Distress regulation in infancy: attachment and temperament in the context of acute pain

Through this study, the relationship between attachment, temperamental fear, and distress regulation during infants' 12-month immunizations was examined. Two broad research questions were answered: (1) Are attachment, temperamental fear, or the interaction between the two associated with pain-related distress reactivity or pain-related distress regulation? and (2) Do infant or caregiver behaviours pre- or post-needle predict attachment? A subsample of 130 caregiver-infant dyads was recruited from an ongoing longitudinal study. Dyads were videotaped during infants' routine immunizations at 12 months and subsequently invited to participate in an assessment of attachment and temperamental fear when infants were 12 to 18 months old. Immediately prior to immunization, avoidant infants exhibited significantly less distress than secure infants. Temperamental fear moderated the relationship between attachment and pain-related distress regulation; under conditions of high temperamental fear, avoidant infants regulated distress more slowly than secure infants but under conditions of low temperamental fear, secure infants regulated distress more slowly than avoidant and disorganized infants. Infants' efforts to snuggle into caregivers following immunization increased the odds of being secure rather than avoidant or disorganized. These novel findings indicate that pain-related distress regulation at 12 months of age is influenced by a dynamic interplay between attachment and temperament. None of the analyses in the current study distinguished organized from disorganized infants, underscoring the need to identify specific behavioural markers of disorganization within the pediatric setting. Clinical implications and suggestions for future research are discussed.