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The Fear of Needles in Children David Gary Fassler Yale University Yale University EliScholar – A Digital Platform for Scholarly Publishing at Yale Yale Medicine Thesis Digital Library School of Medicine 1982 The fear of needles in children David Gary Fassler Yale University Follow this and additional works at: http://elischolar.library.yale.edu/ymtdl Recommended Citation Fassler, David Gary, "The fear of needles in children" (1982). Yale Medicine Thesis Digital Library. 2572. http://elischolar.library.yale.edu/ymtdl/2572 This Open Access Thesis is brought to you for free and open access by the School of Medicine at EliScholar – A Digital Platform for Scholarly Publishing at Yale. It has been accepted for inclusion in Yale Medicine Thesis Digital Library by an authorized administrator of EliScholar – A Digital Platform for Scholarly Publishing at Yale. For more information, please contact [email protected]. Permission for photocopying or microfilming of II II (Title of thesIs) for the purpose of Individual scholarly consultation or refer ence Is hereby granted by the author. This permission is not to be Interpreted as affecting publication of this work or otherwise placing it In the public domain, and the author re¬ serves all rights of ownership guaranteed under common law protection of unpublished manus Signature of Author Date Digitized by the Internet Archive in 2017 with funding from The National Endowment for the Humanities and the Arcadia Fund https://archive.org/details/fearofneedlesincOOfass Yale University * School of Medicine THE FEAR OF NEEDLES IN CHILDREN by DAVID GARY FASSLER Class of 1982 A thesis submitted to the Faculty of the Child Study Center Yale University School of Medicine in partial fulfillment of the requirements for the Degree of Doctor of Medicine New Haven, Connecticut * February, 1982 Med. L'lb ■ <112 ( > . BOSQ> * ) MM: . 'Wftfe- ■ ■ ' '■- v; r r'm , I'J 'fl ' ■' ■! ■'■ > '‘''■JrM-- I *^'i jK' •' -w ■: ■ '■ , ■ '■'■'■■ ■■ - ' ^^:.:■■■. ’ • ■ ;^w:i'#^,.-j'.. ^(/(>, wV':,ii ''' •■/' o'vJi; 7\V « s. Parenteral administration should be avoided whenever possible, since needle penetration may easily lead to unfriendly relations between patient and doctor or nurse. Garrod, 1974 in Diseases of Children Your own assurance to the child that painful treatment will not hurt will subsequently convince him that you are either a fool or a rogue and rob him of any confidence he may have had in you. Harland, 1960 Lots of grown-ups tell children to watch them instead of the shots. I’d rather watch to see what's going on. I'd rather know what's hap¬ pening. It's not scary if you know. Kids get worried when they don't know what's going on. The doctors and nurses often say "Oh, it will take only a minute. It'll go by so fast you won't notice it. Just a little mosquito bite." Well, it isn't a mosquito bite! I'd much rather watch and know. If it goes on too long, like taking blood sometimes, you do get worried. The doctors and nurses should explain everything that's going to happen so kids won't get worried. advice of a 9-year-old boy 11 •V -j ■ Tj rjj/T,a.?i r. '/rtf' '-jyJ ,'.1 iillr- , 1 ‘fO TOJ Tiv^ fcri—i?.,)” 1J. I'i -..‘tnrKq M ^irl.T OJ -rtjv/l*. ■J^'.^i.: i)wc r 7 I ;nH4<oO: f . ' » J'TUii toil inw :-'ir> TO ; -- )':l'o V'MUXS &1K ir-3V. '‘■ti-* -OiJ -'no.'' "iim 3n '^tti: ‘^'0 7 .it^^ tti fef:rf av^rl 0?j^f rCtifii i. 49? i t ■,! 7 i 4^VJ ' > V rtjT' £> i rt -■ Qj ,._)3ti'v n' i , Ri oria :7d : to wd 1 - q r* >J a' l-iii^v.’ v?* ^ t a: ■ .7 i* : t-’ I .'10 ..>* ' iJiirtw .*'’^ Kbc'ili . / ''7, rs>y J i V7 js.*5^ iOO ^'‘' :f) . yajL/i fiq , n7j .*>54 1 ' ..■■-]\J r^^ai^• f>vi7 7 0'«‘ , i-xi/o bn A . in^-fob iv.rtT uoy 1't .tt ofs v.tl Ci>» -Ci ' ft ■"Jtii C<T1 a y;J'to £;il(<5? i-. etJ- J •to'tri',. « .tf> u U . s . >. 7or. J ' Moff /.o-;: b‘ I o J i <j :,■ ^v.H,'! js J ’ ,'ie' :»t: M t*!!! ■ ifettqi ocjvJT tiT) •c,:- ji'\-: yvi r(V D: 1 Jtl fI -J ^ >7 x&li >i? t j- r -.D^ ) '4 Oft) uoy , i«jr i : i.r,4 :(J i.'tliwi '. A*'* f Octb ''^*>-1' t-i biJ if7ow 'i ^' P ■'' • ' ^ ^ ^ ^ rxiqjid .t^ ^/Tfo^ a b i, Jr ■ •} c o ,; -“9 u 1 o '> J ^V o * •**'1 ACKNOWLEDGMENTS This project would not have been possible without the interest and eager participation of the pediatric nursing staff of the orthopedic division of Boston Children's Hospital. I would also like to acknowledge the generous assistance and en¬ couragement of Dr. Myron Belfer and Dr. Gerald Koocher who went out of their way to make my time in Boston a most meaning¬ ful and productive experience. Throughout medical school. Dr. Melvin Lewis, Dr. Albert Solnit, and Dr. Morris Wessel have aided in the development of my interests and activities with their support, encouragement and friendship. I would like to particularly thank Dr. Lewis for the time, attention and helpful suggestions which he pro¬ vided as my advisor during the writing of this thesis. Many of the thoughts and concepts in this thesis were first explored with Nancy Wallace and Dana Alpern, both of whom seem always willing to listen to my half-formulated ideas and speculations. I would also like to thank Dr. Lori Brush and Dr. Carol Lynch who showed me both the rewards and the frustrations of research during my time as an undergraduate at Wesleyan. No undertaking of this type is possible without the sup¬ port and patience of friends and family. Special thanks to Brian and Saul, who fed and sheltered me during my summer data ii i ■li^f b£il. dfOSi.!ii) t©'fMJ / >>i'f’ fclOO a^r -x^^^^rrioiL !sT,3t<^-u 'ti^, n%rs%j^: .Tiff ’iai.''ajET’' ;*<K!>.Tf a ,cr->»’s-^ »^ ■' itn-gi't"c-■O',!' 'if:itp!d^' Y-o Jirf) Ja& '.. ‘ ' '■ ' f.: T'O t-f;-tKQ4')iiav’■»('> ^il.i 'ii.'-. 'Jf^bi^jfe «it7 3'_rt s»^'4’j:oM 'C^ h^B- ., ti'ii fo .1 .. / T'tiiPKi t ri'l:'t;i^ W'xs* ^?.)r*SJ*cel'ai Tii-'j/ii.aci:? '‘>.£' y Tu^Vf X biii -fQ*Js;i 74: npl'iw -u-'C'j Xw'Ic; t>n>r w< :.! iY^i;dr«: ./'Twii'j I'i'tit \o ’..aiw^drb ^fitii 'TO d''*.l^jt4rw edi •^t'.r'Uth "r.tf'Jiiv/lXiP, /;:f;» .0** , aii4^ f^ r ,p. •0\'?'TS*M :.i^ jxS'cM ., i-fx.'iif/' '■. ' •'wtI ■ #;= l-*i-^, ,i:(l osXjk'T . n5naX,ij»i^7i■ ■ ,.»t}«a bui j ■ ■ ■ ‘, ^ V " . ' . ' -f' .bi,fi 9^4 • U'1 oft tj-^iwrf'de')Orh^ tX!7n'i4 io . tCT bs ,. -S: r*.«-<9iw9« d r44r; «V7 s tgf .fLjfif oH ■ ■ 4*^.^ >^75^:44 . -?f X Xo bfltJS. 4'IC ^ ,; .. 4:- V ■llllllf I-^'ig, £iii« t.-i ,* ^^JA8"^JaJl 4i«l*3 wKmi ■ 0 A. collection in Boston; to Jed and Penny, who fed and tolerated me during my winter writing by the fire in Stony Creek; to my father, who showed me the joy of working with people and taught me to ask questions; to my mother, who kindled and encouraged my interest in children; and to my sister, whose sense of humor helps keep life in perspective. For their expert clerical assistance I am very grateful to Ms. Mary Ann Williams and Ms. Myrtle McLean. Finally, I wish to thank the children who shared the thoughts, feelings, drawings, stories and trust which made this project possible. IV ff 'f r ^ 'ft r •1 tfCf-J/ 7vliV 0 c ! V-‘ ',, , i U.t 3I.tl t,n/i i5.i<o ^;.a '.i;o;>iiv ivM . , I>..v-..i0 -m ri .'ir^ihilif:.' tri i '\UI11Ltl t rH 9 - .'X, -1 . 0 . i .-..v-.i0 . • 01 V qe-')?! aqT? ijV9.u-^ . - '//i:>v aij< X <>.>.;r.i->2 .f ix^irfJ To^ .ri-,VI‘->* - :.'i>s- siij-ii:i£W rm» - •■< !;.i'SF*Jfi>l(a ■jrfw ;'•.''•L' ^ I d-' '3'1 J jJ ii.aH J Cij sl^^tw t ^'^X/suli .hi i>i /c i ■'! .»r't'.’.' t,3in ( 'adilotB , *;>♦ pi , .':3|fi 1 ! »<:'- *''1 ^ r. .-vji'l I V eff,^' >- TABLE OF CONTENTS Page Chapter I. Introduction 1 General Background 1 Etiology: The Question of Pain 7 Review of Related Research and Methodology 12 Evaluation of Intervention Techniques 28 Evaluation of Assessment Techniques 29 Selection of Experimental Techniques 31 Hypotheses 33 Chapter II. Method 35 Subjects 35 Measuring Instruments 35 Experimental Method 37 Chapter III. Results 40 Chapter IV. Discussion 51 Analysis of Results 51 Clinical Evaluation 55 Implications 94 Chapter V. Summary 97 References 100 V in-"i yl ia'S>"f-it*' *■ |(Sr/tVTf t '1 i . i -j/g •-v?.:gr>ie i-;i . -w.. -'• 'tiX '’,' ‘, f i f •* Mv' >.':/ ’-^t ■' '1- J ^ ^ t nw i T B ut. '~irtl'' I j< ,^i'■)'jiT.'’ {.'iH; '} .fJ' ’ A'-' W-Syi* ®M <■ '■' 'J '’’,''' ‘ fW , t'X 9,v V • ■ ^ ■■! ’ ''ll? .•3'-2l,dj'fr '• ^1 rTR V'.: b, a•*;^.M' i -Si -> €^-!>;4..i .^'Ti \ifi4> i'}? cr'iv 4' tt. ., .'V J 1 ■; * t •■» 'a ’!" tJ'S'iij'H l0 ^ ‘- '■ ■ '■ V tt Jt/i fT^)J5'.4;ft.u‘’l, 'iiiw r* r>5 ■v„ i •jj Page Appendix A: Letter to Parents 108 Appendix B: Nurse Rating Scale i;i Appendix C: Children's Book Illustrations Depicting Injection 113 Appendix D: Needle Poem 116 VI ' ■ >' ' ' 'K ' ' ' \ '^'t f*'‘J ' ?%' :H.
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