Pain In Children Research Articles

Distraction Technique using a Cooling Vibrator Reduces the Pain of Vein-puncture in Children

Background: Typhoid fever is commony found disease at the hospital. One of the treatments for typhoid fever is intravenous fluid therapy. This procedure certainly causing pain. Actions to minimize pain to children when infusion is carried out are part of the principles of atraumatic care. One of the atraumatic principle can be performed on children is the use of vibrators and cold compresses to minimize pain.Purpose: To determine the effectiveness of vibrator and cold compress against pain in children when taking venous blood.Methods: This research using true experimental with a post-test in control group and divided into 2 groups, intervention and control groups. This research will determine the effectiveness of cooling vibrator. Assessing children's pain using the FLACC instrument. The study was conducted at Tidore Islands Hospital. Data processing was tested with Mann-Whitney test.Result: Mostly respondents are 4 years old. both of them experiencing of having blood drawn before. Most of the control and intervention groups were women. There are differences pain scores founded, in the intervention group was 3.13 and in the control group was 7.87. The results of statistical tests showed that there was a significant difference in pain during venipuncture in the intervention group and the control group.Conclusion: The statistical test show there was a significant difference in intervention group and the control group. The use of a cooling vibrator can be an alternative to reduce pain in children during venipuncture.

Exploring the Psychological Trauma of Mary Turner in Doris Lessing’s The Grass Is Singing

This paper explores the traumas of Mary Turner, the protagonist of the widely celebrated novel The Grass Is Singing (1950) by Doris May Lessing (1919-2013). The plot of the novel centers on Mary Turner, a white farmer’s wife whose declining mental health and eventual tragedy reveal society’s deeply established biases and repressive structures. Psychological trauma includes abuse, violence, accidents, war, and witnessing traumatic occurrences that may cause long-term mental health issues such as flashbacks, nightmares, anxiety, despair, emotional numbness, and relationship issues. Therefore, using trauma theory and psychological frameworks, the study examines Mary’s traumatic experiences that shape her actions and interactions throughout the novel. In the novel, Mary seems to be terrified by her infantile memories, traumatized by the social slurs, and trapped in an African parched terrain, approximating the wasteland, from which she cannot escape. She has relentless nightmares about haunting sexuality, sporadically with her father or Moses. It seems that her repressed desires unlocked into her dreams persecute her inexorably. Therefore, she mislays control over herself and suffers from a complete nervous breakdown. Consequently, Mary undergoes a syndrome of psychopathology that includes neurosis, psychosis, paranoia, and personality disorder for which she cannot lead a normal life. A qualitative content analysis method is adopted to inspect Mary’s childhood trauma that persuades her disorders. The analysis suggests a correlation between adolescent trauma and psychosis, which can disrupt an individual’s sense of self, conduct, and mental state. Accordingly, Mary’s conscious control breaks down as her childhood pain returns, revealing her natural urges and unconscious side. IUBAT Review, 6(2): 115-130

Goldfish or aquatic turtle? Impact of two animal assisted interventions on children's pain, anxiety, and fear during IV catheterization: A randomized controlled trial

PurposeThis study aimed to determine the effect of goldfish and aquatic turtle nursing interventions on children's pain, anxiety, and fear during IV catheter insertion. Design and methodsThe randomized controlled trial included 98 children (control group = 32, goldfish group = 33, aquatic turtle group = 33) aged 5–6 years, attending outpatient clinic for blood sampling and catheterisation procedures. Pain was measured using the Wong Baker Facial Pain Scale, anxiety was measured using the Child Anxiety Scale-State, and child fear was measured using the Child Fear Scale, before, during, and after catheterization. ResultsWhen analyzing the pain, anxiety, and fear findings, no statistical difference was found between the scores of the mother, child, and researcher before the procedure. During the catheterization procedure, the pain, anxiety, and fear scores of the children in the fish and turtle groups increased statistically less than those in the control group. When analyzing the post-procedure findings, the pain, anxiety, and fear scores of the control group were similar to those before the procedure. In the fish and turtle groups, anxiety and fear scores were statistically the lowest (p < 0.05). ConclusionIt can be concluded that animal-assisted practices reduce anxiety and fear during and after the catheterization procedures while diverting attention from pain. Practice implicationsGoldfish or aquatic turtle intervention improve children's attitudes toward pain, anxiety, and fear during IV catheter insertion. Pediatric nurses could consider incorporating, such as the animal assisted intervention, into their clinical practice to reduce the pain, anxiety, and fear experienced by children during medical/nursing procedures.

Predictors of Intra-Operative and Post-Operative Pain Associated with Routine Dental Procedures in Children: A Systematic Review and Meta-Analysis.

Background: Understanding predictors of pain associated with paediatric dental procedures could play an important role in preventing loss of cooperation, which often leads to the procedure having to be performed under general anaesthesia. Aim: We aimed to identify predictors of intra-operative and post-operative pain associated with routine dental procedures in children. Materials and Methods: A systematic review of observational studies was performed using electronic searches on MEDLINE, EMBASE, PsycINFO, Global Health via OVID, PubMed, Scopus, and SciELO. The NIH Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies was used to evaluate the quality of the included studies, which were meta-analysed to estimate the impact of dental procedures and anxiety on children's pain perception. A meta-regression analysis was also performed to determine the relative effect of predictors on children's pain perception measured as mean differences on a visual analogue scale (VAS). Results: The search identified 532 articles; 53 were retrieved for full-text screening; 6 studies were included in the review; and 4 were eligible for the meta-analysis. The meta-analysis showed the types of procedures that predicted intra-operative pain, with dental extractions being the most painful (Mean VAS Difference [MD] 46.51 mm, 95% confidence interval [CI] 40.40 to 52.62 mm). The meta-regression showed that pain scores for dental extractions were significantly higher than polishing (the least painful procedure (reference category)) by VAS MD = 23.80 mm (95% CI 5.13-42.46 mm, p-value = 0.012). It also showed that highly anxious children reported significantly higher pain scores during dental procedures by a 12.31 mm MD VAS score (95% CI 5.23-19.40 mm, p-value = 0.001) compared to those with low anxiety levels. Conclusions: This systematic review demonstrates that the strongest predictors of intra-operative pain associated with paediatric dental procedures are dental extractions followed by drilling. Children with high anxiety also reported more pain for similar procedures. Tailoring interventions to reduce pain associated with paediatric dental procedures should be a priority for future research, as reducing pain can impact compliance and could reduce the need for general anaesthesia in dental treatment.

Pilot testing “Teach Ted”: A digital application for children undergoing blood tests and their parents

ObjectiveIn this pilot study, we evaluated the acceptability and preliminary evidence of the impact of a new educational mobile application, “Teach Ted”, for children undergoing blood tests. MethodsParents of children (4–10 years) completed questionnaires on anxiety and pain before their child had a blood test, and after using Teach Ted and receiving their blood test. Health professionals at each patient's blood test (e.g. technician/nurse) completed questionnaires on patient outcomes and procedure-related outcomes (e.g. time taken). ResultsNine parents and eight health professionals participated. All but one parent (n = 8/9) reported Teach Ted was useful. Seventy-eight percent (n = 7/9) reported they would use Teach Ted again. All health professionals who completed the acceptability measure (n = 3/3) strongly agreed that Teach Ted was relevant/helpful. Many parents perceived Teach Ted helped reduce their/child's anxiety (n = 3/5, 60% and n = 4/6, 67% respectively), although child's pain and child's/parent's anxiety remained similar before and after using Teach Ted (all p > 0.05). The average blood test duration was 7.6 min (range ≤1 to 22), which health professionals (n = 3/3) reported was not elongated by offering Teach Ted. ConclusionsParticipants reported that Teach Ted was acceptable. Further evaluation of Teach Ted's impact on patient's outcomes are needed. InnovationTeach Ted is an innovative mobile application with potential to educate young children about their upcoming procedure and mitigate negative outcomes.

The impact of sufferers' wealth status on pain perceptions: Its development and relation to allocation of healthcare resources.

Wealth-based disparities in health care wherein the poor receive undertreatment in painful conditions are a prominent issue that requires immediate attention. Research with adults suggests that these disparities are partly rooted in stereotypes associating poor individuals with pain insensitivity. However, whether and how children consider a sufferer's wealth status in their pain perceptions remains unknown. The present work addressed this question by testing 4- to 9-year-olds from the US and China. In Study 1 (N=108, 56 girls, 79% White), US participants saw rich and poor White children experiencing identical injuries and indicated who they thought felt more pain. Although 4- to 6-year-olds responded at chance, children aged seven and above attributed more pain to the poor than to the rich. Study 2 with a new sample of US children (N=111, 56 girls, 69% White) extended this effect to judgments of White adults' pain. Pain judgments also informed children's prosocial behaviors, leading them to provide medical resources to the poor. Studies 3 (N=118, 59 girls, 100% Asian) and 4 (N=80, 40 girls, 100% Asian) found that, when evaluating White and Asian people's suffering, Chinese children began to attribute more pain to the poor than to the rich earlier than US children. Thus, unlike US adults, US children and Chinese children recognize the poor's pain from early on. These findings add to our knowledge of group-based beliefs about pain sensitivity and have broad implications on ways to promote equitable health care. RESEARCH HIGHLIGHTS: Four studies examined whether 4- to 9-year-old children's pain perceptions were influenced by sufferers' wealth status. US children attributed more pain to White individuals of low wealth status than those of high wealth status by age seven. Chinese children demonstrated an earlier tendency to attribute more pain to the poor (versus the rich) compared to US children. Children's wealth-based pain judgments underlied their tendency to provide healthcare resources to people of low wealth status.

An examination of questioning methods and the influence of child maltreatment on paediatric pain assessments: Perspectives of healthcare providers.

Children with a history of maltreatment have underestimated and undertreated pain; however, it is unknown if healthcare providers consider maltreatment when assessing children's pain. The current study aimed to address this issue by investigating healthcare providers' pain assessment practices, and specifically, their consideration of child maltreatment. Healthcare providers (N = 100) completed a survey, asking them to reflect upon their pediatric pain assessment practices (e.g., methods and questions used to assess pain) through self-report and case vignette questions. Participants who received continuing education about child maltreatment were more likely to consider maltreatment in several areas of their pediatric pain assessment practice, whereas participants who received continuing education about pediatric pain, were not. Participants were also more likely to report that they would consider maltreatment in vignette responses than in questions regarding their daily practice. Findings indicate healthcare providers use multidimensional methods when assessing children's pain, although it is unclear when or how they use open-ended vs. option posing questions. Healthcare providers also tended to consider the effects of child maltreatment on children's ability to communicate their pain more so when the history of maltreatment was known to them.

Pain in Children and Adolescents with Spinal Muscular Atrophy: A Longitudinal Study from a Patient Registry.

Spinal muscular atrophy (SMA) is a devastating genetic neurodegenerative disease caused by the insufficient production of Survival Motor Neuron (SMN) protein. It presents different phenotypes with frequent contractures and dislocations, scoliosis, and pain. This study aims to report the prevalence and description of pain and how it affects daily life by analyzing a new ad hoc questionnaire. An observational study of patients under 18 years of age with SMA was conducted at two referral centers in Spain. Data were analyzed using a descriptive analysis and a Bayesian ordinal regression model to assess the association with clinical and demographic variables. Fifty-one individuals were included in this study, 27% of whom reported pain with a median duration of 5.2 years and a mean Visual Analogic Scale (VAS) score of 5. Notably, 77% were receiving disease-modifying treatment, with more than 50% receiving analgesic treatment. The Bayesian model showed that functional status, lower limb contractures, and number of visits have a high probability (>90%) of influencing pain. Thus, the prevalence of pain in the SMA population under 18 years is substantial, and its presence could be associated with lower limb contractures, better functional status, and higher RULM (Revised Upper Limb Module) scores.

Parent and clinician perceptions and recommendations on a pediatric cancer pain management app: A qualitative co-design study.

Pain is one of the most prevalent and burdensome pediatric cancer symptoms for young children and their families. A significant proportion of pain episodes are experienced in environments where management options are limited, including at home. Digital innovations such as apps may have positive impacts on pain outcomes for young children in these environments. Our overall aim is to co-design such an app and the objective of this study was to explore the perceptions of children's parents about app utility, needed system features, and challenges. We recruited parents of young children with cancer and multidisciplinary pediatric oncology clinicians from two pediatric cancer care centers to participate in audio-recorded, semi-structured, co-design interviews. We conducted interviews structured around technology acceptance and family caregiving theories until data saturation was reached. Audio-recordings were then transcribed, coded, and analyzed using thematic analysis. Forty-two participants took part in the process. Participants endorsed the concept of an app as a useful, safe, and convenient way to engage caregivers in managing their young child's pain. Overall, the app was valued as a means to provide real-time, multimodal informational and procedural pain support to parents, while also reducing the emotional burden of pain care. Recommendations for intervention design included accessibility-focused features, comprehensive symptom tracking, and embedded scientific- and clinically-sound symptom assessments and management advice. Predicted challenges to app use included the workload burden it may place on parents and clinicians. The insights gathered will inform the design principles of our future childhood cancer pain digital research.

Evaluation of the physical activity in children with functional gastrointestinal disorders

Abstract. Functional gastrointestinal disorders have been known for centuries. However, this concept appeared quite recently, and is currently a common pediatric problem. Interest in functional pathology is fully justified and understandable: despite the fact that functional diseases of the gastrointestinal tract do not pose a direct threat to the patient’s life, they significantly reduce the quality of his life. The problem of functional disorders is also complicated by the fact that they affect all strata of society, regardless of age, socio-economic status, gender or race. The active process of studying the clinical and anamnestic features of various nosological forms, predictors of functional disorders, combined functional disorders and prevention approaches is also due to significant economic damage due to direct and indirect costs of their treatment. The prevalence of functional gastrointestinal disorders in the world reaches 40.3 %, and among children's gastro pathology they occupy one of the leading places. More than half of children of various age groups have at least one of the symptoms, which is a cause of concern for both the child and the parents, as well as entails a violation of the microclimate in the family. The peak prevalence of various symptoms of disorders of the gastrointestinal tract occurs at school age and adolescents, who almost fill the appointment of a pediatrician and a pediatric gastroenterologist. If we trace the evolution of ideas about functional disorders of the digestive organs, it can be noted that it changed many times and influenced the understanding of the pathogenesis and, especially, the etiology of this nasology. According to the Rome Consensus IV (2016), functional gastrointestinal disorders are defined as disorders of the interaction of the «gut-brain» axis, taking into account this concept, a lot of time has been devoted to studying the role of various factors: genetic predisposition, infection theory, nature of feeding at an early age, hormonal imbalance, psychological state, food preferences, lifestyle and physical activity. An important aspect of studying predictors of functional bowel disorders is the level of physical activity of children and adolescents. In the process of studying literary data, it was noted that the role of insufficient physical activity in the development of functional gastrointestinal disorders remains not fully determined. Most of the materials are related to the adult population and critically few among children. That complicates the study of forecasting and prevention of a more severe course of functional dyspepsia and irritable bowel syndrome, and, as a consequence, to optimize therapy. The aim of the study was to assess the level of physical activity in children with FGID. Materials and methods. 72 children aged 8–14 with FGIR were observed. I group of study included 26 patients with combined functional dyspepsia (FD) and irritable bowel syndrome (IBS), the II group – 46 patients with FD. The control group included 22 healthy children. The diagnosis of FD and IBS were established based on the analysis of clinical symptoms according to the Rome IV criteria (2016). The PAQ-C questionnaire, developed by K. Kowalski, P. Kroker, and R. Donen, was used to assess PA in children. Research results. The total PA index in children with combined FD and SPC was 1,87 ± 0,07 and was lower compared to the group of children with FD (2,21 ± 0,05; p &lt; 0,05) and the control group (2,75 ± 0,05; p &lt; 0,01). The total PA index in children with FD is lower than in the control group (p &lt; 0,01). Conclusion. Insufficient physical activity can be considered a risk factor for the development of functional gastrointestinal disorders in children.

The effect of vibrating cold application and puppet use on pain and fear during phlebotomy in children: A randomized controlled study

BackgroundNon-pharmacological methods are often used as a creative strategy to reduce pain and fear in children during a painful procedure such as phlebotomy. ObjectivesThis study was conducted to evaluate the effects of Bee Buzzy and puppet use on pain and fear during phlebotomy in children. MethodsThis randomized controlled study was conducted in the pediatric phlebotomy unit of a university hospital. The CONSORT checklist was used in this study. The sample of 3–6 years children (n = 105) was divided into groups by block randomization. Children's pain and fear scores were evaluated with the Wong-Baker Faces Pain Rating Scale and Children's Fear Scale by the parents and the nurse who attempted phlebotomy during phlebotomy. ResultsA statistically significant difference was found between the Bee Buzzy and puppet and Bee Buzzy and control groups in pain scores (p < .05). Pain scores were lower in the Bee Buzzy group than in the puppet and control groups. A statistical difference was found between Bee Buzzy and the control group or puppet and control group according to all fear scores (p < .05). Fear scores were lower in the Bee Buzzy and puppet group (p < .05). ConclusionsThe results show that the use of Bee Buzzy during phlebotomy has a pain-relieving effect, and the use of Bee Buzzy and puppet has an anti-fear effect in 3–6-year-old children. Implications for practicesThe use of Bee-Buzzy and puppets is effective in reducing pain and fear in children as they increase effective communication and distract attention.Clinical Trial Registration: National Institutes of Health (NIH), ClinicalTrials.gov, NCT05827783.

Management of low back pain accompanying sagittal plane pathologies in children: Spondylolysis/spondylolisthesis and Scheuermann's disease.

Low back pain in childhood was underappreciated for a long time, but recent studies report higher prevalences, up to 70%. Two of the common causes are spondylolyis/spondylolisthesis and Scheuermann's disease. These disorders are relevant in a way they both cause significant back pain, and may disrupt the sagittal spinal balance. To present the current evidence on the diagnosis, natural history and treatment of these disorders with a special focus on sagittal spinal alignment. This study is conducted as a literature review. Spondylolysis and low-grade spondylolisthesis have a benign course and are typically treated conservatively. When pars repair is indicated, pedicle screw-based techniques achieve more than 90% fusion with acceptable complication rates. High-grade spondylolisthesis, however, is frequently progressive. Surgical treatment involves fusion, which can be done in situ or after reduction. Reduction is useful for "unbalanced" patients to acquire sagittal spinopelvic balance, and it is important to distinguish these patients. Despite lowering the risk for pseudoarthrosis, reduction brings a risk for neurologic complications. With re-operation rates as high as 40%, these patients definitely require careful preoperative planning. Scheuermann's disease generally causes back pain in addition to cosmetic discomfort during adolescence. If the kyphosis is lower than 60°, symptoms typically resolve into adulthood with conservative measures only. However, it must be kept in mind that these patients may experience problems with physical performance and have a lower quality of life even when the problem seems to have "resolved". Severe kyphosis and intractable back pain are the most frequently referred surgical indications, and surgery typically involves fusion. Proper utilization of osteotomies and proper selection of the upper and lower fusion levels are of utmost importance to prevent complications in these patients.

An experimental comparison of additional training in phoneme awareness, letter-sound knowledge and decoding for struggling beginner readers.

Despite evidence that synthetic phonics teaching has increased reading attainments, a sizable minority of children struggle to acquire phonics skills and teachers lack clear principles for deciding what types of additional support are most beneficial. Synthetic phonics teaches children to read using a decoding strategy to translate letters into sounds and blend them (e.g., c-a-t = "k - ae - t" = "cat"). To use a decoding strategy, children require letter-sound knowledge (LSK) and the ability to blend sound units (phonological awareness; PA). Training on PA has been shown to benefit struggling beginning readers. However, teachers in English primary schools do not routinely check PA. Instead, struggling beginner readers usually receive additional LSK support. Until now, there has been no systematic comparison of the effectiveness of training on each component of the decoding process. Should additional support for struggling readers focus on improving PA, or on supplementary LSK and/or decoding instruction? We aim to increase understanding of the roles of LSK and PA in children's acquisition of phonics skills and uncover which types of additional training are most likely to be effective for struggling beginner readers. We will compare training on each of these components, using a carefully controlled experimental design. We will identify reception-age children at risk of reading difficulties (target n = 225) and randomly allocate them to either PA, LSK or decoding (DEC) training. We will test whether training type influences post-test performance on word reading and whether any effects depend on participants' pre-test PA and/or LSK. Two hundred and twenty-two participants completed the training. Planned analyses showed no effects of condition on word reading. However, exploratory analyses indicated that the advantage of trained over untrained words was significantly greater for the PA and DEC conditions. There was also a significantly greater improvement in PA for the DEC condition. Overall, our findings suggest a potential advantage of training that includes blending skills, particularly when decoding words that had been included in training. Future research is needed to develop a programme of training on blending skills combined with direct vocabulary instruction for struggling beginner readers.

It takes two: The relative contributions of parent versus child-led regulatory behaviours on toddler vaccination pain.

Past research has established the important role of parent soothing in early childhood pain management. However, limited research has assessed children's own emerging emotion regulation strategies to reduce their pain during vaccination. The purpose of the current study was to understand the relative contributions of child-led emotion-regulation behaviours over and above parent regulatory behaviours and pre-needle distress. Toddler-caregiver dyads were videotaped at their 12- and/or 18-month vaccinations. Videos were coded for pain-related behavioural distress, child-led regulatory behaviours (disengagement of attention, parent-focused behaviours, and physical self-soothing), and parent regulatory/soothing behaviours (distraction, physical comfort, rocking, verbal reassurance). Pre-needle distress, followed by parent regulatory behaviours, followed by child regulatory behaviours were used as hierarchical predictors of pain regulation. Two sets of models were estimated at each age, by incorporating parent and child regulatory behaviours at 1 min and 2 min post-needle, separately. At both ages, child-led parent-focused behaviours predicted less regulation. At 18 months, parent soothing behaviours (e.g. distraction, verbal reassurance, rocking) played a stronger role in regulation, however; the only behaviour that increased regulation was rocking. Measuring both parent and child regulatory behaviours was important for fully understanding pain-related distress regulation. Toddlers' use of parent-focused regulatory behaviours (e.g. proximity seeking) suggests that they signal to their parent directly when they are struggling to regulate post-needle. The only parent behaviour that supported this regulation was rocking at 18 months, suggesting a greater need to understand the sensitivity of parent behaviours post-needle. To our knowledge, this is the first study to examine both parent and child regulatory behaviours following vaccination at different stages in toddlerhood. This investigation allows a deeper understanding of the dyadic nature of early childhood vaccination, as well as the evolving role of the parent through toddlerhood. Importantly, findings suggest that toddlers do not simply wait for their parents to respond to their pain post-needle and provide clear signals to show their need of support in regulation.

Prevalence of chronic pain or analgesic use in children and young people and its long-term impact on substance misuse, mental illness, and prescription opioid use: a retrospective longitudinal cohort study

Epidemiological studies suggest chronic and recurrent pain affects around a quarter of children, while 8% report intense and frequent pain. The long-term implications of chronic pain in childhood are uncertain. Using electronic health records (EHRs) we used both disease codes and medicines prescription records to investigate the scale of chronic pain and long-term analgesic use in children and young people (CYP), and if chronic pain and/or use of analgesic medicines at an early age is associated with substance misuse, use of prescription opioids, and poor mental health in adulthood. We conducted a cohort study using data from IQVIA Medical Research Data UK. We identified individuals aged 2-24 with exposure to either a diagnostic code indicating chronic pain (diagnosis-exposed), repeat prescription for medicines commonly used to treat pain (prescription-exposed), or both. Follow-up began at 25, and the unexposed population acted as comparators. We calculated hazard ratios (HR) for mental health and substance misuse outcomes, and rate ratios (RR) for opioid prescriptions in adulthood. Additionally, we investigated which diagnoses, if any, were over-represented in the prescription-exposed subgroup. The cohort constituted 853,625 individuals; 146,431 had one or more of the exposures of interest (diagnosis-exposed=115,101, prescription-exposed=20,298, both-exposed=11,032), leaving 707,194 as comparators. Median age at index exposure was 18.7 years (IQR 14.7-22.3). On average during follow-up, the pooled exposed group had, respectively, a 31% and 17% higher risk of adverse mental health and substance misuse outcomes (adjusted HR [95% CI] of 1.31 [1.29-1.32] and 1.17 [1.11-1.24]). Exposed individuals also received prescription opioids at double the rate of unexposed individuals on average during follow-up (adjusted RR 2.01 [95% CI 1.95-2.10]). Outcomes varied between exposure subgroups, with prescription- and both-exposure tending to have worse outcomes. Unlike these two subgroups, in the diagnosis-exposed subgroup we did not detect a greater risk of substance misuse. Chronic pain in CYP is associated with increased prescription opioid use and adverse mental health outcomes in adulthood, as is repeat prescription for analgesic medicines, but only the latter is also associated with substance misuse in adulthood. It is essential to avoid the harms of under-treating pain in CYP while giving due consideration to the risks posed by analgesic medicines. Early recognition of chronic pain in CYP and utilising non-pharmacological management options may help minimise overprescribing, and long-term reliance on dependence-forming-drugs. AL is an NIHR funded academic clinical fellow, and was supported by funding from UCLH Charities while carrying out this work. RS and DS are part of the Advanced Pain Discovery Platform and were supported by a UKRI and Versus Arthritis grant (MR/W002566/1) as part of the Consortium Against Pain Inequality. AW was supported by the Wellcome Trust (220558/Z/20/Z).

Impact of Facility Dog and Certified Child Life Specialist Dyad on Children's Pain and Anxiety During Needlestick Procedures in a Pediatric Hematology Oncology Clinic Setting.

Pediatric Hematology Oncology patients undergo frequent needlestick procedures, often leading to negative outcomes including pain and anxiety. Animal-assisted therapy has been shown to minimize pediatric patient distress; however, its utilization by a Certified Child Life Specialist (CCLS) to reduce patient distress has not been widely studied. Pediatric patients receiving needlesticks in the Hematology Oncology Clinic were enrolled between March 2018 and May 2021. Patients who had scheduled visits when the facility dog was present were assigned to the intervention group. Patients were assigned to the control group if the facility dog was not present. The primary objective was to use the Children's Anxiety and Pain Scale to determine whether the CCLS and facility dog dyad minimized patient pain and anxiety during procedures. A total of 285 patients, 5 to 17 years of age, were enrolled. One hundred forty-three patients were assigned the intervention and received procedural support from the CCLS and facility dog; 142 patients were assigned the control group and received support from the CCLS only. Patient-reported pain scores were significantly lower among patients who received the intervention ( P =0.033). Utilization of a CCLS and facility dog dyad during painful needlestick procedures decreases patient-reported pain compared with utilization of CCLS support alone.

Effectiveness of distraction-based interventions for relieving anxiety, fear, and pain in hospitalized children during venous blood sampling: a systematic review protocol.

The aim of this review is to evaluate the effectiveness of active compared with passive distraction-based interventions for relieving anxiety, fear, and pain in hospitalized preschool and school-age children during venous blood sampling. Venous blood sampling remains the most common procedure that causes anxiety, fear, and pain among the pediatric population. It is important that health care professionals relieve a child's pain and the related emotions because untreated pain may have long-term effects on children's growth and development. It is necessary to determine which interventions are effective in relieving these outcomes in preschool and school-age children during blood sampling. This review will include randomized controlled trials and quasi-experimental studies that include active and passive distraction-based interventions for relieving hospitalized preschool and school-age children's anxiety, fear, and pain during venous blood sampling. CINAHL, PubMed, Scopus, and the Cochrane Library databases will be searched for published studies. MedNar, Google Scholar, and PsycEXTRA databases will be searched for in-progress and unpublished studies. Two independent researchers will perform critical appraisal and data extraction using the JBI methodology. Data describing randomized controlled trials and quasi-experimental studies will be pooled in a statistical meta-analysis. If statistical analysis is not possible, the findings will be reported narratively. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach will be used to assess certainty in the quality of evidence. PROSPERO CRD42023455617.

Development and expansion of a pediatric transitional pain service to prevent complex chronic pain.

The prevention of chronic pain is a key priority in North America and around the world. A novel pediatric Transitional Pain Service (pTPS) at the Hospital for Sick Children was established to address four main areas of need, which the authors will describe in more detail: (1) provide comprehensive multi-modal pain management and prevention techniques to children at-risk for the development of chronic pain, (2) provide opioid stewardship for children at-risk for chronic pain and their families at home after discharge, (3) facilitate continuity of pain care for children across transitions between inpatient and outpatient care settings, and (4) support caregivers to manage their child's pain at home. The pTPS works with healthcare providers, patients, and their families to address these areas of need and improve quality of life. Furthermore the service fills the gap between inpatient acute pain services and outpatient chronic pain services (accessible only once pain has persisted for >3 months). In pediatric patients who experience pain in hospital and who have been prescribed opioids, discharge to home or rehabilitation may represent a vulnerable time in which pain may persist and during which analgesic requirements may change. This offers an important opportunity to address and prevent the development of chronic pain, and to monitor opioids while ensuring alternative pain therapy is available. The authors will outline risk factors for persistent postsurgical pain, the development and implementation of a pTPS, present initial clinical outcomes andsuggest areas for future research in this evolving area of care.

Risk Factors for the Development of Multisite Pain in Children.

Chronic pain has economic costs on par with cardiovascular disease, diabetes, and cancer. Despite this impact on the health care system and increasing awareness of the relationship between pain and mortality, efforts to identify simple symptom-based risk factors for the development of pain, particularly in children, have fallen short. This is critically important as pain that manifests during childhood often persists into adulthood. To date, no longitudinal studies have examined symptoms in pain-free children that presage a new, multisite manifestation of pain in the future. We hypothesized that female sex, sleep problems, and heightened somatic symptoms complaints at baseline would be associated with the risk of developing new multisite pain 1 year later. Symptom assessments were completed by parents of youth (ages 9 to 10) enrolled in the Adolescent Brain Cognitive Development study. Multivariate logistic regression models focused on children who developed multisite pain 1 year later (n=331) and children who remained pain free (n=3335). Female sex (odds ratio [OR]=1.35; 95% CI, 1.07, 1.71; P =0.01), elevated nonpainful somatic symptoms (OR=1.17; 95% CI, 1.06, 1.29; P <0.01), total sleep problems (OR=1.20; 95% CI, 1.07, 1.34; P <0.01), and attentional issues (OR=1.22; 95% CI, 1.10, 1.35; P <0.001) at baseline were associated with new multisite pain 1 year later. Baseline negative affect was not associated with new multisite pain. Identifying symptom-based risk factors for multisite pain in children is critical for early prevention. Somatic awareness, sleep and attention problems represent actionable targets for early detection, treatment, and possible prevention of multisite pain in youth.

The effect of buzzy®, DistrACTION® cards on reducing pediatric pain and fear during blood collection in the rheumatology polyclinic: A randomized controlled trial

PurposeThe aim of this study was to compare the effectiveness of Buzzy® and DistrACTION® Cards in reducing children's pain and fear while taking venous blood samples. MethodsThis research was designed as a randomized controlled experimental study. The study population consisted of children aged 6–12 years admitted to the Pediatric Rheumatology Diseases Polyclinic in a Faculty of Medicine in Germany. The sample of the study consisted of 96 children (Buzzy® = 32, DistrACTION® Cards = 32, control = 32) who met the patient selection criteria and agreed to participate in the study. The data were obtained using a Child and Family Information Form, the Children Fear Scale (CFS), and the Faces Pain Scale–Revised (FPS-R). The data were evaluated using the Pearson chi-square test, Kruskal-Wallis test, One-way ANOVA test with Bonferroni correction, and Fisher-Freeman-Halton. FindingsIn the study, the average age of the children was 9.21 ± 2.15 years. The Buzzy® group had the lowest pain and procedural fear scores (self-report = 0.88 ± 1.13, 0.31 ± 0.47; parent report = 0.75 ± 0.98, 0.34 ± 0.48, and researcher report = 0.81 ± 1.00, 0.31 ± 0.54, respectively) than the DC, and control groups. ConclusionsThe Buzzy® method was effective in reducing venipuncture pain and fear in children. Practice implicationsNurses can use the Buzzy® methods to help reduce venipuncture pain and fear in children.The clinical trial registration number is NCT05560074.(https://clinicaltrials.gov/ct2/show/study/NCT05560074).