Caregiver Ratings of Toddler Pain: The Role of Caregiver Psychological Predictors

Introduction/Aim: Young children’s limited ability to self-report pain necessitates an understanding of the factors that influence pain ratings. The current paper examines the relative prediction of caregiver psychological factors and toddler pain behaviours on caregiver pain ratings post-vaccination. Methods: One hundred and fifty-six parent-toddler dyads were video recorded during pediatric vaccinations. Child pain behaviours were coded before, during, and after the needle using the Face, Legs, Activity, Cry, Consolability Scale (FLACC; Merkel et al., 2002) and the Neonatal Facial Coding System (NFCS; Grunau & Craig, 1987). Caregivers rated their child's pain after the needle, reported pre- and post-needle worry during the visit, and completed rating scales assessing other areas of psychological functioning within 2 weeks after the appointment. Regression models were estimated to examine the relative contribution of child and caregiver factors to the prediction of caregiver pain ratings. Results: The regression model predicting caregiver pain ratings from the toddlers’ pain-related distress (facial activity immediately after the needle, overall pain-related behaviour immediately after, 1-minute and 2-minutes post-needle) and caregiver worry were significant (adjusted R-square = 0. 21), with caregiver pre- and post-needle worry being the only significant predictors of caregiver pain ratings. Conclusions: This study outlines that although child distress behaviour remains a significant influence on pain ratings during toddlerhood, when caregiver worry (pre- and post-needle) was entered into the model, they were the only significant predictors of caregiver pain ratings.