Emotion Regulation and Positive Affect in the Context of Salivary Alpha-Amylase Response to Pain in Children with Cancer: Physiology, Self-Report, and Behavior

Children with cancer are repeatedly exposed to aversive stimuli including painful procedures. Therefore, emotional regulation techniques may prove useful during such experiences and contribute to pain resilience. This study aimed to determine whether three different emotional regulation strategies (distraction, reappraisal and reassurance) impacted physiological, self- reported and behavioral pain responses in pediatric patients with cancer ages 6 to 18 years (N = 73). The cold pressor task (CPT), an experimental task in which pain is induced by having participants place their hand in cold water, was used to examine pain responses. Patients placed their hand in 7 degree Celsius water for up to 4 minutes. Saliva samples were collected 15 minutes before, immediately after, and then 15 minutes after the CPT. Saliva samples were assayed for alpha amylase, a proxy for sympathetic nervous system activation. Self-reported pain severity was measured upon hand removal. Pain tolerance was assessed by length of time participants kept their hand in the water. Children in the reassurance condition exhibited salivary alpha amylase levels that continued to rise post completion of the CPT as compared to children in the distraction (Beta = -1.68, SE = 0.73, z = -2.30, p = .021, 95% CI [-3.10, -0.25]) and reappraisal (Beta = -1.24, SE = 0.72, z = -1.73, p = .084, 95% CI [-2.65, 0.17]) conditions. However, when self-reported pain and behavior were examined, no differences in pain severity (Wald Chi-squared (2) = 2.47, p = .292), or pain tolerance (Wald Chi-squared (2) = 1.38, p = 0.502) among the emotional regulation strategies were observed. Thus, significant findings were present for physiological markers of distress, but not for self-reported and behavioral measures. These findings suggest that in terms of physiological measures, specific emotional regulation strategies, such as distraction and reappraisal, may be more beneficial in reducing stress responses to painful medical procedures in pediatric patients with cancer as compared to reassurance. These results also demonstrate the importance of examining physiological outcomes in addition to self-report and behavioral outcomes

Demographic Predictors of Adult Behaviors in the Pediatric Postoperative Environment

Over 85% of children experience postoperative pain. If poorly treated, pediatric postoperative pain may lead to various negative health outcomes. Adult behaviors may be associated with child experiences in the postoperative environment. For example, adult behaviors such as distraction, humor, and coping advice divert a child’s attention away from their pain and thus, may significantly reduce child postoperative distress. In contrast, adult behaviors such as empathy, reassurance, and apology direct a child’s attention towards their pain which may increase a child’s overall postoperative distress. Moreover, patient demographic factors, like child ethnicity, may significantly alter the frequency of use of these adult behaviors. Therefore, this study aimed to determine which participant demographic factors are associated with the use of certain adult behaviors in response to child postoperative distress. This study included children ages 2 to 10 years old (N=112) undergoing elective surgery at the Children’s Hospital of Orange County. Participant demographics including ethnicity and race were collected prior to surgery. Nurse, parent, and child postoperative behavioral interactions were video recorded in the Post Anesthesia Care Unit (PACU). From these video recordings, adult behaviors were coded for their frequency of use. Multiple regressions analyses showed that adults were more likely to use humor with Non-Hispanic White children compared to Hispanic children (b = 0.393, p = 0.049). Moreover, fathers were marginally more likely to use empathy, reassurance, and apology with Hispanic children compared to Non-Hispanic White children (b = 0.249, p = 0.05). These results suggest that Hispanic and Non-Hispanic White children may receive different behavioral treatment in response to their postoperative distress. Implications for these findings suggest that child ethnicity may be predictive of different adult PACU behaviors which may illustrate how cultural differences can influence the child postoperative experience

Pediatric Asthma and Psychological Resilience: Examining Whether Family Functioning and Social Support Relate to Asthma Symptoms and Lung Function

Upwards of 6 million children in the United States are afflicted with pediatric asthma. While previous research has linked asthma to multiple contributing biological and environmental factors, recent research suggests that psychological and social factors may have an impact on physiological outcomes of asthma like lung function and lung inflammation. Therefore, we suggest the need to study the impact of positive psychological factors such as a well-functioning family environment and beneficial social support on symptoms and lung function of children diagnosed with asthma. In the present pilot study, we recruited a total of 15 children with a confirmed asthma diagnosis and their parents from the Division of Pulmonology at the Children’s Hospital of Orange County. Participants were asked to complete an initial baseline assessment as well as ecological momentary assessments four times a day for seven days followed by a final follow up survey. Asthma symptoms and pulmonary function were measured using a 7-item Asthma Control Diary, and peak expiratory flow (PEF) values were gathered using data from self-administered spirometer recordings during the ecological momentary assessment portion of the study. This pilot study demonstrates the feasibility in collecting ecological momentary assessments surrounding positive psychological factors. Further, in testing the associations between family functioning and social support on children’s asthma symptoms and lung function, children who received more support from teachers (b = 0.03, t = 2.34, p = 0.048) and close friends (b = 0.04, t = 3.88, p = 0.006) had worse symptoms and lung function. Family functioning was not significantly associated with asthma symptoms and lung function (b = -0.00, t = -0.03, p = 0.975). Based on the results obtained, significant associations were only found in some aspects of social support. Interestingly, it seems as though children with more social support had worse asthma symptoms and lung function. This negative association might be an issue of reverse causality in which children who need more assistance receive more support. Next steps in this work include testing these associations in a larger-scale study. In sum, as pediatric asthma’s prevalence continues to rise, future studies should further examine the relationship between positive psychological factors and children’s asthma resilience

Parental Satisfaction of Child\u27s Perioperative Care

Background Satisfaction in the hospital setting is an important component of both hospital funding and patient experience. When it comes to a child\u27s hospital experience, parent satisfaction of their child\u27s perioperative care is also necessary to understand. However, little research has been conducted on the predictors of this outcome. Therefore, the purpose of this current study was to validate a priori selected predictors for parental satisfaction in their child\u27s perioperative process. Methods Eight hundred and ten pediatric patients who underwent tonsillectomy and adenoidectomy surgery and their parents were included in this study. The primary outcome was assessed using a 21‐item parent satisfaction questionnaire resulting in three satisfaction scores: overall care satisfaction, OR/induction satisfaction, and total satisfaction. Results Descriptive statistics and correlational analysis found that sedative‐premedication, parental presence at anesthesia induction, child social functioning, parental anxiety, and language were all significant predictors of various components of the satisfaction score. Regression models, however, revealed that only parent anxiety and child social functioning remained significant predictors such that parents who reported lower state anxiety (OR/induction satisfaction: OR = 0.975, 95% CI [0.957, 0.994]; total satisfaction: OR = 0.968, 95% CI [0.943, 0.993]) and who had higher socially functioning children (overall care satisfaction: OR = 1.019, 95% CI [1.005, 1.033]; OR/induction satisfaction: OR = 1.011, 95% CI [1.000, 1.022]) were significantly more satisfied with the perioperative care they received. Conclusion Lower parent anxiety and higher child social functioning were predictive of higher parental satisfaction scores

Parental satisfaction of child's perioperative care.

BackgroundSatisfaction in the hospital setting is an important component of both hospital funding and patient experience. When it comes to a child's hospital experience, parent satisfaction of their child's perioperative care is also necessary to understand. However, little research has been conducted on the predictors of this outcome. Therefore, the purpose of this current study was to validate a priori selected predictors for parental satisfaction in their child's perioperative process.MethodsEight hundred and ten pediatric patients who underwent tonsillectomy and adenoidectomy surgery and their parents were included in this study. The primary outcome was assessed using a 21-item parent satisfaction questionnaire resulting in three satisfaction scores: overall care satisfaction, OR/induction satisfaction, and total satisfaction.ResultsDescriptive statistics and correlational analysis found that sedative-premedication, parental presence at anesthesia induction, child social functioning, parental anxiety, and language were all significant predictors of various components of the satisfaction score. Regression models, however, revealed that only parent anxiety and child social functioning remained significant predictors such that parents who reported lower state anxiety (OR/induction satisfaction: OR = 0.975, 95% CI [0.957, 0.994]; total satisfaction: OR = 0.968, 95% CI [0.943, 0.993]) and who had higher socially functioning children (overall care satisfaction: OR = 1.019, 95% CI [1.005, 1.033]; OR/induction satisfaction: OR = 1.011, 95% CI [1.000, 1.022]) were significantly more satisfied with the perioperative care they received.ConclusionLower parent anxiety and higher child social functioning were predictive of higher parental satisfaction scores