151
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Kleiber C, Jennissen C, McCarthy AM, Ansley T. Evidence-Based Pediatric Pain Management in Emergency Departments of a Rural State. THE JOURNAL OF PAIN 2011; 12:900-10. [DOI: 10.1016/j.jpain.2011.02.349] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2010] [Revised: 01/11/2011] [Accepted: 02/15/2011] [Indexed: 11/25/2022]
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152
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McMurtry CM. Needle and dread: Is it just a little poke? A call for implementation of evidence-based policies for the management of needle pain in clinical settings. Paediatr Child Health 2011; 12:101-2. [PMID: 19030347 DOI: 10.1093/pch/12.2.101] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2006] [Indexed: 11/14/2022] Open
Abstract
The present commentary calls for the implementation of evidence-based policies to manage paediatric needle pain in clinical settings. While there have been fundamental advances in the treatment of needle pain over the past three decades, relevant techniques are often not used in clinical practice. Evidence indicates that needle procedures do hurt, are frequently cited as the most painful experience by children and a subset of children are terrified of them. Pain and distress from needle procedures can and must be addressed because needle procedures are frequently performed on both healthy (eg, immunizations) and ill (eg, bone marrow aspirations, lumbar punctures) children. An essential step in translating research knowledge into practice is the creation of evidence-based policies. Policy statements regarding the management of needle pain must be incorporated at the hospital, clinic and individual office levels to reduce the amount of pain and distress children suffer from needle procedures. Specific suggestions for policies to be incorporated in clinical settings are provided.
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Affiliation(s)
- C Meghan McMurtry
- Department of Psychology, Dalhousie University, Centre for Research in Family Health, IWK Health Centre, Halifax, Nova Scotia
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153
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Stockwell MS, Irigoyen M, Martinez RA, Findley S. How parents' negative experiences at immunization visits affect child immunization status in a community in New York City. Public Health Rep 2011; 126 Suppl 2:24-32. [PMID: 21812166 PMCID: PMC3113427 DOI: 10.1177/00333549111260s204] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Little is known about how families' experiences with immunization visits within the medical home may affect children's immunization status. We assessed the association between families' negative immunization experiences within the medical home and underimmunization. METHODS We surveyed parents (n = 392) of children aged 2-36 months about immunization experiences at community health centers, hospital-based clinics, private practices, and community-based organizations in New York City. We used Chi-square tests and odds ratios (ORs) to assess the relationship between medical home elements and parental immunization experience ratings. We used multivariable analysis to determine the association between negative experiences during immunization visits and underimmunization, controlling for insurance, maternal education, and receipt of benefits from the Special Supplemental Nutrition Program for Women, Infants, and Children. RESULTS The majority of children were of Latino race/ethnicity and had Medicaid and a medical home. One-sixth (16.9%) of families reported a previous negative immunization experience, primarily related to the child's reaction, waiting time, and attitudes of medical and office staff. Parents' negative immunization experiences were associated with the absence of four components of the medical home: continuity of care, family-centered care, compassionate care, and comprehensive care. In addition, children in families who reported a negative experience were more likely to have been underimmunized (adjusted OR = 2.00; 95% confidence interval 1.12, 3.58). CONCLUSIONS In a community in New York City, underimmunization of young children was associated with negative immunization experiences. Strategies to improve family experiences with immunization visits within the medical home (particularly around support for the family), medical and ancillary staff attitudes, and reduced waiting time may lead to improved immunization delivery.
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Affiliation(s)
- Melissa S Stockwell
- Columbia University, Division of General Pediatrics, New York, NY 10032, USA.
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154
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Abstract
With few exceptions, it is currently recommended that all premature infants should receive routine childhood vaccines at the same chronologic age as term infants. Thus, neonatal nurses need to stay current on the recommendations for immunizations commonly used in the NICU setting. It is important for nurses to provide information that is reliable and verifiable with scientific evidence to the parents.
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155
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Ravikiran SR, Kumar PMJ, Meundi AD. Pain response in newborns to the order of injecting BCG and Hepatitis-B vaccines: a randomized trial. Indian J Pediatr 2011; 78:693-7. [PMID: 21193975 DOI: 10.1007/s12098-010-0327-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2010] [Accepted: 12/01/2010] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To determine if acute pain response after administration of the BCG vaccine and the Hepatitis-B vaccine is affected by the order in which they are given. METHODS This Single-center randomized clinical trial was conducted in the Vaccination room in the Pediatrics Outpatient Department at KVG Medical College; Karnataka, India. 76 healthy term neonates undergoing routine immunization were included in this study. Newborns received either BCG vaccine or the Hepatitis-B vaccine first, followed by the other vaccine. The primary outcome was neonatal pain during vaccine injection as assessed by a validated measure, the Neonatal Infant Pain Scale (NIPS), scored by resident doctors blinded to the study purpose and hypothesis. In addition, a nurse rated pain using a 10-cm visual analog scale(VAS). RESULTS A total of 76 infants participated: 38 received the BCG vaccine first and 38 received the Hepatitis-B vaccine first. Demographic characteristics did not differ between the groups. Overall mean (SD) pain scores per neonate were significantly lower when BCG was administered first compared to the order when Hepatitis-B vaccine was administered first (for NIPS 5.55 [0.54] vs. 5.84 [0.29], P = .005; for VAS, 6.25 [0.80] vs. 6.58 [0.54], P = .04). When given first, the BCG vaccine caused significantly less pain (P < .001)than the Hepatitis-B, as assessed by the NIPS and VAS (P < .001). CONCLUSIONS Pain was reduced when the BCG vaccine was administered before the Hepatitis-B in neonates undergoing routine vaccination. The authors recommend that the order of vaccine injections be the BCG vaccine followed by Hepatitis-B.
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Affiliation(s)
- S R Ravikiran
- Department of Pediatrics, KVG Medical College and Hospital, Sullia, Dakshina Kannada, Karnataka, India.
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156
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Ayers S, Muller I, Mahoney L, Seddon P. Understanding needle-related distress in children with cystic fibrosis. Br J Health Psychol 2011; 16:329-43. [PMID: 21489060 DOI: 10.1348/135910710x506895] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To explore the nature and management of needle-related distress in children and adolescents with cystic fibrosis (CF). DESIGN Qualitative study using semi-structured interviews. METHODS Fourteen child-parent dyads took part. Children (5 male; 9 female) had a mean age of 12.4 years (range 7-17) and were mostly diagnosed with CF at birth (N= 11). Frequency of needle procedures ranged from once to six times a year. Parents (3 male; 11 female) had a mean age of 41.5 years and were from a variety of socio-economic backgrounds. Interviews were transcribed and analysed using thematic analysis. RESULTS Most participants identified previous needle experiences and pain as related to their needle anxiety. Over half of parents and children considered 'taking control' to be the optimum coping strategy. The majority of parents and children thought inhaled nitrous oxide gas during needle procedures was helpful in managing needle-related distress. Parent and staff influences on needle-related distress are also examined. CONCLUSIONS Needle-related distress in children with CF has a substantial impact on children and their parents, and may lead to management problems and treatment refusal. Psychological and pharmacological interventions could reduce distress and aid management.
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Affiliation(s)
- Susan Ayers
- School of Psychology, University of Sussex, Falmer, Brighton, Sussex, UK.
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157
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Kristjánsdóttir Ó, Kristjánsdóttir G. Randomized clinical trial of musical distraction with and without headphones for adolescents’ immunization pain. Scand J Caring Sci 2011; 25:19-26. [DOI: 10.1111/j.1471-6712.2010.00784.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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158
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Wolff NJ, Darlington ASE, Hunfeld JAM, Tharner A, Van Ijzendoorn MH, Bakermans-Kranenburg MJ, Moll HA, Jaddoe VWV, Hofman A, Verhulst FC, Passchier J, Tiemeier H. The influence of attachment and temperament on venipuncture distress in 14-month-old infants: the Generation R Study. Infant Behav Dev 2011; 34:293-302. [PMID: 21316110 DOI: 10.1016/j.infbeh.2011.01.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2010] [Revised: 08/25/2010] [Accepted: 01/13/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVE This study examined the effects of attachment and temperament on infant distress during venipuncture. METHOD The study was embedded in the Generation R Study, a prospective population-based study. Two different research procedures (i.e., blood sampling and the Ainsworth Strange Situation Procedure) yielded measures of venipuncture distress and attachment security and disorganization in 246 infants aged 14 months. Four temperament traits (distress to limitations, fear, recovery from distress, and sadness) were assessed using the maternally reported Infant Behavior Questionnaire-Revised, at the age of 6 months. RESULTS There were no differences between mean levels of distress during venipuncture in infants classified as having insecure attachment, but there was a trend for disorganized attachment. The temperament traits were not related to distress. However, children with a disorganized attachment and higher temperamental fear had more venipuncture distress. CONCLUSION When different risk factors are present simultaneously, infant distress is heightened.
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Affiliation(s)
- Noor J Wolff
- Department of Child and Adolescent Psychiatry, Erasmus University Medical Center, Rotterdam,The Netherlands.
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159
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Learning About Pain From Others: An Observational Learning Account. THE JOURNAL OF PAIN 2011; 12:167-74. [DOI: 10.1016/j.jpain.2010.10.001] [Citation(s) in RCA: 122] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2010] [Revised: 09/14/2010] [Accepted: 10/01/2010] [Indexed: 11/18/2022]
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160
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Cortisol, behavior, and heart rate reactivity to immunization pain at 4 months corrected age in infants born very preterm. Clin J Pain 2011; 26:698-704. [PMID: 20664338 DOI: 10.1097/ajp.0b013e3181e5bb00] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Pain response may be altered in infants born very preterm owing to repeated exposure to procedures in the neonatal intensive care unit. Findings have been inconsistent in studies of behavioral and cardiac responses to brief pain in preterm versus full-term infants following neonatal intensive care unit discharge. To our knowledge, cortisol reactivity to pain has not been compared in preterm and full-term infants. We examined pain reactivity to immunization in preterm and full-term infants. METHOD Cortisol, facial behavior, and heart rate reactivity before, during, and after immunization were examined in infants born preterm at extremely low gestational age (ELGA 24 to 28 wk), very low gestational age (VLGA 29 to 32 wk), and full-term, at corrected age 4 months. RESULTS In all groups, cortisol, behavior, and heart rate increased during immunizations. Cortisol concentrations were lower in preterm ELGA and VLGA boys, compared with full-term boys. In contrast, facial and heart rate responses to immunization did not differ between preterm and full-term infants. DISCUSSION Although earlier reports found differences in pain processing in preterm infants earlier and later in development, the present findings indicate that pain responses, indexed by behavior and heart-rate, do not seem to differ in preterm compared with full-term infants at 4 months corrected age. Importantly, however, stress regulation seems altered in preterm male infants. As cortisol impacts development and functioning of the brain, altered stress regulation has important implications beyond pain systems.
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161
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Ağaç E, Güneş ÜY. Effect on pain of changing the needle prior to administering medicine intramuscularly: a randomized controlled trial. J Adv Nurs 2010; 67:563-8. [DOI: 10.1111/j.1365-2648.2010.05513.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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162
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Schechter NL, Bernstein BA, Zempsky WT, Bright NS, Willard AK. Educational outreach to reduce immunization pain in office settings. Pediatrics 2010; 126:e1514-21. [PMID: 21078736 DOI: 10.1542/peds.2010-1597] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The goal was to examine the impact of a teaching module on immunization pain reduction practices in pediatric offices 1 and 6 months after the intervention. METHODS Fourteen practices were selected randomly to receive a 1-hour teaching session on immunization pain reduction techniques, and 13 completed the study. Before the intervention, telephone interviews were conducted with parents concerning their children's recent immunization experiences. At 1 and 6 months after the intervention, parents of children who had recent immunizations were interviewed by using the same questionnaires. Clinicians also were surveyed at baseline and at 6 months. RESULTS A total of 839 telephone interviews and 92 clinician surveys were included. Significant changes from baseline were identified at 1 and 6 months after the intervention. At 1 month, parents were more likely to report receiving information (P = .04), using strategies to reduce pain (P < .01), learning something new (P < .01), using a ShotBlocker (P < .01), using sucrose (P < .01), and having higher levels of satisfaction (P = .015). At 6 months, all rates remained significantly higher than baseline findings (all P < .01) except for satisfaction. Clinician surveys revealed significant increases in the use of longer needles, sucrose, pinwheels, focused breathing, and ShotBlockers at 6 months. CONCLUSIONS A 1-hour teaching session had measurable effects on the use of pain-reducing strategies at 1 and 6 months after the intervention. This research supports the hypothesis that small-group teaching sessions at the site of care can be associated with changes in practice behaviors.
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Affiliation(s)
- Neil L Schechter
- Children's Hospital Boston, Department of Anesthesia, Perioperative and Pain Medicine, 300 Longwood Ave, Boston, MA 02115, USA.
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163
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ABM clinical protocol #23: Non-pharmacologic management of procedure-related pain in the breastfeeding infant. Breastfeed Med 2010; 5:315-9. [PMID: 21029022 DOI: 10.1089/bfm.2010.9978] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
A central goal of The Academy of Breastfeeding Medicine is the development of clinical protocols for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient. These guidelines are not intended to be all-inclusive, but to provide a basic framework for physician education regarding breastfeeding.
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164
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Taddio A, Appleton M, Bortolussi R, Chambers C, Dubey V, Halperin S, Hanrahan A, Ipp M, Lockett D, MacDonald N, Midmer D, Mousmanis P, Palda V, Pielak K, Riddell RP, Rieder M, Scott J, Shah V. Reducing the pain of childhood vaccination: an evidence-based clinical practice guideline. CMAJ 2010; 182:E843-55. [PMID: 21098062 DOI: 10.1503/cmaj.101720] [Citation(s) in RCA: 149] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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165
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Taddio A, Appleton M, Bortolussi R, Chambers C, Dubey V, Halperin S, Hanrahan A, Ipp M, Lockett D, MacDonald N, Midmer D, Mousmanis P, Palda V, Pielak K, Riddell RP, Rieder M, Scott J, Shah V. Reducing the pain of childhood vaccination: an evidence-based clinical practice guideline (summary). CMAJ 2010; 182:1989-95. [PMID: 21098067 DOI: 10.1503/cmaj.092048] [Citation(s) in RCA: 107] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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166
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Vaccine related reactogenicity for primary immunization: a randomized controlled trial of 23(wider) vs. 25(narrower) gauge needles with same lengths. Indian J Pediatr 2010; 77:1241-6. [PMID: 20821281 DOI: 10.1007/s12098-010-0173-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2010] [Accepted: 08/02/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To compare vaccine related reactogenicity during primary immunization in healthy infants using 23 vs. 25 gauge needles. METHODS This randomized controlled trial was conducted in Vaccination Room of the Advanced Pediatrics Center. 155 participants for primary immunization were assigned to two intervention groups (23 vs. 25 gauge). Parent-reported local and systemic reactions were recorded daily for three days after the immunization. RESULTS Swelling (24%) and tenderness (21%) were the two most common parent-reported local symptoms followed by restriction of movements (18%) and redness (10%) on day 1. Any local reaction on day 1 was statistically similar in 25 gauge vs. 23 gauge group (RR 0.77; 95% CI: 0.32 to 1.82) (P = 0.54), but fever (day 1) showed higher trend in 23 gauge needle group (RR 2.24; 95% CI: 0.92-5.47) (P = 0.07). Furthermore, on analysis of serially reported local and systemic reactions for 3 consecutive days by generalized estimating equations, odds of redness, swelling, tenderness, restricted movement and fever were statistically similar between two needle groups. On the other hand, median (± SE) crying time (in seconds) was significantly prolonged in the 25 gauge needle (39 ± 2) as compared to 23 gauge group (30 ± 1.3) (log rank test, P = 0.001). CONCLUSIONS The use of same length needles with narrower (25) or wider (23) gauge did not show significant differences in local reactogenicity during primary immunization. Fever, however, was reduced marginally in 25 gauge group whereas crying duration was significantly shorter with 23 gauge needle. Finally, larger studies are needed to further evaluate objectively the outcome of reactogenicity.
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167
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De Lima J, Carmo KB. Practical pain management in the neonate. Best Pract Res Clin Anaesthesiol 2010; 24:291-307. [DOI: 10.1016/j.bpa.2010.04.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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168
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Williams SE, Blount RL, Walker LS. Children's pain threat appraisal and catastrophizing moderate the impact of parent verbal behavior on children's symptom complaints. J Pediatr Psychol 2010; 36:55-63. [PMID: 20484330 DOI: 10.1093/jpepsy/jsq043] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE We tested the hypothesis that pain threat appraisal and catastrophizing by children with functional abdominal pain (FAP) will moderate the relation between parent verbal behavior and children's symptom complaints following experimentally induced visceral discomfort. METHODS Thirty-three pediatric patients with FAP and their parents participated. Children completed measures of pain threat appraisal and catastrophizing. Weeks later they completed the Water Load Symptom Provocation Test to induce visceral discomfort. Spontaneous parent-child interactions during child discomfort were audiotaped and coded for content. RESULTS Parent symptom-related talk was associated with more child symptom complaints and parent non-symptom-related talk with fewer child complaints. The relation between symptom talk and complaints was greater for children with high catastrophizing. Non-symptom talk was associated with fewer complaints for children with high threat appraisals. CONCLUSIONS Child characteristics should be considered in research on the relation between parent behavior and children's symptom complaints.
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Affiliation(s)
- Sara E Williams
- Department of Pediatrics, Vanderbilt University School of Medicine.
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169
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Huguet A, Stinson JN, McGrath PJ. Measurement of self-reported pain intensity in children and adolescents. J Psychosom Res 2010; 68:329-36. [PMID: 20307699 DOI: 10.1016/j.jpsychores.2009.06.003] [Citation(s) in RCA: 105] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2009] [Revised: 06/11/2009] [Accepted: 06/11/2009] [Indexed: 11/18/2022]
Abstract
Acute and chronic pain is a common experience in children and youth. A thorough assessment is fundamental to understand this experience and to assess and monitor treatment responses. The intensity of pain is the parameter most commonly assessed. In this article, we describe the different methods employed to assess pediatric pain intensity and review well-validated and commonly used self-report measures of pain. This review is based on the recent systematic reviews conducted for the Pediatric Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials Consensus Group and the Society of Pediatric Psychology. Amongst the several types of pediatric pain measures, self-report, when available, is regarded as the primary source of information about pain intensity, to be complemented by observation and knowledge of the context. There is a large number of self-report measures of pediatric pain intensity; and there is some agreement that professionals in the clinical and research practice should assess pain intensity using the Pieces of Hurt Tool, the Faces Pain Scale, the Oucher, or Visual Analogue Scales because these measures have shown to have sound psychometric properties and clinical utility. Despite the increased number of age-appropriate self-report measures of pediatric pain intensity over the last years, we report several research gaps and priorities of future research.
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Affiliation(s)
- Anna Huguet
- IWK Health Centre and Dalhousie University, Halifax, Nova Scotia, Canada.
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170
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Comparison of distress and pain in infants randomized to groups receiving standard versus multiple immunizations. Infant Behav Dev 2010; 33:289-96. [PMID: 20362342 DOI: 10.1016/j.infbeh.2010.03.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2009] [Revised: 10/03/2009] [Accepted: 03/08/2010] [Indexed: 11/22/2022]
Abstract
This randomized controlled trial compared distress and pain in healthy 4-month-old infants receiving three different immunizations either sequentially (control, n=50) or simultaneously, two at the same time, followed by the third (experimental, n=51). Although both groups demonstrated a significant increase in cortisol from baseline levels, the lack of significant difference on salivary cortisol between groups post-immunization suggests the study was underpowered. On NIPS scores, the experimental group demonstrated significantly less pain (Mann-Whitney U=1648.0, p=0.003). Simultaneous injections appeared to be effective in reducing pain behavior responses in infants receiving their 4-month immunizations. Longitudinal studies could determine whether reduced exposure to pain in infancy, through simultaneous immunization injections, could contribute to a reduction in sensitivity to pain and physiologic stress responses.
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171
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Kassab M, Foster JP, Foureur M, Fowler C. Sweet-tasting solutions for needle-related procedural pain in infants one month to one year of age. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2010. [DOI: 10.1002/14651858.cd008411] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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172
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Harrison D, Yamada J, Adams-Webber T, Ohlsson A, Beyene J, Stevens B. Sweet-tasting solutions for needle-related procedural pain in children aged one to 16 years. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2010. [DOI: 10.1002/14651858.cd008408] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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173
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Mahoney L, Ayers S, Seddon P. The Association Between Parent's and Healthcare Professional's Behavior and Children's Coping and Distress During Venepuncture. J Pediatr Psychol 2010; 35:985-95. [DOI: 10.1093/jpepsy/jsq009] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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174
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Strategies for the Prevention and Management of Neonatal and Infant Pain. Curr Pain Headache Rep 2010; 14:113-23. [DOI: 10.1007/s11916-009-0091-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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175
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Wallace DP, Allen KD, Lacroix AE, Pitner SL. The "cough trick:" a brief strategy to manage pediatric pain from immunization injections. Pediatrics 2010; 125:e367-73. [PMID: 20064862 DOI: 10.1542/peds.2009-0539] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The goal was to investigate the effect of a "cough trick" technique on self-reported pain of children receiving routine immunizations. The strategy requires minimal equipment, time, or training for parents, children, and nursing staff members. METHODS A randomized, controlled, unblinded, within-subject study of 68 children receiving prekindergarten (ages 4-5) or pre-junior high school (ages 11-13) immunizations was performed. Participants were recruited from an outpatient pediatric clinic at a large public hospital in the Midwest. The strategy required a single "warm-up" cough of moderate force, followed by a second cough that coincided with needle puncture. The principle outcome was self-reported pain, although parent and nurse report of pain was used to support the accuracy of self-report. Older participants and all nurses completed a measure of their satisfaction with the procedure. RESULTS In the initial analysis, the procedure was found not to be effective. However, post hoc tests revealed that the procedure was effective at a statistically and clinically significant level for participants identified as Hispanic white or non-Hispanic white but not for those identified as non-Hispanic black. Participants and clinic nurses found the procedure acceptable and effective. CONCLUSIONS The results of this study suggest that the cough trick can be an effective strategy for the reduction of pain for some children undergoing routine immunizations. However, additional research is needed to clarify the observed moderation by self-identified race.
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Affiliation(s)
- Dustin P Wallace
- Mayo Clinic, Department of Psychiatry and Psychology, 200 First St SW, Rochester, MN 55901, USA.
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176
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Chambers CT, Taddio A, Uman LS, McMurtry CM. Psychological interventions for reducing pain and distress during routine childhood immunizations: a systematic review. Clin Ther 2009; 31 Suppl 2:S77-S103. [PMID: 19781437 DOI: 10.1016/j.clinthera.2009.07.023] [Citation(s) in RCA: 122] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2009] [Indexed: 01/22/2023]
Abstract
BACKGROUND Immunizations are a common source of pain and distress for children. Psychological interventions consist of a variety of techniques for relaxing and distracting children during immunization with the goal of reducing pain and distress. OBJECTIVE We conducted a systematic review to determine the efficacy of various psychological strategies for reducing pain and distress in children during routine immunizations. METHODS MEDLINE, PsycINFO, EMBASE, CINAHL, and the Cochrane Central Register of Controlled Trials databases were searched to identify randomized controlled trials (RCTs) and quasi-RCTs that determined the effect of psychological interventions on pain and distress during injection of vaccines in children 0 to 18 years of age, using validated child self-reported pain or observer-reported assessments of child distress or pain. We examined the efficacy of 7 psychological interventions: (1) breathing exercises; (2) suggestion; (3) child-directed distraction; (4) parent-led distraction; (5) nurse-led distraction; (6) parent coaching; and (7) combined cognitive-behavioral interventions. All meta-analyses were performed using a fixed-effects model. RESULTS Twenty RCTs involving 1380 infants and children (1 month to 11 years of age) were included in the systematic review. Breathing exercises were effective in reducing children's self-reported pain (standardized mean difference [SMD], -0.43; 95% CI, -0.76 to -0.09; P = 0.01), observer-rated distress (SMD, -0.40; 95% CI, -0.68 to -0.11; P = 0.007), and nurse-reported distress (SMD, -0.57; 95% CI, -0.98 to -0.17; P = 0.005). Self-reported distress ratings appeared to be lower with breathing exercises, but the difference was not statistically significant. No evidence was found to support suggestion as a psychological intervention for reducing pain associated with pediatric immunization. Child-directed distraction was effective in reducing self-reported pain (SMD, -0.28; 95% CI, -0.54 to -0.03; P = 0.03). Parent-led distraction was effective in reducing observer-rated distress (SMD, -0.50; 95% CI, -0.82 to -0.19; P = 0.002), but not other measures of pain or distress. Nurse-led distraction was effective in reducing distress ratings as assessed by the observer (SMD, -0.40; 95% CI, -0.68 to -0.12; P = 0.005), the parent (SMD, -0.37; 95% CI, -0.66 to -0.07; P = 0.01), and the nurse (SMD, -0.42; 95% CI, -0.70 to -0.14; P = 0.004). Parent coaching was effective in reducing observer-rated distress (SMD, -0.71; 95% CI, -1.02 to -0.39; P < 0.001), but not other measures of pain or distress. Combined cognitive-behavioral interventions were effective in reducing children's self-reported pain (SMD, -0.75; 95% CI, -1.03 to -0.48; P < 0.001), observer-rated distress (SMD, -0.53; 95% CI, -0.83 to -0.23; P < 0.001), and parent-rated distress (SMD, -0.97; 95% CI, -1.37 to -0.57; P < 0.001). The methodologic quality of the included trials was generally poor, with 18 (90%) of the 20 studies rated as having a high risk of bias. CONCLUSIONS Evidence suggests that breathing exercises, child-directed distraction, nurse-led distraction, and combined cognitive-behavioral interventions are effective in reducing the pain and distress associated with routine childhood immunizations. Although additional well-designed trials examining psychological interventions are needed, parents and health care professionals should be advised to incorporate psychological interventions to reduce the pain and distress experienced by children during immunization.
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Affiliation(s)
- Christine T Chambers
- Departments of Pediatrics and Psychology, Dalhousie University, Halifax, Nova Scotia, Canada.
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Taddio A, Chambers CT, Halperin SA, Ipp M, Lockett D, Rieder MJ, Shah V. Inadequate pain management during routine childhood immunizations: the nerve of it. Clin Ther 2009; 31 Suppl 2:S152-67. [PMID: 19781434 DOI: 10.1016/j.clinthera.2009.07.022] [Citation(s) in RCA: 159] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2009] [Indexed: 12/17/2022]
Abstract
BACKGROUND Immunization is regarded as one of the most significant medical achievements of all time. Recently, increasing attention has been paid to the pain resulting from routine childhood immunizations. OBJECTIVE This narrative review summarizes existing knowledge about: (1) the epidemiology of childhood immunization pain; (2) the pain experience of children undergoing immunization; (3) current analgesic practices; (4) barriers to practicing pain management in children; and (5) recommendations for improvements in pain management during immunization. METHODS We conducted a search of MEDLINE, PsycINFO, EMBASE, CINAHL, and the Cochrane Central Register of Controlled Trials for primary research and review articles published from inception of the databases through October 2008. Key search terms included immunization, pain, child/infant, vaccine, and intervention. Additional studies were identified through searches of the reference lists in the retrieved articles. No language restrictions were imposed regarding the type of article (eg, full article, abstract) or language. RESULTS Vaccine injections are the most common iatrogenic procedure performed in childhood and a major source of distress for children (of all ages), their parents, and the participating health care professionals, as well as a direct cause of vaccine nonadherence. In addition, lack of adequate pain management during immunization exposes children to unnecessary suffering and the potential for long-term consequences, such as fear of needles. Numerous pain management strategies are available to reduce vaccine injection pain, including: (1) physical interventions and injection techniques; (2) psychological interventions; and (3) phar-macologic and combined interventions. However, adoption of pain-relieving techniques into clinical practice has been suboptimal. The underutilization of pain management strategies can be attributed to a lack of knowledge about pain and effective pain prevention strategies, and the persistence of attitudes about pain that interfere with optimal clinical practices. Current analgesic practices could be improved substantially if all stakeholders involved in immunization (eg, policy makers, practitioners, consumers) participate in efforts to reduce pain. Treating pain during childhood immunization has the potential to reduce distress during the procedure and greatly improve satisfaction with the immunization experience through more positive experiences for children and their families. Other potential benefits include improved adherence to immunization schedules and reduced sequelae of untreated pain. CONCLUSION Immunization is a global health priority. Medical care can be improved if pain management becomes a routine aspect of the delivery of vaccine injections.
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Affiliation(s)
- Anna Taddio
- Division of Pharmacy Practice, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada.
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Tetracaine (ametop) compared to placebo for reducing pain associated with intramuscular injection of palivizumab (synagis). J Pediatr Nurs 2009; 24:529-33. [PMID: 19931151 DOI: 10.1016/j.pedn.2009.05.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2009] [Revised: 05/08/2009] [Accepted: 05/18/2009] [Indexed: 11/23/2022]
Abstract
Infants receive many painful immunizations before they are 2 years old. The purpose of this study was to evaluate if topical tetracaine reduces the pain of intramuscular palivizumab compared to placebo. There were two study injections, one with tetracaine and one with placebo. Pain was scored by their parents and a pediatric nurse. Topical tetracaine was not associated with a significant reduction in pain score, although it did lead to faster recovery times. Additional pain-reduction strategies are required.
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Luthy KE, Beckstrand RL, Peterson NE. Parental hesitation as a factor in delayed childhood immunization. J Pediatr Health Care 2009; 23:388-93. [PMID: 19875026 DOI: 10.1016/j.pedhc.2008.09.006] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2008] [Revised: 08/16/2008] [Accepted: 09/22/2008] [Indexed: 11/17/2022]
Abstract
INTRODUCTION One reason for lower immunization rates is that some parents hesitate to have their children immunized. A hesitancy questionnaire was developed to identify reasons parents hesitate in having their children immunized. METHODS The hesitancy questionnaire was distributed from local pediatric and family practice offices and from the area's county health department. To be eligible, participants needed to be present in the clinic with a child needing a minimum of one immunization that was at least 6 months overdue. RESULTS When questioned why their child was overdue for immunizations, the most common response was that participants were confused about the immunization schedule and not sure when to return. Of the participants who reported having concerns regarding immunizations, the child's pain/crying/anxiety was the most commonly occurring answer. When asked where they receive the majority of childhood immunization information, participants frequently identified their health care provider as the main source of information. DISCUSSION Health care providers may be missing opportunities to educate hesitant parents about immunizations. Parents may not have ample opportunities to discuss their immunization concerns in detail with their health care provider during regularly scheduled clinic visits. It is important for health care providers to suggest ways parents can cope with their child's pain/crying/anxiety when receiving immunizations.
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Affiliation(s)
- Karlen E Luthy
- College of Nursing, Brigham Young University, Provo, UT 84602, USA.
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Plumridge E, Goodyear-Smith F, Ross J. Nurse and parent partnership during children's vaccinations: a conversation analysis. J Adv Nurs 2009; 65:1187-94. [PMID: 19432597 DOI: 10.1111/j.1365-2648.2009.04999.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
AIM This paper is a report of a study conducted to examine the elements of partnership and communication between nurses and parents during actual events of immunization. BACKGROUND Childhood immunizations require collaboration with parents, who may be anxious about immunization safety or subjecting their children to painful procedures. METHODS Ten interactions during immunization events from six purposively selected general practices were videoed in 2005, giving 168 minutes of talk. Conversation analysis was conducted on talk during the short phase of injection administration. FINDINGS During the immunization event nurse and mother talked to the baby/toddler rather than each other. Concurrent talk acted as a chorus, marked by sing-sing prosody, shared laughter and talk or reassuring noises. In coordinated talk nurse and parent took turns. Although overlap might occur, the actions accomplished by each speaker were different. Nurses most commonly cued bravery or stoicism to the child and stressed the progress made in administering the injections. In the less common pattern when pain was recognized as inevitable and there was no stress on stoicism and progress towards completion, the child displayed more distress and began crying before the injection. CONCLUSION Communication skills and rapport are core to nursing work. What happens at the micro-level of turn-taking, where prosody and the actions achieved in talk, is of key importance. Our study suggests 'small talk' is of major importance - a practical professional skill in which nurses not only align with parents but simultaneously cue both mother and child about how the immunization should be conducted.
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Berberich FR, Landman Z. Reducing immunization discomfort in 4- to 6-year-old children: a randomized clinical trial. Pediatrics 2009; 124:e203-9. [PMID: 19596729 DOI: 10.1542/peds.2007-3466] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The goal was to test a multifaceted distraction method designed to reduce injection-associated pain in school-aged children. METHODS A clinical trial evaluated 41 children, 4 to 6 years of age, who were given 3 standard prekindergarten immunizations; 21 were assigned randomly to an office routine control group, whereas 20 received a multifaceted, discomfort-reducing intervention. The intervention added verbal suggestions of diminished sensation and a visual focusing activity to the use of ethyl chloride, an established pain-reducing measure. The distraction materials used for the intervention consisted of topical ethyl chloride spray, an improvised, plastic, multipronged arm gripper, and a vibrating instrument descending on the contralateral arm, which provided the focusing task and visual distraction. RESULTS According to patient and parent Faces Pain Scale-Revised scores and nonblinded, video-taped observations scored according to the face-legs-activity-crying-consolability method, the intervention group showed highly significant reductions in pain and discomfort, compared with the control group (patient self-report, P < .0013; parent report, P < .0002; observation score, P < .0001). CONCLUSION This multifaceted distraction intervention reduced significantly the pain and discomfort of childhood immunizations in children 4 to 6 years of age.
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Abstract
AIM This article explores the role of breastfeeding in different aspects of vaccination in the first 6 months when infants are still developing: (1) pain management; (2) immunomodulation of infants' vaccine responses; (3) metabolism of thimerosal. METHODS Major databases were searched for studies that addressed outcomes of related issues. RESULTS Studies reveal that breastfeeding can: (1) help mothers and infants to cope with the stressful situations that accompany parenteral vaccines; (2) improve response to vaccines in the still maturing immunologic and enterohepatic systems of infants; (3) influence physiologic parameters that can change metabolism of ethylmercury derived from some vaccines. CONCLUSION Health promotion that supports vaccinations should also emphasize early initiation and maintenance of exclusive breastfeeding up until 6 months for maximum protection of the infants with a possible beneficial effect on the vaccine response. Paediatric professionals should inform mothers of the proven benefits of breastfeeding and its importance in complementing vaccination and lowering stress and the risk of untoward reactions on susceptible infants.
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Affiliation(s)
- Josè G Dòrea
- Department of Nutrition, Universidade de Brasília, 70919-970 Brasília, DF, Brazil.
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Drago LA, Singh SB, Douglass-Bright A, Yiadom MY, Baumann BM. Efficacy of ShotBlocker in reducing pediatric pain associated with intramuscular injections. Am J Emerg Med 2009; 27:536-43. [PMID: 19497458 DOI: 10.1016/j.ajem.2008.04.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2008] [Revised: 04/01/2008] [Accepted: 04/09/2008] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE The aim of the study was to determine the efficacy of ShotBlocker (Bionix, Toledo, Ohio) in reducing pediatric pain with intramuscular (IM) injections. METHODS A prospective randomized controlled trial was conducted in children aged 2 months to 17 years who required an IM injection. Children were randomized to the no-intervention group or the ShotBlocker group. Demographic data and the number of IM injections were recorded. Perceived pain scores were obtained from nurses and caregivers using a 6-point Likert-type scale. Baker Wong Faces scale was used in children 36 months or older. Difficulty using the device was also rated by nurses on a 6-point scale. RESULTS One hundred sixty-five children were enrolled with 80 in the no-intervention arm and 85 in the ShotBlocker arm. The mean age of children was 45 months and 56% were male. Perceived pain scores by nurses were higher for the no-intervention group (2.6 vs 1.8, P < .001) as well as by caregivers (2.6 vs 2.1, P = .04). Children aged 36 months and older (n = 64) did not report a difference in pain scores (1.5 vs 1.3, P = .6); however, in a subgroup of children 72 months or older, pain scores trended higher in the no-intervention group (1.3 vs 0.5, P = .051). Nurse-perceived difficulty of ShotBlocker use was low 1.39 (+/-1.1). CONCLUSIONS Nurses and caregivers noted lower pain scores in children assigned to the ShotBlocker group. These differences were not as evident when children rated their own pain.
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Affiliation(s)
- Lisa A Drago
- Department of Emergency Medicine, University of Medicine and Dentistry of New Jersey-Robert Wood Medical School at Camden, NJ 08103, USA.
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186
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Dórea JG. Re: "Determinants of the incidence of childhood asthma: a two-stage case-control study". Am J Epidemiol 2009; 169:1532-3; author reply 1533-4. [PMID: 19433616 DOI: 10.1093/aje/kwp110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
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Abstract
BACKGROUND Pain is largely accepted as being influenced by social context. Unlike most other developmental stages throughout the lifespan, infancy is marked by complete dependence on the caregiver. The present paper discusses the primary importance of understanding the caregiver context when assessing infant pain expression. OBJECTIVES Based on a review of research from both the infant pain and infant mental health fields, three lines of evidence are presented. First, pain assessment is as subjective as the pain experience itself. Second, assessors must be cognizant of the relationship between infant pain expression, and caregiver sensitivity and emotional displays. Finally, larger systemic factors of the infant (such as caregiver relationship styles, caregiver psychological distress or caregiver acculturative stress) directly impact on infant expression. CONCLUSIONS As a result of infants' inability to give a self-report of their pain experience, caregivers play a crucial role in assessing the pain and taking appropriate action to manage it. Caregiver behaviours and predispositions have been shown to have a significant impact on infant pain reactivity and, accordingly, should not be ignored when assessing the infant in pain.
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Dilli D, Küçük IG, Dallar Y. Interventions to reduce pain during vaccination in infancy. J Pediatr 2009; 154:385-90. [PMID: 18849052 DOI: 10.1016/j.jpeds.2008.08.037] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2008] [Revised: 07/03/2008] [Accepted: 08/18/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To investigate interventions that affect pain reduction during vaccination in infants and children attending a well-child unit. STUDY DESIGN A consecutive sample of 243 children between age 0 and 48 months receiving their routine vaccinations was randomly assigned to 1 of the study groups. A total of 158 infants under age 6 months were randomly assigned to breast-feeding or no breast-feeding during immunization, and 85 children age 6 to 48 months were randomly assigned to receive 12% sucrose solution, lidocaine-prilocaine cream, or no intervention. All children were evaluated for crying time and pain score by a pediatrician using the Neonatal Infant Pain Scale (NIPS) for those under age 12 months and the Children's Hospital of Eastern Ontario Pain Scale (CHEOPS) for those over age 12 months. RESULTS Breast-feeding in infants under age 6 months and use of sucrose or lidocaine-prilocaine in children age 6 to 48 months significantly reduced crying time and pain scores compared with controls. No difference in outcome was seen between the sucrose and lidocaine-prilocaine treatment groups. CONCLUSIONS Here we expand on previous findings by demonstrating that breast-feeding may have an analgesic effect up to age 6 months and that in older children, both sucrose and lidocaine-prilocaine reduce vaccination pain.
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Affiliation(s)
- Dilek Dilli
- Department of Paediatrics, Ministry of Health, Ankara Training and Research Hospital, Ankara, Turkey.
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189
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Nonpharmacological interventions for acute wound care distress in pediatric patients with burn injury: a systematic review. J Burn Care Res 2009; 29:730-41. [PMID: 18695617 DOI: 10.1097/bcr.0b013e318184812e] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Acute wound care distress among burn-injured pediatric patients is of major clinical concern. This systematic review evaluates the benefits of nonpharmacological interventions to reduce this distress. MEDLINE, EMBASE, CINAHL, PsycINFO, ERIC, and the Cochrane Library databases were searched using appropriate search terms for articles reporting overall psychological effects of pediatric burn injury. Key references were hand-searched. Searches yielded approximately 900 unique citations. Two authors reviewed each abstract, and 198 articles were retrieved, of which 34 were selected for full review. Of these 34 articles, 12 focused on acute wound care distress and nonpharmacological interventions. Critical appraisal of individual studies was conducted using the methods of the US Preventive Services Task Force, with a particular focus on assessing nonrandomized controlled trial designs. Twelve articles were reviewed and categorized according to intervention types child mediated (CM), parent mediated (PM), and health care provider mediated (HCPM). Using the US Preventive Services Task Force criteria, 7 of the 12 articles were rated "fair" or "good" and five were rated as having "poor" internal validity. The HCPM and CM intervention categories reported patient benefit. The two PM studies were both rated "poor." Studies of nonpharmacological interventions to reduce pediatric burn distress were few, with a significant proportion (5/12) having concerns about internal validity. Patient benefit was reported for HCPM and CM interventions. Research designs incorporating control groups in studies that are adequately powered are needed. Additional research is required in the area of PM interventions in particular.
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190
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Shah V, Taddio A, Rieder MJ. Effectiveness and tolerability of pharmacologic and combined interventions for reducing injection pain during routine childhood immunizations: Systematic review and meta-analyses. Clin Ther 2009; 31 Suppl 2:S104-51. [DOI: 10.1016/j.clinthera.2009.08.001] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2009] [Indexed: 11/16/2022]
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191
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Existe-t-il des différences d’immunogénicité et de tolérance des vaccins en fonction du mode d’injection ? Med Mal Infect 2008; 38:648-57. [DOI: 10.1016/j.medmal.2008.09.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2008] [Revised: 06/11/2008] [Accepted: 09/15/2008] [Indexed: 11/19/2022]
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192
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Winskill R, Andrews D. Minimizing the ‘ouch’—A strategy to minimize pain, fear and anxiety in children presenting to the emergency department. ACTA ACUST UNITED AC 2008. [DOI: 10.1016/j.aenj.2008.05.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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193
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Proczkowska-Björklund M, Runeson I, Gustafsson PA, Svedin CG. Communication and child behaviour associated with unwillingness to take premedication. Acta Paediatr 2008; 97:1238-42. [PMID: 18540904 DOI: 10.1111/j.1651-2227.2008.00896.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM To see how dominance in adult communication and child behaviour during premedication affects the child's unwillingness to take premedication. METHOD Ninety-five children scheduled for ENT surgery were video-filmed during premedication. All communication was translated verbatim and the communication was grouped according to; if the parent or nurse directed their communication towards the child or not, or; if they talked about nonprocedural matters or procedural matters. RESULTS Unwillingness to take premedication was associated with more parent communication and less anaesthetic nurse communication compared to willingness to take premedication. There was a heighten risk that the child took their premedication unwillingly if their parent talked more directly to the child (OR = 4.9, p < or = 0.01), the child gave hesitant eye contact with the anaesthetic nurse (OR = 4.5, p < or = 0.05), the child had experienced an earlier traumatic medical procedure (OR = 4.1. p < or = 0.001) or if the child placed her/himself nearby their parent (OR = 4.0, p < or = 0.001). CONCLUSION Together with behaviour that could be signs of shyness and earlier medical traumatic experience, parents that are actively communicating with their child before premedication may heighten the risk that the child will take the premedication unwillingly.
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Affiliation(s)
- Marie Proczkowska-Björklund
- Division of Child and Adolescent Psychiatry, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
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194
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Evans S, Tsao JC, Zeltzer LK. Paediatric Pain Management: Using Complementary and Alternative Medicine. Rev Pain 2008; 2:14-20. [PMID: 26525515 PMCID: PMC4589933 DOI: 10.1177/204946370800200104] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Children undergo acute painful procedures and many also experience chronic pain.Due to their developing systems, infants and children may be at greater risk than adults for protracted pain sensitivity.There is a need to manage acute and chronic paediatric pain to reduce children's suffering and to prevent future pain problems.Consistent with a biopsychosocial perspective, complementary and alternative medicine (CAM) should be considered in management of acute and chronic paediatric pain.Although research is limited for paediatric pain, CAM interventions receiving the most empirical attention include hypnotherapy, acupuncture and music therapy. Evidence also exists for the therapeutic benefits of yoga, massage, humor therapy and the use of certain biological based therapies.
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Affiliation(s)
- Subhadra Evans
- Paediatric Pain Program, Department of Paediatrics, David Geffen School of Medicine at UCLA
| | - Jennie C.I Tsao
- Paediatric Pain Program, Department of Paediatrics, David Geffen School of Medicine at UCLA
| | - Lonnie K. Zeltzer
- Paediatric Pain Program, Department of Paediatrics, David Geffen School of Medicine at UCLA
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Carbajal R, Biran V, Lenclen R, Epaud R, Cimerman P, Thibault P, Annequin D, Gold F, Fauroux B. EMLA cream and nitrous oxide to alleviate pain induced by palivizumab (Synagis) intramuscular injections in infants and young children. Pediatrics 2008; 121:e1591-8. [PMID: 18458035 DOI: 10.1542/peds.2007-3104] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE Palivizumab (Synagis [Abbot Laboratories, Kent, United Kingdom]) is recommended for the prevention of severe lower respiratory tract infections caused by respiratory syncytial virus in infants at high risk. These injections are very painful, and currently the use of analgesics is not systematic. The objective of this study was to compare the efficacy of EMLA with premixed 50% nitrous oxide/oxygen, used alone or combined with EMLA, for pain alleviation during palivizumab injections. METHODS This randomized, double-blind, multicenter study included children who were younger than 24 months. Each child randomly received during the first 3 monthly injections 3 different analgesic interventions: (1) EMLA: application of EMLA plus air inhalation; (2) nitrous oxide/oxygen: inhalation of 50/50 nitrous oxide/oxygen plus application of a placebo cream; and (3) nitrous oxide/oxygen plus EMLA: inhalation of 50/50 nitrous oxide/oxygen plus application of EMLA. Each child was his or her own control. Procedural pain was assessed through videotapes with the Modified Behavioral Pain Scale. The procedure itself was subdivided in 2 periods: (1) injection and (2) recovery (first 30 seconds after the removal of the needle). Modified Behavioral Pain Scale scores over time (injection and recovery periods) and among treatments were compared by repeated-measures analysis of variance. RESULTS Fifty-five children were included. Mean +/- SD Modified Behavioral Pain Scale pain scores for EMLA, nitrous oxide/oxygen, and nitrous oxide/oxygen plus EMLA were, respectively, 9.3 +/- 1.0, 8.8 +/- 1.2, and 8.2 +/- 1.8 during the injection and 7.8 +/- 1.7, 7.4 +/- 1.9, and 6.9 +/- 2.4 during the recovery period. A significant time and treatment effect in favor of the combined nitrous oxide/oxygen plus EMLA was observed. CONCLUSIONS The administration of 50/50 nitrous oxide/oxygen to infants and young children is effective in decreasing the pain associated with palivizumab intramuscular injections. The combined nitrous oxide/oxygen plus EMLA cream was more effective than either EMLA cream or nitrous oxide/oxygen alone.
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Affiliation(s)
- Ricardo Carbajal
- Centre National de Ressources de Lutte Contre la Douleur, Hôpital d'Enfants Armand Trousseau, 26, av du Dr Netter, 75012 Paris, France.
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Golianu B, Krane E, Seybold J, Almgren C, Anand KJS. Non-pharmacological techniques for pain management in neonates. Semin Perinatol 2007; 31:318-22. [PMID: 17905187 DOI: 10.1053/j.semperi.2007.07.007] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Significant progress in understanding the physiology, clinical correlates, and consequences of neonatal pain have resulted in greater attention to pain management during neonatal intensive care. A number of nonpharmacological therapies have been investigated, including nonnutritive sucking, with and without sucrose use, swaddling or facilitated tucking, kangaroo care, music therapy, and multi-sensorial stimulation. Although the efficacy of these approaches is clearly evident, they cannot provide analgesia for moderate or severe pain in the neonate. Further, some of these therapies cannot be effectively applied to all populations of critically ill neonates. Acupuncture, an ancient practice in Chinese medicine, has gained increasing popularity for symptom control among adults and older children. Acupuncture may provide an effective nonpharmacological approach for the treatment of pain in neonates, even moderate or severe pain, and should be considered for inclusion in a graduated multidisciplinary algorithm for neonatal pain management.
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Affiliation(s)
- Brenda Golianu
- Stanford University School of Medicine, Stanford, CA 94305, USA.
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198
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Sterling J. Recent Publications on Medications and Pharmacy. Hosp Pharm 2007. [DOI: 10.1310/hpj4207-657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Hospital Pharmacy presents this feature to keep pharmacists abreast of new publications in the medical/pharmacy literature. Articles of interest will be abstracted monthly regarding a broad scope of topics.
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