Child's Nervous System

, Volume 34, Issue 9, pp 1735–1743 | Cite as

Evaluation of parental and surgeon stressors and perceptions of distraction osteogenesis in pediatric craniofacial patients: a cross-sectional survey study

  • Rosaline S. Zhang
  • Lawrence O. Lin
  • Ian C. Hoppe
  • Ari M. Wes
  • Jordan W. Swanson
  • Scott P. Bartlett
  • Jesse A. TaylorEmail author
Original Paper



There is a paucity of literature on how limitations of distraction osteogenesis (DO) are perceived by physicians and parents of pediatric patients. Specifically understanding which features of DO are most concerning to these two groups may better inform parent education, as well as direct improvements in distraction protocols and devices.


Parents/guardians of patients (between January 2016 and October 2017) being treated with craniofacial distraction were recruited to complete a survey regarding level of stress (1 = not stressful, 9 = maximally stressful) associated with eight features of DO. Craniofacial surgeons completed a survey asking them to report (1) their personal level of stress and (2) their perceptions of parental stress regarding these same eight features of DO.


Thirty-five parents and 15 craniofacial surgeons completed the survey. The risk of the device getting infected was perceived as most stressful by parents (5.5 ± 2.3) followed by the device sticking through the skin (4.9 ± 2.6) and the second operation for removal (4.7 ± 2.3). These same three features also elicited the highest level of stress among surgeons. Surgeon-perceived parental stress regarding turning of the distractor (5.8 ± 1.5) was significantly higher than parent self-reported stress (4.2 ± 2.8, p = 0.042).


Both parents and surgeons perceive risk of device-associated infection, the protrusion of the device through the skin, and the requirement of a second operation for removal as the most stressful drawbacks of distraction. Infection reduction protocols, less obtrusive devices, and devices that do not require removal are potential targets for stress reduction.


Craniosynostosis Surgery Device Infection 


Compliance with ethical standards

Conflicts of interest

The authors declare that they have no conflict of interest.


This study has been approved by the Institutional Review Board for research involving human subjects at the Children’s Hospital of Philadelphia. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study. This article does not contain any studies with animals performed by any of the authors.

Data sharing

The data that support the findings of this study are available on reasonable request from the corresponding author [JT]. The data are not publicly available due to containing information that could compromise research participant privacy/consent.

Supplementary material

381_2018_3827_MOESM1_ESM.pdf (70 kb)
Supplemental Table 1 Comparison of stress levels by diagnosis (PDF 69 kb)
381_2018_3827_MOESM2_ESM.pdf (59 kb)
Supplemental Table 2 Correlation between reported stress level and time of survey acquisition (PDF 59 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Rosaline S. Zhang
    • 1
  • Lawrence O. Lin
    • 1
  • Ian C. Hoppe
    • 1
  • Ari M. Wes
    • 1
  • Jordan W. Swanson
    • 1
  • Scott P. Bartlett
    • 1
  • Jesse A. Taylor
    • 1
    Email author
  1. 1.Division of Plastic Surgery, Children’s Hospital of PhiladelphiaThe University of PennsylvaniaPhiladelphiaUSA

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