Comforting and reassuring children during painful procedures is a natural instinct for many people. But what we think should be comforting is not always as it seems. I would like to thank these authors for embracing the task of understanding why “comforting” statements may not comfort children, but often results in increased fear and distress.
This article (published in the July 2010 issue of Pain) is the first step to understanding what is it about our language that is comforting and what increases fear and anxiety. It examines not only the word choice, but also intonation and facial expression of the individual speaking. While most of the tests showed only small effect size, it provides us with the initial clues as to how to better construct phrases and to be more aware of tone of voice.
While most of the outcomes of this study may seem very logical to those who frequently work with children, it is reassuring to have some evidence to support those beliefs. For example, one would assume that distraction would be interpreted as less fearful than reassurance. It is interesting that neither non-informative reassurance nor informative reassurance would be interpreted by children as less fearful. It also seems logical that children in this age range would be able to interpret happy facial expressions that could outweigh their interpretation of what was being said or the associated intonation changes. However, it was very interesting to note that when children were interpreting fearful facial expressions, children tended to rely on the vocal cues more to understand the information being present. While few of the results showed a large impact it continues to encourage us to think about what is being said and how it is said.
While I find this article fascinating and look forward to learning more about how to optimize interactions with children during painful procedures I question how often children in a painful situation are actually looking at the parent when they are “comforting” them. Many “comfort” positions we employ for children in the 5-10 year old age range are either being hugged by the parent, with the face of the child either turned to the side or gently snuggled to the chest, or sitting on the parent’s lap facing away from the parent. While it is clear from this study that facial expression provides more reliable information to the child than content of speech or intonation the opportunity for visualizing parents during painful procedures seems quite limited. Perhaps that question will be answered in future research.
Peggy Riley, RN, MN, MPH