Feb. 20, 2019

Parental anxiety can negatively affect children's post-surgical pain memories

UCalgary-led study monitors the pain fears of 78 children and their parents following tonsillectomies
Melanie Noel, an associate professor in the Department of Psychology and member of the Alberta Children's Hospital Research Institute, has co-authored a study looking at the influence of parental anxiety on the post-surgical pain memories of young children.

Melanie Noel has co-authored a study looking at the influence of parental anxiety post-surgery.

Riley Brandt, University of Calgary

Young children who undergo routine surgeries are greatly impacted by the anxiety level of their parents when it comes to their memories of post-surgical pain, according to a University of Calgary study recently published in the medical journal Pain. When parents are overly anxious, their children tend to remember their post-surgical pain as being far worse than it actually was. This can have long-term consequences that may follow a child into adulthood, leading to future pain problems and a fearful avoidance of medical care. 

“Of course, it’s important to be focused on how a child feels after a surgery, but the elephant in the room is really how mom and dad are feeling,” says Dr. Melanie Noel, PhD, senior author of the study, an associate professor in the Department of Psychology and a member of the Alberta Children’s Hospital Research Institute. “That can be even more important for how the child is going to feel in the long term.”  

For the study Noel and her co-researchers followed the progress of 78 children between the ages of five and seven who underwent tonsillectomies. They also followed the progress of one parent of each of the children. 

The parents reported on their anxiety levels before surgery while the anxiety levels of the children were observed at the time of the anaesthesia induction. The children then reported on their post-surgical pain intensity and pain related fears for three days after discharge. One month after surgery the children were followed up with again, asked to recall their pain-related intensity and fears using the same scales previously administered. 

Researchers discovered that the children who remembered their pain as being far worse than it was tended to be those with parents who were the most anxious at the time of the surgery, regardless of how their children actually felt.  

“We could observe which of the children developed these exaggerated, catastrophic, increasingly scary memories and we found that the anxiety of the child didn’t matter,” says Noel. “It was all about how anxious mom or dad was.

“So, if a child rated their pain as a five out of 10 three days after surgery, but then, when we checked back a month later that same kid tells us ‘It was horrible!’ and rates their pain as a nine out of 10, we can determine that child is remembering the pain as being far worse than it really was. And the more stressed parents are the ones who have children saying it was worse than it was a month later. These are the children who developed the scary pain memories.” 

Noel knows from her past research that these exaggerated and distorted pain memories can lead to future problems. “This is the single biggest predictor of how that child is going to fare the next time they go to the hospital, the next time they’ve got to get a shot. And this can follow them throughout their lives. The adult that has a needle-phobia or who avoids the doctor or the dentist — this almost always stems from bad experiences in childhood. Early experiences with pain and health care really set the stage for how you’re going to approach these things in adulthood.” 

Noel notes that the Pain paper shouldn’t be taken as a message of “parent blaming.” Rather, it’s a red flag that health-care providers should be aware of. 

“I think it’s a signal to health-care providers that the more we can do to manage children’s pain the better it is, not only for the kids but also for the parents. Creating this supportive environment will help lower the anxiety of the parents. It’s important to recognize that parental anxiety does have an impact, and we’ve got to get that in check.” 

Among Noel’s co-writers on the Pain paper are former psychology honours student Shanaya Fischer, who won a best thesis award for the research; Dr. Susan Graham, PhD, director of the Owerko Centre at the Alberta Children’s Hospital Research Institute and member of the Hotchkiss Brain Institute; psychology graduate student Maria Pavolva; and Jillian Vinall, a postdoctoral fellow in the Department of Anesthesiology, Perioperative and Pain Medicine at the Cumming School of Medicine. 

Dr. Noel is also an adjunct assistant professor in the Department of Anesthesiology, Perioperative and Pain Medicine and a member of the Hotchkiss Brian Institute and the Mathison Centre for Mental Health Research and Education at the Cumming School of Medicine. 

Led by the Hotchkiss Brain InstituteBrain and Mental Health is one of six research strategies guiding the University of Calgary toward its Eyes High goals. The strategy provides a unifying direction for brain and mental health research at the university and positions researchers to unlock new discoveries and treatments for brain health in our community.