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Predicting preschool pain-related anticipatory distress: the relative contribution of longitudinal and concurrent factors

Racine, Nicole M.; Pillai Riddell, Rebecca R.; Flora, David B.; Taddio, Anna; Garfield, Hartley; Greenberg, Saul

doi: 10.1097/j.pain.0000000000000590
Research Paper

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.

In a longitudinal cohort of parent–child dyads, parent behaviour from infancy and preschool are strongest predictors of anticipatory distress at preschool.

aDepartment of Psychology, York University, Toronto, ON, Canada

bHospital for Sick Children, Toronto, ON, Canada

cUniversity of Toronto, Toronto, ON, Canada

dDepartment of Pharmacy, Hospital for Sick Children,Toronto, ON, Canada

eLeslie Dan Faculty of Pharmacy, University of Toronto,Toronto, ON, Canada

fDepartment of Paediatric Medicine, Hospital for Sick Children, Toronto, ON, Canada

gDepartment of Paediatrics, University of Toronto, Toronto, ON, Canada

Corresponding author. Address: Department of Psychology, York University, 4700 Keele St, OUCH Laboratory, 2004/6 Sherman Health Sciences Building, Toronto, ON M3J 1P3, Canada. Tel.: (416) 736-2100 (ext. 33204). E-mail address: (R.R. Pillai Riddell).

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

Received February 19, 2016

Received in revised form March 29, 2016

Accepted April 12, 2016

© 2016 International Association for the Study of Pain
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