An examination of the reciprocal and concurrent relations between behavioral and cardiac indicators of acute pain in toddlerhood

Abstract

The aim of this study was to examine the concurrent and predictive relations between healthy toddlers' pain behavior and cardiac indicators (ie, heart rate [HR] and respiratory sinus arrhythmia [RSA]) during routine vaccinations. Caregiver–infant dyads were part of a longitudinal cohort observed during their 12- and 18-month vaccinations. Behavioral and cardiac data were simultaneously collected for 1-minute preneedle and 3-minutes postneedle. Videotapes were coded for pain behaviors (FLACC; Merkel et al., 1997), and cardiac data were analyzed (HR, RSA) during sequential 30-second epochs. Four separate cross-lagged path models were estimated using data from the 12- (n = 147) and 18-month (n = 122) vaccinations. Across 12- and 18-month vaccinations, predictive within-measure relations were consistent for FLACC, HR, and RSA, reflecting good stability of these pain indicators. Behavioral indicators predicted subsequent HR and RSA within the immediate postneedle period. Both baseline behavior and HR/RSA predicted future pain scores. Concurrent residual relations between behavioral and cardiac indicators were inconsistent across time and indicators. Results suggest that behavioral and cardiac indicators reflect unique aspects of the nociceptive response. As such, multimodal assessment tools should be used and contextualized by child age, cardiac indicator, baseline behavior/physiology, and pain phase.

Child Distress Expression and Regulation Behaviors: A Systematic Review and Meta-Analysis

“…To gain a more nuanced understanding of emotion regulation, more work is needed that examines how distress regulation behavior and distress expression are temporally associated. Analyses such as cross-lagged path models continue to be explored, particularly in naturalistic settings that facilitate observing varying levels of distress (e.g., [ 61 ]).…”

Getting to the heart of childhood empathy: Relations with shyness and respiratory sinus arrhythmia

“…In our previous experience, we have been able to reliably record ECG data from the child's back, and this procedure has resulted in less behavior-sourced artifact (e.g., Waxman et al, 2020). The electrodes and respiration belt were attached to a MindWare Mobile Impedance…”

The impact of parental contact upon cortical noxious‐related activity in human neonates

“…This is not surprising as physiological, behavioural and cortical noxious‐related responses can vary independently from one another as they are mediated by different parts of the nervous system (i.e. subcortical autonomic, somatic and cortical centres respectively) (Evans, 2001; Jones et al., 2017; Morison et al., 2001; Ranger et al., 2007; Rinn, 1984; Slater et al., 2008; Slater, Cornelissen, et al., 2010; Waxman et al., 2020). Studies that have reported a significant decrease in infant pain‐related behavioural responses during skin‐to‐skin care were carried out over a longer time period and included the additional stimulus of squeezing the heel (Cong, Ludington‐Hoe, & Walsh, 2011; Johnston et al., 2003, 2008; Pillai Riddell et al., 2015).…”

“…These measures are mediated by different parts of the nervous system (i.e. subcortical somatic, autonomic and cortical centers respectively) and are therefore likely to reflect different and partially independent aspects of the sensory response (Evans, 2001; Morison, Grunau, Oberlander, & Whitfield, 2001; Ranger, Johnston, & Anand, 2007; Rinn, 1984; Slater, Cantarella, Franck, Meek, & Fitzgerald, 2008; Slater, Cornelissen, et al., 2010; Waxman et al., 2020). Indeed, these measures are not always directly correlated (Jones et al., 2017), and can be differentially modulated by contextual factors such as baseline stress levels and sucrose administration following the same noxious stimulus (Jones et al., 2017; Slater, Cornelissen, et al., 2010).…”