'I was just screeching!': comparing child and parent derived measures of distress

Systematic Review of Self-Report Measures of Pain Intensity in 3- and 4-Year-Old Children: Bridging a Period of Rapid Cognitive Development

Claims are made for the validity of some self-report pain scales for 3- and 4-year-old children, but little is known about their ability to use such tools. This systematic review identified self-report pain intensity measures used with 3- and/or 4- year-old participants (3-4yo) and considered their reliability and validity within this age span. The search protocol identified research articles that included 3-4yo, reported use of any pain scale, and included self-reported pain intensity ratings. A total of 1,590 articles were screened and 617 articles met inclusion criteria. Of the included studies, 98% aggregated self-report data for 3-4yo with data for older children, leading to overestimates of the reliability and validity of self-report in the younger age group. In the 14 studies that provided nonaggregated data for 3-4yo, there was no evidence for 3-year-old and weak evidence for 4-year-old children being able to use published self-report pain intensity tools in a valid or reliable way. Preschool-age children have been reported to do better with fewer than the 6 response options offered on published faces scales. Simplified tools are being developed for young children; however, more research is needed before these are adopted.

PERSPECTIVE

Some self-report pain scales have been promoted for use with 3- and 4-year-old children, but this is on the basis of studies that aggregated data for younger and older children, resulting in overestimates of reliability and validity for the preschool-age children. Scales with fewer response options show promise, at least for 4-year-old children.

Pediatric Immunization Distress: A Cluster Analyses of Children's, Parents', and Nurses' Behaviors During the Anticipatory Phase

OBJECTIVE

Using cluster analysis, we aimed to identify a typology of nurses', parents', and young children's behaviors during the anticipatory phase of pediatric immunizations to explore the associations between these different typologies and to determine whether these groups differed with respect to the child's procedural distress as rated by the child and the parents and with respect to the adults' self-rated distress.

MATERIALS AND METHODS

Immunizations given by 23 nurses to 220 children aged 3 years and 10 months to 7 years were recorded with behaviors being scored according to Child-Adult Medical Procedure Interaction Scale-Revised, to which 3 new codes were added, and rated with a 6-point Likert scale. Parents' and nurses' ratings of their own distress and of the child's distress, in addition to children's self-rating of distress were obtained. Nine adult and 12 child behavioral codes were submitted for cluster analysis.

RESULTS

A solution with 4 clusters for children, 5 clusters for parents, and 5 clusters for nurses was retained. Our results show high consistency between child and adult clusters. During the anticipatory phase, less distressed children, characterized by either low activity or high coping, interacted with adults who showed low activity or high coping support patterns. More distressed children, characterized by resistance and behavioral distress, interacted with adults who displayed either low activity or less efficient support behaviors, such as reassurance and criticism.

DISCUSSION

The results confirm previous dimensional studies and add relevant knowledge concerning typologies of participant behaviors that may be useful in understanding such behaviors and in helping providers in their management of child immunizations.