Assessing Insensitive Parent Behaviors in a Pain-Related Distress Context Among Infants – The OUCH-IE

• In Event: 2-199 - Cross-sectional and Longitudinal Factors Linked to Pain Experiences Across Child Development

Integrative Statement

Introduction: Sensitive parental behaviors are predictive of infant and young child pain-related distress reactivity and regulation (Din Osmun et al., 2013; Racine et al., 2016; Campbell et al., 2018). Previous research in the vaccination context has shown that parent sensitivity, operationalized by measures such as the Emotional Availability Scales (EAS; Biringen, 2008), Maternal Behaviour Q-sort (MBQS-SF; Tarabulsy et al., 2009) and Measure of Adult and Infant Soothing and Distress (MAISD; Cohen et al, 2005) are associated with infant and preschooler pain-related distress behaviour. However, the magnitudes of the relationship between sensitivity and infant distress have been smaller than expected. The objective of the current presentation is to present the development of a new published measure of insensitive or distress promoting parent behaviours in a pain-related distress context – The OUCH-IE (Pillai Riddell, Gennis et al., 2018 [shared first author]; Badovinac et al. 2018). Parent behaviours that have been shown to have effect of increasing infant distress post-needle (e.g. attempting to dress an infant immediately after needle when child is in highest distress) would be considered insensitive or distress-promoting.
Hypothesis: It is hypothesized that the OUCH-IE measure (i.e. a set of 8 parent behaviours that exacerbate infant distress post-vaccination) will demonstrate convergent and divergent validity, strong reliability, feasibility, and account for unique variance in infant pain responses beyond the variance accounted for by sensitive behaviours.
Study Population: Data from 537 unique infant-caregiver dyads were videotaped during vaccination for a larger study and served as the sample for developing the OUCH-IE. On average, parents were 34.09 years (SD = 5.16), mothers (86.9%) and university educated (76.9%). Infants were initially coded at the 12-month vaccination. Parents self-reported a diverse array of cultural backgrounds (e.g. 37.6% European, 16.1% Asian, 12.1% North American, 8.7% mixed). Eighty-one parent-child dyads who also had data at the 2-month and 6-month vaccinations were also coded to examine how the measure performed over development.
Methods: Following initial generation of OUCH-IE items based on coding over 2000 vaccination appointments, focused group discussions were held with 12 health professionals to establish the measure’s feasibility and validity. Convergent relationships with infant pain-related distress and divergent relationships with parent sensitivity and soothing-promoting behaviours were assessed. Follow up analyses were then conducted at 2-, 6-, and 12-months to establish the relative predictive value of sensitivity, sensitive behaviours and the OUCH-IE (Pillai Riddell, Gennis et al. 2018; Badovinac et al., 2018).
Results: The more OUCH-IE behaviours the parents enacted, the greater the infant’s pain-related distress. In addition, there was a strong divergent relationship between the OUCH-IE and caregiver emotional availability. No relationships were found between OUCH-IE parent behaviours and soothing parent behaviours. The OUCH-IE emerged as predicting significantly more variance than the measures of sensitivity or soothing behaviour.
Conclusion: Much of the literature for parent intervention in the vaccination context focuses on increasing positive soothing behaviours. Current analyses suggests that to help ameliorate infant pain post-needle, teaching parents what not to do may be at least as important as telling them what to do.

Authors

• Rebecca Pillai Riddell, York University
  Presenting Author

• Hannah Gennis, York University
  Non-Presenting Author

• Paula Tablon, York University
  Non-Presenting Author

• Saul Greenberg, University of Toronto
  Non-Presenting Author

• Hartley Garfield, University of Toronto
  Non-Presenting Author