Objectives To explore the behaviors of parents and nurses during the immunization process and their association with children's distress and coping in a sample of Portuguese preschool-aged children; to identify similarities and differences in the behavior of parents, nurses, and children, as well as in the relation between adults’ behaviors and child distress and coping, with those previously identified by the Interactive Model of Acute Child Distress, from Blount et al. (1992). Method A total of nine nurses, 89 children aged 3–6, and their parents participated. Behaviors were videotaped and scored according to CAMPIS-R operational definitions. Measures of parents and nurses’ ratings of children's distress and of child-rated distress were obtained. Results Our results show not only similarities, but also important divergences from previous research. New adult codes were proposed. Only two new codes, and another code previously considered neutral, significantly contributed to explain the association between adult and child behavior. Conclusions Portuguese nurses and parents’ behaviors during immunization show some important cultural differences.