Evaluated the relationship between child distress behavior during lumbar punctures, parent behavior during the procedure, and parental self-reports of parenting stress, discipline strategies, and locus of control in 31 children with cancer. Child distress was measured by behavior observed during the procedure, and self-reported levels of experienced distress. Hierarchical regression analyses were employed to evaluate the combined influence of the variables of interest, after controlling for the effects of age. Parent behaviors found to be significantly related to observed child distress included behavioral commands, reassurance, empathy, commands for procedural activity, and nonprocedural talk to adults. Taken together, these behaviors significantly accounted for 43% of the variance in observed child distress. Parent behaviors significantly related to self-reported child distress included behavioral commands, nonprocedural talk to the child, giving the child control, child's general condition talk, and checking the child's status. In combination, these behaviors significantly accounted for 38% of the variance in reported distress.

Parent characteristics were also evaluated in relationship to parent behavior during the procedure. Reports of child-related parenting stress and use of dependent discipline strategies were significantly related to both sets of distress-associated parent behavior. Taken together, these parent measures accounted for 20% of the variance in objective distress-related parent behavior, and 27% of the variance in subjective distress-related parent behavior. Parenting characteristics were then evaluated in direct relationship to child distress. Findings were similar to those reported for the distress-associated parent behaviors. Child-related parenting stress was the only parent characteristic related to observed distress, and accounted for 15% of the variance in objective distress levels. Child-related parenting stress, use of dependent discipline strategies, and aspects of parental locus of control were related to subjective child distress. These parent characteristics in combination accounted for a 33% of the variance in children's self-reported distress. Findings were discussed in relationship to understanding and intervening with child distress behavior during painful medical procedures.