Physician and parent behavior during invasive pediatric cancer procedures: relationships to child behavioral distress

A Brief Mindfulness Intervention for Parents and Children before Pediatric Venipuncture: A Randomized Controlled Trial

BACKGROUND

Routine needle procedures can be distressing for parents and children. Mindfulness interventions may be helpful for parents and children but have not been examined for pediatric needle procedures despite showing benefits in the context of pediatric chronic pain and in lab-based pain tasks.

METHODS

This preregistered (NCT03941717) two-arm, parallel-group randomized controlled trial examined the effects of a 5 min mindfulness intervention before pediatric venipuncture for parents and children (aged 7-12) compared to a control group on primary outcomes of child pain and fear, secondary outcomes of parent distress, and tertiary outcomes of parent ratings of child pain and fear. Moderators of parent and children's responses to the intervention were examined: state catastrophizing, trait mindfulness, and experiential avoidance.

RESULTS

Sixty-one parent-child dyads were randomized (31 mindfulness; 30 control). Parents and children completed measures, listened to a 5 min audio recording (mindfulness or control), and parents accompanied their child during routine venipuncture. The mindfulness intervention involved breathing and encouraging nonjudgmental attention to one's experiences, while the control condition involved an unfocused attention task. Three between-subject MANCOVAs assessed for group differences. Child pain and fear rated by children and their parents did not differ between groups. Parents in the mindfulness group were less distressed during the venipuncture than the controls. Parent state catastrophizing may have moderated the intervention effects, such that parents with moderate and high catastrophizing levels had lower distress following the mindfulness intervention versus control.

CONCLUSIONS

The intervention did not reduce child pain or fear but reduced parent distress. It appeared most helpful for parents catastrophizing about their child's pain, which is noteworthy as these children are prone to worse outcomes.

The Impact of Parental Pain-attending and Non-pain-attending Responses on Child Pain Behavior in the Context of Cancer-related Painful Procedures: The Moderating Role of Parental Self-oriented Distress

OBJECTIVES

Literature has demonstrated inconsistent findings regarding the impact of parental responses on child pain-related outcomes. Yet, research into factors that may underlie inconsistent findings regarding the variable impact of parental responses is lacking. The current study investigated the moderating role of parental distress in understanding the impact of parental pain-attending (eg, reassuring the child) and non-pain-attending (eg, distracting the child with humor) responses on child pain behavior (eg, crying).

METHODS

Children (18 y and younger) with leukemia, undergoing a lumbar puncture (LP) and/or bone marrow aspiration procedure, and one of their parents, were recruited from the Pediatric Ghent University Hospital. Parent-child interactions were videotaped after the procedure allowing coding of parental responses and child pain behavior. Parents self-reported on experienced personal distress.

RESULTS

Participants consisted of 42 children (24 boys, 18 girls) with leukemia and one of their parents. Children were 0.6 to 15 (7.08±4.39) years old. Findings indicated a positive association between parental pain-attending and child pain behavior, but only when parents reported high levels of distress (β=0.56, P=0.001). No association was observed for parents reporting low levels of distress (β=-0.09, ns). Parental non-pain-attending responses contributed to lower child pain behavior (β=-0.24, P=0.045), independently of parental distress (β=-0.07, ns).

DISCUSSION

The current findings point to the moderating role of parental distress in understanding the impact of parental responses on child pain behavior and highlight the importance of interventions targeting parental emotion regulation to promote optimal child pain outcomes.

Use of Augmented Reality During Inhaled Induction of General Anesthesia in 3 Pediatric Patients: A Case Report

Preoperative anxiety is common in children undergoing surgery and general anesthesia (GA). Augmented reality (AR), an interactive technology that superimposes computer-generated information on the real-world environment, can be a valuable tool to address preoperative anxiety. We describe 3 cases where AR was successfully used as a distraction technique in pediatric patients during induction of GA. Patients and parents were satisfied with the experience and described less patient anxiety as compared to previous inductions. AR can be beneficial as an adjunct or alternative to existing pharmacologic and behavioral distraction techniques for preoperative anxiety.

Pediatric Immunization Distress: A Cluster Analyses of Children's, Parents', and Nurses' Behaviors During the Anticipatory Phase

OBJECTIVE

Using cluster analysis, we aimed to identify a typology of nurses', parents', and young children's behaviors during the anticipatory phase of pediatric immunizations to explore the associations between these different typologies and to determine whether these groups differed with respect to the child's procedural distress as rated by the child and the parents and with respect to the adults' self-rated distress.

MATERIALS AND METHODS

Immunizations given by 23 nurses to 220 children aged 3 years and 10 months to 7 years were recorded with behaviors being scored according to Child-Adult Medical Procedure Interaction Scale-Revised, to which 3 new codes were added, and rated with a 6-point Likert scale. Parents' and nurses' ratings of their own distress and of the child's distress, in addition to children's self-rating of distress were obtained. Nine adult and 12 child behavioral codes were submitted for cluster analysis.

RESULTS

A solution with 4 clusters for children, 5 clusters for parents, and 5 clusters for nurses was retained. Our results show high consistency between child and adult clusters. During the anticipatory phase, less distressed children, characterized by either low activity or high coping, interacted with adults who showed low activity or high coping support patterns. More distressed children, characterized by resistance and behavioral distress, interacted with adults who displayed either low activity or less efficient support behaviors, such as reassurance and criticism.

DISCUSSION

The results confirm previous dimensional studies and add relevant knowledge concerning typologies of participant behaviors that may be useful in understanding such behaviors and in helping providers in their management of child immunizations.

Procedural Preparation and Support as a Standard of Care in Pediatric Oncology

Youth with cancer undergo many repeated and invasive medical procedures that are often painful and highly distressing. A systematic review of published research since 1995 identified 65 papers (11 review articles and 54 empirical studies) that investigated preparatory information and psychological interventions for a variety of medical procedures in pediatric cancer. Distraction, combined cognitive-behavioral strategies, and hypnosis were identified as effective for reducing child pain and increasing child coping. Low- to high-quality evidence informed strong recommendations for all youth with cancer to receive developmentally appropriate preparatory information and psychological intervention for invasive medical procedures.

Children's Immediate Postoperative Distress and Mothers' and Fathers' Touch Behaviors

OBJECTIVE

This study examined mothers' and fathers' use of child-directed touch in the postanesthesia care unit.

METHODS

In all, 142 mothers and 112 fathers of 143 children aged 2-11 years undergoing outpatient surgery participated. Parent touch (instrumental, empathic) and child distress were coded. Mothers' and fathers' rates of touch were compared, and interrelations between touch and child distress were examined (overall and sequentially).

RESULTS

The proportion of mothers and fathers who used touch did not differ, but mothers' rates of touch were higher than fathers'. Parental instrumental touch and mothers embracing touch were positively correlated with children's distress. Mothers were more likely to use embracing touch in response to children's distress than at any other time.

CONCLUSIONS

Results point to potential differences in mothers' and fathers' roles in the postoperative setting, and potentially different functions of touch. Results suggest that mothers may provide embracing touch to soothe or prevent children's distress.

Reassurance and distress behavior in preschool children undergoing dental preventive care procedures in a community setting: a multilevel observational study

BACKGROUND

The effect of reassurance in managing distress among children who receive procedures of a less aversive nature has not been fully investigated.

PURPOSE

This study aimed to investigate the relationship between reassurance by dental staff and distress behavior of preschool children receiving preventive procedures in a community setting.

METHODS

Nurse-child interactions (n = 270) during fluoride varnish application were video recorded and coded. Multilevel logistic regression modeled the probability of the occurrence of child distress behavior as a function of reassurance provision, controlling for child-level and nurse-level variables.

RESULTS

Child distress behavior was positively related to nurse verbal reassurance but negatively linked to the time that this reassurance occurred. Both child initial anxiety and nurse nonprocedural training increased the probability of observable distress behavior.

CONCLUSIONS

The use of verbal reassurance to promote reception of mild invasive procedures was counterindicated, especially when offered early in the intervention ( ClinicalTrials.gov number: NCT00881790).

Parent-reported distress in children under 3 years old during preventive medical and dental care

PURPOSE

This study examined factors related to young children's distress during preventive oral health visits. Additionally, associations between parent-reported child behaviour during the dental visit and during previous medical visits were tested.

METHODS

One hundred twenty-two children under 3 years of age enrolled in a government insurance programme for low-income children were seen for examination, prophylaxis, and fluoride application at a university-based dental clinic. Child distress was rated by parents on a numerical rating scale.

RESULTS

The average age of children enrolled was 23.5 ± 7.3 months. The majority (55.7 %) were judged to have little or no distress pre-examination. Mild or no distress during the examination was reported for 42.6 % of the children and severe distress was reported for 39.4 %. Intensity of distress during the examination was not associated with the child's age, gender, dental health, or previous experience with dental care. Distress was also unrelated to the caregiver's education level or own dental health. Intensity of distress was associated with the child's pre-dental examination distress and distress during prior medical examinations and injections.

CONCLUSIONS

Dental professionals can better anticipate child distress by assessing children before a dental examination and enquiring about previous medical experiences. Strategies to prepare parents and alleviate distress may help children cope with the preventive dental visit.

Mother-child communication and maternal depressive symptoms in families of children with cancer: integrating macro and micro levels of analysis

OBJECTIVES

This study examines associations between maternal depressive symptoms and macro- and micro-level aspects of mothers' communication about their children's cancer.

METHODS

Mothers reported depressive symptoms after diagnosis or relapse (child mean age = 10.4 years; 53% male). Mother-child dyads (N = 94) were subsequently observed discussing the child's cancer and maternal communication was coded.

RESULTS

Macro-level indicators (positive and negative communication) were associated with certain micro-level indicators of communication (topic maintenance, reflections, reframes, and imperatives). Higher depressive symptoms predicted lower positive communication and higher negative communication. Maternal reflections and imperatives predicted positive communication, and topic maintenance and reframes predicted negative communication, beyond child age, family income, and depressive symptoms.

CONCLUSIONS

Findings suggest concrete targets for improving communication in families after diagnosis or relapse.

Children's positive dispositional attributes, parents' empathic responses, and children's responses to painful pediatric oncology treatment procedures

Pain/distress during pediatric cancer treatments has substantial psychosocial consequences for children and families. The authors examined relationships between children's positive dispositional attributes, parents' empathic responses, and children's pain/distress responses to treatment procedures. Participants were 41 pediatric cancer patients and parents. Several weeks before treatment, parents rated children's resilience and positive dimensions of temperament. Parents' pretreatment empathic affective responses to their children were assessed. Children's pain/distress during treatments was rated by multiple independent raters. Children's resilience was significantly and positively associated with parents' empathic affective responses and negatively associated with children's pain/distress. Children's adaptability and attention focusing also showed positive relationships (p < 0.10) with parents' empathic responses. Parents' empathic responses mediated effects of children's resilience on children's pain/distress. Children's positive dispositional attributes influence their pain/distress during cancer treatments; however, these effects may be mediated by parents' empathic responses. These relationships provide critical understanding of the influence of parent-child relationships on coping with treatment.

Effects of parental soothing behavior on stress levels of 2-8 year old children during voiding cystourethrograms by phase of procedure

Using the example of a voiding cystourethrogram (VCUG), a painful radiological procedure, this study investigated whether parental soothing behavior (reassuring comments like "it's almost over" or "You're O.K." and soothing by "sh, sh") in one phase of the procedure influenced the child's distress in the following phase. The sample was comprised of 68 2-8 year-old children and the accompanying parent(s). Child and parental behavior during the VCUG was coded using a standardized rating scale (CAMPIS-R). Parental reassurance during the anticipatory phase significantly increased the child's distress of the following phase, while parental "sh, sh" significantly reduced it. Both parental behaviors showed no significant effect on the child's distress of the following phase when applied during the procedure itself. Results underline the importance of differentiating between anticipatory and procedural phases of the VCUG. Counselling methods for parents on more appropriate strategies to assist their children during procedural phases of the VCUG are necessary.

Coping with pediatric cancer: strategies employed by children and their parents to manage cancer-related stressors during treatment

Pediatric cancer patients and their families face significant physical, emotional, and psychosocial challenges. Few studies have investigated how children manage these challenges and how parents may help in the process. This qualitative study aimed to explore common cancer-related stressors for children and to examine child coping and parental assistance in coping with these stressors during treatment. Fifteen children undergoing cancer treatment and their parents participated in semistructured interviews. Four themes emerged capturing cancer-related stressors: cancer treatment/side effects, distressing emotions, disruption in daily routines, and social challenges. Six themes emerged regarding child coping strategies that were classified within an approach/avoidance coping framework. Approach coping strategies included the following: cognitive restructuring, relaxation, practical strategies, seeking social support, and emotional expression. Distraction was the only avoidant coping strategy. Parents tended to encourage approach coping strategies (eg, cognitive restructuring, social support). Within families, few coping strategies were reported (child: M = 1.47, SD = 0.99; parent: M = 3.33, SD = 1.18), suggesting that early family-based interventions teaching coping techniques for cancer-related stressors may be beneficial.

The influence of adult behaviors on child coping during venipuncture: a sequential analysis

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.

Healthcare provider and parent behavior and children's coping and distress at anesthesia induction

BACKGROUND

To date, no study has evaluated the impact of specific healthcare provider and parent behaviors on children's distress and coping during anesthesia induction.

METHOD

Extensive digital video data were collected on 293 two- to ten-yr-old children undergoing anesthesia induction with a parent present. Anesthesiologist, nurse, and parent behavior and children's distress and coping were coded using the Revised Preoperative Child-Adult Medical Procedure Interaction Scale administered using specialized coding software.

RESULTS

Anesthesiologists and parents engaged in higher rates of most behaviors than nurses. Overall, adult emotion-focused behavior such as empathy and reassurance was significantly positively related to children's distress and negatively related to children's coping behaviors. Adult distracting behavior such as humor and distracting talk showed the opposite pattern. Medical reinterpretation by anesthesiologists was significantly positively related to children's coping behaviors, but the same behavior by parents was significantly positively related to children's distress.

CONCLUSIONS

The data presented here provide evidence for a relation between adult behaviors and children's distress and coping at anesthesia induction. These behaviors are trainable, and hence it is possible to test whether modifying physician behavior can influence child behavior in future studies.

Behavioural assessment of pediatric pain

Behavioural assessment methods have been used to signal the need for intervention and to evaluate treatment effectiveness. Direct observation and rating scales have been used to assess pain and distress associated with acute medical procedures, postoperative pain, critical care, analogue pain induction procedures and other sources. Two recent scholarly reviews of behavioural assessment methods were conducted by the Society of Pediatric Psychology Evidence-Based Assessment Task Force and the Pediatric Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials, which classified various instruments as well established, approaching well established or promising. The characteristics of the eight behavioural assessment scales that were recommended by one of these task forces are further reviewed in the present paper. The results indicate that behavioural assessment scales have been used flexibly to assess pain in a wide variety of situations, across different pediatric populations and for patients of different ages. In the present review, there appears to be no basis for designating the scales as measures of distress versus pain; both emotional and sensory components of pain seem to be assessed by each of the scales. There is considerable overlap among the behavioural indicators of pain used in the different scales. Furthermore, the behavioural codes indicative of pain may occur before, during and after painful events. Recommendations for future research are provided, including using behavioural assessment to focus on children's coping and adults' behaviours, as well as pain.

Comparing stress levels in children aged 2-8 years and in their accompanying parents during first-time versus repeated voiding cystourethrograms

OBJECTIVES

Invasive procedures such as voiding cystourethrograms (VCUGs) cause distress in both children and their accompanying parents. The main purpose of this study was to examine whether stress levels in children and their parents differ during first-time and repeated VCUGs. The second objective was to examine the relationship between parental behavior (behavior promoting child coping and behavior promoting child distress), parental stress levels and child distress in first-time versus repeated VCUGs.

METHODS

In a prospective study, the distress behavior of 31 children aged 2-8 years who were undergoing a repeated VCUG was examined. A second group of 31 children who were undergoing a VCUG for the first time served as a control sample. Child and parental behavior during the VCUG was coded by three independent observers using a standardized rating scale (CAMPIS-R, Blount et al.). Children reported on their stress levels using a faces scale; parents and radiologists rated the child's distress on a visual analog scale. Similarly, parents assessed their own stress levels on a visual analog scale.

RESULTS

The stress levels of children undergoing a repeated VCUG do not differ from those of children undergoing a VCUG for the first time, but parental stress levels were significantly lower during repeated VCUGs. In both VCUG groups there was significant positive correlation between parental distress-promoting behavior and child distress, and between parental stress levels and child distress. Parental coping-promoting behavior showed no significant correlation with child distress or parental stress levels in either VCUG group. Parental stress levels and parental distress-promoting behavior correlated positively only for repeated VCUGs. Neither parental coping- nor distress-promoting behavior differed between first-time versus repeated VCUG groups.

CONCLUSIONS

Repeated VCUGs and first-time VCUGs are both highly distressing procedures for children. Even though parental stress levels are lower during repeated VCUGs, spontaneous parental behavior proves to be ineffective or even counterproductive in reducing the child's distress. Further research into efficient counseling and training methods for parents and children undergoing VCUGs is required.

Communication and child behaviour associated with unwillingness to take premedication

AIM

To see how dominance in adult communication and child behaviour during premedication affects the child's unwillingness to take premedication.

METHOD

Ninety-five children scheduled for ENT surgery were video-filmed during premedication. All communication was translated verbatim and the communication was grouped according to; if the parent or nurse directed their communication towards the child or not, or; if they talked about nonprocedural matters or procedural matters.

RESULTS

Unwillingness to take premedication was associated with more parent communication and less anaesthetic nurse communication compared to willingness to take premedication. There was a heighten risk that the child took their premedication unwillingly if their parent talked more directly to the child (OR = 4.9, p < or = 0.01), the child gave hesitant eye contact with the anaesthetic nurse (OR = 4.5, p < or = 0.05), the child had experienced an earlier traumatic medical procedure (OR = 4.1. p < or = 0.001) or if the child placed her/himself nearby their parent (OR = 4.0, p < or = 0.001).

CONCLUSION

Together with behaviour that could be signs of shyness and earlier medical traumatic experience, parents that are actively communicating with their child before premedication may heighten the risk that the child will take the premedication unwillingly.

Parents' Empathic Responses and Pain and Distress in Pediatric Patients

We investigated the relationship between parents' empathic responses prior to their children undergoing cancer treatment procedures and children's pain/distress during the procedures. We hypothesized: (1) parents' empathic distress would be positively associated with children's pain/distress, (2) parents' empathic concern would be negatively associated with children's pain/distress; and (3) parents' enduring dispositions and social support would be associated with their empathic responses. Parents completed: (1) measures of dispositions and perceived social support several weeks before their children underwent the procedures, and (2) state measures of empathic distress and empathic concern just before the procedures. Empathic distress was positively associated with children's pain; empathic concern was negatively associated with children's pain/distress. Predictions about dispositions and social support were also substantially confirmed.

Parental pain expectancy as a mediator between child expected and experienced procedure-related pain intensity during painful medical procedures

OBJECTIVES

The aim of this prospective investigation was to evaluate child and parental expectancies as a predictor of pain perception in pediatric oncology patients undergoing painful medical procedures.

METHODS

Forty-five children with leukemia or non-Hodgkin lymphoma and their parents rated expected and experienced pain during lumbar punctures at baseline, during intervention (ie, cognitive-behavior therapy) administered by a therapist and when children were using cognitive-behavior therapy skills independently.

RESULTS

Parental and child expectancies were significantly correlated. Parents consistently expected their children to experience more pain than children were expecting themselves. Parental expectancy was found to mediate the relationship between child expected and experienced pain during every phase of the study.

DISCUSSION

It is concluded that parental expectancies are reliable predictors of pediatric procedure-related pain and possible useful targets for psychologic interventions to manage such pain.

Paediatric 99mTc-DMSA imaging: reducing distress and rate of sedation using a psychological approach

AIM

To evaluate the effect of a psychological approach on distress and sedation rates in children undergoing dimer captosuccinic acid-labelled with technetium-99 (99mTc) DMSA imaging.

MATERIALS AND METHODS

Baseline data, on a retrospective consecutive sample of children examined using DMSA over a 6-month period (n = 81), were collected via medical note search and postal questionnaire. A further consecutive sample of 40 children was recruited prospectively to the intervention, which consisted of distraction during medical procedures and environmental manipulation. In addition half of the intervention group were provided with a photo-booklet depicting a coping child model, together with a letter offering advice to parents on how to prepare their child for the procedure.

RESULTS

Sedation rates were lower (p = 0.003) and service satisfaction ratings higher (p = 0.002) in the Intervention group as compared with the Baseline group. Within the intervention condition, children who received the photo-booklet displayed less distress before the procedure (p = 0.01) than those who did not. Also families who received the photo-booklet were more likely to attend the appointment (p = 0.024).

CONCLUSION

In this study, the use of a psychological approach was associated with lower rates of distress and sedation in children undergoing 99mTc-DMSA imaging, without compromising image quality.

Parent communication and child pain and distress during painful pediatric cancer treatments

Children with cancer often consider treatment procedures to be more traumatic and painful than cancer itself. Previous research indicates that parents' behavior before and during painful medical procedures influences children's distress level. Understanding parents' naturally occurring communication patterns is essential to identifying families in need of an intervention to enhance coping and emotional well-being. Using the concept of definition of the situation from a symbolic interactionism theoretical framework, this study developed a typology of parent communication patterns and tested relationships between those patterns and children's responses to potentially painful treatment procedures. Analyses are based on video-recorded observations of 31 children and their primary parents (individuals functioning in a parenting role and serving as the primary familial caregivers during the observed procedure) in the USA during clinic visits for potentially painful pediatric oncology treatments. Four communication patterns emerged: normalizing, invalidating, supportive, and distancing. The most common communication patterns differed by clinic visit phase: normalizing during pre-procedure, supportive during procedure, and both distancing and supportive during post-procedure. Parents' communication also varied by procedure type. Supportive communication was most common during lumbar punctures; normalizing and distancing communication were most common during port starts. Six children (19.4%) experienced invalidation during at least one clinic visit phase. Analyses indicated that invalidated children experienced significantly more pain and distress than children whose parents used other communication patterns. This typology provides a theoretical approach to understanding previous research and offers a framework for the continuing investigation of the influence of parents' communication during potentially painful pediatric oncology procedures.

When Distraction Fails: Parental Anxiety and Children’s Responses to Distraction during Cancer Procedures

OBJECTIVE

To examine parental anxiety in the context of successful and unsuccessful distraction treatment of preschool aged children undergoing chemotherapy procedures.

METHODS

Twenty-nine children (M age = 42 months) experiencing intramuscular or portacatheter injections participated in the study. Parents and children were shown how to use a portable electronic toy as a distractor during chemotherapy injections. Parental anxiety was assessed at baseline and child distress was coded during each procedure.

RESULTS

Parents' baseline state anxiety accounted for 17% of the variance in changes in children's distress following distraction intervention. Parents of children who did not benefit from distraction reported significantly higher state anxiety at baseline than parents of the other participants.

CONCLUSIONS

Results highlight the importance of examining individual outcomes in intervention studies and suggest that parents' emotional states may moderate distraction treatment outcome in young children. Future research formally testing parent anxiety as a moderator is recommended.

Pediatric procedural pain

Pain is subjective. The pain response is individual and is learned through social learning and experience. Early pain experiences may play a particularly important role in shaping an individual's pain responses. Painful medical procedures such as immunizations, venipunctures and dental care, and minor emergency department procedures such as laceration repair, compose a significant portion of the average child's experience with painful events. Inadequate relief of pain and distress during childhood painful medical procedures may have long-term negative effects on future pain tolerance and pain responses. This article reviews the evidence for long-term negative effects of inadequately treated procedural pain, the determinants of an individual's pain response, tools to assess pain in children, and interventions to reduce procedural pain and distress. Future research directions and a model for conceptualizing and studying pediatric procedural pain are proposed.

A criança hospitalizada: análise de um programa de atividades preparatórias para o procedimento médico de inalação

A hospitalização infantil beneficia-se com intervenção psicológica para promover a modificação do comportamento de pacientes. Foram propostos procedimentos observacionais e experimentais para avaliar um programa de atendimento a crianças expostas ao procedimento médico de inalação, tendo como objetivo a diminuição da freqüência de ocorrência de comportamentos concorrentes e o aumento nos comportamentos de adesão. A Observational Scale of Distress Behavior (OSDB) possibilitou o registro das categorias comportamentais. Participaram do estudo, 20 crianças, distribuídas em grupos experimental e controle. Crianças pertencentes ao grupo experimental submeteram-se a um programa que incluiu estratégias relacionadas à leitura, à simulação, ao relaxamento e à fantasia. A análise dos dados demonstrou que os participantes do grupo experimental apresentaram um padrão comportamental mais adaptativo. Relações funcionais foram explicitadas para melhor compreensão do comportamento dos participantes. Os resultados obtidos pretendem subsidiar o desenvolvimento de programas de preparação para procedimentos médicos.

Expected and reported pain in children undergoing ear piercing: a randomized trial of preparation by parents

This study examined experimentally the effectiveness of preparatory information provided by parents in creating accurate expectations and reducing children's procedural pain. Ear piercing was used as an analogue to minor painful medical procedures. Sixty children, aged 5-12 years, requesting ear piercing and accompanied by their parents, were randomly assigned to a parental information or contact-control condition. Parents in the information group were asked to read their child a description of the procedures and sensations of ear piercing. Parents in the contact-control condition played picture games for the same amount of time. Expected pain was measured on a visual analogue scale (VAS) and the Faces Pain Scale-Revised (FPS-R) before and after the parental information or contact-control procedure. Experienced pain was measured on the same two scales immediately after the ear piercing. Prepared children had more accurate expectations and reported significantly less pain (M=27.3) than non-prepared children (M=49.8). The validity of the measures was supported by strong correlations (r=0.87 to 0.96) between the VAS and FPS-R. The findings suggest that parental provision of preparatory information creates accurate expectations and reduces pain for children.

Structuring psychosocial care in pediatric oncology

The requirements for high quality psychosocial care for children with cancer and their families are steadily increasing. As an additional supplement to medical and nursing care, psychosocial work has to consider both the requirements of the medical treatment and the associated stress factors. It is essential to structure the different possibilities of intervention in a way which guarantees the practice of psychosocial care within the ongoing medical care. This requires a standardized psychosocial care manual. In July 1994, a 'Manual for Psychological Care in Pediatric Oncology' was put into practice and has been continually improved in the Department of Pediatric Hematology/Oncology of the University of Bonn. It contains special indications for different standards of psychosocial care, is oriented according to the phases and situations of medical treatment, and consists of a health education program as well as special care measurements. The latter are related to both the stressors primarily caused by the requirements of familial adherence to medical and nursing care and the stressors primarily caused by factors of the individual or the familial life circumstances. The theoretical basis of this manual and concrete information for its use are described in this paper.