AN INVESTIGATION OF FACTORS RELATED TO FIVE-YEAR-OLD CHILDREN'S PSYCHOLOGICAL UPSET DURING AN OUTPATIENT PHYSICAL EXAMINATION

Forty children scheduled for a "kindergarten" physical examination and injection were interviewed in their homes prior to the clinic visit. Information on their health-care concepts, knowledge of medical procedures and instruments, their tendency to associate illness and punishment, and their fear of medical events was obtained. Children's psychological upset in the clinic was assessed through behavioral observation during the examination and through pulse rates taken at the beginning of the examination and following the injection.;Several aspects of the clinic setting were associated with children's responses. Length of time spent in the waiting room prior to examination was directly related to children's pulse rate following injection. In addition, children with siblings present who were also receiving an examination had higher post-injection pulse rates than those with siblings present as bystanders only. Parent state anxiety during the examination was related to children's pulse rate, despite the generally low anxiety scores recorded by parents.;Parent ratings of children's responses to past and present health care were directly related to children's behavioral upset throughout the examination and to their pulse rate after injection. The type of information parents had given their children concerning the clinic visit was unrelated to children's upset. However, all children had been given basic explanations of the visit.;Finally, the effect of prior hospitalization on children's responses was examined. Children previously hospitalized (N = 9) displayed more upset during the injection than those never hospitalized (N = 31). Moreover, children admitted under emergency conditions showed more behavioral upset throughout the examination than those admitted for elective surgery, and displayed more physiological and behavioral upset in response to the injection than children who were never hospitalized. Implications of these findings for identification of and intervention with potentially vulnerable children are discussed.;Results indicated that children's tendency to associate illness and punishment was related to their behavioral upset during the injection. Furthermore, increased ability to identify medical items was associated with reduced upset during the physician's examination. However, neither the sophistication of children's general health-care concepts nor their self-reported fear was related to their upset.