title: Parental distress and catastrophic thoughts about child pain: implications for parental protective behavior in the context of child leukemia-related medical procedures.
abstract: OBJECTIVE
  Treatment for childhood leukemia requires frequent lumbar punctures (LP) and bone marrow aspirations (BMA), often described by children and parents as more distressing than the disease itself. Findings in schoolchildren and chronic pain samples indicate that increased parental distress may increase parental protective, pain-attending behavior, which is associated with more child pain and distress. However, in the context of invasive medical procedures, it is unknown which parents are likely to become most distressed and engage in pain-attending behavior, and how this impacts the children's experiences. The present study investigated the impact of parental catastrophic thoughts upon parental distress and pain-attending behavior (verbal and nonverbal). Furthermore, the association between parental responses and the children's pain behavior, pain, and distress was examined.
  
  
  METHODS
  A total of 46 parents of children with leukemia (range, 0.6 to 15 y) who underwent a LP/BMA procedure participated in this study. Parental catastrophizing was assessed before and parental and child distress was assessed after the LP/BMA procedure. Parental pain-attending behavior and the child's pain behavior were observed before and after the LP/BMA procedure.
  
  
  RESULTS
  Findings indicated that heightened parental catastrophic thinking contributed to increased parental distress during LP/BMA and less pain-attending behavior before the LP/BMA procedure, especially in young children. In contrast, heightened distress in parents with high levels of catastrophizing contributed to increased engagement in postprocedural pain-attending behavior. For young children, increased preprocedural pain-attending behavior was related to more child distress, pain, and pain behavior.
  
  
  CONCLUSIONS
  The findings demonstrate the importance of parental catastrophic thinking in understanding their caregiving responses and preparing parents and children for painful invasive medical procedures.
authors.affiliation: *Centre for Pediatric Pain Research, IWK Health Centre, Halifax, Nova Scotia, Canada †Department of Experimental-Clinical and Health Psychology, Ghent University ‡Department of Pediatric Oncology/Hematology and Stem Cell Transplantation, Ghent University Hospital, Ghent, Belgium.
authors.forename: Line
authors.initials: L
authors.lastname: Caes
authors.forename: Tine
authors.initials: T
authors.lastname: Vervoort
authors.forename: Patricia
authors.initials: P
authors.lastname: Devos
authors.forename: Joris
authors.initials: J
authors.lastname: Verlooy
authors.forename: Yves
authors.initials: Y
authors.lastname: Benoit
authors.forename: Liesbet
authors.initials: L
authors.lastname: Goubert
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D016465:Bone Marrow Purging / Q000009:adverse effects / Q000523:psychology; D058443:Catastrophization; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007938:Leukemia / Q000503:physiopathology* / Q000523:psychology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology / Q000503:physiopathology* / Q000523:psychology; D010287:Parent-Child Relations; D010290:Parents / Q000523:psychology*; D013129:Spinal Puncture / Q000009:adverse effects / Q000523:psychology; D013315:Stress, Psychological; D055815:Young Adult