Trajectories of distress regulation during preschool vaccinations: child and caregiver predictors

Abstract

Recent research has highlighted the need for a deeper understanding of the heterogeneity in trajectories of children's distress after acute pain exposure, moving beyond the group means of behavioural pain scores at a single timepoint. During preschool vaccinations, 3 distinct trajectories of postvaccination pain regulation have been elucidated, with approximately 75% of children displaying trajectories characterized by downregulation to no distress by 2 minutes postneedle and 25% concerningly failing to downregulate by 2 minutes. The objective of this study was to examine child and caregiver predictors of preschool children's postvaccination regulatory patterns. Our results indicated that higher child baseline distress, more caregiver coping-promoting verbalizations in the first minute after the needle, less coping-promoting verbalizations in the second minute, and more caregiver distress-promoting verbalizations in the second minute after the needle were associated with membership in the trajectories characterized by high distress. Furthermore, although all children's painrelated distress at various timepoints throughout the appointment was most strongly predicted by previous pain scores, different patterns of associations emerged depending on the trajectory exhibited. This research highlights both the need to minimize distress before the needle to avoid the highly distressed trajectory and the importance of considering the heterogeneity of trajectories of preschool pain responding when examining the factors that are associated with children's pain-related distress.

Parent and child self‐ and co‐regulation during pediatric venipuncture: Exploring heart rate variability and the effects of a mindfulness intervention

“…Clinically, children's quick regulation response immediately after the needle was inserted suggests children may require the greatest effort to regulate during the anticipatory period and may benefit the most from parent prompts to engage in coping behavior prior to needle insertion. This is in line with recent work on preschooler's distress regulation during vaccinations (Shiff et al., 2022). Our preliminary findings suggest that a brief mindfulness intervention may serve to dampen children's physiological arousal during and following venipuncture.…”

It takes two: The relative contributions of parent versus child‐led regulatory behaviours on toddler vaccination pain

“…As hypothesized, greater distress pre-needle was associated with slower regulation across the vaccination appointment. This finding with pre-needle distress causing longer (Campbell et al, 2013;Lisi et al, 2013;Shiff et al, 2022). If a child is highly distressed pre-needle, it will likely impact not only their parents' behaviour, but their own ability to engage in autonomous self-regulation.…”

Out of the mouth of babes: a lot about pain has nothing to do with pain

“…The path analysis generated in this paper demonstrated a complexity in caregiver behaviors such that coping-promoting behaviors are only predictive of lower pain , when caregivers are not also concurrently enacting distress-promoting behaviors . Most recently, Shiff et al 60 also examined the preschool-aged OUCH cohort wave and found that caregivers who engaged in higher coping-promoting behaviors 1 minute postneedle had children who were less regulated in their pain-related distress and responding, whereas those who engaged in higher coping-promoting behaviors 2 minutes postneedle had children who were more regulated. This suggests it is not just the behaviours themselves that are critical but the timing of these behaviours.…”

“…This pain domino effect has been wellreplicated with both younger and older waves of the OUCH Cohort. 12,31,60…”

“…The first and last papers in the series of 25 papers on the original OUCH cohort was published over the span of a decade 2011 to 2022. 44,60 Recently, a new smaller cohort of toddlers (OUCH Cardio Cohort), aged 12 to 24 months (n 5 232 dyads), was created between 2016 and 2020 and introduced both parent and child physiologies into the analyses. Across the cohorts, families were culturally diverse and recruited from 3 different economically diverse neighbourhoods in Toronto, Ontario, and Canada.…”