Children's Fear Research Articles

Reframe the pain: Divided attention and positive memory reframing to reduce needle pain and distress in children-A feasibility randomized controlled trial.

Negative experiences of needle procedures in childhood can lead to medical avoidance and vaccine hesitancy into adulthood. We evaluated the feasibility of two new interventions provided by clinical nurses to reduce the negative impact of vaccinations: divided attention (DA) and positive memory reframing (PMR). Children (8-12 years) were randomized into four groups: usual care (UC), DA, PMR or combined (DA + PMR). To evaluate feasibility, we undertook in-depth analysis of video-recorded interventions, nurse experiences (phone interviews) and child/parent memory recall of interventions (phone interviews at 2 weeks post-vaccination). Key clinical outcomes included child and parent ratings of needle-related pain intensity and fear assessed at baseline, immediately post-vaccination and 2 weeks post-vaccination (recalled). A total of 54 child-parent dyads were screened, with 41 included (10/group, except PMR [n= 11]). The interventions were not always completed as intended: 10%-22% of participants received complete interventions and two had adverse events related to protocol breach. Preliminary within-group analyses showed no effects on child/parent pain ratings. However, children in DA + PMR had reduced recalled fear (p= 0.008), and PMR (p= 0.025) and DA + PMR (p= 0.003) had reduced fear of future needles. Parent ratings of child fear were also reduced immediately post-vaccination for UC (p= 0.035) and PMR (p= 0.035). The interventions were feasible, although enhanced nurse training is required to improve fidelity. Preliminary clinical results appear promising, particularly for reducing needle-related fear. Protocol number ACTRN12618000687291 at ANZCTR.org.au SIGNIFICANCE: Two new nurse-led interventions to reduce negative impacts of vaccinations in children, divided attention and positive memory reframing, were feasible and may reduce needle-related fear. Nurses were able to deliver the interventions in various environments including non-clinical settings (schools). These interventions have potential to facilitate broader dissemination of vaccinations for children in a manner that minimizes distress.

Music therapy and aromatherapy on dental anxiety and fear: A randomized controlled trial

Background/purposeDental anxiety and fear in children are major public health concerns. This study aimed to determine the effectiveness of music therapy combined with aromatherapy, in reducing the children's dental anxiety and fear. Materials and methodsA total of 128 school-age children aged 10–12 years were randomly allocated into 4 groups: a control group with 32 volunteers, an experimental group that received music therapy, with 33 volunteers, an aromatherapy experimental group with 31 volunteers, and 32 volunteers in an experimental group with music therapy combined with aromatherapy. ResultsThe results found that within-group comparisons before and after the experiment revealed the outcomes with a statistically significant change at the 0.05 level of each group as follows. The control group had increased heart rate. The music therapy group showed decreased dental anxiety and fear and systolic blood pressure. The aromatherapy experimental group exhibited increased oxygen saturation. The experimental group receiving music therapy combined with aromatherapy showed decreased dental anxiety and fear, heart rate, and systolic and diastolic blood pressure as well as increased oxygen saturation values. In addition, it was found that music therapy combined with aromatherapy had a co-influence on dental anxiety and fear (F = 22.22, P < 0.001) and oxygen saturation (F = 17.40, P < 0.001), and the two main treatments also significantly influenced these outcomes at the 0.05 level. ConclusionThe results showed that music therapy in combination with aromatherapy reduced children's anxiety and fear of dental services better than a single treatment.

The effect of virtual reality glasses against the fear of circumcision: A randomized controlled trial

Background/Aim: Circumcision is an invasive operation that male children undergo in our country and some others. During this process, the child can experience fear, anxiety, and pain simultaneously. As a randomized controlled VR study, this research was conducted to determine the effect of virtual reality (VR) glasses on reducing fear/anxiety and pain during circumcision in children.&#x0D; Methods: The study was conducted on 125 children (6-11 years old). The same healthcare team performed the circumcision of the children in both groups. The children were randomly split into VR and control groups. The children in the VR group, just before the circumcision, watched their preferred cartoon film via VR glasses. No additional procedure was applied to the children in the control group except for ordinary procedures in the hospital. The fear and pain status measured by Wong-Baker Faces Pain Rating Scale and Children Fair Scale of all the children were evaluated before and after the operation by the child, parents, and the observer. Descriptive statistics, chi-square, and t-tests analyzed the data.&#x0D; Results: There was no significant difference between the groups regarding demographic characteristics such as age, BMI, previous hospitalization, and anesthetic drug used before the procedure of the children included in the study. Preoperative (VR = 1.03 (0.18), control = 1.05 (0.22)) and pre-procedural (VR = 2.61 (1.02), control = 2.33 (1.22)) fear levels were also similar (P &gt; 0.05). After the procedure, it was determined that the mean duration of the procedure (365.36 (64.73) sec), crying time (21.31 (41.74) sec), and fear scores (0.36 (0.68)) of the children in the VR group were lower (P &lt; 0.001). However, pain mean scores were similar (P &gt; 0.05).&#x0D; Conclusion: It is thought that watching a cartoon with VR glasses during the circumcision operation may be effective in reducing the child's fear level, crying, and operation time.

Effectiveness of art-based distraction in reducing pain and anxiety of hospitalized children during cannulation procedure: A randomized controlled trial.

Peripheral venous cannulation (PIVC) is one of the most common needle procedures associated with the therapies of pediatric patients, which causes pain and anxiety in children. Trace Image and Coloring for Kids-Book (TICK-B) is one of the arts-based interventions to relieve pain and anxiety, but none of the existing studies use the TICK-B to decrease children's pain intensity and anxiety levels during PICV. This study aimed to investigate the effectiveness of the Trace Image and Coloring for Kids-Book (TICK-B) in decreasing children's pain and anxiety during PIVC. A parallel, randomized, double-blind controlled trial was used in this study. Children aged 6-12 years were randomly allocated to one of two groups: intervention or control. The intervention group (n = 48) received the TICK-B during the PIVC, compared to no intervention in the control group (n = 52). The children, their parents, and an observer nurse rated outcomes 1-2 min after completion of the procedure. The patients in both groups were similar in age, gender, duration of hospitalization, injections, mother's age, and education. Faces Pain Scale-Revised (FPS-R), Children's Fear Scale (CFS), and Visual Analog Scale (VAS) were used to measure pain and anxiety. Paired and independent t-tests were used for data analysis. Patients in the intervention group reported significantly reduced pain levels than those in the control group (p <0.001), as reported by children (3.08 vs. 7.06), parents (3.08 vs. 7.13), and the observer nurse (3.06 vs. 7.13), respectively. Anxiety levels were also significantly lower among patients in the intervention group than in the control group (p <0.001), as reported by children (0.88 vs. 3.17), parents (0.94 vs. 3.19), and the observer nurse (0.85 vs. 2.94), respectively. TICK-B is an effective technique for reducing children's pain and anxiety during PIVC. TICK-B is a simple, inexpensive, and effective technique that nurses can use to decrease the levels of pain and anxiety of pediatric patients during intravenous cannulation.

Systematic review and meta-analysis comparing the efficacy of dexmedetomidine to midazolam as premedication and a sedative agent in pediatric patients undergoing dental procedures.

Pediatric dental surgeries are associated with the emotions of fear, anxiety, and other behavioral disturbances of children that need to be managed. Sedation using drugs like dexmedetomidine (DEX) and midazolam (MID) is a common pharmacological behavior managing technique. We conducted this meta-analysis to evaluate the efficacy of both these drugs in current literature. A thorough literature search was conducted on PubMed, MEDLINE, Google Scholar, and Cochrane's database for randomized studies that compared sedative efficacy of dexmedetomidine with midazolam in children of 0-15 years of age undergoing dental surgeries. Sedation in children during dental procedure, when used as a premedication, at the time of separation from parents and at the time of mask induction, onset time, duration of anesthesia, and surgery were evaluated. The mean differences (MDs), odds ratio (OR), and their 95% confidence intervals (CIs) were calculated both for continuous and dichotomous outcome data using random-effects model. Seven studies met out inclusion criteria and were analyzed. Results of premedication with DEX was associated with more anxiolysis (OR=0.29, 95% CI: 0.17-0.52, p=0.0001; I2=0%) and at the time of separation from parents (OR=0.36, 95% CI: 0.19-0.69, p=0.002; I2=52%) in comparison to MID. No significant differences in results were seen at mask induction (OR=0.63, 95% CI: 0.34-1.18, p=0.15; I2=47%) and for sedation in children during dental procedures (OR=0.52, 95% CI: 0.07-3.70, p=0.51; I2=72%). Also, there were no significant differences in onset time, duration of anesthesia, and surgery between the two agents. DEX proved to be a better premedicant than MID for pediatric patients. No significant difference in efficacy of both sedative agents was observed in children undergoing dental treatment. More clinical trials need to be conducted to see its efficacy in dental surgeries in children of standardized ages and with standard doses.

PSYCHOLOGY OF FEARS OF SIX-YEAR-OLD STUDENTS AT THE PRIMARY STAGES OF SCHOOL EDUCATION

The article is related to the theoretical analysis of the psychology of children's fears and empirical research aimed at identifying, clarifying, and receiving additional information about the causes of fears of six-year-old students. The purpose of the research is to identify and analyze the causes that may provoke fears of six-year-old students of the first grade, to offer parents methods of providing psychological assistance to children. Several research methods have been used. Theoretical: theoretical analysis, synthesis, comparison, generalization, systematization; empirical: art therapy technique, test, individual conversations. In particular, the following research methods have been used: drawing technique of art therapy designed to identify the causes that provoke children's fears; test «Fears in houses» (according to M. A. Panfilova) for conducting the diagnosis of fears; individual interviews were carried out to find out what the children were afraid of. It has been determined that the greatest fear of six-year-old boys is the fear of death and physical injury. Girls are most of all afraid of injections and doctors, as well as of height, depth, confined spaces. Both boys and girls are afraid of animals, disease, nightmares. It has been established that the most common fears among the six-year-old pupils are: natural (biological) – those related to the threat to the life of the child; social – fear and apprehension about changing their social status and internal – generated by the imagination, fantasy of the child. A guide for parents on how to avoid fears in six-year-old children at the primary stages of school education has been compiled. The use of art techniques to overcome children's fears has been proposed. It has been emphasized that creative ways of self-expression should be aimed at the development of child’s relationship with himself and the external world. The relevance of using drawing techniques to diagnose and tackle the fears of six-year-old students of the first grade has been justified. It is noted that children's fears require the most careful examination and the earliest elimination in order to prevent the emergence of neurosis as a mental illness of the child at the primary stages of school education. The importance of modifying the work on eliminating children's fears at the initial stages of school education is noted. Keywords: fear; six-year-old students; art techniques; drawing technique; fairy-tale technique.

Improving ambulance care for children suffering acute pain: a qualitative interview study

BackgroundPain is a highly complex sensory and emotional experience. When a child suffers acute pain through illness or injury, they are often transported to hospital by ambulance. Pre-hospital pain management in children is poor, with 61% of children receiving suboptimal pain management. Consequences of poor pain management include the risk of developing post-traumatic stress disorder and altered pain perception. We aimed to identify clinicians’ perceptions of barriers, facilitators and potential improvements for the management of pre-hospital acute pain in children.MethodsQualitative face to face semi-structured recorded interviews were performed in one large UK ambulance service. Audio files were transcribed verbatim with thematic analysis used to generate themes. NVivo 12 was used to support data analysis. Findings were combined with existing evidence to generate a driver diagram.ResultsTwelve ambulance clinicians participated, including 9 registered paramedics and 3 emergency medical technicians. Median (IQR) age was 43.50 (41.50, 45.75) years, 58% were male, median (IQR) experience was 12 (4.25, 15.50) years and 58% were parents. Several themes relating to barriers and facilitators were identified, including physical, emotional, social, organisational, environmental, management, knowledge and experience. Improvement themes were identified relating to management, organisation and education. These data were combined to create a driver diagram; the three primary drivers were 1) explore methods to increase rates of analgesic administration, including utilising intranasal or inhaled routes; 2) reduce fear and anxiety in children, by using child friendly uniform, additional non-pharmacological techniques and more public interaction and 3) reduce fear and anxiety in clinicians, by enhancing training and optimising crew mix.ConclusionsThe quality of care that children receive for acute pain in the ambulance service may be improved by increasing rates of analgesic administration and reducing the fear and anxiety experienced by children and clinicians. Future research involving children and parents would be useful to determine the most important outcome measures and facilitate intervention development.

NURS-03. Effect of psychological intervention on peripherally inserted central catheterization in children with central nervous system tumors

Abstract OBJECTIVE: Peripherally inserted central catheterization (PICC) is a frequently used invasive clinical procedure in children with central nervous system (CNS) tumors. How to reduce the psychological impact brought by the operation process and increase the cooperation of children is a concern of medical staff .The study is to investigate the effect of psychological intervention with game strategy on PICC in children with CNS tumors. METHODS: A total of 120 children with CNS tumors who underwent PICC in Guangdong Sanjiu Brain Hospital from January 2019 to February 2021 were enrolled in this study. Patients were divided into two groups according to whether psychological intervention therapy was accepted during PICC, one group was the intervention group and the other group was the control group, with 60 patients in each group. Anxiety was assessed before and after PICC using the FLACC and Spence scores. T test was used to compare the scores of the two groups. RESULTS: Anxiety was found in both groups before PICC, and there was no significant statistical difference between the two groups (p &amp;gt; 0.05). The FLACC score of the two groups during PICC showed that the degree of pain in the intervention group was lower than that in the control group (P &amp;lt; 0.05). After catheterization, the anxiety score of the intervention group was significantly lower than that of the control group (P &amp;lt; 0.05). CONCLUSION: Psychological intervention based on game can reduce the medical fear of children with CNS tumors in the process of PICC and increase the cooperation of children.

Comparison of two Intranasal Sedatives, Midazolam versus Dexmedetomidine, in Children with High Dental Fear: a Randomized Clinical Trial.

Statement of the Problem: Pharmacologic management of uncooperative behavior is a growing trend in dentistry. Determining the most appropriate drug, route of administration, and proper candidate for sedation have been the goal of several investigations.Purpose: The aim of this study was to compare the sedative effect of intranasal (IN) sedation of midazolam (MDZ) in compare to dexmedetomidine (DEX) while taking into consideration the effect of dental fear, and psychological status on sedation success.Materials and Method: This double-blind randomized clinical trial included 92 uncooperative dental patients aged 4-6. Study participants were randomly assigned to receive either 0.2mg/kg IN MDZ or 1µg/kg DEX. Sedation was evaluated using the Houpt sedation rating scale. Vital signs were recorded before and during sedation. Prior to sedation, the level of dental fear was determined through children's fear survey schedule-dental subscale (CFSS-DS). Psychological characteristics were screened using the strengths and difficulties questionnaire (SDQ). Data were analyzed using T-test, Mann-Whitney, Chi-square, and repeated-measures analysis of variance (ANOVA).Results: Overall ratings of sedation and subscales of sleep, crying, and movement were comparable between groups (p> 0.05); however, more acceptable behavior (overall scores (4+5+6) was observed in MDZ group compared to DEX group (64% vs. 47.7%) (p= 0.007). All participants were found to have abnormal levels of dental fear (CFSS-DS≥38). However, according to SDQ, the study participants have mainly shown normal behavioral status. A significant association was found between dental fear and sedation success (MDZ, p= 0.001, DEX, p= 0.03), while similar findings were not observed for psychological characteristics (MDZ, p= 0.09 and p= 0.41; DEX, p= 0.71 and p= 0.53). Physiological parameters remained within normal limits in both groups.Conclusion: Sedation with IN MDZ resulted in overall behaviors, which were more satisfactory in highly fearful pediatric dental patients. Despite baseline uncooperative behaviors, the psychological status of study participants were close to average and were not associated with sedation failure.

Consequences of fearing police: Associations with youths' mental health and felt obligation to obey both the law and school rules

The procedural justice framework suggests that negative perceptions of the police are linked to crime-related behavior. General strain theory could illuminate a key mechanism; negative perceptions of the police might undermine the obligation to obey laws and rules through promoting strain and psychological distress. This study integrated these two theoretical perspectives to examine whether youths' fear of the police might undermine their felt obligation to obey authority institutions, including the law and school, through promoting psychological distress. Children (N = 342) ages 10–12 were sampled in November of 2020. Consistent with theoretical expectations, children's fear of the police was indirectly associated with their felt obligation to obey both the law and school rules through undermining their mental health. These findings have implications for policy, practice, and research; youths' fear of the police may undermine their mental health and may have downstream consequences on their felt obligation to obey not only the law, but also school rules.

The Effect of a Pain Educational Video Upon Child Pain-Related Memory and the Moderating Role of Parental Pain- and Non-Pain-Attending Verbalizations: An Experimental Lab-Based Study.

Early memories of pain contribute to fear and may underlie the maintenance and development of chronic pain into adulthood. Accordingly, understanding determinants that may impact children's pain memory development is key. This study examined (a) the effect of a brief engaging pain educational video in healthy children before undergoing an experimental pain task upon children's recalled pain intensity and pain-related fear and (b) the moderating role of parental pain- and non-pain-attending verbalizations before and after the pain task. Seventy-seven children (8-15 years old) participated in an experimental heat pain task, including actual heat pain stimuli delivered through a thermode on their forearm. Children were randomized to the experimental group (i.e., watching a pain educational video) or the control group (i.e., no video). Children's recalled pain intensity and pain-related fear were elicited 2 weeks later. Findings showed that recalled pain intensity (but not recalled pain-related fear) of children who watched the pain educational video was significantly lower compared to the control group (p = .028). Further, parental pain-attending verbalizations before the pain task moderated the impact of the video upon children's recalled pain intensity (p = .038). Specifically, children in the control group, but not the experimental group, whose parents used less pain-attending verbalizations recalled higher pain intensity, whereas children whose parents used more pain-attending verbalizations recalled lower pain intensity. As children's pain memories have important implications for pain assessment, treatment, and health across the lifespan, these findings might have important implications for the prevention of development or maintenance of maladaptive pain-related outcomes.

A multicentre Canadian survey of caregiver perspectives on COVID vaccine-related pain and stress for their family.

Caregiver hesitancy for their children to receive the COVID-19 vaccine remains due to concerns regarding safety and efficacy, but also due to fear of vaccine administration-related pain and distress. Study objectives were to determine caregivers' perceptions regarding both their personal and child's COVID-19 vaccine administration-related stress and fear and relate this to their likelihood to allow their child to receive COVID-19 vaccinations. This study was a secondary data analysis of a multicentre, cross-sectional survey of caregivers presenting to four Canadian pediatric emergency departments. Caregivers were surveyed between December 2020 and March 2021 and completed a digital survey on their own smartphones. 331 caregivers responded to the survey (mean age 39.9 years [SD 7.71]); 74.2% (245/331) were mothers. Children's mean age was 8.8 years [SD 5.4]; 49.8% (165/331) were female. 64.1% (209/326) of caregivers were willing to vaccinate their child against COVID-19, while 35.9% (117/326) were not. Greater perceived COVID-19 vaccine administration-related pain (0.88 [0.80; 0.95], p = .003) and stress (0.82 [0.76; 0.89], p = <.001) for their child as well as greater perceived personal stress with their own COVID-19 vaccine administration (0.81 [0.75; 0.88], p = <.001) were associated with caregivers being less likely to vaccinate their child. During the time period between COVID-19 pandemic waves 2 and 3, and after the vaccine had been federally approved for adults, one-third of Canadian caregivers surveyed reported being unwilling to vaccinate their child against COVID-19 in the future. Managing children's and caregivers' vaccine administration-related fear and stress may improve vaccine uptake for children.

An AI-Enabled Internet of Things Based Autism Care System for Improving Cognitive Ability of Children with Autism Spectrum Disorders.

Smart monitoring and assisted living systems for cognitive health assessment play a central role in assessment of individuals' health conditions. Autistic children suffer from some difficulties including social skills, repetitive behaviors, speech and nonverbal communication, and accommodating to the environment around them. Thus, dealing with autistic children is a serious public health problem as it is hard to determine what they feel with a lack of emotional cognitive ability. Currently, no medical treatments have been shown to cure autistic children, with most of the social assistive research to date focusing on Autism Spectrum Disorder (ASD) without suggesting a real treatment. In this paper, we focus on improving cognitive ability and daily living skills and maximizing the ability of the autistic child to function and participate positively in the community. Through utilizing intelligent systems based Artificial Intelligence (AI) and Internet of Things (IoT) technologies, we facilitate the process of adaptation to the world around the autistic children. To this end, we propose an AI-enabled IoT system embodied in a sensor for measuring the heart rate to predict the state of the child and then sending the state to the guardian with feeling and expected behavior of the child via a mobile application. Further, the system can provide a new virtual environment to help the child to be capable of improving eye contact with other people. This way is represented in pictures of these persons in 3D models that break this child's fear barrier. The system follows strategies that have focused on social communication skill development particularly at young ages to be more interactive with others.

Reciprocal effects between young children's negative emotions and mothers' mental health during the COVID-19 pandemic.

ObjectiveTo investigate the relations between young children's negative emotions and their mothers' mental health during the COVID‐19 pandemic.BackgroundThe COVID‐19 pandemic caused the public a certain degree of psychological symptoms, and family environments and relations have been changed dramatically as a result. The relations between young children's negative emotions and their mothers' mental health have not been sufficiently determined for the context of a pandemic or other large‐scale crises.MethodA survey was administrated on 8119 Chinese mothers of 3‐ to 6‐year‐old children with the Symptom Checklist 90 and the Child Negative Emotion Questionnaire.ResultsThe canonical correlation results indicated that there were covariation trends between young children's anger and their mother's obsessive–compulsive symptoms and hostility, children's fear and mothers' phobic anxiety, and children's tension and mothers' interpersonal sensitivity and depression. These correlations were all positively significant.ConclusionDuring the COVID‐19 pandemic, the predictive power of young children's negative emotions to their mothers' mental health was greater than that of the reverse.ImplicationsThis study provides a scientific guidance on the regulation of young children's negative emotions and the improvement of mothers' mental health during the pandemic as well as potential emergencies in the future.

The Role of Identity and Ontological (In)Security in Return Migration: an Empirical Perspective from Hungary

East–West migration has become a dominant spatial phenomenon in Europe since the step-by-step enlargement of the EU, posing considerable socio-economic and demographic challenges for sending countries. However, little is known about the geopolitics and motivations that inspire a return to the country of origin. The objective of this article is to identify the motivations for emigration, adaptation experiences and decisions of Hungarian migrants who worked in the West for a period of time and returned to Hungary, based on their skills and family status before their return. The research is based on in-depth interviews with 48 returnees and builds on the cultural identity model and the notion of ontological security. The study demonstrates the growing role of geopolitics in return migration, although its relevance differs in various groups, with clear distinctions between the high- and low-skilled migrants. The role of family as a geopolitical unit is increasing; factors like their endeavour to hold the family together, fear of children’s assimilation, loss of identity and uncertainty while abroad are important in shaping decisions to return. On the other hand, schemes to enhance the return migration of the highly skilled also build on geopolitical and nationalistic rhetoric, which appear to target experiences of ontological (in)security among migrants.

Association of Dental Anxiety with Color Preferences in Pediatric Dental Patients

Objective: People’s color preferences have been a subject of research and curiosity for many years. Among the methods aimed at minimizing such fears in children is the careful selection of colors in the environment in order to prevent individuals from developing negative feelings. The present study evaluates the association between colors and anxiety in a pediatric dental patient population aged 7–14 through a quantitative test. Material and Methods: The State-Trait Anxiety Inventory for Children (STAIC), the faces version of Modified Child Dental Anxiety Scale (MCDAS-f) and the quick version of the Lüscher Color Test (LCT), respectively, were administered to 65 patients and 48 age and sex matched controls while in the waiting room before treatment. Results: The MCDAS-f and STAIC state scale scores were significantly and moderately correlated with the LCT scores, while there was no statistically significant correlation between the STAIC trait and the LCT scores. The mean LCT score was 6.06±2.85 in the patient group and 3.22±2.21 in controls (p&lt;0.001). Conclusions: The results of this study support that the colors preferred by children during dental examination and treatment are in fact those that reflect their moods rather than those that should be used in dental surgery environments and medical attire, contrary to previous studies investigating the association between color preferences and anxiety in pediatric dentistry.

A digital intervention using virtual reality helmets to reduce dental anxiety of children under local anesthesia and primary teeth extraction: A randomized clinical trial.

IntroductionBehavior management of children during dental treatment is an important but challenging issue. As a new technique, VR has been applied in pediatric dental anxiety. But there is no final conclusion whether VR reduces children's dental anxiety.MethodsThe aim of the study is to assess the effectiveness of a digital intervention using virtual reality (VR) helmets on dental anxiety, pain perception, and behavior triggered for children, as well as occurrence of simulator sickness in local anesthesia and primary teeth extraction. A total of 128 children, who needed primary teeth extraction under local anesthesia, were randomly allocated into two groups: use VR helmets and traditional behavior guidance procedures (control). Modified Child Fear Survey Schedule Dental Subscale (CFSS‐DS), Wong‐Baker FACES Pain Scale, Houpt Scale, and Simulator sickness questionnaire (SSQ) were used to assess children's dental anxiety, pain perception, and behavior triggered and occurrence of simulator sickness.ResultsCFSS‐DS score in the VR group was significantly decreased after dental treatment (34.58±6.90 before operation and 32.32±15.58 after operation, p = .02). The score of Wong Baker Scale in the VR group (3.47±0.76) was significantly lower than that in the control group (5.56±1.13, p = .015). There was no significant difference in the Houpt Behavior Scale score and the SSQ score between the VR group and the control group (p = .35, p = .305).ConclusionThe use of VR helmets in primary teeth extraction can significantly reduce dental anxiety and pain perception in children without occurrence of simulator sickness.

Home administration of needle injections for children with rheumatic diseases: A qualitative study on nurses’ perception of their educational role

PurposeTo explore nurses' perceptions of their educational role, pedagogical competence, and practice in teaching children with rheumatic diseases and their parents to manage subcutaneous injections at home. Design and methodsIn this qualitative study, we used thematic analysis to analyze data from three focus groups with 14 nurses responsible for patient education at one pediatric ward and two outpatient clinics. ResultsWe identified three main themes capturing nurses' perceptions of their educational role: myriad expectations, awareness of own competence, and facilitation and prioritization of patient education. Nurses perceived patient education as an expected but challenging duty of their work. They described a lack of pedagogical competence, insecurity in managing parents' and children's fears and worries, and limited organizational structures guiding their educational role. Nurses who worked in outpatient clinics felt freer to individualize education compared to ward nurses. ConclusionsNurses perceive their educational role as significant in enabling children and parents to manage subcutaneous injections at home; however, they require pedagogical competence integrated with daily practice to provide high-quality care. Short-term admissions require a different organization of patient education than before. Practical implicationsNurses need increased training in communication and management of children's pain and fear during needle injections. Competence development should include opportunities for reflection and guidance in clinical practice. Pediatric specialist nurses at outpatient clinics seem to have better competence to provide individual patient education for these families. The potential advantage of web-based solutions for nurses' patient education is a promising avenue for future research.

MEMORI KETAKUTAN ANAK SEBAGAI SUMBER INSPIRASI KARYA SENI PATUNG

Violence from parents and violence from the immediate environment at the age of children causes them to become children who are easily afraid of sounds (Verbal), fear of physical violence (objects), and fear of the immediate environment. This final artwork project aims to create a sculpture art with the theme of the memory of a child's fear, which also explains the concept and process of creation and also the visual aesthetics of sculpture. The shape of the memory of children's fear is portrayed in the media of sculpture art with cast printing techniques. The creation of sculpture in this final project provides more insight into empirical experiences in creating works of art as well as the deepening of concepts in children's memory of fears.

Dental fear in school children and young adults attending public dental health care: prevalence and relationship to gender, oral disease and dental treatment; trends over 40\xa0years

PurposeTo study prevalence of dental fear and the relationship to gender, oral disease and dental treatment between 1973 and 2013 in school children and young adults attending public dental health care.MethodsEvery ten years from 1973 to 2013 random samples of about 100 individuals in each of the age groups 10, 15 and 20 years took part in a repeated cross-sectional study based on clinical parameters and a questionnaire. Dental fear was estimated by the question: “What do you feel at the prospect of an appointment with a dentist?”. 75–99% of the samples answered the question. Agreement to at least one of the alternative answers: ill at ease, frightened and sick defined dental fear. Frightened and/or sick indicated severe dental fear. The prevalence of caries, gingivitis and number of filled tooth surfaces were calculated. Chi-square tests were used to show differences in proportions between groups and linear regression to show trends over time.ResultsPrevalence of dental fear declined in all age groups over time. In the 20-year olds dental fear was found in 29% of the sample and severe dental fear in 12% of girls and 5% of boys in 2013. Individuals with dental fear had higher mean caries prevalence and number of filled tooth surfaces compared with individuals without dental fear.ConclusionsThis 40-year time trend study showed a reduction in dental fear prevalence in school children and young adults offered regular public dental health care based on prevention and a psychological approach. The prevalence of dental fear was still high in 2013 despite a significant decline in caries during the study period. Further improvements in the psychological approach when treating children are thus needed.