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.     

Assessing Medical Room Behavior During Infants' Painful Procedures: The Measure of Adult and Infant Soothing and Distress (MAISD)

This study evaluated the Measure of Adult and Infant Soothing and Distress (MAISD) for examining infant, parent, and nurse behavior during infants' immunizations. Videotapes of 62 infants, parents, and nurses during immunizations were coded. Concurrent validity and reliability for the MAISD were demonstrated. The scale revealed that infants displayed predominately distress, and adults exhibited primarily reassurance. Parents' and nurses' distractions were positively related to infants' engaging in distraction, and parents' and nurses' reassurance was positively associated with infants' distress. There appear to be avenues in which to intervene to teach parents and nurses how to best behave to help infants during their painful medical events.     

The Effects of Parental Reassurance Versus Distraction on Child Distress and Coping During Immunizations

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.     

Assessment of Coping With Invasive Procedures in Children With Cancer: State-Trait and Approach-Avoidant Dimensions

We examined the relation between children's trait-dependent coping styles and situation-specific coping behaviors during invasive medical procedures. Children with cancer (N = 66) completed the Children's Behavioral Style Scale (CBSS), a measure of approach-avoidant coping styles, and the Procedural Coping Questionnaire (PCQ), an analogous measure of coping behaviors specific to invasive procedures developed for this study. Parents also completed a parent-report version of the PCQ, and both parents and children rated the severity of the child's distress before, during, and after the procedure. Factor analysis of thePCQ produced 3 distinct factors with adequate internal reliability (attention to sensory stimuli, cognitive strategies, preference for sedation), none of which were directly interpretable within the CBSS approach-avoidant framework. CBSS scores did not significantly predict procedural distress, although the higher total coping behavior scores on the PCQ were associated with greater distress, suggesting that higher levels of distress lead to an increase in all categories of coping behaviors. Pending further validation with behavioral observation methods, the PCQ may provide a useful measure of child coping behaviors related to medical procedures.     

Parenting and Child Distress During Cancer Procedures: A Multidimensional Assessment

We examined the relationship between children's distress during invasive cancer procedures and patent anxiety, parent disciplinary attitudes, and parent behavior during the medical procedure. Sixty-six children with cancer and their parents were evaluated during a routine bone marrow aspiration. Significantly higher levels of distress were obtained for young (under age 8) versus older children. Patterns of relationships with parent variables also varied by age. Anxious parents of young children reported relying on less effective discipline strategies. They also were less reassuring prior to the medical procedure and were more agitated during the procedure. Young children's distress was positively associated with parental reassurance, ignoring, and agitation before the procedure and with information-giving during the procedure. Older children's distress was negatively associated with parental distraction during the procedure. Age differences in the correlations between child distress and parenting are discussed in terms of developmental differences in children's dependence on caregivers for emotional regulation and control. Implications for clinical distress reduction programs are also discussed.     

幼儿应对方式对幼儿问题行为的影响

目的 探讨了幼儿的应对方式、应对方式在父母教养方式、幼儿的问题行为之间的中介作用。方法 采用情境故事评价的方法、幼儿父母教养方式问卷、Achenbach幼儿问题行为量表分别测查幼儿的应对方式、幼儿父母的教养方式以及幼儿的问题行为。结果 3～5岁幼儿对应对策略的采用具有情境差异性;4、5岁儿童的问题趋向应对比例均数（分别为0．42±0．28,0．41±0．30）显著大于3岁儿童（0．21±0．19）;问题趋向应对对幼儿的外显和内隐问题行为均有明显的负向预测作用,且在父母的教养方式影响儿童的问题行为中起到部分的中介作用。结论随着年龄的增长,幼儿的应对方式渐趋成熟。问题趋向应对是一种积极的应对方式,可有效预防幼儿的问题行为。     

The Relation Between Nonessential Touch and Children's Distress During Lumbar Punctures

This study represents a first step in assessing the effectiveness of touch that is unrelated to the execution of the medical procedure (nonessential touch) as a means of reducing children's distress during an invasive cancer procedure. The relation between children's overt distress behaviors and adult use of soothing or neutral nonessential touch during lumbar punctures was assessed in 50 children diagnosed with cancer, their parents, and the nursing staff. Contrary to expectation, results indicate that the nonessential touch of parents was unrelated to children's distress behaviors. However, nurses' provision of soothing and/or neutral nonessential touch was consistently related to lower child distress. A stronger inverse relationship between nurse soothing/neutral nonessential touch and child distress was found for children evidencing high anticipatory distress and young children. Overall, results suggest that nurses' soothing/neutral nonessential touch may be effective in reducing children's distress during an invasive medical procedure.     

Children's Distress During magnetic Resonance Imaging Procedures

We investigated the epidemiology of pediatric anxiety and distress associated with magnetic resonance imaging procedures (MRIPs). Scores on the State Trait Anxiety inventory (Spielberger, Gorsuch, Lushene, Vagg, & Jacobs, 1983) and the State-Trait Anxiety Inventory for Children (Spielberger, Edwards, Lushene, Montuori, & Platzek, 1973), and subjective ratings of distress associated with MRIP were obtained from 55 pediatric oncology patients and their parents. Approximately 30% of children and their parents reported that MRIP produced significant distress. However, parents' ratings of their child's distress were significantly higher than children's self-ratings, and agreement between child and parent pairs was poor. Insertion of an intravenous line was identified as the most aversive component of MRIP by both parents (55%) and children (38%). The selective application of cognitive-behavioral interventions for noninvasive diagnostic procedures is suggested.     

Children's Behavior During Immunization Injections: A Principle Components Analysis

Observational assessment is an important component of a comprehensive evaluation of children's procedural pain. An understanding of children's behavior during painful procedures can inform the structure of these measures and is important in the development of effective interventions. This study used principle components analyses to evaluate the structure of children's behavior during routine immunizations. Videotapes of 159 children undergoing routine immunizations were coded using the Child-Adult Medical Procedure Interaction Scale (Blount et al., 1989). Results indicated a 4-component solution was the most appropriate categorization and accounted for 61.2% of the variance in children's behavior. The first 3 components represented “verbal fear” (seeking emotional support, verbal fear, information seeking), “vocal pain” (cry, verbal resistance, verbal pain), and “escape behavior” (need for restraint, flail). The final component, “other verbal behavior” consisted of nonprocedural talk and negative verbal emotion. Taken together, the preliminary results of the correlational analyses and the subsequent principal components analyses support the assertion that children's distress is a multidimensional experience and should be evaluated as such. Attention to multiple dimensions of distress is important in the evaluation of interventions as they may differentially target these dimensions.     

Why do physicians think parents expect antibiotics? What parents report vs what physicians believe

OBJECTIVE: To examine the relation between parent expectations for antibiotics, parent communication behaviors, and physicians' perceptions of parent expectations for antibiotics. STUDY DESIGN: A nested cross-sectional study with parallel measures of parents presenting children for acute respiratory infections (previsit) and physicians (postvisit) and audiotaping of the encounters. POPULATION: Ten physicians in 2 private pediatric practices (1 community-based and 1 university-based) and a consecutive sample of 306 eligible parents (response rate, 86%) who were attending sick visits for their children between October 1996 and March 1997. OUTCOMES MEASURED: Communication behaviors used by parents expecting antibiotics and physicians' perceptions of parents' expectations. RESULTS: Parents' use of "candidate diagnoses" during problem presentation increased the likelihood that physicians would perceive parents as expecting antibiotics (from 29% to 47%; P=.04), as did parents' use of "resistance to the diagnosis" (an increase from 7% to 20%). In the multivariate model, parents' use of candidate diagnoses increased the odds that a doctor would perceive a parental expectation for antibiotics by more than 5 times (odds ratio, 5.23; 95% confidence interval, 3.74-7.31; Plt.001), and parents' use of resistance to a viral diagnosis increased these odds by nearly 3 times (odds ratio, 2.73; 95% confidence interval, 1.97-3.79; Plt.001). CONCLUSIONS: Parents perceived as expecting antibiotics may be seeking reassurance that their child is not seriously ill or that they were correct to obtain medical care. Physicians were significantly more likely to perceive parents as expecting antibiotics if they used certain communication behaviors. This study revealed an incongruity between parents' reported expectations, their communication behaviors, and physicians' perceptions of parents' expectations.     

Toddlers' adjustment to the stress of immunization in function of mothers' general and specific coping tendencies

The aim of this research is to assess the relative influence of mothers' coping strategies in everyday life and mothers' specific coping acts on toddlers' adjustment behavior to pain and distress during a routine immunization. The population is 41 mothers with toddlers (23 girls, 18 boys; mean age, 22.7 months) undergoing a routine immunization in private pediatrician practices. Mothers completed questionnaires about their own coping tendencies and about their toddler's preparation for the immunization. Toddlers' emotional adjustment to the situation was assessed by pediatricians. Results show that children who were informed by their mothers beforehand about the immunization were less distressed. Mothers were more likely to inform their toddler when their general coping options were rather self-oriented than child-oriented and when they were not using avoidant coping strategies. Mothers' own emotional regulation is thus related to coping with medical procedures in their young children.     

Parents and Drug Education: Parents' Concerns, Attitudes and Needs

Parents play a key role in their children's education and social development and therefore can be very influential to their children's learning about drugs. Despite this there has been little research done to date that explores parents' perceptions. This paper reports research from questionnaires, which sampled 947 parents of 14-16-year-olds, telephone interviews of 60 of these responses and six focus groups of primary and secondary school parents. The issues explored included parents' concerns, needs and knowledge of drugs issues in respect to their children as well as parents' perspective on drug education. The results show that parents are concerned about drugs in relation to their children, and report that drugs are easily available to young people and very much part of today's youth culture. The study revealed that parents are largely misinformed about the drug situation and request accurate and up-to-date information. They are unaware of their children's school drug policies and programmes and feel the need for easier access to relevant services. Parents rate drug education as important and report it should begin at late primary school age. Parents predominantly want their children to be taught the 'Just Say No' message. Finally, issues of communication about drugs, between parent(s) and their chiid(ren), were raised. A number of implications of the results for drug education are presented.     

Restricting Access to Foods and Children's Eating

This study evaluated maternal restriction of children's access to snack foods as a predictor of children's intake of those foods when they were made freely available. In addition, child and parent eating-related "risk" factors were used to predict maternal reports of restricting access. Participants were 71, 3-to-5-year-old children (36 boys, 35 girls) and their parents. Children's snack food intake was measured immediately following a meal, in a setting offering free access to palatable snack foods. Child and maternal reports of restricting children's access to those snack foods were obtained. In addition, information on child and parent adiposity as well as parents' restrained and disinhibited eating was used to examine "risk" factors for restricting access. For girls only, child and maternal reports of restricting access predicted girls' snack food intake, with higher levels of restriction predicting higher levels of snack food intake. Maternal restriction, in turn, was predicted by children's adiposity. Additionally, parents' own restrained eating style predicted maternal restriction of girls' access to snack foods.     

家长营养知识和态度对子女饮食行为的影响

目的了解家长营养知识和态度对子女饮食行为的影响程度，为有针对性地对其进行营养教育提供科学依据。方法采用问卷调查法对深圳市300名学龄儿童及其家长进行营养知识、态度、行为的调查。结果家长对儿童营养知识普遍缺乏，大部分学龄儿童存在着不同程度的各种不良饮食习惯，如不吃早餐、吃零食、挑食、偏食、进食速度过快和膳食搭配不合理等。结论家长的营养知识和态度对子女饮食行为和食物消费结构有明显影响；但家长和学生接受营养知识的态度较好，说明在家长和学生中开展有针对性地营养健康教育是非常必要和可行的。     

Parental concerns and medical-seeking behavior after immunization

OBJECTIVE: To examine demographics and immunization attitudes, beliefs, and behaviors of parents who sought medical attention for a child due to an adverse event following immunization (AEFI). METHODS: A sample of households that participated in the National Immunization Survey was re-contacted during 2001. This analysis was conducted in 2004 and 2005. RESULTS: Of 2286 respondents, 223 (6.9%, weighted) sought medical attention for a child due to an AEFI. Compared with parents reporting no adverse event, parents who sought medical attention were less likely to be African American (adjusted odds ratio [AOR]=0.34, 95% confidence interval [CI]=0.16-0.75) or Hispanic (AOR=0.16, 95% CI=0.07-0.39) versus white, aged 35 years or older versus 25 to 34 (AOR=0.35, 95% CI=0.17-0.72), more likely to believe that immunizations cause minor side effects (AOR=5.74, 95% CI=2.99-11.00), report unwanted yet required childhood immunizations (AOR=3.54, 95% CI=1.45-8.66), not want a new baby to be fully immunized (AOR=3.48, 95% CI=1.25-9.67), report concern about immunization safety (AOR=2.08, 95% CI=1.07-4.05), believe that immunizations are dangerous (AOR=3.56, 95% CI=1.14-11.13), and have a child missing two or more doses of three immunizations (measles-containing vaccine, DTaP/DTP, or hepatitis B) (AOR=2.30, 95% CI=1.17-4.55). CONCLUSIONS: This study suggests that research is needed to determine whether negative parental attitudes associated with a child's AEFI might be lessened by improving vaccine safety communication between physician and parent.     

儿童家长免疫回忆真实性调查

目的 评估不同文化程度、不同居住环境的不同家长对儿童免疫接种状况回忆的真实程度。方法 采用横断面调查方法,在河南省18个市各随机选择2个县、1个区,分别调查分析1～2岁的常驻儿童和流动儿童家长免疫回忆的真实性。结果 全省儿童基础免疫四苗全程接种率为89.7％,其中流动儿童为77.9％。儿童家长回忆孩子接种过疫苗的真实性高达96％以上;接种过疫苗的儿童,其家长能明确回忆其接种过该疫苗的比例不超过50％;家长文化程度为中学及以上的免疫回忆真实性高于文盲及小学者;儿童母亲的免疫回忆真实性高于父亲;在家长免疫回忆为不详的儿童中,有高达97％以上的儿童均接种过相关疫苗。结论 儿童家长对已接种过疫苗的肯定回答具有很高的可信性;文化程度较高的儿童母亲,对儿童的免疫回忆具有更高的可信性;免疫史回忆不详的儿童不能作为未免疫者。     

The role of parental presence in the context of children's medical procedures: a systematic review

BACKGROUND: There are conflicting views and practices regarding whether or not parents should be present at the time of their child's medical procedure. A systematic review was conducted to assess the effects of parental presence in the paediatric treatment room on child, parent and health professional outcomes and to synthesize this body of literature. METHODS: Based on a comprehensive literature search, studies investigating parental presence in the paediatric treatment room were included in the review if they had a concurrent control group (i.e. a parent-absent group). RESULTS: A total of 28 studies met inclusion criteria, which included 1256 children with a parent present and 1025 children without a parent present. There were mixed findings regarding the effect of parental presence on measures of child distress and affect, however, studies of lower levels of evidence were more likely to report significant results. Parents who were present during their child's medical intervention were either better off or no different from parents who were absent with regard to their levels of distress and satisfaction. There was no evidence of increased technical complications nor elevated staff anxiety for health professionals attending to children with a parent present as compared to attending to children without their parents. DISCUSSION: Although parental presence may not have a clear, direct influence on child distress and behavioural outcomes, there are potential advantages for parents. It seems appropriate that clinicians provide parents with the opportunity to be present during their child's painful procedure.     

Predicting children's meal preferences: how much do parents know?

We investigate how accurate parents are at predicting their children's meal preferences and what cues best describe parents' predictions. In Study 1, 30 parents predicted their children's school lunch choices from actual school menus. Parents' prediction accuracy matched the stability of children's meal choices (assessed in a 4-month retest), implying that accuracy was as high as can be expected. Parents appeared to make their predictions by using specific knowledge about their child's likes and by projecting their own preferences. In Study 2, we asked 58 parents to predict their children's preferences for 30 randomly drawn school meals, and compared them to the children's actual preferences. Again, parents showed high prediction accuracy and predicted the lunches their children liked correctly more often than the disliked ones. Overall, parents' accuracy in predicting their children's food preferences was as good as or better than found in previous preference prediction studies that used less ecologically relevant task domains.     

Enhancing Head Start parents' conceptions of literacy development and their confidence as literacy teachers: a study of parental involvement

This study examined the influence of six African-American parents' involvement in literacy-related activities at Head Start on their self-confidence, responsivity and sensitivity to children's emerging literacy behaviors. Assuming the role of “parent-teachers” in a literacy-enriched play office setting, the parents engaged children, who voluntarily entered the setting, in literacy-related play over a five month period. Based on ethnographic-like interviews with them, videotaped observations, and self-observation reports drawn from videotaped excerpts, the parents' communication patterns at three points in the study were determined and their views of themselves as literacy teachers described. Results indicated variation in the parents' communication patterns toward greater verbal interaction and acknowledgement of children's emergent literacy behaviors. Content analyses of parental attitudes suggested subtle changes in their confidence and sense of efficacy as teachers following their involvement with the children in the literacy-enriched play setting. Implications for the design and implementation of parental involvement activities in school settings are briefly discussed.     

The Relationship Between Classroom Quality and Ratings of the Social Functioning of Head Start Children

Classroom quality throughout three Head Start programs in the southeastern United States was monitored. A random sample of classrooms was selected to represent high and low quality classrooms in urban and rural settings. Parents and teachers rated the social behaviors of 328 children who were nested within 40 classrooms. Maternal depression was associated with parent reports of fewer positive social behaviors and more problem behaviors. Parent-reported home violence was associated with fewer disruptive behaviors as reported by the teacher. Higher quality classrooms tended to have lower scores on a parent-reported measure of children's problem behaviors. Teachers who interacted less positively with children tended to rate the children in their classrooms as more compliant. The teacher's ability to individualize instruction tended to moderate the association between the child's age and prosocial behaviors while also moderating the association between maternal depression and parents' reports of their children's problem behaviors.