Identifying Parent and Child Contributors to Preschoolers’ Post-Vaccination Distress Regulation Patterns

• In Event: Poster Session 06
  In Poster Session: PS 06 Topic - Parenting & Parent-Child Relationships

Abstract

Objective:

Much of the pediatric pain and distress literature has utilized overall group means of behavioural distress scores at a single time point when examining children’s pain outcomes. Doing so, however, has been shown to meaningfully obscure individual variance in distress responses and patterns of distress response in the post-pain period – both of which carry important information for identifying those in need of support (Pillai Riddell et al., 2013). Recent research by our group addressed this limitation in the literature by elucidating distinct patterns of preschool pain-related distress regulation following vaccination using growth mixture modeling analyses (Waxman et al., 2017). Majority of the sample (75%) had a high probability (>0.8) of membership in the group that displayed mild to moderate initial pain response and ultimately regulated to no-distress by two minutes post-needle. The remaining 25% of participants had high probabilities (>0.8) of membership in one of two groups representing sub-optimal regulation trajectories, in which children do not regulate to no-distress by two-minutes post vaccine (See Figure 1). This finding illustrates that down-regulation to a no-distress state by two-minutes post-vaccination is normative for the preschool period. By uncovering the child and parent within-appointment factors that predict a child’s post-vaccination regulatory pattern, families in need of additional support can be easily identified. The aim of the current study is to gain a deeper understanding of the parent and child factors that predict preschool pain regulation patterns in a high distress context.

Methods and Analysis Plan:

The study will use existing data (n=301) from the preschool wave (i.e., 4 – 6 years of age) of a longitudinal cohort (OUCH Cohort). Parent-child dyads were observed and video-recorded during routine vaccinations throughout the first year of life and a subset were observed at preschool. Video footage from the preschool vaccination appointment was coded for child pain-related distress using The Face, Legs, Activity, Cry, Consolability coding system (FLACC) (Merkel et al., 2002) and caregiver coping- and distress-promoting verbalizations/behaviour were coded using the Child-Adult Medical Procedure Interaction Scale-Revised (CAMPIS-R) (Blount et al., 1997). Caregiver worry before and after the needle was self-reported. One hierarchical multinomial logistic regression model will be used to predict regulatory group membership. Predictors will be entered in three blocks: 1) child variables (baseline distress, sex, age); 2) parent behavioural variables (distress-promoting behaviour, coping-promoting behaviour); 3) parent cognitive variables (pre- and post-needle worry). The blocks will be entered in ascending order of the factors that we hypothesize, based on prior literature, most strongly shape child distress. All data have been collected and coded, and it is feasible that these analyses can be completed prior to the April 2021 SRCD Meeting.

Implications:

It is critical to understand the specific individual and caregiver factors that result in non-normative regulatory patterns at this particular developmental stage, given its foundational importance for lifelong outcomes. Once discerned, clinicians can identify the children and families in need of support and provide specific and actionable guidance, such as training programs and instructional materials, to optimize child distress outcomes.

Authors

• Ilana Shiff, York University
  Presenting Author

• Jordana Waxman, York University
  Non-Presenting Author

• Hartley Garfield
  Non-Presenting Author

• Saul Greenberg
  Non-Presenting Author

• Rebecca Rita Pillai Riddell, York University
  Non-Presenting Author