Lynnda M. Dahlquist

The impact of food allergy on the daily activities of children and their families.

BACKGROUND Food allergy affects a significant number of children, and its management requires considerable time and vigilance. OBJECTIVE To determine the impact of food allergy on the daily activities of food allergic children and their families. METHODS Caregivers of food allergic children from a university-based allergy practice completed a questionnaire that evaluated their perception of the impact of their childs food allergy on family activities. RESULTS Of the 87 families who completed the study, more than 60% of caregivers reported that food allergy significantly affected meal preparation and 49% or more indicated that food allergy affected family social activities. Forty-one percent of parents reported a significant impact on their stress levels and 34% reported that food allergy had an impact on school attendance, with 10% choosing to home school their children because of food allergy. The number of food allergies had a significant impact on activity scores, but the existence of comorbid conditions such as asthma and atopic dermatitis did not significantly affect the results. CONCLUSIONS Food allergy has a significant effect on activities of families of food allergic children. Further study is needed to determine more detailed effects of food allergy on parent-child interactions and development.

Preparing children for medical examinations: the importance of previous medical experience.

The relationship between past medical experience and childrens response to preparation for medical examinations was investigated in 79 pediatric outpatients aged 3 to 12 years. Children were randomly assigned to one of five preparation conditions prior to receiving a medical examination and a throat culture: sensory information about the exam, training in coping skills (deep breathing and positive self-talk), combined sensory information and coping skills training, attention control, and no-treatment control. The results indicated that children with previous negative medical experiences demonstrated more behavioral distress during a throat culture examination that did children with previous positive or neutral medical experiences. In addition, the attention control condition appeared to increase the distress of children with previous negative medical experiences. Amount of past exposure to the specific medical procedure was not related to observed distress. The implications of these findings for the preparation of children for medical procedures are discussed.

Active and passive distraction using a head-mounted display helmet: effects on cold pressor pain in children.

OBJECTIVE The current study tested the effectiveness of interactive versus passive distraction that was delivered via a virtual reality type head-mounted display helmet for children experiencing cold pressor pain. DESIGN Forty children, aged 5 to 13 years, underwent 1 or 2 baseline cold pressor trials followed by interactive distraction and passive distraction trials in counterbalanced order. MAIN OUTCOME MEASURES Pain threshold and pain tolerance. RESULTS Children who experienced either passive or interactive distraction demonstrated significant improvements in both pain tolerance and pain threshold relative to their baseline scores. In contrast, children who underwent a second cold pressor trial without distraction showed no significant improvements in pain tolerance or threshold. CONCLUSION Although both distraction conditions were effective, the interactive distraction condition was significantly more effective. Implications for the treatment of childrens distress during painful medical procedures are discussed.

Distraction intervention for preschoolers undergoing intramuscular injections and subcutaneous port access

This study evaluated a distraction intervention designed to reduce the distress of preschool children undergoing repeated chemotherapy injections. Twenty-nine children aged 2-5 years were randomly assigned either to distraction by a developmentally appropriate electronic toy or to a wait-list control. Children who received the distraction intervention demonstrated lower overt behavioral distress and were rated by parents and nurses as less anxious than children in the control condition. The improvements were maintained over the 8-week intervention. The results suggest that a developmentally appropriate, multisensory, variable-distracting activity that requires active cognitive processing and active motor responses may be a viable cost-effective alternative to more time-intensive parent-training programs for preschool-age children.

Behavioral management of children's distress during chemotherapy

Three children, aged 11-14, undergoing cancer chemotherapy were coached in cue-controlled muscle relaxation, controlled breathing, pleasant imagery and positive self-talk during chemotherapy venopunctures. Using a multiple baseline across subjects design, 46-68% reductions from baseline levels of observed behavioral distress during venopunctures were found during intervention. Medical personnel and self-report ratings of the childrens distress during venopunctures also decreased during intervention. Parental ratings of childrens distress, however, did not change. Methodological issues in inpatient treatment of cancer patients and the self-report assessment of childrens distress are discussed.

Pediatric Pain Management

1. Introduction. 2. Evaluating Pain in Children. 3. Generating Hypotheses Regarding Physical Contributors to the Childs Pain. 4. Generating Hypotheses Regarding Cognitive and Emotional Contributors to the Childs Pain. 5. Generating Hypotheses Regarding Behavioral Contributors to the Childs Pain. 6. Developing an Evaluation Plan. 7. Measuring the Childs Pain. 8. Testing Hypotheses Regarding Physical Contributors to the Childs Pain. 9. Testing Hypotheses Regarding Cognitive and Emotional Contributors to the Childs Pain. 10. Testing Hypotheses Regarding Behavioral Contributors to the Childs Pain. 11. Treating Physical Contributors to the Childs Pain. 12. Treating Cognitive and Emotional Contributors to the Childs Pain. 13. Treating Behavioral Contributors to the Childs Pain. 14. Implementing the Pain Management Program. 15. Concluding Comments. References. Appendices: A. Generating Hypotheses/Evaluation Planning Worksheet. B. Treatment Planning Worksheet. C. Peer Interaction Record (PIR). D. Selected Reading. Index.

Perceived History of Anaphylaxis and Parental Overprotection, Autonomy, Anxiety, and Depression in Food Allergic Young Adults

This study examined autonomy, anxiety, depression, and perceptions of parental behavior in 86 food allergic young adults and 344 healthy young adults between the ages of 18 and 22. Participants completed an online survey measuring self-reported autonomy, anxiety, depression, and perceptions of parental behavior. Results indicated that, as a group, food allergic young adults did not differ from healthy peers. However, food allergic young adults who reported having experienced an anaphylactic reaction described their disease as more severe, reported more worry about their disease, and rated their parents as more overprotective than food allergic young adults who reported never having experienced anaphylaxis. The experience of anaphylaxis may be a reliable indicator of food allergic individuals who are at risk for psychological distress.

Effects of Videogame Distraction using a Virtual Reality Type Head-Mounted Display Helmet on Cold Pressor Pain in Children

OBJECTIVE To test whether a head-mounted display helmet enhances the effectiveness of videogame distraction for children experiencing cold pressor pain. METHOD Forty-one children, aged 6-14 years, underwent one or two baseline cold pressor trials followed by two distraction trials in which they played the same videogame with and without the helmet in counterbalanced order. Pain threshold (elapsed time until the child reported pain) and pain tolerance (total time the child kept the hand submerged in the cold water) were measured for each cold pressor trial. RESULTS Both distraction conditions resulted in improved pain tolerance relative to baseline. Older children appeared to experience additional benefits from using the helmet, whereas younger children benefited equally from both conditions. The findings suggest that virtual reality technology can enhance the effects of distraction for some children. Research is needed to identify the characteristics of children for whom this technology is best suited.

Helping children and caregivers cope with repeated invasive Procedures: How are we doing?

This paper discusses recent developments in the medical and psychological management of child behavioral distress during invasive (i.e., needle stick) procedures for diagnosis and treatment of chronic pediatric disorders. Along with a review of relevant studies from the medical, pediatric psychology and behavior analysis literatures, representative data are presented from recent research on pediatric procedural pain management. The impact of increasing use of implanted subcutaneous intravenous catheters (ports) and decreased reliance on intravenous cannulation is discussed. Similarly, the effects (and limitations) of more frequent use of topical anesthesia to prepare needle sites also are presented. The continuing need for adjunctive, nonpharmacological (i.e., cognitive and behavioral) interventions for procedural pain is emphasized, and recent studies on distraction and counter-conditioning-based treatments are described. Future research is encouraged on (1) behavioral interventions in relation to day-to-day contextual variables that modulate treatment effects and (2) the development of efficient screening measures to identify children and families who are least likely to cope effectively with repeated procedures, allowing them to be given greater priority for allocation of limited resources for psychosocial intervention.

Effects of Videogame Distraction and a Virtual Reality Type Head-Mounted Display Helmet on Cold Pressor Pain in Young Elementary School-Aged Children

OBJECTIVE This study examined the effects of videogame distraction and a virtual reality (VR) type head-mounted display helmet for children undergoing cold pressor pain. METHODS Fifty children between the ages of 6 and 10 years underwent a baseline cold pressor trial followed by two cold pressor trials in which interactive videogame distraction was delivered via a VR helmet or without a VR helmet in counterbalanced order. RESULTS As expected, children demonstrated significant improvements in pain threshold and pain tolerance during both distraction conditions. However, the two distraction conditions did not differ in effectiveness. CONCLUSIONS Using the VR helmet did not result in improved pain tolerance over and above the effects of interactive videogame distraction without VR technology. Clinical implications and possible developmental differences in elementary school-aged childrens ability to use VR technology are discussed.