Factors Explaining Children's Responses to Intravenous Needle Insertions

Abstract

Background Previous research shows that numerous child, parent, and procedural variables affect children’s distress responses to procedures. Cognitive-behavioral interventions such as distraction are effective in reducing pain and distress for many children undergoing these procedures. Objectives The purpose of this report was to examine child, parent, and procedural variables that explain child distress during a scheduled intravenous insertion when parents are distraction coaches for their children. Methods A total of 542 children, between 4 and 10 years of age, and their parents participated. Child age, gender, diagnosis, and ethnicity were measured by questions developed for this study. Standardized instruments were used to measure child experience with procedures, temperament, ability to attend, anxiety, coping style, and pain sensitivity. Questions were developed to measure parent variables, including ethnicity, gender, previous experiences, and expectations, and procedural variables, including use of topical anesthetics and difficulty of procedure. Standardized instruments were used to measure parenting style and parent anxiety, whereas a new instrument was developed to measure parent performance of distraction. Children’s distress responses were measured with the Observation Scale of Behavioral Distress–Revised (behavioral), salivary cortisol (biological), Oucher Pain Scale (self-report), and parent report of child distress (parent report). Regression methods were used for data analyses. Results Variables explaining behavioral, child-report and parent-report measures include child age, typical coping response, and parent expectation of distress (p < .01). Level of parents’ distraction coaching explained a significant portion of behavioral, biological, and parent-report distress measures (p < .05). Child impulsivity and special assistance at school also significantly explained child self-report of pain (p < .05). Additional variables explaining cortisol response were child’s distress in the morning before clinic, diagnoses of attention deficit hyperactivity disorder or anxiety disorder, and timing of preparation for the clinic visit. Discussion The findings can be used to identify children at risk for high distress during procedures. This is the first study to find a relationship between child behavioral distress and level of parent distraction coaching.

Exploring perspectives on restraint during medical procedures in paediatric care: a qualitative interview study with nurses and physicians

“…This adds to discussions identified in earlier studies on restraint (Brenner et al, 2014; Kangasniemi et al, 2014; Kirwan & Coyne, 2016), where studies on distress and pain have found that what parents say and do clearly affect children’s ability to cope with the procedure (Salmon, 2006; Salmon & Pereira, 2002). McCarthy et al (2010) investigated factors affecting children’s responses to PVC and concluded that parental expectations of distress and distractive communication influenced the children’s level of distress. As pointed out by the healthcare providers in our study, parents’ reluctance to actively take part in the medical procedure can help explain the use of restraint.…”

Menurunkan Derajat Flebitis Akibat Terapi Intravena pada Anak dengan Kompres Aloe vera: Studi Pilot

“…Kondisi ini dipengaruhi oleh beberapa faktor, yaitu usia anak, jenis kelamin, pengalaman, tempramen, kecemasan, gaya koping, sensitivitas nyeri, dan genotype, serta persiapan sebelum prosedur. Anak yang lebih muda menunjukkan perilaku distress lebih tinggi dan mengalai nyeri lebih parah akibat prosedur medis (McCarthy, et al, 2010b). Pada penelitian ini tidak dianalisis keterkaitan antara terapi intravena dan karakteristik responden.…”

Matching Doses of Distraction With Child Risk for Distress During a Medical Procedure

“…A new model emerged from the data and included child age, typical coping style, parent expectation of child distress, and the quality and frequency of the parent distraction coaching (McCarthy et al, 2010a). The results of the experimental part of the study showed that not all parent coaches were successful in distracting their children after receiving brief distraction training (McCarthy et al, 2010b).…”