Parental State Anxiety Research Articles

Effect of Short-term Deep Breathing Exercises on Perioperative Anxiety and Pain in Pediatric Orthopedic Patients: A Randomized Controlled Trial

PurposeThere are currently no pediatric studies examining the effects of deep breathing on perioperative pain and anxiety. This study sought to determine the effect of short-term deep breathing exercises on perioperative anxiety and pain in pediatric patients and their parents. DesignA randomized controlled trial was conducted in the Department of Orthopaedic Surgery where pediatric patients about to undergo surgery were allocated to a control group or a deep breathing group. In the intervention group, patients and their main guardian were guided to practice 10 minutes of deep breathing exercises twice a day for 3 to 4 days prior to surgery. Perioperative anxiety and pain were measured for both the children and parents as outcome indicators. MethodsPerioperative anxiety was measured using the modified Yale Preoperative Anxiety Scale-Short Form (mYPAS-SF) and state anxiety was measured using the State-Trait Anxiety Inventory (STAI). Patients reported their pain levels daily using the Wong-Baker FACES Pain Rating Scale. The following cutoffs were determined as high levels of anxiety: STAI (adult) > 44, STAI (child) > 36, and mYPAS-SF ≥ 30. FindingsNo significant differences were found in the STAI, mYPAS-SF, and Wong-Baker FACES Pain Rating Scale scores of the patients between the intervention and control group. Overall statistics showed that parents had significantly higher postoperative state anxiety levels toward female children (44.93 ± 9.01) compared to male children (40.18 ± 9.89). Preoperative and postoperative parental state anxiety levels were correlated with the child’s postoperative anxiety. Furthermore, children’s postoperative state anxiety was slightly correlated with postoperative pain. ConclusionsShort-term use of our deep breathing exercises was ineffective in reducing incidences of perioperative pain and anxiety in pediatric orthopedic patients. A longer period of deep breathing administration may be required for the intervention to be effective. Parental anxiety may have an effect on anxiety levels in children, and postoperative parental anxiety may be affected by the gender of the child.

The effect of written document in perioperative information on the anxiety level and family-centered care of parents of children undergoing ambulatory surgery: A randomized controlled trial

PurposeTo evaluate the effect of preoperative information based on written documents on anxiety levels and the family-centered care of parents of pediatric patients who had ambulatory surgery. Design and methodsIt is a randomized controlled study. Parents were randomly divided into two groups as intervention (n = 30) and control (n = 30). Parents in the intervention group were given written document and verbal information the day before the surgery. A brochure was prepared in accordance with the verbal information describing the perioperative process as a written document. The control group was given only verbal information. Parental State Anxiety Inventory (SAI) and Family Centered Care Assessment Scale (FCCAS) were assessed before and within 1–2 h after surgery, with verbal information based on written documentation. Data were evaluated with Student's t-test for dependent and independent groups and mixed design ANOVA test for time×group interaction. Partial eta square (η2) was calculated for the effect size. ResultsThere was a significant difference between the post-intervention pretest and posttest SAI and FCCAS scores of the parents in the intervention and control groups (p < 0.05). Time group interactions anxiety and family-centered care (p < 0.001) scores had a significant and large effect size. ConclusionVerbal information supported by written documentation before pediatric ambulatory surgery can reduce parental SAI and increase parental FCCAS more than standard care. Practice implicationsProviding written document-based information to parents before surgery may be beneficial in reducing SAI and increasing FCCAS.The trial was registered in ClinicalTrials.gov (identifier: NCT05668416).

Predictors of parental anxiety in a paediatric emergency department

BackgroundChildren experience significant anxiety in the paediatric ED. Although research from preoperative and primary care samples indicates that parents experience anxiety surrounding their children’s medical procedures, less is known about...

Anxiety among pediatric asthma patients and their parents and quick-reliever medication use: The role of physical activity parenting behaviours

BackgroundClinical guidelines recommend the identification of asthma comorbidities, especially treatable problems such as parental behaviours and child and parent anxiety. PurposeWe aimed to (1) explore associations of asthma severity with child and parent state anxiety, trait anxiety, and asthma-related anxiety as well as with caregiver behaviours around physical activity and (2) explore if caregiver behaviours around physical activity were associated with use of inhaled β-Agonists when symptomatic, and with child and parent anxiety. Patients and methodsPatients ages 3–17 years with asthma (n = 72) and their parents were recruited from the Pulmonology-Allergology Pediatric clinic University Hospital Centre Split in Split, Croatia during 2021. During a clinical visit, the pharmacological regimen was assessed and spirometry was performed. Children completed the State-Trait Anxiety Inventory for Children (STAI-C) and the Youth Asthma-Related Anxiety Scale (YASS). Parents completed the State-Trait Anxiety Inventory (STAI), the Parent Asthma-Related Anxiety Scale (PASS), and the Physical Activity Parenting Practices – Short Form (PAPP). ResultsMost patients had mild asthma (69.4%). Children with moderate to severe asthma had increased asthma-related anxiety (mean = 11.94 ± 6.1) compared with children with mild asthma (mean = 5.97 ± 6.39, p = 0.003). Parents of children with mild asthma reported behaviours allowing unsupervised physical activity outside more often when compared to parents of children with moderate or severe asthma. Physical activity facilitation parenting behaviour reduced the odds of a child's need for quick-reliever medication when symptomatic (OR = 0.376,95% CI = −1.885 to −0.072; p = 0.034); more coercive parenting increased the odds of a child's additional use of such medications (OR = 2.602; 95% CI = 0.005 to 1.908; p = 0.049). Parents of children in the highest quartile of trait anxiety showed less non-directive support (1.97 ± 1.01 vs. 2.89 ± 1.19, p = 0.031) and less autonomy support (3.14 ± 1.32 vs. 4.11 ± 1.23, p = 0.037) of physical activity in their children than those with less trait anxiety. ConclusionAsthma-related anxiety was an important construct in this sample of children, associated with their disease severity as well as their parent's behaviours around the child's physical activities. Current research, conducted during the COVID-19 pandemic, recognised the tangible ways that parents support or avoid the asthmatic children's physical activity participation. Child anxiety and recognised parental physical activity behaviours are potentially important factors to assess and target for intervention.

A Multidimensional Approach to Measuring Distress in Children Undergoing Hematopoietic Stem Cell Transplantation: Three Raters’ Perspectives and Stress Biomarkers in Saliva and Blood

Background Hematopoietic stem cell transplantation (HSCT) offers a potentially life-saving cure to adults and children suffering from advanced malignancies or other incurable immunological, hematological, or metabolic diseases. The substantial advances in HSCT-technology during the last 30 years are paralleled by continuously rising numbers of transplantations and improved long-term survival. Despite striking progress, HSCT is still associated with severe physical and psychological distress. While medical aspects of HSCT have received comprehensive scientific attention, there are comparatively few studies examining the psychosocial effects of HSCT in childhood. Material and Methods We analyzed the type, course and influencing factors of distress during pediatric HSCT by using a multidimensional approach encompassing three raters’ perspectives and stress biomarkers in saliva and blood. The aim of this prospective study was to establish a scientific basis for the development of supportive interventions adjusted to the needs of children undergoing HSCT. Methods: We examined mental and somatic distress of n=39 children in the assessment period between ten days before and 200 days after HSCT at eight measurement points (baseline; day -10 before stem cell transfusion, day 0 (day of stem cell transfusion), day +10, day +20, day +30, day +60, day +100 and day +200). At each time point distress was measured by questionnaires administered to parents, medical staff, and children as well as through established stress biomarkers in saliva (alpha-amylase) and blood (cortisol, free triiodothyronine, free thyroxine and thyroid-stimulating hormone). Additionally, state and trait anxiety of parents as well as self-efficacy of adolescents were captured by questionnaires at baseline, day +30 and day +200. Results Particularly adolescents showed already heightened mental distress-levels on admission to hospital. Somatic distress of all children and depressive symptoms of adolescents peaked at the day of stem cell transfusion with a subsequent decline. This trajectory of distress symptoms was not reflected by the course of the stress biomarkers. While there was high agreement between the ratings of parents and their children regarding all distress assessments, proxy reports by parents and medical staff showed higher consensus regarding physical than psychological distress. Thyroid hormone levels correlated significantly negatively with the distress intensity depicted by questionnaires. Age, trait anxiety of parents and self-efficacy of adolescents did not yield significant influence on the extent of distress perceived by the children during HSCT. However, we found significant, positive correlations between state anxiety of parents and self-rated mental distress of their adolescent children as well as between state anxiety of parents and somatic and mental distress of their children as rated by the parents. Clinical factors showed little effect on distress intensity in general. Yet children who received an allogeneic HSCT reported significantly stronger feelings of helplessness than children who received an autologous HSCT. Moreover, cortisol levels were significantly higher in children receiving a haploidentical HSCT (compared to children receiving an HSCT from MSD or MUD) and in children with relapse of their disease (compared to children without relapse). Conclusions An ideal support program should start already prior to HSCT and encompass at least the acute in-patient phase of the transplantation. Furthermore, communication about the psychological distress of children should be actively encouraged in clinical settings and whenever possible the child should be consulted directly. To reevaluate the suitability of biomarkers as distress indicators during HSCT as well as the influence of age, trait anxiety of parents and self-efficacy of adolescents on distress during HSCT additional studies with bigger cohorts are necessary. We suggest testing the effect of psychotherapy for children and their families before and during the acute phase of HSCT in randomized controlled intervention studies to further improve future HSCT care.

Predicting Health-Related Quality of Life Outcomes Following Major Scoliosis Surgery in Adolescents: A Latent Class Growth Analysis.

Prospective cohort study. To identify patient trajectories of recovery defined by change in health-related quality of life (HRQOL) following surgery for adolescent idiopathic scoliosis (AIS). To explore possible predictors of trajectory membership. Adolescent patients scheduled to undergo spinal fusion for AIS were enrolled in the Post-Operative Recovery following Spinal Correction: Home Experience (PORSCHE) study. Responses to the Pediatric Quality of Life Inventory-version 4 (PedsQL-4.0) were collected prior to surgery and 4 to 6 weeks, 3, 6, and 12months post-operatively. Latent class growth analyses identified patient subgroups based on their unique trajectories of physical health (PH) and psychosocial health (PSH) outcomes using the PedsQL-4.0 subscale scores. Predictors included demographic, clinical, and psychosocial factors. Data from up to 190 patients were included (87.4% female; mean±SD age = 14.6 ± 1.9years). Three trajectory subgroups were identified for PH and 4 trajectories were found for PSH, with a majority of patients scoring within the established range of healthy adolescents 12months post-surgery. Increased child and parent pain catastrophizing, child trait anxiety and previous hospitalizations were associated with poorer PH outcomes, whereas increased child and parent pain catastrophizing, child state and trait anxiety, and parent state and trait anxiety were associated with poorer PSH trajectories. The PH and PSH trajectories identified in this study and the factors associated with their membership may inform surgical decision-making for AIS while facilitating patient and family counselling regarding peri-operative recovery and expectations.

The Effects of Parents’ and Their Children’s Characteristics on Parental Involvement in Sport

The present study explored factors potentially influencing parental involvement. A total of 1260 parents ( Mage = 43.54, SD = 5.10) completed an online form including demographic questions, questions on their children’s sport participation, and three self-report measures (Parental Involvement in Sport Questionnaire (PISQ), Competitive State Anxiety Inventory 2 (CSAI-2), and Perceived Autonomy Support Scale for Exercise Setting (PASSES)). Possible predictors of the four assessed types of parental involvement were tested with hierarchical linear regression models. The significant predictors were the parent’s gender, her/his sporting experience (or the lack thereof), and the child’s current stage of sport participation. Furthermore, significant associations were found between directive parental behavior and state anxiety and between parental praise/understanding and autonomy support, which were independent of the parent’s gender and sporting experience, and of the child’s age and sport injuries. The obtained results expand the existing knowledge of the complexity of parents’ importance in children’s sport career.

Psychological Distress and Drug Provocation Test-Related Anxiety Levels of Pediatric Patients and Their Parents.

Background: Drug provocation tests (DPTs) are the gold standard for the diagnosis of drug hypersensitivity reaction (DHR). To the best of our knowledge, there is no previous study reporting DPT-related anxiety levels in children and their parents. This study aimed to determine the difference in pre- and post-DPT anxiety levels of parents and children who were informed of the possibility of another DHR during the DPT, and to evaluate the relationship between parental psychological distress and anxiety levels. Methods: The study included children who underwent DPT in our clinic between July 1, 2019, and February 29, 2020, and accompanying parents who consented to participate. Age-appropriate State-Trait Anxiety Inventory scales were used to assess levels of state and trait anxiety in the patients and parents. The Symptom Checklist-90-Revised (SCL-90-R) was used to screen for psychological symptoms in parents. Results: Data were collected from the parents of 69 children who underwent DPTs. The patients' median age was 7.28 (interquartile range: 4.52-10.06) and their parents' mean age was 35.28 ± 5.38 years. Anxiety-related data were collected from 21 pediatric patients. The children and parents had higher state anxiety scores before DPT compared to after DPT. There was a positive correlation between the parents' trait anxiety and pre-DPT state anxiety scores. In addition, parental pre-DPT state anxiety scores were positively correlated with SCL-90-R general severity index, somatization, anxiety, obsessive-compulsive, and depression subscale scores. Conclusion: The risk of allergic reaction in DPT may cause anxiety. A high level of parental anxiety before DPT, which gradually decreased after negative test results, was associated with history of drug-induced anaphylaxis in their children and high trait anxiety. Appropriate evaluation of patients and parents before DPT and providing detailed information may be important to reduce this anxiety.

Health anxiety and associated constructs in school-age children and adolescents with congenital heart disease and their parents: A children's healthy-heart activity monitoring program in Saskatchewan cohort study.

Youth with congenital heart disease (CHD) have been found to experience higher levels of health anxiety and associated constructs than typically developing peers. The association between youth and parent health anxiety has been explored in typically developing youth but this association remains unknown in youth with CHD. This association was explored using a prospective, cross-sectional study that included 36 school-age children and adolescents with CHD (median age =10.5 years, IQR = 4) and 35 parents (median age = 44 years, IQR = 10.5). Participants completed a demographic form and measures of health anxiety, anxiety sensitivity, intolerance of uncertainty, and anxiety disorder symptom categories (youth) or general anxiety (parent). Associations were observed between child and adolescent panic/agoraphobia symptoms and parent state anxiety (r = .41), child and adolescent intolerance of uncertainty and parent state and trait anxiety (r = .37; r = .46, respectively), and child and adolescent anxiety sensitivity and parent state anxiety (r = .40). No association was observed between health anxiety in children and adolescents and parents nor between child and adolescent health anxiety and parent associated constructs. For parents, associations between health anxiety and all measures of associated constructs of interest were observed. Study findings will facilitate improved understanding of the psychological needs of school-age children and adolescents with CHD.

State and trait anxiety in children with incontinence and their parents.

Maternal anxiety increases the risk for incontinence in children. The aim was to analyze anxiety in children with incontinence and their parents before (t1) and after 6months of incontinence treatment (t2). 40 children with incontinence and 40 controls completed the State-trait Anxiety Inventory for Children, their parents the Child Behavior Checklist (CBCL) and the State-trait Anxiety Inventory at baseline (t1) and 6months later (follow-up, t2). Psychiatric disorders were assessed by a standardized parental diagnostic interview (Kinder-DIPS), IQ was tested by a one-dimensional test. All children were neurologically examined. Children with incontinence underwent a guideline-based treatment during the 6months. At baseline, child and parental state and trait anxiety scores, as well as all CBCL scores were significantly higher in the patient group compared to the control group. At t2, parental anxiety, CBCL scores, and child trait anxiety were significantly higher in patients versus controls, whereas child state anxiety decreased, and parental state anxiety increased from t1 to t2. Incontinence and anxiety are associated. While state anxiety decreases, trait anxiety can remain stable over time. Higher levels of anxiety can influence incontinence treatment and should be assessed in every patient.

Effects of an emotional regulation program on maladaptive cognitive emotion regulation, stress, anxiety, and postpartum depression among South Korean mothers of premature infants in the neonatal intensive care unit

PurposeThis study aimed to evaluate the effects of a rational emotive behavior therapy (REBT)-based emotional regulation program for mothers of premature infants in the neonatal intensive care unit (NICU).MethodsThe study utilized a nonequivalent control group pretest-posttest design. Seventeen mothers were recruited for the experimental group and 21 mothers for the control group. Data were collected from July 9, 2018, to Oct 12, 2018 from mothers of premature infants in the NICU regarding parental stress, state anxiety, depression, and maladaptive cognitive emotion regulation. The experimental group received eight sessions of the REBT-based emotional regulation program for 3-4 weeks, and the control group only received standard nursing care.ResultsSignificant differences were found between the two groups in maladaptive cognitive emotion regulation (Z=−3.88, p<.001), stress (Z=−2.76, p=.006), state anxiety (Z=−3.72, p<.001), and postpartum depression(Z=−2.62, p=.009) after the intervention in the experimental group.ConclusionThe REBT-based emotional regulation program for mothers of premature infants was effective for reducing maladaptive cognitive emotion regulation, stress, anxiety, and postpartum depression. Therefore, it may be necessary to provide an REBT-based emotional regulation program for mothers of premature infants in the NICU in clinical practice.

The Influence of Factors Such as Parenting Stress and Social Support on the State Anxiety in Parents of Special Needs Children During the COVID-19 Epidemic.

ObjectivesThe study aims to investigate the state anxiety of parents of special needs children during the 2019 coronavirus disease (COVID-19) epidemic and the influence of parental stress, social support, and other related variables on the anxiety of parents.MethodsBespoke questionnaires of children’s and parent’s mental and behavioral problems during the epidemic were used in the study. We also used the State Anxiety Inventory (S-AI), the Parenting Stress Index—Short Form-15 (PSI-SF-15), the NEO Five-Factor Inventory (NEO-FFI), and the Multidimensional Scale of Perceived Social Support (MSPSS). The data used in the study were pooled from an online survey of parents of special needs children and analyzed by one-way analysis of variance (ANOVA) and multiple linear regression.ResultsOverall, 1,451 individuals were included, of which 402 were fathers (27.71%) and 1,049 were mothers (72.29%). ANOVA results showed that educational background, family monthly income, and type of their child’s disability made parents’ state anxiety significantly different. The results of multiple linear regression showed that during the epidemic, social support negatively predicted parents’ state anxiety (B = −0.15, p < 0.001), whereas parenting stress (B = 0.07, p = 0.001) and parental mental and behavioral problems (B = 0.37, p < 0.001) positively predicted parents’ state anxiety.ConclusionsDuring the outbreak of COVID-19, parents of special needs children suffered mental and behavioral problems, together with parenting stress and social support, which influenced their state anxiety. These findings can be used to develop relevant psychological interventions to improve the mental health of vulnerable groups during a pandemic like COVID-19.

Evaluating the effect of Family Integrated Care on maternal stress and anxiety in neonatal intensive care units

ABSTRACT Objective: To identify how Family Integrated Care (FICare) affected maternal stress and anxiety. Study Design: This secondary analysis of the FICare cluster randomised controlled trial included infants born between 1 April 2013 and 31 August 2015 at ≤33 weeks’ gestation. Mothers completed the PSS:NICU and STAI questionnaires at enrolment and study day 21. Results: 1383 mothers completed the surveys at one or both time-points. The mean PSS:NICU and STAI scores at day 21 were significantly lower in the FICare mothers than controls (PSS:NICU mean [standard deviation] FICare 2.32 [0.75], control 2.48 [0.78], p = 0.0005; STAI FICare 70.8 [20.0], control 74.2 [19.6], p = 0.0004). The sights and sounds, looks and behaviour, and parental role PSS:NICU subscales and the state and trait STAI subscales were all significantly different between FIC are and controls at day 21. The magnitude of change in all stress and anxiety subscales was greater in the FICare group than controls. These differences remained significant after adjustment for confounders with the greatest change in the parental role (least-squares mean [95% confidence interval] FICare −0.65 [−0.72, 0.57], control −0.31 [−0.38, −0.24], p < 0.0001) and state anxiety subscales. Conclusion: FICare is effective at reducing NICU-related maternal stress and anxiety.

LO63: Humanoid robot-based distraction to reduce pain and distress during venipuncture in the pediatric emergency department: A randomized controlled trial

Introduction: Intravenous insertion (IVI) is identified by children as extremely painful and the resultant distress can have lasting negative consequences. There is an urgent need to effectively manage such procedures. Our primary objective was to compare the pain and distress of IVI with the addition of humanoid robot-based distraction to standard care, versus standard care alone. Methods: This two-armed randomized controlled trial (RCT) was conducted from April 2017 to May 2018 at the Stollery Children's Hospital emergency department (ED). Children aged 6 to 11 years who required IVI were included. Exclusion criteria included hearing or visual impairments, neurocognitive delays, sensory impairment to pain, previous enrolment, and discretion of the ED clinical staff. Primary outcomes were measured using the Observational Scale of Behavioural Distress-Revised (OSBD-R) (distress) and the Faces Pain Scale-Revised (FPS-R) (pain). A total of 426 pediatric patients were screened and 340 were excluded. Results: We recruited 86 children, of which 55% (47/86) were male; 9% (7/82) were premature at birth; 82% (67/82) had a previous ED visit; 30% (25/82) required previous hospitalization; 78% (64/82) had previous IV placement and 96% (78/81) received topical anesthesia. The mean total OSBD-R score was 1.49 ± 2.36 (standard care) compared to 0.78 ± 1.32 (robot group) (p = 0.047). The median FPS-R during the IV procedure was 4 (IQR 2,6) in the standard care group alone, compared to 2 (IQR 0,4) with the addition of humanoid robot-based distraction (p = 0.10). Change in parental state anxiety pre-procedure versus post-procedure was not significantly different between groups (p = 0.49). Parental satisfaction with the IV start was 93% (39/42) in the robot arm compared to 74% (29/39) in the standard care arm (p = 0.03). Parents were also more satisfied with management of their child's pain in the robot group (95% very satisfied) compared with standard care (72% very satisfied) (p = 0.002). Conclusion: A statistically significant reduction in distress was observed with the addition of robot-based distraction to standard care. Humanoid robot-based distraction therapy reduces distress and to a lesser extent, pain, in children undergoing IVI in the ED. Further trials are required to confirm utility in other age groups and settings.

Role of anxiety in young children's pain memory development after surgery.

Pediatric pain is common, and memory for it may be distressing and have long-lasting effects. Children who develop more negatively biased memories for pain (ie, recalled pain is higher than initial pain report) are at risk of worse future pain outcomes. In adolescent samples, higher child and parent catastrophic thinking about pain was associated with negatively biased memories for postsurgical pain. This study examined the influence of child and parent anxiety on the development of younger children's postsurgical pain memories. Seventy-eight children undergoing a tonsillectomy and one of their parents participated. Parents reported on their anxiety (state and trait) before surgery, and trained researchers observationally coded children's anxiety at anaesthesia induction. Children reported on their postsurgical pain intensity and pain-related fear for 3 days after discharge. One month after surgery, children recalled their pain intensity and pain-related fear using the same scales previously administered. Results revealed that higher levels of postsurgical pain and higher parent trait anxiety predicted more negatively biased memories for pain-related fear. Parent state anxiety and child preoperative anxiety were not associated with children's recall. Children who developed negatively biased pain memories had worse postsurgical pain several days after surgery. These findings underscore the importance of reducing parental anxiety and effective postsurgical pain management to potentially buffer against the development of negatively biased pain memories in young children.

Association between children's emotional/behavioral problems before adenotonsillectomy and postoperative pain scores at home.

Children undergoing adenotonsillectomy are at risk of severe postoperative pain and sleep problems. Little is known about the specific child risk factors for these problems. The aim of this study was to assess the occurrence of postoperative pain, sleep problems, and medication adherence, and assess the influence of internalizing and externalizing problems on postoperative pain. This prospective cohort study included 160 children, aged 1.5-5 years undergoing day-care adenotonsillectomy. Parents rated their child's pain with the Parents' Postoperative Pain Measure and their child's sleep problems with Vernon's Post Hospital Behavioral Questionnaire during the first 3 days and at day 10 postoperatively. Emotional/behavioral problems (ie, internalizing and externalizing behaviors) during the past 2 months were assessed using the Child Behavior Checklist. Regression analysis was used to assess whether children's pain intensity at home was associated with internalizing/externalizing problems, after controlling for age, preoperative child state anxiety, parental state anxiety, parental need for information, and socioeconomic status. Applying a threshold of ≥6 on the Parents' Postoperative Pain Measure, the incidence of moderate to severe pain was 57.6% at day 1, 53.5% at day 2, 35.4% at day 3, and 4.8% at day 10. During the first three postoperative nights, 37.1% of the children woke up. Internalizing problems (β = 0.343; P = 0.001) and parental need for information (β = 0.207; P = 0.011) were independently associated with higher pain scores at home during the first 3 days (R2 = 0.225). Following adenotonsillectomy, children often experienced moderate to severe pain and sleep problems during the first 3 days at home. Preoperative internalizing problems and parental need for information were independently associated with increased pain at home. Screening for these problems can help to identify vulnerable children and adapt the perioperative analgesic strategy accordingly (which includes preparation, information, and prescription of pain analgesics).

Internet-delivered, preoperative, preparation program (I-PPP): Development and examination of effectiveness

Study objectiveLimited evidence-based, interactive, Internet-delivered preoperative preparation programs for children and their parents exist. The purpose of this investigation was to develop and examine the effectiveness of the Internet-delivered, preoperative program (I-PPP) in alleviating prepoperative anxiety in children undergoing outpatient surgery. In Study 1, the I-PPP was developed and then evaluated by parent/child dyads and health care professionals. In Study 2, the effectiveness of I-PPP was examined. DesignThis study was a development and effectiveness study. SettingFor Study 1, participants were recruited from the community. For Study 2, participants were recruited from the Royal University Hospital. PatientsIn Study 1, participants were 9 parent/child dyads and 5 health care professionals. In Study 2, participants were 32 children (3–7years) scheduled for outpatient surgery and one parent for each child. InterventionIn Study 1, I-PPP modules were created and parent/child dyads and health care professionals evaluated I-PPP modules and treatment credibility. In Study 2, child patients and their parents completed the I-PPP prior to day of surgery. MeasurementsObserver-rated anxiety of child participants was measured during the day surgery experience. Parent state anxiety was measured prior to completing I-PPP, pre- and post-surgery. Post-surgery parents provided comments regarding the I-PPP. Post-surgery child behaviour change was assessed. Main resultsFor Study 1, ratings for I-PPP components and treatment credibility surpassed our acceptability criterion. Minor changes were made to I-PPP. For Study 2, mYPAS scores were stable across day surgery. mYPAS scores in current study at induction did not differ significantly from benchmark studies. Significant reduction in parent anxiety was observed pre- to post-surgery. Parents positively endorsed the program. Negative post-operative behaviours were observed in a proportion of children. ConclusionsOur findings suggest that I-PPP represents a viable option for preoperative preparation for children and their parents.

Impact of parental presence during induction of anesthesia on anxiety level among pediatric patients and their parents: a randomized clinical trial.

IntroductionAnesthesia induction is a stressful event for children and their parents, and may have potentially harmful consequences on the patient’s physiological and mental situation. Stressful anesthesia induction has psychological adverse effects that recur with repeated anesthesia, can lead to increased pediatric discomfort during the recovery period, and may even induce reactionary postoperative behavior. A randomized controlled trial was performed to assess the impact of parental presence during induction of anesthesia (PPIA) on preoperative anxiety of pediatric patients and their parents at three different times, cooperation of child with anesthesiologist at induction of anesthesia, and parental satisfaction.Patients and methodsA total of 96 pediatric patients undergoing elective minor surgery (ASA 1–2) were randomly divided into two groups. Both groups received oral midazolam (0.5 mg/kg) at least 20 minutes before surgery, but in the PPIA group, the parents were also present in the operating room until loss of consciousness of child at anesthesia induction. Anxiety in the patients (as measured by the modified Yale Preoperative Anxiety Scale [mYPAS]) and parents (as measured by the State and Trait Anxiety Inventory [STAI]), the Induction Compliance Checklist (ICC), and parental satisfaction (as measured by visual analog scale) were assessed.ResultsThere was no significant difference in the mean anxiety scores (mYPAS) of participants in the control and PPIA groups at ward T0 and upon arrival to operating room T1 (P>0.05). However, between the PPIA and control groups, mean mYPAS score was different at the time of induction of anesthesia T2 (35.5±16.6 vs 59.8±22.4; P<0.001). The ICC scores showed that perfect score was significantly different in the PPIA and control groups (66.6% vs 6.3%; P<0.01). The STAI scores of the parents in the two groups did not differ in T0, T1, and T2. The mean parental satisfaction score was higher in the PPIA group than in the control group (7.6±7.0 vs 5.8±6.1; P<0.01).ConclusionPPIA may reduce preoperative state anxiety of pediatric patients and improve quality of anesthesia induction based on ICC scores and higher parental satisfaction, but it does not impact on parental state anxiety.

Parental state anxiety correlates with preoperative anxiety in Chinese preschool children.

Preoperative anxiety in children is largely dependent on age and is influenced by anxiety level in parents. The current study compared the level of preoperative anxiety in preschool children versus school-aged children and its relationship with the state and trait anxiety of the parents. This study included 54 preschool children (2-5 years of age) and 48 school-age children (6-12 years) scheduled to receive ear, nose and throat, plastic or ophthalmologic surgeries. Preoperative anxiety of children was assessed in the holding area immediately prior to the surgery using a modified Yale Preoperative Anxiety Scale (m-YPAS). Compliance with anaesthesia induction was assessed using an Induction Compliance Checklist (ICC). The state and trait anxiety of the parent who accompanied the child was assessed using a State-Trait Anxiety Inventory (STAI) questionnaire. Both m-YPAS and ICC scores were higher in preschool children than in school-age children with significant correlation between the two measures. The STAI-S score of parents was higher in the preschool group than in the school-age group. No significant difference was found in STAI-T score between the two age groups. Children's m-YPAS score correlated with parental STAI-T score in both groups (rho = 0.297, P = 0.029 and rho = 0.338, P = 0.019, respectively) but only with STAI-S score in the preschool group (rho = 0.400, P = 0.003). Both preschool children and their parents are more anxious than school-age dyads prior to surgery. The anxiety level of the children correlates with state anxiety of the parents in preschool children but not in school-age children.

Family identification: a beneficial process for young adults who grow up in homes affected by parental intimate partner violence

Exposure to parental intimate partner violence (parental IPV) is a complex trauma. Research within social psychology establishes that identification with social groups impacts positively on how we appraise, respond to and recover from traumatic events. IPV is also a highly stigmatized social phenomenon and social isolation is a major factor for families affected by IPV, yet strong identification with the family group may act as a beneficial psychological resource to young people who grew up in homes affected by IPV. The current study, an online survey of 355 students (Mage = 20, 70% female), investigated if a psychosocial process, specifically identification with the family, may influence the relationship between the predictor, exposure to parental IPV, and outcomes, global self-esteem and state anxiety. Mediation analysis suggests that identification with the family has a positive influence on the relationship between exposure to parental IPV and psychological outcomes; exposure to parental IPV results in reduced family identification, but when family identification is strong it results in both reduced anxiety and increased self-esteem for young people. The findings highlight the importance of having a strong sense of belonging to the extended family for young people who were exposed to parental IPV, thus has implications for prevention, intervention, and social policy.