York U pain study links parent behaviour to children's fear of needles

More than half of children experience fear and anxiety before a needle or vaccination, and York researchers have found a strong connection between this distress at preschool and their parents’ behaviour during infant vaccinations.

We were interested in whether pain-responding and parent behavior during infancy predicted needle fear at preschool.

A study out of York Professor Rebecca Pillai Riddell’s OUCH (Opportunities to Understand Childhood Hurt) Lab investigated factors contributing to preschool pain-related anticipatory distress, and found that past and concurrent parent behaviour was the biggest predictor of child distress prior to vaccination.

The York research team, including the study’s lead author PhD candidate Nicole Racine, as well as Professors Pillai Riddell and David Flora, note that for some children, the fear of needles and vaccinations before the needle is so severe that they not only experience more pain-related distress right after the needle, this distress will lead to avoidance of medical procedures or appointments in the future.

photo of a nurse administering a needle to a child

An image from the study

It is the first study published from the preschool WAVE of the OUCH Cohort.

The results are published in the study “Predicting preschool pain-related anticipatory distress: the relative contribution of longitudinal and concurrent factors”. This article has just been released ‘in press’ and will be published in the journal Pain this fall.

“This is a major public health concern and stresses the importance of understanding what leads to needle fear in young children and how we can prevent it,” said Racine.

Using data from the largest infant vaccination pain-cohort in the world, the team analyzed 202 parents and their children during their vaccinations at 2, 4, 6, and 12 months of age, and again at 4 to 5 years of age, to find out what leads to children developing needle fear.

This study examined variables from infancy and preschool that predict distress before a needle in children of preschool age.

photo of Rebecca Pillai Riddell

Rebecca Pillai Riddell

“We were interested in whether pain-responding and parent behaviour during infancy predicted needle fear at preschool,” said Pillai Riddell.

The team also examined what variables at preschool — including parent behaviour, health care provider behaviour, child age, child sex, previous experience with painful medical procedures, parent worry and child worry – predicted child distress before a vaccination at the preschool age.

“We observed how these children behaved before their needles and after their needles when they were infants and preschoolers,” said Pillai Riddell. “We also observed how parents interacted with their children, and the types of things they said to their children during infancy and at the preschool age.”

Parents were also asked about how scared they were before the needle, and how scared they thought their child was.

Healthcare professionals were also observed prior to children receiving needles.

photo of Nicole Racine

Nicole Racine

“Of all the variables examined, we found that parent behaviour during infancy, as well as parent behaviour at the preschool age, were the biggest predictors of child distress before a needle, above and beyond any other variables,” said Pillai Riddell.

This information indicates that what parents do and say during their child’s vaccinations is a critical predictor of whether a child will develop higher needle fear. This finding highlights the importance of developing interventions to help parents to best support and coach their children during painful medical procedures right from their first needles as a baby.

This research was funded by the Canadian Institutes of Health Research, Canada Foundation for Innovation and Ontario Ministry of Research and Innovation.

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