87 research outputs found
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
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
The ABCDs of Pain Management: A Double-Blind Randomized Controlled Trial Examining the Impact of a Brief Educational Video on Infants’ and Toddlers’ Pain Scores and Parent Soothing Behavior
Objectives To test the efficacy of a brief behavioral pain management strategy (The ABCDs of Needle Pain Management), delivered via video, on infants’ and toddlers’ pain scores and on parental soothing behavior. Methods This was a double-blind, parallel trial design. Parent–child dyads (N = 128) were recruited before their child’s 6-month (infant) or 18-month (toddler) vaccination in a pediatric clinic and randomly assigned to watch a 5-min treatment video or a placebo video. The primary outcome was the Modified Behavior Pain Scale (Taddio et al., Journal of Pain and Symptom Management, 10, pp. 456–463, 1995), coded during four epochs (Pain Reactivity, Pain Regulation 1 min, Pain Regulation 2 min, and Pain Regulation 3 min) after the last vaccination needle. Secondary analyses examined parental use of distraction, rocking, and physical comforting over this same time period. Results Results demonstrated a treatment effect for toddlers (18-month-olds) for the Pain Regulation 1 (d = 0.84) and Pain Regulation 2 (d = 0.76) postvaccination scores. Secondary analyses found differences in parental rocking and physical comforting between treatment conditions and between age-groups (d’s = 0.37–0.54). Conclusions The ABCD pain management strategy delivered via video was an effective way to reduce toddler pain after vaccination and increase parental use of rocking and physical comforting. The treatment effect was not demonstrated with infants
Parental Report of Self and Child Worry During Acute Pain: A Critical Factor in Determining Parental Pain Judgment
Objective: The objective of this study was to determine which variables predict parental postvaccination pain ratings. It was hypothesized that after child behavior, parental sensitivity, and parental reports of worry would be the strongest predictors. Methods: Data for 215 parent-child dyads were analyzed from a longitudinal cohort at the preschool (4 to 5 y of age) vaccination. Preschoolers' pain behaviors 15 seconds, 1 minute 15 seconds, and 2 minutes 15 seconds after the painful immunization were observed and rated. Parental sensitivity, as well as parental own worry and their assessment of their child's worry, were assessed before and after the needle. Three regression models were used to determine the impact of these variables on parental pain assessment. Results: Preschoolers' pain behaviors moderately accounted for variance in parental pain judgment (R=0.23 to 0.28). Parental sensitivity was not a significant unique predictor of parental pain rating at the preschool age. Parental assessment of their own worry and worry about their preschoolers after the needle were critical contributors to parental pain judgment. Post hoc analyses suggest that parents who report low child worry, are more congruent with their child during regulatory phases postvaccination. However, both parents with high and low self-worry had more congruent pain ratings with child pain behavior scores during the reactivity phase. Discussion: The study suggests that the majority of variance in parent pain ratings was not predominantly based on preschoolers' pain behaviors. Parental worry levels and their assessment of their child's worry were also significant predictors. Clinical implications are discussed
The Clerkship Pediatric Rotation: Does Setting Matter?
ABSTRACTBackground: Medical student rotations in community practice settings are increasingly common within pediatric clerkship curricula yet little evidence exists to support the quality of the educational exposure. Purpose: To assess the impact of clerkship site (community setting vs. exposure to an Academic Health Sciences Center) on the following educational outcomes: 1. Clinical Performance; 2. Examination Performance; 3. Written Assignment Performance; and 4. Successful Matching to a Canadian Pediatric Residency Program.Methods: 340 medical students from the graduating classes of 2007 and 2008 at the University of Toronto, Canada were studied. Rotation performance (clinical assessment, examination mark, and written assignment mark) and acceptance into a Canadian pediatric residency program were assessed in relation to clerkship rotation site. These outcomes were assessed while controlling for the following potential confounders: 1) Pre-clerkship career preference and 2) Pre-rotation site preference as expressed by each medical student. Results: 172 medical students completed rotations that included exposure to an academic health sciences center, while 168 medical students had exclusive exposure to the community setting. Students who completed exclusively community-based pediatric rotations received slightly higher clinical evaluations (p=0.006), but not exam marks (p=0.812) nor written assignment marks (p=0.086). Students who had expressed an interest in paediatrics as a career prior to beginning their clerkship performed better during paediatric clerkship regardless of site (p= .0003) and were more likely to choose a clerkship setting that included exposure to an Academic Health Sciences Center (p=.052). Clerkship setting was not found to impact on successful matching to a Canadian pediatric residency program (p=0.171).Discussion: These results help support the decision of curriculum committees to incorporate the use of community practice settings and inform students and faculty as to the validity of distributed medical education within the field of pediatric medical education
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
The role of infant pain behaviour in predicting parent pain ratings
BACKGROUND: Research investigating how observers empathize or
form estimations of an individual experiencing pain suggests that both
characteristics of the observer (‘top down’) and characteristics of the individual
in pain (‘bottom up’) are influential. However, experts have opined
that infant behaviour should serve as a crucial determinant of infant pain
judgment due to their inability to self-report.
OBJECTIVE: To predict parents’ immunization pain ratings using archival
data. It was hypothesized that infant behaviour (‘bottom up’) and
parental emotional availability (‘top down’) would directly predict the
most variance in parent pain ratings.
METHODS: Healthy infants were naturalistically observed during their
two-, four-, six- and/or 12-month immunization appointments. Crosssectional
latent growth curve models in a structural equation model context
were conducted at each age (n=469 to n=579) to examine direct and
indirect predictors of parental ratings of their infant’s pain.
RESULTS: At each age, each model suggested that moderate amounts of
variance in parent pain report were accounted for by models that included
infant pain behaviours (R2=0.18 to 0.36). Moreover, notable differences
were found for older versus younger infants with regard to parental emotional
availability, infant sex, caregiver age and amount of variance
explained by infant variables.
CONCLUSIONS: The results of the present study suggest that parent
pain ratings are not predominantly predicted by infant behaviours, especially
before four months of age. Current results suggest that recognizing
infant pain behaviours during painful events may be an important area of
parent education, especially for parents of very young infants. Further work
is needed to determine other factors that predict parent judgments of
infant pain
Naturalistic Parental Pain Management During Immunizations over the First Year of Life: Observational Norms from the OUCH Cohort
No research to date has descriptively catalogued what parents
of healthy infants are naturalistically doing to manage their infant's
pain over immunization appointments across the first year of life. This
knowledge, in conjunction with an understanding of the relationships
different parental techniques have with infant pain-related distress,
would be useful when attempting to target parental pain management
strategies in the infant immunization context. This study presents
descriptive information about the pain management techniques parents have
chosen, and examines the relationships these naturalistic techniques have
with infant pain-related distress over the first year of life. 760
parent-infant dyads were recruited from three pediatrician clinics in
Toronto, Canada, and were naturalistically followed and videotaped
longitudinally over four immunization appointments across the infant's
first year of life. Infants were full-term, healthy babies. Videotapes
were subsequently coded for infant pain-related distress behaviours and
parental pain management techniques. After controlling for preceding
infant pain-related distress levels, parent pain management techniques
accounted for, at most, 13% of the variance in infant pain-related
distress scores. Across all age groups, physical comfort, rocking, and
verbal reassurance were the most commonly used non-pharmacological pain
management techniques. Pacifying and distraction appeared to be most
promising in reducing needle-related distress in our sample of healthy
infants. Parents in this sample seldom used pharmacological pain
management techniques. Given the psychological and physical repercussions
involved with unmanaged repetitive acute pain and the paucity of work in
healthy infants, this paper highlights key areas for improving parental
pain management in primary care
Infant pain-regulation as an early predictor of childhood temperament
BACKGROUND: There is considerable variability in infants’ responses
to painful stimuli, including facial and vocal expressions. This variability
in pain-related distress response may be an indicator of temperament styles
in childhood.
OBJECTIVE: To examine the relationships among immunization pain
outcomes (pain reactivity, pain regulation and parent ratings of infant
pain) over the first year of life and parent report of early temperament.
METHODS: A subset of parent-infant dyads in an ongoing Canadian
longitudinal cohort was studied. Infant pain behaviours were coded using
the Modified Behavior Pain Scale. Parental judgments of infant pain were
recorded using the Numeric Rating Scale. Infant temperament was measured
using the Infant Behaviour Questionnaire-Revised. Correlational
analyses and multiple regressions were conducted.
RESULTS: Multiple regressions revealed that the 12-month regulatory
pain scores predicted parent ratings of the Negative Affectivity temperament
dimension at 14 months of age. Parent ratings of infant pain at
12 months of age predicted parent ratings of the Orienting/Affiliation
temperament dimension, with sex differences observed in this substrate.
CONCLUSION: Pain-related distress regulation at one year of age
appears to be a novel indicator of parent report of temperament ratings.
Pain outcomes in the first six months of life were not related to parent
temperament ratings
Variability in Infant Acute Pain Responding Meaningfully Obscured By Averaging Pain Responses
Given the inherent variability in pain responding, using an
"average" pain score may pose serious threats to internal and external
validity of current research findings. Using growth mixture modeling
(GMM), the paper first examines if infants can be differentiated into
stable groups based on their pain response patterns over a two-minute
post-needle period. Secondary analyses, to specifically address the issue
of averaging pain scores to represent a sample, qualitatively described
clinically meaningful differences between pain scores of the discerned
groups and the overall mean (irrespective of groups). Infants were part
of Canadian longitudinal cohort naturalistically observed during their 2-
, 4-, 6-, and/or 12-month immunization appointments (Ns = 458 to 574) at
3 pediatrician clinics between 2007 and 2012. At every age, GMM analyses
discerned distinct groups of infants with significantly variable patterns
of pain responding over the 2 minutes post-needle. Our secondary analyses
suggested that the overall mean pain score immediately post-needle
reflected most groups well at every age. However, for older infants (6
and 12 months, especially), the overall mean pain responses at 1 and 2
minutes post-needle significantly over or underestimated groups that
contained 48% to 100% of the sample. These results combined highlight
the significant variability of infant pain responding patterns between
groups of infants and furthermore, calls into question the validity of
using an overall mean in research with older infants during the
regulatory phase post-needle
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