Children's communication of emotional cues and concerns during a preoperative needle procedure

•Emotional distress is common for children undergoing a needle procedure.•Children commonly express unpleasant emotions through non-verbal communication.•No significant differences seen between age or sex in relation to cues and concerns.•Nurses do not respond explicitly to children’s emotional distress. This study explores children’s expressions of emotional cues and concerns during needle procedures, nurses’ responses and findings in relation to children’s age and sex. Twenty-six children aged 6–12 years were video recorded during a preoperative needle procedure. Emotional communication was analyzed using Verona Coding Definitions of Emotional Sequences. A total of 111 cues or concerns were identified in the observed needle procedures, with a distribution of 77 cues and 34 concerns. A majority of children (85%) expressed emotional cues through non-verbal communication. No differences between child age or sex related to expressed emotion were found. The child elicited the communicated emotion in 98% of sequences. Nurses' responses were coded as not providing space for communication in 75% of sequences. Children are capable of expressing their emotional distress, primarily non-verbally, during needle procedures. A child showing less overt expressions during a needle procedure does not necessarily experience less fear or pain. The nurses’ communication focused on practical information during the needle procedure, with less attention to the child’s distress. Nurses need to develop strategies to be aware of emotions the child communicates before, during and after a needle procedure.