Reassurance and Distress Behavior in Preschool Children Undergoing Dental Preventive Care Procedures in a Community Sett
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ORIGINAL ARTICLE
Reassurance and Distress Behavior in Preschool Children Undergoing Dental Preventive Care Procedures in a Community Setting: a Multilevel Observational Study Yuefang Zhou, Ph.D. & Gerry Michael Humphris, Ph.D.
# The Society of Behavioral Medicine 2013
Abstract Background The effect of reassurance in managing distress among children who receive procedures of a less aversive nature has not been fully investigated. Purpose This study aimed to investigate the relationship between reassurance by dental staff and distress behavior of preschool children receiving preventive procedures in a community setting. Methods Nurse–child interactions (n =270) during fluoride varnish application were video recorded and coded. Multilevel logistic regression modeled the probability of the occurrence of child distress behavior as a function of reassurance provision, controlling for child-level and nurse-level variables. Results Child distress behavior was positively related to nurse verbal reassurance but negatively linked to the time that this reassurance occurred. Both child initial anxiety and nurse nonprocedural training increased the probability of observable distress behavior. Conclusions The use of verbal reassurance to promote reception of mild invasive procedures was counterindicated, especially when offered early in the intervention (ClinicalTrials.gov number: NCT00881790). Keywords Reassurance . Distress behavior . Preschool children . Multilevel . Dental nurses . Fluoride varnish application
Introduction Reassurance is perhaps the most common approach adopted by parents and medical staff intending to alleviate pain and Y. Zhou (*) : G. M. Humphris School of Medicine, University of St Andrews, St Andrews, Fife KY16 9TF, Scotland, UK e-mail: [email protected]
distress of a child undergoing a painful medical procedure. Indeed, the frequency of reassuring comments accounts for more than one quarter of the content of adult vocalization to children during painful procedures [1]. The empirical research evidence, however, does not seem to support this good-willed approach. Correlational [1, 2] and experimental [3, 4] studies have consistently demonstrated that adults’ reassurance is positively correlated with increased distress in children. This finding regarding the detrimental effects of reassurance on child behavior stands fairly consistent in the pediatric pain management literature. Of importance, however, is the lack of clarity of whether reassuring children in a procedure with minimal pain involvement, such as the fluoride varnish application procedure, has a similar consequence. The frequency of minimal interventions with young children is likely to be much higher than more extreme invasive procedures. Furthermore, severe distress behavior in children could lead to staff resorting to sedation, a solution not encouraged with young children, especially in nonpainful procedures, which can be both expensive and likely to have long-term negative effects on anxiety. Given the significant implications for
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