title: Self-regulation (recovery) from pain: association between time-based measures of infant pain behavior and prenatal exposure to maternal depression and anxiety.
abstract: OBJECTIVE
  Capacities for self-regulation that influence infant adaptation to noxious stimulation require investigation of changes in behavior over time. Prenatal exposure to maternal depression and anxiety (MDA) has been linked to altered infant pain reactivity; however, findings are inconclusive about MDA dynamic impacts on recovery. This study quantified the temporal profile of behavioral response and recovery to routine heel lance (HL) of infants with and without prenatal-MDA exposure. Aims were to examine whether MDA were associated with alterations in time-based measures of infant behavior and sequential patterning in pain expression.
  
  
  METHODS
  Videotaped facial, body, and cry behaviors of 21 full-term newborns were coded second-by-second for the duration of HL (baseline, HL, Post-HL) using validated behavioral coding systems. Mean heart rate and proportion of time infants spent exhibiting behavioral measures were compared between infant groups and over subphases of HL. Simple regressions, latency, and Yule-Q measures of effect size examined which behaviors were predicted by prenatal-MDA and magnitude of sequential association between first and subsequent behavior.
  
  
  RESULTS
  During HL, all infants reacted immediately and substantially on heart rate, facial, body, and cry measures. Facial reactivity was followed within 2 seconds by body and cry behavior. There were no group differences in magnitude of initial behavioral reactions, but during Post-HL, MDA-exposed infants spent more time crying in a weak/exhausted manner and displayed strained and erratic limb movement and immobility.
  
  
  CONCLUSIONS
  Temporal measures can further help in understanding of infant complex behavioral responses to pain. Delayed recovery in MDA-exposed infants suggested diminished capacities for self-regulation of noxious distress.
authors.affiliation: *School of Nursing †Developmental Neurosciences, Child and Family Research Institute, University of British Columbia, Vancouver, BC, Canada ‡Department of Psychology, Georgia State University, Atlanta, GA §Faculty of Nursing, University of Goiás, Goiânia-GO, Brazil.
authors.forename: Fay F
authors.initials: FF
authors.lastname: Warnock
authors.forename: Kenneth D
authors.initials: KD
authors.lastname: Craig
authors.forename: Roger
authors.initials: R
authors.lastname: Bakeman
authors.forename: Thaila
authors.initials: T
authors.lastname: Castral
mesh_terms: D001007:Anxiety; D003863:Depression; D005149:Facial Expression; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D007223:Infant; D018730:Infant Behavior / Q000502:physiology / Q000523:psychology*; D008297:Male; D010146:Pain / Q000503:physiopathology / Q000523:psychology*; D010147:Pain Measurement; D011247:Pregnancy; D011297:Prenatal Exposure Delayed Effects / Q000503:physiopathology / Q000523:psychology*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012927:Social Control, Informal