ABSTRACT
OBJECTIVE: Research has demonstrated that emergency department visits for injured children are highly stressful experiences, especially when they include a painful procedure. This pilot study explored the impact of an intervention, which included preparation and distraction on procedure-related distress in children treated for laceration repair in the emergency department. METHOD: Distress and parent ratings of satisfaction were compared between children who received individualized preparation and distraction interventions for laceration repair provided by a child life specialist and children who received no intervention. Twenty-four subjects, aged 3 to 13 yr, were recruited from a pediatric emergency department within a university medical center. Patients receiving the intervention were provided with preprocedure age appropriate information relating to the laceration repair and distraction during the procedure. RESULTS: Results showed that children who received psychosocial intervention had lower observed distress behaviors during suturing compared with patients who did not receive the intervention. Results also showed that parents of patients who received the intervention perceived less distress in their children and rated their overall care significantly higher. CONCLUSION: These findings have significant implications for children's health care and supporting family needs when a child enters the emergency department.
Subject(s)
Anxiety/therapy , Lacerations/therapy , Adolescent , Child , Child, Preschool , Emergency Medical Services/methods , Emergency Service, Hospital , Female , Humans , Male , Parents/psychology , Patient Satisfaction , Pilot Projects , Psychiatric Status Rating Scales , Treatment OutcomeABSTRACT
This study examined whether there was a cortisol response to inoculation or if pre-inoculation levels were already elevated due to an anticipatory response to going to the doctors' office. For 4-year-old children, a base saliva sample was obtained in the home on a non-stress day, and a pre-inoculation saliva sample was obtained in the doctors' office prior to the stress. Doctors' office pre-inoculation cortisol was higher than home-based cortisol, suggesting the occurrence of an anticipatory cortisol response to the impending stress. Post-inoculation cortisol levels (+20 min) were comparable to home-based cortisol, indicating that there was no cortisol response to the inoculation itself. While there was no mean increase in cortisol, individual differences in cortisol response existed. Cortisol increases were related to important aspects of child behavioral functioning, including internalizing and externalizing behavior ratings.
