Development of behavioral distress in reaction to acute pain in two cultures

Studied developmental and gender differences in distress behavior during separate phases of a medical treatment in 2 cultures. Distress reactions of 175 children with cancer (age 8 months-18 years 7 months) were observed during bone marrow aspirations (BMA) in 2 different treatment centers (one in the United States, one in The Netherlands) using a behavioral checklist (Procedure Behavioral Rating Scale). The BMAs contained a preparatory phase, the actual needle introduction, and a recovery period. In both cultures almost all separate distress behaviors occurred less in older children, except for increasing muscle tension during the actual puncture. Distress was highest during the needle introduction and significantly lower during the preparatory and recovery phases; in addition, somewhat different patterns of distress behavior were found in separate phases. Culture and sex differences were found. The latter were less robust than developmental and phase differences.