From the first days of life, children encounter pain. Whether a result of commonly experienced medical procedures (e.g., vaccine injections) or minor injuries resulting in bumps and bruises, children frequently experience pain. Given the highly subjective nature of pain (Merskey & Bogduk, 1994) and the powerful modulating influence that one's cognitions, emotions, and behaviours can have on how pain is experienced, pain is a fascinating field for psychological inquiry. Early pain experiences provide rich learning contexts within which children's pain cognitions and behaviours are socialized. Childhood pain experiences set the stage for pain coping across the life span.One particularly important aspect of pain phenomenology is memory for pain. Pain memory is a critical cognitive requirement for children to self-report on their pain (Chan & von Baeyer, 2016) and invariably shapes their future pain coping (Noel, Chambers, Petter, et al., 2012; von Baeyer, Marche, Rocha, & Salmon, 2004). How individuals remember pain from childhood can have a lasting impact on their future pain and health behaviours well into adulthood. Children's explicit memories for pain have been implicated in the development of fears (e.g., needle phobias) and avoidance of medical care into adulthood (McMurtry et al., 2015). Moreover, conceptual models put forth to understand the development and maintenance of pediatric chronic pain and comorbid mental health issues posit that distressing pain memories may be an underlying cognitive mechanism (Holley, Willson, Noel, & Palermo, 2016). Importantly, pain memories are malleable, particularly in early childhood, making them a powerful target in psychological pain management interventions (Noel, 2016). Changing the pain memory can change the pain experience (Chen, Zeltzer, Craske, & Katz, 1999; Pickrell et al., 2007). Given the deleterious long-term impact of poorly managed acute pain (McMurtry et al., 2015) and the growing (King et al., 2011), costly (Groenewald, Wright, & Palermo, 2015), and debilitating (Palermo, 2000) epidemic of pediatric chronic pain, which pain memories may underlie, understanding the development and modifiable nature of children's pain memories is critically important.Early research on children's pain memories focused on whether or not children could be accurate reporters of their pain. This research had forensic and clinical implications, shedding light on whether or not children could reliably provide eyewitness testimony following stressful/painful events (e.g., abuse) and report on past pain for treatment purposes (e.g., prescribing of pain medications). Researchers then began to examine individual predictors of recall accuracy. Longitudinal studies on the role of pain memories in shaping subsequent pain experiences have been few and far between (Chen, Zeltzer, Craske, & Katz, 2000), and although some researchers have developed and tested interventions to modify pain memories to, in turn, alter subsequent pain experiences (Chen et al., 1999; Pickrell et al., 2007), there has been a dearth of treatment research in this area.This article provides a narrative review of the literature on children's memory for pain. It builds upon previous reviews on this topic (Noel, Chambers, Petter, et al., 2012; Ornstein, Manning, & Pelphrey, 1999; von Baeyer et al., 2004) by synthesizing literature published in the past 5 years. In light of advances in neuroimaging techniques and research in pediatric pain, we summarise relevant literature on the neurobiology of pain memories to stimulate future interdisciplinary research in this area. Given the integral role of children's pain memories in subsequent pain experiences, the potential role of pain memories in the development and maintenance of chronic pain and comorbid psychopathology (e.g., PTSD; Holley et al., 2016), and the development of new memory reframing techniques (Marche, Briere, & von Baeyer, 2016), understanding this literature, and how to advance it, is timely. …
According to person-by-environment models, individual differences in traits may moderate the association between stressors and the development of psychopathology; however, findings in the literature have been inconsistent and little literature has examined adolescent brain structure as a moderator of the effects of stress on adolescent internalizing symptoms. The COVID-19 pandemic presented a unique opportunity to examine the associations between stress, brain structure, and psychopathology. Given links of cortical morphology with adolescent depression and anxiety, the present study investigated whether cortical morphology moderates the relationship between stress from the COVID-19 pandemic on the development of internalizing symptoms in familial high-risk adolescents. Prior to the COVID-19 pandemic, 72 adolescents (27M) completed a measure of depressive and anxiety symptoms and underwent magnetic resonance imaging. T1-weighted images were acquired to assess cortical thickness and surface area. Approximately 6-8 months after COVID-19 was declared a global pandemic, adolescents reported their depressive and anxiety symptoms and pandemic-related stress. Adjusting for pre-pandemic depressive and anxiety symptoms and stress, increased pandemic-related stress was associated with increased depressive but not anxiety symptoms. This relationship was moderated by cortical thickness and surface area in the anterior cingulate and cortical thickness in the medial orbitofrontal cortex such that increased stress was only associated with increased depressive and anxiety symptoms among adolescents with lower cortical surface area and higher cortical thickness in these regions. Results further our understanding of neural vulnerabilities to the associations between stress and internalizing symptoms in general, and during the COVID-19 pandemic in particular.
Abstract Negatively biased memories for pain (ie, recalled pain is higher than initial report) robustly predict future pain experiences. During early childhood, parent–child reminiscing has been posited as playing a critical role in how children's memories are constructed and reconstructed; however, this has not been empirically demonstrated. This study examined the role of parent–child reminiscing about a recent painful surgery in young children's pain memory development. Participants included 112 children (M age = 5.3 years; 60% boys) who underwent a tonsillectomy and one of their parents (34% fathers). Pain was assessed in hospital and during the recovery phase at home. Two weeks after surgery, parents and children attended a laboratory visit to participate in a structured narrative elicitation task wherein they reminisced about the surgery. Four weeks after surgery, children completed an established pain memory interview using the same previously administered scales through telephone. Narratives were coded for style (elaboration) and content (pain and emotion) based on coding schemes drawn from the developmental psychology literature. Findings revealed that a more elaborative parental reminiscing style in addition to greater use of emotional words predicted more accurate/positively biased pain memories. Greater parental use of pain words predicted more negatively biased pain memories. Although there were no sex and parent-role differences in pain memory biases, mothers and fathers differed in how they reminisced with their boys vs girls. This research underscores the importance of parent–child reminiscing in children's pain memory development and may be used to inform the development of a parent-led memory reframing intervention to improve pediatric pain management.
Background: A knowledge synthesis was undertaken to inform the development of a revised and expanded clinical practice guideline about managing vaccination pain in children to include the management of pain across the lifespan and the management of fear in individuals with high levels of needle fear. This manuscript describes the methodological details of the knowledge synthesis and presents the list of included clinical questions, critical and important outcomes, search strategy, and search strategy results. Methods: The Grading of Assessments, Recommendations, Development and Evaluation (GRADE) and Cochrane methodologies provided the general framework. The project team voted on clinical questions for inclusion and critically important and important outcomes. A broad search strategy was used to identify relevant randomized-controlled trials and quasi-randomized-controlled trials. Quality of research evidence was assessed using the Cochrane risk of bias tool and quality across studies was assessed using GRADE. Multiple measures of the same construct within studies (eg, observer-rated and parent-rated infant distress) were combined before pooling. The standardized mean difference and 95% confidence intervals (CI) or relative risk and 95% CI was used to express the effects of an intervention. Results: Altogether, 55 clinical questions were selected for inclusion in the knowledge synthesis; 49 pertained to pain management during vaccine injections and 6 pertained to fear management in individuals with high levels of needle fear. Pain, fear, and distress were typically prioritized as critically important outcomes across clinical questions. The search strategy identified 136 relevant studies. Conclusions: This manuscript describes the methodological details of a knowledge synthesis about pain management during vaccination and fear management in individuals with high levels of needle fear. Subsequent manuscripts in this series will present the results for the included questions.
ABSTRACT Oral language skills in the preschool years are predictive of children's later reading success and literacy acquisition, and among these language skills, vocabulary and narrative ability play important roles. Children from low socioeconomic families face risks to their language development and because of threats to these skills it is important to identify factors that promote their development among high-risk groups. This preliminary study explored two potential factors that may be related to language skills in 56 low SES mother–child dyads (children aged 2 ; 8–4 ; 10), namely child temperament and parenting stress. Results showed that child temperament and parenting stress were related to children's oral language skills. Child temperament characteristics that would likely aid social interaction were related to narrative ability and children rated high on emotionality had poorer receptive vocabulary skills. Parenting stress was related to children's receptive and expressive vocabulary skills. Results are interpreted in terms of the possible mediating role of parent–child interactions in children's oral language skill development, and future directions for family intervention are discussed.
Children's memories for past pain set the stage for their future pain experiences. Parent-child reminiscing about pain plays a key role in shaping children's pain memories. Parental beliefs about the functions of reminiscing are associated with parental reminiscing behaviors. To date, no studies have investigated parental beliefs regarding the functions of reminiscing about past pain or the associations between parental beliefs and reminiscing about past pain. This study aimed to fill these gaps. One-hundred and seven parents (52% fathers) of young children were asked about their beliefs regarding reminiscing about past pain. Interview data were first analyzed using inductive reflexive thematic analysis. A coding scheme was created based on the generated themes to quantitatively characterize parental beliefs. Parents also reminisced with their children about unique past events involving pain. Parent-child reminiscing narratives were coded to capture parent reminiscing behaviors. Inductive reflexive thematic analysis generated three major themes representing parental beliefs regarding reminiscing about past pain: "reminiscing to process past pain," "reminiscing as a learning tool," and "avoiding reminiscing about past pain." Parents who endorsed avoiding reminiscing used fewer optimal reminiscing elements (i.e., open-ended questions) when reminiscing about past painful experiences with children. Parents who endorsed reminiscing to process past pain used more emotion-laden language when reminiscing about past pain. Mothers and fathers of boys and girls endorsed the reminiscing functions to a similar degree. Parents of older, vs. younger, children endorsed reminiscing to process past pain to a greater degree. Developmental considerations and clinical implications of the findings are discussed.
Diagnostic uncertainty, the perceived lack of an accurate explanation of the patient’s health problem, remains relatively unstudied in children. This study examined the prevalence, familial concordance, and correlates of diagnostic uncertainty in children and their parents presenting to a multidisciplinary pain clinic in the United States. One hundred and twenty-six parents and 91 of their children (Mage = 13.93 years, range = 8–18 years) completed a brief three-item measure of diagnostic uncertainty, as well as measures of pain-related distress and functioning. Forty-eight percent of children and 37% of parents believed something else was going on with the child’s pain that doctors had not found out about yet. Across the three items, 66%–77% of children and their parents agreed in their endorsement of diagnostic uncertainty. Parents who believed that something else was going on with their child’s pain had children with higher avoidance of pain-related activities (F = 5.601, p = 0.020) and lower pain willingness (F = 4.782, p = 0.032). Neither parent nor child diagnostic uncertainty was significantly related to the child’s pain-related functioning. Diagnostic uncertainty, particularly in parents, is relevant in the experience of pediatric chronic pain and warrants further investigation as both a risk factor and therapeutic target.
This systematic review evaluated the effectiveness of physical and procedural interventions for reducing pain and related outcomes during vaccination. Databases were searched using a broad search strategy to identify relevant randomized and quasi-randomized controlled trials. Data were extracted according to procedure phase (preprocedure, acute, recovery, and combinations of these) and pooled using established methods. A total of 31 studies were included. Acute infant distress was diminished during intramuscular injection without aspiration (n=313): standardized mean difference (SMD) -0.82 (95% confidence interval [CI]: -1.18, -0.46). Injecting the most painful vaccine last during vaccinations reduced acute infant distress (n=196): SMD -0.69 (95% CI: -0.98, -0.4). Simultaneous injections reduced acute infant distress compared with sequential injections (n=172): SMD -0.56 (95% CI: -0.87, -0.25). There was no benefit of simultaneous injections in children. Less infant distress during the acute and recovery phases combined occurred with vastus lateralis (vs. deltoid) injections (n=185): SMD -0.70 (95% CI: -1.00, -0.41). Skin-to-skin contact in neonates (n=736) reduced acute distress: SMD -0.65 (95% CI: -1.05, -0.25). Holding infants reduced acute distress after removal of the data from 1 methodologically diverse study (n=107): SMD -1.25 (95% CI: -2.05, -0.46). Holding after vaccination (n=417) reduced infant distress during the acute and recovery phases combined: SMD -0.65 (95% CI: -1.08, -0.22). Self-reported fear was reduced for children positioned upright (n=107): SMD -0.39 (95% CI: -0.77, -0.01). Non-nutritive sucking (n=186) reduced acute distress in infants: SMD -1.88 (95% CI: -2.57, -1.18). Manual tactile stimulation did not reduce pain across the lifespan. An external vibrating device and cold reduced pain in children (n=145): SMD -1.23 (95% CI: -1.58, -0.87). There was no benefit of warming the vaccine in adults. Muscle tension was beneficial in selected indices of fainting in adolescents and adults. Interventions with evidence of benefit in select populations include: no aspiration, injecting most painful vaccine last, simultaneous injections, vastus lateralis injection, positioning interventions, non-nutritive sucking, external vibrating device with cold, and muscle tension.
