A Sorrow Shared Is a Sorrow Halved? Patient and Parental Anxiety Associated with Venipuncture in Children before and after Liver Transplantation

Abstract

Taking blood via venipuncture is part of the necessary surveillance before and after liver transplantation. The spectrum of response from children and their parents is variable, ranging from a short and limited aversion to paralyzing phobia. The aim of this retrospective, cross-sectional study was to determine the level of anxiety amongst children during venipuncture, to compare the anxiety reported by children and parents, and to identify the factors affecting the children’s and parents’ anxiety in order to develop therapeutic strategies. In total, 147 children (aged 0–17 years, 78 female) and their parents completed questionnaires. Statistical analysis was performed using qualitative and quantitative methods. Results showed that the majority of children reported anxiety and pain during venipuncture. Younger children had more anxiety (self-reported or assessed by parents). Children and parental reports of anxiety were highly correlated. However, the child’s anxiety was often reported as higher by parents than by the children themselves. The child’s general anxiety as well as the parents’ perceived stress from surgical interventions (but not the number of surgical interventions) prompted parental report of child anxiety. For children, the main stressors that correlated with anxiety and pain were factors during the blood collection itself (e.g., feeling the puncture, seeing the syringe). Parental anxiety was mainly related to circumstances before the blood collection (e.g., approaching the clinic, sitting in the waiting room). The main stressors mentioned by parents were the child’s discomfort and their inability to calm the child. Results indicate that the children’s fear of factors during the blood collection, along with the parents’ perceived stress and helplessness as well as their anticipatory anxiety are important starting points for facilitating the drawing of blood from children before and after liver transplantation, thereby supporting a better disease course in the future.

Parent and child self‐ and co‐regulation during pediatric venipuncture: Exploring heart rate variability and the effects of a mindfulness intervention

“…Parents may have been preoccupied by the procedure as a whole, more generally about their child's health, or perhaps parents viewed the procedure as routine and thereby less distressing, given parent reactivity prior to the needle insertion without significant recovery to baseline. The differing pattern of parent and child responding aligns with recent work demonstrating child pain and anxiety from venipuncture related most strongly to factors proximal to blood collection (seeing the needle, sensing the poke), whereas parent anxiety related more strongly to contextual factors prior to the needle (e.g., sitting in the waiting room; Kaluza et al., 2021). Finally, guided by the Social Communication Model of Pain (e.g., Craig, 2009), additional factors, including verbal and nonverbal behaviors, past experience with needle procedures, and children's cognitive–affective factors, would be relevant for future work as these psychological, behavioral, social, and contextual factors are expected to shape the dyadic interaction.…”

Interventions to alleviate anxiety and pain during venipuncture in children with chronic gastrointestinal and/or liver disease: A single‐center prospective observational study

“…The first intervention group (PE) received age‐appropriate (depending on the assigned age group) psychoeducational brochures focusing on cognitive understanding of anxiety mechanisms and the procedure of blood drawing. A preliminary survey indicated a correlation between the anxiety of children and their parents (for full results see 22 ). Therefore, the brochures were designed to inform both family parts and could be worked through together.…”

“…The brochures informed about health function, natural course, and the potentially vicious cycle of anxiety. It also provided some results from the preliminary survey about anxiety during venipuncture, 22 and links to different online versions of guided progressive muscle relaxation, autogenic training, and book recommendations. Additionally, the children aged 4–7 years old received a storybook about a girl named “Milla” 23 that goes through the process of a clinic visit involving venipuncture.…”

Pharmacological and non-pharmacological interventions in management of peripheral venipuncture-related pain: a randomized clinical trial

“…Parents' reactions to children's stress greatly influence children's ability to deal with stress [35]. An upright position rather than being physically restrained has been shown to increase children's comfort and decrease pain, preferably with a parent holding up with soothing words [36][37][38]. In this study, families were encouraged to accompany children in three groups throughout the venipuncture procedure, which greatly supported children and reduced their stress.…”