Children's self-reports of fear and pain levels during needle procedures.
Lena Hedén, Louise von Essen, Gustaf Ljungman
PMID 31871722WHAT IT FOUND
Children with cancer reported fear as high as pain during needle insertion in a port under topical anaesthesia.
Fear and pain were related, and younger children reported more fear than pain. Assess fear as well as pain.
Key findings
01Children's mean fear level was 14 mm and mean pain level was 12 mm.
02Fear and pain were related (r = .33, p < .01).
03A separate analysis found that children under 12 years reported higher fear than pain.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Only 90 of the initial 175 children self-reported and were analysed. Children who had a documented need for pharmacological sedation were excluded, so the sample may not represent children with the most fear and pain. The analysis combined placebo and study medication groups; the authors analysed the fear-pain relationship separately in the groups and found no differences, but this is not a test of any medication effect. Cortisol sampling may not have captured a true baseline because the first sample was taken at needle insertion. The age-group finding was a separate post hoc analysis, not the primary objective. Self-report was limited to children aged 7 years and older, so it does not describe younger children.
The easy way to misread this
Do not conclude that topical anaesthesia controlled distress or that treating fear will reduce pain. The study reports associations in children receiving standard care with EMLA topical anaesthesia and either placebo or midazolam, morphine, paracetamol, or ibuprofen; it did not test a fear-reducing intervention.