The longitudinal and concurrent relationship between caregiver sensitivity and preschool attachment: A systematic review and meta-analysis.

The present study aimed to systematically review and meta-analyze the concurrent and longitudinal relationship between caregiver sensitivity and preschool attachment measured using the Main and Cassidy (1988) and Cassidy and Marvin (1992) attachment classification systems. This review was pre-registered with the International Prospective Register of Systematic Reviews (PROSPERO; Registration Number CRD42017073417) and completed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The present review identified 36 studies made up of 21 samples (N = 3, 847) examining the relationship between caregiver sensitivity and preschool attachment. Eight primary meta-analyses were conducted separately according to the proximity of the assessment of sensitivity to attachment (i.e., concurrent versus longitudinal), operationalization of caregiver sensitivity (i.e., unidimensional versus multidimensional) and attachment categorizations (i.e., secure-insecure versus organized-disorganized). Overall, the meta-analyses revealed higher levels of caregiver sensitivity among caregivers with secure and organized preschoolers, relative to insecure and disorganized preschoolers, respectively. Medium effect sizes (g = .46 to .59) were found for both longitudinal and concurrent associations between caregiver sensitivity and preschool attachment when a unidimensional measure of caregiver sensitivity was employed, compared to small to medium effect sizes (g = .34 to .49) when a multidimensional measure of caregiver sensitivity was employed. Child age at attachment measurement was a significant moderator of the longitudinal association between unidimensional caregiver sensitivity and preschool attachment. Future directions for the literature and clinical implications are discussed.

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.

Age-related differences in the acute pain facial expression during infancy.

BACKGROUND: The ontogenetic perspective on the development of emotional expressions in infants holds that infants' facial and vocal expressions evolved to serve crucial communicative functions in infancy and contribute to infants' survival. Infants' facial expressions should be contextualized by their own developmental stage rather than presuppositions from verbal populations. The overall aim of this paper was to examine age differences in the temporal patterning of elucidated facial expressions in the first minute following vaccination injections. METHODS: One hundred infants were videotaped longitudinally (2, 4, 6 and 12 months) from 2007-2012 during their routine vaccination appointment over the first year of life and five major negative facial configurations were identified using BabyFACS. In the current study, facial configurations were graphed in 5-s epochs for 1-min post-vaccination and subsequently analysed for facial expression by time effects using Repeated Measures ANOVAs at each age. RESULTS: Clear differences in temporal patterns were displayed as infants aged. ANOVA analyses indicated significant facial expression by time interactions at each age. CONCLUSIONS: Facial expressions illustrating intense/moderate distress and sensory overload were prominent in the first 15 s at the 2-, 4- and 6-month vaccination. However, expressions showing regulation of distress occurred progressively earlier over 1 min post-needle in older infants, suggesting a significant shift in regulatory capacity of pain-related distress occurs after 6-months of age. SIGNIFICANCE: An important developmental milestone was identified in infants' ability to regulate distress at 6 months. Supporting parents' infant pain management is particularly critical in the first months of life as infants' initial facial expressions appear to be more reflective of an organism overwhelmed by distress.

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.

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.

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.