Factors associated with young children's long-term recall of an invasive medical procedure: a preliminary investigation

Acceptability of a novel device to improve child patient experience during venepuncture for blood sampling: Intervention with 'MyShield'

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.

Considerations for Pursuing Multiple Session Forensic Interviews in Child Sexual Abuse Investigations

Multiple session forensic interviews (MSFI) are a useful tool in the field of child sexual abuse forensic interviewing given the complexity of disclosures and the variety of child-centered needs observed in practice. This paper focuses on the Children's Advocacy Centers of Texas (CACTX) model for conducting MSFIs, illustrated by a description of the statewide training models offered to member centers and enumeration of the MSFI protocol guidelines implemented by one center. A brief history and review of the single session forensic interview (SSFI) is provided followed by considerations for MSFIs in order to establish the development of current and new practices. Clarification of terms are outlined with examples of cases to distinguish between multiple sessions and subsequent sessions. The MSFI guidelines presented demonstrate how an MSFI can fit with the SSFI model.

Role of Emotional Appraisal in Episodic Memory in a Sample of Argentinean Preschoolers

Emotional processing and episodic memory are closely related throughout childhood development. With respect to emotional episodic memory, available evidence shows that the consolidation of information is accompanied by an arousal that generates longer duration and persistence of the memory representations. In the case of early stages of development (i.e., first 5 years), it is less clear how these associations emerge and are modulated by individual and environmental factors. In this study, 116 4- to 5-years old Argentinean children from different socio-environmental contexts (i.e., favorable or unfavorable living conditions at home), performed a task of visual emotional memory in which they observed a set of 15 images with variable emotional valences (negative, neutral, and positive). The child’s task was to appraise each image using one of the following three possible valences: (a) drawings of faces with smiles (positive valence), (b) drawings of faces with tears and round mouth with edges down (negative valence), or (c) drawings of faces with horizontal mouth (neutral valence). Five years-old children exhibited greater accuracy appraisal. Individual differences in emotional accuracy appraisal allowed us to observe different performances in free recall of negative visual images. Accuracy appraisal did not vary between children with respect to gender, living conditions at home, or language ability. Seven to ten days after the emotional appraisal children were asked to tell the experimenter all the images they remembered (variables of interest: free recall of negative, positive, or neutral images). Results showed individual (age) differences. Specifically, 5-years-old children evoked more images than 4-years-old children. These findings contribute to the understanding of emotional memory in early developmental stages and raise the need to include emotional appraisal in the assessment of episodic memory.

The relationship between processing style, trauma memory processes, and the development of posttraumatic stress symptoms in children and adolescents

BACKGROUND AND OBJECTIVES

Data-driven processing, peri-event fear, and trauma memory characteristics are hypothesised to play a core role in the development of Posttraumatic Stress Disorder. We assessed the relationships between these characteristics and Posttraumatic Stress (PTS) symptoms in a sample of youth.

METHODS

Study 1 (N = 36, 7-16 years), involved a sample of children who had undergone a stressful orthopaedic procedure. One week later they answered a series of probed recall questions about the trauma (assessed for accuracy by comparison to a video) and reported on their PTS symptoms. They also rated confidence in their probed recall answers to assess meta-cognitive monitoring of their memory for the trauma. In Study 2, a sample of injured children (N = 57, 7-16 years) were assessed within 1-month of a visit to an Emergency Department, and then at 3-month follow-up. They answered probed recall questions, made confidence ratings, and completed measures of data-driven processing, peri-event fear, PTS and associated psychopathology. Memories were verified using witness accounts.

RESULTS

Studies 1 and 2 did not find an association between PTS symptoms and trauma memory accuracy or confidence. In Studies 1 and 2 data-driven processing predicted PTS symptoms.

LIMITATIONS

The studies had modest samples sizes and there were ceiling effects for some accuracy and confidence items.

CONCLUSIONS

Data-driven processing at the time of a trauma was associated with PTS symptoms after accounting for fear at the time of the trauma. Accuracy of recall for trauma memories was not significantly related to PTS symptoms. No decisive conclusion could be drawn regarding the relation between confidence in trauma memories and PTS symptoms.

Use of sedative drugs at reducing the side effects of voiding cystourethrography in children

BACKGROUND

Imaging of the kidneys and urinary tract has a significant and critical role for diagnosis of genitourinary system diseases. Although technological progress goes toward less invasive approaches, some of the current methods are still invasive and annoying. Voiding cystourethrography (VCUG) is the best and most accurate method for diagnosis and grading of vesicoureteral reflux. VCUG is a distressful procedure that gives serious anxiety and pain in a large proportion of children and fear for parents; therefore, using effective sedative drugs with the least side effects is necessary and should be considered.

MATERIALS AND METHODS

In this review article, importance and efficacy of different drugs before catheterization VCUG be compared in the base of literature survey on EMBASE, PubMed, and Cochrane source.

RESULTS

We found that the treatment should be based on nonpharmacological and pharmacological methods; nonpharmacological treatment includes the psychological preparation before procedures as a safety precaution with little or no risk modality, as well as reassuring support. The presence of parents during painful procedures cannot alleviate children distress. Pharmacological methods include oral midazolam (0.5 mg/kg) and intranasal use (0.2 mg/kg) that had been used 10 min before the procedure can effect on anterograde amnesia and sedation without considerable effect on accuracy and grade of reflux. Nitric oxide has a shorter recovery time versus midazolam but has a potential risk for deep sedation and may interfere with the child's voiding phase.

CONCLUSION

In summary, oral midazolam of 0.5-0.6 mg/kg or 0.2 mg/kg intranasal is acceptable drug that can be used before VCUG.

Matching doses of distraction with child risk for distress during a medical procedure: a randomized clinical trial

BACKGROUND

Parents often want to provide support to their children during medical procedures, but not all parents are effective in providing distraction after brief training.

OBJECTIVE

The aim of this study was to investigate the effects of three doses of distraction intervention for children at high and medium risk for procedure-related distress.

METHODS

Children undergoing scheduled intravenous insertions for diagnostic or treatment purposes and their parents participated. A computerized application, Children, Parents and Distraction, was used to predict distress risk. Doses of intervention were basic (parents trained on providing distraction), enhanced (basic training plus tailored instructions, environmental modifications, and support and guidance from the research assistant), and professional (a trained research assistant provided distraction). Outcome measures were Observational Scale of Behavioral Distress-Revised for behavioral distress, Oucher for self-reported pain, parent report of child distress, and salivary cortisol for physiological distress.

RESULTS

A total of 574 children, ages 4-10, and their parents participated. The Children, Parents and Distraction predicted that the risk for distress was high for 156 children, medium for 372, and low for 46. Children predicted to have higher risk for distress displayed more behavioral distress (p < .01). Children in the medium-risk group who had the professional intervention displayed significantly less behavioral distress (p < .001). Children in the high-risk group tended to have less behavioral distress when receiving the professional intervention (p = .07). There were no significant group differences for self-report of pain, parent report of distress, or cortisol levels.

DISCUSSION

Some parents may need additional training in providing distraction to their children during procedures, and some children at medium and high risk for distress may need professional support. Parents should be asked about their preferences in acting as the distraction coach and, if willing, be provided as much training and support as possible in the clinical situation.

Factors explaining children's responses to intravenous needle insertions

BACKGROUND

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.

OBJECTIVES

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.

METHODS

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.

RESULTS

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.

DISCUSSION

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.

Impact of Parent-Provided Distraction on Child Responses to an IV Insertion

This study evaluates the impact of parent-provided distraction on children's responses (behavioral, physiological, parent, and self-report) during an IV insertion. Participants were 542 children, 4 to 10 years old, randomized to an experimental group that received a parent distraction coaching intervention or to routine care. Experimental group children had significantly less cortisol responsivity (p = .026). Children that received the highest level of distraction coaching had the lowest distress on behavioral, parent report, and cortisol measures. When parents provide a higher frequency and quality of distraction, children have lower distress responses on most measures.

Children's autobiographical reports about sexual abuse: A narrative review of the research literature

BACKGROUND

The empirical and theoretical literature on children's autobiographical statements about child sexual abuse and other forms of maltreatment should be of potential importance to all professionals who regularly interview children as part of their professional duties.

AIMS

To present an introduction to this field.

METHODS

Narrative review.

RESULTS

Preschool children appear to be capable of providing reliable testimony on highly salient personal experiences such as sexual abuse, though a substantial proportion of children may choose not to. However, suggestive interviewing practises, particularly when used with younger children, may elicit false allegations. There is little evidence to suggest that experiences from the preverbal period of life can later be meaningfully reconstructed by means of statements or clinical signs.

CONCLUSIONS

Use of children as witnesses and informants requires special considerations, knowledge and skills.

The role of coping and temperament in the adjustment of children with cancer

OBJECTIVE

To examine the extent to which stress, coping, and temperament accounted for variability in adjustment among children with cancer.

METHODS

Seventy-five mothers of children with cancer (ages 5-17) completed questionnaires regarding their child's cancer-related stress; coping; temperament characteristics including positive affect (PA), negative affect (NA), and effortful control (EC); and symptoms of anxiety and depression. Assessments occurred within one year of initial diagnosis or relapse (M = 5.74 months; SD = 4.72).

RESULTS

Cancer-related stress was positively associated with symptoms of depression in children. NA was positively associated with symptoms of anxiety and depression. Primary control coping moderated the association between NA and depression, and primary and secondary control coping mediated this association.

CONCLUSION

Results partially support the utility of an integrated model including cancer-related stress, coping, and NA in identifying children at risk for internalizing symptoms during treatment. Additional research is needed to inform interventions for this population.

Children with high and intermediate imperforate anus: remembering and talking about medical treatment carried out early in life

Treatment of children with high and intermediate imperforate anus entails several different surgical procedures during the first 3-12 months of life, which are accompanied by a strict follow-up treatment regimen. It has not been studied whether the children remember this treatment carried out early in life. Research has shown that small children may demonstrate so-called non-verbal memories of salient events occurring in early childhood. The purpose was to examine whether children with imperforate anus showed distressing memories of previous medical treatment and whether parent-child dialog about medical treatment is related to the child's psychosocial functioning later in life. Parents of 25 children (9 boys, 16 girls) with high and intermediate imperforate anus participated in the study. The mean age among the children was 10.5 years (range 8.0-13.6). A comparison group of 30 children (5 boys and 25 girls) with juvenile chronic arthritis also participated in the study. The mean age was 10.6 years (range 7.8-13.6). All parents answered the Child Behavior Checklist (CBCL/4-18) and a study-specific questionnaire. Children in both groups were reported to show distressing memories of early treatment. Children who had been talked to showed good psychosocial function and were in a better mood and less angry than those who had not been talked to. Parent-child discussions about the child's experiences of medical treatment did not seem to be harmful or in any other way detrimental to the child, instead such discussions seemed to facilitate the child's psychosocial functioning.

Children's recall of emotionally arousing, repeated events: a review and call for further investigation

The influence, if any, of emotional arousal on memory is a controversial topic in the literature. Much of the research on memory for emotionally arousing events has focused on a few specific issues (e.g., differences in types of details recalled in emotionally arousing and neutral events; increasing ecological validity). Although gaining more recent attention, a neglected area in the literature has been memory for instances of repeated, emotionally arousing events. This issue has important implications for understanding children's ability to recall events in a forensic setting. We review existing findings on memory for emotionally arousing events in general and particularly in children, children's memory for events that occur repeatedly, and then discuss the scarce research on repeated emotionally arousing events and the need for further research in this area. We conclude that although it is clear that children are capable of accurately reporting arousing and repeated experiences, it is also apparent that circumstances both within and outside the control of investigative interviewers influence this ability.

Anxiety in children undergoing VCUG: sedation or no sedation?

BACKGROUND

Voiding cystourethrograms are distressing for children and parents. Nonpharmacological methods reduce distress. Pharmacological interventions for VCUG focus on sedation as well as analgesia, anxiolysis, and amnesia. Sedation has cost, time, and safety issues. Which agents and route should we use? Are we sure that sedation does not influence the ability to diagnose vesicoureteric reflux?

METHODS

Literature search of Medline, EMBASE, and the Cochrane Database. Review of comparative studies found.

RESULTS

Seven comparative studies including two randomised controlled trials were reviewed. Midazolam given orally (0.5-0.6 mg/kg) or intranasally (0.2 mg/kg) is effective with no apparent effect on voiding dynamics. Insufficient evidence to recommend other sedating agents was found. Deeper sedating agents may interfere with voiding dynamics.

CONCLUSION

Midazolam reduces the VCUG distress, causes amnesia, and does not appear to interfere with voiding dynamics. Midazolam combined with simple analgesia is an effective method to reduce distress to children undergoing VCUG.

[The influence of cognitive abilities, age and characteristics of their sexual abuse experience on the statement of the presumed victims]

OBJECTIVE

The goal of the present study was to examine the effects of children's age, cognitive abilities and the characteristics of their sexual abuse experience on the quantity of details revealed about the sexual abuse in an investigative interview as a function of the type of questions asked. METHOD VERSION: Transcripts of 37 investigative interviews conducted with children between 6 and 12 years of age were analyzed according to the type of interviewer questions used and the quantity of details given by the child. The children's cognitive abilities were measured using the vocabulary, information and block design subtests of the WISC-III.

RESULTS

Results of multiple regression analyses indicate that children's age and verbal abilities as well as their relationship with the perpetrator explain 50% of the variance of the mean number of details obtained from the child following open-ended interviewer questions.

CONCLUSION

The results of this study suggest that the quantity of details obtained during an investigative interview is influenced not only by children's age but also by their verbal skills and the child-perpetrator relationship.

Clinical course of prenatally detected primary vesicoureteral reflux

The purpose of this study was to report the clinical course of medium-long-term follow-up of children with prenatally detected vesicoureteral reflux (VUR). Between 1986 and 2004, 53 (41 males) children with VUR detected by investigation of prenatal hydronephrosis were followed up for a mean time of 66 months (range: 6-200 months). Newborns were investigated by ultrasound, voiding cystourethrogram (VCUG) and DMSA scan. Follow-up clinical visits were performed at 6-month intervals. After 24 months patients were investigated by conventional VCUG or direct isotope cystogram. Survival analysis was performed in order to evaluate the resolution of the reflux. Differences between subgroups (mild vs moderate/severe reflux) were assessed by the two-sided log rank test. Thirty (58%) infants presented bilateral VUR, for a total of 83 renal units. There was a predominance of severe reflux (54%). Renal damage was detected in 33.7% of the units on first renal scan. There was a significant correlation between severe reflux and renal damage scars (RR=3.4, 95% confidence interval [CI], 1.4-8, p=0.002). Forty-seven patients were treated with continuous prophylaxis. One patient developed systolic hypertension. Urinary tract infection occurred in 12 (25%) children conservatively managed. VUR resolution was evaluated in 56 renal units. Spontaneous resolution was observed in 25 units (45%). At 48 months after diagnosis, 75% of the cases of mild reflux (I-III) and 37% of severe reflux (IV-V) had resolved (log-rank, 5.6, p=0.017). There was an improvement of nutritional parameters between admission and the end of follow-up. In conclusion, the clinical course of prenatally detected VUR followed up on a medium-long-term basis is relatively benign. Our study corroborates the results obtained in other series of infants with reflux that emphasized the heterogeneity of this disorder.

Brief Report: Optimizing Children’s Memory and Management of an Invasive Medical Procedure: The Influence of Procedural Narration and Distraction

OBJECTIVE

To evaluate the influence of two interventions on children's memory of and distress during a voiding cysto-urethrogram (VCUG, X-ray of the kidneys).

METHODS

Sixty-two children (aged 2.5-7.5 years) were allocated to one of three conditions. In one (CI + D), they received complete procedural information during the VCUG, with a cartoon video. In a second (PI + D), children received limited procedural information, with a cartoon video. In a third (standard care, PI), they received limited procedural information. VCUGs were videotaped and distress was coded using the CAMPIS-R. To assess memory, children were interviewed 1 week later.

RESULTS

Relative to the PI condition, children in the CI + D condition recalled more information, appraised the VCUG as less painful, and were less distressed. There were no differences between the PI + D and PI conditions.

CONCLUSIONS

An inexpensive, theoretically driven intervention can enhance children's memory and reduce distress during an invasive procedure.

Timing of follow-up voiding cystourethrogram in children with primary vesicoureteral reflux: development and application of a clinical algorithm

BACKGROUND AND OBJECTIVES

Of children diagnosed with urinary tract infection, 30% to 40% have primary vesicoureteral reflux (VUR). For the majority of these children, treatment involves long-term prophylactic antibiotics (ABX) and a periodic voiding cystourethrogram (VCUG) until resolution of VUR as detected by VCUG. Radiation exposure and considerable discomfort have been associated with VCUG. To date, no clear guidelines exist regarding the timing of follow-up VCUGs. The objective of this study was to develop a clinically applicable algorithm for the optimal timing of repeat VCUGs and validate this algorithm in a retrospective cohort of children with VUR.

METHODS

Based on previously published data regarding the probability of resolution of VUR over time, a decision-tree model (DTM) was developed. The DTM compared the differential impact of 3 timing schedules of VCUGs (yearly, every 2 years, and every 3 years) on the average numbers of VCUGs performed, years of ABX exposure, and overall costs. Based on the DTM, an algorithm optimizing the timing of VCUG was developed. The algorithm then was validated in a retrospective cohort of patients at an urban pediatric referral center. Data were extracted from the medical records regarding number of VCUGs, time of ABX prophylaxis, and complications associated with either. VUR in patients in the cohort was grouped into mild VUR (grades I and II and unilateral grade III for those < or =2 years old), and moderate/severe VUR (other grade III and grade IV). Kaplan-Meier survival curves were created from the cohort data. From the survival curves, the median times to resolution of VUR were determined for the cohort, and these times were compared with the median times to VUR resolution of the data used for the DTM. The numbers of VCUGs performed, time of ABX exposure, and costs in the cohort were compared with those that would have occurred if the algorithm had been applied to both mild and moderate/severe VUR groups.

RESULTS

Using an algorithm that results in a recommendation of VCUGs every 2 years in mild VUR would reduce the average number of VCUGs by 42% and costs by 33%, with an increase in ABX exposure of 16%, compared with a schedule of yearly VCUGs. For moderate/severe VUR, a VCUG performed every 3 years would reduce the average number of VCUGs by 63% and costs by 51%, with an increase in ABX exposure of 10%. Applying this algorithm to the retrospective cohort consisting of 76 patients (between 1 month and 10 years old) with primary VUR would have reduced overall VCUGs by 19% and costs by 6%, with an increase in ABX exposure of 26%. The patterns of VUR resolution, age distribution, and prevalence of severity of VUR were comparable between previously published results and the retrospective cohort.

CONCLUSIONS

Delaying the schedule of VCUG from yearly to every 2 years in children with mild VUR and every 3 years in children with moderate/severe VUR yields substantial reductions in the average numbers of VCUGs and costs, with a modest subsequent increase in ABX exposure.

Hypnosis reduces distress and duration of an invasive medical procedure for children

OBJECTIVE

Voiding cystourethrography (VCUG) is a commonly performed radiologic procedure in children that can be both painful and frightening. Given the distress that some children experience during the VCUG and the need for children to be alert and cooperative during the procedure, finding a psychological intervention that helps children to manage anxiety, distress, and pain is clearly desirable. This study was designed to examine whether relaxation and analgesia facilitated with hypnosis could reduce distress and procedure time for children who undergo this procedure.

METHODS

Forty-four children who were scheduled for an upcoming VCUG were randomized to receive hypnosis (n = 21) or routine care (n = 23) while undergoing the procedure. The sample consisted of 29 (66%) girls and 15 (34%) boys with a mean age of 7.6 years (SD: 2.5; range: 4-15 years). Ethnic/racial backgrounds were 72.7% white, 18.2% Asian, 4.5% Latino, 2.3% black, and 2.3% Filipino. The mean number of previous VCUGs was 2.95 (SD: 2.51; mode: 2; range: 1-15). Potential participants were identified through computerized hospital records of upcoming VCUGs. Parents were contacted by telephone and invited to participate if their child was eligible. To be eligible for the study, the child must have undergone at least 1 previous VCUG, been at least 4 years of age at that time, and experienced distress during that procedure, and both the child and the participating parent had to be English speaking. Each eligible child and parent met with the research assistant (RA) before the day of the scheduled procedure for an initial assessment. Children were queried regarding the degree of crying, fear, and pain that they had experienced during their most recent VCUG. Parents completed a series of parallel questions. Immediately after this assessment, those who were randomized to the hypnosis condition were given a 1-hour training session in self-hypnotic visual imagery by a trained therapist. Parents and children were instructed to practice using the imaginative self-hypnosis procedure several times a day in preparation for the upcoming procedure. The therapist was also present during the procedure to conduct similar exercises with the child. The majority (83%) of those who were randomized to the routine care control group chose to participate in a hospital-provided recreation therapy program (offered as part of routine care). The program includes demonstration of the procedure with dolls, relaxation and breath work training, and assistance during the procedure. On the day of the VCUG, the RA met the family at the clinic before the procedure, and both the child and the parent rated the child's present level of fearfulness. During the procedure, the RA recorded observational ratings of the child's emotional tone and behavior and timed the overall procedure and its phases. Immediately after the VCUG, the child was asked how much crying, fear, and pain he or she had experienced during the procedure; the parent rated the child's experience on the same dimensions and also how traumatic the procedure had been (both generally and compared with their previous one), and the medical staff rated the degree of procedural difficulty. Outcomes included child reports of distress during the procedure, parent reports of how traumatic the present VCUG was compared with the previous one, observer ratings of distress during the procedure, medical staff reports of the difficulty of the procedure overall, and total procedural time.

RESULTS

Results indicate significant benefits for the hypnosis group compared with the routine care group in the following 4 areas: (1) parents of children in the hypnosis group compared with those in the routine care group reported that the procedure was significantly less traumatic for their children compared with their previous VCUG procedure; (2) observational ratings of typical distress levels during the procedure were significantly lower for children in the hypnosis condition compared with those in the routine care condition; (3) medical staff reported a significant difference between groups in the overall difficulty of conducting the procedure, with less difficulty reported for the hypnosis group; and (4) total procedural time was significantly shorter-by almost 14 minutes-for the hypnosis group compared with the routine care group. Moderate to large effect sizes were obtained on each of these 4 outcomes.

CONCLUSIONS

Hypnotic relaxation may provide a systematic method for improving the overall medical care of children with urinary tract abnormalities and may be beneficial for children who undergo other invasive medical procedures. Because the VCUG is an essential part of the evaluation of urinary tract infections and vesicoureteral reflux in children, lower distress during the procedure may improve patient and family compliance with initial as well as follow-up evaluations. These findings augment the accumulating literature demonstrating the benefits of using hypnosis to reduce distress in the pediatric setting. The present findings are noteworthy in that this study was a controlled, randomized trial conducted in a naturalistic medical setting. In this context, we achieved a convergence of subjective and objective outcomes with moderate to large effect sizes, including those that may have an impact on patient care and procedure cost, that were consistently supportive of the beneficial effects of hypnosis-a noninvasive intervention with minimal risk. The findings, therefore, have immediate implications for pediatric care. Limitations of this study include the lack of participant and staff blindness to the child's condition assignment, which could have introduced bias into reports. However, the objective procedural time differences between groups were consistent with the other, more subjective outcome findings. The sample was also small and primarily white in ethnic/racial makeup, which may have restricted our ability to detect some differences and may limit the generalizability of findings to more representative samples. In addition, the sample comprised children who had already undergone at least 1 VCUG during which they had had difficulty. Consequently, additional research is needed to determine whether hypnosis would be helpful to those who are undergoing their first VCUG. Additional limitations, clinical observations, and directions for future research are also discussed.

Children's memory for pain: overview and implications for practice

Children's memories of painful experiences can have long-term consequences for their reaction to later painful events and their acceptance of later health care interventions. This review surveys research on children's memory for pain, emphasizing implications for clinical practice. Topics reviewed include consequences of children's memories of pain; the development of memory; differences between explicit (declarative, verbal, autobiographic) memory and implicit (nondeclarative, nonverbal) memory; and individual differences, situational, and methodologic factors affecting memories of pain. Methods to prevent the adverse consequences of remembered pain are addressed with reference to current research on editing or reframing memories.

PERSPECTIVE

This review covers topics of value to clinicians providing care to children undergoing painful procedures. Specific recommendations are offered regarding the importance of acknowledging and assessing children's previous memories of painful experiences, the type of information that benefits children before and after procedures, and the most appropriate questioning strategies. It might be possible to prevent or reduce the adverse effects of memories of pain.