Pediatric needle procedures: Parent–child interactions, child fear, and evidence-based treatment.

Abstract

AbstractNeedle pain in children is common. The Canadian vaccination schedule recommends more than 20 immunizations before age 6 for healthy children. Children with chronic illnesses such as diabetes or cancer have many more painful needle procedures (e.g., insulin injections, blood glucose testing, lumbar punctures, and bone marrow aspirations). Unmanaged procedural pain and distress can have a myriad of deleterious short- and long-term consequences, including increased distress at future procedures, needle phobia, and avoidance of medical care. This article provides an overview of my research program which focuses on three interrelated aspects of children's procedural pain: (1) the behaviour of parents while their children are in pain, (2) understanding and measuring child needle fear, and (3) evidence-based treatment. Full insight into the nature and impact of parent communicative behaviours during pain is critical as we can change them to decrease child pain and distress. Fear can influence pain perception; therefore, improved understanding of needle fear and measurement of fear in the context of painful medical procedures is important to guide effective intervention.Keywords: pediatric pain, parent-child interactions, fear, reassurance, distraction, needle, child healthPain is complex and is defined as an inherently subjective unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage (Merskey & Bogduk, 1994). Craig's (2009) Social Communication Model of Pain describes numerous elements that interact to create an individual's experience of pain, including social, biological, and psychological factors. Craig's model includes both the person in pain (e.g., child) as well as observers (e.g., parents). In addition to social/interpersonal factors, the model posits that both the person in pain and the observer contribute intrapersonal factors that influence the person's experience and expression of pain, pain assessment, and pain management (Craig, 2009).Pain can be acute (short in duration) or occur recurrently over a longer period of time (e.g., > 3 months). One in five adult Canadians has chronic pain (Moulin, Clark, Speechley & Morley-Forster, 2002) leading to an enormous economic cost higher than heart disease, cancer, and HIV combined ($6 billion/year; Lynch, 2011). Chronic pain is also common in children (median prevalence rates for various types of chronic pain in pediatric populations range from 11% to 38%; King et al., 2011) and is a risk factor for experiencing chronic pain as an adult (Fearon & Hotopf, 2001). Acute pain includes pain from everyday bumps (Fearon, McGrath, & Achat, 1996), sporting injuries (Coates, McMurtry, Pottie, & McGrath, 2010), and pain from medical procedures. An unfortunate myth persisting until the 1 980s held that children experienced less pain than adults as a result of less developed nervous systems, which lead to a societal belief that children do not require relief from medical pain (Lynch, 2011).Pain from needle procedures is highly prevalent for both healthy children (e.g., Canadian children undergo up to 20 immunizations before age 6) and children with chronic illnesses such as diabetes or cancer (e.g., insulin injections, lumbar punctures). Children have reported getting a needle to be one of their most feared and painful experiences (Hart & Bossert, 1994). Needle fear is common in both children and adults; in a recent study, 63% of children and 24% of parents endorsed a fear of needles (Taddio et al., 2012). Far from just a poke, unmanaged needle pain has significant consequences, including exaggerated negative memories of the procedure (Noel, McMurtry, Chambers, & McGrath, 2010), longer procedure times, increased distress at future procedures, needle phobias, avoidance of medical care, and nonadherence to vaccination schedules (Taddio et al. …