Caregivers' responses to pain in their children in the emergency department

Objective: To explore physiological and anxiety responses of caregivers who witness a venipuncture being performed on their child and the effects of caregivers' responses on child pain and distress. Design: Observational study between March 13, 2006, and June 8, 2006. Setting: Tertiary-level pediatric emergency department in Toronto, Ontario. Participants: Fifty-five caregivers of children aged 1 month to 18 years. Main Exposure: Observing a child receive an intravenous cannulation. Outcome Measures: The caregiver's heart rate, blood pressure, and anxiety (measured using a 10-cm visual analogue scale). Child-caregiver interactions were measured using the Child-Adult Medical Procedure Interaction Scale-Short Form (child age, : 2 years) or the Measure of Adult and Infant Soothing and Distress (child age, <2 years). Child pain was measured using the Faces Pain Scale-Revised. Results: During cannulation, there was a significant increase in a caregiver's heart rate (median maximum difference = 12 beats per minute; P<.001) and anxiety (median difference = 2.65 cm; P<.001). Mean arterial pressure decreased after cannulation (median difference = 4.4 mm Hg; P = .004). Backward linear regression revealed that 34% of the variability in child cannulation pain was predicted by caregiver anxiety and caregiver distress-promoting behavior; 31% of the variability in a child's distress during cannulation was predicted by caregiver distress-promoting behavior. Caregiver heart rate and anxiety during cannulation and caregiver distress-promoting behavior during recovery accounted for 51% of the variability in the child's distress during recovery. Conclusions: Caregivers witnessing an intravenous cannulation in their child had elevated heart rate, blood pressure, and anxiety. These responses predicted child pain and distress. Future studies should evaluate interventions designed to decrease distress responses in caregivers.