The role of an early intervention on enhancing the quality of mother-infant interaction

[Prevention of mental health disorders in primary care: Pregnancy in adolescence]

Adolescent pregnancy is generally an unwanted pregnancy, a situation that involves significant biological, psychological and social overloads, with repercussions on the health of the mother and the child. But the psychosocially important fact is that an unwanted pregnancy in its entirety gives rise to the birth of an ambivalently wanted child, a high-risk child. Those born in Spain in 2020 to women under 20 years of age were 8,305, which corresponds to 1.97% of all births. This review presents measures and recommendations for the protection and prevention of the mental health of the mother and child when pregnancy takes place in adolescence.

Effectiveness of The Newborn Behavioral Observation (NBO) System in Improving Mother and Infant Interaction

The interaction of mother and infant is a fundamental basis for the development of the infant. It can also determine the success of the baby in the future. About 4 out of 10 infants experience problems interacting with their parents. The NBO system was created to sensitize parents on their infant’s competencies to help them understand their infant’s behavior, and promote positive interactions between parents and their new infant. This study aimed to evaluate the effectiveness of the NBO system to improve mother-infant interactions and find out the mothers’ knowledge about their infant’s behavior when participating in this observation. This study was a cross-sectional study consisting of all the newborns and their mothers admitted to the Dr. Soetomo General Academic Hospital Surabaya from May 2019 to January 2020 who met the inclusion criteria. Mothers and infants participated in the NBO within 1-3 days after delivering their infants and one month postpartum for the second NBO. The NBO was carried out with 35 mothers and infants. The mothers’ age was on average 28.5±5.98 years old, multiparous mothers accounted for 71.4%, most infants were male (65.7%), the median gestational age was 38 weeks with the median birth weight 2900 grams. The median score of mothers’ knowledge about their infants before the NBO session was 2 (1-6). After the session, these median scores increased to 7 (5–10) significantly (p<0.001). The NBO system was significant to strengthen mother-infant interaction and increased the mothers’ knowledge about their infants’ behavior.

Cross-Cultural Adaptation and Validation of the Brazilian Portuguese Version of an Observational Measure for Parent-Child Responsive Caregiving

Responsive caregiving is the dimension of parenting most consistently related to later child functioning in both developing and developed countries. There is a growing need for efficient, psychometrically sound and culturally appropriate measurement of this construct. This study describes the cross-cultural validation in Brazil of the Responsive Interactions for Learning (RIFL-P) measure, requiring only eight minutes for assessment and coding. The cross-cultural adaptation used a recognized seven-step procedure. The adapted version was applied to a stratified sample of 153 Brazilian mother–child (18 months) dyads. Videos of mother–child interaction were coded using the RIFL-P and a longer gold standard parenting assessment. Mothers completed a survey on child stimulation (18 months) and child outcomes were measured at 24 months. Internal consistency (α = 0.94), inter-rater reliability (r = 0.83), and intra-rater reliability (r = 0.94) were all satisfactory to high. RIFL-P scores were significantly correlated with another measurement of parenting (r’s ranged from 0.32 to 0.47, p < 0.001), stimulation markers (r = 0.34, p < 0.01), and children’s cognition (r = 0.29, p < 0.001), language (r = 0.28, p < 0.001), and positive behavior (r = 0.17, p < 0.05). The Brazilian Portuguese version is a valid and reliable instrument for a brief assessment of responsive caregiving.

Short-term psychodynamic infant-parent interventions at Child health centers: Outcomes on parental depression and infant social-emotional functioning

Randomized controlled trials (RCTs) demonstrate efficacy of parent-infant psychotherapy, but its applicability and effectiveness in public health care are less known. The method followed is Naturalistic study evaluating Short-term Psychodynamic Infant-Parent Interventions at Child Health Centers (SPIPIC) in Stockholm, Sweden. One hundred distressed mothers with infants were recruited by supervised nurses. Six therapists provided 4.3 therapy sessions on average (SD = 3.3). Sessions typically included the mothers, often with the baby present, while fathers rarely attended sessions. The Edinburgh Postnatal Depression Scale (EPDS) and the Ages and Stages Questionnaire: Social-Emotional (ASQ: SE) were distributed at baseline and at 3 and 9 months later. Data from a nonclinical group were collected simultaneously to provide norm data. Multilevel growth models on the mothers' questionnaire scores showed significant decreases over time on both measures. Nine months after baseline, 50% achieved a reliable change on the EPDS and 14% on the ASQ: SE. Prepost effect-sizes (d) were 0.70 and 0.40 for EPDS and ASQ: SE, figures that are comparable to results of other controlled studies. Psychotherapists integrated with public health care seem to achieve good results when supporting distressed mothers with brief interventions in the postnatal period. SPIPIC needs to be compared with other modalities and organizational frameworks.

Mother-infant interaction quality and sense of parenting competence at six months postpartum for first-time mothers in Taiwan: a multiple time series design

BACKGROUND

For first-time mothers, not knowing how to interact with newborn infants increases anxiety and decreases the quality of the parent-infant interactions. A substantial lack of interactional knowledge can ultimately limit the adjustments necessary for a stable transition into motherhood. This study investigated how postpartum parenting education influenced first-time mothers' mother-infant interaction quality and parenting sense of competence.

METHODS

Eighty-one healthy first-time-mother and infant dyads were recruited. The control group (n = 40) received postpartum care based on the medical and cultural norms practiced in Taiwan, while the experimental group (n = 41) received, on top of typical care, education by way of a 40-min videotape on infant states, behaviors, and communication cues, as well as a handout on play practices. Data were collected at five points: within the first week, and during follow-ups in the first, second, third, and sixth months after birth. We administered the Chinese versions of the Parenting Sense of Competence Scale and Edinburgh Perinatal Depression Scale, and used the Nursing Child Assessment Teaching Scale to score videotaped mother-infant interactions.

RESULTS

We observed an increase in the quality of mother-infant interaction within the experimental group only. Furthermore, at the five assessment points, we observed no significant changes in perceived parenting competence. Among all subjects, there were correlations between postpartum depression scores, parenting competency, and quality of mother-infant interaction.

CONCLUSIONS

Our results indicate that first-time mothers in Taiwan who are provided with extra education on infants' abilities and how to effectively play with infants are likely to exhibit improvements in quality of interaction.

Video-based patient decision aids: A scoping review

OBJECTIVE

This study reviews the published literature on the use of video-based decision aids (DA) for patients. The authors describe the areas of medicine in which video-based patient DA have been evaluated, the medical decisions targeted, their reported impact, in which countries studies are being conducted, and publication trends.

METHOD

The literature review was conducted systematically using Medline, Embase, CINAHL, PsychInfo, and Pubmed databases from inception to 2016. References of identified studies were reviewed, and hand-searches of relevant journals were conducted.

RESULTS

488 studies were included and organized based on predefined study characteristics. The most common decisions addressed were cancer screening, risk reduction, advance care planning, and adherence to provider recommendations. Most studies had sample sizes of fewer than 300, and most were performed in the United States. Outcomes were generally reported as positive. This field of study was relatively unknown before 1990s but the number of studies published annually continues to increase.

CONCLUSION

Videos are largely positive interventions but there are significant remaining knowledge gaps including generalizability across populations.

PRACTICE IMPLICATIONS

Clinicians should consider incorporating video-based DA in their patient interactions. Future research should focus on less studied areas and the mechanisms underlying effective patient decision aids.

The Neonatal Behavioral Assessment Scale (NBAS) and Newborn Behavioral Observations (NBO) system for supporting caregivers and improving outcomes in caregivers and their infants

BACKGROUND

The first three years of a child's life are a key period of physical, physiological, cognitive and social development, and the caregiver-infant relationship in early infancy plays an important role in influencing these aspects of development. Specifically, caregiver attunement facilitates the move from coregulation to self-regulation; a parent's ability to understand their infant's behaviour as communication is a key part of this process. Early, brief interventions such as the Neonatal Behavioral Assessment Scale (NBAS) or Neonatal Behavioral Observation (NBO) system are potential methods of improving outcomes for both infant and caregiver.

OBJECTIVES

To assess the effects of the NBAS and NBO system for improving caregiver-infant interaction and related outcomes in caregivers and newborn babies. Secondary objectives were to determine whether the NBAS and NBO are more effective for particular groups of infants or parents, and to identify the factors associated with increased effectiveness (e.g. timing, duration, etc.).

SEARCH METHODS

In September 2017 we searched CENTRAL, MEDLINE, Embase, PsycINFO, 12 other databases and four trials registers. We also handsearched reference lists of included studies and relevant systematic reviews, and we contacted the Brazelton Institute and searched its websites to identify any ongoing and unpublished studies.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) and quasi-RCTs that had used at least one standardised measure to assess the effects of the NBAS or NBO versus inactive control for improving outcomes for caregivers and their infants.

DATA COLLECTION AND ANALYSIS

Two reviewer authors independently assessed the records retrieved from the search. One reviewer extracted data, and a second checked them for accuracy. We presented the results for each outcome in each study as standardised mean differences (SMDs) or as risk ratios (RR) with 95% confidence intervals (CIs). When appropriate, we combined the results in a meta-analysis using standard methodological procedures expected by Cochrane. We used the GRADE approach to assess the overall quality of the body of evidence for each outcome.

MAIN RESULTS

We identified and included 16 RCTs in this review: 13 assessing the NBAS and 3 the NBO for improving outcomes in 851 randomised participants, including parents and their premature or newborn (aged 4 to 12 weeks) infants. All studies took place in the USA, and we judged all of them to be at high risk of bias.Seven studies involving 304 participants contributed data to one meta-analysis of the impact of the NBAS or NBO for caregiver-infant interaction, and the results suggest a significant, medium-sized difference between intervention and control groups (SMD -0.53, 95% CI -0.90 to -0.17; very low-quality evidence), with moderate heterogeneity (I² = 51%). Subgroup analysis comparing the two types of programmes (i.e. NBAS and NBO) found a medium but non-significant effect for the NBAS (-0.49, 95% CI -0.99 to 0.00, 5 studies), with high levels of heterogeneity (I² = 61%), compared with a significant, large effect size for the NBO (-0.69, 95% CI -1.18 to -0.20, 2 studies), with no heterogeneity (I² = 0.0%). A test for subgroup differences between the two models, however, was not significant. One study found a significant impact on the secondary outcome of caregiver knowledge (SMD -1.30, 95% CI -2.16 to -0.44; very low-quality evidence). There was no evidence of an impact on maternal depression. We did not identify any adverse effects.

AUTHORS' CONCLUSIONS

There is currently only very low-quality evidence for the effectiveness of the NBAS and NBO in terms of improving parent-infant interaction for mostly low-risk, first-time caregivers and their infants. Further research is underway regarding the effectiveness of the NBO and is necessary to corroborate these results.

Infant positioning in daily life may mediate associations between physiotherapy and child development-video-analysis of an early intervention RCT

BACKGROUND

Paediatric physiotherapy (PPT) in high-risk infants comprises family involvement, but it is unclear whether parents mediate the intervention effect. We demonstrated in a randomized controlled trial in high-risk infants comparing the family centred programme Coping and Caring for infants with special needs (COPCA) and Traditional Infant Physiotherapy (TIP) that process evaluation revealed associations between COPCA-characteristics and outcome.

AIMS

To assess whether PPT affects how parents position their infant during bathing and whether this is associated with child outcome.

METHODS AND PROCEDURES

21 infants received COPCA and 25 TIP between 3 and 6 months corrected age. Bathing sessions were videotaped at 3, 6 and 18 months. Time spent with specific infant positions was correlated with quantified PPT-actions and functional mobility at 18 months measured with the Paediatric Evaluation of Disability Inventory (PEDI).

OUTCOMES AND RESULTS

At 3 and 18 months bathing position was similar in both groups, but differed at 6 months (time spent on sitting: COPCA 77.7%, TIP 39.2%; median difference 32.0% (95% CI: 10.6-50.5%). Sitting-time at 6 months was associated with higher PEDI functional mobility scores.

CONCLUSIONS AND IMPLICATIONS

Early PPT may affect parental behaviour, such as infant positioning during bathing, which, in turn, may affect child development.

Promotion, prevention and protection: interventions at the population- and community-levels for mental, neurological and substance use disorders in low- and middle-income countries

BACKGROUND

In addition to services within the health system, interventions at the population and community levels are also important for the promotion of mental health, primary prevention of mental, neurological and substance use (MNS) disorders, identification and case detection of MNS disorders; and to a lesser degree treatment, care and rehabilitation. This study aims to identify "best practice" and "good practice" interventions that can feasibly be delivered at these population- and community-levels in low- and middle-income countries (LMICs), to aid the identification of resource efficiencies and allocation in LMICs.

METHODS

A narrative review was conducted given the wide range of relevant interventions. Expert consensus was used to identify "best practice" at the population-level on the basis of existing quasi-experimental natural experiments and cost effectiveness, with small scale emerging and promising evidence comprising "good practice". At the community-level, using expert consensus, the ACE (Assessing Cost-Effectiveness in Prevention Project) grading system was used to differentiate "best practice" interventions with sufficient evidence from "good practice" interventions with limited but promising evidence.

RESULTS

At the population-level, laws and regulations to control alcohol demand and restrict access to lethal means of suicide were considered "best practice". Child protection laws, improved control of neurocysticercosis and mass awareness campaigns were identified as "good practice". At the community level, socio-emotional learning programmes in schools and parenting programmes during infancy were identified as "best practice". The following were all identified as "good practice": Integrating mental health promotion strategies into workplace occupational health and safety policies; mental health information and awareness programmes as well as detection of MNS disorders in schools; early child enrichment/preschool educational programs and parenting programs for children aged 2-14 years; gender equity and/or economic empowerment programs for vulnerable groups; training of gatekeepers to identify people with MNS disorders in the community; and training non-specialist community members at a neighbourhood level to assist with community-based support and rehabilitation of people with mental disorders.

CONCLUSION

Interventions provided at the population- and community-levels have an important role to play in promoting mental health, preventing the onset, and protecting those with MNS disorders. The importance of inter-sectoral engagement and the need for further research on interventions at these levels in LMICs is highlighted.

Synchrony, complexity and directiveness in mothers' interactions with infants pre- and post-cochlear implantation

This study investigated effects of profound hearing loss on mother-infant interactions before and after cochlear implantation with a focus on maternal synchrony, complexity, and directiveness. Participants included two groups of mother-infant dyads: 9 dyads of mothers and infants with normal hearing; and 9 dyads of hearing mothers and infants with profound hearing loss. Dyads were observed at two time points: Time 1, scheduled to occur before cochlear implantation for infants with profound hearing loss (mean age=13.6 months); and Time 2 (mean age=23.3 months), scheduled to occur approximately six months after cochlear implantation. Hearing infants were age-matched to infants with hearing loss at both time points. Dependent variables included the proportion of maternal utterances that overlapped infant vocalizations, maternal mean length of utterance, infant word use, and combined maternal directives and prohibitions. Results showed mothers' utterances overlapped the vocalizations of infants with hearing loss more often before cochlear implantation than after, mothers used less complex utterances with infants with cochlear implants compared to hearing peers (Time 2), and mothers of infants with profound hearing loss used frequent directives and prohibitions both before and after cochlear implantation. Together, mothers and infants adapted relatively quickly to infants' access to cochlear implants, showing improved interactional synchrony, increased infant word use, and levels of maternal language complexity compatible with infants' word use, all within seven months of cochlear implant activation.

Drug addiction in pregnancy: disease not moral failure

Nurses have demonstrated concern for years about their interactions with pregnant women who abuse drugs. Reports of nurses' concern with substance abuse have been reported in the literature since the 1980s. As with any chronic disease, drug addiction causes physiologic changes, and the pathology that occurs in the brain drives characteristic behaviors. Research suggests that choices that addicts make are driven by pathology rather than by failure of a moral compass. This article reviews the theoretical explanations for addictive behaviors, describes the pathophysiology of drug addiction that is responsible for the predictable symptoms and behaviors exhibited by women who abuse prescription drugs and other opioids, and identifies nursing interventions to impact positive outcomes. Nurses who have a working knowledge of this disease will provide more effective nursing care to the women they encounter and are better prepared to make a difference in the lives of both women and their children.

Postnatal parental education for optimizing infant general health and parent-infant relationships

BACKGROUND

Many learning needs arise in the early postpartum period, and it is important to examine interventions used to educate new parents about caring for their newborns during this time.

OBJECTIVES

The primary objective was to assess the effects of structured postnatal education delivered to an individual or group related to infant general health or care and parent-infant relationships.

SEARCH METHODS

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 March 2013).

SELECTION CRITERIA

We included randomized controlled trials of any structured postnatal education provided to individual parents or groups of parents within the first two months post-birth related to the health or care of an infant or parent-infant relationships.

DATA COLLECTION AND ANALYSIS

Two review authors (JB, CTB) assessed trial quality and extracted data from published reports.

MAIN RESULTS

Of the 27 trials (3949 mothers and 579 fathers) that met the inclusion criteria, only 15 (2922 mothers and 388 fathers) reported useable data. Educational interventions included: five on infant sleep enhancement, 12 on infant behaviour, three on general post-birth health, three on general infant care, and four on infant safety. Details of the randomization procedures, allocation concealment, blinding, and participant loss were often not reported. Of the outcomes analyzed, only 13 were measured similarly enough by more than one study to be combined in meta-analyses. Of these 13 meta-analyses, only four were found to have a low enough level of heterogeneity to provide an overall estimate of effect. Education about sleep enhancement resulted in a mean difference of 29 more night-time minutes of infant sleep in 24 hours at six weeks of age (95% confidence interval (CI) 18.53 to 39.73) than usual care. However, it had no significant effect on the mean difference in minutes of crying time in 24 hours at six weeks and 12 weeks of age. Education related to infant behaviour increased maternal knowledge of infant behaviour by a mean difference of 2.85 points (95% CI 1.78 to 3.91).

AUTHORS' CONCLUSIONS

The benefits of educational programs to participants and their newborns remain unclear. Education related to sleep enhancement appears to increase infant sleep but appears to have no effect on infant crying time. Education about infant behaviour potentially enhances mothers' knowledge; however more and larger, well-designed studies are needed to confirm these findings.

Does combining infant stimulation with emergency feeding improve psychosocial outcomes for displaced mothers and babies? A controlled evaluation from northern Uganda

Combined psychosocial and nutrition interventions improve the development of infants. However, there is a paucity of studies examining the effectiveness of such interventions in humanitarian settings. This article examines the impact of combining a group-based psychosocial intervention with an existing emergency feeding program for internally displaced mothers in Northern Uganda. The intervention consisted of mother and baby group sessions and home visits for mothers attending 3 emergency feeding centers. Psychosocial outcomes were compared with a contrast group of mothers who received nutritional support alone. The outcomes investigated were infant stimulation and maternal mood. After controlling for the effects of interview site and baseline scores, mothers in the intervention group (n = 70) showed greater involvement with their babies, more availability of play materials, and less sadness and worry at follow-up in comparison to the contrast group (n = 77). The intervention was acceptable to the mothers and easily taught. A proportion of the mothers chose to continue the intervention spontaneously with other mothers in their neighbourhoods. Further research needs to be done to validate these preliminary findings and explore the longer term impact on child growth and intellectual development as well as maternal mood.

A review of parenting programs in developing countries: opportunities and challenges for preventing emotional and behavioral difficulties in children

Many children in developing countries are at risk of emotional and behavioral difficulties, which are likely to be elevated due to the effects of poverty. Parenting programs have shown to be effective preventative strategies in high-income countries, but to date the research on their effectiveness in lower-income countries is limited. International organizations such as the World Health Organization have called for the implementation of programs to prevent behavioral difficulties through the development of stable relationships between children and their parents. The aim of the present paper was to review the literature on parenting programs in developing countries in order to identify challenges, opportunities and directions for further research. First, reports of international organizations were reviewed in order to gain a preliminary overview of the field. In a second stage, a non-systematic review was carried out. Databases were searched in order to identify empirical evaluations of parenting programs in low-income countries. Finally, a systematic review was carried out to specifically identify evaluations of programs targeting emotional or behavioral outcomes. Only one study had a strong methodology among those designed to prevent emotional and behavioral outcomes. Opportunities for further program development and research are identified.

The Effects of Baby Massage on Attachment between Mother and their Infants

PURPOSE

This study was conducted to examine the effect of baby massage on attachment between mothers and their newborns.

METHODS

This study was carried out from June 2008 to February 2010 in a quasi-experimental design (57 in the experimental group, 60 in the control group). Between the dates of the study, all healthy primipara mothers and their healthy babies were included. Data were collected regarding their demographic characteristics and by using the Maternal Attachment Inventory (MAI). All mothers were assessed on the first and the last days of the 38-day study period. In the experimental group, the babies received a 15-minute massage therapy session everyday during the 38 days.

RESULTS

There was no significant difference found in the pretest mean value baseline of the MAI score in both groups. The posttest mean values of the MAI of the experimental group mothers (90.87 ± 10.76) were significantly higher than those of control group (85.10 ± 15.50). There was a significant difference between groups (p < .05).

CONCLUSION

The results of the study have shown that baby massage is effective in increasing the mother-infant attachment.

Avaliação de necessidades para a implementação de um programa de transição para a parentalidade

Este artigo descreve uma avaliação de necessidades para um programa de transição para a parentalidade, feita em dois estudos. Participaram do primeiro estudo treze casais, cujo bebê contava entre 18 a 36 meses. Entrevistas revelaram como estressores os cuidados com o bebê, as mudanças nos papéis familiares e a intrusividade da rede de apoio. Um segundo estudo investigou, através de entrevistas, o conhecimento de oito casais, com filhos recém-nascidos, sobre as suas experiências pessoais de apego e práticas educativas parentais, capacidades sensoriais do bebê, estressores e enfrentamento usado. Os resultados apontaram a exposição a práticas educativas parentais coercitivas e apego inseguro como fatores de risco para a relação pais-bebê. São discutidas as implicações para o planejamento de programas preventivos.

Maternal rejection of the young child: present status of the clinical syndrome

This article reviews severe disorders of the mother-infant relationship involving emotional rejection of the infant in the first year of its life. Infants exposed to their mother's hatred and rage may suffer far-ranging and long-term disadvantages, and are at risk of maltreatment. Diagnosis, therapy and research have been hampered by the lack of recognition of this clinical syndrome in the classifications. The imminent revision of these classificatory systems must include them.

Postnatal parental education for optimizing infant general health and parent-infant relationships

BACKGROUND

Many learning needs arise in the early postpartum period, and it is important to examine interventions used to educate new parents about caring for their newborns during this time.

OBJECTIVES

The primary objective was to assess the effects of structured postnatal education delivered by an educator to an individual or group on infant general health and parent-infant relationships.

SEARCH STRATEGY

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (April 2009), CINAHL (1982 to July 2009), ERIC (1966 to July 2009), HealthSTAR (1966 to July 2009), PsycINFO (1806 to July 2009), Sociological Abstracts (1974 to July 2009), ClinicalTrials.gov (August 2009), Current Controlled Trials (August 2009), and Trialscentral.org (August 2009).

SELECTION CRITERIA

We included randomized controlled trials of any structured postnatal education provided by an educator to individual parents or groups of parents within the first two months post birth related to the care of an infant or parent-infant relationships. We excluded studies of educational interventions for parents of infants in neonatal intensive care units.

DATA COLLECTION AND ANALYSIS

Both authors assessed trial quality and extracted data from published reports.

MAIN RESULTS

Of the 25 trials (3689 mothers and 793 fathers) that met the inclusion criteria, only 15 (2868 mothers and 613 fathers) reported useable data. Educational interventions included: four on infant sleep enhancement, 13 on infant behaviour, two on general post-birth health, two on infant care, three on infant safety, and one on father involvement/skills with infants. Details of the randomization procedures, allocation concealment, blinding, and participant loss were often not reported. Of the outcomes analyzed, only six were measured similarly enough by more than one study to be combined in meta-analyses. Of these six meta-analyses, only two were found to have a low enough level of heterogeneity to provide an overall estimate of effect. Education on sleep enhancement resulted in a mean difference of 29 more minutes of infant sleep in 24 hours (95% confidence interval (CI) 18.53 to 39.73) than usual care. Education on infant behaviour increased maternal knowledge of infant behaviour by a mean difference of 2.85 points (95% CI 1.78 to 3.91).

AUTHORS' CONCLUSIONS

The benefits of educational programs to participants and their newborns remain unclear. Education on sleep enhancement appears to increase infant sleep and education about infant behaviour potentially enhances mothers' knowledge; however more and larger, well-designed studies are needed to confirm this.

Community-based interventions to optimize early childhood development in low resource settings

OBJECTIVE

Interventions targeting the early childhood period (0 to 3 years) help to improve neuro-cognitive functioning throughout life. Some of the more low cost, low resource-intensive community practices for this age-group are play, reading, music and tactile stimulation. This research was conducted to summarize the evidence regarding the effectiveness of such strategies on child development, with particular focus on techniques that may be transferable to developing countries and to children at risk of developing secondary impairments.

STUDY DESIGN

PubMed, PsycInfo, Embase, ERIC, CINAHL and Cochrane were searched for studies involving the above strategies for early intervention. Reference lists of these studies were scanned and other studies were incorporated based on snow-balling.

RESULT

Overall, 76 articles corresponding to 53 studies, 24 of which were randomized controlled trials, were identified. Sixteen of those studies were from low- and middle-income countries. Play and reading were the two commonest interventions and showed positive impact on intellectual development of the child. Music was evaluated primarily in intensive care settings. Kangaroo Mother Care, and to a lesser extent massage, also showed beneficial effects. Improvement in parent-child interaction was common to all the interventions.

CONCLUSION

Play and reading were effective interventions for early childhood interventions in low- and middle-income countries. More research is needed to judge the effectiveness of music. Kangaroo Mother Care is effective for low birth weight babies in resource poor settings, but further research is needed in community settings. Massage is useful, but needs more rigorous research prior to being advocated for community-level interventions.

Understanding Interventions and Outcomes in Mothers of Infants

The first two years after an infant's birth is a time of transition for mothers as changes in roles, responsibilities, expectations, and behaviors occur in response to the demands of caring for newborn infants and young children. Mothers play pivotal roles in overall child development and health and may benefit from nursing intervention that assists in the transition to motherhood. A review of the intervention literature related to the promotion of effective mothering was performed in order to examine the range of interventions and evidence of their usefulness for maternal-child and pediatric nursing practice. Five broad categories of interventions appropriate for nursing practice were identified through the literature review. Home visiting, skin-to-skin contact, individual, infant-focused education/counseling, and theory-based group intervention have a specific applicability for the promotion of mothering in particular populations of mothers. Based on the evidence, nurses can incorporate selected strategies into nursing care to promote effective mothering during the first years of a child's life.

Postnatal parental education for optimizing infant general health and parent-infant relationships

BACKGROUND

Many learning needs arise in the early postpartum period and it is important to examine interventions being used to educate new parents about caring for themselves and their newborns during this time.

OBJECTIVES

To assess the effects of structured postnatal education delivered by an educator to an individual or group on maternal/paternal and infant outcomes and health services, and whether the effects of structured postnatal education vary by length or type of intervention and by population.

SEARCH STRATEGY

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (November 2007), MEDLINE (1950 to September 2007), CINAHL (1982 to September 2007), ERIC (1966 to September 2007), HealthSTAR (1966 to September 2007), PsycINFO (1806 to September 2007), Sociological Abstracts (1974 to September 2007), ClinicalTrials.gov (August 2007), Current Controlled Trials (August 2007), Trialscentral.org (August 2007) and The National Research Register (August 2007).

SELECTION CRITERIA

We included randomized controlled trials of any structured postnatal education provided by an educator to individual parents or groups of parents within the first two months post birth related to the care of an infant or of the family. We excluded studies of educational interventions for parents of infants in neonatal intensive care units.

DATA COLLECTION AND ANALYSIS

Both authors assessed trial quality and extracted data from published reports.

MAIN RESULTS

We included 14 trials (2934 women) and excluded 24. Of the 14 included studies, education tested included: four on infant sleep enhancement, four on infant behaviour, two on general post-birth health, three on infant safety, and one on father involvement/skills with infants. Details of the randomization procedures, allocation concealment, blinding of outcome assessors, and/or participant accrual/loss were often not reported. Of the outcomes analyzed, only five were measured similarly enough by more than one study to be combined in meta-analyses and these included the same two studies. Of these five meta-analyses, only one was found to have a low enough level of heterogeneity to provide an overall estimate of effect; education on sleep enhancement resulted in a mean difference of 29 more minutes of sleep in 24 hours (95% confidence interval 18.53 to 39.73) than usual care.

AUTHORS' CONCLUSIONS

The benefits of educational programs to participants and their newborn infants remain unclear. Education on sleep enhancement appears to increase infant sleep although more and larger studies are needed to confirm this.

Clinical interventions for children with attachment problems

TOPIC

Applying the current evidence to treating clinical populations with attachment disorders.

PURPOSE

This study aims to review the literature regarding the treatment of childhood attachment disorders, with the goal of guiding clinicians towards evidence-based practice.

SOURCES USED

MEDLINE, CINAHL, PsychBooks, EMBASE and PsychINFO were searched and all articles reporting results of a treatment intervention for attachment disorder were reviewed. Ancestry analysis garnered additional sources.

CONCLUSIONS

There are few studies addressing therapeutic interventions for attachment disorder, but the literature supports benefits to the child-parent attachment relationship in biological families in the application of both psychoeducational and psychotherapeutic treatment modalities. A summary of the important components of applying these techniques in therapy is included. Foster and adoptive families with attachment disorders require different types of intervention than biological families. In particular, foster and adoptive parents need to help repair their child's negative internal representations by responding appropriately to their child's cues. Advanced practice psychiatric nurses are well-prepared to provide evidence-based interventions to both biological and foster families with attachment problems. More research is needed to determine the most appropriate treatment interventions for children with attachment disorders.

Gender and racial differences in the looking and talking behaviors of mothers and their 3-year-old prematurely born children

This study examined the relationship of child gender and maternal race to the looking and talking interactions of fifty-four 3-year-old prematurely born children and their mothers. More gender differences occurred for looking than for talking, whereas racial differences were stronger for talking than for looking. Transitional probabilities between looking situations suggested that gender differences occurred because girls were more likely to respond when their mothers were looking at them than were boys. Transitional probabilities between talking situations suggested that racial differences occurred because non-White mothers (African Americans and Native Americans in this study) were less likely to respond when their children were talking to them than were White mothers. The only significant interaction of gender by race was with White mothers who were more likely to respond when their girls were talking. When analyses were repeated, controlling for the effects of intelligence quotient, gestational age, neurobiologic risk score, and socioeconomic status (SES), gender differences for looking situations became smaller, whereas racial differences for talking situations became larger. Gender and ethnicity differences for looking and talking interactions cannot be explained by simple differences in health status or SES. These differences may possibly be related to the differential brain functions and hormonal effects of boys and girls, as well as to differential socialization that influences gender identity and gender roles. They also may be related to the higher incidence of language delays in non-White children and to differences in sociocultural norms and parenting between White and non-White mothers.

The effectiveness of early intervention and the factors related to child behavioural problems at age 2: a randomized controlled trial

BACKGROUND

The aim of this study was to assess the effectiveness of early home-based intervention as a community health service and evaluate the influence of both early maternal depression and mother-infant relationships on child behavioral problems at age 2 in a longitudinal setting.

METHODS

A randomized controlled trial was conducted in this study. A total of 95 mother-infant pairs were assigned randomly to intervention (48) or control (47) groups. The intervention group received monthly specific home visits between the infant ages of 5 and 9 months while the control group received only routine center-based services. Maternal depression and the mother-infant relationship were assessed by medical checkups at the ages of 4 and 10 months. Child behavioral problems were assessed at age 2.

RESULTS

The intervention had no significant impact on child behavioral problems. However, for mothers who had a disturbed relationship with their infants, the rate of improvement in the quality of the relationship was higher in the intervention group. Disturbed mother-infant relationships at 10 months and early maternal depression significantly increased the risk of high scores on the Child Behavior Checklist (CBCL).

CONCLUSIONS

These findings indicate that intervention is most likely to have a positive impact on the quality of mother-infant relationships in cases where the relationship is disturbed and that a disturbed mother-infant relationship and maternal depression during infancy are relevant to the future mental health of the child. To prevent difficulties in child functioning, more prolonged interventions focusing on disturbed mother-infant relationships may be required.

Cortisol reactivity, maternal sensitivity, and learning in 3-month-old infants

This study investigated the effects of adrenocortical functioning on infant learning during an emotionally challenging event (brief separation from mother). We also explored possible relationships between maternal sensitivity and both infant and maternal cortisol reactivity during the learning/maternal separation episode. Sixty-three 3-month-olds and their mothers were videotaped for a 10 min normal interaction period, and mother-infant behavioral synchrony was measured using Isabella and Belsky's [Isabella, R. A., & Belsky, J. (1991). Interactional synchrony and the origins of infant-mother attachment: A replication study. Child Development, 62, 373-384] coding scheme. The percentage of synchronous behaviors served as a measure of maternal sensitivity. Learning and short-term memory involved relating the infant's mother's voice with a moving colored block in a preferential looking paradigm. Infants whose cortisol increased during the session showed no learning or memory, infants whose cortisol declined appeared to learn and remember the association, while infants whose cortisol did not change evidenced learning, but not memory for the voice/object correspondence. Sensitivity and cortisol reactivity were correlated for mothers, but not for infants. Infant and maternal cortisol values for the first sampling period were highly correlated, but their cortisol reactivity values were uncorrelated, supporting the notion that infants and mothers have coordinated adrenocortical functioning systems when physically together, but become uncoordinated during a separation/learning event.

Responsividade materna em famílias de mães solteiras e famílias nucleares no terceiro mês de vida da criança

O presente estudo investigou a responsividade materna no terceiro mês de vida do bebê em famílias de mães solteiras e famílias nucleares. Participaram do estudo 21 díades mãe-bebê, das quais sete de mães solteiras e quatorze de mães casadas. Uma sessão de observação da interação livre entre mãe e bebê foi utilizada para a avaliação da responsividade materna. Foram examinadas 21 seqüências responsivas e três seqüências não-responsivas envolvendo o sorriso, as vocalizações e o choro do bebê. O Teste Mann-Whitney revelou diferenças significativas entre os dois grupos tanto nas seqüências responsivas, como nas não-responsivas, indicando que as mães solteiras foram menos responsivas do que as mães casadas, em especial, no que se refere à vocalização e ao choro do bebê. Esses resultados corroboram parte da literatura que indica que as mães solteiras podem sofrer maior estresse quando precisam suprir sozinhas as demandas do bebê, principalmente no seu primeiro ano de vida, o que pode ter implicações para a relação da díade.

Child development: risk factors for adverse outcomes in developing countries

Poverty and associated health, nutrition, and social factors prevent at least 200 million children in developing countries from attaining their developmental potential. We review the evidence linking compromised development with modifiable biological and psychosocial risks encountered by children from birth to 5 years of age. We identify four key risk factors where the need for intervention is urgent: stunting, inadequate cognitive stimulation, iodine deficiency, and iron deficiency anaemia. The evidence is also sufficient to warrant interventions for malaria, intrauterine growth restriction, maternal depression, exposure to violence, and exposure to heavy metals. We discuss the research needed to clarify the effect of other potential risk factors on child development. The prevalence of the risk factors and their effect on development and human potential are substantial. Furthermore, risks often occur together or cumulatively, with concomitant increased adverse effects on the development of the world's poorest children.

Attachment linked predictors of women's emotional and cognitive responses to infant distress

The purpose of this study was to examine associations among women's emotional and cognitive responses to infant fear and anger and to identify attachment linked predictors of these responses. Four hundred and forty Caucasian and African American undergraduate college women viewed video clips of two crying infants, one displaying anger and the other displaying fear. They identified what the infants were feeling, made causal attributions about the cause of crying, rated their own emotional reactions to the crying infants, and reported on the extent to which their parents met their emotional needs in childhood and their current adult attachment patterns. Emotional and cognitive responses to infant fear and anger were interrelated. Consistent with prediction, a history of parental emotional rejection and adult attachment anxiety and avoidance correlated negatively with accurate identification of emotions and positively with negative attributions, amusement, and neutral responses to infant distress. Adult attachment security moderated the effects of early parental rejection on emotional and cognitive responses to infant distress, and these results varied based on race and parent gender. Results are discussed from an attachment theory perspective.

Severe disorders of the mother-infant relationship: definitions and frequency

We assessed the frequency of severe disorders of the mother-infant relationship in over 200 mothers referred to services in Birmingham and Christchurch, all of whom were interviewed using the Birmingham Interview for Maternal Mental Health. 10.6% had established rejection and 14.6% threatened rejection of their infants. 28.6% had various degrees of pathological anger, which was severe in 8.3%. Rejection was strongly associated with unwanted pregnancy and lack of interaction with the foetus.

Promoting child development at sick-child visits: a controlled trial

OBJECTIVE

In developing countries, the health care system often is the only existing infrastructure that can reach young children, and health care encounters may be the only opportunity for professionals to have a positive influence on child development. To address the discrepancy between Western and developing countries related to the information that is available for caregivers on how to support their child's development, the World Health Organization Department of Child and Adolescent Health and Development and United Nations International Children's Education Fund have developed the Care for Development Intervention. The Care for Development Intervention aims during acute health visits to enhance caregivers' play and communication with their children. For facilitation of its delivery worldwide, the Care for Development Intervention was developed as an additional module of the Integrated Management of Childhood Illness training course. The purpose of this study was to determine the efficacy and the safety of the Care for Development Intervention when implemented during a young child's visit for acute minor illness.

METHODS

The study design is a sequentially conducted controlled trial, with the comparison arm completed first, Care for Development Intervention training provided for the clinicians next, followed by the intervention arm. At the Pediatric Department of Ankara University School of Medicine, 2 pediatricians who were blinded to the study aims and hypotheses before Care for Development Intervention training provided standard health care to the comparison group; they then received Care for Development Intervention training and provided standard health care plus the Care for Development Intervention to the intervention group. Compliance with treatment and the outcome of illness were determined by a follow-up examination in the clinic 1 week later. One month after the clinic visits, an adapted Home Observation for Measurement of the Environment was administered in the homes by researchers who were blinded to study aims and hypotheses.

RESULTS

Children who were aged < or = 24 months and attended the clinic with minor or no illnesses were recruited for the study: 113 in the comparison group and 120 in the intervention group. At the 1-month home visit, significantly more families had optimal Home Observation for Measurement of the Environment scores (17.5% vs 6.2%), more homemade toys were observed (42.5% vs 10.6%), and more caregivers reported reading to their children (20.0% vs 3.5%) in the intervention than in the comparison group. Three independent predictors of optimal Home Observation for Measurement of the Environment score emerged from the logistic regression analysis: being in the intervention group, child ages >6 months, and maternal education greater than secondary school. Compliance with medical treatment and illness outcomes were not significantly different between the 2 groups.

CONCLUSIONS

The Care for Development Intervention is an effective method of supporting caregivers' efforts to provide a more stimulating environment for their children and can be used by health care professionals during visits for acute minor illness.

Vínculos iniciais e desenvolvimento infantil: abordagem teórica em situação de nascimento de risco

O presente artigo traz considerações sobre o desenvolvimento nos primeiros anos de vida da criança, contrapondo pontos importantes na teoria psicanalítica e na teoria das relações objetais, bem como enfocando autores da contemporaneidade. São abordados aspectos como a importância das primeiras relações, um breve histórico das práticas de cuidados neonatais e a interação mãe-bebê em situações de nascimento de risco, especialmente em casos de nascimento pré-termo. Nestas situações, os processos de formação dos vínculos iniciais e do apego podem apresentar dificuldades. Assim, faz-se uma reflexão sobre possíveis intervenções de promoção e prevenção em saúde coletiva dirigida às famílias que estão com seus filhos internados em Unidade de Terapia Intensiva Neonatal, buscando uma melhor qualidade de vida para os envolvidos neste processo. Formulações que possam vir a prevenir o surgimento de transtornos gerais do desenvolvimento são mencionadas, sugerindo-se que derivem em questões a serem discutidas no âmbito da Saúde Coletiva.

Postpartum psychiatric disorders

This review summarises the psychiatry of the puerperium, in the light of publications during the past 5 years. A wide variety of disorders are seen. Recognition of disorders of the mother-infant relationship is important, because these have pernicious long-term effects but generally respond to treatment. Psychoses complicate about one in 1000 deliveries. The most common is related to manic depression, in which neuroleptic drugs should be used with caution. Post-traumatic stress disorder, obsessions of child harm, and a range of anxiety disorders all require specific psychological treatments. Postpartum depression necessitates thorough exploration. Cessation of breastfeeding is not necessary, because most antidepressant drugs seem not to affect the infant. Controlled trials have shown the benefit of involving the child's father in therapy and of interventions promoting interaction between mother and infant. Owing to its complexity, multidisciplinary specialist teams have an important place in postpartum psychiatry.

Zur Frage der Wirksamkeit von Frühförderung

Zusammenfassung. Eine Literaturübersicht erörtert Beiträge zur Wirksamkeit von Frühförderung für die Publikationsjahre 1995 bis 2002. Methodische Schwierigkeiten wie Definition von Fallgruppen, outcome-Kriterien und Kontrollgruppen schränken die Aussagekraft vorliegender Studien ein und ziehen die Angemessenheit von Effektivitätsprüfungen in Zweifel, die den komplexen interpersonalen Handlungsraum Frühförderung auf wenige Entwicklungsparameter reduzieren. Frühzeitigkeit und Intensität der Förderung scheinen sich zumindest kurzfristig günstig auf kognitive Merkmale wie etwa auch Sprachentwicklung auszuwirken. Für den motorischen Bereich gibt es derzeit keine Anzeichen für die Überlegenheit einer bestimmten Methode. Wenn auch Befunde für günstige Auswirkungen von Förderung positiver und responsiver Eltern-Kind-Interaktionen vorliegen, bilden sich für die Praxis bedeutsame umfassende Variablen wie familiäre Lebensqualität, Kompetenzgefühl und Befindlichkeit bislang kaum in der Forschung ab.

Sensibilidade materna durante o banho

A teoria do apego tem considerado a relação mãe-criança como um determinante do desenvolvimento, sendo que sua qualidade tem sido relacionada com a sensibilidade do cuidador, e conseqüentemente com a qualidade das relações com seus próprios cuidadores. Recentemente, tem se relacionado a sensibilidade materna com vários fatores, incluindo classe social e educação. Este trabalho teve como objetivo investigar as variáveis que influenciam a sensibilidade materna na situação de banho. Foram filmados 60 banhos dados por mães de classe baixa e classe média. As díades foram constituídas por mães que tinham entre 18 a 40 anos de idade, e por crianças de zero a um ano. Encontraram-se menores freqüências de comportamentos sensíveis entre mães de classe baixa do que entre mães de classe média, que possuíam mais escolaridade, mais idade e tinham com quem dividir os cuidados infantis. Estes resultados sugerem que a sensibilidade materna é um fenômeno relacionado com variáveis socioculturais.

Responsiveness in interactions of mothers and sons with ADHD: relations to maternal and child characteristics

We observed mother-child interactions, at baseline, in 136 families of 7-10-year-old boys with attention-deficit/hyperactivity disorder (ADHD) who were part of a large clinical trial, the Multimodal Treatment Study of Children with ADHD. Independent coders rated stylistic aspects of maternal behavior and factor analyses revealed a responsiveness factor that included overall responsiveness and sensitivity to the child, warmth and acceptance, and appropriate control. We examined relations between maternal responsiveness and (a) maternal depressive symptoms and maternal childhood ADHD symptoms, and (b) boys' ADHD and conduct problem symptoms. Controlling for all other variables, maternal responsiveness displayed a unique negative association with mother-reported child conduct problems, but not with child ADHD symptoms, and also was negatively related to maternal depressive symptoms. We discuss the unique association between mother-reported child conduct problems and parenting, and note the utility of studying parenting style in families of children with ADHD. We describe the results within the framework of a transactional model.

Impact of a mother-infant intervention in an indigent peri-urban South African context: pilot study

BACKGROUND

A high rate of maternal depression and associated disturbance in the mother-infant relationship has been found in an indigent peri-urban South African community, Khayelitsha. The question arises whether a community-based intervention could be beneficial.

AIMS

To train community workers to deliver an intervention to mothers and infants in Khayelitsha, and to compare mothers and infants receiving this intervention with a sample receiving no such intervention.

METHOD

Four Khayelitsha women were trained in a mother-infant intervention, which they delivered to 32 women recruited in late pregnancy. At 6 months post-partum, maternal mood, the mother-infant relationship and infant growth were assessed. The findings were compared with a matched group of 32 mothers and infants.

RESULTS

There was no reliable impact of the intervention on maternal mood. However, compared with the comparison sample, the quality of mother-infant engagement was significantly more positive for those who had received the intervention.

CONCLUSIONS

The pilot study produced preliminary evidence of a benefit of a community-based mother-infant intervention delivered by trained, but otherwise unqualified, community workers, sufficient to warrant a formal controlled evaluation of this treatment.

Mother-infant responsiveness: timing, mutual regulation, and interactional context

Mutual regulation during the naturalistic interaction of 150 mothers and their 4-month-old infants was investigated from a dynamic systems perspective. Microanalyses of a wide range of behaviors and analysis of contingencies indicated that a 3-s time period best captured contingencies. Both mothers and infants communicated primarily through vocal signals and responses, although maternal touches and infant looks also elicited responses. Although more expressive mothers did not have infants who behaved similarly, levels of contingent responsiveness between partners were significantly associated and occurred within distinct behavioral channels, suggesting coregulated interactional processes in which contingently responsive mothers shape their infants' communications toward mutual similarity. Mothers were more influential than infants over object play, whereas infants were more influential than mothers over expressive behavior. Interactional context consistently influenced contingent responsiveness; there was less mutual responsiveness when the infant was exploring, being held, or looking.

Improving adolescent parent-infant interactions: a pilot study

The study objective was to pilot test Keys to Caregiving, a program designed to improve interactions and contingent responsiveness between adolescent mothers and their infants. First-time adolescent parents, aged 15 to 19 years, received either the Keys to Caregiving program delivered by 6-weekly visits or a control program consisting of 6-weekly neutral visits. Parent-infant interactions and contingent responsiveness during teaching and feeding, and infant cognitive development were assessed when infants completed the program. The results suggest that the Keys to Caregiving program shows promise as a method of improving adolescent mothers' interactions with their infants.