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Distress Responses in a Routine Vaccination Context: Relationships to Early Childhood Mental Health

Department of Psychology, University of Calgary & Alberta Children’s Hospital Research Institute, Calgary AB T2N 1N4, Canada
Department of Psychology, Faculty of Health, York University, The Opportunities to Understand Childhood Hurt Laboratory, 2006 Sherman Health Sciences Research Centre, Toronto ON M3J 1P3, Canada
Department of Psychiatry Research, The Hospital for Sick Children, Toronto ON M5G 1X8, Canada;
Department of Psychiatry, University of Toronto, Toronto ON M5S 1A1, Canada
Department of Paediatrics, University of Toronto, Toronto ON M5S 1A1, Canada
Department of Paediatrics, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
Author to whom correspondence should be addressed.
Children 2018, 5(2), 29;
Received: 17 January 2018 / Revised: 9 February 2018 / Accepted: 9 February 2018 / Published: 21 February 2018
PDF [225 KB, uploaded 24 February 2018]


Social and emotional competencies, such as distress regulation, are established in early childhood and are critical for the development of children’s mental health and wellbeing. Routine vaccinations in primary care provide a unique opportunity to relate responses to a universal, relatively standardized, distress regulation paradigm (i.e., pain-related distress) to key developmental outcomes. The current study sought to examine distress regulation during routine vaccination in infancy and preschool as predictors of outcomes related to socioemotional competence in preschool. It was hypothesized that children with poorer distress regulation abilities post-vaccination would have lower socioemotional development. Furthermore, it was hypothesized that insensitive parenting would exacerbate this relationship for children with poor distress regulation abilities. As part of an ongoing longitudinal cohort, 172 parent–child dyads were videotaped during vaccinations in infancy and preschool, and subsequently participated in a full-day psychological assessment in a university lab. Videotapes were coded for child pre-needle distress (baseline distress), immediate post-needle pain-related distress reactivity (immediate distress reactivity), and pain-related distress regulation (distress regulation). Parent sensitivity during the preschool vaccination was also coded. Baseline distress prior to vaccination predicted greater externalizing problems and behavioral symptoms. Parent sensitivity did not moderate the association between any child distress behaviors and socioemotional development indicators. Child distress behaviors prior to injection, regardless of parent behavior, during the vaccination context may provide valuable information to health care professionals about child socioemotional functioning in the behavioral and emotional domains. View Full-Text
Keywords: preschooler; distress regulation; mental health; parent sensitivity preschooler; distress regulation; mental health; parent sensitivity
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited (CC BY 4.0).

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MDPI and ACS Style

Racine, N.M.; Gennis, H.G.; Pillai Riddell, R.; Greenberg, S.; Garfield, H. Distress Responses in a Routine Vaccination Context: Relationships to Early Childhood Mental Health. Children 2018, 5, 29.

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