Children’s memories of pain are affected by adult anxiety, study finds

Young children who undergo routine surgery, such as having their tonsils out, are “greatly impacted” by the anxiety levels of the adults around them when it comes to memories of post-surgery pain, according to a study from the University of Calgary, which has also been published in medical journal Pain.

When adults are overly anxious, the children they care for tend to remember their post-surgical pain as being “far worse than it actually was”,researchers said. This misremembering can have long-term consequences that may follow a child into adulthood, leading to future pain problems, and a “fearful avoidance” of medical care, the study found.

Senior author of the study, Dr Melanie Noel, said that whilst it was important to be focused on how a child is feeling post surgery, “the elephant in the room is how the parents are feeling, which can be even more important for how the child is going to feel in the long term”.

The study is of importance to the early childhood education and care (ECEC) sector, not only for those educators who are also parents, but also for the implications in how educators recall post-surgery experiences for children in their care.

For the study, Dr 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 Dr Noel.

“It was all about how anxious mum or dad was. 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 child 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,” Dr Noel said.

Researchers found that the more stressed parents were 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.

Dr Noel said that the study builds on her previous research, which showed that 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 an injection. 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.”

Dr Noel noted that the research should not be construed as a message of “parent blaming”, but rather 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 children but also for the parents.

“Creating this supportive environment will help lower the anxiety of the parents. It’s important to recognise that parental anxiety does have an impact, and we’ve got to get that in check,” she said.

The paper can be viewed here.