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

Campbell, Laurena; Pillai Riddell, Rebeccaa,b,c,*; Cribbie, Roberta; Garfield, Hartleyb,c; Greenberg, Saulb,c

doi: 10.1097/j.pain.0000000000001092
Research Paper
Editor's Choice

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.

Cross-sectional and longitudinal path models suggest a complex interplay of caregiver and infant variables and predicts children's coping responses and outcomes during preschooler vaccination.

aYork University, Toronto, ON, Canada

bHospital for Sick Children, Toronto, ON, Canada

cUniversity of Toronto, Toronto, ON, Canada

Corresponding author. Address: Department of Psychology, Faculty of Health, The Opportunities to Understand Childhood Hurt (OUCH) Laboratory, York University, Room 038J Atkinson College Building, 4700 Keele St, Toronto, ON M3J 1P3, Canada. Tel.: +416-736-2100 x 20177; fax: +416-736-5814. E-mail address: (R. Pillai Riddell).

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Received July 06, 2017

Received in revised form September 11, 2017

Accepted September 21, 2017

© 2018 International Association for the Study of Pain
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