Dimensions of Pediatric Procedural Distress: Children's Anxiety and Pain During Immunizations

Cohen, Lindsey L.; Blount, Ronald L.; Cohen, Rachelle Jansevics; Johnson, Veda

doi:10.1023/b:jocs.0000016268.40662.ed

Cited by 36 publications

(24 citation statements)

References 18 publications

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“…Accurate assessment of paediatric procedural distress is essential to clinical and research endeavours aimed at assisting children during invasive medical events. However, distress is a complex, multidimensional, and subjective phenomenon consisting of sensory and affective components 1 . Dental fear is related to a real, immediately present, specific stimulus (e.g., needles, drilling), whereas in the case of anxiety, the source of the threat is ambiguous, unclear, or not immediately present.…”

Section: Introductionmentioning

confidence: 99%

Can drawing be considered a projective measure for children’s distress in paediatric dentistry?

Aminabadi

Ghoreishizadeh

et al. 2010

International Journal of Paediatric Dentistry

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Section: Introductionmentioning

confidence: 99%

Can drawing be considered a projective measure for children’s distress in paediatric dentistry?

Aminabadi

Ghoreishizadeh

et al. 2010

International Journal of Paediatric Dentistry

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“…2 Only a small number of studies, however, have documented the presence and extent of distress in typically developing children undergoing venipuncture procedures. 1, 3-5 Upon observation, Humphrey, Boon, Chiquit van Linden van den Heuvell, and van de Wiel (1992) found that 83% of pre-school aged children and 51% of primary school aged children experienced “high levels of distress,” defined as a rating of 3 or higher on a 5 point outsider-observer scale. Additionally, a high proportion of this distress bordered on “unacceptable distress” due to the participant’s loss of self-control.…”

mentioning

confidence: 99%

A Pilot Study to Improve Venipuncture Compliance in Children and Adolescents with Autism Spectrum Disorders

Davit¹,

Hundley²,

Molino³

et al. 2011

Journal of Developmental &Amp; Behavioral Pediatrics

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Objective Medical procedures, particularly venipuncture (the puncture of a vein especially for the withdrawal of blood), can cause serious distress and behavior disturbance for many children. Noncompliance to blood draws can have significant ramifications in both research and clinical settings. The negative reactions may be exacerbated in individuals with autism spectrum disorders (ASD). Even so, there has been little research into the prevalence of the problem or effective intervention procedures. In response to these concerns, we developed and evaluated the Blood Draw Intervention Program (BDIP). The program was designed to be easy to use, require little provider or family time, effectively reduce negative behaviors and increase blood draw compliance. Method In a quasi-randomized trial over the course of approximately 18 months, 58 of 210 families with children with ASD participating in a larger study of phenotypic and genotypic factors reported significant concerns about blood draws and elected to use the BDIP. Results Completion of the program increased blood draw compliance rates from 85.4% to 96.6 % (OR = 4.80, 95% CI = 1.12, 20.59 p = 0.03). Conclusion Results indicate the efficacy of the program in a research setting and suggest a potential clinical application. The current intervention, unlike many others for the same or similar difficulties proposed in the past, was successful without requiring extensive time, training, or effort on the part of providers, parents or their children, nor did it require large scale institutional changes.

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“…This comprised an 11-point numerical rating scale on which they were asked to rate their current level of anxiety, ranging from no anxiety (0) to worst anxiety possible (10). A brief numerical anxiety scale was selected to enable direct comparison with pain data collected in this study and with other studies that have used similar measures to assess paediatric procedural distress (Cohen et al 2004). The treating clinician and patients were not blinded to the intervention, but each questionnaire with its unique identifier, once collected, was sent to a central collection centre for the data to be uploaded onto a spreadsheet.…”

Section: Methodsmentioning

confidence: 99%

Chewing gum vs. ibuprofen in the management of orthodontic pain, a multi-centre randomised controlled trial – the effect of anxiety

Ireland

Ellis²,

Jordan

et al. 2017

Journal of Orthodontics

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Objectives: Pain is a common side effect of orthodontic treatment. An objective of this study, part of a large previously reported RCT on pain and analgesic use, was to determine the effect of anxiety on perceived pain and use of analgesia. Methods: 1000 patients aged 11-17 years, undergoing upper and lower fixed appliance treatment in nine hospital departments were recruited into this two-arm parallel design randomised controlled trial. One arm was given sugar-free chewing gum and the other arm ibuprofen for pain relief. Neither the clinicians nor patients were blinded to assignment. In addition to recording pain experience and analgesic use for 3 days following appliance placement and first archwire change, each patient recorded their level of anxiety immediately following the fitting of the appliance and the first archwire change. Results: 419 chewing gum group (84%) and 407 ibuprofen group (83%) questionnaires were returned following appliance placement, and 343 chewing gum group (70%) and 341 ibuprofen group (71%) questionnaires were returned following the first archwire change. The mean anxiety scores following fitting of the appliance and first archwire change were 2.7 (SD 2.1) and 1.6 (SD 1.8), respectively. There were weak but significant positive associations between anxiety scores and pain scores. Multi-level modelling produced a coefficient for anxiety of 0.23 (95% CI 0.17-0.28) for appliance placement, suggesting a small rise (0.23) on the 11-point pain scale for a onepoint increase on the corresponding anxiety scale. Following archwire change, the corresponding coefficient was 0.32 (0.24-0.39). For ibuprofen use, again simple analyses suggested a relationship with anxiety. Multi-level logistic modelling produced an odds ratio for ibuprofen use of 1.11 (95% CI 1.07-1.15) at appliance placement and 1.21 (1.10-1.33) at the first archwire change. There was a 10-20% increase in the odds of using ibuprofen for each onepoint increase on the anxiety scale. No such relationship was found between anxiety and chewing gum use. There were no adverse effects or harms reported during the trial. Approvals were granted by the Research Ethics Committee (08/H0106/139), R&D and MHRA (Eudract 2008-005522-36) and the trial was registered on the ISRCTN (79884739) and NIHR (6631) portfolios. Support was provided by the British Orthodontic Society Foundation. Conclusions: There was a weak positive correlation between anxiety reported and pain experienced following both the initial fitting of the fixed appliances and at the subsequent archwire change. Patients that were more anxious tended to take more ibuprofen for their pain relief. ARTICLE HISTORY

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Dimensions of Pediatric Procedural Distress: Children's Anxiety and Pain During Immunizations

Cited by 36 publications

References 18 publications

Can drawing be considered a projective measure for children’s distress in paediatric dentistry?

Can drawing be considered a projective measure for children’s distress in paediatric dentistry?

A Pilot Study to Improve Venipuncture Compliance in Children and Adolescents with Autism Spectrum Disorders

Chewing gum vs. ibuprofen in the management of orthodontic pain, a multi-centre randomised controlled trial – the effect of anxiety

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