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. 2023 Jul 1;39(7):340-348.
doi: 10.1097/AJP.0000000000001125.

Caregiver and Child Distress as Predictors of Dyadic Physiological Attunement During Vaccination

Miranda G DiLorenzo-Klas  1 , Jordana A Waxman  1 , David B Flora  1 , Louis A Schmidt  2 , Hartley Garfield  3   4 , Dan Flanders  4 , Eitan Weinberg  4 , Deena Savlov  4 , Rebecca R Pillai Riddell  1   3   4
Affiliations

Caregiver and Child Distress as Predictors of Dyadic Physiological Attunement During Vaccination

Miranda G DiLorenzo-Klas et al. Clin J Pain. .

Abstract

Objective: Previous research discerned 3 groups of caregiver-toddler dyads that differed in their physiological coregulatory patterns, also known as physiological attunement, during routine vaccinations in the second year of life. One group of dyads (80% of sample) displayed an attuned regulatory pattern, and 2 groups of dyads (20% of sample) showed maladaptive attunement patterns (ie, a lack of attunement or misattunement). The objective of the current study was to examine how well the pain-related distress of children and caregivers during vaccination predicted these patterns.

Methods: Caregiver-toddler dyads (N = 189) were part of a longitudinal cohort observed at either 12-, 18-, or 24-month vaccination appointments. The caregiver's self-report of worry was assessed before and after the needle, and the child behavioral pain-related distress was also measured during the vaccination appointment. Logistic regression was used to determine how well these variables predicted caregiver-child physiological attunement patterns, as indexed by high-frequency heart rate variability.

Results: Higher behavioral pain-related distress at various timepoints after the needle were associated with membership in the dyad groups that showed misattunement or lack of attunement. Further, caregivers with higher preneedle worry and lower postneedle worry had a greater likelihood of belonging to groups that showed a maladaptive attunement pattern.

Discussion: Findings suggest that caregivers who experience distress associated with their toddlers' vaccination experience more difficulty coregulating with their child during vaccination, and these children are at risk of experiencing higher levels of pain-related distress. This research highlights the need to help caregivers support their children's regulation during vaccination.

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Conflict of interest statement

This research was funded by awards to R.R.P.R. from the Natural Sciences and Engineering Research Council of Canada, Canada [504112], the Ontario Ministry of Research and Innovation, and the Canadian Foundation of Innovation, Canada [532009], as well as Doctoral Training Awards provided to M.G.D.-K. and J.A.W. from the Canadian Institutes of Health Research, the Ontario Graduate Scholarship, and the Meighen Wright Graduate Scholarship in Maternal-Child Health, Canada. M.G. DiLorenzo-Klas and J.A. Waxman are trainee members of the Pain in Child Health (PICH) program, a research training initiative at The Hospital for Children Sick. Funders were not involved in the design or conduct of the current study. The remaining authors declare no conflict of interest.

References

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