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Parents and procedures: a randomized controlled trial
1Division of General Pediatrics, Boston University School of Medicine, Boston Medical Center (formerly Boston City Hospital), MA 02118, USA.
Insights
Parental presence during pediatric procedures did not increase pain or negatively impact procedure outcomes. Parents who were present reported lower anxiety levels compared to those not present, challenging traditional beliefs.
Area of Science:
- Pediatric Emergency Medicine
- Clinical Psychology
- Healthcare Delivery
Background:
- Parents generally prefer to be present during their children's medical procedures.
- Physician attitudes towards parental presence during pediatric procedures are often ambivalent.
Purpose of the Study:
- To evaluate a parent-focused intervention's impact on pediatric procedural pain and performance.
- To assess the intervention's effect on parent and clinician anxiety and parental satisfaction.
- To determine the efficacy of parental presence during common pediatric invasive procedures.
Main Methods:
- A randomized controlled trial involving 431 children under three undergoing venipuncture, cannulation, or catheterization.
- Three groups were studied: parents present with intervention (instructions), parents present without intervention, and parents not present.
- Outcomes measured included pain, procedure performance (attempts, time), clinician anxiety, and parental satisfaction.
Main Results:
- No significant differences were found in pain levels, procedure performance, clinician anxiety, or parental satisfaction across the groups.
- Parents present during procedures rated their children's pain as more severe than clinicians did (52% vs. 15%).
- Parents who were present reported significantly lower anxiety levels than those who were not present.
Conclusions:
- The parent-focused intervention did not effectively reduce procedural pain in young children.
- Parental presence during common pediatric procedures did not negatively affect procedure performance or increase clinician anxiety.
- Encouraging parental presence is supported, as it reduces parental anxiety without compromising care quality.
Introduction:
Previous work has shown that parents prefer to be present when their children undergo common invasive procedures, although physicians are ambivalent about parental presence.
Purpose:
To determine the effect of a parent-focused intervention on the pain and performance of the procedure, anxiety of parents and clinicians, and parental satisfaction with care.
Population:
Children younger than 3 years old undergoing venipuncture, intravenous cannulation, or uretheral catheterization.
Setting:
Pediatric emergency department of Boston City Hospital.
Design:
Randomized controlled trial with three groups; parents present and given instructions on how to help their children; parents present, but no instructions given; and parents not present.
Intervention:
The parents were instructed to touch, talk to, and maintain eye contact during the procedure.
Results:
A total of 431 parents was randomized to the intervention (N = 153), present (N = 147), and not present (N = 131) groups. The groups were equivalent with respect to measured sociodemographic variables and parents' previous experience in the pediatric emergency department. No differences emerged with respect to pain (3-point scale measured by parent and clinician, and analysis of cry); performance of the procedure (number of attempts, completion of procedure by first clinician, time); clinician anxiety; or parental satisfaction with care. Parents who were present were more likely to rate the pain of the children as extreme/severe (52%) in comparison to clinicians (15%, kappa .07, poor agreement) and were significantly less anxious than parents who were not present.
Conclusion:
Overall, the intervention was not effective in reducing the pain of routine procedures. Parental presence did not negatively affect performance of the procedure or increase clinician anxiety. Parents who were present were less anxious than those who were not present.
Clinical Implication:
In general, parents have indicated that they want to be present when their children undergo procedures. The results of this study challenge the traditional belief that parental presence negatively affects our ability to successfully complete procedures. We should encourage parents who want to be present to stay during procedures.
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