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Parental Report of Self and Child Worry During Acute Pain

A Critical Factor in Determining Parental Pain Judgment

Mamedova, Khuraman MA*; Pillai Riddell, Rebecca R. PhD*,†; DiLorenzo, Miranda G. MA*; Flora, David B. PhD*; Garfield, Hartley MD‡,§; Greenberg, Saul MD, FRCPC‡,§

doi: 10.1097/AJP.0000000000000731
Original Articles

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 (R2=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.

*Department of Psychology, York University

Departments of Psychiatry

Paediatrics, Hospital for Sick Children

§Department of Paediatrics, University of Toronto, Toronto, ON, Canada

K.M.: Ontario Graduate Scholarship, Outstanding Health Research Award, Toronto, ON. R.R.P.R.: York Research Chair in Pain and Mental Health, Operating Grants from the Canadian Institutes of Health Research, Canada Foundation for Innovation Infrastructure Grant, Toronto, ON. The remaining authors declare no conflict of interest.

Reprints: Rebecca R. Pillai Riddell, PhD, OUCH Laboratory, Department of Psychology, York University, 4700 Keele Street, 2004/6 Sherman Health Sciences Building, Toronto, ON, Canada M3J 1P3 (e-mail:

Received April 26, 2017

Received in revised form April 25, 2019

Accepted May 17, 2019

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