Conditioned Pain Modulation in Children: The Effects of Painful and Nonpainful Conditioning Stimuli.

Conditioned pain modulation (CPM), a psychophysical measure in which 1 pain stimulus (conditioning stimulus) is used to inhibit another pain stimulus (test stimulus), is an important indicator of endogenous pain inhibition in adults, but is understudied in children. Preliminary evidence suggests that CPM effects are present in healthy children and are more robust in adolescents. However, developmental differences in younger children are not well documented and few studies control for potential distraction effects of the conditioning stimulus (CS). Participants were 54 healthy children aged 6 to 12 years. After a baseline pressure pain threshold (PPT) test, participants underwent 2 conditioning trials in which PPT was assessed while they placed their left hand in a water bath maintained at either 12 °C (painful CS) or 22 °C (nonpainful sham CS) in counterbalanced order. Results revealed a significant CPM effect. PPT values were significantly higher relative to baseline during the painful CS trial; PPT during the nonpainful CS trial did not differ from baseline. There were no significant age differences in magnitude of CPM effect. The results indicate that children as young as 6 years of age demonstrate CPM, suggesting that descending inhibitory pathways may be better developed in young children than previously thought. PERSPECTIVE: This study was successful in producing inhibitory CPM effects in physically healthy children while controlling for sensory distraction. The findings provide strong evidence that the obtained CPM responses cannot be attributed to sensory distraction or other nonspecific effects. Future studies could utilize CPM paradigms to study various aspects of pediatric endogenous pain inhibition, in order to better predict pain responses and improve interventions.

Development of a Food Allergy Knowledge Test for Parents.

Objective: To create a measure of food allergy (FA) knowledge for parents of children with FA. Methods: The food allergy knowledge test (FAKT) was developed following rigorous test-construction guidelines. The preliminary 110-item pool content was developed in consultation with FA experts. After cognitive interviews and revisions, an 88-item preliminary version was administered to 370 parents of children with FA who were recruited online and from an allergy clinic. After item difficulty, discrimination, item-scale correlations analyses, and assessment of internal consistency, a revised 57-item version was administered to a new clinic-based sample (77 parents). Results: The revised FAKT was highly reliable (α =.86). Validity analyses revealed positive correlations ( r = .23-.57) between FAKT scores and parent age, education, insurance status, access to FA information, and auto-injector use. Conclusions: The FAKT was determined to have strong psychometrics and be appropriately reliable and valid, with clinical and research applications.

Parents of Children With Food Allergy: Gender Differences in Perceived Impact and Perceived Food Allergy Severity.

Objective: To compare fathers' and mothers' perceptions of the impact and severity of their child's food allergy and their levels of involvement in allergy-related care. Methods: One hundred parents of children with food allergy (50 mother-father pairs) rated the severity of their child's food allergies and completed the Food Allergy Impact Scale. A subset of 52 parents reported how often they engaged in food allergy-related care. Results: Mothers reported more impact than fathers for meal preparation, family social activities, and stress and free time, and significantly greater involvement in allergy-related care. Fathers who reported more frequent medical appointment attendance perceived meal preparation as being significantly more impacted by food allergy than fathers who were less involved. Conclusions: Fathers who are less involved may be buffered from experiencing the impact of their child's health condition. Differences in involvement rather than other gender differences may explain discrepancies in mothers' and fathers' illness perceptions.

Barriers and motivators to reducing secondhand smoke exposure in African American families of head start children: a qualitative study.

OBJECTIVE: To identify barriers and motivators for reducing secondhand smoke exposure (SHSe) for families of African-American, low-income, urban children. METHOD: Audiotaped intervention sessions of 52 African-American caregivers of Head Start children who reported being a smoker and/or had at least one smoker in the home were randomly sampled from a larger trial examining the effectiveness of a motivational-interviewing intervention in reducing child's SHSe. Counseling sessions were qualitatively coded to identify barriers and motivators to implementing a home smoking ban or quitting smoking. RESULTS: African-American families identified several themes that were either or both barriers and motivators for SHSe reduction, including: asking others not to smoke, other family living in the home, neighborhood safety, absence of childcare, cost/availability of cessation tools, physician support and prevention of health problems. DISCUSSION: Urban, low-income African-American families face numerous barriers to reducing SHSe. Families were able to identify many motivators for reducing SHSe, suggesting an awareness of the importance for SHSe reduction but uncertainty in their confidence to change behaviors. Counseling should include tailoring to be most effective in supporting health behavior change. Greater emphasis on motivators is needed, such as low-cost/free cessation tools, engagement from physicians and greater involvement of extended family members.

Parenting and independent problem-solving in preschool children with food allergy.

OBJECTIVE: To examine autonomy-promoting parenting and independent problem-solving in children with food allergy. METHODS: 66 children with food allergy, aged 3-6 years, and 67 age-matched healthy peers and their mothers were videotaped while completing easy and difficult puzzles. Coders recorded time to puzzle completion, children's direct and indirect requests for help, and maternal help-giving behaviors. RESULTS: Compared with healthy peers, younger (3- to 4-year-old) children with food allergy made more indirect requests for help during the easy puzzle, and their mothers were more likely to provide unnecessary help (i.e., explain where to place a puzzle piece). Differences were not found for older children. CONCLUSIONS: The results suggest that highly involved parenting practices that are medically necessary to manage food allergy may spill over into settings where high levels of involvement are not needed, and that young children with food allergy may be at increased risk for difficulties in autonomy development.