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

Campbell, Lauren; Riddell, Rebecca Pillai; Cribbie, Robert; Garfield, Hartley; Greenberg, Saul
doi: 10.1097/j.pain.0000000000001092
Research Paper: PDF Only


This paper, based on two companion studies, presents an in-depth analysis of preschooler coping with vaccination pain. Study 1 employed 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 five path models and post-hoc analyses over the two 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: two 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.

Corresponding author: Dr. Rebecca Pillai Riddell. Mailing address: The Opportunities to Understand Childhood Hurt (OUCH) Laboratory, York University, Department of Psychology, Faculty of Health, Room 038J Atkinson College Building, 4700 Keele Street, Toronto, ON, M3J 1P3 Phone: 416-736-2100 x 20177 Fax: 416-736-5814 Email address:, URL:

© 2017 International Association for the Study of Pain

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