Commentary: Preparing Young Children for Medical Procedures: Taking Account of Memory

The importance of preparation for children undergoing medical procedures has long been recognized in pediatric psychology. Indeed, 30 years ago, Melamed and Siegel (1975) stated that “there is a consensus that all children need some kind of psychological preparation for the hospital experience” (p. 511). The aims of preparation are typically twofold; to inform the child of the details of the experience, and to teach effective coping strategies. Whereas in earlier approaches, children were provided with procedural information and demonstration of the experience, recent interventions have involved the child and parent actively in cognitive behavioral “packages.” Typical elements include coaching in coping skills, modeling by a coping peer (via video or slideshow), and behavioral rehearsal using role plays or props (e.g., a doll) (Powers, 1999). Cognitive behavioral approaches have received consistent empirical support as a means of reducing distress (for reviews, see Blount, Piira, & Cohen, 2003; Kazdin & Weisz, 1998; Kuppenheimer & Brown, 2002; Powers, 1999). Nonetheless, we know little about the mechanisms by which such interventions are effective (Dahlquist, 1999), limiting our ability to make optimal decisions concerning their use. In considering how best to implement preparatory interventions, there is much to be gained from examining children’s memory of medical procedures. Within pediatric psychology, a nascent but important body of research informs us that the way that children remember a procedure has significant implications for their management of future medical encounters. For example, Chen and colleagues showed that children (aged 3to 18 years) who were distressed during a lumbar puncture (LP) developed exaggerations in memory for its negative aspects, which, in turn, were associated with heightened distress during the next LP. Importantly, distress during the following LP was reduced if, by way of preparation, the children were helped to reappraise and modify their negatively exaggerated memories (Chen, Zeltzer, Craske, & Katz, 1999, 2000). These findings highlight a two–way association between children’s memory and their distress (for reviews, see Ornstein, Manning, & Pelphrey, 1999; von Baeyer, Marche, Rocha, & Salmon, 2004). They also show that memories of medical procedures provide a window into children’s understanding and appraisal of their experience, and that this can be modified by preparation. In designing optimal preparatory interventions, it is also timely to consider the findings of research investigating the influence of pre-event information on young children’s memory for events. Although developmental research has considerable implications for pediatric psychology, as noted by Dahlquist (1999) conceptual issues have often been overshadowed by the need to establish effective interventions. This small body of research has greatest relevance for children undergoing a novel medical procedure, with which the child has no prior experience. In the typical paradigm, the researchers stage a novel event (e.g., visiting the “pirate” or the “pretend zoo”), having provided information in advance. The children are interviewed after a delay to assess their knowledge, understanding, and evaluation of the experience, reflected in their memory of it. The impact of preparation is assessed relative to a control condition (in which children received information unrelated to the event) (McGuigan & Salmon, 2004, 2005; Sutherland, Pipe, Schick, Murray, & Gobbo, 2003).