels can be drawn with doctors who

are conveying bad news. Freese and Maynard (1998) noted that such turns were

characterised by stretched vowels, falling pitch contours and creaky and/or breathy

voice quality, and these were associated with expressions of sorrow. It seems clear

that prosodic manipulations are crucial in making sense of one another’s actions in

talk, and particularly important for understanding children’s expressions of pain and

discomfort.

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3.3 Embodied actions

When vocally conveying episodes of pain children in this study frequently

accompany these with embodied expressions. One such expression is facial displays.

While Mum is talking in extract 9b, repeated below, Charlie, who is five years old,

produces a pain cry “#ah::¿ hh”, furrowing his brow and retracting his lips. This is

co-ordinated with the cry of pain, in a way that momentary heightens the expression

of hurt, a change that Mum is able to see as she holds Charlie’s hand and looks at

him as she talks.

A pain display may also take the form of shifting the body to a different position. In

extract three, duplicated below, Lanie, aged four, asserts that her bottom hurts.

As she delivers the word ‘hurts’ she moves her body from side to side, shifting her

weight in a way that demonstrates discomfort. Speakers may also draw their

recipients’ attention to part of their body using their hands. Reproducing extract 10a

with more context, Lanie asserts that her tummy hurts. Prior to this announcement,

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Lanie has been talking quietly to herself about the drinking straw Dad has gone to

get for her from the kitchen, and she is swinging her legs.

On line 3 Lanie produces the first creaky and short ‘uh’, and after a gap delivers the

laboured inbreath and more extended aspirated moan. At the same time she sits

upright, stops swinging her legs and then slumps into her chair; she used the

placement of her hands to make relevant her tummy. Expressions of pain and

discomfort can involve physical gestures deployed in co-ordination with or in

sequences that contain lexical assertions of pain experiences, displaying a sense of

physical tension, making relevant a specific part of the body, and marking a change

from what came before.

To sum up, we have described a set of distinct features of children’s expressions of

bodily sensation: lexical formulations, which introduce the notion of a sensation into

the interaction; prosodic features which can be embedded in the delivery of these

formulations; pain cries, which are separate from lexical formulations; and

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embodied actions, which make particular parts of the body relevant, and can be

produced when lexical formulations are absent or partial.

4. Pain and interaction So far we have identified distinct components of expressions of physical sensation.

In this next section we will point out some of the interactional functions of these

different features in order to demonstrate the importance of identifying these

distinct characteristics of expressions of pain.

4.1 Expressions of bodily sensation make relevant a trouble source

Expressions of bodily sensation, like disgust markers, can orient recipients to a

‘trouble source’, and they are treated as representing an underlying (often, in our

data, negative) state (Wiggins, 2012). Describing the different components of

expressions of pain enables an understanding of how they individually construct the

nature of this experience, and or indicate an emotional stance. A child’s pain, like

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disgust, becomes a socially accountable activity when it is produced in interaction.

Pain cries display distress and can orient the recipients to the possibility of

forthcoming trouble without having to formulate it in words. However speakers can

simultaneously deploy embodied actions to draw attention to areas of their body. So

when Lanie produces the cry ‘.hhhh u::(h)h::’ in extract 18a, she makes suffering

interactionally relevant in the absence of an assertion in a way patients in medical

consultations do when describing their symptoms (Heath, 2002).

To illustrate this, it is useful to examine what happens when a pain cry is delivered in

the absence of a lexical assertion. In this next extract Isabelle (aged four years)

produces a cry of pain, which later on she describes as ‘stinging’. This is the first

time during the meal that Isabelle has mentioned a sting or pain. In this mealtime

neither Mum nor Isabelle are able to identify what the pain is, and it is not until the

pain reoccurs a few days later that Mum says it is probably pins and needles. Pins

and needles refer to prickly sensations that usually happen when the blood supply to

the nerves in that area is cut off. We join the family over 15 minutes into dinner, at a

point where Isabelle, her Mum, Dad and brother Hayden (aged six) are eating and

conversation has lapsed.

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The expression of pain begins on line 2 when Isabelle produces a small diffuse cry of

pain ‘mm’ followed by a louder and stretched pain cry whilst moving her hand

towards what appears to be her foot, although it is under the table. The pain cries are

not followed by an explanation of its source, which would typically result in a

sequence in which the parent offers a diagnosis or remedy (Jenkins, 2013). Mum

pursues this with “Whassah mattuh.” Mum’s response demonstrates an

understanding of Isabelle’s expression as representative of an experience of bodily

sensation with a negative emotional stance, and treats information pertaining to the

nature of the underlying sensation (such as location and type of pain) she is

experiencing as missing. In response, Isabelle issues various sobs along with the

directive ‘Don’t touch it’ followed by information about the type of pain on line 14 ‘it

stings me’, but not its location. Mum locates her foot, possibly based on Isabelle’s

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embodied actions, and seeks confirmation of her candidate understanding on line 16.

This is pursued over the subsequent talk (material omitted) and is finally resolved

through a more direct embodied action, lifting her foot in the air, on line 41.

Isabelle’s expression of pain is treated as a socially accountable activity when it is

produced in interaction; Isabelle’s mum orients to the trouble, but treats the

sensation as only accessible to Isabelle, a private and internal state to be reported on

by Isabelle. Isabelle uses embodied actions to convey information not only in co-

ordination with a pain cry when a lexical assertion is absent, but also in cases where

the assertion contains only partial information. The existence of a private pain or

sensation with an outward expression is something built here in the interaction.

4.2 Children’s expressions of bodily sensation as relevant to food consumption

In this next section, we demonstrate that whilst expressions can be built as the public

rendering of an otherwise internal state, such expressions are also relevant to other social

activities, particularly in this data, food consumption. In the following extract Lanie

reports a hurting tummy. Stomach ache is a potential candidate for stopping consumption

during a mealtime, and in this example the reported hurt is reworked as hunger in dad’s

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On line 42 Lanie’s “my tummy=ur:ts me dad” contains no pain cry or moan, and

although her delivery is creaky, it doesn’t contain characteristic degrees of stretching

and aspiration found in other pain talk (e.g. extract 2). It seems more like a reporting

to dad than a display of suffering. Dad’s response begins ‘how could’, which would

signal disbelief and call Lanie to account. He self-repairs to a diagnostic causal

suggestion (that embodies a remedy) that the pain is a result of hunger. The term of

endearment maintains affiliation but also sounds sympathetic. Dad further specifies

the remedy ‘why don’t you try eating..’ on line 48. Lanie’s reported pain is thereby

(temporarily) closed down; Dad formulates it as normal, non-serious (due to

hunger), and solvable. Within this episode reported states of hunger and stomach

pain become entangled in the delicate management of getting Lanie to eat (in ways

that reflect previous work on satiety in negotiating eating and finishing a meal -

Hepburn and Wiggins, 2005; Laurier and Wiggins, 2011).

It is also possible to see how the complexity of the relationship between an internal

state and an expression manifests in interaction, with issues of authenticity and

severity being negotiated on a turn-by-turn basis. The fact that expressions of bodily

sensation can be used for, and/or treated as having an interactional function in

mealtime tasks adds a complexity to the notion that the expressions simply represent

an internal state. While the emphasis in this paper has been to describe the

components of children’s expressions of pain, there are a number of features of

responsive turns that we have pointed to here. Firstly, the sense in which parents

engage in diagnostic questioning, which itself relates to the degree of information

about the nature, severity and location of the trouble that is packaged in the initial

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pain expression and its delivery. This contributes to the sense in which the sensation

is internal and private. Secondly, we have started to note some of the resources that

parents can mobilise to close down further complaint, especially if it competes with

other projects – here eating a meal. Finally, the resources and entitlements that

parents then treat themselves as having in order to build a remedy for the problem,

e.g. ‘why don’t you try eating’ rather than ‘just eat your dinner’. A more detailed

examination of these sequences, particularly focusing on parents’ responses and the

negotiated nature of pain in the interaction following a child’s expression, is

described elsewhere (Jenkins, 2015).

Discussion Our interactional analysis demonstrated a constellation of features of children’s

expressions of bodily sensation and pain during family mealtimes. We have

described in detail distinct components of these expressions.

§ Lexical formulations are assertions which may take the form of ‘my X hurts’

and contain information relating to the nature and the location of the

sensation.

§ Prosodic features also found in episodes of crying and upset can be embedded

in the delivery of these assertions. These include heightened pitch, changes in

volume such as sharp elevated volume or aspirated whispering, and

tremulous and creaky voice. These features convey distress and discomfort.

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Another prosodic characteristic, which is not associated with crying, is

stretching, which holds the floor by extending the sounds of the words, and in

this way conveys an on-going suffering.

§ Pain cries produced with recognisable utterances such as ‘ouch’ ‘ow’ ‘owa’ ‘ah’

or more discrete moans.

§ Embodied actions such as grimacing, shifting the body, and placing a hand to

draw attention to a particular body part, particularly when lexical

formulations are absent or partial.

5.1 Implications for traditional measures of children’s pain

We have shown several ways in which this methodological approach contributes to

an examination of children’s pain. Firstly, capturing embodied actions in the context

of the other features in the interaction by positioning still photos of children’s facial

expressions and physical stance alongside transcripts of the talk, allowed us to retain

details about the onset of individual utterances and their overall sequential context.

This enabled us to demonstrate the way in which embodied actions are produced

when lexical formulations are partial or missing.

Secondly, whereas existing measures of children’s pain are built on the premise that

lexical items indicate an increasing quantity of hurt (e.g. from ‘no hurt’ to ‘worst

hurt’), our analysis demonstrates that it is features of upset, crying, stretching of the

sounds, embodied actions and non-lexical groans that function to upgrade the

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severity of the discomfort expressed in children’s naturally occurring expressions of

pain. It is only possible to observe this when these features of delivery are preserved.

Finally, we have shown that although children’s expressions of pain are produced as

rendering visible an otherwise private and subjective internal sensation, the

operation of these expressions still needs to be understood within Wittgenstein’s

(1953) ‘language game’. That is, he emphasised the public and communicative role

of language. In a sense our study, as Heath’s before it, starts to expand on the

language games related to pain, and document the subtlety of pain expressions and

the range of relevant practices that they appear in. We briefly pointed to the way in

which the sensations’ severity and authenticity are interactionally negotiated, and

this is explored more fully elsewhere (Jenkins, 2015). We have also revealed how

children’s expressions of bodily sensation are performing other functions in

interaction: that of avoiding eating, or persuading children to eat. It is only possible

to observe this when working with naturally occurring data and examining how co-

participants display their understanding of the expression’s import or consequence

(Schegloff, 1993). The complex interactional role of children’s expressions of bodily

sensation contribute to the discussion about the inconsistencies described in

reported and observed expressions of pain as measured in traditional studies (e.g.

Hay et al., 2009; Chambers, Craig and Bennett, 2002), and to the controversy with

operationalizing a distinction between pain experience and expression (Craig, et al.,

2010).

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By conducting an empirical exploration of how children’s expressions of pain and

discomfort appear naturalistically, we add to the existing literature on how

expressions of emotion constitute interactional achievements, and can be employed

to build actions in talk. This naturalistic approach has already been effective in

detailing new ways of understanding emotion displays that are different to more

traditional psychophysiological concerns (Goodwin & Goodwin, 2000; Peräkylä &

Sorjonen, 2012).

5.2 Future possibilities

The interactional import of children’s expressions of bodily sensations will be

relevant in different ways in different environments. Whereas Heath (1989)

documented the way in which expressions of pain were used to progress medical

examinations, during the family mealtimes in our data children’s expressions were

treated as relevant to the management of eating. There are exciting opportunities to

explore the interactional function of such expressions in other family situations,

paediatric settings, and physiotherapy, in addition to work in languages other than

British English.

<1>Acknowledgements</1> The authors would like to thank the members of the Discourse and Rhetoric Group at Loughborough University, particularly Jonathan Potter, Derek Edwards, and Alexandra Kent for helpful discussions in data sessions. We would also like to thank the participants for giving up their time for the research. This work was supported by the Economic and Social Research Council [grant number ES/F020864/1, 2007].

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References

Blount, R.L., Cohen, L.L., Frank, N.C., Bachanas, P.J., Smith, A.J., Manimala, M.R., & Pate, J.T. (1997) The Child-Adult Medical Procedure Interaction Scale-Revised: An Assessment of Validity. Journal of Pediatric Psychology, 22(1), 73-88

Butler, C.W., & Fitzgerald, R. (2010) Membership-in-action: Operative identities in a family meal, Journal of Pragmatics, 42, 2462–2474

Carr, T.D., Lemanek, K.L., & Armstrong, D.F. (1998) Pain and Fear Ratings: Clinical Implications of Age and Gender Differences. Journal of Pain and Symptom Management, 15(5), 305-313

Chambers, C.T., Craig, K.D., & Bennett, S.M. (2002) The Impact of Maternal Behaviour on Children’s Pain Experiences: An Experimental Analysis. Journal of Pediatric Psychology, 27(3), 293-301

Chambers, C.T., Giesbrecht, K., Craig, K.D., Bennett, S.M., & Huntsman, E. (1999) A Comparison of Faces Scales for the Measurement of Pediatric Pain: Children's and Parents’ Ratings. Pain, 83(1), 25-35

Couper-Kuhlen, E., & Selting, M. (Eds.). (1996). Prosody in conversation: Interactional studies. Cambridge, England: Cambridge University Press.

Craig, K.D., Versloot, J., Goubert, L., Vervoort, T., & Crombez, G. (2010) Perceiving Pain in Others: Automatic and Controlled Mechanisms. The Journal of Pain, 11(2), 101-108

Craven, A.J., & Potter, J. (2010) Directives: Entitlement and contingency in action, Discourse Studies, 12, 4, 419-422

Doorbar, P., & McClarey, M. (1999) Ouch! Sort it out. Report of a qualitative study of children’s experiences of pain. Clinical Practice Guidelines: Royal College of Nursing Institute and Action for Sick Children, UK

Drew, P. (2005). Conversation analysis. In K.L. Fitch & R.E. Sanders (Eds.), Handbook of Language and Social Interaction. Mahwah, NJ: Lawrence Erlbaum, p. 71-102

Drew, P. (2003) Conversation analysis. In J.A. Smith Ed) Qualitative Psychology: A practical guide to research methods. London: Sage, p. 132-158

Edwards, D. (1997) Discourse and Cognition. London: Sage

Edwards, D., & Potter, J. (1992) Discursive Psychology. London: Sage Publications

Edwards, D., & Potter, J. (2005) Discursive Psychology, Mental States and Descriptions. In, H. Te Molder & J. Potter (Eds) Conversation and Cognition, pp.241-259. Cambridge: Cambridge University Press

Freese, J., & Maynard, D. W. (1998). Prosodic features of bad news and good news in conversation. Language in Society, 27(2), 195-219

Goffman, E. (1978) Response Cries. Language, 54(4); 787-815

Dow

nloa

ded

by [

Lou

ghbo

roug

h U

nive

rsity

], [

Ale

xa H

epbu

rn]

at 0

7:56

14

June

201

5

Accep

ted M

anus

cript

37

Goodenough, B., van Dongen, K., Brouwer, N., Abu-Saad, H.H., & Champion, D.G. (1999) A comparison of the Faces Pain Scale and the Facial Affective Scale for children's estimates of the intensity and unpleasantness of needle pain during blood sampling. European Journal of Pain, 3(4), 301-315

Goodwin, M. H., & Goodwin, C. (2000). Emotion within situated activity. In A. Duranti (Ed). Linguistic Anthropology: A Reader. Malden, MA, Oxford, Blackwell, pp. 239-257

Grivičić, T., & Nilep, C. (2004). When phonation matters: The use and function of yeah and creaky voice. Colorado Research in Linguistics, 17(1), 1-11.

Hadjistavropoulos. T., & Craig, K.D. (2002) A Theoretical Framework for Understanding Self-Report and Observational Measures of Pain: a Communications Model. Behaviour Research and Therapy, 40, 551-570

Hay, I., Oates, J., Giannini, A., Berkowitz, R., & Rotenberg, B. (2009) Pain Perception of Children Undergoing Nasendoscopy for Investigation of Voice and Resonance Disorders, Journal of Voice, 23, 3, 380-388

Heath, C. (1989) Pain Talk: The Expression of Suffering in the Medical Consultation, Social Psychology Quarterly, 52, 113-125

Heath, C. (2002) Demonstrative suffering. The gestural (re)embodiment of symptoms, Journal of Communication, 52, 597-616

Hepburn, A. (2004) 'Crying: Notes on Description, Transcription, and Interaction', Research on Language & Social Interaction, 37, 3, 251-290Hepburn, A. & Bolden, G. (2012). The conversation analytic approach to transcription. In Sidnell, J. & Stivers, T. (Eds). Blackwell Handbook of Conversation Analysis (pp 57-76). Oxford: Blackwell.

Hepburn, A. & Potter, J. (2007). Crying receipts: Time, empathy and institutional practice, Research on Language and Social Interaction, 40, 89-116

Hepburn, A., & Potter, J. (2010) Interrogating Tears: Some Uses of ‘Tag Questions’ in a Child Protection Helpline. In A.F. Freed & S. Ehrlich (Eds) “Why Do You Ask?”: The Function of Questions in Institutional Discourse, pp. 69-86. Oxford: Oxford University Press

Hepburn, A., & Potter, J. (2011). Threats: Power, family mealtimes, and social influence. British Journal of Social Psychology, 50(1), 99-120.

Hepburn, A. & Potter, J. (2012). Crying and Crying Responses. In A. Peräkylä & M-L. Sorjonen (Eds.) Emotion and interaction, pp. 194-210. Oxford: Oxford University Press

Hepburn, A. & Wiggins, S. (Eds.) (2005). Developments in discursive psychology, Discourse & Society (special issue) 16(5).

Hepburn, A., & Wiggins, S. (Eds.). (2007). Discursive research in practice: New approaches to psychology and interaction. Cambridge University Press.

Heritage, J. (1984) Garfinkel and Ethnomethodology. Cambridge: Polity Press

Heritage, J. (2012) The Epistemic Engine: Sequence Organization and Territories of Knowledge. Research on Language & Social Interaction, 45(1), 30-52

Dow

nloa

ded

by [

Lou

ghbo

roug

h U

nive

rsity

], [

Ale

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rn]

at 0

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5

Accep

ted M

anus

cript

38

Heritage, J. & Raymond, G. (2005) The Terms of Agreement: Indexing Epistemic Authority and Subordination in Talk-in-Interaction, Social Psychology Quarterly, 68, 1, 15-38

Huguet, A., Stinson, J.N., & McGrath, P.J. (2010) Measurement of Self-Reported Pain Intensity in Children and Adolescents. Journal of Psychosomatic Research, 68(4), 329-336

IASP (2012) International Association for the study of Pain. http://www.iasp-pain.org/Taxonomy#Pain visited 10/04/15 GMT 10.54

Jefferson, G. (1985). An exercise in the transcription and analysis of laughter. In T. Van Dijk (Ed.), Handbook of discourse analysis (Vol. 3, pp. 25–34). London: Academic

Jefferson, G. (2004). Glossary of transcript symbols with an introduction. In G.H., Lerner (Ed). Conversation Analysis: Studies from the first generation. Amsterdam/Philadelphia: John Benjamins, p. 13-31

Jenkins, L. (2013). Children’s expressions of pain and bodily sensation in family mealtimes. PhD thesis, Loughborough University

Jenkins, L. (2015). Children’s participation in their healthcare: a conversation analysis of children’s expressions of pain and bodily sensation in everyday family life. Sociology of Health and Illness, 37 (2), 298–311

Laurier, E. & Wiggins, S. (2011) Finishing the Family Meal. The Interactional Organisation of Satiety. Appetite, 56, 53–64

Lawton, J. (2003) Lay experiences of health and illness: past research and future agendas, Sociology of Health & Illness, 25, 23–40

Lewandowski, W. (2004) Psychological Factors in Chronic Pain: A Worthwhile Undertaking for Nursing? Archives of Psychiatric Nursing, 18(3), 97-105

Lumley, M.A., Cohen, J.L., Borszcz, G.S., Cano, A., Radcliffe, A.M., Porter, L.S., Schubiner, H., & Keefe, F.J. (2011) Pain and Emotion: a Biopsychosocial Review of Recent Research. Journal of Clinical Psychology, 67(9), 942-968

Maynard, D.W. (1997) The News Delivery Sequence: Bad News and Good News in Conversational Interaction. Research on Language and Social Interaction, 30(2), 93-130

Melzack, R. (1999) From the Gate to the Neuromatrix, Pain, 82, 1, 121-126

Morris, D.B. (1991) The culture of pain. University of California Press: London

Ogden, R. (2001). Turn transition, creak and glottal stop in Finnish talk-in-interaction. Journal of the International Phonetic Association, 31 (01), 139-152

Oxford English Dictionary (2011) Oxford English Dictionary. Oxford: Oxford University Press

Perakyla, A., & Sorjonen, M. L. (2012). Emotion in interaction. Oxford University Press.

Dow

nloa

ded

by [

Lou

ghbo

roug

h U

nive

rsity

], [

Ale

xa H

epbu

rn]

at 0

7:56

14

June

201

5

Accep

ted M

anus

cript

39

Pittam, J. (1987) Listeners’ evaluations of voice quality in Australian English speakers. Language and Speech, 30, 99–113.

Potter, J., & Hepburn, A. (2007). Discursive psychology: mind and reality in practice. In A. Weatherall, B. Watson & C. Gallois (Eds.), Language, discourse and social psychology (pp. 160-181). New York: Palgrave MacMillan.

Rapoff, M.A. & Lindsey, C.B. (2000) The pain puzzle: a visual and conceptual metaphor for understanding and treating pain in pediatric rheumatic disease, Journal of Rheumatology, Supplement, 58, 29-33

Schegloff, E.A. (1986) The Routine as Achievement, Human Studies, 9, 11-151

Schegloff, E.A. (1992) In Another Context. In, Duranti, A., and Goodwin, C. (Eds). Rethinking Context: Language as an Interactive Phenomenon. Cambridge University Press: Great Britain

Schegloff, E.A. (1993) Reflections on Quantification in the Study of Conversation. Research on Language & Social Interaction, 26(1), 99–128

Schegloff, E.A. (1995) Discourse as an Interactional Achievement III: The Omnirelevance of Action" Research on Language and Social Interaction, 28 (2), 185-211

Schegloff, E.A. (2005) On integrity in inquiry . . . of the investigated, not the investigator, Discourse Studies, 7, 4–5, 455–480

Schegloff, E.A. (2007) Sequence organization in interaction: a primer in conversation analysis I. Cambridge: Cambridge University Press

Schneider, F., & Karoly, P. (1983) Conceptions of the Pain Experience: the Emergence of Multidimensional Model and their Implications for Contemporary Clinical Practice. Clinical Psychology Review, 3, 61-86

Stinson, J.M., Kavanagh, T., Yamada, J., Gill, N., & Stevens, B. (2006) Systematic Review of the Psychometric Properties, Interpretability and Feasibility of Self-Report Pain Intensity Measures for Use in Clinical Trials in Children and Adolescents. Pain, 125, 143-157

Spagrud, L.J., von Baeyer, C.L., Ali, K., Mpofu, C., Penkman Fennell, L., Friesen, K., & Mitchell, J. (2008) Venous Access and Adult-Child Interaction Pain, Distress, and Adult-Child Interaction During Venipuncture in Pediatric Oncology: An Examination of Three Types of Venous Access. Journal of Pain and Symptom Management, 36(2), 173-184

Sullivan, M.D. (1995) Pain in Language From Sentience to Sapience. Pain Forum, 4(1), 3-14

Sullivan, M.J.L., Adams, A., & Sullivan, M.E. (2004) Communicative Dimensions of Pain Catastrophizing: Social Cueing Effects on Pain Behaviour and Coping. Pain, 107, 220-226

Sullivan, M.J.L., Martel, M.O., Tripp, D., Savard, A., & Crombez, G. (2006) The Relation Between Catastrophizing and the Communication of Pain Experience. Pain, 122, 282-288

Dow

nloa

ded

by [

Lou

ghbo

roug

h U

nive

rsity

], [

Ale

xa H

epbu

rn]

at 0

7:56

14

June

201

5

Accep

ted M

anus

cript

40

Sullivan, M.J.L., Thorn, B., Haythornthwaite, J.A., Keefe, F., Martin, M., Bradley, L.A., & Lefebvre, J.C. (2001) Theoretical Perspectives on the Relation Between Catastrophizing and Pain. The Clinical Journal of Pain, 17, 52-64

Vervoort, T., Caes, L., Trost, Z., Sullivan, M., Vangronsveld, K., & Goubert, L. (2011) Social Modulation of Facial Pain Display in High-Catastrophizing Children: An Observational Study in Schoolchildren and their Parents. Pain, 152, 1591–1599

Vervoort, T., Goubert, L., Eccleston, C., Verhoeven, K., De Clercq, A., Buysse, A., & Crombez, G. (2008) The Effects of Parental Presence Upon the Facial Expression of Pain: The Moderating Role of Child Pain Catastrophizing. Pain, 138, 277–285

von Baeyer, C.L., & Spagrud, L.J. (2007) Systematic Review of Observational (Behavioral) Measures of Pain for Children and Adolescents Aged 3 to 18 Years. Pain, 127, 140–150

Wiggins, S. (2002) 'Talking With Your Mouth Full: Gustatory Mmms and the Embodiment of Pleasure', Research on Language & Social Interaction, 35, 3, 311 — 336

Wiggins, S. (2012) The Social Life of 'eugh': Disgust as Assessment in Family Mealtimes. British Journal of Social Psychology, 52 (3), 489–509

Wiggins, S., & Hepburn, A. (2007). Food abuse: mealtimes, helplines and 'troubled'eating. In A. Hepburn & S. Wiggins (Eds.) Discursive research in practice: New approaches to psychology and interaction. Cambridge: Cambridge University Press, pp263-280.

Wiggins, S. & Potter, J. (2003). Attitudes and evaluative practices: Category vs. item and subjective vs. objective constructions in everyday food assessments, British Journal of Social Psychology, 42, 513-531.

Wilkinson, S., & Kitzinger, C. (2006) Surprise as an Interactional Achievement: Reaction Tokens in Conversation, Social Psychology Quarterly, 69, 2, 150-182

Wittgenstein, L. (1953) Philosophical Investigations, trans, Blackwell Publishing, Oxford.

<1>About the Authors</1> Laura Jenkins is interested in medical and health issues as they arise in talk-in-interaction in both clinical and mundane settings. Her doctoral work used conversation analysis to describe the complex practices employed by children and their parents during episodes in which children express pain. Laura is currently delivering and evaluating an intervention at the University of Sheffield which seeks to change the way doctors formulate their questions in order to improve diagnosis in neurology clinics. Alexa Hepburn is an expert on the transcription and interactional management of distress, and has published widely on topics related to emotion, epistemics and asymmetry. She is currently working closely with video materials of family mealtimes and clinical and counselling encounters, as well as continuing to analyse helpline and other telephone interaction. This work informs training workshops for practitioners. She is also co-authoring (with Galina Bolden) a book on transcription for interactional researchers.

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