Taking a child to the emergency room or to get a routine immunization is an experience most parents dread. Instinctively, they seek to soothe their children by telling them that everything will turn out fine. But Dalhousie University researchers Meghan McMurtry and Christine Chambers have some surprising advice for parents: you’re trying too hard.
All that reassurance is having the opposite effect to what parents intend — it actually makes children more distressed.
“The most common things that parents say when their children are having a painful medical experience is, ‘It will be over soon’ or ‘It’s OK,’” explains Chambers, a psychologist and Canada Research Chair in Pain and Child Health. “Consistently, these types of reassuring statements have been shown to increase children’s pain and distress.”
Much of Chambers’ work, which centres around trying to reduce children’s pain during medical procedures, has supported this counterintuitive finding, but it was McMurtry, one of Chambers’ graduate students, who decided to investigate why reassurance doesn't work.
As part of her PhD thesis, McMurtry videotaped 100 girls and boys aged 5 to 10, accompanied by a parent, while their blood was being drawn at a Halifax hospital. The video was streamed live to Chambers’ lab, where assistants captured spontaneous, real-time instances of parents saying reassuring things to their children or trying to distract them. The children then watched their video and rated the way they thought their parents were feeling when they made both kinds of statements.
McMurtry, co-supervisor Patrick McGrath and Chambers also showed the children video vignettes of adults using both approaches. The staged vignettes allowed the researchers to control the tone of voice, facial expressions and content of the adults’ messages.
The study indicated that no matter how reassuring the parents’ words, children pick up on their feelings of anxiety, particularly through facial expressions or tone of voice. By contrast, adults who, instead, tried to distract their children were more successful at lessening their children’s pain.
“When kids saw and heard parents reassuring their children, they rated the parents as more fearful than when parents used distraction,” says Chambers.
The adults’ facial expressions were particularly important in cuing children about the parents’ actual emotional state, says McMurtry, who has completed her PhD and has a position lined up as an assistant professor at the University of Guelph.
The study has some important take-home messages for both parents and health-care professionals, says Chambers. Controlling your own fear for your children is critical, and using distraction to lessen their pain is more effective.
And there are long-term implications. If children’s pain during medical procedures is not mitigated, says Chambers, it can lead to serious needle phobias in adulthood. Those with such phobias don’t keep their immunizations current, which can endanger themselves and others. They also often fail to seek medical attention until it is too late, and they refuse to donate blood. Even babies who experience significant pain can become more sensitive to it as they grow up.
“People think pain is a part of life — which it is — but it doesn’t have to be part of medical procedures,” says McMurtry. “One of the reasons I like to study this area is because there is much we can do to significantly reduce pain when children have to get needles, whether it be a healthy child experiencing a routine immunization or diagnosed with a significant medical condition like cancer.”
Chambers and McMurtry hope their research will encourage health-care professionals to reduce children’s pain even during routine medical procedures and will teach parents how to better advocate for pain management for their children. Forty years ago, babies underwent significant cardiac surgeries with inadequate anaesthesia because health professionals had an incomplete understanding of how children experienced pain. Today, the work of Chambers, McMurtry and McGrath is helping to make sure children’s pain is better understood and reduced.
“It’s been rewarding to see that this research in pain and children has changed practice,” says Chambers. “I feel that what we’re doing will really make a difference.”