1University of Georgia, 2Duke Children’s Primary Care, 3Children’s Hospital Boston, and 4University of North

Objective The Child–Adult Medical Procedure Interaction Scale-Infant Version (CAMPIS-IV) was used to examine the influence of adult and infant behaviors on infant distress following injections. Methods In this naturalistic observation study, videotaped interactions of 49 infants, parents, and nurses were coded using the CAMPIS-IV. A series of three lag sequential analyses were used to examine the immediate and delayed effects of each of the CAMPIS-IV criterion behaviors, as well as the effects of the onset of each behavior, on infant distress. Results Strong support was found for beneficial effects of the infants playing with an object and sucking, and for adults ’ belly-to-belly contact and nonprocedural talk to infant. Some benefit was found for bouncing, patting, and rocking the infant. Apologizing, empathizing, and reassuring the infant received no support, with some indication of detrimental effects. Conclusions The CAMPIS-IV was useful for identifying modifiable risk and protective factors for infants undergoing injections. Key words adult–infant interactions; immunizations; infant distress; procedural pain. The recommended immunization schedule for healthy infants from the Centers for Disease Control (CDC) includes 24 vaccination doses administered through multiple injections, in addition to two flu injections, all by 15 months of age (CDC, 2007). Although common and valued as critical components to preventative care, immunization injections are painful procedures. It is imperative to identify factors that impact distress during immunizations and develop strategies to effectively manage infant discomfort. Strategies to manage infant pain have focused on five areas (for review, see Anand, 2001), including: environ