Parental (non-)pain attending verbalizations moderate the relationship between child attention and memory bias for pain

Background Children's negatively biased pain-related memories (i.e. recalling pain as being more intense or fearful than initially reported) have been recognized as a key factor in explaining child pain development. While mechanisms underlying children's pain memory development remain poorly understood, attention biases and parent language have been implicated in conceptual models. This study examined the association between child pain-related attention and memory biases and the moderating role of parental pain and non-pain attending verbalizations. Methods Participants were 51 school children and one of their parents. Probability of initial fixation and gaze duration to pain were assessed using eye tracking methodology. Children performed a cold pressor task (CPT) and reported on experienced pain intensity and pain-related fear. A 3-minute parent-child interaction upon CPT completion allowed measurement of parental pain and non-pain attending verbalizations. Children's pain-related memories were elicited 2 weeks later. Results Findings indicated that the relationship between maintained attention to pain and fear memory bias was moderated by parental non-pain attending verbalizations such that higher gaze duration bias was positively associated with fear memory bias but only among children whose parents demonstrated low levels of non-pain attending verbalizations. The opposite pattern was observed for children whose parents showed high levels of non-pain attending verbalizations. No such effects were observed for child initial attention bias to pain, memory bias for pain and parental pain attending verbalizations. Conclusions Findings highlight the importance of parental and child pain-related variables as well as their interaction in understanding negatively biased pain-related memories. Significance This study on child pain memories is the first to highlight that characteristics of the social context, such as parental (non-)pain-related verbalizations, as well as factors related to the intra-individual experience of pain, such as child attention bias to pain, should be studied jointly, as they interact with each other in their effect on the emergence of negatively biased memories of painful events.