Background & Aims

A visit to the pediatric emergency department (PED) can be highly stressful for young children. The behaviors of caregivers and health personnel are a key factor in children’s coping behaviors during a visit to the pediatric emergency department. A commonly used observational measure analyzing adult and child behavior during medical procedures is the Child–Adult Medical Procedure Interaction Scale-Revised (CAMPIS-R). While the CAMPIS-R has been employed as a measure across different interventions within the emergency department, the scale has never been adapted to accommodate the conditions of a PED. This investigation aimed to perform a cultural adaptation of the Child-Adult Medical Procedure Interaction Scale-Revised (ED-CAMPIS-R) for pediatric emergency departments, considering a triadic interaction between caregiver, preschool child, and healthcare personnel during an emergency department visit.

Methods

100 preschool children (4 to 5 years old), who attended a PED with one of their parents (of which 20% required an invasive medical procedure) participated in a multicenter pilot study in 4 Chilean PED. The emergency pediatric doctor visits were video-recorded (with facial blurring). During the visit, children completed self-report scales of pain and fear, and both caregivers and health personnel used a visual numerical scale to rate the child’s pain and fear during the visit. Verbal and non-verbal behaviors of the child, caregiver and health personnel were identified by coding the video recordings using an adjusted version of the CAMPIS-R. Specifically, verbal and nonverbal behaviors specific to emergency medical care were added through an integration of literature review, consultations with emergency care professionals, and observation of the researchers. One coder coded all the videos, with a second coder coding 20% of the videos. Intercoder reliability analyses was carried out.

Results

The sample had 51% girls. 90% of caregivers were women and had secondary (55%), technical (20%), or university (24%) education. Of the participating families, 45% belonged to a vulnerable socioeconomic level, and 34% were from lower middle class and upper middle class. No upper strata in the sample. Intercoder reliability analyses showed good to excellent agreement for healthcare staff behaviors (0.72 to 0.98), very good for caregiver behaviors (0.82 to 0.85), and for the behaviors of preschool children (0.87 to 0.89). The ED-CAMPIS-R includes 9 child codes that were not previously included in the CAMPIS-R, 4 of which can be both verbal and non-verbal, and 5 exclusively non-verbal (i.e., physical resistance, laughter, exploration of medical objects, etc). Regarding adult codes, 11 new ones were identified, 6 which could be both verbal and non-verbal and 5 exclusively verbal (i.e. Use of physical restraint, contact to reassure, play with the child, etc).

Conclusions

The pilot adaptation of ED-CAMPIS-R shows promising results in evaluating the interactions between caregivers, health personnel, and young children during a PED visit. The inclusion of new codes specific to emergency situations strengthens the scale’s ability to capture triadic behaviors more accurately, both before, during, and after pediatric medical care or emergency invasive medical procedures. The identification of non-verbal codes is significant considering that in preschool age, coping and co-regulation are also non-verbal processes. However, the study had a small sample and focused only on admissions for pediatric reasons. Future studies should be carried out with more extensive and diverse samples to strengthen the applicability of the scale in different emergency conditions (e.g., traumatology and surgery) as well as other age groups.

References

Bai, J., Swanson, K. M., & Santacroce, S. J. (2018). Observational coding systems of parent–child interactions during painful procedures: A systematic review. Pain Practice, 18(1), 130-145.
Blount, R. L., Cohen, L. L., Frank, N. C., Bachanas, P. J., Smith, A. J., Manimala, M. R., & Pate, J. T. (1997). The child-adult medical procedure interaction scale–revised: An assessment of validity. Journal of pediatric psychology, 22(1), 73-88.
Blount, R. L. (2019). Commentary: Acute pediatric procedural pain, distress, and coping. Journal of Pediatric Psychology, 44(7), 798-802.
Brown, E. A., De Young, A., Kimble, R., & Kenardy, J. (2019). Development and validity of the burns-child adult medical procedure interaction scale (B-CAMPIS) for young children. Burns, 45(1), 76-87.
Caes, L. (2019). Commentary: Parent-child interactions during painful medical procedures: Recommendations by Blount and colleagues (1991) have not fallen on deaf ears!. Journal of Pediatric Psychology, 44(7), 794-797.
Constantin, K. L., Lupo-Flewelling, K., Moline, R. L., & McMurtry, C. M. (2023). Child emotion regulation capacity moderates the association between parent behaviors and child distress during pediatric venipuncture. Journal of Pediatric Psychology, 48(2), 108-119.
Constantin, K. L., Moline, R. L., Pillai Riddell, R., Spence, J. R., & McMurtry, C. M. (2022). Biopsychosocial contributors to parent behaviors during child venipuncture. Children, 9(7), 1000.
Constantin, K., Moline, R. L., & McMurtry, C. M. (2018). The role of nonverbal features of caregiving behavior. Social and interpersonal dynamics in pain: We don’t suffer alone, 295-323.
Kaytlin L. Constantin, Rachel L. Moline, Lindsay Labonte, C. Meghan McMurtry, A Multi-Method Approach to Understand Parent Behaviors During Child Acute Pain, Journal of Psychophysiology, 10.1027/0269-8803/a000280, 36, 1, (28-41), (2022).
Kyriakidis, I., Tsamagou, E., & Magos, K. (2021). Play and medical play in teaching pre?school children to cope with medical procedures involving needles: A systematic review. Journal of Paediatrics and Child Health, 57(4), 491-499.
Melanie Noel, C. Meghan McMurtry, Christine T. Chambers, Patrick J. McGrath, Children’s Memory for Painful Procedures: The Relationship of Pain Intensity, Anxiety, and Adult Behaviors to Subsequent Recall, Journal of Pediatric Psychology, Volume 35, Issue 6, July 2010, Pages 626–636.
Shiff, I., Greenberg, S., Garfield, H., & Riddell, R. P. (2022). Trajectories of distress regulation during preschool vaccinations: child and caregiver predictors. Pain, 163(3), 590-598.
Sobol-Kwapi?ska, M., Sobol, M., & Wo?nica-Niesobska, E. (2020). Parental behavior and child distress and pain during pediatric medical procedures: Systematic review and meta-analysis. Health Psychology, 39(7), 558.
Svendsen, E. J., Moen, A., Pedersen, R., & Bjørk, I. T. (2016). Parent–healthcare provider interaction during peripheral vein cannulation with resistive preschool children. Journal of advanced nursing, 72(3), 620-630.
Taylor, C., Sellick, K., & Greenwood, K. (2011). The influence of adult behaviors on child coping during venipuncture: A sequential analysis. Research in nursing & health, 34(2), 116-131.

Presenting Author

Mariela Bustamante

Poster Authors

Mariela Bustamante

PhD

Universidad de Chile. Master in Health Psychology and Doctoral Candidate in Psychology Pontificia Universidad Católica de Chile

Lead Author

E-mail

José Iván Rossel

PhD

Universidad de Chile. Master in Clinical Psychology,Universidad de Chile

Lead Author

E-mail

Valeska Tapia

MD

Universidad de Chile

Lead Author

E-mail

Scarlett Caroca

BNSc

Universidad de Chile

Lead Author

E-mail

Gabriela Ruiz Valenzuela

BNSc

Universidad de Chile. Medical Student, Universidad de Chile

Lead Author

Sofia Hidalgo

BS

Universidad de Chile. Psychology Student, Universidad de Chile

Lead Author

Line Caes

PhD

University of Stirling

Lead Author

E-mail

Topics

  • Pain in Special Populations: Infants/Children