Edwin T. Tan

Adult-child interactions in the postanesthesia care unit: behavior matters.

Background:Many children experience significant distress before and after surgery. Previous studies indicate that healthcare providers’ and parents’ behaviors may influence children’s outcomes. This study examines the influence of adults’ behaviors on children’s distress and coping in the postanesthesia care unit. Methods:Children aged 2–10 yr were videotaped during their postanesthesia care unit stay (n = 146). Adult and child behaviors were coded from video, including the onset, duration, and order of behaviors. Correlations were used to examine relations between behaviors, and time-window sequential statistical analyses were used to examine whether adult behaviors cued or followed children’s distress and coping. Results:Sequential analysis demonstrated that children were significantly less likely to become distressed after an adult used empathy, distraction, or coping/assurance talk than they were at any other time. Conversely, if a child was already distressed, children were significantly more likely to remain distressed if an adult used reassurance or empathy than they were at any other time. Children were more likely to display coping behavior (e.g., distraction, nonprocedural talk) after an adult used this behavior. Conclusions:Adults can influence children’s distress and coping in the postanesthesia care unit. Empathy, distraction, and assurance talk may be helpful in keeping a child from becoming distressed, and nonprocedural talk and distraction may cue children to cope. Reassurance should be avoided when a child is already distressed.

Parental attitudes regarding analgesic use for children: differences in ethnicity and language

PURPOSE The aim of this study was to identify the impact of ethnicity and language on parental attitudes regarding analgesic use to treat childrens pain. METHODS A total of 206 parents of children undergoing outpatient surgery were recruited to complete the Medication Attitudes Questionnaire, a measure of parental beliefs about using analgesic medications to treat childrens pain. Parents were grouped into one of 3 categories according to ethnicity and primary language spoken: English-speaking white, English-speaking Hispanic, and Spanish-speaking Hispanic. Group differences in pain medication attitudes were examined. RESULTS After controlling for socioeconomic status, English-speaking Hispanic parents endorsed higher levels of misconceptions about pain medication use, including a tendency to avoid analgesic use for children, compared with English-speaking white and Spanish-speaking Hispanic parents. CONCLUSIONS This study highlights parental characteristics, including ethnicity and language, which may place children at higher risk for undertreatment of acute pain based on misconceptions about analgesic use for children. Specifically, English-speaking Hispanic parents may be most likely to undertreat childrens pain at home. Future studies are needed to identify the most appropriate means of providing education to counter parental misconceptions and support optimal pain management of childrens pain in the home setting.

Attitudes regarding analgesic use and pain expression in parents of children with cancer.

Background: Children with cancer often experience significant levels of pain and their pain is generally undermanaged. Management of care to patients with cancer has shifted from the hospital to the home, and as such parents are charged with managing children’s pain. However, parents may have misconceptions of analgesic use, which can lead to undertreatment of pain in children. The purpose of this study is to examine attitudes toward pain medication and perceptions of pain expression among parents of children undergoing cancer treatment. Procedure: Parents of children who were undergoing cancer treatment at a hospital were recruited to take part in a survey study. A total of 187 parents completed a survey examining their attitudes toward medication and perceptions of pain expression in children. Results: Many parents reported concerns regarding analgesic use to treat their children’s pain and misconceptions about how children can express pain. Regression analyses noted that parental perceptions of pain expression were related to children’s experience of chronic or recurring pain and the 2 dimensions of child temperament: emotionality and sociability. Conclusions: Many parents of children with cancer have misconceptions regarding issues of pain management; these misconceptions can potentially lead to undertreatment of pain in children. These misconceptions are associated with aspects of children’s temperament.

Children's Behavior in the Postanesthesia Care Unit: The Development of the Child Behavior Coding System-PACU (CBCS-P)

OBJECTIVE To develop and validate a behavioral coding measure, the Childrens Behavior Coding System-PACU (CBCS-P), for childrens distress and nondistress behaviors while in the postanesthesia recovery unit. METHODS A multidisciplinary team examined videotapes of children in the PACU and developed a coding scheme that subsequently underwent a refinement process (CBCS-P). To examine the reliability and validity of the coding system, 121 children and their parents were videotaped during their stay in the PACU. Participants were healthy children undergoing elective, outpatient surgery and general anesthesia. The CBCS-P was utilized and objective data from medical charts (analgesic consumption and pain scores) were extracted to establish validity. RESULTS Kappa values indicated good-to-excellent (κs > .65) interrater reliability of the individual codes. The CBCS-P had good criterion validity when compared to childrens analgesic consumption and pain scores. CONCLUSIONS The CBCS-P is a reliable, observational coding method that captures childrens distress and nondistress postoperative behaviors. These findings highlight the importance of considering context in both the development and application of observational coding schemes.

Exploring the Impact of Cultural Background on Parental Perceptions of Children's Pain

To examine the relation between ethnic background and parent perceptions of childrens pain expression, a study of 215 parents of children aged 1 month to 17 years undergoing outpatient surgery was conducted. Parents were grouped into 3 categories by ethnicity and language spoken: Spanish-speaking Hispanic, English-speaking Hispanic, and English-speaking White. Parental attitudes were assessed by the Parental Pain Expression Perceptions questionnaire. After controlling for demographic variables, Spanish-speaking Hispanic parents noted greater misconceptions of childrens pain expression than English-speaking White parents. Post hoc analyses indicated that Spanish-speaking Hispanic parents also reported greater misconceptions of childrens pain expression than their English-speaking Hispanic counterparts. Findings suggest that Spanish-speaking Hispanic parents endorse misconceptions about childrens expression of pain to a greater degree than English-speaking parents and, as such, more emphasis should be placed on parent education within the context of cultural background.

Ethnicity and parental report of postoperative behavioral changes in children

To examine the role of ethnicity and language in parent report of childrens postoperative behavioral recovery.

Desire for perioperative information and parental ethnicity.

Objectives:  To examine the role of ethnicity, language, and socioeconomic variables in parental desire for information regarding children’s surgery.

Changing Health Care Providers’ Behavior During Pediatric Inductions With an Empirically Based Intervention

COMMENT Advances in medical technology and drug development have revolutionized the practice of anesthesiology during the last 30 years. The importance of pulse oximetry, modern anesthesia machines, and drugs with predictable pharmacology is sometimes overlooked as we enter the next phase of pharmacogenomics and applied pharmacology. In the current era, we administer drugs based on total body weight, although lean body LBM may represent a more accurate means of drug dosing. The current authors previously published methods for deriving LBM from height and weight using elegantly simple formulas (from Boer). Here, Peters et al estimate LBM based on theoretical formulas (eLBM = 3.8 eECVe and eECV = 0.0215 W0.6469 H0.7236) and compare results to empirical data obtained from children and adults. The authors conclude that the theoretical formulas agree with the empirical data for both adults and children (mean ratio of 1.04 for children with an SD of 0.18). The authors have validated a simple method for calculating LBM from height and weight. However, these calculations assume that the linear relationship between ECV and LBM for adults holds true for children. This is quite a big step, if not a leap. Although these relationships may hold true for young children and adolescents, they may prove challenging in neonatal populations with unusual relationships between ECV, weight, and height. The current study provides a simple means for calculating LBM from height and weight that should be studied in neonatal and young infant populations.