Pain that recurs or persists is unfortunately a common experience for children. One of the unique considerations in pediatric chronic pain management is the bidirectional influences of children’s pain experiences and parental and family factors. In this review we present a developmental perspective on understanding pediatric chronic pain and disability, highlighting factors relevant from infancy to adolescence, and family and parent influences. Preliminary evidence indicates that developmental processes are influenced and may also shape the pediatric pain experience. Parent emotions, behaviors, and health also play a role in children’s pain experiences, where overly protective parent behaviors, increased distress, and history of chronic pain are important parent level influences. Research on family level influences has revealed that families of children with chronic pain have poorer family functioning (e.g., more conflict, less cohesion) than families of healthy children. Several important gaps exist in this research, such as in understanding basic developmental processes in children with chronic pain and how they influence children’s perception of and responses to pain. Also, there is a lack of longitudinal data on family relationships and individual adjustment to allow for understanding of whether changes occur in parenting over the course of the child’s chronic pain experience. Although parent interventions have been successfully incorporated into many cognitive-behavioral treatments for children with chronic pain conditions, little guidance exists for adapting intervention strategies to be developmentally appropriate. Additional research is needed to examine whether parent interventions are effective at different developmental stages and the best way to incorporate developmental goals into treatment.

Racial socialization was examined as a protective factor that might buffer African American youth from the negative effects of perceived racial discrimination. Two types of racial socialization were examined: messages about race pride and preparation for bias. One hundred twenty-eight eighthgrade African American students participated in the study. As anticipated, both types of socialization moderated the relationship between discrimination and self-esteem. The negative relationship between perceived discrimination and self-esteem was mitigated for youth who reported more messages about race pride and a moderate amount of preparation for bias from their parents. In contrast, low race pride socialization and both high and low preparation for bias were associated with a negative relationship between perceived discrimination and self-esteem.The rapid physical, psychological, and social changes that occur during adolescence have ramifications for individuals' evolving sense of identity and make youth vulnerable to a variety of risk factors (Caldwell, Kohn-Wood, Schmeelk-Cone, Chavous, & Zimmerman, 2004). This period may be especially daunting for African American youth as they face the task of developing a positive sense of self as members of a minority group while becoming increasingly aware that society is stratified by ethnicity and race. Racial discrimination, defined as "beliefs, attitudes, institutional arrangements, and acts that tend to denigrate individuals or groups because of phenotypic characteristics or ethnic group affiliation," is often viewed as such a risk factor (Clark, Anderson, Clark, & Williams, 1999, p. 805). Wong, Eccles, and Sameroff (2003) suggest that racism is seen as messages from the environment that individuals are not valued due to their race or ethnicity. Such messages may be particularly salient during adolescence, a vulnerable developmental period when the individual is formulating his or her identity and conceptualizations about the social world.A large body of literature has linked perceived racial discrimination to deleterious physiological and psychological outcomes in African American adults (see Clark et al., 1999, for a review). More recently, researchers have begun to explore the effects of racial discrimination on child and adolescent populations. Results from a number of studies have linked experiences of discrimination and perceived racism to a range of psychosocial (Caldwell et al., 2004;Clark, Coleman, & Novak, 2004;DuBois, Burk-Braxton, Swenson, Tevendale, & Hardesty, 2002;Fisher, Wallace, & Fenton, 2000;Nyborg & Curry, 2003;Prelow, Danoff-Burg, Swenson, & Pulgiano, 2004;Wong et al., 2003). Nonetheless, relatively few studies have investigated possible protective factors that may buffer against the negative effects of perceived discrimination (see Caldwell et al., 2004;Sellers & Shelton, 2003; Wong et al., 2003, for exceptions). Thus, the primary goals of the current study were to investigate the link between perceived racial discrimination and psychological w...

Objective The primary aim of this systematic review was to examine the evidence for a pain-sleep relationship in children with persistent pain by reviewing studies using single and mixed pediatric persistent pain samples. Method Electronic searches of Medline, PubMed, the Cochrane Database of Systematic Reviews, and PsycINFO were conducted to identify all relevant empirical studies. Studies were included in the review if the majority of participants were between 0-17 years and from one of the following pediatric pain populations: juvenile idiopathic arthritis, sickle cell disease, migraine/headache, functional abdominal pain, juvenile fibromyalgia syndrome, chronic musculoskeletal pain, or mixed populations including the aforementioned conditions. Results Research from single and mixed sample studies support the hypothesis that children and adolescents with persistent pain suffer from sleep impairment. Literature addressing factors that may influence or mediate the pain-sleep relationship and the functional outcomes of the pain-sleep relationship was reviewed, and a model of the interrelationships with pain and sleep developed. Conclusion Findings from this review highlight the need to assess and treat sleep problems in children presenting with persistent pain. Healthcare providers should consider conducting routine sleep screenings, including a comprehensive description of sleep patterns and behaviors obtained through clinical interview, sleep diaries, and/or the use of standardized measures of sleep. Future research focusing on investigating the mechanisms associating sleep and pediatric persistent pain and on functional outcomes of poor sleep in pediatric pain populations is needed.

Research is needed to fully explore the ways positive and negative mood may relate to pain and sleep characteristics. This information may be beneficial for developing more effective pain management and sleep interventions.