Pain-Related Anticipatory Distress in Preschoolers: Longitudinal and Concurrent Predictors
Racine, Nicole Marie Claire
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Pain-related anticipatory distress prior to a painful medical procedure can lead to negative sequelae including heightened pain experiences, avoidance of future medical procedures, and potential non-compliance with preventative healthcare such as vaccinations. No study to date has examined the longitudinal and concurrent predictors of preschool pain-related anticipatory distress in the vaccination context. This dissertation consists of three studies examining the longitudinal factors from infancy as well as concurrent factors from preschool age that predict pain-related anticipatory distress at the preschool age. Study 1 is a large-scale, published systematic review of the factors predicting pain-related anticipatory distress to painful medical procedures in children using a developmental psychopathology framework. A narrative synthesis of the evidence, which appears to predict anticipatory distress, was presented. Study 2 and 3 were published in an extended research paper. A sample of 202 caregiver-child dyads (OUCH Cohort) was observed during their infant and preschool vaccinations and was used for both Study 2 and Study 3. Study 2 examined how well preschool pain-related anticipatory distress was predicted by infant pain responding at 2, 4, 6 and 12 months of age. Study 3, using a developmental psychopathology framework, examined the predisposing, precipitating, perpetuating, and present factors that led to the development of anticipatory distress during routine preschool vaccinations. In Study 2, pain responding during infancy did not significantly predict pain-related anticipatory distress at preschool. However, a strong explanatory model was created in Study 3 whereby parental behaviours from infancy and preschool were the strongest predictors of child anticipatory distress at preschool, underscoring the importance of parents during the preschool vaccination. Clinical implications and suggestions for future research are discussed.