Background & Aims

An experience of care in the emergency department (ED) can be very stressful for young children, involving high levels of pain and fear. The evidence emphasizes that childhood coping processes play a crucial role in how well children adapt to physical examinations and painful medical procedures in the ED. However, in young children, coping is greatly influenced by caregivers’ coping and co-regulation strategies. Internationally, research primarily focuses on the impact of parental presence and, to a lesser extent, specific parental coping styles and strategies that are effective for child regulation. The limited studies on parenting strategies rely on parental self-report measures, which restrict the analysis of specific behaviors that could either positively or negatively affect the child’s coping experience. Therefore, the main objective is to assess which parental coping behaviors influence the child’s coping experience during care in the ED.

Methods

100 preschool children (4 to 5 years old) and one caregiver per child took part in a multicenter pilot study at 4 Chilean PEDs. The medical procedures were recorded on video, with facial blurring and text overlays. The preschoolers completed self-report scales for pain (FPS-R) and fear (CFS), while caregivers assessed the child’s pain and fear levels using a visual numerical scale. The Child-Adult Medical Procedure Interaction Scale-Revised, tailored to the emergency department (CAMPIS-ED), was used to identify verbal and non-verbal behaviors of both the child and caregiver. Furthermore, caregivers filled out the Parental Scaffolding self-report scale to indicate the strategies employed when helping their children cope with pain and invasive medical procedures. Descriptive statistics and regression analyses were conducted to determine the primary caregiving strategies and their impact on preschoolers’ stress management.

Results

The study involved a distribution of 51% girls and 49% boys, with 90% of female caregivers. 82% of preschoolers experienced pain, with 31% reporting mild pain, 26% moderate and 23% severe. Responses to pain and fear expressions were similar in 4 and 5 years old. Regarding key child regulation strategies, 100% mentioned using comforting physical contact, 97% engaged in dialogue about the child’s feelings, 96% used distraction and reinforcement, 93% provided reassuring affirmations, 90% normalized the experience, 86% encouraged learning from the experience and 69% employed behavioral limitations. Parents who used dialogue strategies were associated with higher perception of fear levels, while those who reacted alarmingly or used behavioral limitations or minimisation were linked to lower reports of fear and pain. Parents who reported more use of humor were associated with lower reports of child pain. Observational measures suggest that the most effective parental strategies in child regulation include comforting physical contact and comments, coping behavioral commands, procedure explanations and distraction strategies.

Conclusions

The research indicates that the parenting style of caregivers may impact how they perceive children’s pain and fear, as well as the children’s own accounts of their experiences. Caregivers mainly use behaviors that help the child regulate their emotions, such as physical contact, verbal reassurance, guidance on coping with stressful situations, and strategies focused on learning and reinforcement. To enhance the effectiveness of these strategies, it is recommended to advise caregivers to maintain physical contact with the child, prepare the child before a stressful situation, offer guidance on using coping strategies during the situation, and implement reinforcement strategies afterward. However, it is important to conduct subgroup analyses based on the child’s initial level of fear and pain in order to provide tailored strategies for each child’s experience.

References

Carver, C. S., Scheier, M. F., & Weintraub, J. K. (1989). Assessing Coping Strategies: A Theoretically Based Approach. Journal of Personality and Social Psychology, 56(2), 267-283. https://doi.org/10.1037//0022-3514.56.2.267

Corral, A. (2023). Influencia de la presencia de los padres mientras se realizan procedimientos dolorosos, invasivos y/o RCP a los niños en los servicios de urgencias pediátricas [Tesis de Grado, Universidad de Alicante]. https://hdl.handle.net/10045/134695

García, F. E., Barraza-Peña, C. G., Wlodarczyk, A., Alvear-Carrasco, M., & Reyes-Reyes, A. (2018). Psychometric properties of the Brief-COPE for the evaluation of coping strategies in the Chilean population. Reflexão e Crítica, 31(22). https://doi.org/10.1186/s41155-018-0102-3

Jee, R. A., Shepherd, J. R., Boyles, C. E., Marsh, M. J., Thomas, P. W., & Ross, O. C. (2012). Evaluation and comparison of parental needs, stressors, and coping strategies in a pediatric intensive care unit. Pediatric Critical Care Medicine, 13(3), 166-175. https://doi.org/10.1097/pcc.0b013e31823893ad

Mangurten, J., Scott, S., Guzzetta, C. E., Clark, A. P., Vinson, L., Sperry, J., Hicks, B., & Voelmeck, W. (2006). Effects of Family Presence During Resuscitation and Invasive Procedures in a Pediatric Emergency Department. Journal of Emergency Nursing, 32(3), 225-233. https://doi.org/10.1016/j.jen.2006.02.012

Martínez-Montilla, J. M., Amador-Marín, B., & Guerra-Martín, M. D. (2017). Family coping strategies and impacts on family health: A literature review. Enfermería Global, 16(3), 592-604. https://dx.doi.org/10.6018/eglobal.16.3.255721

Pancekauskait?, G. & Jankauskait?, L. (2018). Paediatric Pain Medicine: Pain Differences, Recognition and Coping Acute Procedural Pain in Paediatric Emergency Room. Medicina, 54(6), 94. https://doi.org/10.3390/medicina54060094

Power, T. G. (2004). Stress and Coping in Childhood: The Parents’ Role. Parenting, 4(4), 271–317. https://doi.org/10.1207/s15327922par0404_1

Power, T. G., García, K. S., Martinez, A. D., Parker, L., Hidalgo-Mendez, J., & Ramos, G. (2022). Randomized controlled trial of a program to help Latina mothers help their children cope with stress: Effects on parenting, child coping, and adjustment. Prevention Science, 23(6), 1018-1028. https://doi.org/10.1007/s11121-022-01353-9

Power, T. G., Ramos, G., Guerrero, Y. O., Martinez, A. D., Parker, L., & Lee, S. (2021). Evaluation of a program to help Low-Income, Latina mothers help their children cope with stress. The Journal of Primary Prevention, 42(3), 257-277. https://doi.org/10.1007/s10935-021-00632-5

Sönmez, D. & Ça?lar, S. (2019). The Effect of Parental Presence on Pain and Anxiety Levels During Invasive Procedures in the Pediatric Emergency Department. Journal of emergency Nursing, 5(3), 278-285. https://doi.org/10.1016/j.jen.2018.07.003

Presenting Author

Sofía Hidalgo Vilche

Poster Authors

Sofía Hidalgo Vilche

BS

Universidad de Chile. Psychology Student, Universidad de Chile

Lead Author

Mariela Bustamante

PhD

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

Lead Author

Gabriela Ruiz

BNSc

Universidad de Chile. Medical Student, Universidad de Chile

Lead Author

Scarlett Caroca

BNSc

Universidad de Chile. Medical Student, Universidad de Chile

Lead Author

Topics

  • Pain in Special Populations: Infants/Children