Psychosocial predictors of children's postoperative pain.

The purpose of this study was to investigate the influence of psychosocial variables in the prediction of children's pain intensity following surgery. Forty-two children, ages 7 to 17 years (M = 12.26, SD = 3.06), completed an interview 1 week prior to surgery assessing anticipatory distress related to their forthcoming surgery and history of coping strategy use. Following surgery, children reported the intensity of their pain using visual analog scales. Findings demonstrated that the majority of children experienced moderate to severe postoperative pain. Hierarchical multiple regression analyses revealed that psychosocial variables added to the prediction of children's postoperative pain after controlling for the influence of surgery-related and demographic variables. These findings lend initial support for the inclusion of psychosocial assessment measures (e.g., anticipatory surgery distress) in the preoperative assessment of pediatric patients who may be at risk for excessive postsurgical pain.

Psychological response to HIV positivity in hemophilia.

OBJECTIVE: To compare the psychological and family adaptation of children and adolescents with hemophilia who were seropositive for human immunodeficiency virus type 1 (HIV-1) with an HIV-negative group of comparable age, demographic characteristics, and disease severity in a multi-site study. DESIGN: Cross-sectional, controlled study. SETTING: Thirty-three hemophilia treatment centers throughout the United States. SAMPLE: Ninety-one children and adolescents with hemophilia who were seropositive for HIV and 92 children and adolescents with hemophilia who were seronegative and of comparable age, demographic characteristics, and disease severity. RESULTS: HIV-seropositive children and adolescents reported less positive affect [(lower well being) (P < .05)], and more frequent hemophilia-related school absences were identified among HIV-infected patients (P < .005). However, the two groups demonstrated surprisingly comparable levels of psychological, social, hemophilia-related adjustment, general family relations, and hemophilia-related family adaptation, as reported by patients and parents. However, mothers of HIV-seropositive children and adolescents reported higher levels of general psychological distress (P < .008) and higher levels of distress related to hemophilia (P < .0002) than parents of HIV-negative children. CONCLUSIONS: Seropositive children and adolescents with hemophilia demonstrate psychological resilience and levels of psychological adjustment that were comparable to seronegative counterparts. However, mothers of seropositive children were more distressed than mothers of HIV-negative children. Practitioners should ensure that stressed mothers obtain necessary psychological support.

[Significance of bond security of the child to the mother for the psychological and physical development of failure to thrive children]. / Die Bedeutung der Bindungssicherheit vom Kind zur Mutter für die psychische und physische Entwicklung von gedeihschwachen Kindern.

The present investigation was guided by two main objectives. Our first objective was to describe the relationship between infant-mother attachment and the pediatric condition of failure-to-thrive (FTT). Second, we intended to see if differences in the security of attachment could predict individual differences in the developmental outcome of FTT children. Sixty-eight infants with the disorder of failure-to-thrive were assessed to test the following hypotheses: 1) Infants with a "secure" attachment classification at 12 months would score higher than infants classified as "insecure" on "ego-resilience" measures at 42 months. 2) Infants classified as "secure" at 12 months would show less chronicity of FTT at 42 months of age than "insecure" infants. Attachment was assessed by Ainsworth and Wittig's (1969) Strange Situation attachment classification system. At 12 months roughly half of the children (49%) were securely attached; the remainder of the sample were either avoidant (33%), resistant (12%), or unclassified (6%) (Drotar, Malone, Nowak, 1985). Attachment classification at 12 months proved to be related to ego-resilience at 42 months as measured by correlations between Ego Resilience Index Scores (Block & Block, 1980, 1984) and scores on items of the California Child Q-Sort. The results were in the predicted direction, with the secure attachment group scoring slightly higher on ego-resilience than the insecure group. However the difference was not statistically significant at the p less than .05 level. Children rated "secure" also scored higher than those rated "insecure" on 4 out of 13 ego-resilience items from the California Child Q-Sort.(ABSTRACT TRUNCATED AT 250 WORDS)

Intellectual and social development following prolonged isolation.

A patient with severe combined immunodeficiency required protective isolation for the first year of life. He was discharged after an effective treatment program was developed and has remained well. Developmental testing at 14 and 16 months revealed near age level social and intellectual functioning. Optimal nursing care, frequent and prolonged maternal contact, and the patient's adaptive capacities permitted rapid adjustment to normal life following prolonged isolation.