No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Systematic Review: A Systematic Review of the Interrelationships Among Children's Coping Responses, Children's Coping Outcomes, and Parent Cognitive-Affective, Behavioral, and Contextual Variables in the Needle-Related Procedures Context
Abstract
Objective:
To conduct a systematic review of the interrelationships between children's coping responses, children's coping outcomes, and parent variables during needle-related procedures. A systematic literature search was conducted. It was required that the study examined a painful needle-related procedure in children from 3 to 12 years of age, and included a children's coping response, a children's coping outcome, and a parent variable. In all, 6,081 articles were retrieved to review against inclusion criteria. Twenty studies were included. Parent coping-promoting behaviors and distress-promoting behaviors enacted in combination are the most consistent predictors of optimal children's coping responses, and less optimal children's coping outcomes, respectively. Additional key findings are presented. Children's coping with needle-related procedures is a complex process involving a variety of different dimensions that interact in unison. Parents play an important role in this process. Future researchers are encouraged to disentangle coping responses from coping outcomes when exploring this dynamic process.
... Os critérios de inclusão foram ser acompanhante da criança hospitalizada e ser alfabetizado. Como critérios de exclusão foram utilizados o controle de variáveis que pudessem influenciar os temas trazidos, como crianças com doenças graves (câncer, doenças neurológicas, síndromes genéticas, cardiopatias, doenças crônicas) e tempo de internação superior a um mês, pois são questões relacionadas a aumento do estresse (Campbell, DiLorenzo, Atkinson, & Riddell, 2017;Marsac et al., 2011). ...
... Ainda as formas de distração e o uso de tecnologias também podem acrescentar ao conjunto de modos de enfrentamento. Todos esses processos podem ajudar a diminuir efeitos negativos associados ao adoecimento e internação, tais como estresse, ansiedade, humor deprimido, auxiliar na adesão ao tratamento, colaborar em desfechos positivos do adoecimento (Campbell et al., 2017;Moskowtiz, Addington, & Cheung, 2019;Nikrahan et al., 2019;Pressman, Jenkins, & Moskowitz, 2019). Tendo em vista estas considerações, reitera-se que compreender o fenômeno da hospitalização infantil sob o princípio de que as experiências positivas expandem favoravelmente a forma de vivenciar estressores colocado por estudos da psicologia positiva (Fredrickson, 2004;Pressman et al., 2019) amplia o olhar sobre o sofrimento associado ao adoecimento, visando um nível ótimo de funcionamento. ...
... Sugere-se que novos estudos continuem investigando as estratégias positivas utilizadas pelos familiares de crianças hospitalizadas. Aponta-se a importância de trabalhos que enfatizem o fortalecimento das famílias durante este momento, e não apenas o foco nas dificuldades por que passam (Campbell et al., 2017). Nesse sentido, as intervenções em psicologia positiva direcionadas ao contexto da saúde podem ser uma alternativa de investimento dos profissionais. ...
As estratégias de enfrentamento são esforços cognitivos ou comportamentais utilizados para manejo do estresse. O presente estudo buscou identificar e descrever as estratégias utilizadas por familiares durante a hospitalização dos filhos. Foi utilizado um delineamento misto (quantitativo e qualitativo), descritivo e exploratório, em que foi aplicada uma entrevista semiestruturada. Trinta e oito participantes, com média de idade de 27,81 (DP = 8,95), compuseram a amostra. Os familiares destacaram o uso da rede de apoio, a assistência médica hospitalar, o diálogo, a regulação das emoções e o uso de tecnologias como estratégias positivas para lidar com a hospitalização.
... Os critérios de inclusão foram ser acompanhante da criança hospitalizada e ser alfabetizado. Como critérios de exclusão foram utilizados o controle de variáveis que pudessem influenciar os temas trazidos, como crianças com doenças graves (câncer, doenças neurológicas, síndromes genéticas, cardiopatias, doenças crônicas) e tempo de internação superior a um mês, pois são questões relacionadas a aumento do estresse (Campbell, DiLorenzo, Atkinson, & Riddell, 2017;Marsac et al., 2011). ...
... Ainda as formas de distração e o uso de tecnologias também podem acrescentar ao conjunto de modos de enfrentamento. Todos esses processos podem ajudar a diminuir efeitos negativos associados ao adoecimento e internação, tais como estresse, ansiedade, humor deprimido, auxiliar na adesão ao tratamento, colaborar em desfechos positivos do adoecimento (Campbell et al., 2017;Moskowtiz, Addington, & Cheung, 2019;Nikrahan et al., 2019;Pressman, Jenkins, & Moskowitz, 2019). Tendo em vista estas considerações, reitera-se que compreender o fenômeno da hospitalização infantil sob o princípio de que as experiências positivas expandem favoravelmente a forma de vivenciar estressores colocado por estudos da psicologia positiva (Fredrickson, 2004;Pressman et al., 2019) amplia o olhar sobre o sofrimento associado ao adoecimento, visando um nível ótimo de funcionamento. ...
... Sugere-se que novos estudos continuem investigando as estratégias positivas utilizadas pelos familiares de crianças hospitalizadas. Aponta-se a importância de trabalhos que enfatizem o fortalecimento das famílias durante este momento, e não apenas o foco nas dificuldades por que passam (Campbell et al., 2017). Nesse sentido, as intervenções em psicologia positiva direcionadas ao contexto da saúde podem ser uma alternativa de investimento dos profissionais. ...
... Apart from the fact that stress experienced by children during painful medical procedures is unpleasant, stress may also lead to increased fear of further treatment, impair the quality of the child's mental functioning, and have a negative effect on the child's health (Bakker, Van Loey, Van Son, & Van der Heijden, 2010;Campbell, DiLorenzo, Atkinson, & Pillai Riddell, 2017;McGarry et al., 2015). The unpleasant experience of going through pediatric medical procedures may take their toll on the child's adaptive skills, producing such effects as tantrums, nightmares, bed wetting, or attention seeking (Sadhasivam et al., 2010). ...
... Chambers, Taddio, Uman, and McMurtry (2009) conducted a review of studies on the effectiveness of psychological interventions at the time of preventive vaccination. Campbell et al. (2017) reviewed studies on the relationship between parent behavior and behaviors indicative of good coping skills in children during painful medical pediatric procedures. Bai et al. (2018) performed a review of studies in which observational scales were used to measure parent-child interactions at the time of painful medical procedures. ...
... These results can also be related to the specificity of Erikson's developmental stages in which the first year of life is marked by the fundamental importance of physical closeness with the caregiver that may be accompanied by certain parental behaviors referred to as reassurance. Campbell et al. (2017) pointed out that parent behaviors toward children, such as proximal soothing and reassurance, are a complex phenomenon that should be analyzed in the context of other concomitant behaviors. ...
Objective:
In this study review, the relationship between observed parental behavior and the observed symptoms of distress in pediatric patients, as well as the subjective experiences of pain in pediatric patients undergoing painful medical procedures, was analyzed.
Method:
A systematic search of articles using PsycARTICLES, PsycINFO, PubMed, MEDLINE, Scopus, Cochrane, and DARE was performed. The risk of bias and the level of evidence were assessed. Meta-analyses were performed for the selected variables.
Results:
Twenty-nine relevant publications were selected. The results of the analyses showed that apology, giving control to the child, empathy, and criticism were most strongly associated with children's distress and pain during painful medical procedures in the group of patients aged 2 to 18 years. In the case of patients below the age of 2, insensitive behaviors were positively related to the level of distress.
Conclusions:
The lack of tender, physical closeness with the parent increases distress in children under 2 years of age during painful medical procedures, and adults drawing their attention to the threatening aspects of a medical situation produces this effect in older children. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
... Frequency of each type of behavior is summed and divided by procedural time or total behaviors. It has been argued that the child's coping behavior is a coping response, while the child's distress behavior (and pain/anxiety scores) is a coping outcome to the stressful stimulus (Campbell et al. 2017a). ...
... Their published lag analyses can be summarized as three sequences: (1) Adult distress-promoting behaviors (excluding reassurance behavior) tended to precede child distress behavior; (2) child distress behavior tended to precede adult reassurance behavior (but not other distress-promoting behaviors); and (3) adult coping-promoting behavior tended to precede and follow child coping behaviors. Similarly, a systematic review of parent-child behavior during needle-related procedures concluded a bidirectional relationship is likely, however noting parental behavior tended to precede child coping response (Campbell et al. 2017a). This comment aligns with the structure of the CAMPIS-R measure , which is designed to identify adult coping-promoting behaviors that encourage child coping responses (i.e., instructing child to blow bubbles, followed by child engaging in the instructed behavior). ...
Understanding how parents influence their child’s medical procedures can inform future work to reduce pediatric procedural distress and improve recovery outcomes. Following a pediatric injury or illness diagnosis, the associated medical procedures can be potentially traumatic events that are often painful and distressing and can lead to the child experiencing long-term physical and psychological problems. Children under 6 years old are particularly at risk of illness or injury, yet their pain-related distress during medical procedures is often difficult to manage because of their young developmental level. Parents can also experience ongoing psychological distress following a child’s injury or illness diagnosis. The parent and parenting behavior is one of many risk factors for increased pediatric procedural distress. The impact of parents on pediatric procedural distress is an important yet not well-understood phenomenon. There is some evidence to indicate parents influence their child through their own psychological distress and through parenting behavior. This paper has three purposes: (1) review current empirical research on parent-related risk factors for distressing pediatric medical procedures, and longer-term recovery outcomes; (2) consider and develop existing theories to present a new model for understanding the parent–child distress relationship during medical procedures; and (3) review and make recommendations regarding current assessment tools and developing parenting behavior interventions for reducing pediatric procedural distress.
... Qualitative work may be beneficial in understanding the factors that shape parents' perceptions of pain sensitivity, which in turn could lead to more informed approaches to pain assessment and treatment for the RTT population. There is substantial evidence from studies in the general population that cognitive, behavioral, and affective factors affect how people express pain and perceive pain in others, [38][39][40][41] but few studies have investigated these factors in relation to caregiver reports of pain among individuals with neurodevelopmental disabilities. ...
Background:
Although delayed or decreased responses to pain are commonly reported among caregivers of individuals with Rett syndrome (RTT), previous studies in relatively small samples have documented that caregivers are concerned about pain, particularly due to gastrointestinal and musculoskeletal conditions.
Aims:
The purpose of the current study was to investigate in detail caregivers' perceptions of pain sensitivity, as well as the types, severity, and effect of pain experienced by individuals with RTT in a larger sample than previous studies.
Methods:
A total of 51 caregivers (mostly mothers) participated in the study, which involved standardized questionnaires and interviews. The individuals with RTT ranged in age from 2 to 52 years of age, and most (n = 46; 90%) met criteria for classic RTT.
Results:
Across the sample, 84% of caregivers reported that they believed that their child was less sensitive to pain compared to her typically developing peers. Despite this perception, 63% of caregivers reported that their child had experienced at least one form of pain in the previous 7 days, and 57% reported their child experienced at least one form of chronic pain. On average, caregivers reported that their child's pain was of moderate severity and interfered with at least one activity of daily living.
Conclusions:
The results suggest that pain is a substantial concern among caregivers of individuals with RTT and indicate that additional research is needed to understand the apparent paradox of frequently reported pain experiences despite widespread perceptions of decreased pain sensitivity.
... Multidisciplinary research has long demonstrated that infants, children and youth understand medical information differently, often in accordance with their unique cognitive abilities and experiences gleaned from previous healthcare encounters (Bibace & Walsh, 2016). These cognitive appraisals shape the way the child will cope with and respond to the stressors they encounter in healthcare situations (Campbell et al., 2017;Compas et al., 2001), moderating the likelihood of long-term psychopathology or behavioural change. When children are excluded from active participation in their healthcare experiences, they are more likely to develop Pediatric Medical Traumatic Stress (PMTS) as a result, which hinders normative growth and development (Marsac et al., 2016;Price et al., 2016). ...
Background:
Legacy building is a developmentally grounded, trauma-informed and family-centred psychosocial intervention designed to bolster patient and family resilience through collaborative activities and meaning making. However, little is known about the effects of these interventions, partially because of a lack of clarity regarding how children of different developmental levels understand the concept of legacy. Therefore, this study explored the ways in which hospitalized children defined the concept of legacy.
Methods:
Semi-structured interviews were conducted with 45 hospitalized children (ages 6 to 18 years) on the acute and critical care units of an academic children's medical centre. Interviews were audio-recorded and transcribed verbatim; transcripts were independently coded by at least two members of the research team using an inductive, line-by-line approach; and codes were categorized and assembled into four overarching themes, resulting in a developmental typology of the concept of legacy.
Results:
Participants described legacy as (1) concepts, actions or feelings motivated by the future; (2) represented through both tangible and intangible means; (3) informed by personal, educational, experiential and ideological sources; and (4) experienced as good, bad or neutral.
Conclusions:
The findings of this study demonstrate that hospitalized children are aware of and can articulate an emerging concept of legacy - one that mirrors the progression of cognitive complexity shaped by their unique personal life and healthcare experiences. The developmental typology presented in this study can be a useful starting point for clinicians as they present and facilitate legacy building interventions throughout a child's hospital stay.
... Children often depend on their parents for help and coregulatory support to manage painful and stressful situations, as the capacity for emotion regulation develops gradually across childhood (Noel et al., 2018;Palermo, 2014). In the context of research on needle procedures, a strong body of literature has demonstrated that children's experience of distress is bidirectionally related to their parent's behaviors and responses to the needle procedure (Caes et al., 2014;Campbell et al., 2017). In this issue of JPP, Constantin and colleagues focused on parent behaviors described as "distress-promoting behaviours" that have been associated with increased child pain during medical procedures (i.e. ...
... Indeed, higher anxiety and catastrophizing tend to relate to greater parent and child distress about child pain (e.g., Birnie et al., 2016;Caes et al., 2014;. A robust body of literature and well-established theory demonstrate children's experiences with needles bidirectionally relate to their parent's behaviors and responses to the procedure (e.g., Campbell et al., 2017;Craig, 2009). Children rely on their parents for co-regulatory support to manage stressful situations since emotion regulation develops gradually across childhood (Tottenham et al., 2011), and children are more likely to experience distress before and during needles without prompts to engage in coping strategies (Blount, 2019;Blount et al., 1990). ...
Needle procedures are common throughout childhood and often elicit distress in children and parents. Heart rate variability (HRV), as an index of emotion regulation, can inform both self‐regulatory and co‐regulatory processes. Mindfulness may serve to regulate distress; however, no research has studied mindfulness or parent and child regulatory responding concurrently during venipuncture. Stemming from a randomized controlled trial investigating a mindfulness intervention, this study sought to describe regulatory responding (via HRV) throughout pediatric venipuncture and the role of cognitive–affective factors (mindfulness, parent anxiety, catastrophizing) in 61 parent–child dyads (7–12 years). We examined (1) patterns of parent and child HRV throughout venipuncture and whether a brief, randomly assigned audio‐guided mindfulness versus control exercise affected this pattern and (2) the extent to which changes in parent and child HRV were synchronized throughout venipuncture, and whether parent catastrophizing and anxiety moderated this association. HRV differed as a function of procedural phase. Practicing the mindfulness versus control exercise did not consistently affect HRV in dyads. Positive synchrony was observed during the end of the intervention in dyads with high parental catastrophizing. Otherwise, a pattern of nonsynchrony emerged. Results provide foundational knowledge regarding children's internal (self) and external (parent) regulation mechanisms. RCT registration: NCT03941717.
... 36,37 Parent avoidant coping may in turn impact how their child copes and adjusts to treatment and procedures. 38 Others have found that caregiver distress can lead to a poorer-quality relationship with the child, and the quality of this relationship can in turn influence child emotional adjustment. 39 Notably, caregivers are often the main recipients of cancer-related information and play a key role in sharing this information with children. ...
Objectives
A pediatric cancer diagnosis can have a significant impact on the quality of life (QOL) of the child. Diagnosis and treatment impact caregiver anxiety/depression symptoms and family functioning, and these in turn may influence child QOL. However, there has been limited longitudinal examination of the impact of both caregiver anxiety/depression symptoms and family functioning on youth QOL at specific points during the early diagnosis and treatment period.
Methods
Ninety-six caregivers of youth (diagnosed with leukemia/lymphoma or a solid tumor) reported on their own anxiety/depression symptoms, family functioning, demographic and medical factors, and on their child’s generic and cancer-specific QOL shortly after diagnosis (T1) and 6 months later (T2).
Results
Caregiver anxiety/depression symptoms were associated with poorer cancer-specific and generic child QOL within and across time points. Family conflict was associated with youth cancer-related QOL at T1.
Conclusions
Attendance to caregiver anxiety/depression symptoms and family functioning, beginning early in the cancer trajectory, is an important aspect of family-centered care. Routine psychosocial screening and triage may help identify and intervene to support both caregiver and child psychosocial well-being.
... Por último, es importante resaltar que los niños en edades tempranas requieren de un ambiente seguro y protección para su desarrollo de afrontamiento funcional (Skinner & Zimmer-Gembeck, 2020) y que los padres juegan un rol muy importante porque de acuerdo con la forma en cómo los padres afronten las adversidades, resulta un predictor del afrontamiento de los niños (Campbell et al., 2017). ...
El estrés en las primeras edades de la vida, así como la forma de afrontar las situaciones adversas pueden tener repercusiones a futuro en la salud mental. El sexo y la edad son variables que juegan un rol importante en ambas variables, sin embargo, han sido poco estudiadas en la población preescolar, analizar dichas variables contribuye en el desarrollo de intervenciones preventivas. Objetivo: Analizar las diferencias en el nivel de estrés y tipos de afrontamiento según el sexo y la edad; para esto, se realizó un estudio transversal. Método. Se trabajó con una muestra no probabilística de 115 preescolares mexicanos entre 4 y 5 años (M = 4.6; DE= 0.49), a quienes se les aplicó la Escala de Estrés Cotidiano y la Escala de Afrontamiento. Los resultados mostraron que el estrés afecta de la misma forma a niños y niñas de 4 y 5 años; los niños emplean más el Afrontamiento Disfuncional y los más pequeños (4 años) emplean más el Afrontamiento Emocional, Disfuncional y Evitativo. Estos datos se discuten en términos del desarrollo del afrontamiento en niños mexicanos y sus implicaciones para la instrumentación de intervenciones preventivas encaminadas a promover la salud mental.
... Revisão sistemática revela que as crianças apresentam sequelas cognitivas, como medo, e sequelas sensoriais, como dor ao estímulo físico, durante a realização da CIP. 1 Nesse sentido, a equipe de Enfermagem precisa preparar a criança para a CIP por meio de recursos adequados à faixa etária da criança e ao seu desenvolvimento, tal como a distração, que possam contribuir para que a experiência da venopunção seja menos traumática para a criança. Destaca-se que revisão sistemática relatou que a distração, hipnose, terapia cognitivo-comportamental combinada e intervenções respiratórias durante procedimentos invasivos e dolorosos em crianças, como a CIP, reduzem a dor, apesar do baixo e muito baixo nível de qualidade das evidências analisadas. 2 No entanto, foi verificado o desenvolvimento de um ensaio clínico randomizado que avaliou o impacto da utilização de uma tecnologia visual associada à oferta de informações por meio de estória ou jogo interativo, não somente na angústia e na dor das crianças, como na obtenção do sucesso da CIP na primeira tentativa, duração do procedimento, satisfação do profissional e custo--efetividade do procedimento. ...
Objective:
to build and validate the contents of the booklet “It is time to get my vein: what do I do?”, Together with expert judges in the field of Pediatrics, for the preparation of children in need of peripheral intravenous catheterization.
Method:
this is a methodological study of the content validation type, developed according to the COSMIM checklist, carried out from February 2015 to February 2017, in four stages: situational diagnosis, bibliographic survey, selection and summarization of the content, preparation of the booklet and its validation. Eleven judges specialized in Pediatrics participated in the study. For the validation process, the Delphi technique was used. Values equal to or greater than 0.80 were considered as a content validation index.
Results:
the booklet obtained satisfactory indexes in the categories content, language, illustration, layout, motivation, culture, and applicability, being validated in the second round with a global content validation index of 0.93.
Conclusion:
the objective of the study was achieved, with the booklet being constructed and validated by the expert judges, therefore, it can be a technological resource for the promotion of care for children in need of peripheral intravenous catheterization, configuring itself as a patient safety measure.
... Clinical and experimental literature has demonstrated that parent responses to their child's pain can positively or negatively influence their child's responses, impacting outcomes such as child distress, pain sensitivity, and pain tolerance (see Piira et al., 2005;Campbell et al., 2017). The predominant evidence for parental support during their child's painful experiences has been drawn from clinical (e.g., needle-pain procedures) and experimental literature (e.g., cold-pressor tests or hypothetical pain scenarios). ...
Objective: Parental influence during children’s “everyday” pain events is under-explored, compared to clinical or experimental pains. We trialed two digital reporting methods for parents to record the real-world context surrounding their child’s everyday pain events within the family home.
Methods: Parents (N = 21) completed a structured e-diary for 14 days, reporting on one pain event experienced by their child (aged 2.5–6 years) each day, and describing child pain responses, parental supervision, parental estimates of pain severity and intensity, and parental catastrophizing, distress, and behavioral responses. During the same 2-week period, a subsample of parent-child pairs (N = 9) completed digital ecological momentary assessments (EMA), immediately after any chosen pain event. Children reported their current pain while parents estimated the child’s pain and indicated their own distress.
Results: “Everyday” pain events frequently featured minor injuries to the child’s head, hands or knees, and child responses included crying and non-verbal comments (e.g., “Ouch!”). Pain events occurred less frequently when parents had been supervising their child, and supervising parents reported lower levels of worry and anxiety than non-supervising parents. Child sex was significantly associated with parental estimates of pain intensity, with parents of girls giving higher estimates than parents of boys. Child age was significantly associated with both the number of pain events and with parental estimates of pain intensity and child distress: the youngest children (2–3 years) experienced the fewest pain events but received higher pain and distress estimates from parents than older children. Hierarchal Linear Modeling revealed that parental estimates of pain severity were significant positive predictors of parental distress and catastrophizing in response to a specific pain event. Furthermore, higher levels of parental catastrophic thinking in response to a specific pain event resulted in increased distress, solicitousness, and coping-promoting behaviors in parents. The EMA data revealed that children reported significantly higher pain intensity than their parents.
Conclusion: The electronic pain diary provided a key insight into the nature of “everyday” pain experiences around the family home. Digital daily reporting of how the family copes with “everyday” events represents a viable means to explore a child’s everyday pains without disrupting their home environment.
... Most studies in this review were observational studies. Thus, we used a checklist of study quality used previously in other reviews of observational studies (Campbell et al., 2017;Macfarlane et al., 2001;Downs & Black, 1998). This checklist included 19 items pertaining to methodological criteria and were scored as "yes," "no," or "not applicable." ...
Objective
This review synthesizes the literature on benefit-finding and growth (BFG) among youth with medical illnesses and disabilities and their parents. Specifically, we summarized: (a) methods for assessing BFG; (b) personal characteristics, personal, and environmental resources, as well as positive outcomes, associated with BFG; (c) interventions that have enhanced BFG; and (d) the quality of the literature.
Methods
A medical research librarian conducted the search across PubMed, Scopus, PsycInfo, Google Scholar, and Cochrane Library. Studies on BFG among children ages 0–18 with chronic illnesses and disabilities, or the parents of these youth were eligible for inclusion. Articles were uploaded into Covidence; all articles were screened by two reviewers, who then extracted data (e.g., study characteristics and findings related to BFG) independently and in duplicate for each eligible study. The review was based on a systematic narrative synthesis framework and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PROSPERO registration number: CRD42020189339).
Results
In total, 110 articles were included in this review. Generally, BFG capabilities were present across a range of pediatric health conditions and disabilities. Correlates of both youth and parent BFG are presented, including personal and environmental resources, coping resources, and positive outcomes. In addition, studies describing interventions aimed at enhancing BFG are discussed, and a quality assessment of the included studies is provided.
Conclusions
Recommendations are provided regarding how to assess BFG and with whom to study BFG to diversify and extend our current literature.
... Poorly managed child pain and fear during needle procedures can contribute to a host of individual and societal costs, including unnecessary suffering, longer procedure time, and vaccine hesitancy, which compromises herd immunity (Kennedy et al., 2008;McLenon & Rogers, 2019;McMurtry et al., 2015). Parent behaviors during children's needle procedures are important and account for up to 53-64% of the variance in child pain outcomes (Campbell et al., 2017;Cohen et al., 2002;Mahoney et al., 2010;Martin et al., 2013;Racine et al., 2016). Parent verbal behaviors are often categorized as conducive to child coping ("coping-promoting") or child distress ("distress-promoting"; Blount et al., 1989Blount et al., , 2003Taylor et al., 2011). ...
Parent behaviors strongly predict child responses to acute pain; less studied are the factors shaping parent behaviors. Heart rate variability (HRV) is considered a physiological correlate of emotional responding. Resting or “trait” HRV is indicative of the capacity for emotion regulation, while momentary changes or “state” HRV is reflective of current emotion regulatory efforts. This study aimed to examine: (1) parent state HRV as a contributor to parent verbal behaviors before and during child pain and (2) parent trait HRV as a moderator between parent emotional states (anxiety, catastrophizing) and parent behaviors. Children 7–12 years of age completed the cold pressor task (CPT) in the presence of a primary caregiver. Parents rated their state anxiety and catastrophizing about child pain. Parent HRV was examined at 30-second epochs at rest (“trait HRV”), before (“state HRV-warm”), and during their child’s CPT (“state HRV-cold”). Parent behaviors were video recorded and coded as coping-promoting or distress-promoting. Thirty-one parents had complete cardiac, observational, and self-report data. A small to moderate negative correlation emerged between state HRV-cold and CP behaviors during CPT. Trait HRV moderated the association between parent state catastrophizing and distress-promoting behaviors. Parents experiencing state catastrophizing were more likely to engage in distress-promoting behavior if they had low trait HRV. This novel work suggests parents who generally have a low (vs. high) HRV, reflective of low capacity for emotion regulation, may be at risk of engaging in behaviors that increase child distress when catastrophizing about their child’s pain.
... Increasing food allergies in Chile, a developing country postepidemiological transitionTo the Editor,The clinical spectrum of food allergy (FA) is broad and includes immediate hypersensitivity reactions, typically IgE-mediated reactions, such as food-induced urticaria and food-induced anaphylaxis (FIA), and delayed or non-IgE-mediated reactions such as allergic proctocolitis and food protein-induced enterocolitis syndrome.IgE-mediated FA affects up to 2.5% of the adult population and 6%-8% of children.1 Most of the epidemiological studies reporting an increase in IgE-mediated FA have been done in developed countries using proxies of FA incidence such as FIA hospitalizations and epinephrine autoinjector sales.2 Although the literature on temporal trends of non-IgE-mediated FA is scarce, in developed countries its prevalence may have increased in parallel to the increase in IgEmediated FA.3 To date, FA temporal trends have not been studied in developing countries.Chile is a developing country that has undergone rapid demographic and epidemiological transitions over few decades. ...
Subcutaneous Allergen Immunotherapy (SCIT) is an effective treatment of respiratory allergy, but injections in children may cause pain, fear, and sometimes systemic adverse events. Needle‐free injectors, who generate a “liquid needle” with a sufficient force to pass through the skin and enter the subcutaneous tissue, don’t inject fluids directly into the vein. They have never been used for the delivery of SCIT. In this prospective, double‐arm, randomized, patient‐blinded, intra‐individual multi‐center clinical trial, we compared a needleless vs. a traditional administration of SCIT in children and adolescents with grass pollen or House Dust Mite (HDM) allergy.
... The current cross-sectional results supported the parental reinforcement mechanism of transmission, with greater proportion of parental attending to child pain during the CPT being associated with greater child pain intensity and lower tolerance through the mediator of child pain-attending. This is consistent with previous studies of children's acute [13,25,45,63,79] and chronic pain [52,61,62,76]. Greater parent attending to child pain may contribute to the development of child chronic pain through its relationship with parent responses to child pain expression. ...
Children of parents with chronic pain have higher rates of pain and internalizing (e.g., anxiety, depressive) symptoms than children of parents without chronic pain. Parental modeling of pain behaviour and reinforcement of child pain have been hypothesized to underlie these relationships. These mechanisms were tested in a sample of 72 parents with chronic pain and their children (ages 8-15). Standardized measures were completed by parents (pain characteristics, pain interference, child internalizing) and children (pain catastrophizing, pain over previous three months, and internalizing). In a laboratory session, children completed the cold pressor task (CPT) in the presence of their parent, and parent-child verbalizations were coded. Significant indirect effects of parental pain interference on child self-reported (B = 0.12, 95% CI: 0.01, 0.29) and parent-reported (B = 0.16, 95% CI: 0.03, 0.40) internalizing symptoms through child pain catastrophizing were found (parental modeling mechanism), and were not moderated by child chronic pain status. Significant indirect effects were found between parent pain-attending verbalizations and child self-reported (B = 2.58, 95% CI: 1.03, 5.31) and parent-reported (B = 2.18, 95% CI: 0.93, 4.27) CPT pain intensity and tolerance (B = -1.02, 95% CI: -1.92, -0.42) through child pain-attending verbalizations (parental reinforcement mechanism). While further understanding of the temporal relationships between these variables is needed, the current study identifies constructs (e.g., parent pain interference, child pain catastrophizing, parent reinforcement of child pain) which should be further examined as potential targets for prevention and intervention of pain and internalizing symptoms in children of parents with chronic pain.
... A key difference between research designs may be that our study limited data collection to observing the first dressing change. A recent study found procedural distress predicted later procedural coping through parental worry (Campbell, DiLorenzo, Atkinson, & Pillai Riddell, 2017), indicating that parents can learn anticipatory procedural anxiety. In the current study, it is possible parents did not know what to expect, and therefore pre-procedural anxiety did not drive behavior during this dressing change. ...
Pediatric burn injuries and subsequent wound care can be painful and distressing for children and their parents. This study tested parenting behavior as a mediator for the relationship between parental acute psychological distress and child behavior during burn wound care. Eighty-seven parents of children (1–6-years-old) self-reported accident-related posttraumatic stress symptoms (PTSS), pre-procedural anxiety, general anxiety/depression symptoms, and guilt before the first dressing change. Parent–child behavior was observed during the first dressing change. Mediation analyses identified three indirect effects. Parental PTSS predicted more child distress, mediated through parental distress-promoting behavior. Parental guilt predicted more child distress, mediated through parental distress-promoting behavior. Parental general anxiety/depression symptoms predicted less child coping, mediated through less parental coping-promoting behavior. Parents with accident-related psychological distress have difficulty supporting their child through subsequent medical care. Nature of parental symptomology differentially influenced behavior. Increased acute psychological support for parents may reduce young child procedural pain-related distress.
... A systematic review recently sorted and synthesized coping responses and coping outcomes in children aged 3 to 12 years. 16 This review highlighted the paucity of studies, taking account of the phase of the needle-related procedure, the lack of developmental (age-related) considerations, the lack of longitudinal design, and the importance of caregiver variables and the child's developing cognitive abilities. ...
This paper, based on two companion studies, presents an in-depth analysis of preschooler coping with vaccination pain. Study 1 employed an autoregressive cross-lagged path model to investigate the dynamic and reciprocal relationships between young children's coping responses (how they cope with pain and distress) and coping outcomes (pain behaviors) at the preschool vaccination. Expanding on this analysis, Study 2 then modeled preschool coping responses and outcomes using both caregiver and child variables from the child's 12-month vaccination (n=548), preschool vaccination (n=302), and a preschool psychological assessment (n=172). Summarizing over the five path models and post-hoc analyses over the two studies, novel transactional and longitudinal pathways predicting preschooler coping responses and outcomes were elucidated. Our research has provided empirical support for the need to differentiate between coping responses and coping outcomes: two different, yet interrelated, components of "coping." Among our key findings, the results suggest that: a preschooler's ability to cope is a powerful tool to reduce pain-related distress but must be maintained throughout the appointment; caregiver behavior and poorer pain regulation from the 12-month vaccination appointment predicted forward to preschool coping responses and/or outcomes; robust concurrent relationships exist between caregiver behaviors and both child coping responses and outcomes, and finally caregiver behaviors during vaccinations are not only critical to both child pain coping responses and outcomes in the short- and long-term but also show relationships to broader child cognitive abilities as well.
Background:
Retinoblastoma is a rare childhood ophthalmic cancer that requires frequent eye examinations under anaesthesia and painful or distressing procedures. This can cause significant anxiety for children and their families.
Objective:
We evaluated a Starlight Children's Foundation programme, 'Captains on Call', at the Queensland Children's Hospital, which aims to provide positive distraction and reduce stress, anxiety and pain during the perioperative journey for children in the retinoblastoma treatment pathway. This study examined the impact of the programme on the perioperative experience of the children and their families, using a qualitative design.
Methods:
This study was conducted in a paediatric operating suite at a tertiary-level children's hospital in Australia. We interviewed a parent from 20 families (from a cohort of 40 families, including 44 children), whose children received treatment or screening for retinoblastoma, focusing on the programme's impact on the child and family at various stages during the perioperative journey. We undertook a thematic analysis of transcribed interviews.
Results:
We identified two themes, each with two sub-themes: (1) the programme positively contributed to the overall treatment journey, by addressing different needs at different times, and helping to reframe a traumatic medical experience, and (2), the programme supported the whole family unit by empowering children through play, and adopting a family systems approach which recognised the impact of cancer treatment on the whole family.
Conclusion:
This study highlights the value of the Captains on Call programme in supporting children with retinoblastoma and their families during perioperative visits. The Captains, particularly as non-medicalised professionals in a healthcare setting, built trust and rapport with the children through play over repeated episodes of care. The interprofessional collaborative approach with a reflective cycle of practice extended it beyond a programme providing simple distraction. Other retinoblastoma services may benefit from implementing a similar approach.
Pediatric consultation-liaison (C-L) psychiatry is a dynamic and growing subspecialty. Pediatric C-L psychiatrists serve a variety of roles at the intersection of physical and psychiatric illness in children, including supporting the psychiatric well-being of children with chronic physical illness, assessing for psychiatric manifestations of physical illness, and treating children with primary psychiatric illness who require medical intervention or are awaiting inpatient psychiatric placement. After a brief introduction to the field, this chapter discusses the role of the pediatric C-L psychiatrist; highlights the unique aspects of pediatric C-L psychiatry, including a discussion of the developmental approach to chronic illness; explores common reasons for pediatric C-L psychiatry requests; discusses evolving systems of C-L care; and reviews legal and ethical concerns encountered in pediatric C-L psychiatry. While the role of pediatric C-L psychiatry is expanding, this chapter focuses primarily on pediatric C-L in the inpatient pediatric setting, a primary location for the practice of pediatric C-L psychiatry.
Youth decision-making involvement (DMI) in medical treatment associates with greater adherence and feelings of self-efficacy. However, little is known about youth DMI regarding medical evaluation and diagnostic procedures. Using thematic analysis of semi-structured interviews, we explored parent (n = 24) and youth (n = 24) perceptions of youth roles in the decision to undergo evaluation for short stature. Five themes emerged about evaluation decisions including: parents/providers were gatekeepers, some parents sought youth agreement, conversations focused on logistics, some parents gave limited information, and youth expressed anxiety. Results suggest that including youth in discussions about evaluation may alleviate anxiety and uncertainty about upcoming procedures.
This study aimed to explore the acceptability of a novel device ('MyShield'): a device used for distraction during clinical procedures. It is a cardboard cuff, designed to fit around the arm, either above the elbow or around the wrist and used to hide the procedure from view. This device was tested in practice, to establish acceptability to children, parents and clinical staff. Fifty-eight children tried 'MyShield' during a venepuncture procedure. Feedback from 54 children, 58 parents/carers and 16 clinical staff was collected using surveys and interviews. In 24 cases, observational data were also collected. A large majority of children (94%, n = 51) and parents (96%, n = 56) reported a positive experience when using 'MyShield'; saying they would likely use it again. Potential of 'MyShield' in promoting parent/clinician interaction with the child was highlighted. Data suggests that 'MyShield' may be a useful device for children undergoing venepuncture, when used in conjunction with standard care, and subject to individual preferences and choice. Further work is required to establish mechanism of action and whether use of 'MyShield' has any impact across a range of short- and long-term outcome measures relating to patient experience and effectiveness.
Mothers exercise an important role in their children hospitalization process. Positive psychology interventions may contribute to the strengthening of mothers positive resources, which in turn helps in childrens health recovery. This study aims presents a positive intervention pilot project enforcement and evaluation report, directing to demonstrate evidence of intervention clinical utility. The intervention pursued to decrease anxiety, depression and stress symptons, increase subjective well being and positive coping strategies to the hospital context in parents. Results demonstrated that intervention may have helped mothers to use positive strategies during hospitalization and to alternate them according the need. Moreover, mothers could glimpse positive elements presents and feel supported.
The behavior of children in a dental setting is an interesting window through which many domains, including, among others, biological, genetic, psychosocial, cognitive, and emotional are expressed either imperceptibly or overtly in a relatively short period of time. Sedation of children is a common and accepted modality of patient management during potentially painful procedures. The process and need for safety in performing sedation during dental procedures involves several factors that are directed toward positive general outcomes. Airway sounds are more important during sedation as they transmit information on the function and patency of the upper airway as well as secondary anatomical structures and sounds. Common sense, standard protocol, and sedation guide lines will require patient monitoring on the day of the procedure. The American Academy of Pediatric Dentistry's website has a sedation record that is detailed and consistent with all requirements of the sedation guidelines.
The family has long been acknowledged as an important social context where children learn and receive support for experienced pain. When a child is in pain, the family is responsible for identifying pain and seeking appropriate evaluation and care. Families’ responses may inadvertently encourage or discourage the expression of pain and play a critical role in influencing children’s ability to cope with pain, both positively and negatively. Having a child in pain can pose significant personal, familial, and economic strains to parents, and parents’ health can impact pain and psychological symptoms in their offspring. Therefore, consideration of the family is critical in understanding children’s pain. This chapter describes relevant theoretical models and summarizes current major research themes regarding the role of the family in both acute and chronic pediatric pain. Two illustrative case examples and a parent perspective are provided and key areas for future research are identified.
Background:
This is the second update of a Cochrane Review (Issue 4, 2006). Pain and distress from needle-related procedures are common during childhood and can be reduced through use of psychological interventions (cognitive or behavioral strategies, or both). Our first review update (Issue 10, 2013) showed efficacy of distraction and hypnosis for needle-related pain and distress in children and adolescents.
Objectives:
To assess the efficacy of psychological interventions for needle-related procedural pain and distress in children and adolescents.
Search methods:
We searched six electronic databases for relevant trials: Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE; PsycINFO; Embase; Web of Science (ISI Web of Knowledge); and Cumulative Index to Nursing and Allied Health Literature (CINAHL). We sent requests for additional studies to pediatric pain and child health electronic listservs. We also searched registries for relevant completed trials: clinicaltrials.gov; and World Health Organization International Clinical Trials Registry Platform (www.who.int.trialsearch). We conducted searches up to September 2017 to identify records published since the last review update in 2013.
Selection criteria:
We included peer-reviewed published randomized controlled trials (RCTs) with at least five participants per study arm, comparing a psychological intervention with a control or comparison group. Trials involved children aged two to 19 years undergoing any needle-related medical procedure.
Data collection and analysis:
Two review authors extracted data and assessed risks of bias using the Cochrane 'Risk of bias' tool. We examined pain and distress assessed by child self-report, observer global report, and behavioral measurement (primary outcomes). We also examined any reported physiological outcomes and adverse events (secondary outcomes). We used meta-analysis to assess the efficacy of identified psychological interventions relative to a comparator (i.e. no treatment, other active treatment, treatment as usual, or waitlist) for each outcome separately. We used Review Manager 5 software to compute standardized mean differences (SMDs) with 95% confidence intervals (CIs), and GRADE to assess the quality of the evidence.
Main results:
We included 59 trials (20 new for this update) with 5550 participants. Needle procedures primarily included venipuncture, intravenous insertion, and vaccine injections. Studies included children aged two to 19 years, with few trials focused on adolescents. The most common psychological interventions were distraction (n = 32), combined cognitive behavioral therapy (CBT; n = 18), and hypnosis (n = 8). Preparation/information (n = 4), breathing (n = 4), suggestion (n = 3), and memory alteration (n = 1) were also included. Control groups were often 'standard care', which varied across studies. Across all studies, 'Risk of bias' scores indicated several domains at high or unclear risk, most notably allocation concealment, blinding of participants and outcome assessment, and selective reporting. We downgraded the quality of evidence largely due to serious study limitations, inconsistency, and imprecision.Very low- to low-quality evidence supported the efficacy of distraction for self-reported pain (n = 30, 2802 participants; SMD -0.56, 95% CI -0.78 to -0.33) and distress (n = 4, 426 participants; SMD -0.82, 95% CI -1.45 to -0.18), observer-reported pain (n = 11, 1512 participants; SMD -0.62, 95% CI -1.00 to -0.23) and distress (n = 5, 1067 participants; SMD -0.72, 95% CI -1.41 to -0.03), and behavioral distress (n = 7, 500 participants; SMD -0.44, 95% CI -0.84 to -0.04). Distraction was not efficacious for behavioral pain (n = 4, 309 participants; SMD -0.33, 95% CI -0.69 to 0.03). Very low-quality evidence indicated hypnosis was efficacious for reducing self-reported pain (n = 5, 176 participants; SMD -1.40, 95% CI -2.32 to -0.48) and distress (n = 5, 176 participants; SMD -2.53, 95% CI -3.93 to -1.12), and behavioral distress (n = 6, 193 participants; SMD -1.15, 95% CI -1.76 to -0.53), but not behavioral pain (n = 2, 69 participants; SMD -0.38, 95% CI -1.57 to 0.81). No studies assessed hypnosis for observer-reported pain and only one study assessed observer-reported distress. Very low- to low-quality evidence supported the efficacy of combined CBT for observer-reported pain (n = 4, 385 participants; SMD -0.52, 95% CI -0.73 to -0.30) and behavioral distress (n = 11, 1105 participants; SMD -0.40, 95% CI -0.67 to -0.14), but not self-reported pain (n = 14, 1359 participants; SMD -0.27, 95% CI -0.58 to 0.03), self-reported distress (n = 6, 234 participants; SMD -0.26, 95% CI -0.56 to 0.04), observer-reported distress (n = 6, 765 participants; SMD 0.08, 95% CI -0.34 to 0.50), or behavioral pain (n = 2, 95 participants; SMD -0.65, 95% CI -2.36 to 1.06). Very low-quality evidence showed efficacy of breathing interventions for self-reported pain (n = 4, 298 participants; SMD -1.04, 95% CI -1.86 to -0.22), but there were too few studies for meta-analysis of other outcomes. Very low-quality evidence revealed no effect for preparation/information (n = 4, 313 participants) or suggestion (n = 3, 218 participants) for any pain or distress outcome. Given only a single trial, we could draw no conclusions about memory alteration. Adverse events of respiratory difficulties were only reported in one breathing intervention.
Authors' conclusions:
We identified evidence supporting the efficacy of distraction, hypnosis, combined CBT, and breathing interventions for reducing children's needle-related pain or distress, or both. Support for the efficacy of combined CBT and breathing interventions is new from our last review update due to the availability of new evidence. The quality of trials and overall evidence remains low to very low, underscoring the need for improved methodological rigor and trial reporting. Despite low-quality evidence, the potential benefits of reduced pain or distress or both support the evidence in favor of using these interventions in clinical practice.
A medical condition, especially a chronic or life-threatening illness, can have a profound impact on children and their families. It is estimated that in the past 20 years chronic illness in children has more than doubled, so helping children to understand and process their feelings about their illness is imperative (Eccleston et al. 2012). Recent studies recognize parents’ critical role in positively or negatively influencing their child’s adjustment to a chronic illness (Eccleston et al. 2012; Campbell et al. 2017). Additional factors influencing this adjustment include the age or developmental stage of the child, parental or family stressors, and family dynamics. One way to help children and their families adapt to an illness is to promote active coping skills. The concept of coping can be described as the ability to manage or overcome life’s challenges with limited, or without, distress. This is often difficult to do with children and adolescents, especially during a medical illness. Children can experience fear, worry, and pain and may not always know how best to manage these feelings. The published literature recognizes that helping children and their families with effective coping strategies is beneficial and can optimize recovery and improve treatment outcomes (Eccleston et al. 2012; Coakley and Wihak 2017; Mechtel and Stoeckle 2017; Schonfeld and Demaria 2015).
An examination of factors was conducted to determine the effectiveness of the distraction component of a behavioral intervention (use of a party blower). In one condition, parents were instructed to coach children in the use of a party blower and to praise child cooperation. In a second condition, nurses were instructed to assist parents in coaching the child. Parents used the coaching skills they learned and got their children to use the distraction technique. Use of the distraction technique was associated with less crying. Encouragement from a health care professional and intervention early in the procedure did not enhance the intervention's effectiveness. Older children and children who were less distressed during the initial phase of the procedure were less likely to reject the intervention.
Systematic reviews and meta-analyses have become increasingly important in health care. Clinicians read them to keep up to date with their field [1],[2], and they are often used as a starting point for developing clinical practice guidelines. Granting agencies may require a systematic review to ensure there is justification for further research [3], and some health care journals are moving in this direction [4]. As with all research, the value of a systematic review depends on what was done, what was found, and the clarity of reporting. As with other publications, the reporting quality of systematic reviews varies, limiting readers' ability to assess the strengths and weaknesses of those reviews.
Several early studies evaluated the quality of review reports. In 1987, Mulrow examined 50 review articles published in four leading medical journals in 1985 and 1986 and found that none met all eight explicit scientific criteria, such as a quality assessment of included studies [5]. In 1987, Sacks and colleagues [6] evaluated the adequacy of reporting of 83 meta-analyses on 23 characteristics in six domains. Reporting was generally poor; between one and 14 characteristics were adequately reported (mean = 7.7; standard deviation = 2.7). A 1996 update of this study found little improvement [7].
In 1996, to address the suboptimal reporting of meta-analyses, an international group developed a guidance called the QUOROM Statement (QUality Of Reporting Of Meta-analyses), which focused on the reporting of meta-analyses of randomized controlled trials [8]. In this article, we summarize a revision of these guidelines, renamed PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses), which have been updated to address several conceptual and practical advances in the science of systematic reviews (Box 1).
Box 1: Conceptual Issues in the Evolution from QUOROM to PRISMA
Completing a Systematic Review Is an Iterative Process
The conduct of a systematic review depends heavily on the scope and quality of included studies: thus systematic reviewers may need to modify their original review protocol during its conduct. Any systematic review reporting guideline should recommend that such changes can be reported and explained without suggesting that they are inappropriate. The PRISMA Statement (Items 5, 11, 16, and 23) acknowledges this iterative process. Aside from Cochrane reviews, all of which should have a protocol, only about 10% of systematic reviewers report working from a protocol [22]. Without a protocol that is publicly accessible, it is difficult to judge between appropriate and inappropriate modifications.
Background:
This systematic review evaluated the effectiveness of physical and procedural interventions for reducing pain and related outcomes during vaccination.
Design/methods:
Databases were searched using a broad search strategy to identify relevant randomized and quasi-randomized controlled trials. Data were extracted according to procedure phase (preprocedure, acute, recovery, and combinations of these) and pooled using established methods.
Results:
A total of 31 studies were included. Acute infant distress was diminished during intramuscular injection without aspiration (n=313): standardized mean difference (SMD) -0.82 (95% confidence interval [CI]: -1.18, -0.46). Injecting the most painful vaccine last during vaccinations reduced acute infant distress (n=196): SMD -0.69 (95% CI: -0.98, -0.4). Simultaneous injections reduced acute infant distress compared with sequential injections (n=172): SMD -0.56 (95% CI: -0.87, -0.25). There was no benefit of simultaneous injections in children. Less infant distress during the acute and recovery phases combined occurred with vastus lateralis (vs. deltoid) injections (n=185): SMD -0.70 (95% CI: -1.00, -0.41). Skin-to-skin contact in neonates (n=736) reduced acute distress: SMD -0.65 (95% CI: -1.05, -0.25). Holding infants reduced acute distress after removal of the data from 1 methodologically diverse study (n=107): SMD -1.25 (95% CI: -2.05, -0.46). Holding after vaccination (n=417) reduced infant distress during the acute and recovery phases combined: SMD -0.65 (95% CI: -1.08, -0.22). Self-reported fear was reduced for children positioned upright (n=107): SMD -0.39 (95% CI: -0.77, -0.01). Non-nutritive sucking (n=186) reduced acute distress in infants: SMD -1.88 (95% CI: -2.57, -1.18). Manual tactile stimulation did not reduce pain across the lifespan. An external vibrating device and cold reduced pain in children (n=145): SMD -1.23 (95% CI: -1.58, -0.87). There was no benefit of warming the vaccine in adults. Muscle tension was beneficial in selected indices of fainting in adolescents and adults.
Conclusions:
Interventions with evidence of benefit in select populations include: no aspiration, injecting most painful vaccine last, simultaneous injections, vastus lateralis injection, positioning interventions, non-nutritive sucking, external vibrating device with cold, and muscle tension.
Objective: To examine the efficacy of training children to cope with immunization pain without the assistance of trained coaches and determine whether untrained parents or nurses are more effective at decreasing children's distress.
Methods: We compared the procedural coping and distress behavior of 31 3- to 7-year-old children trained in coping skills to 30 who did not receive training. The behavior of the untrained parents and nurses was evaluated as it related to child coping and distress.
Results: Children demonstrated understanding of the training, but they did not use the coping skills during the procedure. In general, the nurses' behavior was associated with child coping and parents' behavior with child distress.
Conclusions: More extensive child training or the involvement of coaches for procedural distress might be necessary. Nurses' behavior appears to center on encouraging child coping, and parents tend to comfort child distress.
Objective To examine a computerized parent training program, “Bear Essentials,” to improve parents’ knowledge and coaching to help
relieve preschoolers’ immunization distress. Method In a randomized controlled trial, 90 parent–child dyads received Bear Essentials parent training plus distraction, distraction
only, or control. Outcomes were parent knowledge, parent and child behavior, and child pain. Results Bear Essentials resulted in improved knowledge of the effects of parents’ reassurance, provision of information, and apologizing
on children’s procedural distress. Trained parents also engaged in less reassurance and more distraction and encouragement
of deep breathing. Children in Bear Essentials engaged in more distraction and deep breathing than children in other groups.
There were no effects on measures of child distress or pain. Conclusions Results suggest that the interactive computer training program impacted parent knowledge, parent behavior, and child behavior
as hypothesized, but modifications will be necessary to have more robust outcomes on child procedural distress.
Evaluated a low cost and practical intervention deigned to decrease children's, parents', and nurses' distress during children's immunizations. The intervention consisted of children viewing a popular cartoon movie and being coached by nurses and parents to attend to the movie. Ninety-two children, 4—6 years of age, and their parents were alternatively assigned to either a nurse coach interven- tion, a nurse coach plus train parent and child intervention, or a standard medical care condition. Based on previous findings of generalizatio n of adult behaviors during medical procedures, it was hypothesized that training only the nurses to coach the children would cost-effectively reduce all participants levels of distress. Observational measures and subjective ratings were used to assess the following dependent variables: children's coping, distress, pain, and need for restraint; nurses' and parents' coaching behavior; and parents' and nurses' distress. Results indicate that, in the two intervention conditions, children coped more and were less distressed, nurses and parents exhibited more coping promot- ing behavior and less distress promoting behavior, and parents and nurses were less distressed than in the control condition. Although neither intervention was superior on any of the variables assessed in the study, nurse coach was markedly 'This article is based on the master's thesis of the first author under the direction of the second, at the University of Georgia in partial fulfillment of the requirements for the master's degree. This study was supported in part by the Routh Research Grant from the Society of Pediatric Psychology. The authors thank Marilyn Williams and Nancy Jacobs, of the Walton County Health Center, their patients and families, and Barbie Bushey and Claude Burnett, of the Northeast Georgia Health District.
In this study we compared the effects of parents' distraction versus reassurance on children's coping and distress during immunizations. Eighty-two parent-child dyads were randomly assigned to attention control, distraction, or reassurance conditions. The children were 3.8 to 5.9 years old, from lower to middle socioeconomic classes, who were reporting for preschool immunizations at a county health department. The dependent variables included measures of behavioral distress using the Child-Adult Medical Procedure Interaction Scale, children's self-report of their fear, and parents' reports of their ability to help their child and of their own upset. It was hypothesized that children in the distraction group would be the least distressed, followed by the control group, and that children in the reassurance group would be the most distressed. Results generally support the hypotheses. Children in the distraction group showed the least amount of distress on several indexes. When compared to children in the control group, children in the reassurance group were restrained during a greater proportion of the immunization procedure. Three times as many children in the reassurance group required restraint, when compared to children in the distraction group. Children in the reassurance group also displayed more verbal fear than children in the control or distraction groups. Following training and prior to the immunizations, parents in the reassurance group were least upset and expected to be able to provide the greatest amount of help to their children. However, after the children's immunizations, parents in the reassurance group rated themselves as being more distressed than parents in either the distraction or the control groups.
In this study we evaluated the relation between parents' reports of their usual procedural behavior, their observed behavior, and children's coping and distress during immunization procedures. Fifty-five children, 4 to 6 years old, and their parents participated in the study. Prior to the children's immunizations, the parents provided reports of the therapeutic behaviors they typically engage in during their children's painful medical procedures. The immunization procedure was videotaped, and parent and child behaviors were later coded with the Child-Adult Medical Procedure Interaction Scale. Results indicated that parents overestimate the quantity of their therapeutic behaviors and that no relation exists between parents' reports of their behavior and their actual behavior during children's immunizations. Further, parents' reports of their behavior were unrelated to their children's distress or coping. However, parents' behaviors were significantly related to children's distress. These findings suggest that preoperative parent self-report is not a valid index of actual behavior during children's acute painful procedures. Therefore, parent behavior, rather than parent report, should be used to determine their need for training in how to help their children cope with painful medical treatments.
The contribution of the child's and parents' catastrophizing about pain was explored in explaining procedural pain and fear in children. Procedural fear and pain were investigated in 44 children with Type I diabetes undergoing a finger prick. The relationships between parents' catastrophizing and parents' own fear and estimates of their child's pain were also investigated. The children and their mothers completed questionnaires prior to a routine consultation with the diabetes physician. Children completed a situation-specific measure of the Pain Catastrophizing Scale for Children (PCS-C) and provided ratings of their experienced pain and fear on a 0-10 numerical rating scale (NRS). Parents completed a situation-specific measure of the Pain Catastrophizing Scale For Parents (PCS-P) d provided estimates of their child's pain and their own experienced fear on a 0-10 NRS. Analyses indicated that higher catastrophizing by children was associated with more fear and pain during the finger prick. Scores for parents' catastrophzing about their children's pain were positively related to parents' scores for their own fear, estimates of their children's pain, and child-reported fear, but not the amount of pain reported by the child. The findings attest to the importance of assessing for and targeting child and parents' catastrophizing about pain. Addressing catastrophizing and related fears and concerns of both parents and children may be necessary to assure appropriate self-management. Further investigation of the mechanisms relating catastrophizing to deleterious outcomes is warranted.
Coping refers to behavior that protects people from being psychologically harmed by problematic social experience, a behavior that importantly mediates the impact that societies have on their members. The protective function of coping behavior can be exercised in 3 ways: by eliminating or modifying conditions giving rise to problems; by perceptually controlling the meaning of experience in a manner that neutralizes its problematic character; and by keeping the emotional consequences of problems within manageable bounds. The efficacy of a number of concrete coping behaviors representing these 3 functions was evaluated. Results indicate that individuals' coping interventions are most effective when dealing with problems within the close interpersonal role areas of marriage and child-rearing and least effective when dealing with the more impersonal problems found in occupation. The effective coping modes are unequally distributed in society, with men, the educated, and the affluent making greater use of the efficacious mechanisms.
Adult–child interactions during stressful medical procedures were investigated in 43 pediatric patients videotaped during a venipuncture procedure in the course of cancer treatment. Relations among six adult behavior categories (explain, distract, command to engage in coping behavior, give control to the child, praise, and criticize/threat/bargain) and three child behavior categories (momentary distress, cry/scream, and cope) were examined using correlational and sequential analysis. Results indicated that adult distraction resulted in increased child coping and reduced momentary distress and crying. Adult explanations, although a likely response to child distress and crying, did not result in a reduction of these behaviors. Attempts to give the child control reduced child crying. Implications for clinical interventions during painful medical procedures are discussed.
Key words: pediatric pain, pediatric cancer, acute pain, invasive medical procedures, sequential analysis, adult-child interaction
Coded behaviors of pediatric oncology patients undergoing bone marrow aspirations and lumbar punctures, parents, and medical staff using the Child-Adult Medical Procedure Interaction Scale. Children were grouped into high and low coping groups for three analyses. Results indicated that adults with the high coping children engaged in more coping-promoting behaviors than adults with the low coping children. Further, high coping children were more likely to respond with coping to coping-promoting prompts. However, both groups of children were more likely to respond by coping following coping-promoting antecedents than following distress-promoting or adult neutral antecedents. Both groups were more likely to respond with distress following distress-promoting antecedents. When interacting with children, staff engaged in a higher proportions of giving control to the child and apologies than did parents. Also, children were more likely to display coping than distress following staff's and parents' nonprocedural talk (distraction).
Laboratory and field research indicates that the relationships between personal control and stress, coping, and adaptational outcomes are more complex than was once assumed. Believing that an event is controllable does not always lead to a reduction in stress or to a positive outcome, and believing that an event is uncontrollable does not always lead to an increase in stress or to a negative outcome. These complex relationships involving control are examined in the context of Lazarus's cognitive theory of stress and coping. The first part of the article elaborates this theory and shows how two forms of control, generalized beliefs about control and situational appraisals of control, fit into the overall model. Situational appraisals of control are explored in this section, including the question, Control over what? which must be addressed in order to explain some of the perplexing findings. The second part of the article draws on the theoretical formulation of stress and coping to examine three important issues: (a) how believing one has control in a stressful transaction can heighten threat, (b) the relationship between control and coping, and (c) pathways through which control can affect the adaptational outcomes of stressful encounters.
The recent burgeoning of theory and research on how children cope with painful medical stressors warrants close scrutiny. The authors examine the prominent typologies of coping and the research on child adjustment and outcomes stimulated by those typologies. They focus on what researchers know and need to know about moderators (characteristics of the child and the environment that influence coping and outcome) and mediators (mechanisms linking stress, coping, and adjustment). It is argued that important advances can be achieved through efforts to (a) conceptualize and study pain and coping within a multidisciplinary framework; (b) clearly distinguish among coping responses, goals, and outcomes; and (c) replace simplistic conceptualizations with transactional and goodness-of-fit models.
Investigated the validity of the Child–Adult Medical Procedure Interaction Scale-Revised (CAMPIS-R) using multiple concurrent
objective and subjective measures of child distress, approach–avoidance behavior, fear, pain, child cooperation, and parents'
perceived ability to help their preschool children during routine immunizations. Partents', staffs', and children's behaviors
in the treatment room were videotaped and coded. Results indicate that the validity of the CAMPIS–R codes of Child Coping
and Distress, Parent Distress Promoting and Coping Promoting, and Staff Distress Promoting and Coping Promoting behavior were
supported, with all significant correlations being in the predicted direction. An unanticipated finding was that the child,
parent, and staff Neutral behaviors were inversely related to some measures of distress and positively related to some measures
of coping. Interobserver reliability was high for each CAMPIS–R code.
To examine the efficacy of training children to cope with immunization pain without the assistance of trained coaches and determine whether untrained parents or nurses are more effective at decreasing children's distress.
We compared the procedural coping and distress behavior of 31 3- to 7-year-old children trained in coping skills to 30 who did not receive training. The behavior of the untrained parents and nurses was evaluated as it related to child coping and distress.
Children demonstrated understanding of the training, but they did not use the coping skills during the procedure. In general, the nurses' behavior was associated with child coping and parents' behavior with child distress.
More extensive child training or the involvement of coaches for procedural distress might be necessary. Nurses' behavior appears to center on encouraging child coping, and parents tend to comfort child distress.
Research on coping during childhood and adolescence is distinguished by its focus on how children deal with actual stressors in real-life contexts. Despite burgeoning literatures within age groups, studies on developmental differences and changes have proven difficult to integrate. Two recent advances promise progress toward a developmental framework. First, dual-process models that conceptualize coping as "regulation under stress" establish links to the development of emotional, attentional, and behavioral self-regulation and suggest constitutional underpinnings and social factors that shape coping development. Second, analyses of the functions of higher-order coping families allow identification of corresponding lower-order ways of coping that, despite their differences, are developmentally graded members of the same family. This emerging framework was used to integrate 44 studies reporting age differences or changes in coping from infancy through adolescence. Together, these advances outline a systems perspective in which, as regulatory subsystems are integrated, general mechanisms of coping accumulate developmentally, suggesting multiple directions for future research.
Background:
Despite evidence of the long-term implications of unrelieved pain during infancy, it is evident that infant pain is still under-managed and unmanaged. Inadequately managed pain in infancy, a period of exponential development, can have implications across the lifespan. Therefore, a comprehensive and systematic review of pain management strategies is integral to appropriate infant pain management. This is an update of a previously published review update in the Cochrane Database of Systematic Reviews (2015, Issue 12) of the same title.
Objectives:
To assess the efficacy and adverse events of non-pharmacological interventions for infant and child (aged up to three years) acute pain, excluding kangaroo care, sucrose, breastfeeding/breast milk, and music.
Search methods:
For this update, we searched CENTRAL, MEDLINE-Ovid platform, EMBASE-OVID platform, PsycINFO-OVID platform, CINAHL-EBSCO platform and trial registration websites (ClinicalTrials.gov; International Clinical Trials Registry Platform) (March 2015 to October 2020). An update search was completed in July 2022, but studies identified at this point were added to 'Awaiting classification' for a future update. We also searched reference lists and contacted researchers via electronic list-serves. We incorporated 76 new studies into the review. SELECTION CRITERIA: Participants included infants from birth to three years in randomised controlled trials (RCTs) or cross-over RCTs that had a no-treatment control comparison. Studies were eligible for inclusion in the analysis if they compared a non-pharmacological pain management strategy to a no-treatment control group (15 different strategies). In addition, we also analysed studies when the unique effect of adding a non-pharmacological pain management strategy onto another pain management strategy could be assessed (i.e. additive effects on a sweet solution, non-nutritive sucking, or swaddling) (three strategies). The eligible control groups for these additive studies were sweet solution only, non-nutritive sucking only, or swaddling only, respectively. Finally, we qualitatively described six interventions that met the eligibility criteria for inclusion in the review, but not in the analysis. DATA COLLECTION AND ANALYSIS: The outcomes assessed in the review were pain response (reactivity and regulation) and adverse events. The level of certainty in the evidence and risk of bias were based on the Cochrane risk of bias tool and the GRADE approach. We analysed the standardised mean difference (SMD) using the generic inverse variance method to determine effect sizes. MAIN RESULTS: We included total of 138 studies (11,058 participants), which includes an additional 76 new studies for this update. Of these 138 studies, we analysed 115 (9048 participants) and described 23 (2010 participants) qualitatively. We described qualitatively studies that could not be meta-analysed due to being the only studies in their category or statistical reporting issues. We report the results of the 138 included studies here. An SMD effect size of 0.2 represents a small effect, 0.5 a moderate effect, and 0.8 a large effect. The thresholds for the I2 interpretation were established as follows: not important (0% to 40%); moderate heterogeneity (30% to 60%); substantial heterogeneity (50% to 90%); considerable heterogeneity (75% to 100%). The most commonly studied acute procedures were heel sticks (63 studies) and needlestick procedures for the purposes of vaccines/vitamins (35 studies). We judged most studies to have high risk of bias (103 out of 138), with the most common methodological concerns relating to blinding of personnel and outcome assessors. Pain responses were examined during two separate pain phases: pain reactivity (within the first 30 seconds after the acutely painful stimulus) and immediate pain regulation (after the first 30 seconds following the acutely painful stimulus). We report below the strategies with the strongest evidence base for each age group. In preterm born neonates, non-nutritive sucking may reduce pain reactivity (SMD -0.57, 95% confidence interval (CI) -1.03 to -0.11, moderate effect; I2 = 93%, considerable heterogeneity) and improve immediate pain regulation (SMD -0.61, 95% CI -0.95 to -0.27, moderate effect; I2 = 81%, considerable heterogeneity), based on very low-certainty evidence. Facilitated tucking may also reduce pain reactivity (SMD -1.01, 95% CI -1.44 to -0.58, large effect; I2 = 93%, considerable heterogeneity) and improve immediate pain regulation (SMD -0.59, 95% CI -0.92 to -0.26, moderate effect; I2 = 87%, considerable heterogeneity); however, this is also based on very low-certainty evidence. While swaddling likely does not reduce pain reactivity in preterm neonates (SMD -0.60, 95% CI -1.23 to 0.04, no effect; I2 = 91%, considerable heterogeneity), it has been shown to possibly improve immediate pain regulation (SMD -1.21, 95% CI -2.05 to -0.38, large effect; I2 = 89%, considerable heterogeneity), based on very low-certainty evidence. In full-term born neonates, non-nutritive sucking may reduce pain reactivity (SMD -1.13, 95% CI -1.57 to -0.68, large effect; I2 = 82%, considerable heterogeneity) and improve immediate pain regulation (SMD -1.49, 95% CI -2.20 to -0.78, large effect; I2 = 92%, considerable heterogeneity), based on very low-certainty evidence. In full-term born older infants, structured parent involvement was the intervention most studied. Results showed that this intervention has little to no effect in reducing pain reactivity (SMD -0.18, 95% CI -0.40 to 0.03, no effect; I2 = 46%, moderate heterogeneity) or improving immediate pain regulation (SMD -0.09, 95% CI -0.40 to 0.21, no effect; I2 = 74%, substantial heterogeneity), based on low- to moderate-certainty evidence. Of these five interventions most studied, only two studies observed adverse events, specifically vomiting (one preterm neonate) and desaturation (one full-term neonate hospitalised in the NICU) following the non-nutritive sucking intervention. The presence of considerable heterogeneity limited our confidence in the findings for certain analyses, as did the preponderance of evidence of very low to low certainty based on GRADE judgements.
Authors' conclusions:
Overall, non-nutritive sucking, facilitated tucking, and swaddling may reduce pain behaviours in preterm born neonates. Non-nutritive sucking may also reduce pain behaviours in full-term neonates. No interventions based on a substantial body of evidence showed promise in reducing pain behaviours in older infants. Most analyses were based on very low- or low-certainty grades of evidence and none were based on high-certainty evidence. Therefore, the lack of confidence in the evidence would require further research before we could draw a definitive conclusion.
Background: Infant pain has been historically under-managed. Review question: This review assessed 24 different ways of reducing young children's pain during medical procedures without using drugs, such as using a pacifier, distracting the child, and rocking a child. We analysed studies separately for babies who were born preterm, full-term newborns, and older infants from one month to three years. We also looked at if there was a difference on the impact of the interventions depending on whether the infant had just had the painful procedure (pain reactivity), as opposed to calming down from their peak distress (immediate pain regulation). Study characteristics: This updated review examined 63 randomised controlled trials of 4905 participants. Key results and Quality of evidence: While there was evidence for non-nutritive sucking, swaddling and tucking, massage, environment modification, rocking, video distraction, structured non-parent involvement at different ages, and pain types, none of the analyses were based on sufficient evidence to allow us to draw firm conclusions (i.e. high quality studies from at least two independent laboratories).
There are many ways research advances the science of pediatric psychology, as well as clinical psychology in general. Research contributes to the knowledge and thought base on which the future of the field is built. (Roberts and McNeal (1995)) distinguish among four types of empirical research in pediatric psychology: explicative, assessment, prevention, and treatment research. Each approach contributes uniquely to the study of the clinical phenomenon that are the subject matter of pediatric psychology. However, in recent years the balance among these four types of contributions has become skewed. In particular, there is an overemphasis on explicative research, which examines the associations among variables. In addition, there appears to be a chasm between explicative and treatment research, with explicative research seldom informing the development of treatment programs. However, the chasm has not always been there (see Roberts & McNeal, 1995), and was not characteristic of the early days of the field. Clinical research at that time primarily had an applied goal: to produce clinically significant treatment gains for the patients, as opposed to the current theoretical or model building goal of much of explicative research today. While important, explicative research and the associated theory development were not the primary focus of the majority of research.
To conduct a systematic review of the factors predicting anticipatory distress to painful medical procedures in children. METHODS: A systematic search was conducted to identify studies with factors related to anticipatory distress to painful medical procedures in children aged 0-18 years. The search retrieved 7,088 articles to review against inclusion criteria. A total of 77 studies were included in the review. RESULTS: 31 factors were found to predict anticipatory distress to painful medical procedures in children. A narrative synthesis of the evidence was conducted, and a summary figure is presented. CONCLUSIONS: Many factors were elucidated that contribute to the occurrence of anticipatory distress to painful medical procedures. The factors that appear to increase anticipatory distress are child psychopathology, difficult child temperament, parent distress promoting behaviors, parent situational distress, previous pain events, parent anticipation of distress, and parent anxious predisposition. Longitudinal and experimental research is needed to further elucidate these factors.
© The Author 2015. Published by Oxford University Press on behalf of the Society of Pediatric Psychology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.
The purpose of this chapter is to review existing biopsychosocial models of paediatric pain and to examine common key factors across different theoretical conceptualizations. Critical gaps in the empirical and theoretical literature are elucidated. In particular, lack of specific attention to developmental factors in biological, behavioural, and social functioning and the need for models that examine gaps in different types of pain responding (e.g. immediate acute pain response, acute pain responding in the context of chronic pain) are highlighted. Moreover, the need for comprehensive, conceptual models, representative of current knowledge, that readily generate specific hypotheses confirmable by experimentation are also discussed as ways of moving the field of paediatric pain forward, both conceptually and pragmatically.
This study evaluated the concurrent and construct validity of the Child–Adult Medical Procedure Interaction Scale-Short Form (CAMPIS-SF), a behavior rating scale of children's acute procedural distress and coping, and the coping promoting behaviors and distress promoting behaviors of their parents and the medical personnel who were present in the medical treatment room. Sixty preschool children undergoing immunizations at a county health department served as subjects. Videotapes of the procedures were scored using three observational measures in addition to the CAMPIS-SF. Also, parent, nurse, and child report measures of child distress, fear, pain, and cooperation were obtained. Results indicated that the validity of the CAMPIS-SF codes of Child Coping, Child Distress, Parent Coping Promoting, Parent Distress Promoting, Nurse Coping Promoting, and Nurse Distress Promoting behaviors was supported by multiple significant correlations with the other measures. The interrater reliability of the 5-point CAMPIS-SF scales was good to excellent. The results emphasize that the CAMPIS-SF scales can be used to monitor not only children's acute procedural distress, but also their coping and the various adults' behaviors that significantly influence children's distress. Further, because of the CAMPIS-SF's ease of use, it is likely that the study of the effects of the social environment on children's distress and coping will be facilitated.
The Cochrane Handbook for Systematic Reviews of Interventions (the Handbook) has undergone a substantial update, and Version 5 of the Handbook is now available online at www.cochrane-handbook.org and in RevMan 5. In addition, for the first time, the Handbook will soon be available as a printed volume, published by Wiley-Blackwell. We are anticipating release of this at the Colloquium in Freiburg. Version 5 of the Handbook describes the new methods available in RevMan 5, as well as containing extensive guidance on all aspects of Cochrane review methodology. It has a new structure, with 22 chapters divided into three parts. Part 1, relevant to all reviews, introduces Cochrane reviews, covering their planning and preparation, and their maintenance and updating, and ends with a guide to the contents of a Cochrane protocol and review. Part 2, relevant to all reviews, provides general methodological guidance on preparing reviews, covering question development, eligibility criteria, searching, collecting data, within-study bias (including completion of the Risk of Bias table), analysing data, reporting bias, presenting and interpreting results (including Summary of Findings tables). Part 3 addresses special topics that will be relevant to some, but not all, reviews, including particular considerations in addressing adverse effects, meta-analysis with non-standard study designs and using individual participant data. This part has new chapters on incorporating economic evaluations, non-randomized studies, qualitative research, patient-reported outcomes in reviews, prospective meta-analysis, reviews in health promotion and public health, and the new review type of overviews of reviews.
The tendency to "catastrophize" during painful stimulation contributes to more intense pain experience and increased emotional distress. Catastrophizing has been broadly conceived as an exaggerated negative "mental set" brought to bear during painful experiences. Although findings have been consistent in showing a relation between catastrophizing and pain, research in this area has proceeded in the relative absence of a guiding theoretical framework. This article reviews the literature on the relation between catastrophizing and pain and examines the relative strengths and limitations of different theoretical models that could be advanced to account for the pattern of available findings. The article evaluates the explanatory power of a schema activation model, an appraisal model, an attention model, and a communal coping model of pain perception. It is suggested that catastrophizing might best be viewed from the perspective of hierarchical levels of analysis, where social factors and social goals may play a role in the development and maintenance of catastrophizing, whereas appraisal-related processes may point to the mechanisms that link catastrophizing to pain experience. Directions for future research are suggested.
Preschool children (n=30) undergoing routine immunizations at a health department were taught to use distraction prior to the medical procedure and to use a party blower, as an age appropriate version of deep breathing, just prior to and during the injection. Parents were taught to coach their children. A no-treatment control group (n=30) was used to evaluate effectiveness. Results indicated that trained parents engaged in more prompting of their child to use the blower than untrained parents. Trained children engaged in more blower usage than untrained children. Child distress was lower on two of three observational measures for the trained children. Parents of trained children reported that both they and their children were less distressed when compared to how they normally would be during the procedures. Staff, who were not trained nor instructed to change their behavior, engaged in significantly more coaching of trained than of untrained children to use the blower, suggesting generalization of the behavior from parents to staff. Suggestions for future research are included.
The study examined the impact of three coping behaviors (non-procedure-related statements and behaviors, information seeking, and requests for modifications in the procedure) exhibited during stressful medical procedures performed on 45 children undergoing cancer treatment. Using videotaped recordings of venipunctures, the relations among the three coping behaviors and the relations between coping and distress were investigated. Because age was associated with both distress and coping, age was partialled out when computing correlations. Coping behaviors were independent (i.e., not correlated). A pattern of consistent, weak-to-moderate associations was noted between non-procedure-related behaviors and reductions in both concurrent and subsequent distress. The role of developmental differences in the study of children's coping are discussed.
This study examined the behavioral variations of pediatric oncology patients, their parents, and the medical staff across phases of medical procedures. Child coping and distress behaviors, as well as the behaviors of the adults, were considered. Results indicated differences in both level and type of child distress, with distress peaking during the bone marrow aspiration. During the early phases, more anticipatory distress was observed, while later the distress was more demonstrative. The type, but not the level, of child coping varied by phase. During the early, nonpainful phases, more verbal coping (nonprocedural talk and humor by the child) was used, whereas during the later painful phases, there was more audible deep breathing. Certain adult behaviors were shown to be highly correlated with phase-specific coping by the child, whereas other adult behaviors were highly correlated with child distress throughout the procedure.
The influence of the immediate social environment on the child's ability to cope during painful medical procedures was examined. Transcriptions and audiotapes of verbal interactions among residents, nurses, mothers, fathers, and children that occurred during bone marrow aspirations and lumbar puncture procedures were scored using the Child-Adult Medical Procedure Interaction Scale (CAMPIS). Using Sackett's lag analysis to determine conditional probabilities, during the medical procedure it was found that adults' reassuring comments, apologies to the child, giving control to the child, and criticism of the child typically preceded child distress. Also, when the child emitted any one of eight distress behaviors, adults generally attempted to reassure the child. Child coping typically was preceded and followed by adult commands to the child to engage in coping procedures, by nonprocedural talk to the child, and by humor directed to the child. Implications for future research are discussed.
The aim of this exploratory study was to investigate the influences of adult behaviors on child coping behaviors during venipunctures (VPs) in an emergency department. Observations of children and adults from 66 VPs were coded using a modified version of the Child-Adult Medical Procedure Interaction Scale and analyzed using sequential analysis. Results showed adult reassurance behavior promoted child distress behaviors, such as crying, as well as nondistress behaviors, such as information seeking; adult distraction behaviors promoted children's distraction, control, and coping behaviors; and children frequently ignored adult behaviors. Findings suggest further exploration of children's internal strategies for coping, such as appraisal, and clarifying the role of adult reassurance in child coping behaviors.
Previous research shows that numerous child, parent, and procedural variables affect children's distress responses to procedures. Cognitive-behavioral interventions such as distraction are effective in reducing pain and distress for many children undergoing these procedures.
The purpose of this report was to examine child, parent, and procedural variables that explain child distress during a scheduled intravenous insertion when parents are distraction coaches for their children.
A total of 542 children, between 4 and 10 years of age, and their parents participated. Child age, gender, diagnosis, and ethnicity were measured by questions developed for this study. Standardized instruments were used to measure child experience with procedures, temperament, ability to attend, anxiety, coping style, and pain sensitivity. Questions were developed to measure parent variables, including ethnicity, gender, previous experiences, and expectations, and procedural variables, including use of topical anesthetics and difficulty of procedure. Standardized instruments were used to measure parenting style and parent anxiety, whereas a new instrument was developed to measure parent performance of distraction. Children's distress responses were measured with the Observation Scale of Behavioral Distress-Revised (behavioral), salivary cortisol (biological), Oucher Pain Scale (self-report), and parent report of child distress (parent report). Regression methods were used for data analyses.
Variables explaining behavioral, child-report and parent-report measures include child age, typical coping response, and parent expectation of distress (p < .01). Level of parents' distraction coaching explained a significant portion of behavioral, biological, and parent-report distress measures (p < .05). Child impulsivity and special assistance at school also significantly explained child self-report of pain (p < .05). Additional variables explaining cortisol response were child's distress in the morning before clinic, diagnoses of attention deficit hyperactivity disorder or anxiety disorder, and timing of preparation for the clinic visit.
The findings can be used to identify children at risk for high distress during procedures. This is the first study to find a relationship between child behavioral distress and level of parent distraction coaching.
Assessed the influence of adult in-session behavior and psychological variables on 77 preschool children's coping and distress during routine immunizations. Maternal anxiety was not related to the behavior of the parent, staff, or child. However, in-session behavior by one person was highly correlated with insession behavior by the other people in the treatment room. The effects of parent and staff in-session behaviors, previous child medical experience, and maternal anxiety on child distress and coping was examined using hierarchical multiple regression procedures. Child coping was predicted by parent and staff behavior whereas child distress was predicted by parent behavior and by the level of the child's distress during previous medical and dental experiences. Implications for intervention and future research are discussed.
Observed 47 children ranging in age from 13 months to 7 years 9 months receiving injections as part of a regular visit to
a pediatric clinic. Twenty-three children were randomly assigned to a condition with parent (mainly mothers) present and 24
to a condition with parent absent. During the medical procedure, the child's reactions were observed via videotape (for later
behavioral coding) and physiological recording (to measure heart rates). Following the injection, data were collected on the
child's preference of condition (either parent present or parent absent) for future injections. Older children (but not younger
ones) showed significantly more behavioral distress when the parent was present. However, the oldest children's preference
of condition for future injections was overwhelmingly that of parent present (86%).
Assessed the influence of adult in-session behavior and psychological variables on 77 preschool children's coping and distress during routine immunizations. Maternal anxiety was not related to the behavior of the parent, staff, or child. However, in-session behavior by one person was highly correlated with in-session behavior by the other people in the treatment room. The effects of parent and staff in-session behaviors, previous child medical experience, and maternal anxiety on child distress and coping was examined using hierarchical multiple regression procedures. Child coping was predicted by parent and staff behavior whereas child distress was predicted by parent behavior and by the level of the child's distress during previous medical and dental experiences. Implications for intervention and future research are discussed.
An examination of factors was conducted to determine the effectiveness of the distraction component of a behavioral intervention (use of a party blower). In one condition, parents were instructed to coach children in the use of a party blower and to praise child cooperation. In a second condition, nurses were instructed to assist parents in coaching the child. Parents used the coaching skills they learned and got their children to use the distraction technique. Use of the distraction technique was associated with less crying. Encouragement from a health care professional and intervention early in the procedure did not enhance the intervention's effectiveness. Older children and children who were less distressed during the initial phase of the procedure were less likely to reject the intervention.
Manipulated experimentally mothers' verbal behavior during a routine intramuscular injection in order to help clarify the role of nonprocedural talk (distraction) and parental reassurance on children's reaction to the injection. 42 child-mother dyads were recruited from a general pediatric primary care clinic and were randomly assigned to a parental reassurance, parental nonprocedural talk (distraction) or minimal-treatment control group. Children in the maternal distraction condition exhibited significantly less distress during the immunization injection than those in the reassurance and control conditions. Specifically, children in the maternal distraction group exhibited less crying than children in the other two groups. Children in the reassurance and control groups did not differ from each other in terms of behavioral distress. The present findings serve further to bolster the evidence for the efficacy of maternal distraction as a way to ameliorate child distress during invasive medical procedures.
In this essay in honor of Donald Oken, I emphasize coping as a key concept for theory and research on adaptation and health. My focus will be the contrasts between two approaches to coping, one that empha- sizes style—that is, it treats coping as a personality characteristic—and another that emphasizes proc- ess—that is, efforts to manage stress that change over time and are shaped by the adaptational con- text out of which it is generated. I begin with an account of the style and process approaches, discuss their history briefly, set forth the principles of a process approach, describe my own efforts at measurement, and define coping and its functions from a process standpoint. This is fol- lowed by a digest of major generalizations that re- sulted from coping process research. The essay con- cludes with a discussion of special issues of coping measurement, in particular, the limitations of both coping style and process approaches and how these limitations might be dealt with. There has been a prodigious volume of coping research in the last decade or two, which I can only touch on very selectively. In this essay, I also ignore a host of important developmental issues that have to do with the emergence of coping and its cognitive and motivational bases in infants, as well as a grow- ing literature on whether, how, and why the coping process changes with aging.
To test the feasibility of creating a valid and reliable checklist with the following features: appropriate for assessing both randomised and non-randomised studies; provision of both an overall score for study quality and a profile of scores not only for the quality of reporting, internal validity (bias and confounding) and power, but also for external validity.
A pilot version was first developed, based on epidemiological principles, reviews, and existing checklists for randomised studies. Face and content validity were assessed by three experienced reviewers and reliability was determined using two raters assessing 10 randomised and 10 non-randomised studies. Using different raters, the checklist was revised and tested for internal consistency (Kuder-Richardson 20), test-retest and inter-rater reliability (Spearman correlation coefficient and sign rank test; kappa statistics), criterion validity, and respondent burden.
The performance of the checklist improved considerably after revision of a pilot version. The Quality Index had high internal consistency (KR-20: 0.89) as did the subscales apart from external validity (KR-20: 0.54). Test-retest (r 0.88) and inter-rater (r 0.75) reliability of the Quality Index were good. Reliability of the subscales varied from good (bias) to poor (external validity). The Quality Index correlated highly with an existing, established instrument for assessing randomised studies (r 0.90). There was little difference between its performance with non-randomised and with randomised studies. Raters took about 20 minutes to assess each paper (range 10 to 45 minutes).
This study has shown that it is feasible to develop a checklist that can be used to assess the methodological quality not only of randomised controlled trials but also non-randomised studies. It has also shown that it is possible to produce a checklist that provides a profile of the paper, alerting reviewers to its particular methodological strengths and weaknesses. Further work is required to improve the checklist and the training of raters in the assessment of external validity.
This study evaluated the concurrent and construct validity of the Child-Adult Medical Procedure Interaction Scale-Short Form (CAMPIS-SF), a behavior rating scale of children's acute procedural distress and coping, and the coping promoting behaviors and distress promoting behaviors of their parents and the medical personnel who were present in the medical treatment room. Sixty preschool children undergoing immunizations at a county health department served as subjects. Videotapes of the procedures were scored using three observational measures in addition to the CAMPIS-SF. Also, parent, nurse, and child report measures of child distress, fear, pain, and cooperation were obtained. Results indicated that the validity of the CAMPIS-SF codes of Child Coping, Child Distress, Parent Coping Promoting, Parent Distress Promoting, Nurse Coping Promoting, and Nurse Distress Promoting behaviors was supported by multiple significant correlations with the other measures. The interrater reliability of the 5-point CAMPIS-SF scales was good to excellent. The results emphasize that the CAMPIS-SF scales can be used to monitor not only children's acute procedural distress, but also their coping and the various adults' behaviors that significantly influence children's distress. Further, because of the CAMPIS-SF's ease of use, it is likely that the study of the effects of the social environment on children's distress and coping will be facilitated.
To conduct a systematic review of epidemiological literature in order to determine the prevalence and associated risk factors of oro-facial pain.
Population based observational studies (cohorts, cross-sectional and case-control studies) of oro-facial pain, published in the English language, prior to 1999 were included.
Electronic databases (Medline, Embase, Cinahl, BIDS and Health CD) were searched. Reference lists of relevant articles were examined, and the journals "Pain" and "Community Dentistry and Oral Epidemiology" were handsearched for the years 1994-1998.
The results of the search strategy were screened for relevance. A standardised checklist was used to assess the methodological quality of each study by two reviewers before an attempt was made to summarise the results. The median quality score was 70% of the maximum attainable score. Due to methodological issues, it was not possible to pool the data on the prevalence of oro-facial pain. Age, gender and psychological factors were found to be associated with OFP, however there was not enough information on other factors such as local mechanical and co-morbidities to draw any reliable conclusions. None of the factors fully fulfilled criteria for causality.
There is a need for good quality epidemiological studies of oro-facial pain in the general population. To enable comprehensive examination of the aetiology of oro-facial pain, it is necessary to address a broad range of factors including demography and life-style, local mechanical factors, medical history and psychological factors. Future studies should recruit adequately sized samples for precise determination of the prevalence and detection of important associated factors. Data on potential confounders and effect modifiers should also be collected and adjusted for in the statistical analysis.