Last week we heard from clinical psychologist and professor of psychology Rebecca Pilai Riddell about how parents can calm their children when they’re in pain.  This week we delve into the methods of her study on infant pain and how a parent’s inability to soothe their child in pain may actually be a signal that the parent needs help.

How did you narrow in on the role of the parent, as opposed to simply showing that the initial infant reaction to pain wasn’t related to later pain experiences?
As you know life is full of variables so we looked at a number of things. Once we got over our initial shock that the pain expressed by the infant wasn’t related to the distress they experienced in relation to needle pain as they grew up we started to look at the other variables that we observed during the visit.

We conducted a multivariate analysis using a structural equation model, not just your traditional regression analysis. We were able to display our data so that it looked sort of like a web, and while other variables do have an impact on the child’s experience of pain more than any other was the relationship between the parent and the child.

You mentioned that you considered other variables, what else did you look at?
We looked at the behavior of the health care professional, the behavior of the parents (during infant and preschool vaccinations), we looked at the expressed pain response by the infant, how much pain the infant expressed, and the age of the child. We looked at a whole host of variables, but none of them were as significant as the role of the parent.

So let’s take a step back and talk about your methods, because I’m imagining that it’s difficult to quantify parent behaviors in a situation like this.
This is the first in a set of studies following children since they were two months old and into preschool. We had an original sample size of 760, but for this analysis we were only able to use 202 families. To get a sample size that large, we basically lived in three pediatrician clinics for seven years!

It’s important to note that we only looked at healthy children for this study. We know that infants that spend time in the neonatal intensive care unit (NICU) or who are born with certain health conditions have a heightened pain response. The development of the nervous system is actually altered by the onslaught of procedures that many infants receive in the NICU, or immediately after birth if they require significant medical interventions. That wasn’t what we were looking for here, so those children were removed from consideration for the study.

When we examined the behavior of the parent we looked at something we call emotional availability. Emotional availability in behavioral science can be quantified on a formal scale, but it’s not easy. It takes a lot for scientist to be considered reliable on it and our team trained on it for quite a while before they were considered reliable. I would highly doubt that anyone has coded more encounters cases for emotional availability than us, simply due to the sample size.

So what is emotional availability in a scientific sense? I’m sure a lot of people are used to using the phrase “not emotionally available” to describe unpleasant encounters with, or perpetually difficult family members.
Well that use of the phrase may be accurate depending on the circumstance, but in a study like this what we’re looking at is if this parent’s behavior is contingent [or reliant upon] the child’s. So, does the parent modify their behavior based on the child’s behavior? If the child is upset does the parent respond? If the child doesn’t soothe, does the parent try something else?

We weren’t necessarily looking for a successfully soothed child, because some babies and children are simply harder to regulate, but that doesn’t mean that the parent didn’t try. It’s that effort to soothe, the patience in the face of frustration, that reaction to the child’s needs that we look for when we evaluate emotional availability.

That’s interesting to me, that emotional availability wasn’t measured by how well the child was soothed.
Look, some babies are just more difficult than others. I’ve had both easy babies and more difficult babies, and I’ve been there when all the ssshing, swaying and singing won’t help. I’d hate to be judged based on that! I think we need to be honest with parents about this. Some kids are hearty dandelions, they will grow tall and strong no matter where they’re planted and others are delicate orchids that are very sensitive to the environment and even little changes impact thriving. What matters is that the parent responds to the needs of the child and provides the environment they need. If you try to treat an orchid like a dandelion, it won’t work out.

If a physician or provider notices that a parent isn’t emotionally available during the well-visit, what could that be an indicator of?
It could just be an indicator of a bad day. We’ve all been there. Some days it’s just survival, but usually when a parent sees their child in pain they try to soothe them. If it looks to be a pattern, then it may be an indicator of a parent that’s being challenged emotionally. That could mean any number of things. It could be indicative of depression or a mood disorder. It could mean that the parent doesn’t have enough help at home, has returned to work too soon or maybe there’s another stressor like a financial issue or an illness in the family. Regardless it’s an indicator that something’s up and the parent needs self-care too.

Mothers in particular are extraordinarily self-sacrificing. A mother will go without physical or mental health care for herself, but she will make sure that her baby is at the well visits and gets the care it needs. As parents we can’t do it all. We try, but we really can’t. We need to support mom at those appointments too.

We need to view mom’s health as a pediatric health issue. I think this is part of a growing body of research that shows that the mental health of parents and caregivers is crucial to the health and wellbeing of the baby. We really train pediatricians to look after the kids, but maybe it’s time we expanded that role to use those baby well-visits for the parents as well.

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Categories: Infectious Disease + Vaccines, Mental, Emotional, + Behavioral Health