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Pain in children: psychosocial
102 (974) Verbal pain communication among children with Down Syndrome E. Job, C. Chambers, K. Craig, T. Oberlander; University of British Columbia, Vancouver, BC Language is an integral part of pediatric pain assessment. Recent research has found that young children tend to use a variety of words for pain, and that the most frequently used words (i.e., ‘hurt’, ‘ouch’, ‘ow’) appear in children‘s vocabularies as early as 17 months of age. No research has examined how children with developmental disabilities communicate pain in words. The purpose of this study was to describe the frequency and age of emergence of seven primary English pain wordstems in children with Down Syndrome. Data from three studies included in the CHILDES database, a large transcript database of child speech, were examined. Participants were 57 children with Down Syndrome (30 male, 27 female) between the ages 36 and 146 months (M ⫽ 72.82, SD ⫽ 31.74). Transcripts were searched for the presence of seven word-stems: ‘ache,’ ‘boo-boo,’ ‘hurt,’ ‘ouch,’ ‘ow,’ ‘pain,’ and ‘sore’. ‘Ow’ and ‘hurt’ were the most frequently used words for pain. The pain word-stems ‘ache,’ ‘boo-boo’ and ‘ouch’ were used infrequently, while ‘sore’ and ‘pain’ did not appear. The earliest word-stem to emerge was ‘ow’ (36 months). The word-stem latest to emerge was ‘ache’ (84 months). Generally, the most frequently used-word stems were earliest to appear. The results of this study indicate that children with Down Syndrome have a small and specific vocabulary of pain-related words. In contrast to previous research using this database, children with Down Syndrome appear to have smaller pain-related vocabularies and begin using pain word-stems later in childhood than children without Down Syndrome. Information about the words that children with Down Syndrome use to describe pain is important to consider when assessing pain in these children. Tailoring pain assessment techniques to the developmental level of individual children will likely lead to improved pain management.
(975) Maternal influences on adolescents’ pain management J. Hatchette, P. McGrath, M. Murray, G. Finley; Dalhousie University, Halifax, NS Adolescents independently medicate for various recurrent pain types (e.g. muscle pain, headache, back pain and menstrual pain). Among this age group over-the-counter analgesic use is high, sometimes inappropriate and knowledge is poor. To date, no known research has addressed how adolescents acquire attitudes about pain and pain management and how attitudes effect pain management practices. A qualitative study was designed to assess maternal influences on adolescents’ independent pain management. 20 parent-adolescents dyads, from St. John‘s Newfoundland, composed of 20 mothers (mean age⫽42.72 years; SD⫽5.42), 10 male adolescents (mean age⫽ 13.6 years; SD⫽1.43) and 10 female adolescents (mean age⫽13.4 years; SD⫽1.07). Semi-structured interviews. Demographic data were collected using the Pain Assessment Questionnaire. Semi-structured interviews conducted with parents and adolescents yielded rich textual data, reduced to central themes using qualitative content analysis. Results: Pain complaints reported by adolescents were consistent with the pain literature. Attitudes toward OTC analgesics were negative; adolescents and mothers reported using OTCs for pain relief, but typically as a last resort. Although adolescents reported self-medicating for pain, OTC analgesic use was largely mother-assisted. The intergenerational transmission of information about pain and pain management was apparent in dyadic statements. Mothers transmitted information to adolescents’ through their (1) attitudes toward pain, (2) pain management practices and (3) knowledge of OTCs. Shared attitudes and pain management strategies underscored the important role of mothers as models for their adolescents’ transition toward autonomy in pain management. Mothers emerged as essential facilitators of their children‘s independent pain management. The mechanisms by which mothers transmitted information to adolescents about pain and pain management were primarily verbal communications and modeling. These findings provide further support for the importance of maternal influences on children‘s pain expression, as well as the importance of maternal influences on adolescent pain management choices.
Abstracts (976) Implementing a parent-directed cognitive-behavioral pain management intervention for patients seen in the pediatric emergency department J. Hardial, C. Chambers, M. Pusic, S. MacRae; University of British Columbia, Vancouver, BC Pain is a common experience for patients seen in the pediatric emergency department (ED). The purpose of the current study was to develop and test the effectiveness of a parent-directed cognitive-behavioral intervention for pain in patients seen in the pediatric ED. Participants were 107 children (65 male, 42 female) between the ages of 0 and 16 years (Median ⫽ 4 years) and one of their caregivers (77 mothers, 27 fathers, 3 other) evaluated during a 72-hour period in a pediatric ED. The intervention consisted of the provision of a kit with a brochure for parents on pain and various tools to assist parents with pain assessment and management (e.g., bubbles, stress ball). Using a return to baseline design, 79 parents received the kit and 28 did not. At discharge from the ED, parents and children (aged 7 years and over) rated current, worst, and average pain levels and average anxiety while in the ED. Results indicated that parents who received the kit reported significantly lower levels of anxiety in their children while in the ED; there were no significant differences in parent reports of pain as a function of whether they received the kit or not. However, children whose parents received the kit tended to report lower levels of current and worst pain. The majority of parents who received the kit reported that they had read the materials (83.3%) and that they had used the strategies with their children (61%). The parents who used the kit reported that it was “somewhat” (22%) to “very” (59%) helpful in assisting them with their child‘s pain management. The results of the current study indicate that a simple parentdirected cognitive-behavioral intervention may be helpful in reducing pain and anxiety among patients seen in the pediatric emergency department.
(977) Maternal “Babytalk” for management of procedural pain in preterm neonates C. Johnston, F. Filion, C. Walker, J. Emed, M. Aita, L. Duhn; McGill University, Montreal, QC The aim was to determine if a recording of a mother‘s voice talking soothingly to her baby (referred to as Babytalk/Nursery Rhyme) is useful in controlling pain in newborns born between 32 to 36 PMA (post menstrual age) during routine painful procedures. Preterm infants between 32 to 36 PMA (n⫽40) are recruited from two level III NICU‘s within their first week of life. Mothers are approached to give informed consent after permission to do so obtain by hospital staff. The mother is recorded talking soothingly to her baby (babytalk), this recording is filtered to simulate the mother‘s voice traveling through amniotic fluid. The recording of the mother‘s voice is repeated up to 10 minutes duration. It is calibrated to a sound level of 70 dB maximum. The recording is played by a portable cassette tape player to the infants 3 times daily following feedings (gavage, bottle or breast) during quiet sleep state for 48 hours. At the end of 48 hours when bloodwork is needed for clinical purposes, the intervention is tested in cross-over design with alternating conditions. The Premature Infant Pain Profile (PIPP) is used. This is a composite measure using heart rate, oxygen saturation, three facial actions, behavioural state and post-conceptual age. This measure has demonstrated very good reliability and validity indexes. The collection of data is underway. The end of the study is scheduled for the end of March 2004. Preliminary analysis on the facial actions of the data show a trend (p⫽.18) suggesting the baby might be soothed with his/her mother‘s voice during a routine heelstick procedure. Mothers may be able to provide comfort to preterm neonates during painful procedures even if they cannot be physically present.
(975) Maternal influences on adolescents’ pain management J. Hatchette, P. McGrath, M. Murray, G. Finley; Dalhousie University, Halifax, NS Adolescents independently medicate for various recurrent pain types (e.g. muscle pain, headache, back pain and menstrual pain). Among this age group over-the-counter analgesic use is high, sometimes inappropriate and knowledge is poor. To date, no known research has addressed how adolescents acquire attitudes about pain and pain management and how attitudes effect pain management practices. A qualitative study was designed to assess maternal influences on adolescents’ independent pain management. 20 parent-adolescents dyads, from St. John‘s Newfoundland, composed of 20 mothers (mean age⫽42.72 years; SD⫽5.42), 10 male adolescents (mean age⫽ 13.6 years; SD⫽1.43) and 10 female adolescents (mean age⫽13.4 years; SD⫽1.07). Semi-structured interviews. Demographic data were collected using the Pain Assessment Questionnaire. Semi-structured interviews conducted with parents and adolescents yielded rich textual data, reduced to central themes using qualitative content analysis. Results: Pain complaints reported by adolescents were consistent with the pain literature. Attitudes toward OTC analgesics were negative; adolescents and mothers reported using OTCs for pain relief, but typically as a last resort. Although adolescents reported self-medicating for pain, OTC analgesic use was largely mother-assisted. The intergenerational transmission of information about pain and pain management was apparent in dyadic statements. Mothers transmitted information to adolescents’ through their (1) attitudes toward pain, (2) pain management practices and (3) knowledge of OTCs. Shared attitudes and pain management strategies underscored the important role of mothers as models for their adolescents’ transition toward autonomy in pain management. Mothers emerged as essential facilitators of their children‘s independent pain management. The mechanisms by which mothers transmitted information to adolescents about pain and pain management were primarily verbal communications and modeling. These findings provide further support for the importance of maternal influences on children‘s pain expression, as well as the importance of maternal influences on adolescent pain management choices.
Abstracts (976) Implementing a parent-directed cognitive-behavioral pain management intervention for patients seen in the pediatric emergency department J. Hardial, C. Chambers, M. Pusic, S. MacRae; University of British Columbia, Vancouver, BC Pain is a common experience for patients seen in the pediatric emergency department (ED). The purpose of the current study was to develop and test the effectiveness of a parent-directed cognitive-behavioral intervention for pain in patients seen in the pediatric ED. Participants were 107 children (65 male, 42 female) between the ages of 0 and 16 years (Median ⫽ 4 years) and one of their caregivers (77 mothers, 27 fathers, 3 other) evaluated during a 72-hour period in a pediatric ED. The intervention consisted of the provision of a kit with a brochure for parents on pain and various tools to assist parents with pain assessment and management (e.g., bubbles, stress ball). Using a return to baseline design, 79 parents received the kit and 28 did not. At discharge from the ED, parents and children (aged 7 years and over) rated current, worst, and average pain levels and average anxiety while in the ED. Results indicated that parents who received the kit reported significantly lower levels of anxiety in their children while in the ED; there were no significant differences in parent reports of pain as a function of whether they received the kit or not. However, children whose parents received the kit tended to report lower levels of current and worst pain. The majority of parents who received the kit reported that they had read the materials (83.3%) and that they had used the strategies with their children (61%). The parents who used the kit reported that it was “somewhat” (22%) to “very” (59%) helpful in assisting them with their child‘s pain management. The results of the current study indicate that a simple parentdirected cognitive-behavioral intervention may be helpful in reducing pain and anxiety among patients seen in the pediatric emergency department.
(977) Maternal “Babytalk” for management of procedural pain in preterm neonates C. Johnston, F. Filion, C. Walker, J. Emed, M. Aita, L. Duhn; McGill University, Montreal, QC The aim was to determine if a recording of a mother‘s voice talking soothingly to her baby (referred to as Babytalk/Nursery Rhyme) is useful in controlling pain in newborns born between 32 to 36 PMA (post menstrual age) during routine painful procedures. Preterm infants between 32 to 36 PMA (n⫽40) are recruited from two level III NICU‘s within their first week of life. Mothers are approached to give informed consent after permission to do so obtain by hospital staff. The mother is recorded talking soothingly to her baby (babytalk), this recording is filtered to simulate the mother‘s voice traveling through amniotic fluid. The recording of the mother‘s voice is repeated up to 10 minutes duration. It is calibrated to a sound level of 70 dB maximum. The recording is played by a portable cassette tape player to the infants 3 times daily following feedings (gavage, bottle or breast) during quiet sleep state for 48 hours. At the end of 48 hours when bloodwork is needed for clinical purposes, the intervention is tested in cross-over design with alternating conditions. The Premature Infant Pain Profile (PIPP) is used. This is a composite measure using heart rate, oxygen saturation, three facial actions, behavioural state and post-conceptual age. This measure has demonstrated very good reliability and validity indexes. The collection of data is underway. The end of the study is scheduled for the end of March 2004. Preliminary analysis on the facial actions of the data show a trend (p⫽.18) suggesting the baby might be soothed with his/her mother‘s voice during a routine heelstick procedure. Mothers may be able to provide comfort to preterm neonates during painful procedures even if they cannot be physically present.