81 Development and evalutation of the Hospital Hero app 4 Background (Pre)procedural anxiety and its negative (health)consequence in children – short and long term Medical procedures in children such as blood drawing performed at the outpatient department are often accompanied by stress and anxiety before and during the procedure (1). Feelings of stress and anxiety during procedures may elicit strong behavioural responses such as crying, withdrawal or showing uncooperative behaviour. Subsequently, procedural distress, especially experienced in early life, can result in numerous disadvantageous psychological health outcomes (2) and pose a substantial burden on children, their caregivers and healthcare providers involved. Generally, children are able to remember their experiences and exaggerate these negative memories when considerable distress is experienced, which in turn can lead to more distress in subsequent hospital visits (3). In the long term, procedural distress can have severe implications for the individual experiencing distress and the society as a whole. A growing body of evidence shows that early childhood hospital-related trauma is associated with hospital-induced anxiety and needle trauma later in life (4-6). Also negative experiences with healthcare may negatively influence a child’s attitude towards healthcare and healthcare providers in general and influence appropriate coping skills in adulthood (6). In addition, distress may increase pain sensation and decrease analgesic efficacy, resulting in a higher titration need and decreased compliance with future procedures and treatments (7). Coping strategies While invasive procedures such as blood drawing or injections are a common source of pre-procedural distress, non-invasive procedures or the hospital environment in general can also cause stress and anxiety (6). As such, procedural comfort, directed at minimizing distress throughout a hospital visit, is considered an essential part of paediatric care and has been included in medical guidelines as a necessary adjuvant to procedural sedation. In fact, more recently, academics have opted for procedural comfort as the starting point and sedation as the adjuvant. Procedural comfort aims to provide children with appropriate coping skills. As such, these nonpharmacological interventions can roughly be categorized into (1) distraction (i.e., diverting the attention from the procedure to something more positive; e.g., focus on an object, watching a funny movie), (2) emotional control (e.g. use of comfort talk, relaxation), (3) psychological preparation (i.e. information about procedures and sensations to expect, normalization of anxiety) and giving the child a feeling of autonomy and control. Providing children with coping skills is especially important for younger children, as they are not yet able to verbally express their feelings and understand the rationale for a specific procedure as a way to cope with a stressful event (8). Additionally, the child’s understanding of the degree of discomfort expected is not well developed.
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