POSTOPERATIVE PAIN IN CHILDREN - DEVELOPMENTAL AND FAMILY INFLUENCES ON SPONTANEOUS COPING STRATEGIES

Despite advances in pharmacological approaches to pain control, most children who undergo surgery continue to experience moderate to severe postoperative pain. Children and their parents are forced to rely on personal resources to cope with this severe stressor. This study examined children and parents' reactions to post-operative pain, including stress appraisal and cognitive-behavioural coping processes from a developmental perspective. Sixty children (7-16 years) and their parents provided interview and psychometric data about pain and coping on the day following surgery. Observational data also was provided by nurses. Findings indicated moderate to severe levels of postoperative pain were common. Older children (10-16 years) provided more complex and multidimensional pain descriptions. All children described a variety of self-control strategies found to be helpful in managing postoperative pain. Older children were more likely to report using cognitive coping strategies, yet they reported lower overall self-efficacy. Multiple regression analyses revealed that coping strategy use, perceived self-efficacy, and frequency of catastrophizing thoughts were significantly predictive of children's pain, affective distress, and physical recovery. Parents were accurate judges of their child's pain and affective distress. Parental anxiety was positively related to child anxiety, and inversely related to child self-efficacy and frequency of cognitive coping. Parents acknowledged historical transmission of coping ideas, largely through verbal suggestions and reassurances. Implications for clinical practice are discussed.