ESPE Abstracts (2019) 92 P1-79

The experience of Pain in Children with Growth Hormone Deficiency and Psychosocial Correlates: Preliminary Data from a Longitudinal Prospective Study

Alessandra Bettini1,2, Caterina Teodori1, Francesca Maffei1, Daniele Ciofi2, Stefano Stagi2,3


1Pediatric Psychology, Anna Meyer Children's University Hospital, Florence, Italy. 2Department of Health Science, University of Florence, Anna Meyer Children's University Hospital, Florence, Italy. 3Division of Pediatric Endocrinology, Anna Meyer Children's University Hospital, Florence, Italy


Background: Pain represents one of the most stressful experiences for children undergoing medical therapies (Kortesluoma, 2008), but is under represented in literature for what concerns pediatric endocrinology. Children consider Injections one of the most painful, frighteningand distressing procedures (Fassler, 1985). The treatment for patients with Growth Hormone Deficiency requires daily subcutaneous injection, performed by parents or patients themselves. This may represent a burden for family and have an impact on Quality of Life (QoL) (Brod et al., 2017; Bullinger et. al, 2009). The present study aims to assess pain experience in pediatric patients undergoing GH therapy and explore psychosocial correlates.

Methods: 42 pediatric patients undergoing daily treatment with GH injections (males=61.5%, M age=11.8, SD=3.5) and one of their parents (mothers=73.1%) completed some questionnaire regarding QoL (QoLISSY, parent and child version), treatment burden (specifically designed questionnaire, parent and child version), emotional and behavioural characteristics of the child (CBCL, parent version). Also, a 7-day 0-10 points pain diary (Wong Baker Faces scale or VAS, based on age) was given to the family and returned to the researcher when completed, filled out by the patient after injection.

Results: Average pain score was 2.32, with younger children (3-10 years) experiencing significantly higher pain (M=3.04, SD=2.41) than older children (M=1.8, SD=1.07) [p< .05].

QoL was satisfying for 61.2% of patients and 46.6% of parents. A high number of participants described an insufficient QoL in all the considered sub-scales. In particular, "coping" scale was the most critical for patients (72.2% scored under cut-off) and parents (73.1%), who also reported issues in "beliefs" (65.4%) and "treatment" scales (88.5%).

Treatment burden for patients regarded the worry about forgetting to do the injection and their frequency, while parents reported feeling of sadness.

The 42.3% of parents described internalizing problems of their child (19.2% depressive symptoms; 11.5% somatic and social problems), while 11.2% reported externalising problems. Also, 23.1% of patients satisfied the DSM-IV criteria for Affective and Anxiety disorder.

Conclusions: These results highlight the presence of pain in young children in therapy for a GH deficiency, as well as a not satisfying situation for what concerns QoL and emotional/behavioural well-being, suggesting the need to pay attention to such issues in order to plan a better care of patients and families.

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