Understanding the concurrent and predictive relations between child-led emotion regulation behaviors and pain during vaccination in toddlerhood

Gennis, Hannah; Flora, David B.; Norton, Lucas; McMurtry, C. Meghan; Merlano, Tatiana Espinosa; Zaghi, Ameer; Flanders, Daniel; Weinberg, Eitan; Savlov, Deena; Garfield, Hartley; Riddell, Rebecca Pillai

doi:10.1097/j.pain.0000000000002816

Cited by 3 publications

(7 citation statements)

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“…These findings suggest that when toddlers struggle to self‐regulate across the appointment, they signal to their parent for support or seek comfort. This result is consistent with our recent work that showed positive relationships between parent signalling and pain‐related distress (Gennis et al., 2022), and the central attachment tenet that children are hardwired to signal to their parents when they are in need of support regulating their emotions and experiences (Bowlby, 1969).…”

Section: Discussionsupporting

confidence: 92%

“…As described in Gennis et al. (2022) (https://hdl.handle.net/10315/41417), after recruitment and attrition, 163 caregiver‐toddler dyads were observed at 12 months and 149 dyads were observed at 18 months.…”

Section: Methodsmentioning

confidence: 82%

“…Data were from an ongoing longitudinal study (Gennis et al., 2022; Waxman et al., 2020) of caregiver‐toddler dyads. Dyads were recruited from two paediatric clinics in the Greater Toronto Area using a cohort‐sequential design.…”

Section: Methodsmentioning

confidence: 99%

“…Child‐led regulatory behaviours were coded using a modified coding system from the Laboratory Temperament Assessment Battery (Lab‐TAB) Locomotor Version 3.1 (Gennis et al., 2022; Goldsmith & Rothbart, 1999). Dr. J. Gagne (Texas A & M University) consulted in the initial phase of coding to ensure the validity of the measure when applied to the vaccination context.…”

Section: Methodsmentioning

confidence: 99%

“…By better understanding early childhood emotion regulation behaviours during these types of procedures, we will be able to make stronger developmental connections across the lifespan, to better understand how children's coping skills develop and when we may be able to intervene. A recent study by our team on this dataset showed that while behaviours such as child‐led disengagement of attention and physical self‐soothing are related to decreases in distress post‐needle, children continue to signal to their parents through gaze or proximity‐seeking behaviour (Gennis et al., 2022), likely in attempt to receive additional support. Given the known impact of pre‐needle distress on post‐needle distress (Campbell et al., 2013; Lisi et al., 2013; Shiff et al., 2022), accounting for its role when exploring parent and child‐led regulatory behaviours was seen as important.…”

Section: Introductionmentioning

confidence: 98%

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

Gennis,

Flora,

McMurtry

et al. 2023

European Journal of Pain

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BackgroundPast research has established the important role of parent soothing in early childhood pain management. However, limited research has assessed children's own emerging emotion regulation strategies to reduce their pain during vaccination. The purpose of the current study was to understand the relative contributions of child‐led emotion‐regulation behaviours over and above parent regulatory behaviours and pre‐needle distress.MethodsToddler‐caregiver dyads were videotaped at their 12‐ and/or 18‐month vaccinations. Videos were coded for pain‐related behavioural distress, child‐led regulatory behaviours (disengagement of attention, parent‐focused behaviours, and physical self‐soothing), and parent regulatory/soothing behaviours (distraction, physical comfort, rocking, verbal reassurance). Pre‐needle distress, followed by parent regulatory behaviours, followed by child regulatory behaviours were used as hierarchical predictors of pain regulation. Two sets of models were estimated at each age, by incorporating parent and child regulatory behaviours at 1 min and 2 min post‐needle, separately.ResultsAt both ages, child‐led parent‐focused behaviours predicted less regulation. At 18 months, parent soothing behaviours (e.g. distraction, verbal reassurance, rocking) played a stronger role in regulation, however; the only behaviour that increased regulation was rocking.ConclusionsMeasuring both parent and child regulatory behaviours was important for fully understanding pain‐related distress regulation. Toddlers' use of parent‐focused regulatory behaviours (e.g. proximity seeking) suggests that they signal to their parent directly when they are struggling to regulate post‐needle. The only parent behaviour that supported this regulation was rocking at 18 months, suggesting a greater need to understand the sensitivity of parent behaviours post‐needle.SignificanceTo our knowledge, this is the first study to examine both parent and child regulatory behaviours following vaccination at different stages in toddlerhood. This investigation allows a deeper understanding of the dyadic nature of early childhood vaccination, as well as the evolving role of the parent through toddlerhood. Importantly, findings suggest that toddlers do not simply wait for their parents to respond to their pain post‐needle and provide clear signals to show their need of support in regulation.

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Section: Discussionsupporting

confidence: 92%

Section: Methodsmentioning

confidence: 82%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 98%

See 3 more Smart Citations

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

Gennis,

Flora,

McMurtry

et al. 2023

European Journal of Pain

Self Cite

View full text Add to dashboard Cite

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A Measure of Caregivers’ Distress-Promoting Behaviors During Toddler Vaccination: Validation of the OUCHIE-RV

Badovinac

Flora

Edgell

et al. 2023

Journal of Pediatric Psychology

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Objective The current study discusses the development and preliminary validation of an observational measure of caregivers’ distress-promoting behavior (OUCHIE-RV) in the context of toddler routine vaccination. Methods Measure validation was based on a sample of caregiver–toddler dyads (N = 223) from a longitudinal cohort-sequential study who were observed during toddlers’ 12-, 18-, or 24-month routine vaccinations. Validity was assessed using correlations and cross-lagged path analysis and associations were tested between OUCHIE-RV composite scores and toddlers’ pain-related distress as well as caregivers’ state anxiety, soothing behaviors, heart rate, and heart rate variability. Interrater reliability was examined using intraclass correlations (ICC) and kappa coefficients. Results Results of a cross-lagged path analysis indicated positive concurrent (β = .27 to β = .37) and cross-lagged predictive associations (β = .01 to β = .34) between OUCHIE-RV composite scores (reflecting the frequency and intensity of caregivers’ distress-promoting behavior) and toddlers’ pain-related distress. OUCHIE-RV composite scores were negatively associated with caregivers’ concurrent use of physical comfort (r = −.34 to −.24) and rocking (r = −.36 to −.19) and showed minimal associations with caregivers’ use of verbal reassurance (r = .06 to .12), state anxiety (r = −.02 to r = .09), heart rate (r = −.15 to r = .05), and heart rate variability (r = −.04 to r = .13). Interrater reliability was strong (Cohen’s k = .86 to .97, ICC = .77 to .85). Conclusions Findings provide support for the validity and reliability of the OUCHIE-RV as a research tool for measuring caregiver behaviors that promote toddlers’ pain-related distress during routine vaccinations and contribute to a better understanding of the dynamics of caregiver–toddler interaction in acute pain contexts.

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Caregivers’ physiological responses during toddler vaccinations: associations with psychological and behavioral responses

Badovinac,

Flora,

Edgell

et al. 2024

Journal of Pediatric Psychology

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Objective This study investigated biological, psychological, and behavioral aspects of caregivers’ responses to toddlers’ pain-related distress by measuring caregivers’ high-frequency heart rate variability (HRV) responses during toddler vaccination pain and examining associations with caregivers’ behavioral responses and psychological stress. Methods Participants included caregiver–toddler dyads (N = 194) from a longitudinal cohort-sequential study who were observed during toddlers’ 12-, 18-, or 24-month routine vaccinations. Changes in caregiver HRV were analyzed using growth curve modeling. Conditional growth curve models examined associations between caregiver HRV and caregivers’ concurrent behavior and psychological stress. Results The unconditional growth curve model indicated a slight linear decrease in caregiver HRV (i.e., vagal withdrawal) across the 3 min post-needle (unstandardized B = –0.06, p = .049). In conditional growth curve models, higher levels of parenting stress were associated with less vagal withdrawal during the post-needle period (standardized B = 0.47, unstandardized B = 0.02, p = .003). Caregivers’ behavioral responses (i.e., use of soothing and distress-promoting behaviors), state anxiety, and general anxiety symptomology were not significantly associated with HRV responses. Conclusions Caregiver parasympathetic nervous system activity levels changed minimally from baseline to post-needle and decreased slightly across the post-needle period. Caregivers’ self-reported parenting stress was associated with their parasympathetic responses to the procedure. Findings support an improved understanding of the mechanisms underlying caregivers’ responses to children’s pain-related distress in a naturalistic setting.

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Understanding the concurrent and predictive relations between child-led emotion regulation behaviors and pain during vaccination in toddlerhood

Abstract: Supplemental Digital Content is Available in the Text.Self-regulation skills during needles emerge in toddlerhood. Disengagement of attention and physical soothing regulate distress postneedle. Toddlers also signal parent to reduce distress.

Cited by 3 publications

References 44 publications

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

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

A Measure of Caregivers’ Distress-Promoting Behaviors During Toddler Vaccination: Validation of the OUCHIE-RV

Caregivers’ physiological responses during toddler vaccinations: associations with psychological and behavioral responses

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