An androgynous five-year-old dressed in drab gender-neutral clothing grimaces as a nurse sticks a needle into their forearm. Watching the action on a screen, 264 adults take notes. They all see the same pain and fear and the same child. But half have been told that the kid is named Samuel. The other half have been told her name is Samantha. It’s a classic study of gender bias in pediatric pain assessment. And it doesn’t go well for Samantha.

The results are telling: Adults who think they’re looking at a girl rate her pain at 58.75 out of 100. Those who think they’re watching a boy suffer rate his pain 65.15. “Explicit gender stereotypes—for example, that boys are more stoic or girls are more emotive—may bias adult assessment of children’s pain,” according to the new study. “We found that the ‘boy’ was rated as experiencing more pain than the ‘girl’ despite identical clinical circumstances and identical pain behavior.” In other words, adults naturally assumed that a young girl would overreact.

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This isn’t the first research to demonstrate a gender bias in pain management. Multiple analyses have shown that medical professionals tend to take women’s reports of pain less seriously, and women are disproportionately given sedatives rather than painkillers to manage their discomfort. When it comes to children, evidence of a gender bias is no less salient. In fact, researchers conducted the exact same study as this one in 2014, complete with a gender-neutral Samuel/Samantha, but with fewer adults subjects.

“To confirm, clarify, and extend this finding, we conducted a replication experiment and follow-up study,” write the authors of the newest study. And that new study did all of the above.

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The findings, then, were not surprising. Far more interesting was that adult women were far more likely to exercise gender bias. Adult males, in fact, rated Samantha’s pain slightly higher than Samuel’s pain, on average. “We didn’t expect that,” coauthor on the study Brian Earp of Yale University told Quartz. Earp, based on prior work by Cornell University philosopher Kate Manne, went on to speculate that women may be socialized to take male pain more seriously.

Solutions to the problem are not forthcoming. But the first step may be recognizing that a clinical pain assessment carries some inherent bias. If healthcare providers and parents alike remember that they may take male pain more seriously than female pain, they can adjust accordingly. “Young children may not be able to verbalize in eloquent ways what they’re experiencing,” Earp says. “We’d better have a clear sense of how our judgments work.”