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Parental catastrophizing about child's pain and its relationship with activity restriction: the mediating role of parental distress

&NA; Recent research has demonstrated that parental behaviors have an important impact upon child and adolescent pain outcomes. At present, however, we do not know which parents engage in particular behaviors and why. In 2 studies, the impact of parental catastrophizing about their childs pain upon parental tendency to stop their childs pain‐inducing activity was investigated. Further, the mediating role of parental distress was explored. In study 1, a sample of schoolchildren (n = 62; M = 12.48 years; SD = 1.72) took part in a cold‐pressor task. In study 2, a clinical sample of adolescents with chronic pain (n = 36; M = 15.68 years; SD = 1.85) performed a 2‐min walking task designed as a pain‐inducing activity. In both studies, the accompanying parent was asked to watch their child performing the pain task. Findings revealed, for both studies, that parents with a high level of catastrophic thinking about their childs pain experienced more distress and a greater behavioral tendency of wanting to stop their childs pain‐inducing activity. Further, parental feelings of distress mediated the relationship between parental catastrophic thinking and parents’ tendency to restrict their childs activity. The findings are discussed in light of an affective‐motivational conceptualization of pain and pain behavior. Parental catastrophizing was associated with parental tendency to restrict their childs engagement in a painful test, and this relationship was mediated by parental distress.

Sex differences in experimental pain among healthy children: a systematic review and meta-analysis.

Summary A meta‐analysis found that girls had increased pain intensity on the cold pressor task, and lower pain tolerance and threshold in response to heat pain. ABSTRACT Sex differences in response to experimental pain are commonly reported in systematic reviews in the adult literature. The objective of the present research was to conduct a systematic review and meta‐analysis of sex differences in healthy childrens responses to experimental pain (eg, cold pressor, heat pain, pressure pain) and, where possible, to conduct analyses separately for children and adolescents. A search was conducted of electronic databases for published papers in English of empirical research using experimental pain tasks to examine pain‐related outcomes in healthy boys and girls between 0 and 18 years of age. Eighty articles were eligible for inclusion and were coded to extract information relevant to sex differences. The systematic review indicated that, across different experimental pain tasks, the majority of studies reported no significant differences between boys and girls on pain‐related outcomes. However, the meta‐analysis of available combined data found that girls reported significantly higher cold pressor pain intensity compared to boys in studies where the mean age of participants was greater than 12 years. Additionally, a meta‐analysis of heat pain found that boys had significantly higher tolerance than girls overall, and boys had significantly higher heat pain threshold than girls in studies where the mean age of participants was 12 years or younger. These findings suggest that developmental stage may be relevant for understanding sex differences in pain.

Social modulation of facial pain display in high-catastrophizing children: An observational study in schoolchildren and their parents

&NA; The present study examined existing communal and operant accounts of children’s pain behavior by looking at the impact of parental presence and parental attention upon children’s pain expression as a function of child pain catastrophizing. Participants were 38 school children and 1 of their parents. Children completed a cold pressor pain task (CPT) twice, first when told that no one was observing (alone condition) and subsequently when told that they were being observed by their parent (parent‐present condition). A 3‐minute parent–child interaction occurred between the 2 CPT immersions, allowing measurement of parental attention to their child’s pain (ie, parental pain‐attending talk vs non‐pain‐attending talk). Findings showed that child pain catastrophizing moderated the impact of parental presence upon facial displays of pain. Specifically, low‐catastrophizing children expressed more pain in the presence of their parent, whereas high‐catastrophizing children showed equally pronounced pain expression when alone or in the presence of a parent. Furthermore, children’s catastrophizing moderated the impact of parental attention upon facial displays and self‐reports of pain; higher levels of parental nonpain talk were associated with increased facial expression and self‐reports of pain among high‐catastrophizing children; for low‐catastrophizing children, facial and self‐report of pain was independent of parental attention to pain. The findings are discussed in terms of possible mechanisms that may drive and maintain pain expression in high‐catastrophizing children, as well as potential limitations of traditional theories in explaining pediatric pain expression. The impact of parental presence and parental attention to the child’s pain upon the child’s pain expression is moderated by the child’s catastrophizing about pain.

Parental catastrophizing about children’s pain and selective attention to varying levels of facial expression of pain in children: A dot-probe study

&NA; The attentional demand of pain has primarily been investigated within an intrapersonal context. Little is known about observers’ attentional processing of another’s pain. The present study investigated, within a sample of parents (n = 65; 51 mothers, 14 fathers) of school children, parental selective attention to children’s facial display of pain and the moderating role of child’s facial expressiveness of pain and parental catastrophizing about their child’s pain. Parents performed a dot‐probe task in which child facial display of pain (of varying pain expressiveness) were presented. Findings provided evidence of parental selective attention to child pain displays. Low facial displays of pain appeared sufficiently and also, as compared with higher facial displays of pain, equally capable of engaging parents’ attention to the location of threat. Severity of facial displays of pain had a nonspatial effect on attention; that is, there was increased interference (ie, delayed responding) with increasing facial expressiveness. This interference effect was particularly pronounced for high‐catastrophizing parents, suggesting that being confronted with increasing child pain displays becomes particularly demanding for high‐catastrophizing parents. Finally, parents with higher levels of catastrophizing increasingly attended away from low pain expressions, whereas selective attention to high‐pain expressions did not differ between high‐catastrophizing and low‐catastrophizing parents. Theoretical implications and further research directions are discussed. Parental attentional processing of child pain is dependent on parental catastrophizing about the child’s pain, child facial expressiveness of pain, and the interaction between the two.

Impact of parental catastrophizing and contextual threat on parents' emotional and behavioral responses to their child's pain.

Summary Heightened contextual threat induces elevated levels of parental psychophysiological distress in response to child pain, and is associated with more pain‐attending talk in catastrophizing parents. Abstract Limited research has addressed processes underlying parents’ empathic responses to their child’s pain. The present study investigated the effects of parental catastrophizing, threatening information about the child’s pain, and child pain expression upon parental emotional and behavioral responses to their child’s pain. A total of 56 school children participated in a heat pain task consisting of 48 trials while being observed by 1 of their parents. Trials were preceded by a blue or yellow circle, signaling possible pain stimulation (i.e., pain signal) or no pain stimulation (i.e., safety signal). Parents received either neutral or threatening information regarding the heat stimulus. Parents’ negative emotional responses when anticipating their child’s pain were assessed using psychophysiological measures— i.e., fear‐potentiated startle and corrugator EMG activity. Parental behavioral response to their child’s pain (i.e., pain attending talk) was assessed during a 3‐minute parent–child interaction that followed the pain task. The Child Facial Coding System (CFCS) was used to assess children’s facial pain expression during the pain task. Results indicated that receiving threatening information was associated with a stronger parental corrugator EMG activity during pain signals in comparison with safety signals. The same pattern was found for parental fear‐potentiated startle reflex, particularly when the child’s facial pain expression was high. In addition, parents who reported high levels of catastrophizing thought about their child’s pain engaged, in comparison with low‐catastrophizing parents, in more pain‐attending talk when they received threatening information. The findings are discussed in the context of affective‐motivational theories of pain.

Systematic Review: Family Resilience After Pediatric Cancer Diagnosis

OBJECTIVES A systematic review was conducted to (1) investigate family resilience in the context of pediatric cancer, and (2) examine theoretical, methodological, and statistical issues in this literature. Family resilience was operationalized as competent family functioning after exposure to a significant risk. METHODS Following guidelines for systematic reviews, searches were performed using Web of Science, Pubmed, Cochrane, PsycInfo, and Embase. After screening 5,563 articles, 85 fulfilled inclusion criteria and were extracted for review. RESULTS Findings indicated that most families are resilient, adapting well to the crisis of cancer diagnosis. However, a subset still experiences difficulties. Methodological issues in the current literature hamper strong nuanced conclusions. CONCLUSIONS We suggest future research with a greater focus on family resilience and factors predicting it, based on available theory, and conducted with attention toward unit of measurement and use of appropriate statistical analyses. Improvements in research are needed to best inform family-based clinical efforts.

Parents who catastrophize about their child's pain prioritize attempts to control pain

TOC summary Parents endorsing catastrophic thoughts about child pain have a higher priority for pain control attempts over encouraging engagement of their child in daily activities. Abstract How parents respond to their child in pain is critically important to how both parent and child attempt to cope with pain. We examined the influence of parental catastrophic thinking about child pain on their prioritization for pain control. Using a vignette methodology, parents reported, in response to different pain scenarios, on their imagined motivation for 2 competing goals: to control their child’s pain (ie, pain control) or to encourage their child’s participation in daily activities (ie, activity engagement). The effects of parent gender, pain intensity, and duration on parental goal priority were also explored. Findings indicated that higher levels of parental catastrophic thoughts were associated with the parents prioritizing child pain control over activity engagement. This effect was significantly moderated by pain duration. Specifically, pain control was more of a priority for those high in catastrophic thinking when the pain was more acute. In contrast, parental catastrophic thoughts had no effect on the pain control strategy favored by parents in situations with longer‐lasting pain. Furthermore, independently of parental catastrophic thoughts, heightened priority for pain control was observed in highly intense and chronic pain situations. Moreover, in highly intense pain, priority for pain control was stronger for mothers compared with fathers. Theoretical and clinical implications and directions for future research are discussed.

Parental distress and catastrophic thoughts about child pain: Implications for parental protective behavior in the context of child leukemia-related medical procedures

Objectives:Treatment for childhood leukemia requires frequent lumbar punctures (LP) and bone marrow aspirations (BMA), often described by children and parents as more distressing than the disease itself. Findings in schoolchildren and chronic pain samples indicate that increased parental distress may increase parental protective, pain-attending behavior, which is associated with more child pain and distress. However, in the context of invasive medical procedures, it is unknown which parents are likely to become most distressed and engage in pain-attending behavior, and how this impacts the children’s experiences. The present study investigated the impact of parental catastrophic thoughts upon parental distress and pain-attending behavior (verbal and nonverbal). Furthermore, the association between parental responses and the children’s pain behavior, pain, and distress was examined. Materials and Methods:A total of 46 parents of children with leukemia (range, 0.6 to 15 y) who underwent a LP/BMA procedure participated in this study. Parental catastrophizing was assessed before and parental and child distress was assessed after the LP/BMA procedure. Parental pain-attending behavior and the child’s pain behavior were observed before and after the LP/BMA procedure. Results:Findings indicated that heightened parental catastrophic thinking contributed to increased parental distress during LP/BMA and less pain-attending behavior before the LP/BMA procedure, especially in young children. In contrast, heightened distress in parents with high levels of catastrophizing contributed to increased engagement in postprocedural pain-attending behavior. For young children, increased preprocedural pain-attending behavior was related to more child distress, pain, and pain behavior. Discussion:The findings demonstrate the importance of parental catastrophic thinking in understanding their caregiving responses and preparing parents and children for painful invasive medical procedures.

Systematic Review: Associations Between Family Functioning and Child Adjustment After Pediatric Cancer Diagnosis: A Meta-Analysis

Objectives A systematic review and meta-analysis was conducted to investigate associations between family functioning and child adjustment (patient/siblings) after pediatric cancer diagnosis. Methods Database searches were performed using Web of Science, Pubmed, Cochrane, PsycInfo, and Embase. After screening 5,563 articles, 35 were identified regarding this topic; 30 contributed data for meta-analyses. Pearson’s r correlations were the effect of interest. Omnibus and family functioning domain-specific random-effects meta-analyses were conducted. Data are depicted in forest plots. Results A statistically significant association was found between family functioning and child adjustment (patient/siblings) after cancer diagnosis (r  =  0.19; 95% CI: 0.13–0.24). Greater family cohesion, expressiveness, and support and less family conflict were each associated with better child adjustment outcomes. Conclusions Family functioning is associated with patient and sibling adjustment after pediatric cancer diagnosis. Limitations in the existing literature preclude strong conclusions about the size of these effects and potential moderators.

Offspring of Parents with Chronic Pain: A Systematic Review and Meta-Analysis of Pain, Health, Psychological, and Family Outcomes

Abstract Offspring of parents with chronic pain may be at risk for poorer outcomes than offspring of healthy parents. The objective of this research was to provide a comprehensive mixed-methods systematic synthesis of all available research on outcomes in offspring of parents with chronic pain. A systematic search was conducted for published articles in English examining pain, health, psychological, or family outcomes in offspring of parents with chronic pain. Fifty-nine eligible articles were identified (31 population-based, 25 clinical, 3 qualitative), including offspring from birth to adulthood and parents with varying chronic pain diagnoses (eg, mixed pain samples, arthritis). Meta-analysis was used to synthesize the results from population-based and clinical studies, while meta-ethnography was used to synthesize the results of qualitative studies. Increased pain complaints were found in offspring of mothers and of fathers with chronic pain and when both parents had chronic pain. Newborns of mothers with chronic pain were more likely to have adverse birth outcomes, including low birthweight, preterm delivery, caesarian section, intensive care admission, and mortality. Offspring of parents with chronic pain had greater externalizing and internalizing problems and poorer social competence and family outcomes. No significant differences were found on teacher-reported externalizing problems. The meta-ethnography identified 6 key concepts (developing independence, developing compassion, learning about health and coping, missing out, emotional health, and struggles communicating with parents). Across study designs, offspring of parents with chronic pain had poorer outcomes than other offspring, although the meta-ethnography noted some constructive impact of having a parent with chronic pain.