Parental judgments of infant pain: Importance of perceived cognitive abilities, behavioural cues and contextual cues.

BACKGROUND: Despite blatant indications, such as behavioural and contextual cues, infant pain is often undermanaged by adult caretakers. The belief that infants are limited in their abilities to comprehend the meaning of an experience or recall that experience has been used to minimize or deny the need for intervention in this vulnerable population. OBJECTIVES: This investigation explored parental beliefs regarding the impact of infant cognitive capabilities, behavioural cues and contextual cues to their pain judgments. Particular interest was focused on their beliefs regarding the general cognitive capabilities of infants of different ages. METHODS: Forty-nine parents viewed videotapes of healthy infants, aged two, four, six, 12 and 18 months, receiving routine immunization injections and provided judgements of the severity of pain on a 100 mm Visual Analogue Scale. Upon completion of their pain judgements for each of the five age groups (two infants per age group; 10 infants total), parents completed questionnaires regarding their beliefs about the capabilities of infants in that age group and then reported the importance of the various cues utilized to formulate their pain judgements. RESULTS: Parents attributed substantial pain to infants in all age groups, almost twice the amount they hypothesized an adult undergoing a similar injection would experience. The cues rated as most important for judgements were similar for infants of varying ages. Overall, facial expressions, sounds and body movements were consistently reported to be most important. Parents acknowledged the development of memory and understanding of pain throughout infancy. However, these beliefs were not deemed by parents as important to their pain ratings, nor were their importance ratings directly related to the pain ratings. CONCLUSION: Parents judged that infants undergoing a routine immunization were experiencing clinically significant levels of pain. However, despite generally acknowledging a developing trajectory for memory and understanding across the five age groups, parents did not indicate that a child’s ability to remember and understand pain were essential features of their pain judgements. The results indicated that memory and understanding did not influence parental judgements of infant pain demonstrating the validity of the parents’ selfassessments

Фигуры мысли в анонимной римской «Риторике для Геренния» (86-82 гг. До н.э.) и их соответствия или аналоги в современном гуманитарном знании : аннотация к магистерской диссертации / Куприянова Анастасия Александровна, Филологический факультет, Кафедра теоретического и славянского языкознания; научный руководитель Мечковская Нина Борисовна

Premature infants hospitalized after birth are exposed to repeated painful procedures as part of their routine medical care. Early neonatal exposure to unmanaged pain has been linked to numerous negative long-term outcomes, such as the development of pain hypersensitivity, detrimental psychological symptomology, and altered neurodevelopment. These findings emphasize the crucial role of pain management in neonatal care. The aim of this article is to give an overview of evidence-based non-pharmacological pain management techniques for hospitalized neonates. Research supporting the effectiveness of various proximal, distal, and procedural pain management methods in neonates will be presented. Additionally, understanding the larger biopsychosocial context of the infant that underpins the mechanisms of these pain management methods is essential. Therefore, two important models that inform non-pharmacological approaches to infant pain management (DIAPR-R [The Development of Infant Acute Pain Responding-Revised], Attachment Theory) will be discussed

The relationship between caregiver sensitivity and infant pain behaviors across the first year of life.

Recent research has begun to examine discrete caregiver pain management behaviors in the infant immunization context. However, there is a dearth of research exploring more global caregiving constructs, such as emotional availability, which can be used to examine the overall sensitivity of caregiver pain management. The aim of the present study was to examine the relationships between caregiver sensitivity (emotional availability) and infant pain behavior (baseline, immediately postneedle, 1 minute after needle) over the first year of life. Parents and infants were a part of a Canadian longitudinal cohort (The OUCH cohort) followed during their 2-, 4-, 6- and 12-month immunizations (current n=731). Both 'within-age' group analyses and 'over-age' analyses were performed. Results indicated that: 1) over age, previous infant pain behavior predicts future infant pain behavior, but this varied depending on timing of pain response and age of infant; 2) over age, previous caregiver sensitivity strongly predicts future caregiver sensitivity; and 3) the concurrent relationship between caregiver sensitivity and every type of infant pain response is only consistently seen at the 12-month immunization. Caregiver sensitivity to the infant in pain is predicted most reliably from previous caregiver sensitivity, not infant pain behaviour. The significant concurrent relationship between caregiver sensitivity and infant pain behaviours is not seen until 12 months, replicating patterns in the infant development literature regarding the time at which the attachment relationship between parent and child can be reliably measured. Discussion addresses implications for both researchers and clinicians who work with infants in pain

Infant Clinical Pain Assessment: Core Behavioural Cues

Diverse behavioral cues have been proposed to be useful cues in infant pain assessment, but there is a paucity of evidence on the basis of formal psychometric evaluation to establish their validity for this purpose. We aimed to examine 2 widely used coding systems, the Neonatal Facial Coding System (NFCS) and the Modified Behavior Pain Scale (MBPS), by examining their factor structures with confirmatory factor analysis using a large archival data set. The results indicated that an item-reduced NFCS scale with 3 items produced a 1-factor pain model that maintained the good psychometric properties of the 7-item scale. In addition, it was found that MBPS also has challenging internal consistency, with items that are weakly correlated as well as highly redundant. One item of the MBPS may be able to capture the construct of pain equally well or potentially improve its psychometric properties. Redefinition of the MBPS with cry as a sole indicator was suggested. This analysis provides 2 new iterations of the NFCS and MBPS that improve construct validity and internal consistency. These shorter versions also improve the feasibility of both measures and increase their potential for clinical use because less time is required for their administration. PERSPECTIVE: This article presents new iterations of the NFCS and MBPS scales. These revised measures improve the internal consistency of the measures, feasibility of use of the tools in research settings, and the efficiency of the coding process. The revised tools could also improve the feasibility of coding within clinical settings

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

Developing a Measure of Distress-Promoting Parent Behaviours During Infant Vaccination: Assessing Reliability and Validity

Background: Infants rely on their parents’ sensitive and contingent soothing to support their regulation from pain-related distress. However, despite being of potentially equal or greater import, there has been little focus on how to measure distress-promoting parent behaviors. Aims: The goal of this article was to develop and validate a measure of distress-promoting parent behaviors for acute painful procedures (e.g., vaccinations) that could be used by researchers and clinicians. Methods: Following initial generation of measure items, focused group discussions were held with vaccinating clinicians to understand the measure’s face, content, and ecological validity. Archival video footage (n = 537 videos of infant-caregiver dyads during vaccination) was then coded using the measure of distress-promoting behaviors for 3 minutes post vaccine injection. Validity and reliability were examined using correlational analyses. Construct validity was assessed by convergent relationships with infant pain-related distress and divergent relationships were assessed with parent sensitivity and soothing-promoting behaviors. Results: The measure demonstrated both moderate to excellent interrater and test-retest reliability and convergent and divergent validity (absolute magnitude of r’s = 0.30 to 0.46). Conclusions: By demonstrating strong reliability and validity, this measure represents a promising new way to understand how caregivers interact with infants during painful procedures. Through focusing on distress promotion and using a format that may be coded both from video or in vivo, it is a feasible way to operationalize the impact of the caregiver on the infant’s pain experience in both research and clinical settings

Convergence of behavioral and cardiac indicators of distress in toddlerhood: A systematic review and narrative synthesis

The objective of the current study was to systematically review the available literature on the relation between behavioral and cardiac indicators used to measure distress in toddlerhood. After ascertaining the eligibility of 2,424 articles through a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and PROSPERO (International Prospective Register of Systematic Reviews) guided search process, 22 articles (N = 2,504) that investigated associations between behavioral and cardiac indicators of distress in toddlerhood were identified. The narrative synthesis described the overall relation (direction [positive, negative], strength [Cohen’s D]) between behavioral and cardiac indicators and was organized by cardiac indicator (i.e., heart rate [HR], heart period, respiratory sinus arrhythmia, pre-ejection period) and type of behavior measured (i.e., coding for expressed emotion behaviors vs. emotion regulation behaviors). Methodological characteristics (i.e., timing of measurement for behavioral and cardiac indicators [concurrent, predictive], length of measurement epochs, inclusion of covariates and moderators) were also described. HR was consistently positively (D = .05 to .54) related to expressed emotion behaviors. No other cardiac and behavioral indicators were consistently related. Methodological differences related to behavioral and cardiac indicators utilized, timing of measurement, and length of measurement epochs may be responsible for heterogeneity in findings. The findings suggest that researchers might get divergent results depending on whether distress is measured with cardiac or behavioral indicators of distress in toddlerhood. Suggestions for future psychophysiological research with young children are offered

Predicting preschool pain-related anticipatory distress: the relative contribution of longitudinal and concurrent factors

Anticipatory distress prior to a painful medical procedure can lead to negative sequelae including heightened pain experiences, avoidance of future medical procedures, and potential non-compliance with preventative healthcare such as vaccinations. Few studies have examined the longitudinal and concurrent predictors of pain-related anticipatory distress. This paper consists of two companion studies to examine both the longitudinal factors from infancy, as well as concurrent factors from preschool that predict pain-related anticipatory distress at the preschool age. Study 1 examined how well preschool pain-related anticipatory distress was predicted by infant pain responding at 2, 4, 6 and 12 months of age. In Study 2, using a developmental psychopathology framework, longitudinal analyses examined the predisposing, precipitating, perpetuating, and present factors that led to the development of anticipatory distress during routine preschool vaccinations. A sample of 202 caregiverchild dyads was observed during their infant and preschool vaccinations (OUCH Cohort) and was used for both studies. In Study 1, pain responding during infancy was not found to significantly predict pain-related anticipatory distress at preschool. In Study 2, a strong explanatory model was created whereby 40% of the variance in preschool anticipatory distress was explained. Parental behaviours from infancy and preschool were the strongest predictors of child anticipatory distress at preschool. Child age positively predicted child anticipatory distress. This strongly suggests that the involvement of parents in pain management interventions during immunization is one of the most critical factors in predicting anticipatory distress to the preschool vaccination

A cross-sectional examination of the relationships between caregiver proximal soothing and infant pain over the first year of life

Although previous research has examined the relationships between caregiver proximal soothing and infant pain, there is a paucity of work taking infant age into account, despite the steep developmental trajectory that occurs across the infancy period. Moreover, no studies have differentially examined the relationships between caregiver proximal soothing and initial infant pain reactivity and pain regulation. This study examined how much variance in pain reactivity and pain regulation was accounted for by caregiver proximal soothing at four routine immunizations (2, 4, 6, 12 months) across the first year of life, controlling for pre-needle distress. One latent growth model was replicated at each of the four infant ages, using a sample of 760 caregiver-infant dyads followed longitudinally. Controlling for pre-needle infant distress, caregiver proximal soothing accounted for little to no variance in infant pain reactivity or regulation at all four ages. Pre-needle distress and pain reactivity accounted for the largest amount of variance in pain regulation, with this increasing after 2- months. It was concluded that, within each immunization appointment across the first year of life, earlier infant pain behavior is a stronger predictor of subsequent infant pain behavior than caregiver proximal soothing. Given the longer-term benefits that have been demonstrated for proximal soothing during distressing contexts, caregivers are still encouraged to use proximal soothing during infant immunizations

Psychological interventions for vaccine injections in young children 0 to 3 years: Systematic review of randomized controlled trials and quasi-randomized controlled trials

Background: This systematic review evaluated the effectiveness of distraction for reducing infant distress during vaccinations in young children aged 0 to 3 years. Design/Methods: Database searches identified relevant randomized and quasi-randomized controlled trials. Three separate clinical questions related to variants of the psychological strategy of distraction (directed video; directed toy; nondirected toy) were pursued. Distress was identified as the critical outcome to assess the benefits of distraction and extracted from relevant trials. Distress was analyzed by phase of procedure (distress preprocedure; distress acute; distress recovery; idiosyncratic phases based on some or all of the 3 aforementioned phases). Results: Ten studies were included in the review. Significant results are presented herein. For directed video distraction, moderate quality evidence suggested that distress was lowered in the treatment group standardized mean difference (SMD -0.68 lower [95% confidence interval (CI), -1.04 to -0.32]) for the acute+recovery phase as well as the preprocedure phase (SMD -0.49 lower [95% CI, -7.6 to -0.22]). For directed toy distraction, the analysis of low-quality evidence for a combined preprocedure+acute+ recovery phase of distress (analysis n=81), suggested that distress was lowered in the treatment group (SMD -0.47 lower [95% CI, -0.91 to -0.02]). An effect for nondirected toy distraction was also seen, analyzing very-low-quality evidence, for the acute distress phase (n=290; SMD -0.93 lower [95% CI, -1.86 to 0.00]). Conclusion: Generally low-quality to very-low-quality evidence suggests that there may be an effect of directed (toy and video) and nondirected toy distraction for children aged 0 to 3 years, for certain phases of the vaccination