Children's Fear Research Articles

Earthquake From the Perspectives of Amputee Children and Their Parents/Caregivers: A Phenomenological Study.

Earthquakes cause significant psychological and physical trauma in children, especially when leading to amputations, as they disrupt physical, emotional, and social well-being. This study was conducted phenomenologically to explore the experiences of children amputated in the Kahramanmaraş earthquake and their parents/caregivers. This study was conducted as a phenomenological study with children who were amputated in the Kahramanmaraş earthquake and their parents/caregivers between August and October 2023. The sample of the study consisted of seven children and their parents/caregivers who met the inclusion criteria and volunteered to participate in the study through purposive sampling method. Data were collected through in-depth interviews using an introductory information form and a semistructured interview form developed by the researcher. It was found that 57.2% of the children who participated in our study were male and their mean age was 11.25 ± 4.02 years. It was found that all the children's houses were destroyed in the earthquake, they were trapped under the debris, and they experienced losses in their family members and relatives. As a result of data analysis, nine themes were identified as apocalypse, pain, fear, and hopelessness for children and apocalypse, helplessness, pain, anger, and hopelessness for parents/caregivers. This study found that earthquake-affected amputee children perceived the earthquake as an apocalypse, experienced prolonged pain during hospitalization, continued to fear the earthquake, and felt hopeless about the future. The children's parents/caregivers also reported that they perceived the earthquake as an apocalypse, that they felt helpless and hopeless for themselves and the children, and that the children had angry/irritable behavior with pain after the disaster.

Gender-stereotypical attribution of fear and fearlessness in preschool children.

Fear and fearlessness are two distinct emotional responses that can occur when a person faces a potentially dangerous situation. These responses seem to be linked to gender stereotypes (fearful female and fearless male). This study examines whether preschool children attribute fear and fearlessness stereotypically in relation to gender and whether their attributions vary as a function of age and gender. One hundred and twenty children (60 boys and 60 girls) aged 3, 4 and 5 years participated in this study. We examined children's gender-stereotypical performance through emotional scenarios and drawing tasks involving fear and fearlessness conditions. The results showed that children's performance was equally stereotypical in the two conditions. An age effect was found: children's gender stereotypical attributions increased with age. The results showed no differences in children's stereotypical performance in regards to their gender and task type (emotional scenarios and drawing tasks). The significance and implications of these findings are discussed in the context of gender-emotion stereotypes.

Experiences of migrant seasonal agricultural worker mothers in earthquakes: A phenomenological study.

Seasonal agricultural migration leads to both economic hardship and humanitarian challenges. Individuals involved in this migration face severe poverty and deprivation, with mothers critical participants in agrarian work, being especially vulnerable due to challenging conditions and family responsibilities. This study explores the experiences of migratory seasonal agricultural worker mothers and their children, particularly how the earthquake in Turkey impacted them on February 6, 2023. This descriptive phenomenological study was conducted with seasonal agricultural worker mothers who participated in hazelnut harvest in northern Turkey between August and September 2023. Study data were obtained from 22 mothers who agreed to participate. Data were analyzed using the MAXQDA 2022 qualitative data analysis program. It has been determined that the earthquake affects both mothers and children, creates confusion in mothers, creates fear, anxiety, and insecurity in children, and causes behavioral problems such as insomnia and loss of appetite. It has also been determined that positive changes occur in mothers' parenting practices and strengthen family ties. It has been revealed that mothers derive their psychological resilience from their belief systems and social interactions. It was concluded that earthquake experiences positively and negatively affected migratory seasonal agricultural worker mothers and caused emotional and behavioral problems in children.

Virtual Reality as Active Distraction in Laceration Repair: A Game Changer?

We conducted an unblinded, randomized control trial to determine if immersive virtual reality (VR) goggles decrease pain and fear scores in children undergoing laceration repair in the pediatric emergency department (PED) compared to the standard of care. Secondary outcomes included duration of procedure, physical holding, anxiolytic usage, and desire to use VR goggles again. Ninety-one patients aged 6-17 years in a PED with simple lacerations sutured by PED staff completed surveys. Eligible patients were randomized to receive either VR or standard of care. Guardians and providers also completed surveys. Self-reported pain scores were assessed by the Wong-Baker Faces Pain Scale and fear scores by Children's Fear Scale. There were significant reductions in pain and fear scores for VR goggles compared to standard of care. Patients rated their mean pain score as 3.7 in controls and 2.3 in the VR group, and mean fear score of 3.0 and 2.2. The likelihood of physical holding was significantly lower among those who used VR goggles (adjusted odds ratio = 0.34, 95% confidence interval [0.13-0.92], P = 0.033). The likelihood of receiving anxiolytics was lower among the 12- to 17-year-olds (adjusted odds ratio = 0.27, 95% confidence interval [0.11-0.69], P = 0.006). There was no significant difference in the procedure duration (P = 0.06). A total of 97.9% of parents, 93.6% of patients, and 95.7% of providers would use VR again. Virtual reality goggles are an effective tool for distraction for simple laceration repairs. Their use leads to decreased pain and fear. Children who used VR goggles did not require to be held as often for sutures. There was no significant difference in anxiolytics or duration of procedure.

Effect of using a kaleidoscope projector and matching cards on fear and vital signs in children aged 3-6 years receiving inhaled medication.

The aim of this study was to investigate the effect of the use of projector kaleidoscope and matching card on children's fear and physiological parameters in children aged 3-6 years receiving inhaled medication. This randomised controlled study was conducted with the guidelines of Consolidated Standards of Reporting Trials (CONSORT). The sample of children was allocated to the projector kaleidoscope group (n = 38), matching card group (n = 38) and control group (n = 38). Fear and vital signs were measured. In the study, the mean age of the children in the projector kaleidoscope group was 4.39 ± 1.10, the mean age of the children in the matching card group was 4.34 ± 0.96 and the mean age of the children in the control group was 4.28 ± 1.18. There was a statistically significant difference between the post-test scores of the Children's Fear Scale in the evaluation of parents and nurses according to the groups of children. There was a statistically significant difference between the respiratory post-test scores according to the groups of children. It was observed that the mean heart rate of the control group participants was higher than that of the children in the matching card group. There were no statistically significant differences in the post-test saturation values among the groups of children. It was observed that the projector kaleidoscope and matching card reduced fear and prevented increased respiratory rate in children receiving inhaler medication. In addition, it was determined that matching card had more effect on heart and respiratory rate than projector kaleidoscope.

“Fear for children”, Mother-Child Dyad and Future Mobility Trajectories of Displaced Ukrainians in Czechia and Poland: Children as a Factor for Fleeing and Living after the Full-Scale Invasion

This article addresses the issue of children’s care-receiving practices in the context of Ukrainian displacement in Czechia and Poland. Single mothers often need to care for their children alone, creating specific family power dynamics, especially in the setting of transnational reconfiguration, as fathers remain in Ukraine. This article aims to adopt the subjective bottom-up perception of connections associated with navigation in the new environment and shows that power dynamics is on the side of children as they are the dominant driver in the living arrangement in a new country and in the case of future mobility trajectories of the families. Using a qualitative methodology, drawing on 56 semi-structured interviews with Ukrainian displaced women in Czechia and Poland in 2023, this paper sheds light on the issue of family in the war situation. While studying the position of children in migration studies is not new, examining displaced family arrangements offers promising new insights into this topic. The focus on children will be provided from the perspective of Ukrainian female participants living in Czechia and Poland, using the concept of “doing family”.

Development of a Clinical Decision-Making Framework to Address Parental Substance Use and Child Safety

SYNOPSIS Objective. Clinicians caring for families impacted by substance use disorder often feel uncomfortable assessing for child protective concerns in the setting of non-prescribed parental substance use. This leads to a lack of standardization of care, where some clinicians choose to not ask any questions about the care of children for fear of receiving information that will leave them in an uncomfortable position as a mandated reporter, while others may reflexively report any identification of substance use to child protective services. The primary aim of this descriptive manuscript is to present a framework developed by a multidisciplinary team in a medical setting to address concerns about a recurrence of parental substance use. Design. We highlight the development, implementation, and evolution of a clinical decision-making framework designed to help standardize clinicians’ discussions around whether substance use could be affecting a parent’s ability to safely care for their children. Discussion. Five main assessment areas are discussed, including: (1) Safety of the child while substance use is occurring; (2) Safety of parental use patterns; (3) Parental treatment engagement; (4) Willingness to escalate treatment services; and (5) Stability of the home environment. We will present a clinical scenario to highlight how the framework is used as an aid to determine action planning with respect to immediate safety concerns, treatment escalation, and opportunities to maximize recovery supports. We discuss the challenges we’ve experienced and opportunities that arise in attempting to incorporate the principles of harm reduction within the context of assessments of child safety and well-being.

Assessing Fears of Negative Consequences in Children With Symptoms of Avoidant Restrictive Food Intake Disorder.

Fear of Aversive Consequences (FOAC), such as choking or vomiting, is an important associated feature of Avoidant/Restrictive Food Intake Disorder (ARFID). However, the manifestation of FOAC in young children is poorly understood. This study aimed to describe the fears of children with ARFID symptoms and examine the concordance between parent and child ratings of fear. Child-reported FOAC was assessed using an interview designed for children between 6 and 10 years old, the Gustatory Avoidance and Gastrointestinal Stress Symptoms (GAGSS). Parents were administered a semi-structured diagnostic interview regarding their child's symptoms, the Pica, ARFID, and Rumination Interview. Among 68 children with ARFID diagnoses or symptoms (41.2% female, 85.3% White, mean age = 8.2 years, SD = 1.1 years; range 5.2-9.9 years), 91.2% of children endorsed at least one fear relative to 26.5% of parents. Among parent-child dyads, 36.8% disagreed about the child's fear of stomach pain (κ = 0.12) and 48.5% disagreed about the child's fear of vomiting, (κ = 0.08), both indicating low inter-rater reliability. On average, children endorsed 4.3 (SD = 2.3) fears out of 9 options. The most frequently endorsed fears were that food will "taste bad," (n = 43, 63.2%), "make you gag" (n = 37, 54.4%), and "look disgusting" (n = 36, 52.9%). Findings highlight ways in which fear may manifest in children with ARFID that are not easily discernable by adults. Greater precision in depicting childhood fears may facilitate the earlier detection of problematic eating behaviors.

Dental fear and caries prevalence in schoolchildren with hearing impairment in Greece.

There have been limited reports on hearing impaired (HI) children's oral health, but no data on their dental fear. The aim of this study was to assess dental fear and caries prevalence in HI children and adolescents. Upon ethical approval, all elementary and junior/senior high schools for the HI in Greece were invited to participate in the study. Students were asked to fill in the Children's Fear Survey Schedule-Dental Subscale (CFSS-DS). High school students additionally answered the Modified Dental Anxiety Scale (MDAS). Both questionnaires were translated into sign language by the same licensed interpreter. Caries prevalence was evaluated by dmfs/DMFS indices. Statistics by SPSS Statistics 28 (IBM) included parametric and non-parametric tests (significance at p ≤ 0.05). 33 elementary and 53 junior/senior high school students (mean age = 10.89 ± 2.63 and 16.23 ± 1.33years, respectively) participated in the study. Means of CFSS-DS were 24.1 ± 9.9 and 26.9 ± 10.5, respectively. Mean MDAS (high school students) was 11.3 ± 4.7. Mean dmfs was 2.5 ± 5.2 for elementary and mean DMFS was 3.5 ± 5.4 for elementary and 7.3 ± 9.0 for high school students, higher than similar-age general population. Dental fear was not significantly associated to age, gender, severity of hearing impairment (HI) or caries prevalence. HI children present similar dental fear values, but higher caries prevalence compared to similar-age Greek hearing population.

Golden Breath: Feasibility and acceptability of a biofeedback-based virtual reality game on reducing children's needle-related pain and fear

BackgroundNeedle procedures can cause pain and fear in children. Current literature reports that biofeedback-based virtual reality applications may help alleviate children's pain and fear. This study aims to evaluate the feasibility, acceptability, and safety of the newly developed game Golden Breath, which uses biofeedback-based virtual reality to reduce children's needle-related pain and fear. MethodsThe development of Golden Breath includes; (1) development of the application's features based on needs assessment, (2) gamification of the application content based on literature, (3) development of the prototype, (4) expert evaluation and feedback on the application content, (5) usability testing by 11 children (4–12 years). ResultsRegarding acceptability, the expert evaluation showed a high usability of the system. All children provided positive feedback and reported high satisfaction with Golden Breath. The game was feasible and effective for reducing children's pain and fear levels during needle procedures. Golden Breath was deemed safe for children because it did not cause symptoms such as dizziness, vomiting, or nausea. ConclusionThe expert evaluation, children's feedback, and pilot study results showed that the Golden Breath game is feasible, acceptable, and safe for children during the needle-related procedure. The pilot study revealed that the Golden Breath game effectively reduced pain and fear during blood sampling in children. Practice to implicationsIt is recommended that healthcare professionals use Golden Breath to optimize the well-being of children receiving treatment for chronic and acute diseases.

The Effectiveness of Applying Artificial Intelligence in Sick Children's Communication.

Pediatric nursing students are required to be taught how to overcome their own psychological stress during their internship in order to understand sick children's emotional reactions, as well as to be able to interact and communicate with such children. This quasi-experimental study proves that the application of AI image health education e-books by the nursing teacher is more effective than traditional paper handout teaching materials in improving nursing students' self-efficacy when using therapeutic games to deal with and reduce sick children's fears of medical examinations and treatments (p < 0.05). AI-driven tools can enable the development of personalized e-learning materials that target specific areas for cognitive improvement. This targeted approach can enhance knowledge retention and skill development, resulting in better-prepared healthcare professionals.

The Role of Ibuprofen and Midazolam in Pediatric Dentistry: A Retrospective Study and Neurophysiological Considerations.

Background: Managing anxiety and behavior during pediatric dental procedures is challenging. This study examines the effects of combining ibuprofen with midazolam sedation using both behavioral management and clinical hypnosis to improve patient cooperation and reduce post-treatment pain. Methods: A retrospective cohort study of 311 children (mean age 74.2 months, standard deviation (SD) = 24.7) was conducted. Patients received either midazolam with ibuprofen (n = 156) or midazolam only (n = 155). Behavior was assessed using the Venham Behavior Rating Scale and anxiety with the Dental Subscale of Children's Fear Survey Schedule (CFSS-DS) and the Inventory of Stressful Situations (ISS) questionnaires. Statistical analyses included Mann-Whitney U tests and correlation analyses. Results: Ibuprofen did not significantly improve behavior during procedures (drinking phase 0.61, SD 1.31, p = 0.13; before treatment 0.25, SD 0.93, p = 0.53, anesthesia 1.21, SD 1.55, p = 0.29; after treatment 0.51, SD 1.22, p = 0.68), indicating that pharmacological pain management alone is insufficient to address behavioral challenges. Ibuprofen significantly reduced post-treatment pain, with 7.2% of cases reporting pain in the non-ibuprofen group compared to none in the ibuprofen group (p < 0.05). Conclusions: Ibuprofen had no effect on intraoperative behavior and only a limited effect on post-procedural pain, mainly for more invasive procedures. This study highlights the integration of sedation with behavioral strategies, such as clinical hypnosis, to manage anxiety and improve patient cooperation, aiming to enhance treatment outcomes using this integrative approach to pediatric dentistry. Further research is needed to optimize these strategies and verify them in a prospective setting.

Retraction Note to: Effects of artificial intelligence aibo intervention on alleviating distress and fear in children

Retraction Note to: Effects of artificial intelligence aibo intervention on alleviating distress and fear in children

Dental Fear in Children with Cleft Lip and Palate and their Correlation to Salivary Cortisol Levels

Dental Fear in Children with Cleft Lip and Palate and their Correlation to Salivary Cortisol Levels

Reduction of Dental Anxiety in Children Using Virtual Reality: A Randomised Controlled Trial.

The aim of this research is examining the effectiveness of Virtual Reality (VR) in the reduction of dental anxiety in children with novel methods. The three arm parallel-group randomised clinical study was conducted in children aged 6-10 years. Pulpotomy procedure was performed on randomised 90 selected children (n=30 in each group; AG: group applied active distraction using VR glasses, PG: group applied passive distraction, i.e., watching cartoons on a screen mounted onto a dental unit, CG: control group). Before and after the procedure, children were administered Facial Pain Scale (FIS), Children's Fear Rating Scale (CFSS-DS) and Frankl Behaviour Rating Scale (FBRS). The pulse rate was measured to check the anxiety levels of all treated children at five different time points. Statistical significance was determined as p<0.05. VR has been found to positively contribute to the performance of children in adapting to dental treatment. The VR application aims to create positive attitude in children by providing them a safe atmosphere and becoming a useful tool in the dental profession.

Research on the comprehensive child life intervention program (CCLIP) for adjusting medical fear in children with central nervous system (CNS) cancers: a randomized controlled trial study protocol

BackgroundMedical fear is a common psychological reaction in hospitalized children, especially during radiotherapy for central nervous system (CNS) cancers. This fear not only causes negative emotions such as anxiety and depression but also affects children’s quality of life and treatment outcomes. It is exacerbated by factors such as unfamiliar environments during radiation therapy and separation from parents. Child Life, as a professional service, offers physical and mental support to children through medical understanding and psychological preparation, addressing their social and psychological needs, among other things. This study aims to construct a comprehensive Child Life intervention program (CCLIP), consisting of four key components: psychological adjustment and preparation, therapeutic play, pain management and coping strategies, and family support. The integration of effective intervention methods aims to reduce medical fear in children undergoing radiotherapy, promote psychological well-being, improve treatment compliance, and enhance quality of life.MethodsThis study is a protocol for a randomized controlled trial. Using a random number table method, we plan to recruit 38 eligible children who meet the inclusion criteria and then randomize them into two distinct groups: the intervention group and the control group. The intervention group will receive the CCLIP, and the control group will receive standardized care. Data will be collected through questionnaires and on-site assessments during the one-month intervention period at four distinct time points: the day of admission (T0), the first radiotherapy positioning (T1), mid-radiotherapy (T2), and postradiotherapy (T3). The primary outcome measure is the effectiveness of the CCLIP in reducing medical fear among children receiving radiation treatment for CNS cancers. Secondary outcomes include anxiety, depression, radiation adherence, quality of life among children, and parental satisfaction.DiscussionThis study aims to alleviate medical fear among children with CNS tumors undergoing radiotherapy through the implementation of the CCLIP while enhancing their mental health and quality of life. The expected outcomes of this research include providing effective intervention strategies for clinical practice, improving the treatment experience and long-term prognosis of children, and having positive impacts on children and their families.Trial registrationThis study is registered at the Chinese Clinical Trial Registry, ChiCTR2400082622. Registered 2 April, 2024.

The Effect of Finger Puppet Play on Pain and Anxiety during Peripheral Vascular Opening Attempts in Preschool-age Children during Emergency Room Visits: Randomized Controlled Study

Objective: The pupose of this study is to examine the effect of finger puppet play on pain and anxiety during peripheral vascular access in preschool-age children in the emergency room. Design and methods: The study was conducted in a randomised controlled manner. The study population consisted of children aged 4–6 years who came to the paediatric emergency room of a hospital in Turkey between 25 May and 25 June 2022. The sample consisted of 97 children who met the research criteria between these dates (49 in the control group, 48 in the finger puppet play group). Stratification and block randomisation methods were used to determine the experimental and control groups.The data were collected with the Survey Form, Child Fear and Anxiety Inventory (CFAI) and Wong-Baker Facial Expression Rating Scale (WB-FAS) through interviews conducted by the researchers. Finger puppet play was shown to the experimental group during the procedure. Results: In the experimental and control groups, the child's pain and anxiety were evaluated by the child, parent, and researcher before the procedure, and similar pain and anxiety values were found from each source (p&gt;0.05). During the procedure, the child's pain and anxiety were evaluated by the child, the parent, and the researcher, and it was found that the children in the finger puppet game group experienced significantly less pain and anxiety than the children in the control group (p &lt; 0.05). Results: According to these results, the application of finger puppetry to children aged 4–6 years undergoing peripheral vascular access was effective in reducing pain and anxiety.

Infectious Diseases-Approved Virtual Reality Goggles for Common Procedures in Pediatric Surgical Patients.

Background/Objective: Virtual reality (VR) technology has been reported as effective in mitigating fear, anxiety, and pain in children undergoing various medical procedures. Our aim was to test the effectiveness of non-sponge-coated mobile phone-operated VR goggles approved by infectious diseases (ID) control in pediatric surgical patients. Methods: A prospective randomized trial in which pre-procedural and post-procedural heart rate, fear, and anxiety, and post-procedural pain were measured in pediatric surgical patients assigned to receive standard care versus standard care and VR goggles. The patients underwent line insertions, peripheral venipunctures for blood draws, drain removals, and wound care. Results: The control group and the intention-to-treat group were each randomly assigned twenty-four patients. Since eight patients who received VR goggles removed them prior to completion of the procedure, the study group included sixteen patients. In the study group, heart rate, fear, and anxiety scores were significantly lower after the procedure as compared to prior to the procedure. In the control group, these parameters were similar before and after the procedure. Post-procedural decrease in fear and anxiety was significant when comparing VR to control. However, despite better post-procedural physiological and emotional scores in the VR group as compared to control, the differences were not statistically significant. Pre-procedural anxiety was significantly higher in the study group. Conclusions: ID-approved VR goggles can reduce fear and anxiety associated with procedures commonly performed in pedicatric surgical patients. However, since increased baseline anxiety might be associated with VR, a higher benefit might be achieved if goggles were worn only by children who express a clear desire to use them.

Effectiveness of Virtual Reality for Managing Pain, Fear, and Anxiety in Children and Adolescents Undergoing Needle-Related Procedures: Systematic Review with Meta-Analysis.

The most frequently performed invasive procedures in hospitals and healthcare centers are needle-related procedures, such as intravenous cannulation and phlebotomy, and they are identified as the major sources of pain, fear, and anxiety in children and adolescents. The objective of this systematic review was to evaluate the effectiveness of VR as a distraction measure to reduce pain, fear, and anxiety in children and adolescents undergoing needle-related invasive procedures. For this purpose, the CINAHL, Scopus, WOS, and Cochrane Library scientific databases were used. The protocol review was registered in PROSPERO (ID:42024563245), and inclusion and exclusion criteria were applied. Twenty-one studies were included in the systematic review, involving a total of 2663 participants. Significant differences favored the use of virtual reality for the control of pain intensity (WBFSpatients p = 0.001; MD = -1.83; 95% CI -2.93 to -0.72; WBFSparents p = 0.0002; MD = -2.61; 95% CI -4.00 to -1.23; WBFSnurses p = 0.0001; MD = -2.71; 95% CI -2.82 to -2.60; VAS/NRS p = 0.001, MD = -0.71; 95% CI -1.13 to -0.28), anxiety (CAMpatient p = 0.02, MD = -2.92; 95% CI -5.45 to -0.38; CAMparents p = 0.01, MD = -3.87; 95% CI -6.99 to -0.75) and fear (CFSpatients p = 0.0005, MD = -1.27; 95% CI -1.99 to -0.56; CFSparents p = 0.0005, MD = -1.33; 95% CI -2.08 to -0.58; and CFSnurses p = 0.04, MD = -1.13; 95% CI -2.24 to -0.03). However, high heterogeneity was noted. The use of virtual reality as a distraction appears to be a valuable strategy for reducing pain, fear, and anxiety during needle-related procedures, although further studies with higher methodological rigor, based on a standardized protocol, are needed.

Association between Dental Fear and Children's Oral Health-Related Quality of Life.

This study aimed to examine the association between both parental dental fear and children's dental fear and its impact on the Oral Health-Related Quality of Life (OHRQoL) of Saudi children in the Eastern Province of Saudi Arabia. Data on 93 individuals aged 7-12 years were collected using clinical examination and Arabic-validated questionnaires: the Child Oral Health Impact Profile-Short Form (COHIP-SF19), and the Children's Fear Survey Schedule-Dental Subscale (CFSS-DS). Negative binomial regression analysis was performed to study the association between children's fear and parental dental fear as well as the OHRQoL, while adjusting for certain confounders. Overall, our multivariate analyses showed that children with high dental fear (CFSS-DS ≥ 38, p = 0.027) and a higher percentage of dental caries (p = 0.013) had a significantly lower OHRQoL after adjusting for clinical and socio-demographic factors. Further, parental fear of dentists was significantly associated with children's fear of dentists (p < 0.001). Our findings demonstrate that children's fear and dental caries are both associated with poorer OHRQoL. Further, parental dental fear about dentists was associated with children's fear of dentists.