PEDIATRICS Vol. 87 No. 2 February 1991, pp. 171-177
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Individual Differences in Children's Response to Pain: Role of Temperament and Parental Characteristics

Neil L. Schechter MD1, Bruce A. Bernstein PhD1, Arne Beck PhD2, Lisa Hart MA3, and Lawrence Scherzer MD4

1 From the Department of Pediatrics, Saint Francis Hospital and Medical Center, Hartford, Connecticut and the Department of Pediatrics, University of Connecticut School of Medicine, Farmington
2 Program Evaluation and Planning Department, Fort Logan Mental Health Center, Denver, Colorado
3 From the Department of Pediatrics, Saint Francis Hospital and Medical Center, Hartford, Connecticut
4 From the Department of Pediatrics, University of Connecticut School of Medicine, Farmington, and the Department of Pediatrics, Kaiser Permanente Health Center, East Hartford, Connecticut

Sixty-five families were enlisted in a study exploring factors associated with distress behavior in 5-year-old children receiving diphtheria-tetanus-pertussis immunizations. At a home visit 1 month before the immunization, the following measures were obtained: (1) the Behavioral Style Questionnaire, a measure of temperament; (2) parental self-reports of medically related attributes (eg, "good patient"); (3) parental attitudes toward pain in children and responsiveness to their child's pain; and (4) parental prediction of distress at upcoming immunization. The child's distress behavior during the immunization was evaluated using a modification of the Procedure Rating Scale-Revised and, after the procedure, the child's assessment of his or her pain was elicited using the Oucher. Children's mean Procedure Rating Scale-Revised score was 2.57 of a possible 11. Thirty-one (48%) had low (le1) and 7 (11%) had high distress scores (ge2 SD above the mean). Factors positively correlated with distressed behavior included more "difficult child" cluster characteristics, the individual temperamental dimension of adaptability, but few parental attitudes and attributes. Parents' predictions of distress were the strongest correlates. These findings document the variation that children demonstrate in response to pain and offer some insight into associated innate and environmental factors. These results imply that treatment strategies derived from parental knowledge and tailored to individual characteristics of the child may be most effective in alleviating pain-related distress in medical settings.

Key Words: Pain • immunization • temperament • parental attitude

Submitted on December 7, 1989
Accepted on February 5, 1990




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