Original Articles
Parental anxiety associated with referral of a child to a pediatric cardiologist for evaluation of a Still's murmur

https://doi.org/10.1067/mpd.2002.124379Get rights and content

Abstract

Objective: We assessed factors contributing to parental anxiety when children are referred to a cardiology clinic for evaluation of a Still's murmur. Methods: Parents of 95 children completed questionnaires designed to assess family and patient characteristics, parents' ratings of their anxiety and the reassurance they received from their pediatrician, and current (state) and general anxiety levels. Results: Parents reported anxiety about multiple issues including the need for medication (49%), sports restrictions (41%), cardiac surgery (29%), cardiac risk for siblings (20%), and premature death (13%). Of reporting mothers, 19% felt the murmur resulted from something they did wrong during pregnancy. Although 54% of parents were extremely reassured by their pediatrician, only 17% had no anxiety associated with the specialty visit. After reassurance from the cardiologist, 7% of parents had persistent anxiety. In multivariable analysis, 2 features, both related to the referring pediatrician, were significantly related to parental anxiety level. High parental anxiety was associated with lower pediatrician reassurance ratings and greater pediatrician practice years. Conclusions: Parental anxiety is common among parents of children referred for specialty evaluation. Educational strategies to improve pediatrician communication skills with parents may improve quality of care. (J Pediatr 2002;140:747-52)

Section snippets

Study population

Participants in this study consisted of 122 parents of 95 pediatric patients referred to one of 6 outpatient satellite clinics. Data were collected throughout a 12-month period beginning in July 1999. Parents were asked to participate if their child was >1 year old, had no previous pediatric cardiology evaluation, had no cardiac symptoms, had a normal electrocardiogram, and was diagnosed to have a Still's murmur and no structural heart disease by the cardiologist. The diagnosis of a Still's

Study group

Most of the parents were female, white, and had completed college (Table I).

. Study population characteristics

Parent
Age (y), (mean ± SD); median (range)35 ± 4.935 (25-46)
Gender (F)64 (67)
Education level ≥college59 (62)
White88 (93)
Family history of heart disease61 (64)
Family history of innocent murmur54 (57)
Child
Age (y), (mean ± SD); median (range)4.6 ± 3.04.0 (1-14)
First-born or only child46 (48)
Other medical condition33 (35)
Murmur detected <3 y53 (56)

Data in parentheses represent percent.

For a

Discussion

This study indicates that many parents whose children are referred to a pediatric cardiologist for evaluation of a Still's murmur are anxious about multiple aspects of their child's health. Many parents are unaware that murmurs in children can be benign and transient,21 or that heart disease in children usually is not associated with myocardial infarction or sudden death as can occur in adult coronary artery disease.10 Parental anxiety may contribute to the parent's view of the child as

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    Reprint requests: Robert L. Geggel, MD, Department of Cardiology, Children's Hospital, 300 Longwood Ave, Boston, MA 02115.

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