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Management of distressing procedures in children and young people: time to adhere to the guidelines
  1. Alistair J A Duff1,
  2. Sarah L Gaskell2,
  3. Konrad Jacobs3,
  4. Judith M Houghton4
  1. 1Department of Clinical & Health Psychology, Leeds Teaching Hospitals, Leeds, UK
  2. 2Department of Paediatric Psychosocial Service, Royal Manchester Children's Hospital, Manchester, UK
  3. 3Department of Paediatric Psychology, Oxford Radcliffe Hospitals, Oxford, UK
  4. 4Department of Paediatric Psychology & Play Therapy, Birmingham Children's Hospital, Birmingham, UK
  1. Correspondence to Alistair J A Duff, Leeds Teaching Hospitals, Clinical & Health Psychology, Leeds, UK; alistair.duff{at}

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Routine medical care involving blood sampling and other potentially painful procedures can lead to considerable distress for children and their carers. It is important that these should be undertaken with as little pain as possible. Yet despite the availability of effective topical and systemic analgesic agents, children and young people continue to find such procedures, particularly those involving needles, one of the most frightening aspects of attending primary and secondary healthcare services.1 While many cope, many do not; giving rise to a range of negative emotional and behavioural consequences, fear and pain. Some children and young people exhibit such distress that the process becomes fraught and eventually abandoned, or they are restrained, intensifying the anguish for all involved.

Needle-associated fear and pain in children and young people can lead to poor health consequences (eg, living with pain) and lower uptake rates of immunisation and medical treatment. In a large study of over 1350 high school adolescents, 16% reported high levels of fear during dental and medical injections and directly attributed this to avoidance of subsequent treatment.2

While age has long since been considered a salient predictor of distress during venepuncture,3 it is a myth that children and adolescents simply ‘grow out of it’. Approximately 10% of adults have such extreme fear of needles that they are considered ‘phobic’4 and engage in a wide range of avoidance behaviours (eg, failing to attend for dental care, vaccinations and other routine medical tests). The financial and operational costs to the UK health economy are indefinably large, resulting from rescheduling missed consultations, spending on topical anaesthesia and sedation (both conscious and unconscious) and ultimately morbidity4; indeed, in some extreme cases, mortality.5 …

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  • Competing interests None.

  • Provenance and peer review Commissioned; internally peer reviewed.