Trajectories of distress regulation during preschool vaccinations: child and caregiver predictors.

ABSTRACT: Recent research has highlighted the need for a deeper understanding of the heterogeneity in trajectories of children's distress after acute pain exposure, moving beyond the group means of behavioural pain scores at a single timepoint. During preschool vaccinations, 3 distinct trajectories of postvaccination pain regulation have been elucidated, with approximately 75% of children displaying trajectories characterized by downregulation to no distress by 2 minutes postneedle and 25% concerningly failing to downregulate by 2 minutes. The objective of this study was to examine child and caregiver predictors of preschool children's postvaccination regulatory patterns. Our results indicated that higher child baseline distress, more caregiver coping-promoting verbalizations in the first minute after the needle, less coping-promoting verbalizations in the second minute, and more caregiver distress-promoting verbalizations in the second minute after the needle were associated with membership in the trajectories characterized by high distress. Furthermore, although all children's pain-related distress at various timepoints throughout the appointment was most strongly predicted by previous pain scores, different patterns of associations emerged depending on the trajectory exhibited. This research highlights both the need to minimize distress before the needle to avoid the highly distressed trajectory and the importance of considering the heterogeneity of trajectories of preschool pain responding when examining the factors that are associated with children's pain-related distress.

Longitudinal and concurrent relationships between caregiver-child behaviours in the vaccination context and preschool attachment.

ABSTRACT: This article consists of 2 separate studies in which the overarching aim was to examine the relationships between caregiver-child behaviours in the vaccination context (infant and preschool) and preschool attachment outcomes. It provides for the first time an examination of acute pain behaviours during early childhood and how it relates to a critical aspect of child development (ie, attachment status) at the end of early childhood. Study 1 examined the longitudinal relationships between caregiver-infant behaviours during infants' first routine vaccination (2 months) and preschool attachment (n = 84). Study 2 examined the concurrent relationships between caregiver-preschooler behaviours during the last routine vaccination of preschool (4-5 years) and preschool attachment (n = 117). Hierarchical multiple regression analyses were used. Although there were several nonsignificant findings, the results revealed that higher caregiver sensitivity and higher proximal soothing 1 minute before the needle during infants' 2-month vaccinations predicted higher levels of preschooler avoidance and lower levels of preschooler ambivalence, respectively. In addition, higher infant pain-related distress at 2 minutes after the needle was related to higher preschooler security and lower preschooler disorganization and controlling-punitive attachments. In terms of concurrent relationships, only caregiver sensitivity was significantly related to preschool attachment outcomes. Specifically, higher caregiver sensitivity at preschoolers' 4- to 5-year vaccinations was related to higher preschooler attachment security. The study findings provide evidence that child-caregiver behavioural patterns during the infant and preschool routine vaccination relate to preschoolers' patterns of attachment. Moreover, it underscores the potential importance of health professionals teaching and supporting attuned caregiving to the child in pain.

Three critical factors affecting automated image species recognition performance for camera traps.

Ecological camera traps are increasingly used by wildlife biologists to unobtrusively monitor an ecosystems animal population. However, manual inspection of the images produced is expensive, laborious, and time-consuming. The success of deep learning systems using camera trap images has been previously explored in preliminary stages. These studies, however, are lacking in their practicality. They are primarily focused on extremely large datasets, often millions of images, and there is little to no focus on performance when tasked with species identification in new locations not seen during training. Our goal was to test the capabilities of deep learning systems trained on camera trap images using modestly sized training data, compare performance when considering unseen background locations, and quantify the gradient of lower bound performance to provide a guideline of data requirements in correspondence to performance expectations. We use a dataset provided by Parks Canada containing 47,279 images collected from 36 unique geographic locations across multiple environments. Images represent 55 animal species and human activity with high-class imbalance. We trained, tested, and compared the capabilities of six deep learning computer vision networks using transfer learning and image augmentation: DenseNet201, Inception-ResNet-V3, InceptionV3, NASNetMobile, MobileNetV2, and Xception. We compare overall performance on "trained" locations where DenseNet201 performed best with 95.6% top-1 accuracy showing promise for deep learning methods for smaller scale research efforts. Using trained locations, classifications with <500 images had low and highly variable recall of 0.750 ± 0.329, while classifications with over 1,000 images had a high and stable recall of 0.971 ± 0.0137. Models tasked with classifying species from untrained locations were less accurate, with DenseNet201 performing best with 68.7% top-1 accuracy. Finally, we provide an open repository where ecologists can insert their image data to train and test custom species detection models for their desired ecological domain.

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.

Design patterns for wildlife-related camera trap image analysis.

This paper describes and explains design patterns for software that supports how analysts can efficiently inspect and classify camera trap images for wildlife-related ecological attributes. Broadly speaking, a design pattern identifies a commonly occurring problem and a general reusable design approach to solve that problem. A developer can then use that design approach to create a specific software solution appropriate to the particular situation under consideration. In particular, design patterns for camera trap image analysis by wildlife biologists address solutions to commonly occurring problems they face while inspecting a large number of images and entering ecological data describing image attributes. We developed design patterns for image classification based on our understanding of biologists' needs that we acquired over 8 years during development and application of the freely available Timelapse image analysis system. For each design pattern presented, we describe the problem, a design approach that solves that problem, and a concrete example of how Timelapse addresses the design pattern. Our design patterns offer both general and specific solutions related to: maintaining data consistency, efficiencies in image inspection, methods for navigating between images, efficiencies in data entry including highly repetitious data entry, and sorting and filtering image into sequences, episodes, and subsets. These design patterns can inform the design of other camera trap systems and can help biologists assess how competing software products address their project-specific needs along with determining an efficient workflow.

Parental Psychological Distress Moderates the Impact of a Video Intervention to Help Parents Manage Young Child Vaccination Pain.

Objective: The current study sets out to conduct a post hoc analysis of the moderating effect of parent psychological distress on a pediatric pain management intervention. Methods: Parents of 6-month-old infants (n = 64) and 18-month-old toddlers (n = 64 each) were randomized to a treatment (The ABCDs of Pain Management) or control video and videotaped during the vaccination. Parent psychological distress was also measured at the vaccination. Outcomes were children's pain, parent worry, and parent soothing behavior post-vaccination. Results: Parent psychological distress only moderated video effect on toddler pain during the regulation phase. Parent psychological distress did not moderate the impact of the video on parent worry or parent soothing post-needle at either age. The video did increase parent soothing in parents of both infants and toddlers, and reduced worry in parents of toddlers. Conclusions: To our knowledge, this is the first study to assess a moderating factor on a child pain management intervention. The video's efficacy was moderated for toddlers' pain regulation, such that parents with high psychological distress did not show as much benefit from the intervention. No other moderations were found in either age group for any other outcome. Main effects for the video impacting soothing behavior of parents of both infants and toddlers were confirmed, and a new finding of video efficacy was seen through the significantly lower worry of toddlers' parents post-needle. Given the nonclinical sample, low levels of psychological distress were found. Efforts to replicate this study in a higher risk sample are necessary.

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

Parents play a critical role in supporting infants' ability to manage strong emotions. Routine vaccinations provide an ideal context to observe the effect of parents' behaviors on infants' pain-related distress. Previous research in the vaccination context showed that parent sensitivity, operationalized by variables such as emotional availability and proximal soothing behaviors, is associated with infant pain-related distress behavior. However, the magnitudes of these relationships were smaller than expected given the established importance of parents in the development of distress regulation. In recent work, a reliable and valid measure to operationalize insensitive behaviors was developed. The objective of the current study was to examine the relative contribution of variables representing sensitive and insensitive behaviors to the prediction of infant pain-related distress behaviors during the reactivity and regulation phases of needle pain. Archival data was used to analyze a subsample of infants followed during their two-month, six-month, and 12-month vaccinations (n= 81). Results of regression analyses indicated that parent insensitive behaviors generally had the strongest relationships with pain outcomes across all ages, with a greater influence on regulation-phase pain-related distress behavior, rather than reactivity-phase pain-related distress behavior. Our findings support the utility of a measure of distress-promoting parent behaviors in a vaccination context, and highlight the potential value of this measure for clinicians and researchers.

Distress Responses in a Routine Vaccination Context: Relationships to Early Childhood Mental Health.

Social and emotional competencies, such as distress regulation, are established in early childhood and are critical for the development of children's mental health and wellbeing. Routine vaccinations in primary care provide a unique opportunity to relate responses to a universal, relatively standardized, distress regulation paradigm (i.e., pain-related distress) to key developmental outcomes. The current study sought to examine distress regulation during routine vaccination in infancy and preschool as predictors of outcomes related to socioemotional competence in preschool. It was hypothesized that children with poorer distress regulation abilities post-vaccination would have lower socioemotional development. Furthermore, it was hypothesized that insensitive parenting would exacerbate this relationship for children with poor distress regulation abilities. As part of an ongoing longitudinal cohort, 172 parent-child dyads were videotaped during vaccinations in infancy and preschool, and subsequently participated in a full-day psychological assessment in a university lab. Videotapes were coded for child pre-needle distress (baseline distress), immediate post-needle pain-related distress reactivity (immediate distress reactivity), and pain-related distress regulation (distress regulation). Parent sensitivity during the preschool vaccination was also coded. Baseline distress prior to vaccination predicted greater externalizing problems and behavioral symptoms. Parent sensitivity did not moderate the association between any child distress behaviors and socioemotional development indicators. Child distress behaviors prior to injection, regardless of parent behavior, during the vaccination context may provide valuable information to health care professionals about child socioemotional functioning in the behavioral and emotional domains.

Developing a measure of distress-promoting parent behaviors 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.

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 détresse liée à la douleur du nourrisson, tandis que les relations divergentes ont été évaluées avec la sensibilité parentale et les comportements d'apaisement.Résultats: L'outil de mesure a démontré un degré de fiabilité inter-évaluateurs et de fiabilité test-retest allant de modéré à excellent, ainsi qu'une validité convergente et divergente (valeur absolue de f 0,30 à 0,46).Conclusions: En démontrant une grande fiabiilité et une grande validité, cet outil de mesure représente une nouvelle façon prometteuse de comprendre comment les prestataires de soins interagissent avec les nourissons pendant les procédures douloureuses. En mettant l'accent sur ce qui favorise la détresse et en ayant recours à un format qui peut être codifié à partir d'une vidéo ou in vivo, il est possible d'opérationnaliser l'effet du prestataire de soins sur l'expérience de douleur de l'enfant, que ce soit dans le cadre d'une étude ou dans un cadre clinique.

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 = 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.

Featured Article: 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.

Preschool Needle Pain Responding: Establishing 'Normal'.

The current study sets forth to provide descriptive data for preschool vaccination pain responding as well as examine longitudinal relationships over early childhood. Growth mixture modeling was first used to describe stable subgroups of preschoolers on the basis of their pain response patterns over 2-minutes post-needle. Secondly, a parallel-process growth curve model was used to assess the stability of acute pain responding from 12 months of age to preschool age. Specifically, we examined whether preschool pain-related distress or regulation could be predicted from 12-month acute pain responding. Preschool participants were part of a Canadian longitudinal cohort (The Opportunities to Understand Childhood Hurt [OUCH] cohort; N = 302). Growth mixture modeling analyses discerned 3 distinct groups of preschoolers, with an important minority not regulating to low-no pain by 2 minutes post-needle. There were no significant associations between 12-month and preschool pain responding. These results highlight the steep trajectory of development between these different stages of early childhood and the variability of pain responding at the preschool vaccination. PERSPECTIVE: This study provides descriptive data for preschool vaccination pain responding as well as examines longitudinal relationships over early childhood. Demonstrating significantly different pain patterns from infancy, 25% of preschoolers are displaying suboptimal regulation trajectories. This considerable minority poses a significant concern because of the established trajectory of phobia onset in middle childhood.

Does Caregiver Behavior Mediate the Relationship Between Cultural Individualism and Infant Pain at 12 Months of Age?

This study aimed to understand the relationship between caregiver culture and infant pain expression at the 12-month immunization and discern if a mechanism subsuming this relationship was the quality of caregiver behaviors (emotional availability). Infants (N = 393) with immunization data at 12 months of age were examined. On the basis of the Development of Infant Acute Pain Responding model, a mediation model was developed to examine how caregiver behaviors mediate the relationship between caregiver heritage culture and infant pain. Culture was operationalized by an objectively derived quantification of caregivers' self-reported heritage culture's individualism. Two mediation models were estimated, examining infant pain expression at 1 and 2 minutes post-needle. Caregivers who self-reported heritage cultures that were more highly individualistic tended to show greater emotional availability, which in turn predicted decreased infant pain expression at 1 and 2 minutes post-needle. The present findings further our understanding of one mechanism by which caregiver culture affects infant acute pain expression. PERSPECTIVE: Adding to the literature examining direct relationships between culture and infant immunization pain, this article proposes the quality of caregiver behaviors as a mechanism by which culture affects infant acute pain expression at 12 months of age. Results support the proposed mechanism and inform our understanding of the role of caregiver culture in the infant pain context.

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 noncompliance with preventative health care, such as vaccinations. Few studies have examined the longitudinal and concurrent predictors of pain-related anticipatory distress. This article consists of 2 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 response 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 caregiver-child dyads was observed during their infant and preschool vaccinations (the Opportunities to Understand Childhood Hurt cohort) and was used for both studies. In study 1, pain response 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.

Caregiver Soothing Behaviors After Immunization and Infant Attachment: A Longitudinal Analysis.

OBJECTIVES: There were 2 primary objectives to the current study: (1) to relate caregiver behavior trajectories across immunization appointments over the first year of life to subsequent infant attachment and (2) to relate caregiver behavior trajectories within each immunization appointment over the first year of life to subsequent infant attachment. METHOD: A subsample of 130 caregivers and their infants were recruited from a sample of 760 caregivers who were part of an ongoing longitudinal cohort that videotaped infants' 2-, 4-, 6-, and 12-month immunization appointments. This subsample of caregivers and their infants (n = 130) were invited to participate in an assessment of attachment when infants were between 12 and 18 months of age at the local children's hospital. RESULTS: Caregiver proximal soothing behaviors were the only caregiver behaviors postimmunization that were related to subsequent infant attachment. Higher frequencies of caregiver proximal soothing at 12 months were related to infants' organized attachment, whereas steeper decreases in proximal soothing across the first year were associated with disorganized infant attachment. In addition, when caregivers engaged in proximal soothing for longer after their 12 month olds' immunizations, these infants were more likely to be secure or organized in their attachment. CONCLUSION: These results provide empirical support for the ecological validity of studying infant attachment in a pediatric pain context. The pediatric "well-baby" visit may provide a potential opportunity to feasibly integrate brief infant mental health screening and intervention.

14-year-old boy with painful nail changes.

Doxycycline is a classically implicated cause of phototoxic reactions. Photo-onycholysis is a rare manifestation of phototoxicity. Nail changes may typically include nail pain, subungual hemorrhages, or distal onycholysis. Self-resolution can be expected in 3 to 6 months. Patients prescribed doxycycline should be counseled about the potential for phototoxicity and the need for appropriate sun protection while taking the medication.

Probiotics for infantile colic: a randomized, double-blind, placebo-controlled trial investigating Lactobacillus reuteri DSM 17938.

OBJECTIVE: To investigate the effectiveness of Lactobacillus reuteri DSM 17938 for the treatment of infantile colic in breastfed Canadian infants, compared with placebo. STUDY DESIGN: A randomized, double-blind, placebo-controlled trial was conducted involving 52 infants with colic, according to modified Wessel criteria, who were assigned at random to receive L reuteri DSM 17938 (10(8) colony-forming units) (n = 24) or placebo (n = 28) for 21 days. Daily crying and fussing times were recorded in a structured diary, and maternal questionnaires were completed to monitor changes in infant colic symptoms and adverse events. RESULTS: Total average crying and fussing times throughout the study (from baseline to day 21) were significantly shorter among infants with colic in the probiotic group compared with infants in the placebo group (1719 ± 750 minutes [29 ± 13 hours] vs 2195 ± 764 minutes [37 ± 13 hours]; P = .028) (relative risk, 0.78; 95% CI, 0.58-0.98). Infants given L reuteri DSM 17938 showed a significant reduction in daily crying and fussing times at the end of treatment period compared with those receiving placebo (median, 60 minutes/day [IQR, 64 minutes/day] vs 102 minutes/day [IQR, 87 minutes/day]; P = .045). On day 21, a significantly higher proportion of infants in the L reuteri DSM 17938 group responded to treatment with a ≥50% crying time reduction compared with infants given placebo (17 vs 6, P = .035; relative risk, 3.3; 95% CI, 1.55-7.03). CONCLUSION: Administration of L reuteri DSM 17938 significantly improved colic symptoms by reducing crying and fussing times in breastfed Canadian infants with colic.

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. Cross-sectional 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.

Infant pain regulation as an early indicator 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.