Mother's early perception of her infant's difficult temperament, parenting stress and early mother-infant interaction

Mother-infant interaction characteristics associate with infant falling reactivity and child peer problems at pre-school age

This longitudinal study investigated the associations between mother-infant interaction characteristics at 9 months of age, maternal mental health, infant temperament in the first year postpartum, and child behaviour at 3 years of age. The infants (N = 54, 22 females) mainly had White British ethnic backgrounds (85.7%). Results showed that i) mother-infant dyadic affective mutuality positively correlated with infant falling reactivity, suggesting that better infant regulatory skills are associated with the dyad's ability to share and understand each other's emotions; and ii) maternal respect for infant autonomy predicted fewer child peer problems at 3 years of age, suggesting that maternal respect for the validity of the infant's individuality promotes better social and emotional development in early childhood.

Perceived Stress of Mothers, Harsh Discipline, and Early Childhood Mental Health: Insights from a Cross-Sectional Study in Marginalized Roma Communities

Objectives: This study aims to compare the early childhood mental health of children from marginalized Roma communities (MRCs) in Slovakia with that of the majority and explore possible mediating pathways of mothers' perceived stress and harsh discipline practices. Methods: We used data from the first wave of the longitudinal RomaREACH study collected in 2021-2022. Two populations were included in the sample: 94 mother-child dyads from MRCs and 79 from the majority population (children aged 14-18 months). Data were analysed using linear regression, and mediation was tested using PROCESS Macro in SPSS. Results: Belonging to MRCs vs. the majority, perceived stress of mothers and harsh discipline were found to be associated with early mental health problems in children. Perceived stress of mothers partially mediates the relationship between belonging to MRCs vs. majority and harsh discipline and harsh discipline partially mediates the relationship between perceived stress of mothers and the mental health of children. Conclusion: Mothers from MRCs perceive more stress, which is associated with more frequent use of harsh discipline practices having a negative impact on the mental health of young children.

Changes in relationship satisfaction in the transition to parenthood among fathers

To date, research on the transition to parenthood and associated changes in relationship satisfaction (RS) has focused predominantly on mothers with their firstborn. This study targeted fathers to investigate their trajectories of RS with a particular focus on emerging differences between first- and second-time fathers. It furthermore considered various predictors such as the role of age, education, income, duration of relationship, marital status, child's biological sex, and child temperament. Data from a total of 606 fathers from the prospective longitudinal cohort study DREAM were analyzed. The analyses included assessments of four measurement time points (T1: prepartum; T2-T4: postpartum) over a period of more than 2 years. Latent growth curve modeling was applied with RS as the dependent variable and number of children as one of eight predictors of growth over time. First-time fathers showed higher initial RS, however experienced a steeper decline in the transition to parenthood than second-time fathers. At 8 weeks postpartum, first-time fathers still reported higher RS than second-time fathers. While RS continued to decline for first-time fathers up until 14 months postpartum, second-time fathers experienced an increase in RS. At 14 months and 2 years postpartum, second-time fathers showed higher RS scores than first-time fathers. Similar to first-time mothers, first-time fathers seem to experience a stronger RS decline during the transition to parenthood than second-time fathers, suggesting that especially couples becoming parents for the first time should be prepared for expected changes in their relationship.

Mother-infant interaction and maternal postnatal psychological distress are associated with negative emotional reactivity among infants and toddlers- A FinnBrain Birth Cohort study

Studies have reported mixed findings regarding the effects of mother-infant interaction and maternal distress on children's negative emotional reactivity. In the current study (N = 134 and 107), we examined the effects of maternal Emotional Availability (sensitivity, structuring, non-intrusiveness and non-hostility) and maternal psychological distress on negative reactivity among children in the FinnBrain birth cohort study. In addition, the possible moderating effect of mother-infant interaction on the associations between maternal psychological distress and children's negative reactivity was examined. We used questionnaires to asses maternal psychological distress, observations of mother-infant interaction and observations as well maternal reports of child temperament to overcome the key limitations of many studies relying on single-method assessments. Our results showed that higher maternal sensitivity and structuring at 8 months of child's age were associated with lower mother-reported negative reactivity among children at 24 months. Higher maternal postnatal distress associated with higher parent-reported negative reactivity in children at 12 and 24 months of age when the effects of prenatal distress and the quality of mother-infant interaction were controlled for. Mother-infant interaction and maternal psychological distress did not associate with observations of child negative reactivity. We found no moderation effects of mother-infant interaction regarding the associations between maternal distress and children's negative emotional reactivity. Our findings reflect the importance of developing interventions to reduce the maternal distress symptoms while enhancing maternal sensitivity and structuring to prevent the possible harmful effects of these on child negative reactivity.

Association of self-reported mother-infant relationship with child and adolescent mental health

BACKGROUND

The quality of the relationship between mother and infant may have profound implications for the development of a child. Early indicators of psychological vulnerability may allow targeting of support for the child's cognitive, emotional and social development. A challenging mother-infant relationship could be one indicator of risk.

AIMS

This study examined variations in psychological well-being and psychopathology among boys and girls according to early maternal perception of the mother-infant relationship.

METHOD

This study is based on 64 663 mother-infant pairs from the Danish National Birth Cohort, for which data on the mother-infant relationship were collected at 6 months postpartum. Behavioural problems were assessed with the Danish version of the Strengths and Difficulties Questionnaire (SDQ) at child ages 7, 11 and 18 years, and we retrieved information on diagnosed childhood and adolescent psychiatric disorders and prescriptions of psychotropic drugs from Danish registries.

RESULTS

Children in the challenging mother-infant relationship group had higher odds of behavioural problems at age 7 among both boys and girls. The same pattern of elevated estimates was identified for boys across all SDQ domains and for girls in three of five SDQ domains. All associations were attenuated at age 18, but increased odds of behavioural problems still existed. A challenging early mother-infant relationship increased the offspring's risk of being diagnosed with a psychiatric disorder or being prescribed a psychotropic drug before the age of 18.

CONCLUSION

A challenging self-reported mother-infant relationship was associated with later psychopathological difficulties. Routine clinical enquiry may be useful in identification of future vulnerability.

Pandemic beyond the virus: maternal COVID-related postnatal stress is associated with infant temperament

BACKGROUND

Studies have shown that infant temperament varies with maternal psychosocial factors, in utero illness, and environmental stressors. We predicted that the pandemic would shape infant temperament through maternal SARS-CoV-2 infection during pregnancy and/or maternal postnatal stress. To test this, we examined associations among infant temperament, maternal prenatal SARS-CoV-2 infection, maternal postnatal stress, and postnatal COVID-related life disruptions.

METHODS

We tested 63 mother-infant dyads with prenatal maternal SARS-CoV-2 infections and a comparable group of 110 dyads without infections. To assess postnatal maternal stress, mothers completed the Perceived Stress Scale 4 months postpartum and an evaluation of COVID-related stress and life disruptions 6 months postpartum. Mothers reported on infant temperament when infants were 6-months-old using the Infant Behavior Questionnaire-Revised (IBQ-R) Very Short Form.

RESULTS

Maternal SARS-CoV-2 infection during pregnancy was not associated with infant temperament or maternal postnatal stress. Mothers with higher self-reported postnatal stress rated their infants lower on the Positive Affectivity/Surgency and Orienting/Regulation IBQ-R subscales. Mothers who reported greater COVID-related life disruptions rated their infants higher on the Negative Emotionality IBQ-R subscale.

CONCLUSIONS

Despite no effect of prenatal maternal SARS-CoV-2 infection, stress and life disruptions incurred by the COVID-19 pandemic were associated with infant temperament at 6-months.

IMPACT

SARS-CoV-2 infection during pregnancy is not associated with postnatal ratings of COVID-related life disruptions, maternal stress, or infant temperament. Postnatal ratings of maternal stress during the COVID-19 pandemic are associated with normative variation in maternal report of infant temperament at 6 months of age. Higher postnatal ratings of maternal stress are associated with lower scores on infant Positive Affectivity/Surgency and Orienting/Regulation at 6 months of age. Higher postnatal ratings of COVID-related life disruptions are associated with higher scores on infant Negative Emotionality at 6 months of age.

Dyadic parent-infant interaction patterns at 12 months: Exploring dyadic parent-infant gender compositions

This study investigates differences in dyadic mother-infant and father-infant interaction patterns at infant age 12 months, and the relation between different parent-infant gender compositions and the dyadic interaction. Data were drawn from a large-scale, population-based Norwegian community sample comprising 671 mother-infant and 337 father-infant interactions. The Early Relational Health Screen (ERHS), a screening method for observing dyadic parent-infant interactions, was used to assess the parent-infant interactions. Scores on the ERHS were employed to investigate dyadic differences in the overall interaction scores, and dyadic interaction on seven sub-dimensions between mother-infant and father-infant pairs. The relation between different parent-infant gender compositions and the dyadic interaction scores was also examined. As expected in a normative sample, most parent-infant interactions received scores in the upper rating levels. Differences between mother-infant and father-infant patterns were generally small, but mother-infant dyads tended to obtain slightly higher scores. The mother-infant dyads received higher scores on the dimensions of engagement and enjoyment, but no other significant differences between the parent-infant pairs were found for the remaining dimensions. We did not find evidence for a moderation effect of child gender. However, parent-daughter dyads received somewhat higher scores than the parent-son dyads.

The Relationship Between Neonatal Surgery, Postpartum Depression, and Infant Clinical Course

OBJECTIVE

Postpartum depression (PPD) affects 10-15% of mothers in the general population, and studies show increased incidence for mothers of infants with serious health conditions. This study investigates incidence of PPD in mothers of surgical patients in the neonatal intensive care unit (NICU) and characterizes these patients' clinical and neurodevelopmental outcomes.

METHODS

This retrospective cohort study analyzed Nebraska's Tracking Infant Progress Statewide (TIPS) database and referring hospital medical records from February 2013 to June 2018. Upon NICU discharge, children were referred to the TIPS program, with scheduled follow-up appointments at approximately 6 months corrected age. All patients seen in NICU follow-up clinic with recorded scores for maternal Edinburgh postnatal depression screen (EPDS) were eligible except infants with congenital heart disease as this cohort was previously studied. Patients were stratified into groups based on presence or absence of a general surgical procedure within the first 6 months of life and positive (≥ 10) or negative (< 10) EPDS score. Statistical analyses assessed for significant differences between groups regarding gestational age, birth weight, maternal age, length of NICU stay (LOS), number of days on a ventilator, payment method, ethnicity, developmental testing, and rate of referral for early intervention services.

RESULTS

Of 436 patients, 83 were surgical patients (16 with positive EPDS; 19.3% incidence), and 353 were non-surgical patients (44 with positive EPDS; 12.5% incidence). Statistical analysis showed no significant relationship between neonatal surgery and positive EPDS (χ² = 2.6, p = 0.1). While the surgical cohort had longer LOS and days on ventilator, maternal EPDS did not predict these factors. In the surgical cohort, mothers of children not independent on oral feeding at discharge were more likely to screen positive for depression (7/14, 50% vs. 7/61, 11%; p < 0.05).

CONCLUSION

Mothers of surgical patients are not significantly more likely to screen positive for post-partum depression compared to other NICU mothers. This underscores the importance of routine screening for PPD in mothers of both surgical and non-surgical NICU patients in order to identify parents and children at risk.

Spontaneous movements, motor milestones, and temperament of preterm-born infants: Associations with mother-infant attunement

Preterm-born infants and their mothers are at higher risk of showing less attuned interactions. We sought to identify characteristics of preterm-born infants associated with the attunement of mother-infant interactions at the corrected ages of 3-4 months, looking specifically at motor behaviors. We focused on infants' spontaneous movements, achievement of motor milestones, and temperament, which at this young age is often manifested via movement. Sixty preterm-born infants (Mdn_{gestation age in weeks}  = 33, 57.38% male, corrected age Mdn = 14 weeks, interquartile range = 13-16) and their mothers participated. Independent observers rated mother-infant attunement, infants' spontaneous movements, and infants' achievement of motor milestones. Mothers reported infant temperament. We found infants' smooth and fluent movement character and continual fidgety movements were associated with better attunement in terms of higher maternal sensitivity and non-intrusiveness and higher infant responsiveness and involvement. Unexpectedly, infants' achievement of motor milestones was not significantly associated with mother-infant attunement, and maternal reports of infants' higher soothability were associated with lower maternal sensitivity. The study illustrates the value of including the assessment of infants' spontaneous movements, designed for early detection of neurological deficiencies, in research and in clinical practice with parents and preterm-born infants.

[Structural Equation Modeling of the Interaction between Mothers and Preschool-Age Children]

PURPOSE

This study aimed to identify the factors influencing the interaction between mothers and preschool-age children and construct a structural equation model based on the factors identified.

METHODS

The data were collected from the mothers of children aged three to six years enrolled in kindergartens in Seoul, Gyeonggi, Chungbuk, and Jeonbuk. A total of 328 questionnaires were used for the analysis. Analysis was performed using SPSS 26.0 and AMOS 26.0 programs.

RESULTS

The child's self-regulation (β = .42, p < .001) had the most significant influence on the interaction between mothers and preschool children, followed by the mother's parenting stress (β = -.23, p =.008), social support (β = .17, p < .001), and the child's active temperament (β = .15, p < .001). The child's gender, emotional temperament, social temperament, and mother's education level had indirect influences.

CONCLUSION

These results suggest that interventions considering the child's temperament, mother's parenting stress, and social support are required to promote the interaction between preschool-age children and mothers.

Psychopathology and Parental Stress in 3-6-Year-Old Children with Incontinence

Objective: Incontinence and functional gastrointestinal disorders are common in young children and are associated with higher rates of psychological symptoms and mental disorders. This article focuses on the mutual association between incontinence and related toilet refusal syndrome, parental stress, and children's psychopathology especially in young children. Methods: Children's psychological symptoms, mental disorders, and parental stress levels were assessed in 38 parent-child dyads involving children with incontinence and 42 dyads of typically developing (TD) children. Results: Compared to TD children, patients had higher internalizing and externalizing CBCL scores and higher rates of clinically relevant externalizing problems. However, the rates of clinically relevant internalizing problems and mental disorders did not differ. The parents of children with incontinence reported significantly higher stress levels regarding child-related stress factors (PSI-CD) than did parents of TD children. However, there were no clinically relevant parental stress scores on a group level, which remained below the clinical range (T-value < 60). When simultaneously analyzed, children's (comorbid) mental disorders but not incontinence had a major impact on parental stress. Conclusions: Despite moderate stress levels, incontinence symptoms, urinary and fecal incontinence are highly prevalent in young children. However, stress among parents of young children was mainly elicited by any (comorbid) mental disorder.

Intergenerational Transmission of Corporal Punishment: The Independent and Interactive Moderating Role of Children's Negative Affectivity and Effortful Control

The present study examined the independent and interactive moderating effects of children's negative affectivity (NA) and effortful control (EC) on the relations between parental childhood history of corporal punishment (CP) and their current use of CP. A total of 634 Chinese father-mother dyads with preschoolers (M age = 4.69 years, 53.8% boys) reported on their experience of CP in childhood, their current use of CP toward children, and their children's NA and EC. For both mothers and fathers, hierarchical regression analyses revealed that children's NA and EC independently and interactively moderated the relations between parental childhood history of CP and their current use of CP. Specifically, high NA intensified but high EC weakened the relations between parental childhood history of CP and their current use of CP. Moreover, high EC also weakened the intensifying effect of NA, with the intergenerational stability of CP being weakest and even disrupted when children were at low NA and high EC meanwhile. Findings from the present study highlight the importance of considering how the child factor may influence the intergenerational transmission of CP.

Psychological Adjustment of Children and Adolescents with 22q11.2 Deletion Syndrome and Their Mothers' Stress and Coping-A Longitudinal Study

At present, there is a lack of longitudinal studies on the psychological adjustment of both children and adolescents with 22q11.2 deletion syndrome (22q11.2DS) and their primary caregivers. To fill this gap, we performed a four-year follow-up study. Mothers filled out the Child Behavior Checklist 4–18, the Social Orientation of Parents with Handicapped Children questionnaire to assess maternal stress and coping strategies, and the Freiburger Personality Inventory-Revised—subscales strain and life satisfaction. Fifty-five subjects with 22q11.2DS (26 males and 29 females; age: M = 10.79 years, SD = 3.56 years) and their biological mothers (age: M = 40.84 years, SD = 4.68 years) were included in this study. Significantly higher levels of behavior problems than in the general population and an increase in these problems, especially internalizing ones, over time could be found. In contrast, maternal stress did not change significantly over time, but mothers demonstrated increased levels of strain and reduced life satisfaction at T2. Thus, careful monitoring as well as early and adequate interventions, if indicated, should be offered to families with a child with 22q11.2DS, not only for somatic complaints but also for problems with psychological adjustment.

Maternal trauma and emotional availability in early mother-infant interaction: findings from the Mercy Pregnancy and Emotional Well-being Study (MPEWS) cohort

Understanding how a mother's traumatic experiences influence her interactions with her infant may have importance for understanding infant development and mental health. Data for this study were drawn from an Australian pregnancy cohort, the Mercy Pregnancy and Emotional Wellbeing Study. Maternal trauma from Childhood, Childbirth Experiences, and Stressful Life Events were examined. At six-months postpartum, 211 predominantly first-time mothers (mean age 31.5 years), and their infants, were video-recorded interacting for 40 minutes. Interactions were assessed with the Emotional Availability (EA) Scales. Using structural equation modelling to test multiple mediation pathways, moderate-to-severe childhood trauma had only a direct effect on reducing maternal EA with the infant (β=-.17, p=.031), as did current stressful life events (β=-.19, p=.019), after controlling for maternal depression, age, and tertiary education. This highlights that proximate trauma specific to the perinatal period may not account for the effect of distal childhood trauma on maternal EA at six-months postpartum.

Motor Learning, Neuroplasticity, and Strength and Skill Training: Moving From Compensation to Retraining in Behavioral Management of Dysphagia

Purpose Learning a motor skill and regaining a motor skill after it is lost are key tenets to the field of speech-language pathology. Motor learning and relearning have many theoretical underpinnings that serve as a foundation for our clinical practice. This review article applies selective motor learning theories and principles to feeding and swallowing across the life span. Conclusion In reviewing these theoretical fundamentals, clinical exemplars surrounding the roles of strength, skill, experience, compensation, and retraining, and their influence on motor learning and plasticity in regard to swallowing/feeding skills throughout the life span are discussed.

Early detection of parenting stress in mothers of preterm infants during their first-year home

Background

Maternal stress following the birth of an infant is well acknowledged. It is particularly so when infants are born prematurely as their mothers cannot fully take on their parenting role until their infant(s) is discharged from neonatal intensive care units (NICUs). In this exploratory study, we examined whether these mothers’ parenting stress would lessen during their first-year reunification with their infant(s) as they settle into motherhood at home.

Methods

Two groups of mothers with infants born between 24- and 33-week gestational age were recruited. A group of 25 mothers were monitored at their infants’ 1-month corrected age (CA) and a second group of 24 mothers were monitored at their infants’ 12-month CA. Subjects completed the long form Parental Stress Index (PSI) ranking how stressful they perceive the individual subscales in the Child and Parent Domains of the self-reported questionnaire (PSI-3; Abidin; PAR Inc). The PSI theorizes that the stress mothers perceive is a resultant of their respective characteristics, interactions with their infant(s), family, and environment. Statistical analyses include descriptive statistics, χ² square analysis, and independent t-test.

Results

There was no significant difference in the levels of perceived stress in the PSI subscales between the two groups of mothers at 1- and 12-month CA. Scores for the majority of respondents fell within the 15th to 80th percentile (% ile) distribution of Abidin’s normative population, with some mothers falling below the 15th % ile.

Discussion/conclusion

The data collected suggest that: 1. the perceived stress experienced by mothers during their first-year reunited with their preterm infants is within the normal range observed in Abidin’s normative population. 2. As the PSI is a self-reported survey, care providers need to be aware that some mothers may downplay their stress responses. 3. With the ability to monitor individual participants, the PSI can be readily offered to mothers at their infants’ first year routine clinical visits to assist in the early identification of parenting issues that may threaten the development of a healthy mother-infant dyad. Early appropriate guidance and social support would help “at-risk” mothers develop more constructive parenting routines.

Parenting stress trajectories during infancy in infants with congenital heart disease: Comparison of single-ventricle and biventricular heart physiology

OBJECTIVE

Parents of infants with congenital heart disease (CHD) experience increased parenting stress levels, potentially interfering with parenting practices and bear adverse family outcomes. Condition severity has been linked to parenting stress. The current study aimed to explore parenting stress trajectories over infancy in parents of infants with complex CHD, and to compare them by post-operative cardiac physiology.

DESIGN

Data from a larger prospective cohort study was analyzed using longitudinal mixed-effects regression modeling.

SETTING

Cardiac intensive care unit and outpatient clinic of a 480-bed children's hospital in the American North-Atlantic region.

PARTICIPANTS

Parents of infants with complex CHD (n = 90).

MEASURES

Parenting stress was measured via the parenting stress index-long form over four time points during infancy.

RESULTS

Parents of infants with a single-ventricle heart experienced a decrease in total stress over time. Parents of infants with a biventricular heart experienced a decrease in attachment-related stress, and an increase in stress related to infant temperament over time. Parenting stress trajectories over time significantly differed between groups on infant temperamental subscales.

CONCLUSIONS

Findings highlight stressful and potentially risky periods for parents of infants with complex CHD, and introduce additional illness-related and psychosocial/familial aspects to the parenting stress concept. Early intervention may promote parental adaptive coping and productive parenting practices in this population.

Infant temperament and perinatal depressive and anxiety symptoms in Mexican women

AIM

This study explores the association between infant temperament at six months postpartum and pre- and postpartum depressive and anxiety symptoms. The association between infant temperament and stressful life events is also evaluated.

METHOD

A total of 210 Mexican women were assessed during pregnancy (gestational age 32.39 ± 4.01) and at six months postpartum. The instruments used were: Patient Health Questionnaire (PHQ-9), the Anxiety Subscale of the Hopkins Symptoms Checklist (SCL-90R), a short form of Stressful Life Events and The Infant Characteristics Questionnaire, when infants were six months old.

RESULTS

Although a mother's emotional state during pregnancy (depressive and anxiety symptoms and stressful life events) was not associated with difficult infant temperament, it was associated with depressive and anxious symptomatology during the postpartum period. Mothers with prenatal depressive symptoms who remained depressed and mothers who only had depression symptoms during the postpartum period reported having more difficult infants. Likewise, mothers with prenatal anxiety symptoms who maintained anxiety symptoms postpartum and mothers with anxiety symptoms during the postpartum period alone reported having more difficult infants. Comorbidity was found between depressive and anxious postnatal symptomatology in its association with difficult infant temperament.

CONCLUSION

In this study, postpartum depressive and anxiety symptoms played an important role in shaping difficult infant temperament. Comorbidity between the two conditions warrants clinical attention and additional research, since it is related to maternal perception of difficult infant temperament. Psychological interventions are required, since these women may require assistance with emotional adaptation in the transition to motherhood.

Profiles of infant communicative behavior

Prior studies of mother-infant interaction have generally used a variable-centered approach to associate face-to-face communication with psychosocial outcomes. Herein, we use a person-centered approach to identify clusters of infants who exhibit similar behavioral profiles during face-to-face communication with their mothers. Four infant communication channels were examined-gaze, facial affect, vocal affect, and head orientation-coded from videotape at a 1-s temporal resolution. We used k-means clustering to classify community infants (N = 132) into 10 groups, based on variation in the intercept and the autocorrelation function at the first time lag, representing respectively the overall level of behavior and the predictability of the infant's moment-by-moment behavioral stream, in each of the 4 communication channels. In this exploratory study, 10 clusters were identified, some with unusual levels or predictability of behavior in varying channels, and clusters associated differentially with risk outcomes (infant 4-month temperament and 12-month attachment). Distinct forms of affective dysregulation were identified: sustained negative vocal affect associated with degree of disorganization; random vocal affect associated with attachment resistance; random facial affect and vocal affect, irrespective of positive/negative valence, associated with infant difficult temperament. Clustering multiple channels of infant communication generated unique behavioral profiles and predicted 4- and 12-month outcomes, suggesting that these clusters may indeed represent natural types of infant communicative behavior, not easily observed with the naked eye, that may be useful behavioral markers of clinical risk. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Parents' Perception of Their 2⁻10-Year-Old Children's Contribution to The Dyadic Parent-Child Relationship in Terms of Positive and Negative Behaviors

Parent-child relationship is developed and changed through reciprocal interactions between a child and his/her parent, and these interactions can strongly influence the child's development across domains (e.g., emotional, physical, and intellectual). However, little is known about the parental perception of the child's contribution to the dyadic parent-child relationship in terms of positive and negative behaviors. We therefore aimed to develop and validate an economical parent-report instrument to assess these important aspects. The validation study included 1642 mothers (Mage = 37.1) and 1068 fathers (Mage = 40.4) of 1712 children aged 2⁻10 years (Mage = 6.6) who completed the new instrument, the Child Relationship Behavior Inventory (CRBI). Statistical results indicated that the CRBI is a reliable and valid measure. Mothers reported more positive child behaviors towards them, whereas fathers perceived fewer problems with problematic relationship behavior than mothers. In their parents' perception, girls showed more positive and less problematic relationship behaviors than boys. The frequency of problematic child relationship behavior significantly decreased with increasing child age while positive relationship behavior did not show any correlation with the child's age. To assess both positive and negative child relationship behaviors could be helpful to better understand the relevance of these different aspects for the development of the parent-child relationship.

Genetic and Environmental Risk Factors for Cannabis Use: Preliminary Results for the Role of Parental Care Perception

BACKGROUND

Vulnerability to cannabis use (CU) initiation and problematic use have been shown to be affected by both genetic and environmental factors, with still inconclusive and uncertain evidence.

OBJECTIVE

Aim of the present study was to investigate the possible interplay between gene polymorphisms and psychosocial conditions in CU susceptibility.

METHODS

Ninety-two cannabis users and ninety-three controls have been included in the study. Exclusion criteria were serious mental health disorders and severe somatic disorders, use of other drugs and alcohol abuse; control subjects were not screened to remove Reward Deficiency Syndrome (RDS) behaviors. A candidate gene association study was performed, including variants related to dopaminergic and endocannabinoids pathways. Adverse childhood experiences and quality of parental care have been retrospectively explored utilizing ACES (Adverse Children Experience Scale), CECA-q (Child Experience of Care and Abuse Questionnaire), PBI (Parental Bonding Instrument).

RESULTS

Our findings evidenced a significant association between rs1800497 Taq1A of ANKK1 gene and CU. Parental care was found to be protective factor, with emotional and physical neglect specifically influencing CU. Gender also played a role in CU, with males smoking more than females. However, when tested together genotypes and psychosocial variables, the significance of observed genetic differences disappeared.

CONCLUSIONS

Our results confirm a significant role of Taq1A polymorphism in CU vulnerability. A primary role of environmental factors in mediating genetic risk has been highlighted: parental care could be considered the main target to design early prevention programs and strategies.

The Multiple Determinants of Maternal Parenting Stress 12 Months After Birth: The Contribution of Antenatal Attachment Style, Adverse Childhood Experiences, and Infant Temperament

Parenting stress can influence caregiving behavior negatively, which in turn may harm children's development. Identifying precursors of parenting stress, preferably beginning during pregnancy and throughout the first year of life, is therefore important. The present study aims to provide novel knowledge on this issue through a detailed examination of the association between maternal attachment style and later parenting stress. Moreover, we examine the role of several additional risk factors, specificially the mothers' own adverse childhood experiences (ACE), as well as infants' temperamental characteristics. Data from a community based longitudinal study of 1,036 Norwegian mothers, collected during pregnancy and 12 months after childbirth, were used. Results showed that attachment style in pregnancy predicted parenting stress 1 year after birth. In addition, it was demonstrated that the mothers' own ACEs predicted postnatal parenting stress, and that attachment style operated as a mediator of this association. A significant association between perceived infant temperament and parenting stress was also found. The study illustrates the importance of understanding the multifactorial antecedents of parenting stress. The results may inform early intervention efforts aimed at supporting mothers and their partners in the potentially difficult transition period around childbirth.

Maternal Distress and Infant Social Withdrawal (ADBB) Following Infant Cardiac Surgery for Congenital Heart Disease

Background:

Mothers and infants are exposed to multiple stresses when cardiac surgery is required for the infant. This study reviewed infant responsiveness using a standardized objective observational measure of social withdrawal and explored its association with measures of maternal distress.

Methods:

Mother–infant pairs involving infants surviving early cardiac surgery were assessed when the infant was aged two months. Infant social withdrawal was measured using the Alarm Distress Baby Scale. Maternal distress was assessed using self-report measures for maternal depression (Edinburgh Postnatal Depression Scale), anxiety (Spielberger State-Trait Anxiety Scale), and parenting stress (Parenting Stress Index–Short Form). Potential associations between infant social withdrawal and maternal distress were evaluated.

Results:

High levels of maternal distress and infant social withdrawal were identified relative to community norms with a positive association. Such an association was not found between infant social withdrawal and the cardiac abnormality and surgery performed.

Conclusion:

The vulnerability of infants requiring cardiac surgery may be better understood when factors beyond their medical condition are considered. The findings suggested an association between maternal distress and infant social withdrawal, which may be consistent with mothers’ distress placing infants subjected to cardiac surgery at substantially increased risk of social withdrawal. However, it is unclear to what extent infant withdrawal may trigger maternal distress and what the interactive effects are. Further research is warranted. Trialing a mother–infant support program may be helpful in alleviating distress and improving the well-being and outcomes for these families.

Maternal personality disorder symptoms in primary health care: associations with mother-toddler interactions at one-year follow-up

BACKGROUND

Research is scarce on how mothers' symptoms of personality disorders are linked to the mother-toddler relationship. In this study we have explored the extent to which these symptoms are associated with mutual mother-toddler interactions assessed 1 year after the initial assessment.

METHODS

Mothers and their 0-24-month-old children (n = 112) were recruited by nurses at well-baby clinics due to either self-reported or observed mother-toddler interaction problems. At inclusion (T1), mothers filled out the DSM-IV and ICD-10 Personality Questionnaire (DIP-Q), which measures symptoms of ten personality disorders. A year later (T2), mother-toddler interactions were video-recorded and coded using a standardised observation measure, the Emotional Availability Scales.

RESULTS

Only maternal schizotypal personality disorder symptoms predicted both the mothers' and the toddlers' interactional styles. Mothers with schizotypal personality symptoms appeared less sensitive, less structuring and more intrusive in their interactions with their toddlers, while mothers' borderline personality disorder symptoms were associated with increased hostility. Furthermore, toddlers who had mothers with schizotypal personality symptoms were less responsive towards their mothers.

CONCLUSION

Measured dimensionally by self-report, maternal schizotypal personality symptoms were observed to predict the interaction styles of both mothers and their toddlers in the dyad, while borderline personality disorder symptoms predicted mothers' interactional behaviour only.

TRIAL REGISTRATION

Current Controlled Trials ISRCTN99793905 , retrospectively registered. Registered on (04/08/2014).

A Person-Centered Approach to Child Temperament and Parenting

The aim of this study was to examine how variations in children's temperamental reactivity and mothers' parenting stress relate to parenting behavior. A sample of 3,001 mother-child dyads was assessed when children were 14, 24, 36, and 54 months. Latent profile analysis identified a group of temperamentally "easy" children whose mothers experienced little parenting stress, along with two groups of highly reactive children differentiated by mothers' stress levels. Maternal negative regard over time was highest in the group of reactive children with highly stressed mothers. Mothers in this group also perceived more child behavior problems and had less knowledge of child development. Results are discussed relative to Person × Environment interactions and the complex interplay between parent and child characteristics.

Mother's Lived Experience During Repair of Long-Gap Esophageal Atresia: A Phenomenological Inquiry

BACKGROUND

Infants born with long-gap esophageal atresia (LGEA) pose unique physiologic risks in the newborn period. Anatomic and physiologic anomalies require an extended hospitalization with procedural analgesia and sedation that impact the mother's experience of birth, maternal response, and nurturing of her infant.

PURPOSE

The aim of this study was to understand the meaning of experiences that mothers of infants born with LGEA encounter in the neonatal intensive care unit while their infant undergoes esophageal repair.

METHODS

A hermeneutical phenomenological design was used to guide this inquiry. Three mothers were interviewed on 3 separate occasions. The conversations were audio-recorded and transcribed verbatim. The findings were analyzed using fundamental existential lifeworld themes.

RESULTS

The essence that conceptualized the study was "making connections: day-by-day." Themes that emerged are (a) the many phases; (b) the long and winding road; (c) a new me, my purpose; and (d) our new community.

IMPLICATIONS FOR PRACTICE

Nurses' knowledge and understanding of maternal experiences of having an infant with LGEA will enable for increased physical closeness, optimizing time spent together to learn their infant's unique personality. Creating partnerships with mothers can enhance our understanding of their perspectives, concerns, needs, and guide interventions.

IMPLICATIONS FOR RESEARCH

Further exploration of family dynamics including fathers, siblings, and contextual factors may illuminate interventions to enhance relationships and communication that may influence developmental outcomes for families of infants with LGEA.

Preterm infant development, maternal distress and sensitivity: The influence of severity of birth weight

OBJECTIVE

To evaluate the influence of the severity of prematurity based on birth weight on maternal distress and sensitivity and on infant development.

METHODS

Sixty-eight mothers and their preterm babies (30 babies classified into Extremely-Low-Birth Weight-ELBW and 38 into Very-Low-Birth Weight-VLBW) were assessed at 9months of infant corrected age, using: Griffiths Scales for infant development, CARE-Index for maternal sensitivity during 5-minute of mother-infant interaction, and Parenting Stress Index-Short Form (PSI-SF) for maternal distress. Sixty-six healthy full-term infants (FT) and their mothers were assessed with the same procedure.

RESULTS

ELBW, VLBW and FT groups showed similar levels at CARE-Index and PSI-SF. Nevertheless, considering infant development as outcome, a significant interaction between birth weight and maternal distress emerged, with higher Hearing & Language mean quotients in association with Non-Distressed mothers, but only in VLBW infants, compared to FT ones. Also the interaction between birth weight and maternal sensitivity influenced infant development: higher quotients (Eye-hand coordination, Hearing & Language, Locomotor) were significantly associated with sensitive mothers but only in ELBW infants.

CONCLUSION

The severity of prematurity, in interaction with the degree of maternal distress and sensitivity, influenced the level of infant development.

PRACTICAL IMPLICATIONS

Taken together, these results suggest the relevance of considering severity of prematurity and maternal variables in order to implement appropriate interventions for supporting parenting role after a preterm birth and promoting an adequate infant development.

The Development of the Mother-Infant Mutualistic Screening Scale

BACKGROUND

The integrity of a mother-infant dyad is essential for the proper development of maternal behavior and infant growth/ development. At present, there is a lack of objective approaches to monitor mother-infant behavioral exchanges.

OBJECTIVES

This is an exploratory prospective study designed to evaluate the Mother-Infant Mutualistic Screening Scale (MIMSS), a novel observational tool focused on monitoring the mutual/ reciprocal sensitivity and responsiveness that mother and infant express toward one another's behaviors/ actions during the obligatory setting of daily meal times.

METHODS

Mother-infant interactions were assessed from videotaped feeding sessions conducted under recurrent naturalistic observations. Data were collected from 27 mother-preterm infant singleton dyads at 6 and 12 month corrected age (CA). Four levels of MIMSS are defined: Level I - both mother and infant are not responsive (NR) to one another's actions; Level II - mother is not responsive (NR) to infant, but infant is responsive (R) to mother; Level III - mother is responsive (R) to infant, but infant is not responsive (NR) to mother; Level IV - both mother and infant are responsive (R) to one another.

RESULTS

Inter- and intra-rater reliability between two raters was 93% and ≥ 85%, respectively. At 6 and 12 month CA, 78% and 81% of the dyads were at a MIMSS Level IV, respectively. A change in mother-infant reciprocal behavioral responses or MIMSS levels was observed in 9 of the dyads between these two ages. No association was observed between MIMSS levels and infant growth/ development as monitored by percentile Weight, Length, and Weight by Length at both corrected ages.

CONCLUSIONS

The MIMSS is easy to use with high inter- and intra-rater reliabilities. With the ability to differentiate between mother and infant reciprocal behavioral responses toward one another's actions, MIMSS can help health professionals assess the quality of mother-infant interactions and identify the partner(s) who may benefit from individualized assistance. Although MIMSS uses mealtime as a recurrent setting, it offers a conceptual frame work for evaluating co-regulatory processes under different contexts.

Early Childhood Dental Problems

Investigations into the wider bioecological understanding of dental problems in early childhood are limited in national surveys. Classification tree analysis (CTA) was used to explore multilevel interactions among key aspects of child and primary caregiver (PCG) psychosocial and physical health affecting dental problems in preschool children. Data were derived from the Growing Up in Ireland study, a nationally representative sample of 9-mo-olds (N = 11,134) in 2007/2008 followed up at age 3 y (N = 9,793) in 2010/2011. Analysis included PCG reports of children’s dental problems, general health, temperament, emotional and behavioral difficulties, and their own general health, stress and depression, relationship, and sociodemographic variables. Misclassification costs were specified for the model by applying a higher penalty for misclassifying those with a dental problem (minority class). Logistic regression analyses were carried out for comparison. Dental problems were reported among 302 infants (2.7%) at 9 mo of age and 493 children (5.0%) at 3 y. CTA identified infant temperament (Infant Characteristics Questionnaire unpredictable) as the primary predictor of dental problems at 9 mo and child global health at 3 y of age. First-level predictors were PCG depression score and use of a soother at 9 mo and PCG ethnicity and unscheduled hospital visits at 3 y of age. Regression analyses results supported the most important predictors at 9 mo and 3 y of age. The CTA model for 9-mo-old infants had a specificity of 90.4%, sensitivity of 31.2%, and overall accuracy of 88.8% while that for 3-y-olds had a specificity of 58.5%, sensitivity of 66%, and overall accuracy of 59%. Key aspects of infant/child and PCG health, as well as psychosocial characteristics associated with reported dental problems, should be considered in future multidisciplinary approaches to child health.

Knowledge Transfer Statement: The results of this data analysis should help raise awareness among clinicians of how primary caregiver and child psychosocial and general health factors are associated with early childhood dental problems, even before the primary dentition is complete. Classification tree analysis visually demonstrates how factors such as infant temperament (9 mo) and child global health (3 y) can interact at multiple levels and affect different subgroups of the child population. Future intervention strategies for oral health should involve consideration of the psychological and general health characteristics of the young child and PCG at both the patient and population levels. This knowledge could assist decision makers adopt an integrated multidisciplinary approach in formulating a coherent oral health policy for preschool children.

Perceived parenting stress in the course of postpartum depression: the buffering effect of maternal bonding

Research investigating maternal bonding and parenting stress in the course of postpartum depression is lacking. Aim of the study was to investigate the development and potential mediation of both constructs in the course of postpartum depression. n = 31 mothers with postpartum depression according to DSM-IV and n = 32 healthy controls completed the German version of the Postpartum Bonding Questionnaire and the Parenting Stress Index at two measuring times: acute depression (T1) and remission (T2). At T1, the clinical group reported lower bonding and higher parenting stress. Bonding was found to partially mediate the link between maternal diagnosis and parenting stress. Furthermore, the clinical group reported lower bonding and higher parenting stress averaged over both measurement times. However, at T2, the clinical group still differed from the controls even though they improved in bonding and reported less parenting stress. A significant increase of bonding was also observed in the control group. Maternal bonding seems to buffer the negative impact of postpartum depression on parenting stress. The results emphasize the need for interventions focusing on maternal bonding and mother-infant interaction in order to prevent impairment of the mother-child relationship.

The Association Between Infant Temperament and Breastfeeding Duration: A Cross-Sectional Study

BACKGROUND

Little is known about the relationship between infant temperament and breastfeeding. The few studies investigating this report mixed results. Some suggest that difficult infants are breastfed for shorter duration, others report opposing results or no association between the two.

AIM

This study investigated associations between infant difficult temperament and breastfeeding duration in a nationally representative cohort of Irish 9-month-old infants.

METHODS

Breastfed, normal birth-weight singletons from The Infant Cohort of the Growing Up in Ireland Study (n = 5,955) were considered in this research. The Infant Characteristics Questionnaire (ICQ), completed by the mother, was used to assess four different dimensions of difficult temperament: fussy, unpredictable, unadaptable, and dull. Our main interest was the fussy dimension as this is captured best by the ICQ. Initially, a logistic regression (LR) model having the binary version, short (<90 days) or long breastfeeding (≥90 days) as outcome variable, was constructed. Next, a proportional odds logistic regression (POLR) model examining the five-level categorical version (≤1 week, 2 weeks-<1 month, 1-<3 months, 3-<6 months, and ≥6 months) of breastfeeding duration was developed. All regression models were adjusted for relevant sociodemographic data.

RESULTS

A total of 3,119 infants were breastfed for less than 90 days, while 2,836 were breastfed for 90 days or longer. The LR and POLR models showed a mild inverse association between infant fussiness/difficultness and breastfeeding duration (LR: OR = 0.98, 95% CI: 0.97-0.99, POLR: OR = 0.98, 95% CI: 0.97-0.99). Higher infant unpredictability is associated with longer breastfeeding duration (LR: OR = 1.04, 95% CI: 1.02-1.07, POLR: OR = 1.04, 95% CI: 1.02-1.06).

CONCLUSIONS

In this cross-sectional study, we found that breastfeeding duration was inversely associated with infant fussiness and positively associated with infant unpredictability.

The Relationship between Genetic Attributions, Appraisals of Birth Mothers' Health, and the Parenting of Adoptive Mothers and Fathers

Parenting beliefs and attributions can influence parenting behavior. We used an adoption design to examine the associations among perinatal risk and poor birth mother health, adoptive parent appraisals of birth mothers' mental health, and genetic attributions to adoptive parents' feelings and behaviors toward their adopted infants. A sample of 361 pairs of adoptive parents and birth mothers were interviewed using standardized measures when infants were between 4 and 9 months old. Adoptive mothers and fathers were observed during play tasks when their infants were 9 months old. We found that adoptive mothers' and fathers' appraisals of birth mothers' health were associated with perinatal risk and poor birth mother health. Adoptive mothers' appraisals were linked to hostile parenting, after accounting for characteristics of the child that may influence her appraisals and attributions. These associations were not present for adoptive fathers. Genetic attributions were associated with both adoptive mother and fathers' feelings of daily hassles in parenting. These findings have implications for prevention and intervention.

Relationships between regulatory temperament dimensions and self-regulatory behaviors at 4 and 6 months of age

The present study focused on relationships between temperament and behavior in early regulation development. Unlike most studies on the topic, we observed infant behavior in a naturalistic playful situation rather than in experimental stressful procedure, and employed temperament measures uniquely reflecting regulatory dispositions rather than a global measure of reactivity. The infant's self-regulatory behaviors were observed at 4 and 6 months during face-to-face interactions and regulatory dimensions were assessed at 4 months. We found that low intensity pleasure and soothability dimensions, related to the infant physical and social experience, respectively, significantly affected regulatory behavior and their influence showed to depend on the infant's age, with the former dimension being influential at the earlier age and the latter being influential when the behavior was observed at the later age. Results are interpreted on the light of a dynamic view of regulation development.

Longitudinal development of mother-infant interaction during the first year of life among mothers with substance abuse and psychiatric problems and their infants

The quality of mother-infant interaction during the first year may be hampered by maternal substance abuse and co-existing non-optimal factors such as psychiatric problems and difficult relational experiences. In the present study three groups of women were recruited during pregnancy: One group with substance abuse problems from residential treatment centers (n = 28), a second group from psychiatric outpatient treatment centers (n = 22), and a third group from well-baby clinics (n = 30). Four maternal optimality indexes were assessed (substance abuse, psychiatric problems, relational experiences and SES). Mother-infant interaction was observed at 3 and 12 months. The substance abuse group showed the most disturbed mother-infant interaction at 12 months. Low maternal optimality as well as impairments in maternal affective involvement at 3 months influenced negatively both on infant and dyadic affective behavior in interaction at 12 months. Long-term interventions are needed to promote affective reciprocity among mother-baby pairs with low optimality.

Mental health related determinants of parenting stress among urban mothers of young children--results from a birth-cohort study in Ghana and Côte d'Ivoire

BACKGROUND

There are limited data on the parenting stress (PS) levels in sub-Saharan African mothers and on the association between ante- and postnatal depression and anxiety on PS.

METHODS

A longitudinal birth cohort of 577 women from Ghana and Côte d'Ivoire was followed from the 3rd trimester in pregnancy to 2 years postpartum between 2010 and 2013. Depression and anxiety were assessed by the Patient Health Questionnaire depression module (PHQ-9) and the Generalized Anxiety Disorder (GAD-7) at baseline, 3 month, 12 month and 24 month postpartum. PS was measured using the Parenting Stress Index-Short Form (PSI-SF) at 3, 12 and 24 month. The mean total PS score and the subscale scores were compared among depressed vs. non-depressed and among anxious vs. non-anxious mothers at 3, 12 and 24 month postpartum. The proportions of clinical PS (PSI-SF raw score > 90) in depressed vs. non-depressed and anxious vs. non-anxious mothers were also compared. A generalized estimating equation (GEE) approach was used to estimate population-averaged associations between women's depression/anxiety and PS adjusting for age, child sex, women's anemia, education, occupation, spouse's education, and number of sick child visits.

RESULTS

A total of 577, 531 and 264 women completed the PS assessment at 3 month, 12 month and 24 month postpartum across the two sites and the prevalences of clinical PS at each time point was 33.1%, 24.4% and 14.9% in Ghana and 30.2%, 33.5% and 22.6% in Côte d'Ivoire, respectively. At all three time points, the PS scores were significantly higher among depressed mothers vs. non-depressed mothers. In the multivariate regression analyses, antepartum and postpartum depression were consistently associated with PS after adjusting for other variables.

CONCLUSIONS

Parenting stress is frequent and levels are high compared with previous studies from high-income countries. Antepartum and postpartum depression were both associated with PS, while antepartum and postpartum anxiety were not after adjusting for confounders. More quantitative and qualitative data are needed in sub-Saharan African populations to assess the burden of PS and understand associated mechanisms. Should our findings be replicated, it appears prudent to design and subsequently evaluate intervention strategies.

How mothers perceive infants with unspecific gastrointestinal symptoms suggestive of cow's milk allergy?

AIM

To determine whether specific infant behavioural characteristics are present in children suspected of cow's milk allergy because of gastrointestinal symptoms.

METHODS

We prospectively recruited 57 children (median age 8.7 months) with a suspicion of gastrointestinally manifested cow's milk protein allergy (GI-CMPA). None had detectable cow's milk-specific IgE. Mothers were asked to complete the Parenting Stress Index (PSI) Child Domain, and those with children below 18 months of age (n = 49) also the Infant Temperament Questionnaire (ITQ). GI-CMPA was diagnosed with the double-blind, placebo-controlled food challenge. Control group (n = 22) consisted of patients (age range 4-26 months), attending the Pediatric Allergy Unit, who did not have diagnosed or suspected food allergies.

RESULTS

The scores were significantly higher for the PSI (n = 48) Child Domain (p < 0.0001) and for the ITQ (n = 44) subscale Difficultness (p = 0.0045) compared with the control patients without suspected/diagnosed food allergy. The difference between the challenge positive (n = 18) and negative (n = 39) patients remained statistically insignificant. After 6 months, in both groups, the scores (PSI Child Domain p = 0.0004, ITQ Difficultness p = 0.0393) were lower, but the ITQ Difficultness score still remained higher than in the controls (p = 0.0453).

CONCLUSION

The mothers often perceive infants with unspecific symptoms suggestive of GI-CMPA as demanding and temperamentally difficult.

Self-reported maternal parenting style and confidence and infant temperament in a multi-ethnic community: results from the Born in Bradford cohort

Ethnic minority children in the United Kingdom often experience health disadvantage. Parenting influences children's current and future health, but little is known about whether parenting behaviours and mother's perception of her infant vary by ethnicity. Using the Born in Bradford (BiB) birth cohort, which is located in an ethnically diverse and economically deprived UK city, we conducted a cross-sectional analysis of mother's self-reported parenting confidence, self-efficacy, hostility and warmth, and infant temperament at six months of age. We examined responses from women of Pakistani (N = 554) and White British (N = 439) origin. Pakistani mothers reported feeling more confident about their abilities as a parent. Significantly fewer Pakistani women adopted a hostile approach to parenting, an effect that was attenuated after adjustment for socioeconomic status and mental health. Overall, women with more self-efficacious, warm and less hostile parenting styles reported significantly fewer problems with their infant's temperaments. Of women with higher self-efficacy parenting styles, Pakistani mothers were significantly more likely than White British mothers to report more problematic infant temperaments, although absolute differences were small. It is unlikely that the ethnic variation seen in children's cognitive and behavioural outcomes in childhood is attributable to differences in parenting or infant characteristics reported at six months.

Mastery motivation in children with congenital hemiplegia: individual and environmental associations

AIM

The aim of this study was to examine the relationship between mastery motivation and individual and environmental characteristics in school-aged children with congenital hemiplegia.

METHOD

Forty-eight child-caregiver dyads (children's mean age 7y 11mo, SD 2y 4mo; 33 males, 15 females; Manual Ability Classification System [MACS] level I, n=25, and level II, n=23; predominant motor type spastic hemiplegia, n=47) were recruited to this cross-sectional study. Children were assessed using the Melbourne Assessment of Unilateral Upper Limb Function (MUUL) and the Assisting Hand Assessment. Caregivers completed the Dimensions of Mastery Questionnaire, the Parenting Scale, and a demographic questionnaire.

RESULTS

Consistent and positive parental disciplinary practices were associated with higher total motivation (p=0.006) and instrumental aspect scores (p=0.009). Children with siblings and from single-parent families experienced greater negative reactions to failure (p=0.006). Children from two-parent families (p=0.018) and with better bimanual performance (p=0.015) demonstrated greater object-oriented persistence. Age, sex, limitations in manual ability (MACS), and movement and body function of the impaired limb (MUUL) did not contribute significantly to mastery motivation.

INTERPRETATION

Inconsistent, excessively lax, and verbose parenting practices may discourage children from persevering with challenging tasks. Functional parenting styles, positive discipline practices, and autonomy-supportive strategies for task engagement should be encouraged when intervening with children with cerebral palsy. Parents should be supported to engage in these practices in all aspects of daily activities.

The influence of maternal optimality and infant temperament on parenting stress at 12 months among mothers with substance abuse and psychiatric problems

The present prospective longitudinal study aimed to investigate the long-term impact of maternal optimality assessed during pregnancy on parenting stress at infant age 12 months. In this study the concept of optimality was utilized to investigate maternal variations regarding resources during pregnancy in relation to later parenting stress, among three different groups of mothers that were recruited from substance abuse treatment, psychiatric outpatient treatment and well-baby clinics respectively. The influence of infant temperament on parenting stress was also examined. All mothers were interviewed during pregnancy. At 12 months, infant temperament (Colorado Childhood Temperament Inventory; Rowe & Plomin, 1977) and stress in the parent and child domain (Parenting Stress Index; Abidin, 1955) were assessed. Results demonstrated higher levels of parenting stress among mothers in the clinical groups, compared to the non-clinical group. Furthermore, it was the maternal psychiatric optimality index in combination with child temperament characteristics (child emotionality) that contributed uniquely to stress in the parent domain, while stress in the child domain was significantly associated only with child temperament characteristics (both child emotionality and soothability). The association between maternal psychiatric optimality assessed in pregnancy, infant temperament and parenting stress when the infants were 12 months old, points to the importance of simultaneously addressing the mothers' own psychological distress, and to support positive mother-infant interactions. Each woman's individual optimality profile may be used to display needs of follow-up in order to prevent enduring effects of non-optimality on parenting stress.

The influence of geographic isolation on late preterm infant and mother outcomes

PURPOSE

Risk of adverse outcome in late-preterm infants (born between 34 and 36 weeks and 6 days' gestation) is heightened for those living in geographic isolation (GI). We examined the relationships between GI and several mother and infant outcomes.

SUBJECTS AND DESIGN

This was a tricenter cross-sectional study of 38 English-speaking late-preterm infant/mother dyads admitted to neonatal intensive care in a predominately rural Midwestern state. Eligibility for the study included English-speaking mothers and their biologically born late-preterm infants with no known anomalies. METHODS AND MAIN OUTCOME: Outcomes included maternal knowledge of infant development (Knowledge of Infant Development Inventory) and competence (Competence in Preterm Infant Care questionnaire), maternal perception of vulnerability (Vulnerable Baby Scale ([VBS]), risk, and temperament (Pictorial Assessment of Temperament ([PAT]). Infant readmission and follow-up data were also examined. Potential covariates included any use of the Internet for healthcare information, demographic data, and mother and infant health history and were obtained from medical records and from the mother. Level of GI was determined by time and distance traveled (minutes) from the mother's primary residence to the closest regional healthcare center.

RESULTS

Study participants traveled 61 ± 58 miles and 72 ± 62 minutes on average. The Mean ± SD scores on assessment were as follows: Knowledge of Infant Development Inventory 77 ± 10, and Competence in Preterm Infant Care questionnaire 90 ± 14, VBS 27.5 ± 3.5, and PAT 17.5 ± 3. Bivariate associations were observed between distance and time and VBS scores (P = .03 for both). Multiple regression analysis showed significant relationship between time (P = .02) and PAT scores when maternal education (0.09) and the number of hours spent in the NICU (P = .01) were entered into the model. The association between time traveled and VBS scores became marginally significant when maternal age and Internet use were entered into the regression models. The odds for a mother to perceive her infant at risk for suboptimal outcomes were 6 times greater for each 1-hour additional travel time (odds ratio = 6.0; 95% confidence interval: 1.3-36; P = .001). There was no association between GI and readmission rate and follow-up care. Readmission rate was 8%, and anticipatory guidance was found to be inadequate.

CONCLUSION

Remote access to appropriate healthcare services elicits more than legitimate concerns for the late preterm infant and warrants further investigation with consideration for how services might be more easily accessed for this at-risk group.

Stability of parental care across siblings from undisturbed and challenged pregnancies: intrinsic maternal dispositions of female rhesus monkeys

The concept of fetal programming is based on the idea that the developmental trajectory of infants is adjusted in response to in utero conditions. In species with extended parental care, these prenatally derived tendencies are further substantiated by behavioral attributes of the mother during the postnatal period. We investigated the stability of maternal behavioral interactions with infant monkeys and carefully varied prenatal conditions across siblings reared by the same mother. We hypothesized that effects of prenatal disturbance and the infant's susceptibility would be differentially affected by maternal attributes. Using hierarchical linear modeling, we analyzed observational data on 121 rhesus macaques reared by a total of 35 multiparous mothers. A portion of the variance in 5 dyadic behaviors was statistically driven by the infant (or was unique to a particular mother-infant pair), but stable maternal propensities and a consistent style of care across siblings also substantially influenced behavioral interactions. Moreover, the magnitude and direction of the prenatal effects were contingent on a female's intrinsic dispositions. When mothers typically exhibited high levels of a corresponding behavior, responsiveness to infants was enhanced as a consequence of prenatal disturbance. The opposite was true for less expressive females. Challenges to the well-being of pregnancy thus served to accentuate maternal predispositions and served to magnify the range of variation in mother-infant behavior across the whole population.

Parental stress in early parenthood among mothers and fathers in Sweden

BACKGROUND

Parental stress affects parenting behaviour and the quality of dyadic parent-child interactions. Mothers generally show higher parental stress than fathers.

AIMS

Our aims were to assess the perceived level of parental stress in early parenthood and examine the differences between mothers and fathers within couples in relation to their levels of education, parental experience, existence of a parental role model and sense of coherence.

METHODS

In total, 307 mothers and 301 fathers of 18-month-old children answered the Swedish Parenthood Stress Questionnaire (SPSQ); and 318 mothers and 311 fathers answered the Sense of Coherence (SOC-3) scale; 283 couples answered both the SPSQ and SOC-3.

RESULTS

Mothers perceived higher levels of stress than fathers in the sub-areas incompetence (p < 0.001), role restriction (p < 0.001), spouse relationship problems (p = 0.004) and health problems (p = 0.027), and in total (p = 0.001). In contrast, fathers perceived higher stress than mothers in the sub-area social isolation (p < 0.001). When the data were stratified with respect to education, parental experience, existence of a parental role model and sense of coherence, significant results were observed in some of these sub-areas.

CONCLUSIONS

Mothers and fathers experience stress in different areas during their early parenthood. Healthcare professionals should be aware of the differences in stress that exist between mothers and fathers, so that parents can be adequately prepared for parenthood and avoid parental stress.

Predictors of maternal identity of Korean primiparas

PURPOSE

The purpose of this study was to identify factors influencing maternal identity of Korean primiparas.

METHODS

The data were collected by a self-report questionnaire in 2006. The participants were 210 healthy primiparous women who delivered at one of three medical centers and revisited the outpatient department for follow up between 4 to 6 weeks after childbirth. Data were analyzed using the SPSS WIN 17.0 program with descriptive statistics, t-test, one way ANOVA, Pearson correlation coefficient, and stepwise multiple regression.

RESULTS

Maternal identity was significantly correlated with Taekyo accomplishment, the culturally based prenatal preparation (p<.001). Transitional gratification to motherhood (p<.001), postpartum depression (p<.001), childcare stress (p<.001), infant temperament (p<.001), and social support (p<.001) were also significantly correlated with maternal identity. The stepwise multiple regression analysis showed that maternal identity was significantly predicted by transitional gratification to motherhood, infant temperament, childcare stress, and Taekyo accomplishment. These variables explained 31.0% of the variance of maternal identity.

CONCLUSION

The results of this study suggest that postpartum nursing interventions to promote maternal identity should focus on reinforcing education and support for reducing childcare stress and infant difficulty, and increasing transitional gratification to motherhood. Also, prenatal encouragement and education for improving Taekyo accomplishment may be helpful to promote maternal identity after birth.