Diagnostic uncertainty, the perceived lack of an accurate explanation of the patient’s health problem, remains relatively unstudied in children. This study examined the prevalence, familial concordance, and correlates of diagnostic uncertainty in children and their parents presenting to a multidisciplinary pain clinic in the United States. One hundred and twenty-six parents and 91 of their children (Mage = 13.93 years, range = 8–18 years) completed a brief three-item measure of diagnostic uncertainty, as well as measures of pain-related distress and functioning. Forty-eight percent of children and 37% of parents believed something else was going on with the child’s pain that doctors had not found out about yet. Across the three items, 66%–77% of children and their parents agreed in their endorsement of diagnostic uncertainty. Parents who believed that something else was going on with their child’s pain had children with higher avoidance of pain-related activities (F = 5.601, p = 0.020) and lower pain willingness (F = 4.782, p = 0.032). Neither parent nor child diagnostic uncertainty was significantly related to the child’s pain-related functioning. Diagnostic uncertainty, particularly in parents, is relevant in the experience of pediatric chronic pain and warrants further investigation as both a risk factor and therapeutic target.

Objective Parent responses can have a major impact on their child’s pain. The purpose of this systematic review is to (a) identify and describe measures assessing pain-related cognitive, affective, and behavioral responses in parents of children with chronic pain and (b) meta-analyze reported correlations between parent constructs and child outcomes (i.e., pain intensity, functional disability, and school functioning). Prospero protocol registration ID: CRD42019125496. Methods We conducted a systematic search of studies including a measure of parent/caregiver responses to their child’s chronic pain. Study characteristics and correlations between parent measures and child outcomes were extracted. Data were summarized and meta-analyzed. Results Seventy-nine met inclusion criteria using 18 different measures of cognitive/affective (n = 3), behavioral (n = 5), and multidimensional responses (n = 10). Measures were used a median of three times (range 1–48), predominantly completed by mothers (88%), and primarily in mixed pain samples. Psychometrics of measures were generally adequate. Meta-analyses were based on 42 papers across five measures. Results showed that each of the cognitive, affective, and behavioral parent constructs we examined was significantly associated with pain-related functional disability. A small number of measures assessing parent cognitions and affective functioning were associated with higher child pain intensity; however, the majority were not. Conclusion Findings demonstrate that there is a wealth of measures available, with adequate reliability overall but a lack of psychometrics on temporal stability. Synthesizing data across studies revealed small effects between parent responses and child functioning, and even smaller and/or absent effects on child pain intensity.

Objective Scan‐related anxiety (“scanxiety”) refers to the fear, stress, and anxiety in anticipation of tests and scans in follow‐up cancer care. This study assessed the feasibility of Ecological Momentary Assessment (EMA) for real‐world, real‐time capture of scanxiety using patients' personal smartphone. Methods Adolescent and Young Adult survivors of childhood cancer were prompted to complete EMA surveys on a smartphone app three times per day for 11 days (33 surveys total) around their routine surveillance scans. Participants provided structured feedback on the EMA protocol. Results Thirty out of 46 contacted survivors (65%) enrolled, exceeding the preregistered feasibility cutoff of 55%. The survey completion rate (83%) greatly exceeded the preregistered feasibility cutoff of 65%. Participants generally found the smartphone app easy and enjoyable to use and reported low levels of distress from answering surveys. Participants reported significantly more daily fear of cancer recurrence (FCR) and negative affect in the days before compared to the days after surveillance scans, aligning with the expected trajectory of scanxiety. Participants who reported greater FCR and scanxiety using comprehensive measures at baseline also reported significantly more daily FCR around their surveillance scans, indicating validity of EMA items. Bodily threat monitoring was prospectively and concurrently associated with daily FCR, thus warranting further investigation as a risk factor for scanxiety. Conclusions Findings indicate the feasibility, acceptability, and validity of EMA as a research tool to capture the dynamics and potential risk factors for scanxiety.

No abstract

Editor-Harkin et al reported the death of a young child in Dublin caused by methadone stored in a baby's bottle. 1 They rightly encourage the routine supply of measuring devices with methadone prescriptions, although perhaps a more appropriate arrangement in families with young children might be ongoing supervised administration within a pharmacy, which may also reduce the opportunity for resale of the drug among drug misusers. Such tragedies are not new. 2 During 1998, among 315 children admitted for observation and treatment for poisoning to the Royal Hospital for Sick Children in Glasgow, 22 had been poisoned with illicit drugs or methadone (table). All came from the local area. They included 11 preschool children who had accidentally ingested drugs, usually within the home. Methadone played a part in three of these 11 cases, although none was related to storage in feeding bottles. Some of these children were seriously ill, and one required intensive care. A further 11 children of school age were admitted over the same period, primarily poisoned by illicit drugs during experimental use or in the context of major psychosocial problems. These events, together with comparatively common accidental needlestick injuries seen after exposure to discarded injecting equipment, highlight the risks run by young children living in households or environments where illegal drugs or their substitutes are used. They represent an additional issue to be considered in supervising and protecting children in such families. Jack Beattie Consultant paediatrician-emergency medicine Royal Hospital for Sick Children, Glasgow G3 8SJ 1 Harkin K, Quinn C, Bradley F. Storing methadone in babies' bottles puts young children at risk [letter].