Observational Study of Pediatric Inpatient Pain, Nausea/Vomiting and Anxiety

Abstract

Background: The prevalence and severity of pain, nausea/vomiting, and anxiety (PNVA) among hospitalized children is not well established. We describe the prevalence and severity of PNVA among hospitalized patients from oncology, general pediatrics, and cardiology services in a tertiary care center. Methods: Patients were recruited on admission and enrolled if their caregiver consented, spoke English, and were anticipated to stay 2–30 days. Symptoms were measured weekdays using age-validated tools. PNVA symptoms were described and compared. Results: We enrolled 496 (49.4%) patients of 1005 admitted. Patients were predominantly Caucasian (57.9%) on their first admission (53.6%). The average (SD) age was 8.6 years (5.9) in oncology, 4.2 (5.3) in general pediatrics and 2.6 (4.0) in cardiology. 325 (65.6%) patients reported anxiety, 275 (55.4%) reported nausea and 256 (52.0%) reported pain. Mean (SD) severity out of 10 was 3.7 (2.5) for anxiety, 3.2 (2.1) for nausea and 3.0 (1.5) for pain. Prevalence of PNVA was no different between clinical programs, but pain (p = 0.008) and nausea (p = 0.006) severity were. PNVA symptom co-occurrence was positively correlated (p < 0.001). Conclusions: Anxiety was the most common and severe symptom for hospitalized children. Patients in oncology demonstrated the least severe pain and nausea with no difference in anxiety between services.

The effect of play-based occupational therapy on symptoms and participation in daily life activities in children with cancer: A randomized controlled trial

“…The faces anxiety scale (FAS) is designed for children aged 6–12 years and consists of five cartoon faces measuring the level of anxiety and stress in the child from 1 (no anxiety) to 5 (very severe anxiety). The reliability and validity of VAS-F have been reported in previous studies (Buchanan and Niven, 2002; Quiles et al., 2013; Schlegelmilch et al., 2019).…”

A Systematic Review of Self-Report Instruments for the Measurement of Anxiety in Hospitalized Children with Cancer

“…Instruments that offer pictorial support may be suitable for use by communication-vulnerable children, i.e., children with verbal communication difficulties and language barriers [ 44 ], to enable them to self-report their symptoms. Pictures have been proven to be more effective in describing subjective emotions, such as anxiety [ 1 ]. Thus, pictorial supports are typically preferred for obtaining self-reported anxiety from children with cancer or with communication disability as pictures are more easily understood by younger children.…”

“…Anxiety has been identified as a severe and long-lasting symptom experienced by hospitalized children with cancer [ 1 ]. The stress of hospitalization, healthcare professionals’ limited understanding of the children’s illness, limited coping strategies, and the pain of invasive medical procedures and treatment regimens have been found to be primary causes of anxiety in children with cancer [ 2 ].…”

“…Unrecognized symptoms in children with cancer cannot be treated and may result in more intense subsequent symptom experiences [ 1 ]. Untreated symptoms also add further suffering and may result in significant psychosocial symptoms in children receiving cancer treatments [ 4 ].…”

“…For example, anxiety has been found to exacerbate pain, which, in turn, increases the children’s experience of anxiety and increases the need for sedatives [ 2 ]. Additionally, anxiety has been found to be an important predictor of the quality of life in children with cancer and, thus, if left untreated, may result in a decreased quality of life [ 1 ].…”