January 1997

Parents and procedures: a randomized controlled trial.

Bauchner H, Vinci R, Bak S, Pearson C, Corsin MJ

Pediatrics 1996:98:861-867

[ no abstract available ]

This paper examined parents' response to being present or not being present when their child was undergoing a painful procedure in the emergency room (venipuncture, intravenous cannulation, or urethral catheterization. All children were younger than 3 years. 431 parents were randomized to "intervention present" or intervention not present".

The groups were similar in terms of sociodemographic variables and prior emergency room experience. There were no differences between groups to pain (3 point scale measured by parent, clinician and analysis of cry); performance of procedure (number of attempts, completion of procedure by first clinician, time); clinician anxiety; or parental satisfaction with care. Pain tended to be rated higher by parents than by clinicians. Parental presence did not reduce pain.

Comment: This paper is important because it "challenges the traditional belief that parental presence negatively affects our ability to successfully complete procedures". I believe that this is consistent with our experience with parents present during the induction of anesthesia. In general parents were less anxious when they were allowed to be present. My personal experience has been that parents are very grateful to have been allowed to accompany their child to the operating room.

This paper confirms from a slightly different viewpoint that parents who wish to be with their children during a stressful process should be allowed and encouraged to be there. Obviously induction of anesthesia in a 2 year old who is not premedicated may be more stressful than induction in a child who has been premedicated. The choice and route of premedication remains a challenge for the clinician but I would certainly recommend premedication of children who are too young to be reasoned with or distracted by the telling of a story (hypnotic induction).