• Ilana Shiff, Saul Greenberg, Hartley Garfield, and Rebecca Pillai Riddell.
• Department of Psychology, Faculty of Health, York University, Toronto, ON, Canada.
• Pain. 2022 Mar 1; 163 (3): 590-598.

AbstractRecent research has highlighted the need for a deeper understanding of the heterogeneity in trajectories of children's distress after acute pain exposure, moving beyond the group means of behavioural pain scores at a single timepoint. During preschool vaccinations, 3 distinct trajectories of postvaccination pain regulation have been elucidated, with approximately 75% of children displaying trajectories characterized by downregulation to no distress by 2 minutes postneedle and 25% concerningly failing to downregulate by 2 minutes. The objective of this study was to examine child and caregiver predictors of preschool children's postvaccination regulatory patterns. Our results indicated that higher child baseline distress, more caregiver coping-promoting verbalizations in the first minute after the needle, less coping-promoting verbalizations in the second minute, and more caregiver distress-promoting verbalizations in the second minute after the needle were associated with membership in the trajectories characterized by high distress. Furthermore, although all children's pain-related distress at various timepoints throughout the appointment was most strongly predicted by previous pain scores, different patterns of associations emerged depending on the trajectory exhibited. This research highlights both the need to minimize distress before the needle to avoid the highly distressed trajectory and the importance of considering the heterogeneity of trajectories of preschool pain responding when examining the factors that are associated with children's pain-related distress.Copyright © 2021 International Association for the Study of Pain.

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