Developing a measure of distress-promoting parent behaviors during infant vaccination: Assessing reliability and validity

Abstract

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. RÉSUMÉ Contexte: Les nourrissons dépendent de l'apaisement que peuvent éventuellement leur procurer leurs parents avec sensibilité afin de les soutenir dans la régulation de leur détresse liée à la douleur. Toutefois, malgré le fait qu'ils soient d'importance égale ou supérieure, peu d'attention a été accordée à la façon de mesurer les comportements parentaux qui favorisent la détresse. But: Le but de cet article était de développer et de valider un outil de mesure de la détresse suscitée par les comportements parentaux dans le cadre de procédures entrainant une douleur aigue (ex.: la vaccination), qui pourrait être utilisée par les chercheurs et les cliniciens. Méthodes: Suite à une première production d'outils de mesure, des groupes de discussion ont été menés avec des cliniciens faisant de la vaccination afin de comprendre la validité apparente, la validité de contenu et la validité écologique de l'outil de mesure. Des séquences vidéo d'archives (n = 537 vidéos de dyades nourrisson-prestataire de soins) ont ensuite été codifiées afin de mesurer les comportements qui favorisent la détresse au cours des trois minutes suivant l'injection du vaccin. La validité et la fiabilité ont été étudiées à l'aide d'analyses corrélationnelles. La validité de construit a été évaluée par les relations convergentes avec la dét...

Understanding the Relative Contributions of Sensitive and Insensitive Parent Behaviors on Infant Vaccination Pain

“…Parent distress-promoting behaviors were assessed using a checklist of observable distress-promoting behaviors with established validity and reliability in a vaccination context [ 18 ]. The checklist examines the presence of eight suboptimal or insensitive parent behaviors: (1) fathom wrong (i.e., making comments toward the distressed infant that either do not address, or discredit the infant’s distress, such as saying “It’s not so bad”), (2) face cover (i.e., covering the distressed infant’s face with any object such as a hand or blanket), (3) fashion first (i.e., dressing a distressed infant with no attempt to soothe the infant), (4) forceful (i.e., handling the infant roughly), (5) frustration (i.e., any facial expressions that reflect irritation with the infant’s distress, such as rolling eyes or sighing), (6) fearful (i.e., any parental facial expression that suggests they are scared or frightened), (7) flit away (i.e., any behavior or parental positioning that does not bring the infant close to the parent when the infant is distressed), and (8) flat face (i.e., a complete lack of emotional expression in response to the infant’s distress).…”

“…Whether this pattern holds for infant pain-related distress is unclear. Although previous research involving infant samples seems to suggest strong relationships with distress-promoting parent behaviors [ 18 ], and significant but small relationships with coping-promoting (e.g., emotional availability [ 13 , 14 , 15 ] and proximal soothing [ 6 , 8 , 9 , 10 ]) behaviors, these behaviors were not examined concurrently, to our knowledge.…”

“…This suggests that the aspects of parent behavior that are traditionally studied in a vaccination context may not capture the full extent of parents’ influence on infant pain outcomes. More recently, a different aspect of parent behavior was examined in an infant vaccination context [ 18 ]. Referred to as distress-promoting behaviors, these are behaviors that, while potentially well intentioned, have the paradoxical effect of exacerbating post-needle distress in infants during both the reactivity and regulation phases.…”

“…This lack of attunement between the child’s needs and the parent’s response is seen as being reflective of insensitive parent behavior. In support of this premise, strong negative relationships were found between these insensitive or distress-promoting parent behaviors and parent emotional availability [ 18 ].…”

Research Poster Abstracts

“…Introduction/Aim : Previous studies have shown strong relationships between infant pain-related distress and parents’ use of insensitive behaviors post-vaccination. 1 , 2 The present study explored predictors of parents’ insensitive behavior in response to infant pain-related distress, focusing on parent psychopathology, parenting stress, pre-needle worry, and pre-needle physiological arousal, as well as infant pre-needle distress.…”