Systematic Review: Predisposing, Precipitating, Perpetuating, and Present Factors Predicting Anticipatory Distress to Painful Medical Procedures in Children

J Pediatr Psychol. 2016 Mar;41(2):159-81. doi: 10.1093/jpepsy/jsv076. Epub 2015 Sep 3.


Objective: To conduct a systematic review of the factors predicting anticipatory distress to painful medical procedures in children.

Methods: A systematic search was conducted to identify studies with factors related to anticipatory distress to painful medical procedures in children aged 0-18 years. The search retrieved 7,088 articles to review against inclusion criteria. A total of 77 studies were included in the review.

Results: 31 factors were found to predict anticipatory distress to painful medical procedures in children. A narrative synthesis of the evidence was conducted, and a summary figure is presented.

Conclusions: Many factors were elucidated that contribute to the occurrence of anticipatory distress to painful medical procedures. The factors that appear to increase anticipatory distress are child psychopathology, difficult child temperament, parent distress promoting behaviors, parent situational distress, previous pain events, parent anticipation of distress, and parent anxious predisposition. Longitudinal and experimental research is needed to further elucidate these factors.

Keywords: anxiety; children; infancy; pain; parents; systematic review.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • Adolescent
  • Anticipation, Psychological*
  • Anxiety / psychology*
  • Child
  • Child, Preschool
  • Female
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Mental Recall
  • Pain / psychology*
  • Parent-Child Relations
  • Parents
  • Psychopathology
  • Risk Factors
  • Temperament