Children’s Coping with Stressful Medical Procedures

  • Lizette Peterson
  • Krista K. Oliver
  • Lisa Saldana
Part of the Issues in Clinical Child Psychology book series (ICCP)


Childhood is a time in which children are cared for and protected by their parents. Medical procedures involving children thus provide a paradoxical situation for children and their families. Nowhere else in their experience are children subjected to a planned event that is frightening and often painful, while the parents look on passively or even assist in restraining the children. This same paradox of adult presence without protection, which presents such a challenge to children and their families, allows a unique opportunity for the investigation of how children cope with anxiety-provoking and painful experiences. Because most elective medical procedures are planned in advance, children and their families’ responses to a procedure can and have been meticulously explored through observation, interview, self-report, parent ratings, and physiological assessment (Peterson, 1984).


Preschool Child Coping Style Medical Procedure Secondary Coping Coping Skill Training 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Azarnoff, P., & Woody, R. D. (1981). Preparation of children for hospitalization in acute care hospitals in the United States. Pediatrics, 68, 361–368.PubMedGoogle Scholar
  2. Bachanas, P. J., & Roberts, M. C. (1995). Factors affecting children’s attitudes toward health care and responses to stressful medical procedures. Journal of Pediatric Psychology, 20, 261–275.PubMedGoogle Scholar
  3. Band, E. B., & Weisz, J. R. (1988). How to feel better when it feels bad: Children’s perspectives on coping with every day stress. Developmental Psychology, 24, 247–253.Google Scholar
  4. Blount, R. L., Bachanas, P. J., Powers, S. W., Cotter, M. C., Franklin, A., Chaplin, W., Mayfield, J., Henderson, M., & Blount, S. D. (1992). Training children to cope and parents to coach them during routine immunizations: Effects on child, parent, and staff behaviors. Behavior Therapy, 23, 689–705.Google Scholar
  5. Brain, D., J., & Maclay, I. (1968). Controlled study of mothers and children in hospital. British Medical Journal, 1, 278–280.Google Scholar
  6. Brown, J. M., O’Keefe, J., Sanders, S. H., & Baker, B. (1986). Developmental changes in children’s cognitions to stressful and painful situations. Journal of Pediatric Psychology, 11, 343–357.PubMedGoogle Scholar
  7. Burstein, S., & Meichenbaum, D. (1979). The work of worrying in children undergoing surgery. Journal of Abnormal Child Psychology, 7, 121–132.PubMedGoogle Scholar
  8. Bush, J. P., Melamed, B. G., Sheras, P. L., & Greenbaum, P. E. (1986). Mother-child patterns of coping with anticipatory medical stress. Health Psychology, 5, 137–157.PubMedGoogle Scholar
  9. Campbell, L. A., Kirkpatrick, S. E., Berry, C. C., Penn, N. E., Waldman, J. D., & Mathewson, J. W. (1992). Psychological preparation of mothers of preschool children undergoing cardiac catheterization. Psychology and Health, 7, 175–185.Google Scholar
  10. Cassell, S. (1965). Effects of brief puppet therapy upon the emotional responses of children undergoing cardiac catheterization. Journal of Consulting and Clinical Psychology, 29, 1–8.Google Scholar
  11. Chapman, A. H., Loeb, D. G., & Gibbons, M. J. (1956). Psychiatric aspects of hospitalizing children. Archives of Pediatrics, 73, 77–88.PubMedGoogle Scholar
  12. Chassin, L. A., Presson, C. C., & Sherman, S. J. (1985). Stepping backwards in order to step forward: An acquisition-oriented approach to primary prevention. Journal of Consulting and Clinical Psychology, 53, 612–622.PubMedGoogle Scholar
  13. Cicchetti, D., & Schneider-Rosen, K. (1986). An organizational approach to childhood depression. In M. Rutter, C. E. Izard, & P. B. Read (Eds.), Depression in young people: Clinical and developmental perspectives (pp. 71–134). New York: Guilford Press.Google Scholar
  14. Cortez, V. L., & Bugental, D. B. (1995). Priming of perceived control in young children as a buffer against fear-inducing events. Child Development, 66, 687–696.PubMedGoogle Scholar
  15. Dahlquist, L. M., Gil, K. M., Armstrong, D., Ginsberg, A., & Jones, B. (1985). Behavioral management of children’s distress during chemotherapy. Journal of Behavior Therapy and Experimental Psychiatry, 16, 325–329.PubMedGoogle Scholar
  16. Douglas, J.W.B. (1975). Early hospital admission and later disturbances of behaviour and learning. Developmental Medicine and Child Neurology, 17, 456–480.PubMedGoogle Scholar
  17. Eland, J. M., & Anderson, J. E. (1977). The experience of pain in children. In A. Jacox (Ed.), Pain: A source book for nurses and other professionals (pp. 453–473). Boston: Little, Brown.Google Scholar
  18. Elkins, P. D., & Roberts, M. C. (1985). Reducing medical fears in a general population of children: A comparison of three audiovisual modeling procedures. Journal of Pediatric Psychology, 10, 65–75.PubMedGoogle Scholar
  19. Elliott, C. H., & Olson, R. A. (1983). The management of children’s behavioral distress in response to painful medical treatment for burn injuries. Behaviour Research and Therapy, 21, 675–683.PubMedGoogle Scholar
  20. Faust, J., & Melamed, B. G. (1984). Influence of arousal, previous experience, and age on surgery preparation of same-day surgery and in-hospital patients. Journal of Consulting and Clinical Psychology, 52, 359–365.PubMedGoogle Scholar
  21. Faust, J., Olson, R., & Rodriguez, H. (1991). Same-day surgery preparation: Reduction of pediatric patient arousal and distress through participant modeling. Journal of Consulting and Clinical Psychology, 59, 475–478.PubMedGoogle Scholar
  22. Fawcett, S. B., Seekins, A., & Jason, L. A. (1987). Policy research and child passenger safety legislation: A case study and experimental evaluation. Journal of Social Issues, 43(2), 133–148.Google Scholar
  23. Ferguson, B. F. (1979). Preparing young children for hospitalization: A comparison of two methods. Pediatrics, 64, 656–664.PubMedGoogle Scholar
  24. Field, T. M. (1985). Attachment as psycho-biological attunement: Being on the same wavelength. In M. Reite & T. Field (Eds.), Psychobiology of attachment and separation (pp. 90–118). New York: Academic Press.Google Scholar
  25. Fishman, B. E., Cook, E. W., Hammock, S. J., Gregory, B. R., & Thomas, J. P. (1989, April). Familial transmission offear: Effects of maternal anxiety and presence on children’s response to dental treatment. Paper presented at the Florida Conference on Child Health Psychology, Gainesville, FL.Google Scholar
  26. Frank, N. C., Blount, R. L., Smith, A. J., Manimala, M. R., & Martin, J. K. (1995). Parent and staff behavior, previous child medical experience, and maternal anxiety as they relate to child procedural distress and coping. Journal of Pediatric Psychology, 20, 277–289.PubMedGoogle Scholar
  27. Frankl, S. N., Shiere, F. R., & Fogels, H. R. (1962). Should the parent remain with the child in the dental operatory? Journal of Dentistry for Children, 29, 150–163.Google Scholar
  28. Gabriel, H. P. (1977). A practical approach to preparing children for dermatologic surgery. Journal of Dermatological Surgery and Oncology, 3, 523–526.Google Scholar
  29. Gershen, J. A. (1976). Maternal influence on the behavior patterns of children in the dental situation. Journal of Dentistry for Children, 43, 28–32.PubMedGoogle Scholar
  30. Gonzalez, J. C., Routh, D. K., Saab, P. G., Armstrong, F. D., Shifman, L., Gueria, E., & Fawcett, N. (1989). Effect of parent presence on children’s reactions to injections: Behavioral, physiological, and subjective aspects. Journal of Pediatric Psychology, 14, 449–462.PubMedGoogle Scholar
  31. Gross, A. M., Stern, R. M., Levin, R. B., Dale, J., & Wojnilower, P. A. (1983). The effect of mother-child separation on the behavior of children experiencing a diagnostic medical procedure. Journal of Consulting and Clinical Psychology, 51, 783–785.PubMedGoogle Scholar
  32. Harbeck, C., & Peterson, L. (1992). Elephants dancing in my head: A developmental approach to children’s concepts of specific pains. Child Development, 63, 138–149.PubMedGoogle Scholar
  33. Hardgrove, C. B. (1980). Helping parents on the pediatric ward: A report on a survey of hospitals with “living-in” programs. Pediatrician, 9, 220–223.Google Scholar
  34. Hubert, N. C., Jay, S. M., Saltoun, M., & Hayes, M. (1988). Approach/avoidance and distress in children undergoing preparation for painful medical procedures. Journal of Clinical Child Psychology, 17, 194–202.Google Scholar
  35. Jackson, K., Winkley, R., Faust, O. A., & Cermack, E. (1952). The problem of emotional trauma in the hospital treatment of children. Journal of the American Medical Association, 149, 1536–1538.PubMedGoogle Scholar
  36. Jay, S. M., & Elliott, C. H. (1990). A stressful inoculation program for parents whose children are undergoing painful medical procedures. Journal of Consulting and Clinical Psychology, 58, 799–804.PubMedGoogle Scholar
  37. Jay, S. M., Elliott, C. H., Ozolins, M., & Olson, R. (1983). Behavioral management of children’s distress during painful medical procedures. Unpublished manuscript.Google Scholar
  38. Jensen, R. A. (1955). The hospitalized child: Round table. American Journal of Orthopsychiatry, 25, 293–318.PubMedGoogle Scholar
  39. Johnson, J. E., Kirchoff, K. T., & Endress, M. P. (1975). Altering children’s distress behavior during orthopedic case removal. Nursing Research, 24, 404–410.PubMedGoogle Scholar
  40. Kelley, M. L., Jarvie, G. J., Middlebrook, J. L., McNeer, M. F., & Drabman, R. S. (1984). Decreasing burned children’s pain behavior: Impacting the trauma of hydrotherapy. Journal of Applied Behavior Analysis, 17, 147–158.PubMedGoogle Scholar
  41. Klingman, A., Melamed, B. G., Cuthbert, M. I., & Hermecz, D. A. (1984). Effects of participant modeling on information acquisition and skill utilization. Journal of Consulting and Clinical Psychology, 52, 414–422.PubMedGoogle Scholar
  42. Knight, R. B., Atkins, A., Eagle, C., Evans, N., Finkelstein, J. W., Fukushima, D., Katz, J., & Weiner, H. (1979). Psychological stress, ego-defense, and cortisol production in children hospitalized for elective surgery. Psychosomatic Medicine, 41, 40–49.PubMedGoogle Scholar
  43. Kohen, D. (1986). Applications of relaxation/mental imagery (self-hypnosis) in pediatric emergencies. The International Journal of Clinical and Experimental Hypnosis, 34, 283–294.PubMedGoogle Scholar
  44. Kuttner, L. (1989). Management of young children’s acute pain and anxiety during invasive medical procedures. Pediatrician, 16, 39–44.PubMedGoogle Scholar
  45. Kuttner, L., Bowman, M., & Teasdale, M. (1988). Psychological treatment of distress, pain, and anxiety for young children with cancer. Developmental and Behavioral Pediatrics, 9, 374–381.Google Scholar
  46. LaBaw, W., Holton, C., Tewell, K., & Eccles, D. (1975). The use of self-hypnosis by children with cancer. The American Journal of Clinical Hypnosis, 17, 233–238.Google Scholar
  47. LaMontagne, L. L. (1984). Children’s locus of control beliefs as predictors of preoperative coping behavior. Nursing Research, 32, 76–79, 85.Google Scholar
  48. LaMontagne, L. L. (1987). Children’s preoperative coping: Replication and extension. Nursing Research, 36, 163–167.Google Scholar
  49. Lazarus, R. S., & Lanier, R. (1978). Stress-related transactions between person and environment. In L. A. Pervin & M. Lewis (Eds.), Perspectives in interactional psychology (pp. 287–327). New York: Plenum Press.Google Scholar
  50. Lumley, M. A., Abeles, L. A., Melamed, B. G., Pistone, L. M., & Johnson, J. H. (1990). Coping outcomes in children undergoing stressful medical procedures: The role of child-environment variables. Behavioral Assessment, 12, 223–238.Google Scholar
  51. Manne, S. L., Bakeman, R., Jacobsen, P., Gorfinkle, K., Bernstein, D., & Redd, W. (1992). Adult-child interaction during invasive medical procedures. Health Psychology, 11, 241–249.PubMedGoogle Scholar
  52. Manne, S. L., Bakeman, R., Jacobsen, P., & Redd, W. H. (1993). Children’s coping during invasive medical procedures. Behavior Therapy, 24, 143–158.Google Scholar
  53. Manne, S. L., Redd, W. H., Jacobsen, P. B., Gorfinkle, K., Shorr, O., & Rapkin, B. (1990). Behavioral intervention to reduce child and parent distress during venipuncture. Journal of Consulting and Clinical Psychology, 58, 565–572.PubMedGoogle Scholar
  54. Melamed, B. (1982). Reduction of medical fears: An information processing analysis. In J. Boulougouris (Ed.), Learning theory approaches to psychiatry (pp. 205–218). New York: WileyInterscience.Google Scholar
  55. Melamed, B. G. (1993). Putting the family back in the child. Behaviour Research and Therapy, 31, 239–247.PubMedGoogle Scholar
  56. Melamed, B. G., Dearborn, M. I., & Hermecz, D. A. (1983). Necessary considerations for surgery preparation: Age and previous experience. Psychosomatic Medicine, 45, 517–525.PubMedGoogle Scholar
  57. Melamed, B. G., Meyer, R., Gee, C., & Soule, L. (1976). The influence of time and type of preparation on children’s adjustment to hospitalization. Journal of Pediatric Psychology, 1, 31–37.Google Scholar
  58. Melamed, B. G., Robbins, R. L., & Fernandez, J. (1982). Factors to be considered in psychological preparation for surgery. In D. Routh & M. Wolraich (Eds.), Advances in developmental and behavioral pediatrics (pp. 51–72). New York: JAI.Google Scholar
  59. Melamed, B. G., & Siegel, L. J. (1975). Reduction of anxiety in children facing hospitalization and surgery by use of filmed modeling. Journal of Consulting and Clinical Psychology, 43, 511–521.PubMedGoogle Scholar
  60. Miller, S. M., Roussi, P., Caputo, G. C., & Kruus, L. (1995). Patterns of children’s coping with an aversive dental treatment. Health Psychology, 14, 236–246.PubMedGoogle Scholar
  61. O’Byrne K., Peterson, L., & Saldana, L. (in press). Predicting the selection of effective prehospital preparation programs: Pediatric hospital response to survey. Health Psychology.Google Scholar
  62. Olson, A. L., Johnson, S. G., Powers, L. E., Pope, J. B., & Klein, R. B. (1993). Cognitive coping strategies of children with chronic illness. Developmental and Behavioral Pediatrics, 14, 217–223.Google Scholar
  63. Peterson, L. (1984). A brief methodological comment on possible inaccuracies induced by multimodal measurement analysis and reporting. Journal of Behavior Medicine, 7, 307–313.Google Scholar
  64. Peterson, L. (1989). Coping by children undergoing stressful medical procedures: Some conceptual, methodological, and therapeutic issues. Journal of Consulting and Clinical Psychology, 57, 380–387.PubMedGoogle Scholar
  65. Peterson, L., & Harbeck, C. (1988). The pediatric psychologist: Issues in professional development and practice. Champaign, IL: Research Press.Google Scholar
  66. Peterson, L., Harbeck, C., Chaney, J., Farmer, J., & Thomas, A. M. (1990). Children’s coping with medical procedures: A conceptual overview and integration. Behavioral Assessment, 12, 197–212.Google Scholar
  67. Peterson, L., Mori, L., & Carter, P. (1985). The role of the family in children’s responses to stressful medical procedures. Journal of Clinical Child Psychology, 14, 98–104.Google Scholar
  68. Peterson, L., & Oliver, K. K. (1994). Prevention of injuries and diseases. In M. C. Roberts (Ed.), Handbook of pediatric psychology (pp. 185–199). New York: Guilford Press.Google Scholar
  69. Peterson, L., & Ridley-Johnson, R. (1980). Pediatric hospital response to surgery on prehospital preparation for children. Journal of Pediatric Psychology, 5, 1–7.PubMedGoogle Scholar
  70. Peterson, L., Ridley-Johnson, R., Tracy, K., & Mullins, L. L. (1984). Developing cost-effective presurgical preparation: A comparative analysis. Journal of Pediatric Psychology, 9, 274–296.Google Scholar
  71. Peterson, L., Schultheis, K., Ridley-Johnson, R., Miller, D. V., & Tracy, K. C. (1984). Comparison of three modeling procedures on the presurgical and postsurgical reactions of children. Behavior Therapy, 15, 197–203.Google Scholar
  72. Peterson, L., & Shigetomi, C. (1981). The use of coping techniques to minimize anxiety in hospitalized children. Behavior Therapy, 12, 1–14.Google Scholar
  73. Peterson, L., & Shigetomi, C. (1982). One-year follow-up of elective surgery child patients perceiving preoperative preparation. Journal of Pediatric Psychology, 7, 43–48.PubMedGoogle Scholar
  74. Peterson, L., & Starr, L. (1994, April). Coping with medical procedures and injury: Issues in children coping with medical proced ures. Paper presented at the 15th Annual Scientific Session of the Society of Behavioral Medicine, Boston, MA.Google Scholar
  75. Peterson, L., & Toler, S. M. (1986). An information seeking disposition in child surgery patients: Some preliminary evidence. Health Psychology, 5, 343–358.PubMedGoogle Scholar
  76. Pidgeon, V. (1981). Children’s concepts of illness: Implications for health teaching. Maternal-Child Nursing Journal, 14, 23–35.Google Scholar
  77. Pinto, R. P., & Hollandsworth, J. G. (1989). Using video tape modeling to prepare children psychologically for surgery: Influence of parents and costs versus benefits of providing preparation services. Health Psychology, 8, 79–95.PubMedGoogle Scholar
  78. Polister, P. (1988). Ambulatory surgery: Some issues and considerations. American College of Surgery Bulletin, 73, 26–29.Google Scholar
  79. Poster, E. C., (1983). Stress immunization: Techniques to help children cope with hospitalization. Maternal-Child Nursing Journal, 12, 119–134.PubMedGoogle Scholar
  80. Powers, S. W., Blount, R. L., Bachanas, P. L., Cotter, M. W., & Swan, S. C. (1993). Helping preschool leukemia patients and their parents cope during injections. Journal of Pediatric Psychology, 18, 681–695.PubMedGoogle Scholar
  81. Prugh, D. G., & Jordon, K. (1975). Physical illness or injury: The hospital as a source of emotional disturbances in child and family. In I. N. Berlin (Ed.), Advocacy for children in mental health (pp. 208–249). New York: Brunner/Mazel.Google Scholar
  82. Prugh, D. G., Staub, E. M., Sands, H. H., Kirschbaum, R. M., & Lenihan, E. A. (1953). A study of the emotional reactions of children and families to hospitalization and illness. American Journal of Orthopsychiatry, 23, 70–106.PubMedGoogle Scholar
  83. Rapoff, M. A., Christophersen, E. R., & Rapoff, K. E. (1982). The management of common childhood bedtime problems by pediatric nurse practitioners. Journal of Pediatric Psychology, 7, 179–196.PubMedGoogle Scholar
  84. Rasnake, L. K., & Linscheid, T. R. (1989). Anxiety reduction in children receiving medical care: Developmental considerations. Journal of Developmental and Behavioral Pediatrics, 10, 169–175.PubMedGoogle Scholar
  85. Roder, R. E., Lewis, T. M., & Law, D. B. (1961). Physiological responses of dentists to the presence of the parent in the operatory. Journal of Dentistry for Children, 28, 263–270.Google Scholar
  86. Roskies, E., Mongeon, M., & Gagnon-Lefebre, B. (1978). Increasing participation in the hospitalization of young children. Medical Care, 16, 765–777.PubMedGoogle Scholar
  87. Schultheis, K., Peterson, L., & Selby, V. (1987). Preparation for stressful medical procedures and person x treatment interactions. Clinical Psychology Review, 7, 329–352.Google Scholar
  88. Shaw, E. G., & Routh, D. K. (1982). Effects of mother presence on children’s reaction to adverse procedures. Journal of Pediatric Psychology, 7, 33–42.PubMedGoogle Scholar
  89. Sheridan, M. S. (1975). Talk time for hospitalized children. Social Work, 20, 40–44.Google Scholar
  90. Siegel, L. J. (1976). Preparation of children of hospitalization: A selected review of the research literature. Journal of Pediatric Psychology, 1, 26–30.Google Scholar
  91. Siegel, L. J. (1981, April). Naturalistic study of coping strategies in children facing medical proced ures. Paper presented at the meeting of the Southeastern Psychological Association, Atlanta, GA.Google Scholar
  92. Siegel, L. J., & Peterson, L. (1980). Stress reduction in young dental patients through coping skills and sensory information. Journal of Consulting and Clinical Psychology, 48, 785–787.PubMedGoogle Scholar
  93. Siegel, L. J., & Peterson, L. (1981). Maintenance effects of coping skills and sensory information on young children’s response to repeated dental procedures. Behavior Therapy, 12, 530–535.Google Scholar
  94. Simeonsson, R. J., Buckley, L., & Munson, L. (1979). Conceptions of illness causality in hospitalized children. Journal of Pediatric Psychology, 4, 77–84.Google Scholar
  95. Skipper, J. K., & Leonard, R. C. (1968). Children, stress, and hospitalization: A field experiment. Journal of Health and Social Behavior, 9, 275–287.PubMedGoogle Scholar
  96. Skipper, J. K., Leonard, R. C., & Rhymes, J. (1968). Child hospitalization and social interaction: An experimental study of mothers’ feelings of stress, adaptation, and satisfaction. Medical Care, 6, 496–506.Google Scholar
  97. Smith, K. E., Ackerson, J. P., & Blotcky, A. D. (1989). Reducing distress during invasive medical procedures: Relating behavioral interventions to preferred coping style in pediatric cancer patients. Journal of Pediatric Psychology, 14, 405–419.PubMedGoogle Scholar
  98. Smith, K. E., Ackerson, J. P., Blotcky, A. D., & Berkow, R. (1990). Preferred coping styles of pediatric cancer patients during invasive medical procedures. Journal of Psychosocial Oncology, 8, 59–70.Google Scholar
  99. Thompson, M. L. (1994). Information-seeking coping and anxiety in school-age children anticipating surgery. Children’s Health Care, 23, 87–97.PubMedGoogle Scholar
  100. Venham, L. L. (1973). The effect of the mother’s presence on the child’s response to a stressful situation. Unpublished manuscript. University of Connecticut, Storrs.Google Scholar
  101. Vernon, D.T.A., Foley, J. M., & Shulman, J. L. (1967). Effect of mother—child separation and birth order on young children’s responses to two potentially stressful experiences. Journal of Personality and Social Psychology, 5, 162–174.PubMedGoogle Scholar
  102. Vernon, D.T.A., & Thompson, R. H. (1993). Research on the effect of experimental interventions on children’s behavior after hospitalization: A review and synthesis. Journal of Developmental and Behavioral Pediatrics, 14, 36–44.PubMedGoogle Scholar
  103. Weisz, J. R., McCabe, M. A., & Dennig, M. D. (1994). Primary and secondary control among children undergoing medical procedures: Adjustment as a function of coping style. Journal of Consulting and Clinical Psychology, 62, 324–332.PubMedGoogle Scholar
  104. Wilson, A. M. (1982). A familiar face. Anaesthesia, 37, 1225.PubMedGoogle Scholar
  105. Wolfer, J. A., & Visintainer, M. A. (1975). Pediatric surgery patients’ and parents’ stress responses and adjustment. Nursing Research, 24, 244–255.PubMedGoogle Scholar
  106. Zastowny, T. R., Kirschenbaum, D. S., & Meng, A. L. (1986). Coping skills training for children: Effect on distress before, during, and after hospitalization for surgery. Health Psychology, 5, 231–247.PubMedGoogle Scholar
  107. Zeltzer, L., & LeBaron, S. (1982). Hypnosis and nonhypnotic techniques for reduction of pain and anxiety during painful procedures in children and adolescents with cancer. Journal of Pediatrics, 101, 1032–1035.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 1997

Authors and Affiliations

  • Lizette Peterson
    • 1
  • Krista K. Oliver
    • 1
  • Lisa Saldana
    • 1
  1. 1.Department of PsychologyUniversity of Missouri at ColumbiaColumbiaUSA

Personalised recommendations