Psychosocial adjustment and physical health of children living with maternal chronic pain. Journal of Paediatrics and Child Health, 43, 262-70

University of Otago, Taieri, Otago, New Zealand
Journal of Paediatrics and Child Health (Impact Factor: 1.15). 05/2007; 43(4):262-70. DOI: 10.1111/j.1440-1754.2007.01057.x
Source: PubMed


There is limited research examining the functioning of children living with parental chronic pain and illness. The aim of this study was to examine the psychosocial adjustment and physical health of children living with a mother experiencing chronic pain.
One-hundred and three children aged 6-12 years served as participants, with approximately equal numbers of children in maternal chronic pain (n=55) and control groups (n=48). Children completed self-reports about their internalising behaviour, health and attachment security. Mothers, fathers and teachers completed questionnaires relating to children's internalising and externalising behaviour, social behaviour and physical health.
Reports from children, mothers and fathers indicated significantly more internalising, externalising, insecure attachment and social and health problems for children in the maternal chronic pain group compared with control children. Teachers reported decreased social skills and increased pain complaints for children in the maternal chronic pain group. Boys in the maternal chronic pain group appear to be affected more than girls. Boys reported more anxiety and insecure attachment, while mothers reported greater social problems and increased illness behaviour for boys. Characteristics of the mother's pain condition, such as, severity, length and frequency were generally unrelated to child functioning.
The study demonstrates the importance of maternal and family variables to child outcomes. The results are discussed in terms of maternal chronic pain comprising a considerable, yet rarely studied, influence in the lives of young children.

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    • "Next to the unpleasantness of pain, insufficiently treated acute pain after CS can contribute to long-term negative outcomes such as chronic post-operative pain (Nikolajsen et al., 2004; Eisenach et al., 2008; Kainu et al., 2010), a threefold risk of developing postpartum depression, a risk for delayed breastfeeding and a feeling of guilt if the woman is not able to care for her newborn (Eisenach et al., 2008; Woods et al., 2012). Persistent maternal pain and depression have also been demonstrated to impair cognitive processes and might induce later behavioural disturbances in the child (Wrate et al., 1985; Grace et al., 2003; Evans et al., 2007). Despite the large number of RCTs to date, national guidelines are equivocal in their recommendations for perioperative pain management for CS, consequently there is no 'gold standard' (McDonnell et al., 2009; Kuczkowski, 2010; Gizzo et al., 2014). "
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    ABSTRACT: BackgroundA large cohort study recently reported high pain scores after caesarean section (CS). The aim of this study was to analyse how pain after CS interferes with patients' activities and to identify possible causes of insufficient pain treatment.Methods We analysed pain scores, pain-related interferences (with movement, deep breathing, mood and sleep), analgesic techniques, analgesic consumption, adverse effects and the wish to have received more analgesics during the first 24 h after surgery. To better evaluate the severity of impairment by pain, the results of CS patients were compared with those of patients undergoing hysterectomy.ResultsCS patients (n = 811) were compared with patients undergoing abdominal, laparoscopic-assisted vaginal or vaginal hysterectomy (n = 2406, from 54 hospitals). Pain intensity, wish for more analgesics and most interference outcomes were significantly worse after CS compared with hysterectomies. CS patients with spinal or general anaesthesia and without patient-controlled analgesia (PCA) received significantly less opioids on the ward (62% without any opioid) compared with patients with PCA (p < 0.001). Patients with PCA reported pain-related interference with movement and deep breathing between 49% and 52% compared with patients without PCA (between 68% and 73%; p-values between 0.004 and 0.013; not statistically significant after correction for multiple testing).Conclusion In daily clinical practice, pain after CS is much higher than previously thought. Pain management was insufficient compared with patients undergoing hysterectomy. Unfavourable outcome was mainly associated with low opioid administration after CS. Contradictory pain treatment guidelines for patients undergoing CS and for breastfeeding mothers might contribute to reluctance of opioid administration in CS patients.
    European journal of pain (London, England) 12/2014; 19(7). DOI:10.1002/ejp.619 · 2.93 Impact Factor
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    • "Children of parents with Parkinson disease (N = 77) reported a high frequency of daily hassles affecting their personal life (Dufour et al. 2006). Evans et al. (2007) examined attachment in children of mothers with chronic pain resulting from arthritis, other conditions or no medical condition, concluding that these children had more insecure attachment than controls. Further, children of parents with stroke frequently exhibited daily hassles (Dufour et al. 2006) and elevated levels of problem behavior even several years post-stroke (Visser-Meily et al. 2005). "
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    ABSTRACT: Approximately 10% of children grow up with a parent who has been diagnosed with a chronic medical condition (CMC) and seem to be at risk for adjustment difficulties. We examined differences in behavioral, psychosocial and academic outcomes between 161 adolescents from 101 families with a chronically ill parent and 112 adolescents from 68 families with healthy parents, accounting for statistical dependence within siblings. Children between 10 and 20 years and their parents were visited at home and filled in questionnaires. Multilevel analyses showed that 20-60% of the variance in most adolescent outcomes was due to the family cluster effect, especially in internalizing problem behavior, caregiving variables and quality of parent attachment. Conversely, the variance in stress and coping variables and grade point average (GPA) was mainly due to individual characteristics. Adolescents with parents affected by CMC displayed more internalizing problems than the comparison group and scored higher on frequency of household chores, caregiving responsibilities, activity restrictions, isolation, daily hassles and stress. In addition, their grade point average was comparatively worse. No group differences in externalizing problems, coping skills and quality of parent attachment were found. In conclusion, the family cluster effect largely explains adolescent outcomes and should be accounted for. Adolescents with parents affected by CMC are subject to an increased risk for internalizing problems, adverse caregiving characteristics, daily hassles, stress and a low GPA. According to a family-centered approach, school counselors and health care practitioners should be alert to adjustment difficulties of children with a chronically ill parent.
    Journal of Child and Family Studies 02/2013; 22(2):209-218. DOI:10.1007/s10826-012-9570-8 · 1.42 Impact Factor
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    • "In terms of illness-related characteristics, we hypothesize that long illness duration and high unpredictability of illness are positively related to adolescent problem behavior [1, 6, 11, 13, 16]. Concerning family characteristics, we hypothesize that adolescent problem behavior is predicted by low SES, poor quality of parent attachment, low marital functioning and high frequency of daily hassles concerning both parents [1, 15, 17]. "
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    ABSTRACT: A wide array of risk factors for problem behavior in adolescents with chronically ill parents emerges from the literature. This study aims to identify those factors with the highest impact on internalizing problem behavior (anxious, depressed and withdrawn behavior, and somatic complaints) and externalizing problem behavior (aggressive and rule-breaking behavior) as measured by the Youth Self-Report (YSR). The YSR was filled in by 160 adolescents (mean age = 15.1 years) from 100 families (102 chronically ill parents and 83 healthy spouses). Linear mixed model analyses were used, enabling separation of variance attributable to individual factors and variance attributable to family membership (i.e., family cluster effect). Predictors were child, parent, illness-related and family characteristics. The results showed that almost half of the variance in internalizing problem scores was explained by family membership, while externalizing problems were mainly explained by individual factors. Roughly 60 % of the variance in internalizing problems was predicted by illness duration, adolescents' feeling of isolation, daily hassles affecting personal life and alienation from the mother. Approximately a third of the variance in externalizing problems was predicted by adolescents' male gender, daily hassles concerning ill parents and alienation from both parents. In conclusion, the variance in adolescent problem behavior is largely accounted for by family membership, children's daily hassles and parent-child attachment. To prevent marginalization of adolescents with a chronically ill parent, it is important to be alert for signs of problem behavior and foster the peer and family support system.
    European Child & Adolescent Psychiatry 04/2012; 21(8):459-71. DOI:10.1007/s00787-012-0279-4 · 3.34 Impact Factor
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