A randomized clinical trial of lidocaine gel for reducing infant distress during urethral catheterization.

OBJECTIVES: The purpose of this study was to determine whether a lidocaine-enhanced lubricant that was used topically and instilled into the urethra decreased infants' distress that was associated with catheterization. METHODS: Eligible study participants were febrile 2- to 24-month-old pediatric emergency department patients in need of a catheter-obtained urinalysis. Patients were randomly assigned to 1 of 3 groups. Patients had catheterization performed after a 4-minute protocol that included a topical lubricant control, topical and intraurethral lubricants, or topical and intraurethral lidocaines. All patients were filmed during the procedure and evaluated at 3 phases: the start of the study, time of instillation, and at the time of maximal catheter insertion. The 3 phases were analyzed by blinded coders using the Modified Behavioral Pain Scale. RESULTS: A total of 45 patients were enrolled in 1 of the 3 study groups. Patients who received lidocaine had a lower overall distress at a level approaching significance at the time of catheterization (phase 3; P = 0.065) and a significantly lower distress as measured by crying during the catheterization (phase 3; P = 0.036) than infants who did not have a lubricant instilled into the urethra. CONCLUSIONS: The use of topical and intraurethral lidocaine resulted in a lower distress when compared with a topical lubricant, at a level approaching significance for global distress. When a subsection of the total distress score that measured infant cry was evaluated, the difference between the intraurethral lidocaine group and the group without intraurethral instillation was statistically significant. Although the results are promising, intraurethral lidocaine did not fully alleviate discomfort associated with urethral catherization. The use of lidocaine is suggested for pediatric patients undergoing urethral catherization; however, evaluation of additional agents and techniques for further decreasing pain is also warranted.

Evidence-based assessment in pediatric psychology: measures of psychosocial adjustment and psychopathology.

OBJECTIVE: To provide an evidence-based review of measures of psychosocial adjustment and psychopathology, with a specific focus on their use in the field of pediatric psychology. METHODS: As part of a larger survey of pediatric psychologists from the Society of Pediatric Psychology e-mail listserv (American Psychological Association, APA, Division 54), 37 measures were selected for this psychometric review. Measures that qualified for the review fell into one of the following three categories: (a) internalizing or externalizing rating scales, (b) broad-band rating scales, and (c) self-related rating scales. RESULTS: Psychometric characteristics (i.e., three types of reliability, two types of validity) were strong for the majority of measures reviewed, with 34 of the 37 measures meeting "well-established" evidence-based assessment (EBA) criteria. Strengths and weaknesses of existing measures were noted. CONCLUSIONS: Recommendations for future work in this area of assessment are presented, including suggestions that more fine-grained EBA criteria be developed and that evidence-based "profiles" be devised for each measure.

Functions of parent-child reminiscing about emotionally negative events.

Parent-child reminiscing about negative experiences influences children's developing "emotional self-concept", which comprises three interrelated functions: self-defining (this is the kind of emotional person I am), self-in-relation (this is how I express and share my emotions with others), and coping (this is how I cope with and resolve negative emotion). In this study, we examined how 70 mostly white, middle-class mothers discuss three negative experiences (fear, anger, and sadness) with their 4-year-old children. Conversations about fear elaborate on the facts of the event and emotional resolutions, thus focusing on coping. Conversations about sadness contain evaluative feedback and emotional resolutions, thus focusing on self-in-relation and coping. Finally, conversations about anger highlight the emotional state itself, thus focusing on self-definition. Mothers are also more elaborative and more evaluative with daughters than with sons, and place emotional events in a more interpersonal context with daughters than sons. Thus girls may be forming a more elaborated and more interpersonal emotional self-concept than boys.