{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T21:44:01Z","timestamp":1792446241996,"version":"4.5.0"},"reference-count":54,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,1,22]],"date-time":"2021-01-22T00:00:00Z","timestamp":1611273600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2021,1,22]],"date-time":"2021-01-22T00:00:00Z","timestamp":1611273600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100009471","name":"EkstraStiftelsen Helse og Rehabilitering","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100009471","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Pediatr Rheumatol"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Overall outcomes of pediatric rheumatic diseases (RD) have improved due to treatment with biologic agents and methotrexate. For many children, this treatment often entails regular needle injections. Pain and fear of needle injections are common in childhood, but how children and parents handle long-term needle injections at home has not been fully explored. This study aimed to explore how regular needle injections affect children with RD and their parents in their daily living.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This explorative qualitative study used individual interviews and focus groups to ensure a comprehensive investigation of the topic. Children aged 6 to 16\u2009years (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20097) and their parents (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20098) were interviewed individually 4 to 6\u2009months after the onset of needle injection treatment. The focus groups included children aged 11 to 17\u2009years (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20099) and parents (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20098) with a minimum of 6\u2009months of experience with injection treatment. Data were analyzed using thematic analysis.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The main themes; \u201cchallenges,\u201d \u201cmotivational factors,\u201d and \u201croutines\u201d captured experiences and strategies that influenced the continuation of needle injections at home. Many children feared the moment immediately before the needle stick, although they had become accustomed to the pain. Most parents felt insecure about handling needle injections and lacked follow-up from healthcare providers. The children\u2019s experience of treatment effects and self-confidence were essential to maintain motivation for further injections. A number of coping strategies helped children focus away from injection related discomfort, often discovered by chance. Facilitating firm routines and shared responsibility within families helped children develop self-confidence during the procedure. Children and parents struggled to find suitable information on the Internet.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Children and parents experienced long-term needle injections challenging. They used their own limited resources and cooperated within the families to create routines and to introduce coping strategies necessary to manage and keep up with the procedure. Although the injection itself was not experienced very painful, the discomfort, worries and impact on daily life represented far more than a little needle stick, and thus needs more attention from healthcare providers.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12969-021-00495-4","type":"journal-article","created":{"date-parts":[[2021,1,22]],"date-time":"2021-01-22T03:03:37Z","timestamp":1611284617000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":21,"title":["I don\u2019t want to think about it: a qualitative study of children (6\u201318\u2009years) with rheumatic diseases and parents\u2019 experiences with regular needle injections at home"],"prefix":"10.1186","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2719-0807","authenticated-orcid":false,"given":"Kari","family":"S\u00f8rensen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helge","family":"Skirbekk","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gunnvald","family":"Kvarstein","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hilde","family":"W\u00f8ien","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,1,22]]},"reference":[{"issue":"1","key":"495_CR1","doi-asserted-by":"publisher","first-page":"45","DOI":"10.1186\/s12969-018-0261-x","volume":"16","author":"HI Brunner","year":"2018","unstructured":"Brunner HI, Rider LG, Kingsbury DJ, Co D, Schneider R, Goldmuntz E, et al. Pediatric rheumatology collaborative study group - over four decades of pivotal clinical drug research in pediatric rheumatology. Pediatr Rheumatol Online J. 2018;16(1):45.","journal-title":"Pediatr Rheumatol Online J"},{"issue":"9","key":"495_CR2","doi-asserted-by":"publisher","first-page":"1147","DOI":"10.1007\/s00431-017-2960-6","volume":"176","author":"F Vanoni","year":"2017","unstructured":"Vanoni F, Minoia F, Malattia C. Biologics in juvenile idiopathic arthritis: a narrative review. Eur J Pediatr. 2017;176(9):1147\u201353.","journal-title":"Eur J Pediatr"},{"issue":"10","key":"495_CR3","doi-asserted-by":"publisher","first-page":"1854","DOI":"10.1136\/annrheumdis-2014-205372","volume":"74","author":"J Guzman","year":"2015","unstructured":"Guzman J, Oen K, Tucker LB, Huber AM, Shiff N, Boire G, et al. The outcomes of juvenile idiopathic arthritis in children managed with contemporary treatments: results from the ReACCh-out cohort. Ann Rheum Dis. 2015;74(10):1854\u201360.","journal-title":"Ann Rheum Dis"},{"issue":"1","key":"495_CR4","doi-asserted-by":"publisher","first-page":"64","DOI":"10.1186\/s12969-018-0281-6","volume":"16","author":"K Risum","year":"2018","unstructured":"Risum K, Hansen BH, Selvaag AM, Molberg O, Dagfinrud H, Sanner H. Physical activity in patients with oligo- and polyarticular juvenile idiopathic arthritis diagnosed in the era of biologics: a controlled cross-sectional study. Pediatr Rheumatol Online J. 2018;16(1):64.","journal-title":"Pediatr Rheumatol Online J"},{"key":"495_CR5","first-page":"1","volume":"00","author":"J McLenon","year":"2018","unstructured":"McLenon J, Rogers MAM. The fear of needles: a systematic review and meta-analysis. J Adv Nurs. 2018;00:1\u201313.","journal-title":"J Adv Nurs"},{"issue":"32","key":"495_CR6","doi-asserted-by":"publisher","first-page":"4807","DOI":"10.1016\/j.vaccine.2012.05.011","volume":"30","author":"A Taddio","year":"2012","unstructured":"Taddio A, Ipp M, Thivakaran S, Jamal A, Parikh C, Smart S, et al. Survey of the prevalence of immunization non-compliance due to needle fears in children and adults. Vaccine. 2012;30(32):4807\u201312.","journal-title":"Vaccine."},{"issue":"3","key":"495_CR7","first-page":"480","volume":"25","author":"A van der Meer","year":"2007","unstructured":"van der Meer A, Wulffraat NM, Prakken BJ, Gijsbers B, Rademaker CM, Sinnema G. Psychological side effects of MTX treatment in juvenile idiopathic arthritis: a pilot study. Clin Exp Rheumatol. 2007;25(3):480\u20135.","journal-title":"Clin Exp Rheumatol"},{"issue":"1","key":"495_CR8","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1007\/s00431-018-3286-8","volume":"178","author":"J Jacobse","year":"2019","unstructured":"Jacobse J, Ten Voorde W, Rissmann R, Burggraaf J, Ten Cate R, Schrier L. The effect of repeated methotrexate injections on the quality of life of children with rheumatic diseases. Eur J Pediatr. 2019;178(1):17\u201320.","journal-title":"Eur J Pediatr"},{"issue":"10 Suppl","key":"495_CR9","doi-asserted-by":"publisher","first-page":"S3","DOI":"10.1097\/AJP.0000000000000272","volume":"31","author":"CM McMurtry","year":"2015","unstructured":"McMurtry CM, Pillai Riddell R, Taddio A, Racine N, Asmundson GJ, Noel M, et al. Far from \"just a poke\": common painful needle procedures and the development of needle fear. Clin J Pain. 2015;31(10 Suppl):S3\u201311.","journal-title":"Clin J Pain"},{"key":"495_CR10","doi-asserted-by":"publisher","first-page":"S152","DOI":"10.1016\/j.clinthera.2009.07.022","volume":"31","author":"A Taddio","year":"2009","unstructured":"Taddio A, Chambers CT, Halperin SA, Ipp M, Lockett D, Rieder MJ, et al. Inadequate pain management during routine childhood immunizations: the nerve of it. Clin Ther. 2009;31:S152\u2013S67.","journal-title":"Clin Ther"},{"issue":"1","key":"495_CR11","doi-asserted-by":"publisher","first-page":"24","DOI":"10.1177\/0145445505282438","volume":"30","author":"RL Blount","year":"2006","unstructured":"Blount RL, Piira T, Cohen LL, Cheng PS. Pediatric procedural pain. Behav Modif. 2006;30(1):24\u201349.","journal-title":"Behav Modif"},{"key":"495_CR12","doi-asserted-by":"publisher","unstructured":"Uman LS, Birnie KA, Noel M, Parker JA, Chambers CT, McGrath PJ, et al. Psychological interventions for needle-related procedural pain and distress in children and adolescents. Cochrane Database Syst Rev. 2013;10(10):CD005179. https:\/\/doi.org\/10.1002\/14651858.CD005179.pub3.","DOI":"10.1002\/14651858.CD005179.pub3"},{"key":"495_CR13","doi-asserted-by":"publisher","unstructured":"Harrison D, Yamada J, Adams-Webber T, Ohlsson A, Beyene J, Stevens B. Sweet tasting solutions for reduction of needle-related procedural pain in children aged one to 16 years. Cochrane Database Syst Rev. 2015;2015(5):CD008408. https:\/\/doi.org\/10.1002\/14651858.CD008408.pub3.","DOI":"10.1002\/14651858.CD008408.pub3"},{"key":"495_CR14","doi-asserted-by":"crossref","unstructured":"Pillai Riddell RR, Racine NM, Gennis HG, Turcotte K, Uman LS, Horton RE, et al. Non-pharmacological management of infant and young child procedural pain. Cochrane Database Syst Rev. 2015;2015(12):CD006275. https:\/\/doi.org\/10.1002\/14651858.CD006275.pub3.","DOI":"10.1002\/14651858.CD006275.pub3"},{"key":"495_CR15","doi-asserted-by":"publisher","unstructured":"Birnie KA, Noel M, Chambers CT, Uman LS, Parker JA. Psychological interventions for needle-related procedural pain and distress in children and adolescents. Cochrane Database Syst Rev. 2018;10(10):CD005179. https:\/\/doi.org\/10.1002\/14651858.CD005179.pub4.","DOI":"10.1002\/14651858.CD005179.pub4"},{"issue":"3","key":"495_CR16","doi-asserted-by":"publisher","first-page":"620","DOI":"10.1111\/jan.12852","volume":"72","author":"EJ Svendsen","year":"2015","unstructured":"Svendsen EJ, Moen A, Pedersen R, Bj\u00f8rk IT. Parent-healthcare provider interaction during peripheral vein cannulation with resistive preschool children. J Adv Nurs. 2015;72(3):620\u201330.","journal-title":"J Adv Nurs"},{"issue":"2","key":"495_CR17","doi-asserted-by":"publisher","first-page":"157","DOI":"10.1111\/nin.12074","volume":"22","author":"L Bray","year":"2015","unstructured":"Bray L, Snodin J, Carter B. Holding and restraining children for clinical procedures within an acute care setting: an ethical consideration of the evidence. Nurs Inq. 2015;22(2):157\u201367.","journal-title":"Nurs Inq"},{"issue":"5","key":"495_CR18","doi-asserted-by":"publisher","first-page":"487","DOI":"10.2217\/pmt.12.41","volume":"2","author":"M Noel","year":"2012","unstructured":"Noel M, Chambers CT, Petter M, McGrath PJ, Klein RM, Stewart SH. Pain is not over when the needle ends: a review and preliminary model of acute pain memory development in childhood. Pain Manag. 2012;2(5):487\u201397.","journal-title":"Pain Manag"},{"issue":"1","key":"495_CR19","doi-asserted-by":"publisher","first-page":"233","DOI":"10.1017\/S0954579406060135","volume":"18","author":"TH Diseth","year":"2006","unstructured":"Diseth TH. Dissociation following traumatic medical treatment procedures in childhood: a longitudinal follow-up. Dev Psychopathol. 2006;18(1):233\u201351.","journal-title":"Dev Psychopathol"},{"issue":"7","key":"495_CR20","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2018-027775","volume":"9","author":"D Van de Velde","year":"2019","unstructured":"Van de Velde D, De Zutter F, Satink T, Costa U, Janquart S, Senn D, et al. Delineating the concept of self-management in chronic conditions: a concept analysis. BMJ Open. 2019;9(7):e027775.","journal-title":"BMJ Open"},{"issue":"1","key":"495_CR21","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1186\/s12969-020-0406-6","volume":"18","author":"K S\u00f8rensen","year":"2020","unstructured":"S\u00f8rensen K, Skirbekk H, Kvarstein G, W\u00f8ien H. Children's fear of needle injections: a qualitative study of training sessions for children with rheumatic diseases before home administration. Pediatr Rheumatol Online J. 2020;18(1):13.","journal-title":"Pediatr Rheumatol Online J"},{"issue":"1","key":"495_CR22","doi-asserted-by":"publisher","first-page":"361","DOI":"10.1186\/s12889-017-4267-y","volume":"17","author":"J Br\u00f6der","year":"2017","unstructured":"Br\u00f6der J, Okan O, Bauer U, Bruland D, Schlupp S, Bollweg TM, et al. Health literacy in childhood and youth: a systematic review of definitions and models. BMC Public Health. 2017;17(1):361.","journal-title":"BMC Public Health"},{"key":"495_CR23","first-page":"410","volume-title":"Qualitative methods for Health Research","author":"J Green","year":"2018","unstructured":"Green J, Thorogood N. Qualitative methods for Health Research. 4th ed. Los Angeles; London; New Delhi; Singapore; Washington DC; Melbourne: Sage Publications Inc; 2018. p. 410.","edition":"4"},{"key":"495_CR24","first-page":"252","volume-title":"Focus groups: a practical guide for applied research","author":"RA Krueger","year":"2015","unstructured":"Krueger RA, Casey MA. Focus groups: a practical guide for applied research. 5th ed. Los Angeles: Sage Publications, Inc; 2015. p. 252.","edition":"5"},{"issue":"13","key":"495_CR25","doi-asserted-by":"publisher","first-page":"1753","DOI":"10.1177\/1049732315617444","volume":"26","author":"K Malterud","year":"2016","unstructured":"Malterud K, Siersma VD, Guassora AD. Sample size in qualitative interview studies: guided by information power. Qual Health Res. 2016;26(13):1753\u201360.","journal-title":"Qual Health Res"},{"issue":"2","key":"495_CR26","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1191\/1478088706qp063oa","volume":"3","author":"V Braun","year":"2006","unstructured":"Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77\u2013101.","journal-title":"Qual Res Psychol"},{"key":"495_CR27","first-page":"47","volume-title":"The SAGE handbook of qualitative research in psychology","author":"G Terry","year":"2017","unstructured":"Terry G, Hayfield N, Clarke V, Braun V. Thematic analysis. In: Rogers CWWS, editor. The SAGE handbook of qualitative research in psychology. London: SAGE Publications LTD; 2017. p. 47\u201370."},{"issue":"6","key":"495_CR28","doi-asserted-by":"publisher","first-page":"349","DOI":"10.1093\/intqhc\/mzm042","volume":"19","author":"A Tong","year":"2007","unstructured":"Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitaitve research (COREQ): a 32 item checklist for interviews and focus groups. Int J Qual Health Care. 2007;19(6):349\u201357.","journal-title":"Int J Qual Health Care"},{"issue":"1","key":"495_CR29","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1186\/s12969-016-0073-9","volume":"14","author":"O G\u00f3mez-Ram\u00edrez","year":"2016","unstructured":"G\u00f3mez-Ram\u00edrez O, Gibbon M, Berard R, Jurencak R, Green J, Tucker L, et al. A recurring rollercoaster ride: a qualitative study of the emotional experiences of parents of children with juvenile idiopathic arthritis. Pediatr Rheumatol Online J. 2016;14(1):13.","journal-title":"Pediatr Rheumatol Online J"},{"issue":"1","key":"495_CR30","doi-asserted-by":"publisher","first-page":"30","DOI":"10.1186\/s12969-019-0332-7","volume":"17","author":"P Livermore","year":"2019","unstructured":"Livermore P, Gray S, Mulligan K, Stinson JN, Wedderburn LR, Gibson F. Being on the juvenile dermatomyositis rollercoaster: a qualitative study. Pediatr Rheumatol Online J. 2019;17(1):30.","journal-title":"Pediatr Rheumatol Online J"},{"issue":"1","key":"495_CR31","doi-asserted-by":"publisher","first-page":"123","DOI":"10.1111\/papr.12572","volume":"18","author":"M Noel","year":"2018","unstructured":"Noel M, McMurtry CM, Pavlova M, Taddio A. Brief clinical report: a systematic review and meta-analysis of pain memory-reframing interventions for Children's needle procedures. Pain Pract. 2018;18(1):123\u20139.","journal-title":"Pain Pract"},{"issue":"3","key":"495_CR32","doi-asserted-by":"publisher","first-page":"217","DOI":"10.1080\/16506073.2016.1157204","volume":"45","author":"CM McMurtry","year":"2016","unstructured":"McMurtry CM, Taddio A, Noel M, Antony MM, Chambers CT, Asmundson GJ, et al. Exposure-based interventions for the management of individuals with high levels of needle fear across the lifespan: a clinical practice guideline and call for further research. Cogn Behav Ther. 2016;45(3):217\u201335.","journal-title":"Cogn Behav Ther"},{"issue":"3","key":"495_CR33","doi-asserted-by":"publisher","first-page":"183","DOI":"10.3109\/01460862.2014.942443","volume":"37","author":"N Kajikawa","year":"2014","unstructured":"Kajikawa N, Maeno T, Maeno T. Does a child's fear of needles decrease through a learning event with needles? Issues Compr Pediatr Nurs. 2014;37(3):183\u201394.","journal-title":"Issues Compr Pediatr Nurs"},{"key":"495_CR34","doi-asserted-by":"publisher","first-page":"S134","DOI":"10.1542\/peds.2008-1055f","volume":"122","author":"LL Cohen","year":"2008","unstructured":"Cohen LL. Behavioral approaches to anxiety and pain management for pediatric venous access. Pediatrics. 2008;122:S134\u20139.","journal-title":"Pediatrics."},{"issue":"6","key":"495_CR35","doi-asserted-by":"publisher","first-page":"652","DOI":"10.1016\/j.pedn.2011.08.001","volume":"27","author":"D Koller","year":"2012","unstructured":"Koller D, Goldman RD. Distraction techniques for children undergoing procedures: a critical review of pediatric research. J Pediatr Nurs. 2012;27(6):652\u201381.","journal-title":"J Pediatr Nurs"},{"issue":"1","key":"495_CR36","doi-asserted-by":"publisher","first-page":"51","DOI":"10.1155\/2008\/465891","volume":"13","author":"J Stinson","year":"2008","unstructured":"Stinson J, Yamada J, Dickson A, Lamba J, Stevens B. Review of systematic reviews on acute procedural pain in children in the hospital setting. Pain Res Manag. 2008;13(1):51\u20137.","journal-title":"Pain Res Manag"},{"issue":"1","key":"495_CR37","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1016\/j.pmn.2014.03.003","volume":"16","author":"N Canbulat","year":"2015","unstructured":"Canbulat N, Ayhan F, Inal S. Effectiveness of external cold and vibration for procedural pain relief during peripheral intravenous cannulation in pediatric patients. Pain Manag Nurs. 2015;16(1):33\u20139.","journal-title":"Pain Manag Nurs"},{"issue":"6","key":"495_CR38","doi-asserted-by":"publisher","first-page":"406","DOI":"10.1177\/1043454218782138","volume":"35","author":"KA Birnie","year":"2018","unstructured":"Birnie KA, Kulandaivelu Y, Jibb L, Hroch P, Positano K, Robertson S, et al. Usability testing of an interactive virtual reality distraction intervention to reduce procedural pain in children and adolescents with cancer. J Pediatr Oncol Nurs. 2018;35(6):406\u201316.","journal-title":"J Pediatr Oncol Nurs"},{"issue":"5","key":"495_CR39","doi-asserted-by":"publisher","first-page":"685","DOI":"10.1016\/j.pmn.2015.03.001","volume":"16","author":"Y Hua","year":"2015","unstructured":"Hua Y, Qiu R, Yao WY, Zhang Q, Chen XL. The effect of virtual reality distraction on pain relief during dressing changes in children with chronic wounds on lower limbs. Pain Manag Nurs. 2015;16(5):685\u201391.","journal-title":"Pain Manag Nurs"},{"key":"495_CR40","doi-asserted-by":"publisher","first-page":"590","DOI":"10.1111\/pme.12877","volume":"17","author":"S Burns-Nader","year":"2016","unstructured":"Burns-Nader S, Atencio S, Chavez M. Computer Tablet Distraction in Children Receiving an Injection. Pain Med. 2016;17:590\u20135. https:\/\/doi.org\/10.1111\/pme.12877.","journal-title":"Pain Med."},{"issue":"4","key":"495_CR41","doi-asserted-by":"publisher","first-page":"e19","DOI":"10.1016\/j.pedn.2014.01.015","volume":"29","author":"EJ Svendsen","year":"2014","unstructured":"Svendsen EJ, Bj\u00f8rk IT. Experienced nurses' use of non-pharmacological approaches comprise more than relief from pain. J Pediatr Nurs. 2014;29(4):e19\u201328.","journal-title":"J Pediatr Nurs"},{"issue":"Pt 2","key":"495_CR42","doi-asserted-by":"publisher","first-page":"329","DOI":"10.1348\/135910710X506895","volume":"16","author":"S Ayers","year":"2011","unstructured":"Ayers S, Muller I, Mahoney L, Seddon P. Understanding needle-related distress in children with cystic fibrosis. Br J Health Psychol. 2011;16(Pt 2):329\u201343.","journal-title":"Br J Health Psychol"},{"key":"495_CR43","doi-asserted-by":"publisher","first-page":"585","DOI":"10.1016\/S0005-7894(89)80136-4","volume":"20","author":"RL Blount","year":"1989","unstructured":"Blount RL, Corbin SM, Sturges JW, Wolfe VV, Prater JM, James LD. The Relationship Between Adults' Behavior and Child Coping and Distress During BMA\/LP Procedures: A Sequential Analysis. Behav Ther. 1989;20:585\u2013601.","journal-title":"Behav Ther"},{"issue":"6","key":"495_CR44","doi-asserted-by":"publisher","first-page":"397","DOI":"10.1097\/NNR.0000000000000056","volume":"63","author":"AM McCarthy","year":"2014","unstructured":"McCarthy AM, Kleiber C, Hanrahan K, Zimmerman MB, Ersig A, Westhus N, et al. Matching doses of distraction with child risk for distress during a medical procedure: a randomized clinical trial. Nurs Res. 2014;63(6):397\u2013407.","journal-title":"Nurs Res"},{"issue":"1","key":"495_CR45","doi-asserted-by":"publisher","first-page":"13","DOI":"10.2217\/pmt.15.54","volume":"6","author":"R Pillai Riddell","year":"2016","unstructured":"Pillai Riddell R, Gennis H, Taddio A, Racine N. Are parents really that important to managing vaccination pain during infancy? Pain Manag. 2016;6(1):13\u20137.","journal-title":"Pain Manag"},{"issue":"1","key":"495_CR46","doi-asserted-by":"publisher","first-page":"172","DOI":"10.1016\/j.pain.2007.12.005","volume":"138","author":"RL Claar","year":"2008","unstructured":"Claar RL, Simons LE, Logan DE. Parental response to children's pain: the moderating impact of children's emotional distress on symptoms and disability. Pain. 2008;138(1):172\u20139.","journal-title":"Pain."},{"issue":"3","key":"495_CR47","doi-asserted-by":"publisher","first-page":"151","DOI":"10.1080\/01460860290042585","volume":"25","author":"ME Megel","year":"2002","unstructured":"Megel ME, Heser R, Matthews K. Parents' assistance to children having immunizations. Issues Compr Pediatr Nurs. 2002;25(3):151\u201365.","journal-title":"Issues Compr Pediatr Nurs"},{"issue":"2","key":"495_CR48","doi-asserted-by":"publisher","first-page":"89","DOI":"10.2217\/pmt-2016-0050","volume":"7","author":"SJ Friedrichsdorf","year":"2017","unstructured":"Friedrichsdorf SJ. Four steps to eliminate or reduce pain in children caused by needles (part 1). Pain Manag. 2017;7(2):89\u201394.","journal-title":"Pain Manag"},{"issue":"1","key":"495_CR49","doi-asserted-by":"publisher","first-page":"44","DOI":"10.1186\/s12969-019-0341-6","volume":"17","author":"E Nordal","year":"2019","unstructured":"Nordal E, Rypdal V, Arnstad ED, Aalto K, Berntson L, Ekelund M, et al. Participation in school and physical education in juvenile idiopathic arthritis in a Nordic long-term cohort study. Pediatr Rheumatol. 2019;17(1):44.","journal-title":"Pediatr Rheumatol"},{"issue":"7","key":"495_CR50","doi-asserted-by":"publisher","first-page":"e0219539","DOI":"10.1371\/journal.pone.0219539","volume":"14","author":"N Kyvsgaard","year":"2019","unstructured":"Kyvsgaard N, Mikkelsen TS, Thastum M, Christensen AE, Wehner PS, Nysom K, et al. Increased methotrexate intolerance in juvenile idiopathic arthritis compared to acute lymphoblastic leukaemia in children. PLoS One. 2019;14(7):e0219539. https:\/\/doi.org\/10.1371\/journal.pone.0219539.","journal-title":"PLoS One."},{"key":"495_CR51","doi-asserted-by":"publisher","first-page":"54","DOI":"10.1186\/1546-0096-12-54","volume":"12","author":"MA Bechard","year":"2014","unstructured":"Bechard MA, Lemieux JR, Roth J, Watanabe Duffy K, Duffy CM, Aglipay MO, et al. Procedural pain and patient-reported side effects with weekly injections of subcutaneous methotrexate in children with rheumatic disorders. Pediatr Rheumatol Online J. 2014;12:54.","journal-title":"Pediatr Rheumatol Online J"},{"issue":"1","key":"495_CR52","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1186\/1546-0096-11-23","volume":"11","author":"K Mulligan","year":"2013","unstructured":"Mulligan K, Kassoumeri L, Etheridge A, Moncrieffe H, Wedderburn LR, Newman S. Mothers' reports of the difficulties that their children experience in taking methotrexate for juvenile idiopathic arthritis and how these impact on quality of life. Pediatr Rheumatol Online J. 2013;11(1):23.","journal-title":"Pediatr Rheumatol Online J"},{"key":"495_CR53","doi-asserted-by":"publisher","first-page":"49","DOI":"10.1016\/j.pedn.2019.06.004","volume":"48","author":"S Khan","year":"2019","unstructured":"Khan S, Mancini J, Hopper C, Resnick JE. Perceptions of Methotrexate Intolerance and Its Impact on Daily Life in School-Age Children with Juvenile Idiopathic Arthritis. J Pediatr Nurs. 2019;48:49\u201354.","journal-title":"J Pediatr Nurs."},{"key":"495_CR54","unstructured":"United Nations Human Right. Convention of the rights of the child 1989. Available from: https:\/\/www.ohchr.org\/en\/professionalinterest\/pages\/crc.aspx. Cited 2020 15.05.20"}],"container-title":["Pediatric Rheumatology"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s12969-021-00495-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/article\/10.1186\/s12969-021-00495-4\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s12969-021-00495-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,1,22]],"date-time":"2021-01-22T03:16:33Z","timestamp":1611285393000},"score":1,"resource":{"primary":{"URL":"https:\/\/ped-rheum.biomedcentral.com\/articles\/10.1186\/s12969-021-00495-4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,1,22]]},"references-count":54,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["495"],"URL":"https:\/\/doi.org\/10.1186\/s12969-021-00495-4","relation":{"has-preprint":[{"id-type":"doi","id":"10.21203\/rs.3.rs-40099\/v2","asserted-by":"object"},{"id-type":"doi","id":"10.21203\/rs.3.rs-40099\/v1","asserted-by":"object"}]},"ISSN":["1546-0096"],"issn-type":[{"value":"1546-0096","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,1,22]]},"assertion":[{"value":"3 July 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"11 January 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"22 January 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The study was approved by the South Eastern Regional Committee for Medical and Health Research Ethics in Norway (2016\/1749, 2017\/2194). According to article 12 of the United Nations Convention on the Rights of the Child, children (0\u201318\u2009years) have the right to express their views on all matters affecting them [\n                      \n                      ]. Oral and written consent was obtained from parents and children \u226512\u2009years. Children \u226516\u2009years gave their independent written consent. Children <\u200912\u2009years gave oral consent. All data were stored in the Services for Sensitive Data Unit (TSD) at the University of Oslo. Results have been presented without individually recognizable data, but quotations have been exposed in terms of the context and age.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors have declared that they have no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"8"}}