Addressing parent distress during paediatric medical procedures

Abstract

Background. Paediatric burn dressing changes are repetitive, painful and distressing to the child. Some parents are distressed themselves following the injury, and this seems to impair their ability to support the child through the repeated procedures. Greater understanding this impact of parent distress on the child can lead to targeted intervention. We hypothesised parent distress would impact child coping and distress behaviour, through parent behaviour. Methods. Eighty-seven families were recruited at the Pegg Leditschke Burn Outpatient Clinic, Lady Cilento Children’s Hospital, Brisbane, Australia. Parents completed a mental health screen. Parent and child behaviour were observed during the dressing change. Mediation analyses were employed. Findings. Parents with higher anxiety/depression demonstrated less coping-promoting, which reduced the positive effect on child coping (ab=-.04; 95%CI=-.11 to -.01). Parents with higher posttraumatic stress demonstrated more distress-promoting, which increased the negative effect on child coping (ab=-.04; 95%CI=-.13 to -.0003), and also increased the positive effect on child distress (ab=.21; 95%CI=.02 to .61). Independent of these mediations, parent mental health did not directly influence child coping or distress (c’s<.22, ps>.068). Discussion. Parent mental health affects how a parent supports a child, and leads to reduced child coping during a dressing change. This research suggests that some parents will need specific support to assist with their coping during paediatric burn dressing changes. A short video intervention, addressing psychological distress and behavioural modification is currently being tested for acceptability and feasibility in the busy clinical burn outpatient environment.