Factors Predicting Parent Anxiety Around Infant and Toddler Postoperative and Pain

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

PURPOSE

There 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.

DESIGN

A 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.

METHODS

Perioperative 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.

FINDINGS

No 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.

CONCLUSIONS

Short-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.

Development of a Japanese Version of the Parenting Sense of Competence Scale, and Examining the Structure of Japanese Mothers' Parenting Self-Efficacy

OBJECTIVE

Parenting self-efficacy (PSE) is an important factor in children's development. Mothers' PSE tends to be the lowest 1 month postpartum. A common measure of PSE is the Parenting Sense of Competence (PSOC) scale. However, no existing scale measures the PSE of Japanese mothers with newborns. Therefore, this study developed a Japanese version of the PSOC scale for mothers 1 month postpartum (Study 1) and investigated the structure of their PSE (Study 2).

METHODS

In Study 1, data were collected from mothers 1 month postpartum from April to October 2017, and an exploratory factor analysis was performed on their PSOC scores. In Study 2, data were collected from mothers 1 month postpartum from January to September 2022. A confirmatory factor analysis was conducted of the Japanese PSOC scale developed in Study 1 to investigate the structure of the participants' PSE 1 month postpartum.

RESULTS

In Study 1, a 2-factor (Efficacy and Satisfaction) 12-item Japanese PSOC scale was obtained after deleting four items because of low factor loadings. In Study 2, the model showed an acceptable fit. The Japanese PSOC (12 items) had a moderate positive correlation with Rosenberg's Self-Esteem Scale and the Maternal Attachment Inventory and a moderate negative correlation with the Edinburgh Postpartum Depression Scale. Furthermore, mothers whose children had siblings (versus no siblings) and mothers with three children (versus two children) had significantly higher PSOC scores.

CONCLUSIONS

We developed a reliable and valid Japanese version of the PSOC for mothers 1 month postpartum and revealed the structure of their PSE.

Assessment of anxiety in parents of children undergoing tonsillectomy under general anaesthesia: A cross-sectional study

Background and Aims

Surgery in the pediatric age group entails a significant amount of anxiety for parents. Due to anxiety, parents are unable to take care of their children, which could affect the child's well-being and contributes to poor outcomes. The primary objective of this study is to determine the frequency of preoperative anxiety in parents before the surgery of their children.

Methods

It is a cross-sectional descriptive study that included either parent of 147 children of American Society of Anaesthesiology (ASA) I & II, aged 1-12 years undergoing tonsillectomy over the period of 1 year. Each parent's demographic data were recorded and requested to answer a proforma containing the Amsterdam Preoperative Anxiety Information Scale (APAIS) for assessing anxiety on a 5-point Likert scale. Median interquartile range (IQR), and frequency (%) were used to report the normal, skewed, and categorical variables. APAIS anxiety and information scores were compared by using either the Mann-Whitney U-test or the Kruskal-Wallis test. Furthermore, anxiety scores were grouped (present/absent) with a cut-off score of 11 for the presence of anxiety, and multivariate logistic regression was performed to explore the relationship between potential risk factors and the parent's anxiety.

Results

Overall, anxiety was present in 59 (40.1%) respondents with 20 (33.9%) being fathers and 39 (66.1%) mothers. The median (IQR) for APAIS anxiety and information score were 9 ± 5 and 5 ± 2, respectively. Higher median anxiety scores were observed statistically significant in children under 5 years old, mother respondents, mothers aged 35 or younger, fathers under 40, and mothers with graduate or higher education (p < 0.05). Father respondents (AOR = 0.3, 95% CI = 0.1-0.8, p = 0.01), and mother's education less than graduation (AOR = 0.2, 95% CI = 0.1-0.6, p = 0.006) were also found to be statistically significant predictors.

Conclusion

There is a significant prevalence of anxiety in parents of children who underwent surgery under general anaesthesia, and mothers have showed significantly higher anxiety levels than fathers.

Risk of acute kidney injury after lower urinary tract reconstruction with early NSAID therapy: A propensity matched retrospective analysis

INTRODUCTION

The opioid epidemic response led to increased use of postoperative, non-opioid analgesia. Some pediatric urologists do not routinely use non-steroidal anti-inflammatory drugs (NSAIDs) for fear of causing acute kidney injury (AKI). While previous studies have demonstrated the safety and efficacy of NSAIDs in children, safety after lower urinary tract reconstruction has not been well characterized.

OBJECTIVE

ptUsing the Kidney Disease: Improving Global Outcomes (KDIGO) criteria for AKI (increase in creatinine ≥0.3 mg/dL or increase in creatinine ≥1.5x baseline or urine output <0.5 mL/kg/hr for 6 h), we hypothesized there would be a difference in the incidence of postoperative AKI between patients who did and did not receive NSAIDs following surgery.

STUDY DESIGN

Patients 2-18 years old who underwent lower urinary tract reconstruction (i.e., bladder augmentation and/or creation of a catheterizable channel) from 2009 to 2021 and had documented urine output were retrospectively reviewed. Chronic kidney disease (CKD) stage was calculated from creatinine and cystatin C within 6 months of surgery using the CKiD U25 equations. Patients who received NSAIDs were propensity matched on 11 characteristics with patients undergoing similar surgeries who did not receive NSAIDs. The primary outcome was incidence of AKI within 48 h of surgery.

RESULTS

The unmatched cohorts included 243 patients. Propensity matching identified 166 patients in the NSAID arm and 41 in the no NSAID arm. 26 patients with CKD stage 2-3 were included. There was no significant difference in the incidence of postoperative AKI based on any KDIGO criteria (17.1% no NSAID versus 16.3% NSAID, p = 0.87). Median postoperative opioids fell from 0.88 mg/kg in the no NSAID arm to 0.37 mg/kg morphine equivalents in the NSAID arm, although this was not statistically significant. Log-rank testing by Kaplan-Meier analysis demonstrated no difference in time to incidence of low urine output between the groups (p = 0.32). In the whole population not stratified by NSAID use, no differences were seen in AKI between those with and without CKD (16.7% with versus 17.9% without CKD).

DISCUSSION

There was no difference in the incidence of postoperative AKI among patients who did and did not receive NSAIDs after lower urinary tract reconstruction, excluding those with advanced CKD.

CONCLUSION

These results support that postoperative NSAIDs were an unlikely source of AKI. However, AKI remained a risk following these surgeries, regardless of NSAID use, likely owing to underlying disease, longer operations, and fluid shifts.

The Effect of Therapeutic Play on Children's Pain, Anxiety and Mothers' Anxiety during Pre- and Postcircumcision Period

PURPOSE

The study was conducted to determine the effect of the therapeutic play method implemented on the pre- and postcircumcision pain and anxiety levels of children and mothers' anxiety levels in the pediatric surgery clinic.

DESIGN

Prospective, randomized clinical trial.

METHODS

The study consisted of children between the ages of 3 to 6 admitted to the pediatric surgery clinic and their mothers (N = 120; Therapeutic playgroup = 60, Control group = 60). As a therapeutic play method the children and their mothers used play dough during the structured conversation for about 10 minutes before and after the operation. A questionnaire, the Face, Legs, Activity, Cry, Consolability (FLACC) pain scale, the Children's Emotional Manifestation Scale (CEMS) anxiety scale, and State-Trait Anxiety Inventory-S (STAI-S) anxiety scale for parents were used to collect data.

FINDINGS

In the pre- and postcircumcision period, the pain and anxiety levels of children and mothers' anxiety levels in the therapeutic playgroup were statistically lower compared to the control group (P < .05). In the postoperative period, a positive and significance correlation was found between anxiety levels of the mothers and pain and anxiety levels of children in the control group (P < .05).

CONCLUSIONS

The therapeutic play method was effective in reducing the pain and anxiety levels of children and mothers' anxiety in the pre- and postcircumcision period.

Keep Calm: Does parental preoperative anxiety affect post-tonsillectomy pain scores in children?

PURPOSE

To understand if high parental anxiety leads to increased post-tonsillectomy pain in children.

METHODS

Prospective study including parents of children aged 3-10 years old submitted to tonsillectomy with or without adenoidectomy. To evaluate anxiety, parents were asked to fill the State-Trait Anxiety Inventory form-Y, with postoperative pain being evaluated with the Wong-Baker FACES pain scale at postoperative days 1, 3 and 7. Parents were also asked to register the number of days during which children took analgesic and the number of analgesic intakes needed.

RESULTS

41 parents were enrolled, of which 95.1% (n = 39) were female with a mean age of 35.64 years (SD 5.751), with 41 children also being enrolled, of which 85.4% of children (n = 35) underwent tonsillectomy and adenoidectomy. 43.9% (n = 18) of parents presented State anxiety scores above the cut-off level and 53.7% (n = 22) above the Trait anxiety scores above the cut-off. Children of parents with high State anxiety presented statistically higher pain scores in both the third (p = 0.035) and the seventh postoperative days (p = 0.006), with significantly longer use of analgesic medication (p = 0.043) being found, as well as a statistically higher number of analgesic intakes (p = 0.045) (Table 4).

CONCLUSION

The present study establishes an association between preoperative parental anxiety, postoperative pain scores and the need for longer analgesic use in children undergoing tonsillectomy. This reinforces the importance of reducing parental anxiety and opens the door for further strategies to better post-tonsillectomy outcomes.

The impact of audiovisual information on parental anxiety levels prior to hypospadias surgery: A prospective single center cohort study

BACKGROUND

Most parents have anxiety before a pediatric surgical procedure. Parental anxiety may impair the parents' ability to cope with new or stressful situations while their children are undergoing surgery. By effectively improving the education of parents regarding the diagnosis, treatment, and potential complications of hypospadias and surgical repair, it might be feasible to reduce their anxiety during this process.

OBJECTIVE

To determine whether structured audiovisual information would reduce parents' anxiety levels compared to classic verbal information.

MATERIAL AND METHODS

The diagnosis was made and, treatment options were explained, and State-Trait Anxiety Inventory Form - State Anxiety (STAI-I) forms were filled out by parents at the first consultation. In the second consultation, parents were divided into structured audio-visual-information (Group-1) and classic verbal information (Group-2) groups. Following these consultations, all parents in both groups filled out STAI-I again. Parents filled out the forms for the last time on the postoperative-14th-day and the results were compared.

RESULTS

A total of 124 (51.2%) parents were informed with structured-audiovisual-informational material and 118 parents (48.8%) were informed with classic verbal information. First STAI-I scores were 57.65 ± 5.17 and 56.91 ± 5.28 for Group-1 and Group-2, respectively, and there was no difference between the groups (p = 0.709). The STAI-I scores after the second consultation were 44.82 ± 5.65 and 49.42 ± 2.81 for Group-1 and Group-2, respectively. Parental anxiety decreased in both groups following the second consultation. Notably, a statistically significant superiority was found between the groups in favor of Group-1 (p = 0.001).

DISCUSSION

Parents whose children will undergo hypospadias surgery experience significant anxiety. We observed that informing patients adequately and in appropriate language using a suitable method was associated with less anxiety. Preoperative parental anxiety is influenced by several variables, including parent age, parent gender, child age, lack of knowledge, and concerns over complications or pain. Although we are unable to alter the factors of child age and parent gender, we can impact parents' concerns regarding postoperative pain and anesthesia by enhancing their comprehension of the procedure via providing them of sufficient and accurate information.

CONCLUSION

Providing parents with structured audio-visual information about the preoperative and postoperative period before hypospadias surgery is associated with lower parental anxiety levels. Supplying structured audiovisual information regarding the preoperative and postoperative periods can help parents have an improved comprehension of the procedure and minimize their anxiety.

Severity and associated factors of postoperative pain in paediatric surgical patients aged 2 months-7 years at selected Addis Ababa Public Hospitals: a multicenter prospective longitudinal study

Background

Postoperative pain is a common and distressing consequence of surgery in children. It can lead to suffering, prolonged recovery, impaired physical functioning, and even chronic pain. Effective postoperative pain management is crucial for improving patient outcomes. However, several factors hinder the accurate assessment and management of pain in children, particularly in low-income countries. This study aims to evaluate the severity of postoperative pain in paediatric patients and identify its predictors.

Materials and methods

A longitudinal study was conducted on 235 paediatric surgical patients aged 2 months-7 years in Public Hospitals of Addis Ababa from January to April 2023. The primary outcome, pain severity, was assessed at three different times using a pain assessment tool. Cochran's q-test was used to compare postoperative pain incidences. The Generalized Estimating Equation was used to determine predictor variables' effects on pain severity over time. The study demonstrated the direction of association and significance using an AOR with a 95% CI at a P value of 0.05.

Result

The incidence of moderate to severe postoperative pain was 36.6% at 12 h, 20% at 24 h, and 10% at 36 h. Patients with preoperative pain and preoperative anxiety were more likely to experience moderate to severe postoperative pain [adjusted odds ratio (AOR)=3.41, CI=1.15, 10.00 and AOR=2.28, CI=1.219, 4.277, respectively). Intraoperative predictors of postoperative pain severity included longer duration of surgery (AOR=6.62, CI=1.90, 23.00) and major surgery (AOR=5.2, CI=2.11, 12.88). Postoperative pain severity was reduced in patients receiving multimodal analgesia (AOR=0.24; CI=0.091, 0.652) and in patients assessed frequently in the postoperative period (AOR=0.09; CI=0.022, 0.393).

Conclusion

A significant portion of paediatric surgical patients in this study experienced high levels of postoperative pain, particularly within the first 24 h. The most influential factors affecting pain severity were postoperative pain management strategies and assessment practices.

Caregiver Observations of Infant Well-Being Before and After Cleft Lip Surgery

OBJECTIVE

To evaluate the sensitivity to change of daily ratings of the comfort (COMF) and behavioral/emotional health (BEH) domains of the Infants with Clefts Observation Outcomes Instrument (iCOO) at 3 time points, and to assess the association of post-surgical interventions on iCOO ratings.

DESIGN

The COMF and BEH domains were completed by caregivers before (T0), immediately after (T1), and 2-months after (T2) cleft lip (CL) surgery. Analyses included descriptive statistics, correlations, t-tests, and generalized estimating equations.

PARTICIPANTS

Caregivers (N  =  140) of infants with CL with/without cleft palate.

MAIN OUTCOME MEASURES

The COMF and BEH domain scores of the iCOO: Scale (SCALE), a summary of observable signs; and Global Impression (IMPR), a single item measuring caregivers' overall impression.

RESULTS

Daily COMF and BEH SCALE and IMPR scores changed significantly during T1 (P's < 0.001) but not T0 or T2. Day 1 and 7 T0 scores were significantly higher than Day 1 and 7 T1 scores (P's <0.001 to <0.012) but similar at T2 (P's > 0.05). After CL surgery, the combined use of immobilizers and nasal stents and the use of multiple feeding methods with treatment for gastroesophageal reflux were associated with lower daily scores in COMF and BEH SCALE and IMPR (P's: 0.040 to <0.001).

CONCLUSIONS

COMF and BEH iCOO scores were sensitive to daily changes in infant well-being following CL surgery. Future studies should further investigate impact of post-surgical treatments on infant well-being.

Easing the Burden on Caregivers- Applications of Artificial Intelligence for Physicians and Caregivers of Children with Cleft Lip and Palate

OBJECTIVE

Many caregivers of children with cleft lip and palate experience a high level of anxiety throughout their child's medical and surgical care. We aim to evaluate artificial intelligence (AI) as a tool to mitigate these feelings and can aid clinicians in the development of robust pediatric educational materials for caregivers and families.

DESIGN

Thirteen of the most common postoperative questions following cleft lip and/or palate repair were developed by an expert panel of senior Pediatric Plastic Surgeons and were posed to ChatGPT. Professional answers from the expert panel were provided and compared to responses from ChatGPT. A literature review was also conducted to generate a new support model for caregivers with children undergoing a surgical procedure.

SETTING

Department of Pediatric Plastic Surgery at a metropolitan Children's Hospital.

PARTICIPANTS

Senior Pediatric Plastic Surgeons at a metropolitan Children's Hospital.

INTERVENTIONS

None.

MAIN OUTCOME MEASURE

The primary outcome was to determine the ability of ChatGPT to respond to common postoperative questions and to develop a model for AI assistance in family-centered perioperative care.

RESULTS

ChatGPT had a postoperative question response accuracy rate of 69% when compared with subject matter expert responses, with its greatest errors being information errors. An extensive literature search revealed that AI can assist in multiple traditional perioperative strategies to reduce caregivers and patient anxiety.

CONCLUSIONS

Artificial Intelligence can help to reduce the burden of generating patient education materials as well as support caregivers in multiple aspects and perioperative care.

I saw myself as an important piece of a jigsaw puzzle: Parents experiences of their child's anaesthesia induction

Anxiety in children, as well as their parents, is common in high-tech environments such as an operating room. This study aimed to describe parents' experiences of being present when their child is being anaesthetised. Twenty-four parents were interviewed and data were analysed using a descriptive phenomenological approach. Findings show that being present at a child's anaesthesia and surgery is a long, continuous process that begins at home. Parents struggle to face strong emotions in a special and frightening environment, focussing on their child's well-being while trying to remain control in this situation. Security and trust are vital, but it's challenging to relinquish control in an uncertain situation. Professional caregivers can promote trust and participation, but an awareness that something can go wrong affects parents on a deep level. In conclusion, parental presence at induction of anaesthesia is important but can be overwhelming and anxiety-inducing for some parents. Parents should be seen as a resource rather than a disturbance. Overall, the healthcare system should prioritise parents' involvement and seek to create an environment where they feel supported and included.

Cross-cultural adaptation and psychometric properties of Spanish Child Pain Anxiety Symptoms Scale

INTRODUCTION

Pain anxiety is a psychological component that can regulate and modulate the experience of pain in children and adolescents. It can also have an impact on the outcomes of surgical procedures, chronic pain management and psychological interventions. The aim of our study was to translate the Child Pain Anxiety Symptoms Scale (CPASS) into Spanish and assess the psychometric properties of the Spanish version.

PATIENTS AND METHODS

First, the CPASS was translated according to international guidelines. Secondly, to assess the psychometric properties of the translated version, we conducted an analysis in a paediatric sample. A total of 160 children, 49.37% female, with a mean age of 14.5 years (SD, 2.3; range, 8-18 years) completed pain catastrophising, health-related quality of life, pain interference and pain intensity scales. We assessed the following psychometric properties: construct validity (exploratory and confirmatory factor analysis), internal consistency, floor and ceiling effects and convergent validity (correlation of CPASS to the other completed questionnaires completed and with objective aspects of the health history).

RESULTS

In the exploratory factor analysis, the final 18-item version (having excluded items 18 and 19) of the CPASS was the best fit, with all items included in the hypothetical construct and exhibiting optimal factor loadings. The confirmatory factor analysis showed that the final 18-item, 4-factor model was adequate for the scale structure. We did not detect any floor or ceiling effects in the final version. Lastly, the results confirmed that the Spanish version has good internal consistency (Cronbach  α, 0.88) and an adequate convergent validity.

CONCLUSION

The Spanish CPASS exhibits good psychometric proprieties and it can be used to assess pain anxiety in the paediatric population.

Factors Related to Anxiety in Paediatric Patients and Their Parents before and after a Modified Ravitch Procedure-A Single-Centre Cohort Study

OBJECTIVE

To assess the factors related to perioperative state anxiety in paediatric patients and their parents.

METHODS

A cohort study was conducted on paediatric patients 9-17 years of age, who underwent the modified Ravitch procedure (n = 96), and their parents (n = 96). The level of anxiety was measured using the State-Trait Anxiety Inventory questionnaire. Multivariable linear regression models were calculated to find the relationships between the pre- and postoperative state anxiety of the patients/parents and the independent variables, both demographic (age, gender) and clinical (e.g., postoperative pain, trait anxiety).

RESULTS

Preoperative anxiety in the paediatric patients was positively correlated with their trait anxiety (β = 0.47; 95% CI: 0.29 to 0.64) and preoperative parental anxiety (β = 0.24; 95% CI: 0.07 to 0.42). The high level of preoperative anxiety (vs. low and moderate) (β = 0.40; 95% CI: 0.22 to 0.58), trait anxiety (β = 0.22; 95% CI: 0.04 to 0.40) and average postoperative pain at rest (β = 0.18; 95% CI: 0.01 to 0.34) had a positive impact on the postoperative anxiety in patients. However, the patients' age was negatively correlated with postoperative anxiety (β = -0.19; 95% CI: -0.35 to -0.02). Three variables were found to predict preoperative parental anxiety: their trait anxiety (β = 0.41; 95% CI: 0.23 to 0.59), female gender (β = 0.18; 95% CI: 0.002 to 0.36) and the intravenous route for the postoperative pain management in the patients (β = -0.18; 95% CI: -0.36 to -0.001). The parental postoperative anxiety was influenced by their trait anxiety (β = 0.24; 95% CI: 0.04 to 0.43), preoperative anxiety in patients (β = 0.21; 95% CI: 0.02 to 0.40) and female gender of children (β = 0.19; 95% CI: 0.001 to 0.39).

CONCLUSIONS

Trait anxiety was a strong factor positively affecting the perioperative state anxiety. In addition, paediatric patient anxiety before surgery was related to their parents' anxiety, and, after surgery, this was associated with high preoperative anxiety, pain and age. The parents' anxiety before surgery was influenced by gender and the type of postoperative analgesia in the patients, while, after surgery, this was influenced by the patients' preoperative anxiety/gender.

Nurse anesthetist attitudes towards parental presence during anesthesia induction- a nationwide survey

AIMS

To describe nurse anesthetists' attitudes towards the importance of parental presence during their child's anaesthesia induction and to explore associating factors.

DESIGN

A cross-sectional design.

METHODS

Nurse anesthetists from 55 Swedish hospitals were asked to participate (n = 1,285). A total of 809 completed the questionnaire, Families' Importance in Nursing Care-Nurses' Attitudes (FINC-NA) during 2018. Data were analysed by descriptive statistics and multiple linear regression analysis.

RESULTS

Nurse anesthetists generally had a positive attitude towards the importance of parental presence. They reported a more positive attitude in family as a resource in nursing care (median = 40) followed by family as a conversational partner (median = 25), family not as a burden (median = 17) and family as its own resource (median = 13). Multiple linear regression analyses showed that working in a district hospital, working only with children, having routines/memorandum about parental presence, being a woman, allowing both parents to be present in their child's anaesthesia and greater experience of children's anesthesia, were associated with a more positive attitude.

CONCLUSION

This nationwide survey contributes important knowledge for understanding nurse anesthetists' attitudes and the result shows that nurse anesthetists generally have a positive attitude towards the importance of parents. Areas of improvement were, however, identified; the nurses tend to not value family as its own resource and family as a conversational partner highly.

IMPACT

Nurse anesthetists have a crucial role in children's anesthesia care since the quality of parental presence experience depends on a positive attitude from the nurses. Parental involvement is important to establish a child-centered anaesthesia care, which should be highlighted in the education of nurse anesthetists. Parental involvement should also be addressed in healthcare policies and routines should be established.

The role of anxiety and related states in pediatric postsurgical pain

Background: Nearly 20% of children and adolescents have pain with disability 1 year after surgery, and they experience poor sleep, school absence, and decreased activities. Negative clinical, psychological, and developmental effects include greater pain medication use, longer recovery, and fear of future medical care. Research has found psychological and family influences (i.e., child and parental anxiety) on pediatric chronic postsurgical pain (CPSP), but a better understanding of the role of perioperative anxiety and its related states in predicting pediatric postsurgical pain is needed. The poor understanding of the causes of child CPSP can lead to misdiagnosis and inadequate treatment, with significant short- and long-term effects. Objectives: The aim of this review was to summarize the literature on children's perioperative anxiety and parental anxiety in relation to acute postsurgical pain, CPSP, and pain trajectories. We also examined other related psychological factors (i.e., anxiety sensitivity, catastrophizing, pain anxiety, and fear of pain) in relation to pediatric acute and chronic postsurgical pain. Lastly, we discuss the interventions that may be effective in reducing children's and parents' preoperative anxiety. Conclusions: Our findings may improve the understanding of the causes of CPSP and highlight the gaps in research and need for further study.

Magnitude and Factors Associated with Preoperative Anxiety Among Pediatric Patients: Cross-Sectional Study

Background

Anesthesia and surgery are common sources of anxiety and stressful experiences in children. This unpleasant sensation depends on several factors. This study aimed to determine the magnitude of preoperative anxiety and associated factors in pediatrics patients at the University of Gondar Comprehensive Specialized Hospital North West Ethiopia 2020.

Methods

An institutional-based cross-sectional observational study was conducted from March to September 2020 at the University of Gondar Comprehensive Specialized Hospital. After obtaining ethical approval from the institutional review board. All consecutive ASA physical status I & II boys and girls with the age of 2–12 years scheduled for a variety of elective (general, urologic, ENT, ophthalmic and other surgical) operations were included. The level of anxiety was measured using the Modified Yale Preoperative Anxiety Scale short form (m-YPAS-SF) observational tool. Parental anxiety was assessed using Spielberger’s short version of state-trait anxiety. Binary logistic regression analysis was performed to identify the association between preoperative children’s anxiety and independent variables. The strength of the association was present by adjusted odds ratios.

Results

The magnitude of preoperative anxiety in children in the operation room was 75.44% (95% confidence interval (CI): 68.36, 81.34). Age (AOR: 3.83; 95% CI: 1.58, 9.30), previous surgery and anesthesia (AOR: 6.73, 95% CI: 1.25, 36.19), outpatient surgery (AOR: 5.16, 95% CI: 1.32, 20.23) and parental anxiety (AOR: 3.26, 95% CI: 1.30, 20.23) were significantly associated with preoperative children anxiety.

Conclusion

The magnitude of preoperative anxiety in pediatric patients was considerably high in our setup. Younger age, previous surgery and anesthesia, outpatient surgical setting, and parental anxiety were the independent risk factors for preoperative anxiety. Therefore, the operating staff should assess the child’s anxiety and should consider appropriate anxiety reduction methods during the preoperative visit of pediatric patients and their families.

Experiences of Canadian Parents of Young Children With Cleft Lip and/or Palate

PURPOSE

Prior literature has described the perspectives of parents of young children with clip lip and/or palate; however, few studies have described parents' experiences within a Canadian health care system. This study aims to better understand the experiences of parents of young children with cleft lip and/or palate seen at a Canadian tertiary care center and identify their care needs.

DESIGN

In-depth semistructured interviews.

SETTING

Pediatric tertiary care center.

PARTICIPANTS

Parents of children younger than 7 years of age with cleft lip and/or palate.

RESULTS

From 14 interviews, 4 themes were identified. The diagnosis theme was associated with reactions, timing, and search for information. Key concerns within the theme of physiology and function were around feeding and speech. The health care experience theme included burden of care, peripheral hospitals and services, the cleft lip and palate clinic, and clinicians. The psychosocial theme included parents' reactions to their child's pain, coping strategies, family interactions, and school/day care experiences. Parents felt care could be improved by having: access to good information and community speech therapists, shorter appointment wait times, a peer support network, and increased cleft knowledge within their child's school and peer groups.

CONCLUSIONS

The experience of parents of children with cleft lip and/or palate is complex but can be organized into 4 themes. Clinics may consider suggestions offered by parents to improve care. Future work should address parents' needs and aim to create a parent-reported quality-of-life measure specific to parents of young children with cleft lip and/or palate.

The Predictors of Postoperative Pain Among Children Based on the Theory of Unpleasant Symptoms: A Descriptive-Correlational Study

PURPOSE

Postoperative pain (POP) is a common outcome of surgical interventions among children. Identifying POP contributing factors can help identify children who are at risk for POP and facilitate POP management. The aim of the study was to determine the predictors of POP based on the Theory of Unpleasant Symptoms.

DESIGN AND METHODS

This descriptive-correlational study was conducted in 2018-2019 on 153 children purposively recruited. Data were collected using a personal characteristics questionnaire, the Coping Strategies Questionnaire, the Child Pain Anxiety Symptoms Scale, and a Visual Analogue Scale for Pain. The SPSS software (v. 21.0) was used for data analysis.

RESULTS

Twelve participants were excluded and final data analysis was done on the data obtained from 141 participants. Most of participants were male (65.2%), underwent abdominal surgery (53.2%), and experienced POP (86.5%). Their age mean was 8.58±2.23. Linear regression analysis revealed that the physiological factors of heart rate, preoperative pain, and surgery duration as well as the psychological factors of anxiety and coping strategies were significant predictors of POP among children. All these factors collectively explained 34% of the total variance of POP. Situational factors (such as age, gender, and ethnicity) had no significant effects on POP.

CONCLUSIONS

Heart rate, preoperative pain, surgery duration, anxiety and coping as predictive factors of POP can be considered when designing effective POP management strategies.

PRACTICE IMPLICATIONS

The findings provide a better understanding about the predictors of POP and can be used to develop pain management among children.

Association Between Race and Ethnicity with Intraoperative Analgesic Administration and Initial Recovery Room Pain Scores in Pediatric Patients: a Single-Center Study of 21,229 Surgeries

INTRODUCTION

Perioperative pain may have deleterious effects for all patients. We aim to examine disparities in pain management for children in the perioperative period to understand whether any racial and ethnic groups are at increased risk of poor pain control.

METHODS

Medical records from children ≤ 18 years of age who underwent surgery from May 2014 to May 2018 were reviewed. The primary outcome was total intraoperative morphine equivalents. The secondary outcomes were intraoperative non-opioid analgesic administration and first conscious pain score. The exposure was race and ethnicity. The associations of race and ethnicity with outcomes of interest were modeled using linear or logistic regression, adjusted for preselected confounders and covariates. Bonferroni corrections were made for multiple comparisons.

RESULTS

A total of 21,229 anesthetics were included in analyses. In the adjusted analysis, no racial and ethnic group received significantly more or less opioids intraoperatively than non-Hispanic (NH) whites. Asians, Hispanics, and Pacific Islanders were estimated to have significantly lower odds of receiving non-opioid analgesics than NH whites: odds ratio (OR) = 0.83 (95% confidence interval (CI): 0.70, 0.97); OR = 0.84 (95% CI: 0.74, 0.97), and OR = 0.53 (95% CI: 0.33, 0.84) respectively. Asians were estimated to have significantly lower odds of reporting moderate-to-severe pain on awakening than NH whites: OR = 0.80 (95% CI: 0.66, 0.99).

CONCLUSIONS

Although children of all races and ethnicities investigated received similar total intraoperative opioid doses, some were less likely to receive non-opioid analgesics intraoperatively. Asians were less likely to report moderate-severe pain upon awakening. Further investigation may delineate how these differences lead to disparate patient outcomes and are influenced by patient, provider, and system factors.

The Effect of Nursing Care Provided to Turkish Mothers of Infants Born With Cleft Lip and Palate on Maternal Attachment and Self-efficacy: A Quasi-Experimental Study

PURPOSE

The present study evaluated the effect of the nursing care provided to the mothers of the infants born with a cleft lip and palate (CLP) until the time of cleft palate (CP) repair surgery, on maternal attachment and self-efficacy.

DESIGN AND METHODS

The present study was designed as a quasi-experimental study with a pre-test and post-test control group design. The study included 32 mothers whose infants were born with CLP and had undergone CL repair surgery. Nursing care was provided to the mothers and the infants included in the study group through a total of seven home visits over a period of nine weeks. The data for the study were collected using a socio-demographic form, a home-care needs evaluation form, the Maternal Attachment Inventory (MAI), and the Parental Self-Efficacy Scale (PSE).

RESULTS

The scores for the mothers in the intervention group increased as the visits progressed, and it was observed that by the end of the ninth week, the difference between the mothers in the intervention group and those in the control group in terms of post-test MAI and PSE had become statistically significant.

CONCLUSIONS

Providing nine weeks of home-based nursing care to the mothers and the infants has the potential of reducing the problems experienced by the mothers of infants born with CLP.

PRACTICE IMPLICATIONS

Obtaining a better understanding of the barriers to the nursing care provided to the mothers of the infants born with CLP in-home setting would contribute immensely to the development of appropriate nursing-care practices.

Does parental anxiety affect children's perception of pain during intravenous cannulation?

BACKGROUND

Pain associated with invasive medical procedures is a significant cause of anxiety for parents. This may increase children's anxiety, pain and fear.

AIM

To determine the anxiety perceived by parents of children undergoing intravenous cannulation and the influence of parental anxiety on the intensity of pain experienced, and to explore the association between selected variables and anxiety perceived by parents.

METHOD

A descriptive correlational approach was adopted and a purposive sample of 48 children and their parents was selected. The pilot study was conducted in the children's wards of a selected hospital in Mumbai, India, between August 2017 and January 2018. Parental anxiety was assessed using the short version of the Depression and Anxiety Stress Scales. Pain experienced by children was assessed using the Faces Pain Scale-Revised.

RESULTS

Mild anxiety was experienced by 6% ( n =6) of parents, while 52% ( n =25) had moderate to extreme anxiety. More than one third of the children (35%, n =17) reported moderate pain and 31% ( n =15) reported severe pain. A positive correlation was found between pain and parental anxiety and between parental anxiety and age and birth order.

CONCLUSION

Parental anxiety influences the perception of pain in children. Parents should be made aware of how their anxiety can affect children's pain experiences during medical procedures and take measures to reduce anxiety, such as relaxation, distraction and deep breathing. Children's nurses can help parents manage preprocedural anxiety to reduce the traumatic effect on children.

Reducing Children's Pain and Parents' Anxiety in the Postoperative Period: A Therapeutic Model in Turkish Sample

PURPOSE

This study was conducted to determine the effect of a new therapeutic model (a therapeutic play/play therapy (TP/PT) program) on alleviating pain in children receiving inpatient treatment in paediatric surgery units and parents' anxiety levels in the post-operative period.

DESIGN AND METHODS

The study was designed as a semi-experimental model using the TP/PT program. Four measurements (pre-test, two interim tests and post-test) for children and two measurements (pre-test and post-test) for parents were performed. The data were collected using the Child and Parent Information Form, the Wong-Baker Faces Pain (WBFP) Rating Scale and the State-Trait Anxiety Inventory (STAI).

RESULTS

The mean pain score for children after TP/PT decreased in each measurement, and a significant difference was found between these measurements. The mean state anxiety score for parents significantly decreased after the TP/PT program, and a statistically significant difference was found between these measurements (p = 0.000).

CONCLUSIONS

This study determined that the post-operative TP/PT program was an effective method to reduce acute post-operative pain in children. Parental anxiety levels were found to correlate with levels of pre- and post-operative pain in children.

PRACTICE IMPLICATIONS

The findings of this study provide a basis for using a new therapeutic model that is easy to apply and effective for reducing children's pain and parents' anxiety.

Exploring Non-Pharmacological Management among Anesthesia Providers to Reduce Preoperative Distress in Children

Preparation for surgery with the induction of general anesthesia is one of the most stressful events that a child can experience. It produces several threats to the child, including physical harm, parent separation, and fear of the unknown. Anesthesia providers utilize non-pharmacological and pharmacological interventions to decrease this preoperatively. However, little is known about the non-pharmacological interventions utilized by anesthesia providers in practice. The purpose of this study was to explore non-pharmacological interventions utilized by anesthesia providers before and during the induction of general anesthesia to reduce preoperative distress in children ages one to six years old. A qualitative descriptive approach was used in this study. Twenty anesthesia providers, fourteen registered nurse anesthetists and six anesthesiologists, participated in face to face, in-depth interviews in South Florida. Content analysis was used to identify and define the major themes that emerged from the interviews. A total of seven main themes were identified. Only the three themes directly related to parent-provider-child relationship are discussed in this paper: (I) Communication, (II) Observational Skills, and (III) Parental Presence. The anesthesia providers who participated in this study offered an opportunity to better understand the non-pharmacological interventions used to impact the management of preoperative distress among children. Study findings provide evidence about non-pharmacological anesthesia providers' clinical work not found elsewhere in the literature. Non-pharmacological interventions are effective in reducing preoperative distress in children.

Effects of a posttonsillectomy management program using a mobile instant messenger on parents' knowledge and anxiety, and their children's compliance, bleeding, and pain

PURPOSE

Pediatric tonsillectomy is a highly common surgery for children. The inclusion of tonsillectomy in the diagnosis-related group payment system in Korea has resulted in a shorter hospital stay for patients who undergo tonsillectomy. This, in turn, provides parents with additional caregiver roles in the home.

OBJECTIVES

This study aimed to investigate the effects of a postdischarge management program (PDMP) using Mobile Instant Messenger (MIM) on parents' knowledge and state anxiety about postoperative care, and their children's compliance with care instructions at home, frequency of bleeding, and pain intensity after tonsillectomy.

DESIGN AND METHODS

A nonequivalent control group nonsynchronized design.

SETTINGS AND PARTICIPANTS

Participants were 52 tonsillectomy children aged 3-7 years and their 52 parents (27 for the experimental group and 25 for the control group) from a hospital, in Korea. The control group received a routine written and oral predischarge education, while the experimental group received a predischarge education and a daily MIM for 7 days. For the experimental group, bidirectional communication between the nurse and parent when necessary using MIM are available during the intervention period.

RESULTS

Parents in the experimental group reported a significantly higher knowledge about postdischarge management and lower state anxiety than the control group. Children in the experimental group showed a significantly greater improvement in compliance with the care instructions at home than the control group. However, bleeding frequency and pain intensity were not significantly lower in the experimental group than that in the control group.

PRACTICAL IMPLICATIONS

Nurses play a critical role in preventing and managing the complications of tonsillectomy. Providing proper parental education about pediatric posttonsillectomy care at home is critical for a successful recovery. With the explosion of smartphone technology, the MIM-based PDMP is a useful and effective strategy in helping parents and children in posttonsillectomy care at home.

'Total Pain' in Children with Severe Neurological Impairment

Many children with palliative care needs experience difficulty in managing pain. Perhaps none more so than those with severe neurological impairment. For many years; behaviours in these children were misunderstood. As a result; pain was poorly recognised and inadequately managed. Significant advances have been made in the assessment and management of pain in this challenging group of patients. We summarise these advances; drawing on our own experience working with infants; children and young adults with palliative care needs within a UK tertiary paediatric palliative care service. We expand on the recent understanding of 'Total Pain'; applying a holistic approach to pain assessment and management in children with severe neurological impairment.

Safety of Patient-Controlled Analgesia After Surgery in Children And Adolescents: Concerns And Potential Solutions

Patient-controlled analgesia (PCA) is common practice for acute postoperative pain management. Postoperative PCA use decreases pain intensity and improves patient satisfaction when compared to non-PCA routes of medication administration. Although PCA has several advantages regarding efficacy and safety, adverse events remain a concern. Programming errors and protocols, patient monitoring, and PCA by proxy or with continuous infusion are recurring silent dangers of PCA use in children and adolescents. Innovative considerations need to be emphasized for future improvement of PCA devices for elective surgical patients. With technology within the healthcare setting advancing at a fast pace, smart pump technology is something to look forward to.