Assessment of acute pain and anxiety in children and adolescents by self-reports, observer reports, and a behavior checklist.

Abstract

Children and adolescents with cancer are frequently subjected to painful medical procedures that often result in anxiety and resistance to treatment. In a primary study of procedure-related distress in children, a behavioral rating scale was developed to assess the presence of distress behaviors. In the present study, a checklist of distress behaviors was compared to patient and observer ratings of pain and anxiety. Similar to the findings of previous investigations, children showed greater evidence of behavioral distress than adolescents only during the actual medical procedure. However, additional behaviors were observed that suggested that the checklist was age biased and that the two age groups experienced an equal amount of stress. This assumption was supported by a measure of intensity and by observer reports and patient self-reports that showed no differences between the two age groups. None of the measures showed any significant differences for sex or ethnic origin. The present data did confirm earlier findings that younger patients have less physical control and more emotional outbursts than adolescents during a stressful procedure. Because investigations of the efficacy of behavioral interventions for painful procedures must rely on some form of assessment of children's distress, these results support our conclusion that clinical research on pain and anxiety should incorporate both self-report and observer data.

Prevalence of dental fear and its relationship to dental caries and gingival disease among school children in Puducherry: A cross-sectional study

“…Males are more probable to prompt their fear through different emotional expressions such as anger or impatience. [10] According to LeBaron and Zeltzer, [11] children may learn to control the way to express their fear as they grow older which is in accordance with our present study that dental fear scores decreased with increasing age.…”

Intravenous Methohexital for Brief Sedation of Pediatric Oncology Outpatients: Physiologic and Behavioral Responses

“…In this study, we attempted to maximize their reliability by utilizing in prospective fashion an established, standardized, relatively simple checklist of clearly defined behavioral items appropriate for detecting anxiety in children. 8 Further, we limited our study's behavioral observers to two: a research project physician with pediatric anesthesiology training and experience (M.T.N. ), and an experienced pediatric hematology registered nurse, both of whom observed several sedation procedures and were familiar with the Procedure Behavioral Checklist before performing assessments for this study.…”

“…Behavioral responses of children undergoing MHX sedation for painful procedures were measured utilizing the Procedure Behavioral Checklist, a standardized observational distress scale developed by LeBaron and Zeltzer. 8 For each sedation event, one of two dedicated observers involved with the study (M.T.N. or a trained registered nurse) evaluated eight defined distress behaviors exhibited by the child, categorized as verbal (crying, screaming, and verbalized stalling, anxiety, and pain) or muscular (muscle tension, physical movement, and need for restraint).…”

Ansiedade, a criança e os pais

“…Foi observado que elevados níveis de ansiedade pré-operatória estão associados a maior intensidade de dor pós-operatória [32][33][34] , maior demanda por analgésico em analgesia controlada pelo paciente 34,35 , baixos níveis de satisfação com o tratamento 34 , e alterações de comportamento após a cirurgia 12 . Por outro lado, crianças com dor pós-operatória moderada a intensa, têm 14 vezes mais probabilidade de desenvolver ansiedade intensa 1 .…”

“…It has been observed that high preoperative anxiety levels are associated to more severe postoperative pain [32][33][34] , higher demand for analgesics during patient controlled analgesia 34,35 , low levels of satisfaction with the treatment 34 and postoperative behavior changes 12 . On the other hand, children with moderate to severe postoperative pain have 14 times more chance of developing severe anxiety 1 .…”