Jennifer A. Parker

Systematic review and meta-analysis of distraction and hypnosis for needle-related pain and distress in children and adolescents.

OBJECTIVE To systematically review the evidence (and quality) for distraction and hypnosis for needle-related pain and distress in children and adolescents. To explore the effects of distraction characteristics (e.g., adult involvement, type of distracter), child age, and study risk of bias on treatment efficacy.  METHODS 26 distraction and 7 hypnosis trials were included and self-report, observer-report, and behavioral pain intensity and distress examined. Distraction studies were coded for 4 intervention characteristics, and all studies coded for child age and study risk of bias.  RESULTS Findings showed strong support for distraction and hypnosis for reducing pain and distress from needle procedures. The quality of available evidence was low, however. Characteristics of distraction interventions, child age, and study risk of bias showed some influence on treatment efficacy. CONCLUSIONS Distraction and hypnosis are efficacious in reducing needle-related pain and distress in children. The quality of trials in this area needs to be improved.

A comprehensive categorical and bibliometric analysis of published research articles on pediatric pain from 1975 to 2010.

Abstract The field of pediatric pain research began in the mid-1970s and has undergone significant growth and development in recent years as evidenced by the variety of books, conferences, and journals on the topic and also the number of disciplines engaged in work in this area. Using categorical and bibliometric meta-trend analysis, this study offers a synthesis of research on pediatric pain published between 1975 and 2010 in peer-reviewed journals. Abstracts from 4256 articles, retrieved from Web of Science, were coded across 4 categories: article type, article topic, type and age of participants, and pain stimulus. The affiliation of the first author and number of citations were also gathered. The results suggest a significant increase in the number of publications over the time period investigated, with 96% of the included articles published since 1990 and most research being multiauthored publications in pain-focused journals. First authors were most often from the United States and affiliated with a medical department. Most studies were original research articles; the most frequent topics were pain characterization (39.86%), pain intervention (37.49%), and pain assessment (25.00%). Clinical samples were most frequent, with participants most often characterized as children (6-12 years) or adolescents (13-18 years) experiencing chronic or acute pain. The findings provide a comprehensive overview of contributions in the field of pediatric pain research over 35 years and offers recommendations for future research in the area.

Cognitive Behavioral Therapy for Pediatric Chronic Pain: The Problem, Research, and Practice

The purpose of this article is to outline the rationale and use of cognitive behavioral therapy (CBT) for the treatment of pediatric chronic pain. The article begins by demonstrating the scope and impact of the problem of pediatric chronic pain. It then provides an overview of the framework of CBT for pediatric chronic pain and standard treatment components are outlined. A summary of the current state of research and its efficacy is provided. The article concludes by presenting outcome data from a specific example of a CBT group for pediatric recurrent abdominal pain. Future directions for research in this area are discussed.

Caregiver accuracy in detecting deception in facial expressions of pain in children

Summary Nurses demonstrated significantly better accuracy than parents at detecting deception in children’s facial expressions of pain, with pediatricians not differing from either nurses or parents. Abstract Facial expressions provide a primary source of inference about a child’s pain. Although facial expressions typically appear spontaneous, children have some capacity to fake or suppress displays of pain, thereby potentially misleading caregiver judgments. The present study was designed to compare accuracy of different groups of caregivers in detecting deception in children’s facial expressions of pain when voluntarily controlled. Caregivers (15 pediatricians, 15 pediatric nurses, and 15 parents) viewed 48 video clips of children, 12 in each of 4 conditions (genuine pain, faked pain, suppressed pain, neutral baseline), and judged which condition was apparent to them. A 3 (group: pediatrician vs pediatric nurse vs parent) × 4 (condition: genuine vs faked vs suppressed vs neutral) mixed analysis of variance (ANOVA) of judgment accuracies revealed a significant main effect of group, with nurses demonstrating higher overall accuracy scores than parents, and pediatricians not differing from either group. As well, all caregivers, regardless of group, demonstrated the lowest accuracy when viewing the genuine condition, relative to the faked and suppressed conditions, with accuracy for the neutral condition not differing significantly from the other conditions. Overall, caregivers were more successful at identifying faked and suppressed than genuine expressions of pain in children, and pediatric nurses fared better overall in judgment accuracy than parents.

Parent Perceptions and Satisfaction with Inpatient Child Life Specialist Interventions and the Role of Child Temperament

This study examined parent perceptions and satisfaction with interventions by inpatient child life specialists (CLSs) and the role of child temperament. Forty-nine parents of children (12 months–7 years) completed questionnaires assessing knowledge of the CLS’s role, perceived need for CLS intervention, whether they received and were satisfied with the intervention(s), and their child’s temperament. Results indicated that most parents were unaware of the CLS role prior to admission; they received the interventions needed and were satisfied. Child temperament was related to perceived need and receipt of developmental support and family facilitation interventions, and children with more challenging temperament received more interventions. Implications for practice are discussed.

Relevance of Water Temperature, Apparatus, and Age to Children's Pain during the Cold Pressor Task

Effective use of experimental pain in research depends on a thorough understanding of factors influencing their use. Although studies using the cold pressor task (CPT) have critically advanced our knowledge of pain mechanisms, assessment, and management in adults and children, the impact of identified methodological variability in its use is not known (ie, water temperature and apparatus); furthermore, whether methodological variations differentially impact children across development.

Effectiveness of the Corrective Babbling Speech Treatment Program for Children With a History of Cleft Palate or Velopharyngeal Dysfunction

Objective To investigate the effectiveness of a phonetic-based, parent-administered treatment to reduce cleft-related speech errors. Design Immediate treatment (IT) versus delayed treatment (DT) comparison followed by analysis of gains over approximately 4 months and again after a longer period of treatment for participants in both groups. Participants Thirteen participants with a history of cleft palate or velopharyngeal dysfunction and speech disorder. Intervention After training, parents were instructed to conduct daily 10-minute sessions of phonetic drills with their children. Main Outcome Measures Group differences in percent consonants correct (PCC) were compared between those who did and those who did not receive the treatment. Pre- and posttreatment PCC comparisons were made after approximately 4 months of treatment and after termination of treatment. Results Participants receiving Corrective Babbling therapy showed significant gains in PCC in limited contexts after 4 months of therapy. However, gains were not significantly greater for the IT versus DT group. Participants who continued with the treatment for longer than 4 months showed the greatest gains in PCC and had significant improvements in all speech contexts assessed. Parents reported satisfaction with the program. Conclusions The results of this study indicate that this treatment shows promise for at least some children with a history of cleft palate and velopharyngeal dysfunction.

Pain in Children with Cancer: Prevalence, Characteristics, and Parent Management

Objectives:Pain is a common and distressing symptom of pediatric cancer, as reported by both children and their parents. Increasingly, children with cancer are cared for as outpatients, yet little is known about how parents manage their cancer-related pain. The aim of the current study was to examine pain prevalence and characteristics, and the pharmacological, physical, and psychological pain management strategies used by parents to manage their child’s cancer pain. Materials and Methods:In total, 230 parents and caregivers (89% mothers) of children (mean age=8.93 y, SD=4.50) with cancer currently in treatment or who are survivors completed an online survey about their child’s pain in the preceding month. Results:Results indicated that children with cancer who were on active treatment and who were posttreatment experienced clinically significant levels of pain. Parents reported using more physical and psychological strategies than pharmacological strategies to manage their child’s pain. The most frequently used physical/psychological strategy was distraction and acetaminophen was the most frequently administered pain medication. Parents’ confidence in managing their child’s pain was inversely associated with both how much pain they perceived their child had, and also whether they had given any pain medication. Discussion:The results of this study suggest that despite parents’ use of pain management strategies, management of cancer-related pain continues to be a problem for children during treatment and into survivorship.

Impact on parents of receiving individualized feedback of psychological testing conducted with children as part of a research study.

While many researchers accept the principle that participants have a right to receive information learned from their participation in research, there are few studies examining the impact of receiving results on participants. This study was developed to examine the impact on parents of the receipt of individual results of research-based psychological testing of their children. A summary of the childs individual results of standardized measures of language and development was sent by mail with the questionnaire designed to assess the impact of receiving results. Response rate from the mailed questionnaire was 55.6% (n = 74/133). Most parents reported the results as helpful and positive. The majority would receive results again. Overall, the sharing of individualized feedback from psychological testing conducted as part of a research study was well accepted by parents. This practice appears ethically permissible with appropriate support options for addressing participant concerns upon receiving the results as well options for clinical follow-up for the child.

Boo-boos as the building blocks of pain expression: An observational examination of parental responses to everyday pain in toddlers

ABSTRACT Background: Everyday pain experiences (minor bumps/scrapes) are common in early childhood and create frequent opportunities for socialization of pain behaviors. Nevertheless, everyday pain during the formative toddler period has been largely overlooked. Aims: The aim of the current study was to describe the frequency and nature of toddlers’ everyday pain experiences, child and parent responses, and the relationship between child characteristics (age, sex, temperament) and responses. Methods: Fifty-two children aged 12–32 months and their parents were observed at an indoor play facility. Using an observational checklist, trained observers recorded children’s everyday pain incidents and associated child and parent responses. Results: Overall, 101 pain incidents were observed, the majority of which evoked low levels of pain and distress, which resolved after 1 min. Pain incidents occurred at a rate of 1.02 incidents/child/hour, with 81% of children experiencing at least one incident, which is higher than previous research with preschoolers and daycare staff. Common parent responses included a range of verbal (reassurance) and nonverbal (staying closer, hugging/kissing child) behaviors. Boys were more likely to not exhibit any protective behaviors. Parents were more likely to pick up older toddlers. Conclusions: Future research should examine the link between self-reported and observed parent responses to child pain in everyday and clinical contexts.