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

Abstract

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 = 548), preschool vaccination (n = 302), and a preschool psychological assessment (n = 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.

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

“…This finding supports our second hypothesis, and makes a novel contribution to our understanding of the mechanisms through which parent behaviors influence infant acute pain outcomes. It also replicates findings from previous studies that identified stronger relationships between parent distress-promoting behaviors (when compared with coping-promoting behaviors) and pain-related distress in in preschoolers [ 19 ] and older children [ 20 , 21 ]. Taken together, these findings suggest that teaching parents to avoid engaging in suboptimal behaviors may be more impactful than solely emphasizing optimal behaviors in the management of vaccination pain.…”

“…Finally, we found that emotional availability made negligible contributions to pain outcomes when other aspects of parent behaviors were put in the model. While previous work with the OUCH cohort identified relationships between emotional availability and pain outcomes, these studies did not examine the concurrent contributions of emotional availability in the context of other parent factors [ 14 , 15 , 19 ]. Given that many of the behaviors accounted for by our measure of distress-promoting behaviors are reflective of a low degree of emotional attunement between parent and infant, and can, therefore, be conceptualized as being indicative of parent insensitivity, our finding is not surprising.…”

“…Parent–infant dyads were eligible to participate if the infant was born full-term (≥37 weeks), had no suspected developmental delays, impairments, or chronic illnesses, and was never admitted to a neonatal intensive care unit, and if the parent was able to speak and read English. The original sample included 760 parent–infant dyads who were followed at routine vaccinations throughout the first year of life (for full sample demographics, see References [ 13 , 19 ]).…”

“…Although insensitive parent behaviors appear to be a key factor contributing to infant pain-related distress, an understanding of the influence of these behaviors in the context of other more optimal behaviors (e.g., emotional availability and proximal soothing) is needed. Among preschoolers [ 19 ] and older children [ 20 , 21 ], when parent distress-promoting and coping-promoting behaviors were assessed concurrently in a vaccination context, distress-promoting behaviors were consistently shown to have stronger relationships with pain-related distress. This suggests that, in the context of toddler and child vaccinations, instructing parents to avoid engaging in distress-promoting behavior may be more important than instructing parents to engage in coping-promoting behaviors [ 19 ].…”

Psychological and procedural distress following a young child’s burn injury

“…Recently, researchers have recommended parents are explicitly discouraged from using distresspromoting behavior (during needle-related procedures) (Campbell, DiLorenzo, et al, 2017;Campbell, Pillai Riddell, Cribbie, Garfield, & Greenberg, 2017;Pillai Riddell et al, 2017). This recommendation stems from findings that suggest reducing parental distress-promoting behavior is more important for child coping outcomes than increasing parental coping-promoting behavior .…”