Department of Psychology, Faculty of Health, York University, Toronto, ON, Canada.
Department of Psychiatry Research, Hospital for Sick Children, Toronto, ON, Canada.
Pain. 2021 Mar 1;162(3):823-834. doi: 10.1097/j.pain.0000000000002091.
This article consists of 2 separate studies in which the overarching aim was to examine the relationships between caregiver-child behaviours in the vaccination context (infant and preschool) and preschool attachment outcomes. It provides for the first time an examination of acute pain behaviours during early childhood and how it relates to a critical aspect of child development (ie, attachment status) at the end of early childhood. Study 1 examined the longitudinal relationships between caregiver-infant behaviours during infants' first routine vaccination (2 months) and preschool attachment (n = 84). Study 2 examined the concurrent relationships between caregiver-preschooler behaviours during the last routine vaccination of preschool (4-5 years) and preschool attachment (n = 117). Hierarchical multiple regression analyses were used. Although there were several nonsignificant findings, the results revealed that higher caregiver sensitivity and higher proximal soothing 1 minute before the needle during infants' 2-month vaccinations predicted higher levels of preschooler avoidance and lower levels of preschooler ambivalence, respectively. In addition, higher infant pain-related distress at 2 minutes after the needle was related to higher preschooler security and lower preschooler disorganization and controlling-punitive attachments. In terms of concurrent relationships, only caregiver sensitivity was significantly related to preschool attachment outcomes. Specifically, higher caregiver sensitivity at preschoolers' 4- to 5-year vaccinations was related to higher preschooler attachment security. The study findings provide evidence that child-caregiver behavioural patterns during the infant and preschool routine vaccination relate to preschoolers' patterns of attachment. Moreover, it underscores the potential importance of health professionals teaching and supporting attuned caregiving to the child in pain.
本文由两项独立研究组成，其总体目标是检验疫苗接种背景下（婴儿和学前）照顾者与儿童行为之间的关系，以及学前依恋结果。它首次提供了对幼儿期急性疼痛行为的检查，并探讨了其与幼儿发展的一个关键方面（即依恋状态）之间的关系。研究 1 考察了婴儿首次常规疫苗接种（2 个月）期间照顾者与婴儿行为的纵向关系与学前依恋（n = 84）。研究 2 考察了学前最后一次常规疫苗接种（4-5 岁）期间照顾者与学前儿童行为的同期关系与学前依恋（n = 117）。采用分层多元回归分析。尽管有一些无显著意义的发现，但结果表明，在婴儿 2 个月大的疫苗接种期间，照顾者的敏感性越高，在针头前 1 分钟进行的近端抚慰越多，分别预测学前儿童回避程度越高，矛盾程度越低。此外，针头后 2 分钟婴儿疼痛相关痛苦越高，与学前儿童安全感越高，学前儿童组织混乱和控制惩罚依恋越低有关。就同期关系而言，只有照顾者的敏感性与学前依恋结果显著相关。具体来说，在学前儿童 4-5 岁的疫苗接种时，照顾者的敏感性越高，与学前儿童的依恋安全性越高。研究结果表明，婴儿和学前常规疫苗接种期间的儿童照顾者行为模式与学前儿童的依恋模式有关。此外，它强调了健康专业人员教授和支持对疼痛中的儿童进行协调一致的照顾的重要性。
