Preschool children’s coping responses and outcomes in the vaccination context: child and caregiver transactional and longitudinal relationships

This article, based on 2 companion studies, presents an in-depth analysis of preschoolers coping with vaccination pain. Study 1 used an autoregressive cross-lagged path model to investigate the dynamic and reciprocal relationships between young children’s coping responses (how they cope with pain and distress) and coping outcomes (pain behaviors) at the preschool vaccination. Expanding on this analysis, study 2 then modeled preschool coping responses and outcomes using both caregiver and child variables from the child’s 12-month vaccination (n 5 548), preschool vaccination (n 5 302), and a preschool psychological assessment (n 5 172). Summarizing over the 5 path models and post hoc analyses over the 2 studies, novel transactional and longitudinal pathways predicting preschooler coping responses and outcomes were elucidated. Our research has provided empirical support for the need to differentiate between coping responses and coping outcomes: 2 different, yet interrelated, components of “coping.”Among our key findings, the results suggest that a preschooler’s ability to cope is a powerful tool to reduce pain-related distress but must be maintained throughout the appointment; caregiver behavior and poorer pain regulation from the 12-month vaccination appointment predicted forward to preschool coping responses and/or outcomes; robust concurrent relationships exist between caregiver behaviors and both child coping responses and outcomes, and finally, caregiver behaviors during vaccinations are not only critical to both child pain coping responses and outcomes in the short- and long-term but also show relationships to broader child cognitive abilities as well

Caregiver and Child Distress as Predictors of Dyadic Physiological Attunement During Vaccination

This is a non-final version of an article published in final form in DiLorenzo-Klas, Miranda G. PhD*; Waxman, Jordana A. PhD*; Flora, David B. PhD*; Schmidt, Louis A. PhD†; Garfield, Hartley MD‡,§; Flanders, Dan MD§; Weinberg, Eitan MD§; Savlov, Deena MD§; Pillai Riddell, Rebecca R. PhD*,‡,§. Caregiver and Child Distress as Predictors of Dyadic Physiological Attunement During Vaccination. The Clinical Journal of Pain 39(7):p 340-348, July 2023. | DOI: 10.1097/AJP.0000000000001125Objective: Previous research discerned three groups of caregiver-toddler dyads that differed in their physiological co-regulatory patterns, also known as physiological attunement, during routine vaccinations in the second year of life. One group of dyads (80% of sample) displayed an attuned regulatory pattern and two groups of dyads (20% of sample) showed maladaptive attunement patterns (i.e., a lack of attunement or misattunement). The objective of the current study was to examine how well pain-related distress of children and caregivers during vaccination predicted these patterns. Methods: Caregiver-toddler dyads (N = 189) were part of a longitudinal cohort observed at either 12-, 18-, or 24-month vaccination appointments. Caregiver self-report of worry was assessed before and after the needle and child behavioural pain-related distress was also measured during the vaccination appointment. Logistic regression was used to determine how well these variables predicted caregiver-child physiological attunement patterns, as indexed by high-frequency heart rate variability. Results: Higher behavioural pain-related distress at various timepoints after the needle were associated with membership in the dyad groups that showed misattunement or lack of attunement. Further, caregivers with higher pre-needle worry and lower post-needle worry had a greater likelihood of belonging to groups that showed a maladaptive attunement pattern. Discussion: Findings suggest that caregivers who experience distress associated with their toddlers' vaccination experience more difficulty co-regulating with their child during vaccination, and these children are at risk of experiencing higher levels of pain related distress. This research highlights the need to help caregivers support their children's regulation during vaccination.This research was funded by awards to R.R. Pillai Riddell from the Natural Sciences and Engineering Research Council of Canada [504112], the Ontario Ministry of Research and Innovation, and the Canadian Foundation of Innovation [532009], as well as Doctoral Training Awards provided to M.G. DiLorenzo-Klas and J.A. Waxman from the Canadian Institutes of Health Research, the Ontario Graduate Scholarship, and the Meighen Wright Graduate Scholarship in Maternal-Child Health. M.G. DiLorenzo-Klas and J.A. Waxman are trainee members of the Pain in Child Health (PICH) program, a research training initiative at Sick Kids