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Nurses' reassurances may not help kids' stress: study

By Kathleen Raven

NEW YORK (Reuters Health) - Nurses understandably want to reassure kids during a medical procedure. But a new Scottish study looking at dental care suggests that placating words might only increase a child's anxiety.

Reassurances given at the beginning of a routine dental task were tied to more child distress compared to encouraging words offered near the end of the procedure.

Children who were not anxious at the start of the visit and who heard reassurances about 15 seconds into the event had a 2 in 3 chance of getting more stressed by reassurances. For kids who were anxious at the 15-second mark, the chances jumped to nearly 3 in 4.

"For children who are very anxious, the reassurance can have even more negative effects," said Yuefang Zhou.

Zhou and her colleague, Gerry Michael Humphris, both of the University of St. Andrews in Scotland, conducted the study.

Since the late 1980s, researchers have known that phrases intended to soothe - "Don't worry. It won't hurt," for example - might only add to kids' stress levels during painful and major events like surgery or cancer treatment.

The current study published in the Annals of Behavioral Medicine confirms the same relationship found in past research on more serious procedures, said Keith Allen.

"In that sense, this study does offer a small contribution," he said.

Allen, a professor of psychology at the University of Nebraska Medical Center, was not involved in the current study.

For the study, Zhou and Humphris videotaped 270 boys and girls between ages 3 and 5 in local nursery schools and their interactions with a female dental nurse while she applied varnish to their teeth. The varnish - not to be confused with sealant - is painted on kids' teeth and forms a protective film against tooth decay.

Researchers coded behaviors, such as whether a child appeared stressed out or whether the nurse offered verbal reassurance.

All of the data was analyzed using specific software that allowed researchers to insert a "time stamp" at the moment a behavior occurred.

The time stamps provided a new twist in analyzing the relationship between reassurance and child anxiety, Allen said.

"But, that element, I think, is an artifact," he said. "The fact is that towards the end of a procedure, kids tend to get better anyway, because usually the doctor or nurse is doing less invasive things."

Zhou and Humphris also point to the fact that a child's distress does not provide a straightforward link with reassurance.

Allen agreed. "It's possible that when kids have disruptive behavior, the nurse may say more reassuring things," he said.

"So we don't know if the comments caused the distress, or, if the distress caused the nurses to give reassuring comments," Allen said.

Tooth decay is the most common chronic childhood disease and five times more common than asthma, according to the American Academy of Pediatric Dentistry.

The good news is that alternatives exist.

"One alternative to reassurance is to offer praise," Zhou said. "But it is important to use specific praise."

"So if a child opens his or her mouth wide, then the nurse can say, ‘Well done for opening your mouth wide!'" she said.

Parents and nurses could consider engaging the child in an activity, like singing his or her favorite song, said Humphris.

When nurses or parents say things like "It's not going to last much longer," or "It's going to be okay," said Allen, they are putting the focus on the negative aspects of the experience.

"We found that question-oriented or permission-seeking instructions do not work very well for patients at these young ages," Zhou said.

"If a nurse says, ‘Would you please open your mouth?' then the child can refuse," she said.

"So it is best to give them instructions in a firm way," Zhou said, adding: "Don't fool them."

SOURCE: Annals of Behavioral Medicine, online December 6, 2013.

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