Hospital Ingrassia - Child Neuropsychiatry Department, Palermo, Italy.
Headache. 2010 Feb;50(2):290-300. doi: 10.1111/j.1526-4610.2009.01583.x. Epub 2009 Dec 21.
Headache is a frequent occurrence among children and adolescents, and one of the most common causes of medical consultation. While serious conditions presenting headache as the chief complaint are not common in the pediatric population, enormous sums are invested to perform very expensive and often unnecessary diagnostic investigations. Pediatricians should adopt a flexible and diversified diagnostic/therapeutic approach and, at the same time, should not forget to take into consideration the demands, expectations, and worries of children and their parents.
The aim of this study was to assess simultaneously children's and mothers' expectations from the pediatric consultation concerning headache, and pediatricians' opinions about said expectations. In addition, we attempted to investigate mothers', children's, and pediatricians' opinions about symptomatic and prophylactic treatment of headache.
A total of 100 young headache sufferers, 50 were male and 50 were female, from 10 to 16 years of age, were enrolled in this study. Two diversified, self-administered, ad hoc questionnaires about their expectations from the pediatric treatment of headache and about symptomatic and prophylactic treatment were delivered to each patient and their mother, to which they responded separately. A third self-administered questionnaire was delivered to a sample of 50 pediatricians.
Our study showed that children and their mothers sometimes have different expectations about the consultation of the pediatrician and of the headache specialist. Frequency of pain was the main reason for pediatric consultation for 70% of mothers, whereas only 2% of them (as opposed to what pediatricians believed) consulted the pediatrician because they were worried about a tumor. Moreover, a high percentage of children and mothers expected from the pediatric consultation to be reassured that it is not a serious illness and to find out the causes of headache (60% and 47%, and 45% and 62%, respectively). A total of 26% of children wanted to know the progression of headache in the future, but only 3% of mothers shared the same demand. With regard to their expectations, pediatricians agree only in part with children and their mothers. On the contrary, the majority of children (68%), mothers (49%), and pediatricians (90%) agree that a symptomatic treatment was necessary in the presence of a severe pain. In addition, 61% of children, 37% of mothers, and 74% of pediatricians believed that a prophylactic treatment was necessary when the pain is severe and long-lasting.
Pediatricians sometimes do not consider sufficiently children's and mothers' wishes and expectations and, consequently, could limit the outcome of their diagnostic-therapeutic approach. This is particularly important because, in the developmental age, an accurate recognition of patients' and parents' expectations represents an essential requirement for a favorable outcome of the consultation.
头痛在儿童和青少年中很常见，也是最常见的就医原因之一。虽然儿科人群中出现以头痛为主要症状的严重疾病并不常见，但为了进行非常昂贵且通常不必要的诊断检查，却投入了大量资金。儿科医生应采取灵活多样的诊断/治疗方法，同时不应忽视儿童及其父母的需求、期望和担忧。
本研究旨在同时评估儿童和母亲对头痛儿科就诊的期望，以及儿科医生对这些期望的看法。此外，我们还试图调查母亲、儿童和儿科医生对头痛症状和预防性治疗的看法。
共纳入 100 例 10 至 16 岁的年轻头痛患者，其中 50 例为男性，50 例为女性。向每位患者及其母亲发放了两份关于他们对头痛儿科治疗的期望以及关于症状和预防性治疗的专门、自我管理的调查问卷，他们分别进行了回答。向 50 名儿科医生发放了第三份自我管理的调查问卷。
我们的研究表明，儿童及其母亲对儿科医生就诊和头痛专科医生就诊的期望有时并不相同。70%的母亲因疼痛频率而就诊，而只有 2%的母亲（与儿科医生的看法相反）因担心肿瘤而就诊。此外，许多儿童和母亲希望从儿科就诊中得到保证，即头痛不是严重疾病，并找出头痛的原因（分别为 60%和 47%，45%和 62%）。共有 26%的儿童想了解头痛的未来进展，但只有 3%的母亲有同样的需求。在期望方面，儿科医生仅部分同意儿童和母亲的看法。相反，大多数儿童（68%）、母亲（49%）和儿科医生（90%）认为在疼痛严重时需要进行对症治疗。此外，61%的儿童、37%的母亲和 74%的儿科医生认为在疼痛严重且持续时间长时需要进行预防性治疗。
儿科医生有时没有充分考虑儿童和母亲的愿望和期望，从而可能限制他们的诊断治疗方法的结果。这一点尤为重要，因为在发育阶段，准确识别患者和家长的期望是咨询结果良好的基本要求。
