Distress In Children Research Articles

Pilot study of a parent-based intervention for functional somatic symptoms in children.

Functional somatic symptoms are associated with significant distress and impairment for children and their families. Despite the central role that families play in their children's care, there is little clinical research to guide how parents can support their children with functional somatic symptoms and promote better functioning. To address this gap, we developed a parent-based intervention for functional somatic symptoms in children and obtained preliminary data on acceptability, feasibility, treatment satisfaction, and clinical outcomes. The intervention was adapted from SPACE (Supportive Parenting for Anxious Childhood Emotions), an evidence-based treatment for anxiety and related disorders in children. The intervention, SPACE-Somatic, was delivered to parents of 16 children (Mage = 14.50 years; 75% girls) with a range of functional somatic symptoms. Parents participated in seven weekly group sessions conducted via telehealth. We found that SPACE-Somatic was acceptable, feasible, and satisfactory to parents. There were significant improvements in several clinical outcomes from baseline to posttreatment, including children's level of functional impairment, with some gains maintained at 3-month follow-up. Parents also reported improvements in their own stress and their accommodation of children's symptoms. This pilot study provides preliminary evidence that a parent-based intervention is viable and beneficial to children with functional somatic symptoms and their parents.

Attachment, feeling, and feeding: Associations between caregivers' attachment, emotional and feeding responsiveness, and Children's food consumption

A substantial body of literature links attachment to childhood obesity. However, research on the mechanisms underlying this association is scarce. The present study aimed to test four serial indirect path models to examine whether caregivers' insecure attachment is related to children's food consumption, through its influence on emotional and feeding responsiveness. A total of 352 caregivers of preschool children reported on their attachment orientation, emotional responses to their children's distress, feeding practices, and their children's food consumption. Results showed that caregivers with higher levels of attachment avoidance and anxiety were more likely to use unsupportive emotional responses to children's distress, which predicted the increased use of unresponsive feeding practices, and consequently children's higher sugary and fatty/salty food consumption. Higher levels of attachment avoidance were also associated with children's lower fruit and vegetable consumption through lower use of supportive emotional responses and responsive feeding practices, while higher levels of attachment anxiety were associated with children's lower fruit and vegetable consumption only by lower use of responsive feeding practices. These findings suggest that the influence of insecure attachment on caregivers' emotion regulation may contribute to the use of specific feeding practices that, in turn, affect children's food intake and may have implications for obesity risk.

54 Efficacy of a quality improvement project in paediatric procedural pain management during needle procedures

Abstract Background In paediatric hospital settings, needle procedures significantly contribute to children’s experiences of pain and distress. A structured approach integrating preparation, comfort positions, distraction, relaxation techniques, and topical anesthetics can enhance children’s ability to cope with procedural discomfort. We developed a quality improvement (QI) initiative aiming to alleviate procedural pain and distress through a staggered implementation approach over a 3-year period. Objectives This study aimed to evaluate the impact of the first 2 years of an institutional QI initiative on managing procedural pain and distress in children undergoing needle procedures. The primary objective was to evaluate the use of multimodal strategies to reduce needle-related procedural pain/distress following the QI initiative. The secondary objective was to compare pain scores for needle procedures before and after the QI initiative. Design/Methods This observational study was conducted in a tertiary care university-affiliated paediatric hospital with an ongoing hospital-wide QI initiative aiming to alleviate procedural pain and distress in children undergoing needle procedures. The QI initiative consisted of mandatory sector-by-sector training of healthcare providers (HCP) on procedural pain/distress strategies to increase the use of multimodal pain care. Pain scores were measured during needle procedures (i.e. Numerical Rating Scale (NRS), Faces Pain Scale-R (FPS-R) or the FLACC scales, according to patient age) pre and 3-6 months post implementation of the QI initiative. Scheduled audits were conducted using a standardized questionnaire by a deployment champion nurse during needle procedures to document pain scales and pain/distress strategies used by the HCP during needle procedures in each of the hospital services. Results Throughout the first two implementation years (June 2021-June 2023), 363 audits were conducted on needle procedures for 363 children (Median age 7 yo (0month-18yo□). At this stage, audits took place in 14 different hospital services. The most frequent procedures were IV-line insertions (34%), venous blood draws (27%), and capillary blood sampling (26%). Parental presence and the use of distraction techniques were frequently used (90% and 80% of procedures, respectively). Of the 363 audits, 221 were pre-implementation and 142 post-implementation. Post QI initiative, an increased number of procedures were realized using multimodal strategies (4 or more strategies) to reduce pain/distress (from 60% to 78%). Pain scores were recorded for 203/221 audits pre and 134/142 post with a reduction in severe pain scores (7 or more) from 25% pre to 5% post-implementation. Conclusion The institutional QI initiative demonstrated both an increase in the number of strategies used to prevent pain/distress and a reduction in severe pain scores associated with paediatric needle procedures. This project emphasizes the significance of employing a multifaceted approach to managing procedural pain/distress in children undergoing needle procedures.

32 A randomized controlled trial of virtual reality-based distraction for intravenous cannulation-related distress in children

Abstract Background Children commonly experience under-treated pain and distress related to medical procedures, such as intravenous insertions (IVI), leading to both short- and long-term negative consequences for patients and their caregivers. Virtual reality (VR) has emerged as a promising tool to ameliorate procedure-related distress in the paediatric healthcare setting; however, existing evidence has largely employed custom VR software, which can be expensive and inaccessible. As such, we aimed to characterize whether commercially available VR applications are effective in reducing children’s procedure-related distress. Objectives To assess the effectiveness of commercially available VR-based distraction when added to standard of care (SOC, which included topical anesthetic cream), in reducing distress for children undergoing IVI in the paediatric emergency department (PED). Design/Methods Children aged 6 to 17 years requiring IVI in a Canadian PED were recruited for a two-arm randomized controlled trial. The primary outcome was child distress, measured using the Observational Scale of Behavioural Distress – Revised (OSBD-R, score range 0-23.5). Secondary outcomes included child pain intensity (measured with the Faces Pain Scale-Revised, score range 0-10) and caregiver anxiety [measured by the State-Trait Anxiety Inventory-State (STAI-S), score range 20-80] during the procedure. Trial registration number: NCT04291404C. Results 82 children and their caregivers were included. 41 children received VR distraction in addition to SOC (mean age 10.8 years, SD 3.0), while 41 children received SOC alone (mean age 11.3 years, SD 2.8). There was no significant difference between OSBD-R-measured distress in the VR arm (mean 1.05, SD 1.52) compared to the SOC arm (mean 0.71, SD 1.40) (p = 0.08). There was no significant reduction in procedural pain intensity in the VR group (mean 4.20,SD 3.10) compared to the SOC group (mean 4.10, SD 3.20) (p = 0.85). There was no difference in caregiver STAI-S score immediately following IVI in the VR arm (mean 32.3, SD 11.3) versus the SOC arm (mean 32.3, SD 11.9) (p = 0.86). Conclusion VR distraction therapy employing commercially available software was not associated with reduction in procedural distress or pain, above that provided with SOC in the PED, for children undergoing IVI. This result highlights the need for more accessible custom VR distraction software, created to meet the unique psychological needs of children undergoing medical procedures. Further study is needed to directly compare custom versus commercially available VR software for this application.

Achieving RoutIne Screening for Emotional health (ARISE) in pediatric subspecialty clinics.

This study aims to describe the experience of implementing a psychosocial distress screening system for children with serious or chronic medical conditions. Achieving RoutIne Screening for Emotional health (ARISE) was developed to systematically evaluate psychosocial distress in children with serious medical or chronic medical illnesses, by integrating patient-reported outcome measures (PROM) into care delivery. ARISE was developed using a user-centered approach with extensive input from patients, families, and healthcare professionals to overcome barriers to routine PROM collection and integration into care as usual. It comprises a system to capture PROMs and then relay results to clinicians for changing care. We sought to implement ARISE at four subspecialty pediatric clinics caring for patients with cystic fibrosis, sickle cell disease, hemophilia, and neurological malignancy. Problems with acceptability, appropriateness, and feasibility represented barriers to implementation which were overcome by modifying the intervention using stakeholder input during the planning phase, leading to broad program acceptance. ARISE was implemented in three of the four clinics, in which 79.8% of eligible children and their family completed PROMs. The ARISE program demonstrated the feasibility and effectiveness of integrating psychosocial screenings into subspecialty pediatric clinics, thereby enhancing the identification and management of psychosocial issues in children with serious and chronic medical illnesses.

Mothers’ Stress as a Predictor of Preschoolers’ Stress in the Context of Parental Practices

Background/Objectives: Over the past decade, there has been a significant increase in distress among children, as well as in the long-term effects of childhood stress. Parents, particularly mothers, are the most important social partners for preschool-aged children and may help protect them from stress. The current study aims to investigate how parental practices impact children’s perceived stress in relation to their mothers’ stress. Methods: The sample comprised 346 mothers of preschoolers aged 20 to 48 years (M = 34.39, SD = 6.16). Participants completed an online survey that included the Perceived Stress Scale for Parents of Preschoolers, the Perceived Stress Scale, the Alabama Parenting Questionnaire—Preschool Revision, and questions regarding their socio-demographic characteristics. Results: Punitive parenting contributed positively, while positive parenting contributed negatively to children’s distress. When mothers’ perceived stress was taken into account, positive parenting lost its significance. Punitive parenting and maternal perceived stress were the only positive predictors of child distress. Conclusions: Stress in mothers may lead to a decrease in their involvement in the upbringing and parenting of preschoolers, potentially contributing to increased stress levels in children. Intervention programs aimed at reducing preschoolers’ stress should incorporate classes for parents that also could be focused on stress regulation for parents and training in positive parenting practices.

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

Beyond the First Child: Unveiling the Reasons Behind Stopping Childbearing in Iran.

The determinants of the intention to stop childbearing tend to differ over time and contexts. This allows the issue of families' childbearing intentions to continually remain on the research agenda. As societal context and temporal variability will matter for second childbearing intentions, this study aimed at uncovering the reasons behind the intentions to stop childbearing from one-child mothers' perspective. A qualitative descriptive study in Isfahan City, Iran, was used to scrutinize reasons behind the unwillingness to have a second pregnancy. A purposeful sampling with maximum variation was used to select one-child mothers. Until reaching saturation, 48 semistructured interviews were conducted. A thematic analysis was used to analyse the qualitative data. Five themes and 19 subthemes emerged from the data analysis as structural attributes (economic, social and political conditions), parental attributes (parental (dis)agreements, childrearing troubles, having impatience and being at the inappropriate age for childbearing), husband attributes (having the intention to stop parenting, financially and emotionally nonsupportive and being busy by working), maternal attributes (health-related problems, adverse experience during former pregnancy, being employed, self-compassion, the fear of parity progression and being pessimistic) and child attributes (having a naughty child and having the physical or mental distress of the first child). Overall, findings highlight the multifaceted nature of factors influencing second childbearing intentions. Structural reasons at macro level, intrafamily relationship, mothers' self-related factors and challenges of raising the first child all play distinct roles in discouraging mothers from a second child intention. Understanding these key reasons can help policymakers, researchers and individuals alike to comprehend the complexities involved in family planning and fertility decisions.

Illness-related communication between siblings and parents of children with chronic illness and life-limiting conditions: A qualitative analysis.

Having a brother or sister who has a chronic illness (lasting >6 months and requiring long-term care) or life-limiting condition (LLC; where cure is highly unlikely and the child is expected to die) has major impacts on siblings. Parent-sibling illness-related communication may contribute to siblings' capacity to cope. In this study, we aimed to explore parent-sibling illness-related communication, from the perspectives of parents and siblings. We also aimed to qualitatively compare participants' responses according to illness group (chronic illness vs. LLCs). We collected qualitative data from siblings (32 with a brother/sister with a chronic illness, 37 with a brother/sister with an LLC) and parents of a child with a chronic illness (n = 86) or LLC (n = 38) using purpose-designed, open-ended survey questions regarding illness-related communication. We used an inductive qualitative content analysis and matrix coding to explore themes and compare across illness groups. Two-thirds of siblings expressed satisfaction with their family's illness-related communication. Siblings typically reported satisfaction with communication when it was open and age-appropriate, and reported dissatisfaction when information was withheld or they felt overwhelmed with more information than they could manage. Parents generally favored an open communication style with the siblings, though this was more common among parents of children with an LLC than chronic illness. Our findings show that while many siblings shared that they felt satisfied with familial illness-related communication, parents should enquire with the siblings about their communication preferences in order to tailor illness-related information to the child's maturity level, distress, and age.

COVID-19-Associated Worry and Emotional Distress in Children with CKD

COVID-19-Associated Worry and Emotional Distress in Children with CKD

Screening for psychological distress in childhood and mental health-related hospital attendance among young adults

ObjectivesThe prevalence of mental disorders is high and increasing among children and young people. Investigating the relationship between self-reported poor mental health and mental health service utilisation can provide evidence on the benefits of universal screening, but longitudinal data is rare. ApproachData from a nationally representative English cohort (Next Steps) were linked to NHS Hospital Episode Statistics. GHQ-12 assessed psychological distress in Next Steps at age 15; participants were followed until their first mental health-related hospital presentations or were censored at the end of the study (age 27). Cox proportionate hazard models with survey weights estimated associations. ResultsOut of 4058 young people included in the analyses, 19% reported high levels of distress at age 15. During the 12-year follow-up, 5.3%, 2.9% and 2.7% of the participants had at least one mental disorder, drug/alcohol misuse and self-harm presentation, respectively, and 4.2% had a mental health treatment. Higher GHQ-12 scores were associated with mental disorder presentations (HR=1.10, 95% CI:1.04-1.16), and mental health treatments (HR=1.14, 95% CI:1.08-1.20). Associations were weaker for young people living in deprived areas, or if their main parent had lower education. ConclusionsAdolescent psychological distress predicts subsequent hospital attendance in young adulthood, but there are treatment gaps in service utilisation among more disadvantaged individuals. Detecting youth with mental health difficulties through universal screening, may facilitate early intervention, improve life-course outcomes, and reduce secondary healthcare use. ImplicationsLinked cohort and administrative data can improve our understanding on long-term healthcare utilisation and treatment needs.

Development and validation of a short version of the quality of life-DSD questionnaire for parents of young children with conditions affecting sex development.

There is a paucity of information on health-related quality of life (HRQoL) outcomes in parents and children with conditions affecting sex development. The objective of this study was to develop short forms of HRQoL questionnaires which consist of a 63-item and 25-item parent self-report (PSR) and parent proxy-report (PPR), respectively, optimizing use in routine clinical settings. Short questionnaires were developed following exploratory factor analysis using raw data from 132 parents. Long and short PSRs were completed by 24 parents of children with conditions affecting sex development, with a median age of 3.6 years (range 0.1, 6.6); 21 (88%) were boys, and 11 (46%) had proximal hypospadias. A subset of 19 parents completed both long and short PPRs. Item selection, based on factor loadings of >0.8 and expert consultation, produced short PSRs and PPRs containing 16 and 7 items, respectively. There was no statistically significant difference in 11 out of 12 (92%) scales on the PSR and 4 out of 5 (80%) scales on the PPR when comparing short and long questionnaire scores. The short and long questionnaires took <1 min and 5 min to complete, respectively. Eighteen parents (75%) reported that the time taken to complete the short questionnaires was acceptable; 10 (42%) preferred short questionnaires. Ten (42%) versus 6 (25%) stated a preference for completing the short versus long questionnaires. The short versions were largely representative of the long questionnaires and are acceptable for evaluating psychosocial distress in young children and their caregivers. Further psychometric validation of the short forms is warranted.

Administration of Nitrous Oxide by Medical Assistants for Painful Procedures in Outpatient Pediatric Settings.

Managing pain and distress in children experiencing procedural pain is a priority in pediatric care. Nitrous oxide (pre-mixed formulation of 50% nitrous oxide to 50% oxygen) is widely used to alleviate anxiety or pain during care procedures in various medical domains. This pharmacological intervention is safe to administer to children. Administration by non-anesthesiologist personnel is widespread throughout the world, though it is almost exclusively performed by doctors and nurses. The purpose of this study is to describe the experience of nitrous oxide (N2O) use by medical assistants and safe handling during the performance of painful procedures. A retrospective study was conducted in a pediatric outpatient unit of a regional hospital, including medical and surgical consultations. Nitrous oxide was administered by medical assistants to 324 children aged 3 to 19 years. No respiratory and/or cardiovascular problems were noted. Most patients were calm and relaxed. The use of N2O for minor procedures in children in a pediatric outpatient unit improved pain management through administration by medical assistants with a high level of satisfaction from patients, parents and health professionals. This study suggests that the use of nitrous oxide by trained medical assistants can be safe, feasible and effective within the specific context of this study.

Loop-mediated isothermal amplification (LAMP) for detection of atypical enterovirus D68 strain VR-1197

A method that has rapidly evolved for detection of viral pathogens are loop-mediated isothermal amplification (LAMP) assays. The available LAMP assays usually target the most common viral strains, including enteroviruses, but for the atypical enterovirus D68 strain VR-1197 this method has not yet been developed. Enterovirus D68 are known for severe respiratory distress in children, and atypical strains are less likely to be detected by traditional methods. This study targets the atypical EVD68 strain VR-1197 and have developed a rapid detection method saving time when differentiating enterovirus strains. This study present method development and review the sensitivity and specificity compared to traditional RT-qPCR, and wet lab cross reactivity with other airway pathogens. The EVD68 VR-1197 assay can be a rapid POC (Point of care) test for atypical EVD68 VR-1197 and have the potential as reliable detection method with minimal technological requirements.

Within-person bidirectional associations between maternal cortisol reactivity and harsh parenting across infancy and toddlerhood.

To understand transactional associations between mothers' biological stress responsivity and parenting behaviors, we examined bidirectional effects between maternal cortisol reactivity to observing their children during distress-eliciting paradigms and harsh parenting across infancy and toddlerhood using longitudinal data from the Family Life Project (N = 1,292, 41.5% African American). Children completed a series of distress-eliciting laboratory paradigms when they were 7, 15, and 24 months old, and mothers observed their children during the paradigms. Maternal cortisol reactivity was computed as a residualized change score from baseline to 20 min postparadigm, controlling for the time of day the saliva sample was collected. Harsh parenting was measured using five items from the Home Observation Measurement of the Environment inventory. A random-intercept cross-lagged panel model revealed that increases in maternal cortisol reactivity at 15 months predicted subsequent increases in harsh parenting at 24 months. Similarly, increases in harsh parenting at 15 months predicted increases in maternal cortisol reactivity at 24 months. Findings indicate that increased cortisol reactivity to children's distress in early toddlerhood may indicate a risk for harsh parenting in late toddlerhood and that increases in harsh parenting can also negatively impact mothers' stress physiology over time. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

LA DETRESSE RESPIRATOIRE CHEZ LENFANT

The objective of this study was to examine the clinical and epidemiological characteristics of respiratory distress in children, identify the responsible pathologies, and describe the therapeutic management. This retrospective study analyzed medical records of children aged between 1 month and 14 years admitted for respiratory distress over a one-year period, with a sex ratio (M/F) of 1.4. Dyspnea was the primary symptom (100%), cough was present in 57% of cases, feeding difficulties in 18%, and influenza-like illness in 15%. Pneumonia was the leading cause of pulmonary respiratory distress in our study, accounting for 35.5% of cases, while congenital heart defects were the most common extrapulmonary cause (16% of cases). The outcome was favorable in 76.5% of patients. Death was noted in 21% of cases. Respiratory distress is a true emergency that requires a thorough clinical assessment to quickly detect signs of severity necessitating urgent, symptomatic, and etiological management.

"Out and about": relationships between children's independent mobility and mental health in a national longitudinal study

ABSTRACT Children's independent mobility (CIM) represents their freedom to travel in their neighborhood without adult supervision. Secular declines in CIM coincided with a major increase in mental health problems among children. We investigated relationships between two indicators of CIM and parent-perceived child distress in a national longitudinal study involving 2,291 Canadian parents of 7- to 12-year-olds at baseline (December 2020) with up to four follow-ups, every six months. We assessed mobility licenses (i.e. children's permission to do certain activities on their own) with 6 items, and home range (i.e. how far [in minutes] children can roam with friends and/or siblings) with a 4-point item. We used generalized estimating equations controlling for children's age and gender, household income, study wave, school attendance, and COVID-19 isolation in the week preceding the survey. At each successive time point, 51.8%, 44.0%, 43.2% and 42.4% of children experienced clinically elevated distress. Compared to children allowed to roam for 15 minutes (OR = 0.61; 95% CI: 0.51-0.72) had lower odds of elevated distress. However, CIM licenses were not associated with distress. Our findings underscore the need to support extending children's home range.

Intranasal midazolam for procedural distress in children in the emergency department: a systematic review and meta-analysis.

Intranasal (IN) midazolam is the most common anxiolytic for children in the emergency department (ED), but evidence of benefit is conflicting. We synthesized the evidence on IN midazolam for procedural distress in children undergoing ED painful procedures. We included trials involving painful ED procedures in children 0-18years involving IN midazolam. Primary outcome was procedural distress. We summarized results using Tricco et al.'s classification of "neutral" (p ≥ 0.05), "favorable," and "unfavorable" (p < 0.05), supporting IN midazolam or comparator, respectively, or "indeterminate" (unable to judge). Where possible, we pooled results using meta-analysis.Methodologic quality of evidence was evaluated using Cochrane Collaboration's risk of bias tool and GRADE system. We included 41 trials (n = 2973 participants). Thirty trials involved intravenous insertion. IN midazolam was superior to placebo (RR = 7.2; 95% CI: 3.43, 15.25; 3 trials; I2 = 0%). However, 56-90% of the IN midazolam group resisted the procedure. Focusing on the three trials that used validated measures, IN midazolam was "neutral" versus IN ketamine and either "neutral" or "unfavorable" versus IN dexmedetomidine. There was no difference in the proportion of children with a satisfactory distress score between IN midazolam and oral midazolam (RR = 1.1; 95% CI: 0.74, 1.73; 2 trials; I2 = 53%), IN ketamine (RR = 1.1; 95% CI: 0.91, 1.25; 6 trials; I2 = 0%), or IN dexmedetomidine (RR = 0.4; 95% CI: 0.17, 1.05; 3 trials; I2 = 84%). Ten trials involved laceration repair. IN midazolam was "favorable" versus placebo; however, both groups scored in the anxious range. There was no difference in distress between IN midazolam and oral midazolam (SMD = 0.01; 95% CI:-0.32, 0.34; 2 trials; I2 = 0%) (Fig.3E) [64,65]. Using validated instruments, IN midazolam was "unfavorable" versus IN dexmedetomidine but "favorable" versus oral diazepam and placebo. There is limited methodologically rigorous evidence that IN midazolam is better than placebo for IV insertion and laceration repair. At the doses studied, preliminary evidence suggests that IN dexmedetomidine may be superior to IN midazolam for both IV insertion and laceration repair.

Cost, Quality, &amp; Satisfaction With Dental Care Provided to Autistic Children in a Sensory-Adapted Environment

Abstract Date Presented 03/23/24 Oral health is integral to well-being. Use of an OT-created sensory-adapted dental environment significantly decreases distress in autistic children. This presentation will describe the cost, quality, and satisfaction with this type of adapted care. Primary Author and Speaker: Leah I. Stein Duker Contributing Authors: Sharon A. Cermak, Jose Polido, Cynthia Gong

The Effects of Hospital-Based School Lessons on Children's Emotions, Distress and Pain.

Lessons conducted in hospitals ensure school continuity for hospitalized children unable to attend regular school. Hospital-based school (HS) provides a tailored experience that ensures normality for children through education. The objective of this study is to evaluate the effects of the proposed lessons in reducing negative emotions, distress, and pain in children, as well as fostering positive affects. The study was conducted with 32 hospitalized children, aged 8-12 years, in the Onco-Hematology and Pediatric Unit of Meyer Children's Hospital IRCCS (Florence, Italy). Positive and negative emotions were measured using the Positive and Negative Affect Scale for Children; distress was measured using the Physiological Hyperarousal for Children; pain was measured using the Visual Analogue Scale for children. Variables were assessed before (T0) and after (T1) lessons, for three times; for each variable, collected data were averaged at both T0 and T1. Statistical analyses showed a significant increase in positive emotions in hospitalized children and a significant decrease in negative emotions, distress, and pain; nevertheless, only for pain the significant correlation between its scores before and after the HS lessons indicated that the detected change occurred for all participants in much the same way. These preliminary results suggest that HS lessons can promote hospitalized children's well-being, at least as far as pain reduction is concerned.