title: Comparing stress levels in children aged 2-8 years and in their accompanying parents during first-time versus repeated voiding cystourethrograms.
abstract: OBJECTIVE
  Invasive procedures such as voiding cystourethrograms (VCUGs) cause distress in both children and their accompanying parents. The main purpose of this study was to examine whether stress levels in children and their parents differ during first-time and repeated VCUGs. The second objective was to examine the relationship between parental behavior (behavior promoting child coping and behavior promoting child distress), parental stress levels and child distress in first-time versus repeated VCUGs.
  
  
  METHODS
  In a prospective study, the distress behavior of 31 children aged 2-8 years who were undergoing a repeated VCUG was examined. A second group of 31 children who were undergoing a VCUG for the first time served as a control sample. Child and parental behavior during the VCUG was coded by three independent observers using a standardized rating scale (CAMPIS-R, Blount et al.). Children reported on their stress levels using a faces scale; parents and radiologists rated the child's distress on a visual analog scale. Similarly, parents assessed their own stress levels on a visual analog scale.
  
  
  RESULTS
  The stress levels of children undergoing a repeated VCUG do not differ from those of children undergoing a VCUG for the first time, but parental stress levels were significantly lower during repeated VCUGs. In both VCUG groups there was significant positive correlation between parental distress-promoting behavior and child distress, and between parental stress levels and child distress. Parental coping-promoting behavior showed no significant correlation with child distress or parental stress levels in either VCUG group. Parental stress levels and parental distress-promoting behavior correlated positively only for repeated VCUGs. Neither parental coping- nor distress-promoting behavior differed between first-time versus repeated VCUG groups.
  
  
  CONCLUSIONS
  Repeated VCUGs and first-time VCUGs are both highly distressing procedures for children. Even though parental stress levels are lower during repeated VCUGs, spontaneous parental behavior proves to be ineffective or even counterproductive in reducing the child's distress. Further research into efficient counseling and training methods for parents and children undergoing VCUGs is required.
authors: Department of Psychiatry for Children and Adolescents, Medical University Vienna, Vienna, Austria. sabine.voelkl-kernstock@meduniwien.ac.at
authors: Sabine
authors: S
authors: Völkl-Kernstock
authors: Michaela
authors: M
authors: Felber
authors: Alfred
authors: A
authors: Schabmann
authors: Nicole
authors: N
authors: Inschlag
authors: Lisa
authors: L
authors: Karesch
authors: Elisabeth
authors: E
authors: Ponocny-Seliger
authors: Max H
authors: MH
authors: Friedrich
mesh_terms: D000223:Adaptation, Psychological; D001288:Attention; D002648:Child; D002653:Child Behavior Disorders / Q000175:diagnosis / Q000523:psychology; D002675:Child, Preschool; D004645:Empathy; D005260:Female; D006801:Humans; D008297:Male; D010147:Pain Measurement; D010287:Parent-Child Relations; D016487:Parenting / Q000523:psychology*; D010290:Parents / Q000523:psychology; D012307:Risk Factors; D013315:Stress, Psychological / Q000150:complications / Q000523:psychology*; D014567:Urography / Q000523:psychology*