Can behaviour during immunisation be used to identify attachment patterns? A feasibility study

Abstract

Can behaviour during immunisation be used to identify attachment patterns?A feasibility study. AbstractBackground Infant attachment is a strong predictor of mental health, and current measures involve placing children into a stressful situation in order to observe how the child uses their primary caregiver to assuage their distress.Objectives This study aimed to explore observational correlates of attachment patterns during immunisation.Participants and Setting 18 parent child pairs were included in the study. They were all recruited through a single GP practice.Methods Infant immunisation videos were observed and coded for parenting behaviours as well as pain promoting and pain reducing strategies. These scores were compared between different attachment groups, as measured with the Manchester Child Attachment Story Task. Results Parents of securely attached children scored higher on positive MellowParenting Observational System behaviours, but not at a statistically significant level.Parents of securely attached children were also significantly more likely to engage in pain reducing behaviours (p<0.01) than parents of insecurely attached children. 2Conclusions Future research should go on to develop robust, composite measures for attachment informative behaviours in the immunisation situation and test these in a fully powered study.Keywords; attachment, immunisation, infant, observation, primary care. What is already known about the topic?There is a need to develop a new attachment measure because there is no current tool suitable for use in non-specialist settings (e.g. in primary care or paediatric clinics) particularly, as in primary care consultations, where there are significant time constraints. What this paper adds?This paper is a proof of the concept that immunisation has the potential to be used as an attachment measure which has great clinical potential. Attachment could be classified without placing a child into an artificial state of distress, as well as providing a measurement which could be used with children of different ages. This gives the potential for earlier diagnosis and treatment of attachment problems. Classifying attachmentDespite various methods of classifying attachment in childhood, a systematic review (Lim et al. 2010), concluded that there is a need to develop a new attachment measure because there is no current tool suitable for use in non-specialist settings (eg in primary care or paediatric clinics) particularly, as in primary care consultations, where there are significant time constraints (O'Connor and Byrne 2007). 4 Immunisation and attachmentAttachment behaviours are activated when a child is under stress. Most attachment assessments place a child into a stressful situation and then evaluate how they use their primary caregiver to gain comfort. Wilson et al (Wilson et al. 2008) examined the ways in which health visitors (public health nurses) routinely assess parent/child relationships and the authors proposed immunisation clinics as a setting where attachment behaviours cou...

Associations between attachment and pain: From infant to adolescent

“…First, there are a limited number of studies on attachment and pain in infancy and early childhood compared to later developmental stage. Furthermore, studies in infancy are mainly focused on immunization pain 34,35,37 or venipuncture. 36 Second, literature linking attachment and functional pain conditions is scarce (e.g.…”

“…35 Consistently, higher venipuncture distress was also found in disorganized children in a population-based study using the SSP. 36 Moreover, despite results on the impact of parental presence during child’s procedure are mixed, a recent study focused on toddlerhood 37 revealed that pain-reducing behaviors are more common in parents of securely attached children, suggesting the potential role of attachment in clarifying caregiving contribution in the context of acute pain. In addition, there are other attachment-related factors that influence child’s pain response during pain procedures.…”

“…Pritchett et al 37 To explore observational correlates of attachment patterns during immunization. Secure base phenomena extend to pain situations.…”

Where do children learn about pain? The role of caregiver responses to preschoolers' pain experience within natural settings

“…Unlike everyday pains, clinical settings do not represent a child's typical environment: procedural pain occurs in unfamiliar environments, with unfamiliar medical staff present [55].…”

“…Unlike everyday pains, clinical settings do not represent a child's typical environment; procedural pain occurs in unfamiliar environments, with unfamiliar medical staff present. 55 Even when parents are present, children respond differently to pain, 27,34,42 and parental involvement is recommended as best practice during needle procedures 1,35,66 and other clinical procedures. 4,53 Parental protective behaviours (physical comfort and verbal reassurance) can amplify child distress, 32 whereas coping-promoting behaviours (distraction and deep breathing) foster positive child pain outcomes 8,10,67 (for comprehensive reviews 4,9,62 ).…”