Child-Adult Medical Procedure Interaction Scale-Revised Research Articles

Child Emotion Regulation Capacity Moderates the Association Between Parent Behaviors and Child Distress During Pediatric Venipuncture.

Medical needle procedures are a common source of pain, distress, and fear for children, which can worsen over time and lead to needle noncompliance and avoidance, if unaddressed. Children's pain experience is multiply determined by external (e.g., parent behaviors) and internal (e.g., cognitive and affective) factors. Some parent behaviors (e.g., reassurance, giving control to child, empathy, apologies, criticism) have related to poor child pain experiences. No research has examined how children's internal emotion regulation, commonly measured via heart rate variability (HRV), may buffer, or strengthen this association. This study is the first to examine child HRV in relation to pain experiences, and as a moderator between a constellation of parent behaviors (reassurance, giving control, empathy) and child pain, fear, and distress. Sixty-one children aged 7-12 years undergoing venipuncture and a parent participated. Child HRV was measured before the procedure. After venipuncture, children rated their pain and fear. Parent and child behaviors during venipuncture were coded using the "distress promoting" and "distress" composites of the Child-Adult Medical Procedure Interaction Scale-Revised. Children with lower HRV displayed greater distress. Child HRV moderated the positive association between parent behaviors (reassurance, giving control, empathy) and child distress such that the association was strongest among children with low HRV. Findings suggest children with lower HRV, indicative of lower emotion regulation capacity, may be at risk of experiencing higher levels of distress and may be more vulnerable to distress when facing parent reassurance, giving control, and empathy verbalizations during venipuncture.

Adult behavior toward the child before surgery and pediatric emergence delirium.

Emergence delirium is one of the problems that occur when a child wakes from anesthesia. Research results indicate that psychological factors are associated with this phenomenon. The relationship between adult behavior before child surgery and pediatric emergence delirium has not been investigated before. The aim of this study was to explore the associations of parent, anesthesiologist, and nurse behaviors before child surgery with pediatric emergence delirium. The study included 99 pediatric patients (aged 2-17years) undergoing surgery with general anesthesia, their accompanying parents, an anesthesiologist, and nurses. The study was conducted directly before surgery and after recovery from anesthesia. Before surgery, the behaviors of children, parents, and medical staff were videotaped and then scored using the Child-Adult Medical Procedure Interaction Scale-Revised. Emergence delirium was measured with the Pediatric Anesthesia Emergence Delirium Scale. Parent reassuring comments (ꞵ=0.22, B=1.32, 95% CI 0.14-2.49, p=.028) and parent giving control to child (ꞵ=0.21, B=7.02, 95% CI 0.68-13.56, p=.031) were positive predictors of emergence delirium in the group of children aged 2-8years. Parent behavior explained an additional 10% of the variance in pediatric emergence delirium. Our results suggest that parent reassuring comments and giving control to the child before surgery are related to the level of child emergence delirium in children aged 2 to 8years.

Development and validity of the Burns-Child Adult Medical Procedure Interaction Scale (B-CAMPIS) for young children

BackgroundYoung children are at increased risk of burn injury and of procedural distress during the subsequent wound care. There are currently few observational measures validated for use with young children during medical procedures. The aim of this research was to adapt the Child–Adult Medical Procedure Interaction Scale-Revised (CAMPIS-R) to assess parent-young child interactions during burn wound care by including nonverbal behavioral coding. MethodEighty-seven families of children (1–6years old) were recruited at their first burn dressing change. Potential behaviors were identified through a literature review, consulting health professionals, and direct observation of parents and children during burn wound care. Nonverbal behaviors were coded live, and verbal behaviors were audio recorded for later assessment. ResultsInter-coder reliability was good to excellent for the Burns-CAMPIS (B-CAMPIS). The additional behaviors were correlated with the hypothesized coping, distress, coping-promoting and distress-promoting categories of the CAMPIS-R. Some behaviors differed in frequency across child age groups, with older children demonstrating more verbal behaviors. Convergent validity was demonstrated through correlations with previously validated observational parent–child behavior measures, and parent– and nurse– reported measures of child pain and anxiety. Univariate regression analyses demonstrated the child categories of the B-CAMPIS accounted for equal or more of the variance of parent– and nurse– reported child pain and anxiety, compared to the CAMPIS-R. ConclusionsThe B-CAMPIS is a reliable and valid measure, for assessing coping and distress relationships in young children and their families. Pending further validation, the B-CAMPIS assists researchers and clinicians to recognize and target important behaviors to improve young child coping during pediatric burn wound care.

Children's anxious reactions to an invasive medical procedure: The role of medical and non-medical fears.

This study investigated the relationship of medical and non-medical fears to children's anxiety, pain, and distress during an invasive medical procedure, the voiding cystourethrogram. Parents of 34 children completed the Fear Survey Schedule-II prior to their child's procedure. Child distress behaviors during the procedure were audiotaped and coded using the Child-Adult Medical Procedure Interaction Scale-Revised. Ratings of child procedural anxiety and pain were obtained from children, parents, and examining technologists within minutes following the procedure. Associations were observed between medical fears, procedural anxiety (parent and staff reports), and coded distress behaviors. Findings may inform preparation efforts to reduce anxiety around invasive medical procedures.

Pediatric Immunization Distress

Using cluster analysis, we aimed to identify a typology of nurses', parents', and young children's behaviors during the anticipatory phase of pediatric immunizations to explore the associations between these different typologies and to determine whether these groups differed with respect to the child's procedural distress as rated by the child and the parents and with respect to the adults' self-rated distress. Immunizations given by 23 nurses to 220 children aged 3 years and 10 months to 7 years were recorded with behaviors being scored according to Child-Adult Medical Procedure Interaction Scale-Revised, to which 3 new codes were added, and rated with a 6-point Likert scale. Parents' and nurses' ratings of their own distress and of the child's distress, in addition to children's self-rating of distress were obtained. Nine adult and 12 child behavioral codes were submitted for cluster analysis. A solution with 4 clusters for children, 5 clusters for parents, and 5 clusters for nurses was retained. Our results show high consistency between child and adult clusters. During the anticipatory phase, less distressed children, characterized by either low activity or high coping, interacted with adults who showed low activity or high coping support patterns. More distressed children, characterized by resistance and behavioral distress, interacted with adults who displayed either low activity or less efficient support behaviors, such as reassurance and criticism. The results confirm previous dimensional studies and add relevant knowledge concerning typologies of participant behaviors that may be useful in understanding such behaviors and in helping providers in their management of child immunizations.

Music Therapy as Procedural Support for Young Children Undergoing Immunizations: A Randomized Controlled Study.

Children undergoing routine immunizations frequently experience severe distress, which may be improved through music therapy as procedural support. The purpose of this study was to examine effects of live, cognitive-behavioral music therapy during immunizations on (a) the behaviors of children, their parents, and their nurses; and (b) parental perceptions. Participants were children between the ages of 4 and 6 years (N = 58) who underwent immunizations, their parents (N = 62), and the nurses who administered the procedure (N = 19). Parent/child dyads were randomly assigned to receive music therapy (n = 29) or standard care (n = 29) during their immunization. Afterward, each parent rated their child's level of pain and the distress their child experienced compared to previous medical experiences. All procedures were videotaped and later viewed by trained observers, who classified child, parent, and nurse behaviors using the categories of the Child-Adult Medical Procedure Interaction Scale-Revised (CAMPIS-R). Significant differences between the music therapy and control groups were found in rates of child coping and distress behaviors and parent distress-promoting behaviors. Parents of children who received music therapy reported that their child's level of distress was less than during previous medical experiences, whereas parents of children in the control group reported that their child's level of distress was greater. No significant differences between groups were found in parents' ratings of children's pain or in rates of nurse behavior. Live, cognitive-behavioral music therapy has potential benefits for young children and their parents during immunizations.

The Association Between Parent's and Healthcare Professional's Behavior and Children's Coping and Distress During Venepuncture

Examine the association between children's distress and coping during venepuncture with parent's and healthcare professional's behavior in a sample from the UK. Fifty children aged 7-16 years accompanied by a carer were videotaped while having venepuncture. Verbalizations of children, parents, and healthcare professionals were coded using the Child-Adult Medical Procedure Interaction Scale-Revised. Children's distress was associated with child's age, anxiety, and distress promoting behavior of adults (R(2) = .91). Children's coping was associated with age, anxiety, and coping promoting behaviors of adults (R(2) = .57). Associations were stronger between healthcare professional's behavior and child coping; and between parent's behaviors and child distress. Empathizing, apologizing, and criticism were not frequently used by adults in this sample (<12%). This study supports and extends previous research showing adult's behavior is important in children's distress and coping during needle procedures. Clinical implications and methodological issues are discussed.

Pain, Distress, and Adult-Child Interaction During Venipuncture in Pediatric Oncology: An Examination of Three Types of Venous Access

This study examined pain and distress from needles in children undergoing blood sampling as a function of adult-child interaction and type of venous access (i.e., central external venous lines, internalized ports, or peripheral access via venipuncture). Participants were 55 pediatric oncology patients, aged 3–18 years, who were undergoing routine blood work. Pain ratings were obtained using the Faces Pain Scale—Revised (FPS-R) and conversation during the procedure was audio taped for coding using the Child-Adult Medical Procedure Interaction Scale—Revised (CAMPIS-R). Children's ratings of pain using the FPS-R were similar in the port (M = 2.57/10, standard deviation [SD] = 3.46) and peripheral (M = 2.56/10, SD = 3.24) groups, despite the fact that most children with internal ports were given a topical anesthetic. Similarly, there were no differences between port and peripheral groups in rates of child coping or distress, or parent and nurse observations of child pain. As would be expected, external line access was not associated with pain or distress, even among very young children, suggesting that they appropriately understood the pain rating scale. Results of the transcribed CAMPIS-R data indicate that the influences in adult-child interaction are bidirectional. Support was found for the well-established positive relationship between child distress and adult reassurance and empathy. Implications for intervention and selection of central venous access devices are discussed.

Factors associated with infant pain response following an immunization injection

Objectives Specific potential determinants of infant pain response were assessed in the context of a 4- or 6-month immunization injection. The distal influences of gender, gestational and current age, temperament, and early nociceptive stimuli were considered, as well as the proximal influences of parental and nurse coping-promoting statements within the treatment room. Study design An observational study design was used. Pain responses in 93 infants receiving an immunization injection were videoed and coded using the Neonatal Facial Coding System (NFCS) and duration of crying was recorded. Parent and nurse vocalizations were coded using the Child–Adult Medical Procedure Interaction Scale-Revised. Results A multiple regression analysis evaluated the influence of the 5 distal and 2 proximal factors on NFCS scores, and found parental coping-promoting statements in the 30 s period before the injection to have the strongest effect on facial pain response ( p < 0.01). Parents made significantly more coping-promoting statements ( p < 0.05), and generally talked more ( p < 0.05), to female infants than male infants. Conclusions The findings suggest that parental behavior in the treatment room has a key role in influencing how infants respond to painful procedures.

The Child-Adult Medical Procedure Interaction Scale-Revised: an assessment of validity.

Investigated the validity of the Child-Adult Medical Procedure Interaction Scale-Revised (CAMPIS-R) using multiple concurrent objective and subjective measures of child distress, approach-avoidance behavior, fear, pain, child cooperation, and parents' perceived ability to help their preschool children during routine immunizations. Parents', staffs', and children's behaviors in the treatment room were videotaped and coded. Results indicate that the validity of the CAMPIS-R codes of Child Coping and Distress, Parent Distress Promoting and Coping Promoting, and Staff Distress Promoting and Coping Promoting behavior were supported, with all significant correlations being in the predicted direction. An unanticipated finding was that the child, parent, and staff Neutral behaviors were inversely related to some measures of distress and positively related to some measures of coping. Interobserver reliability was high for each CAMPIS-R code.

Helping preschool leukemia patients and their parents cope during injections.

Taught 4 preschool leukemia patients (ages 3-5) to engage in specific coping behaviors before and during painful intramuscular and intravenous injections. Parents were taught to coach their children in the use of the coping behaviors. Intervention was delivered in a multiple baseline across-subjects design. Parent and child behavior was coded using the Child-Adult Medical Procedure Interaction Scale-Revised (CAMPIS-R, Blount, Powers, & Sturges) and Observation Scale of Behavioral Distress (OSBD, Elliott, Jay, Woody). Parents and nurses rated child behavior as well. Results indicated that parents learned coping-promoting behaviors, children learned specific coping behaviors, and children displayed less behavioral distress. Maintenance of behavior change was addressed. Contributions of this study to the current literature on children's coping with invasive medical procedures and implications for future research and clinical practice are discussed.