Effects of parental soothing behavior on stress levels of 2-8 year old children during voiding cystourethrograms by phase of procedure.

Using the example of a voiding cystourethrogram (VCUG), a painful radiological procedure, this study investigated whether parental soothing behavior (reassuring comments like "it's almost over" or "You're O.K." and soothing by "sh, sh") in one phase of the procedure influenced the child's distress in the following phase. The sample was comprised of 68 2-8 year-old children and the accompanying parent(s). Child and parental behavior during the VCUG was coded using a standardized rating scale (CAMPIS-R). Parental reassurance during the anticipatory phase significantly increased the child's distress of the following phase, while parental "sh, sh" significantly reduced it. Both parental behaviors showed no significant effect on the child's distress of the following phase when applied during the procedure itself. Results underline the importance of differentiating between anticipatory and procedural phases of the VCUG. Counselling methods for parents on more appropriate strategies to assist their children during procedural phases of the VCUG are necessary.

Comparing stress levels in children aged 2-8 years and in their accompanying parents during first-time versus repeated voiding cystourethrograms.

OBJECTIVES: Invasive procedures such as voiding cystourethrograms (VCUGs) cause distress in both children and their accompanying parents. The main purpose of this study was to examine whether stress levels in children and their parents differ during first-time and repeated VCUGs. The second objective was to examine the relationship between parental behavior (behavior promoting child coping and behavior promoting child distress), parental stress levels and child distress in first-time versus repeated VCUGs. METHODS: In a prospective study, the distress behavior of 31 children aged 2-8 years who were undergoing a repeated VCUG was examined. A second group of 31 children who were undergoing a VCUG for the first time served as a control sample. Child and parental behavior during the VCUG was coded by three independent observers using a standardized rating scale (CAMPIS-R, Blount et al.). Children reported on their stress levels using a faces scale; parents and radiologists rated the child's distress on a visual analog scale. Similarly, parents assessed their own stress levels on a visual analog scale. RESULTS: The stress levels of children undergoing a repeated VCUG do not differ from those of children undergoing a VCUG for the first time, but parental stress levels were significantly lower during repeated VCUGs. In both VCUG groups there was significant positive correlation between parental distress-promoting behavior and child distress, and between parental stress levels and child distress. Parental coping-promoting behavior showed no significant correlation with child distress or parental stress levels in either VCUG group. Parental stress levels and parental distress-promoting behavior correlated positively only for repeated VCUGs. Neither parental coping- nor distress-promoting behavior differed between first-time versus repeated VCUG groups. CONCLUSIONS: Repeated VCUGs and first-time VCUGs are both highly distressing procedures for children. Even though parental stress levels are lower during repeated VCUGs, spontaneous parental behavior proves to be ineffective or even counterproductive in reducing the child's distress. Further research into efficient counseling and training methods for parents and children undergoing VCUGs is required.