Paediatric patients' distress and coping: an observational measure.

In the 1980s, the amount of behavioural distress in ill children was seen by researchers as an indirect measure of children’s coping; low distress was taken to indicate successful coping had occurred. By the 1990s, coping strategies were assessed by self report. However, observing a young patient’s distress behaviour is still a useful measure of their coping, and has been shown to be a good indicator of the way they feel about a particular medical treatment. Observational measures of distress have the added advantage that they can be used with very young children. In general, infants confronted with the sudden onset of a painful stimulus respond with a scream, followed by tears, grimaces, and body movements. At around 6 months of age, they show apprehension of a painful event—for example, an injection or a blood test—and the discomfort that this involves initiates distress behaviour. The capacity to anticipate an unpleasant event is a mark of a child’s development of learning and memory. During a toddler’s 2nd year, the period of screaming and crying generally decreases, and they visually begin to search out the mother and/or nurse before an injection. The first part of our paper describes an assessment procedure for distress behaviour, and the second part explains how the same instrument can be extended and used to assess the child’s coping behaviour.