Caregivers' physiological responses during toddler vaccinations: associations with psychological and behavioral responses

OBJECTIVE

This study investigated biological, psychological, and behavioral aspects of caregivers' responses to toddlers' pain-related distress by measuring caregivers' high-frequency heart rate variability (HRV) responses during toddler vaccination pain and examining associations with caregivers' behavioral responses and psychological stress.

METHODS

Participants included caregiver-toddler dyads (N = 194) from a longitudinal cohort-sequential study who were observed during toddlers' 12-, 18-, or 24-month routine vaccinations. Changes in caregiver HRV were analyzed using growth curve modeling. Conditional growth curve models examined associations between caregiver HRV and caregivers' concurrent behavior and psychological stress.

RESULTS

The unconditional growth curve model indicated a slight linear decrease in caregiver HRV (i.e., vagal withdrawal) across the 3 min post-needle (unstandardized B = -0.06, p = .049). In conditional growth curve models, higher levels of parenting stress were associated with less vagal withdrawal during the post-needle period (standardized B = 0.47, unstandardized B = 0.02, p = .003). Caregivers' behavioral responses (i.e., use of soothing and distress-promoting behaviors), state anxiety, and general anxiety symptomology were not significantly associated with HRV responses.

CONCLUSIONS

Caregiver parasympathetic nervous system activity levels changed minimally from baseline to post-needle and decreased slightly across the post-needle period. Caregivers' self-reported parenting stress was associated with their parasympathetic responses to the procedure. Findings support an improved understanding of the mechanisms underlying caregivers' responses to children's pain-related distress in a naturalistic setting.

Parenting in Israel amid COVID-19: the Protective Role of Mentalization and Emotion Regulation

The global COVID-19 pandemic changed the life of numerous parents. The medical worry, the financial hardship, and the need to take care of children 24/7 caused an enormous burden on parenting, resulting in an elevation in parenting stress and in harsh parenting. In the current study, we were interested in assessing the role of parental emotion regulation and parental mentalization as resilience-promoting factors, by mitigating the harmful relationship between parental distress and negative and positive parenting. Seventy Israeli parents of children (aged 6-14) participated in the study. We assessed parental mentalization and emotion dysregulation before the COVID-19 pandemic. During the national lockdown in Israel in May 2020, we assessed parental distress, COVID-related financial risk, and parental practices. Results indicated elevations in parental distress compared to the population mean, alongside high rates of financial risk. The results indicated that although parental distress was significantly related to parenting practices, parental mentalization, and emotion regulation moderated these relationships in differential ways. Improved capacity for emotion regulation reduced the prevalence of negative parenting practices and higher parental mentalization increased the prevalence of positive parenting, these are despite elevation in parental distress. The results suggested that when parents are able to regulate their own negative emotions and think about a child's mind, they can remain available to support the child's needs despite the elevation in parental distress. Supporting parental capacity for mentalization and emotion regulation during stressful times may prevent the harmful consequences of parental distress on parenting.

Biopsychosocial Contributors to Parent Behaviors during Child Venipuncture

Children's needle-related distress is strongly related to parental verbal behaviors. Yet, empirical data supporting theorized contributors to parent behaviors in this context remain limited. This is the first study to collectively measure biological (heart rate variability; HRV), psychological (catastrophizing, anxiety), and social (child behaviors) contributors to parent verbal behaviors throughout pediatric venipuncture. HRV was used as a measure of emotion regulation capacity and examined as a moderator in the associations between parent psychological factors and their behaviors, and between child and parent behaviors. Sixty-one children aged 7 to 12 years who presented at an outpatient blood lab for venipuncture and a parent participated. Parent baseline HRV, state catastrophizing, and anxiety were measured prior to venipuncture. The procedure was video-recorded for later coding of pairs' verbal behaviors. Strong associations emerged between child behaviors and parent behaviors. Baseline HRV moderated the association between parent catastrophizing and behavior. Social factors remain a strong influence related to parent behaviors. Psychologically, parent negative cognitions differentially related to parent behaviors based on their emotion regulation capacity. Biologically, low baseline HRV may increase the risk that certain parents engage in a constellation of behaviors that simultaneously direct their child's attention toward the procedure and inadvertently communicate parental worry, fear, or concern.