The influence of caregivers’ behaviors on infant pain physiology during immunization

• In Event: Biobehavioral influences of environmental stress and caregiving behaviors on child outcomes

Abstract

Background: Caregivers have been identified as a strong predictor of infant pain-related distress (Pillai Riddell, et al. 2016; Pillai Riddell & Racine, 2009; Racine et al., 2016). Previous research has shown a positive relationship between verbal reassurance and infant pain observed behaviors (Racine et al., 2012). However, there is a paucity of research exploring the relations between caregiving behaviors and infant pain physiology. Recent research has shown that infant cardiac responses (i.e., heart rate) are strongly associated with behavioral pain indicators in toddlerhood. Heart rate has been suggested to be used alongside expressed behavioral pain, and other physiological and cortical indicators to effectively assess acute pain-related distress in infants (Waxman et al. 2020). To date, the influence of caregiving behaviors (i.e., soothing behaviors) on infant pain physiology (i.e., cardiac responses) during immunization have not been examined.
Aim: The aim of this study was to examine the associations between caregivers’ behavioral responses and infants’ cardiac responses during routine vaccinations at ages 12 and 18 months.
Hypotheses: Based on the previous literature, it was hypothesized that: 1) Preceding infant cardiac responses would predict subsequent infant cardiac responses; 2) Caregivers’ soothing behaviors would predict subsequent infant cardiac responses; 3) Positive relations would be found between caregivers’ soothing behaviors and infant cardiac responses.
Methods: Caregiver–infant dyads were part of a longitudinal cohort observed during their routine 12-month (n=147) and 18-month (n=122) vaccinations. Parent soothing behaviors (i.e., verbal reassurance, distraction) were measured using the Measure of Adult and Infant Soothing and Distress (MAISD; Cohen et al., 2005). Infant cardiac responses were indicated by infant heart rate (HR) and heart rate variability (HRV). Parents’ behavioral and infants’ cardiac data were collected simultaneously from one minute pre-needle (baseline) through to three minutes post-needle. Videotapes are currently being coded by 3 trained laboratory research assistants for parents’ soothing behaviors, and infants cardiac data (HR, HRV) will be analyzed during sequential 30-second epochs. The anticipated completion for coding is December 31st, 2020. All data will be analyzed subsequently.
Data Analytic Plan: Autoregressive cross-lagged path models will be used to examine the relations between parent behaviours and infant cardiac responses across epochs. Within each model, three types of relations will be examined: 1) Predictive within-measure: the prediction of infant cardiac response based on the preceding infant cardiac response; 2) Predictive between-measure: the prediction of infant cardiac response from the preceding parent behavioural response; and 3) Concurrent between-measure: concurrent associations between parent behavioural and infant cardiac responses within each epoch. A separate analysis will be conducted to examine contextual factors (i.e., demographic and baseline data) that may impact the relations between parent behavioural and infant cardiac responses.
Discussion: This is the first longitudinal study to examine the reciprocal temporal relations between parent soothing behaviors and infant pain physiology during immunization.

Authors

• Cheryl Chow, York University
  Presenting Author

• Hannah Gabrielle Gennis, York University
  Non-Presenting Author

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