Cecelia R. Valrie

Family and parent influences on pediatric chronic pain: a developmental perspective.

Pain that recurs or persists is unfortunately a common experience for children. One of the unique considerations in pediatric chronic pain management is the bidirectional influences of childrens pain experiences and parental and family factors. In this review we present a developmental perspective on understanding pediatric chronic pain and disability, highlighting factors relevant from infancy to adolescence, and family and parent influences. Preliminary evidence indicates that developmental processes are influenced and may also shape the pediatric pain experience. Parent emotions, behaviors, and health also play a role in childrens pain experiences, where overly protective parent behaviors, increased distress, and history of chronic pain are important parent-level influences. Research on family-level influences has revealed that families of children with chronic pain have poorer family functioning (e.g., more conflict, less cohesion) than families of healthy children. Several important gaps exist in this research, such as in understanding basic developmental processes in children with chronic pain and how they influence childrens perception of and responses to pain. Also, there is a lack of longitudinal data on family relationships and individual adjustment to allow for understanding of whether changes occur in parenting over the course of the childs chronic pain experience. Although parent interventions have been successfully incorporated into many cognitive-behavioral treatments for children with chronic pain conditions, little guidance exists for adapting intervention strategies to be developmentally appropriate. Additional research is needed to examine whether parent interventions are effective at different developmental stages and the best way to incorporate developmental goals into treatment.

A systematic review of sleep in pediatric pain populations

Objective: The primary aim of this systematic review was to examine the evidence for a pain-sleep relationship in children with persistent pain by reviewing studies using single and mixed pediatric persistent pain samples. Methods: Electronic searches of Medline, PubMed, the Cochrane Database of Systematic Reviews, and PsycINFO were conducted to identify all relevant empirical studies. Studies were included in the review if the majority of participants were between 0 and 17 years and from one of the following pediatric pain populations: juvenile idiopathic arthritis, sickle cell disease, migraine/headache, functional abdominal pain, juvenile fibromyalgia syndrome, chronic musculoskeletal pain, or mixed populations including the aforementioned conditions. Results: Research from single and mixed sample studies support the hypothesis that children and adolescents with persistent pain suffer from sleep impairment. Literature addressing factors that may influence or mediate the pain-sleep relationship and the functional outcomes of the pain-sleep relationship was reviewed, and a model of the interrelationships with pain and sleep was developed. Conclusion: Findings from this review highlight the need to assess and treat sleep problems in children presenting with persistent pain. Health care providers should consider conducting routine sleep screenings, including a comprehensive description of sleep patterns and behaviors obtained through clinical interview, sleep diaries, and/or the use of standardized measures of sleep. Future research focusing on investigating the mechanisms associating sleep and pediatric persistent pain and on functional outcomes of poor sleep in pediatric pain populations is needed.

The Influence of Maternal Behaviors During Childhood on Self-Efficacy in Individuals With Sickle Cell Disease

Little is known about the influence of maternal behaviors during childhood on the self-efficacy of individuals with sickle cell disease (SCD).This study retrospectively investigated the relationship between maternal overprotection and caring during childhood and self-efficacy in adulthood. Using a cross-sectional survey design, 32 adults with SCD completed questionnaires about demographics, maternal parenting behaviors, and self-efficacy. On average, adults with SCD reported moderate levels of SCD self-efficacy, high levels of overprotection, and high levels of caring. Self-efficacy was significantly related to educational level ( r = .39, p = .04), number of SCD crises per year (r = —.41, p = .04), and caring (r = .48, p = .01). Using simultaneous regression modeling, maternal caring was significantly predictive of self-efficacy (β = .44, p = .03). Results suggest that maternal caring during childhood may promote the development of self-efficacy in adults with SCD.

Relationship of sleep quality, baseline weight status, and weight-loss responsiveness in obese adolescents in an immersion treatment program

OBJECTIVE The objective of this study was to investigate the effect of baseline sleep on baseline weight status and weight-loss responsiveness in obese adolescents. METHODS Twenty-five obese adolescents who participated in a 19-day summer camp-based immersion treatment (IT) program completed pre-intervention measures of sleep duration and quality, and pre- and post-intervention body mass index z-scores (zBMI) and waist circumference (WC) assessments. Objective measures of sleep were obtained by actigraphy for a random subset of six participants for 1 week pre- and post-intervention. RESULTS Shorter weekday sleep durations and more sleep debt were related to higher pre-intervention WCs (r = -0.54, p = 0.01 and r = -0.56, p = 0.01), and lower subjective sleep quality was related to higher pre-intervention zBMIs (r = -0.49, p = 0.02). Longer weekend sleep durations and more sleep debt were related to smaller reductions in pre- to post-intervention zBMIs (r = -0.47, p = 0.04 and r = -0.51, p = 0.03). For the subgroup of adolescents who wore actigraphs pre- and post-intervention, an increase in their sleep durations (d = -0.25) and a reduction in their sleep latencies (d = 0.52), zBMIs (d = 0.31), and WCs (d = 0.20) were observed. CONCLUSIONS These results provide further evidence linking poor sleep patterns and obesity in adolescence, and suggest that sleep patterns may impact the effectiveness of pediatric obesity interventions and that IT programs may improve sleep in obese adolescents. Overall, they provide support for addressing sleep problems as part of obesity interventions.

Risk and resilience factors for grade retention in youth with sickle cell disease

Youth with sickle cell disease (SCD) are at higher risk for grade retention than healthy peers. This is salient because research suggests grade retention is ineffective and places youth at additional risk for negative outcomes. The aims of the present study were to identify possible risk factors for grade retention in youth with SCD and to examine positive family functioning as a possible resilience factor.

Experiences of Pediatric Patients With Sickle Cell Disease in Rural Emergency Departments.

Background: The aims of this study were to describe guardian perceptions of the experiences of a sample of youth with sickle cell disease (SCD) in rural emergency departments (EDs) with a focus on overall patient satisfaction and characteristics of care. Procedure: Guardians of 139 children with SCD (0 to 17 y) seen at a rural pediatric SCD clinic completed a survey concerning their children’s ED experiences in the past 6 months, including information about ED wait times, quality of communications and interactions with the ED health care providers, pain management, perceptions of speed of care, and overall satisfaction. Results: About 41% of guardians reported that their child visited the ED in the past 6 months. Guardians reported moderate satisfaction with ED care. About 25% of those who visited the ED indicated that health care providers did not spend enough time with them and their children did not receive speedy care. Shorter ED wait times and higher ratings of speed of care predicted higher satisfaction. Conclusions: Families of youth with SCD are experiencing longer wait times in rural EDs which contribute to dissatisfaction with care. Efforts are needed to develop strategies to reduce ED wait times and improve speed of care which may improve outcomes following ED care.