Naturalistic parental pain management during immunizations during the first year of life: Observational norms from the OUCH cohort

Abstract

No research to date has descriptively catalogued what parents of healthy infants are naturalistically doing to manage their infant's pain over immunization appointments during the first year of life. This knowledge, in conjunction with an understanding of the relationships different parental techniques have with infant pain-related distress, would be useful when attempting to target parental pain management strategies in the infant immunization context. This study presents descriptive information about the pain management techniques parents have chosen and examines the relationships these naturalistic techniques have with infant pain-related distress during the first year of life. A total of 760 parent-infant dyads were recruited from 3 pediatric clinics in Toronto, ON, Canada, and were naturalistically followed and videotaped longitudinally over 4 immunization appointments during the infant's first year of life. Infants were full-term, healthy babies. Videotapes were subsequently coded for infant pain-related distress behaviors and parental pain management techniques. After controlling for preceding infant pain-related distress levels, parent pain management techniques accounted for, at most, 13% of the variance in infant pain-related distress scores. Across all age groups, physical comfort, rocking, and verbal reassurance were the most commonly used nonpharmacological pain management techniques. Pacifying and distraction appeared to be most promising in reducing needle-related distress in our sample of healthy infants. Parents in this sample seldom used pharmacological pain management techniques. Given the psychological and physical repercussions involved with unmanaged repetitive acute pain and the paucity of work in healthy infants, this paper highlights key areas for improving parental pain management in primary care.

Too many crying babies: a systematic review of pain management practices during immunizations on YouTube

“…It is however possible that the pain control measures apparent during vaccinations as seen in the posted videos are not representative of all vaccinations, as the act of videotaping precludes holding the infant, breastfeeding or administering sucrose unless a tripod or third party is available to operate the camera. However, the observed infrequent use of recommended pain management strategies are concordant with results of published surveys of health care professionals’ pain management practices during immunization [4,7,25,26] as well as a recent observational study of pain management practices in infants during immunization [38]. This highlights that, so far, current evidence and guidelines relating to pain management strategies, most of which has been available prior to the date of the first YouTube posting, have been unsuccessful in changing immunization pain practices.…”

Infant Clinical Pain Assessment: Core Behavioral Cues

“…There was also weak concurrent validity between the 3-item NFCS pain scores and MAISD caregiver behaviours (physical comfort, rocking and verbal reassurance). In line with previous research by Lisi et al [22], again using the same dataset but the full 7-item version of the scale, small positive associations were found between pain scores and caregiver behaviours. The magnitude of relationships between NFCS and caregiver behaviours were similar for both the seven-and three-item versions of NFCS.…”

“…were included in the current analyses, as they have been shown to have the strongest relationship with infant pain-related distress [6,22]. The three caregiver behaviours were coded as present (1) or absent (0) for five-second epochs during the following three 60-second periods: (1) the oneminute period prior to the needle, (2) the one-minute period following the last needle, and (3) the two-minute period following the last needle.…”

“…Additionally, because the association between infant pain-related distress and caregiver behaviours is one of the most reliable infant pain relationships documented in the literature [e.g., 14,22], concurrent validity between the pain measures and caregiver behaviours also was examined. Spearman correlations were used to examine the relationships between NFCS, and MBPS and caregiver behaviours because the distributions of the associations were not linear.…”

Are Parents Really That Important To Managing Vaccination Pain During Infancy?

“…The first infant waves of the cohort were naturalistic observations of infants and their parents at their 2, 4, 6 and 12 month immunizations. Among the findings from this longitudinal study, it was found that commonly occurring parent pain management strategies from the literature (e.g., rocking, proximal soothing, verbal reassurance) accounted for statistically significant yet minimal amounts of variance in infant pain responding (ranging from 2 to 13%) [5][6][7]. It was shown that as children aged over the first year of life, parent strategies accounted for increasing variance in observed childhood pain-related distress.…”