Furthering the understanding of parent-child relationships: a nursing scholarship review series. Part 3: Interaction and the parent-child relationship--assessment and intervention studies

Measurement of the quality of mother-infant feeding interactions across the first year: Reliability and stability of the parent-child early relational assessment

This study examines the psychometric properties of the Parent-Child Early Relational Assessment (PCERA) in the context of mother-infant feeding interaction. Utilizing a longitudinal design, data were collected from 114 mother-infant dyads, including healthy full-term infants and those born prematurely with diagnosed respiratory disease, one group with chronic respiratory disease (Bronchopulmonary Dysplasia) and the second group with acute respiratory disease (Respiratory Distress Syndrome). Observational data were collected at 1, 4, 8, and 12 months post-term age, focusing on parental behavior, infant variables, and dyadic interactions during feeding. Confirmatory factor analysis was employed to assess the congeneric structure of the PCERA across three domains: parental, infant, and dyadic. Results indicated support for the congeneric model in all domains, demonstrating that each factor measured a single common latent variable despite variations in item loadings and error terms. Reliability analysis using Cronbach alpha and McDonald's omega coefficients revealed high internal consistency for all eight PCERA factors, indicative of robust measurement properties (Table 3). Further examination of factorial invariance across four time periods (1, 4, 8, and 12 months) demonstrated consistent measurement properties of the PCERA factors throughout the infant's first year of life. This finding suggests stability and reliability in measuring the underlying constructs of mother-infant feeding interaction over time. The study underscores the utility of the PCERA as an observational tool for assessing various dimensions of parent-child interaction during feeding. Findings support its application in diverse settings, including the study of infants with complex medical conditions, such as prematurity and respiratory disease. Additionally, the study highlights the importance of examining parent and infant characteristics as predictors of feeding interaction quality, aiming to identify dyads at risk of poorer interaction outcomes and inform clinical interventions.

Parenting Style Interventions in Parents of Preterm and High-Risk Infants: Controversies, Cost, and Future Directions

This review highlights the current state of evidence on interventions whose primary purpose is to change parenting style in parents of preterm, and other-high risk, infants. To date, interventions for parents of preterm infants are heterogeneous with variability in intervention timing, measured outcomes, program components, and cost. Most interventions target parental responsivity/sensitivity. Most reported outcomes are short-term, measured at age less than 2 years. The few studies that report later child outcomes in prekindergarten/school-aged children are encouraging, overall indicating improved cognition and behavior in the children of parents who received a parenting style intervention.

Mother-Child Social Cognition Among Multicultural Families in South Korea

Objective

Despite the rapidly growing number of multicultural families in South Korea, factors influencing parenting and mother-child interactions have not been well-understood. To our knowledge, the present study is the first to have examined how maternal social-cognitive capacity is associated with children's social cognition (e.g., theory of mind and emotion recognition) among multicultural families dwelling in South Korea.

Methods

Forty-seven multicultural mother-child dyads were recruited. The comprehensive measures on social cognition were administered to both the mothers and children, and social functioning and emotion regulation were administered to the children.

Results

A series of hierarchical regressions indicated that mothers' social cognition significantly explained children's ability to recognize static and dynamic emotional expressions, accounting for 27 and 34% of the variance, respectively. Furthermore, mothers' social cognition was significantly correlated to children's social functioning and emotion regulation. However, mothers' social cognition and children's theory of mind were non-significantly related.

Discussion

The current study examined the effects of social cognition of immigrant mothers on their children's socio-emotional development. As the findings indicated an important role of maternal factors (i.e., social cognition) for children's social cognition and their functions, psycho-social approaches (e.g., social cognition parenting education and training) should be incorporated in services for multicultural families.

Assessing and promoting responsive interaction between parents and children - A qualitative study of the experiences of child health care nurses in Sweden

PURPOSE

One of the main tasks of a child health care nurse is to assess and promote a responsive interaction and secure connection between children and their parents for the future. This study aims to develop an understanding of Swedish child health care nurses´ experiences of assessing and promoting responsive interaction between parents and children.

DESIGN AND METHOD

A qualitative interview study using an inductive approach was implemented. Eleven nurses were interviewed (range: 30-58 min) during the period March to August 2016, and the transcripts were analysed using qualitative content analysis according to Graneheim and Lundman.

RESULTS

Three categories emerged: Interpreting signals in parent and child behaviour, Reinforcing the parents in their role and Feeling inadequate as professional. Interpreting signals in parent and child behaviour was described fundamental when promoting responsive interaction. Further reinforcing the parents in their role was described central. The child health care nurses also described how they often felt inadequate in promoting responsive interaction.

CONCLUSIONS

Assessing and promoting responsive interaction is an important but challenging task which requires extensive knowledge and good communication skills. The child health care nurses express their insufficiency in that regard.

PRACTICE IMPLICATIONS

A targeted education and sufficient time for each visit at the child health care center should be allocated to facilitate the important work on parenting and child interaction and to enhance nurses' feelings of managing their work.

Early Intervention for Preterm Infants and Their Mothers: A Systematic Review

This systematic review evaluates the efficacy of various early interventions on maternal emotional outcomes, mother-infant interaction, and subsequent infant outcomes during neonatal intensive care unit admission and postdischarge. Key interventions associated with outcomes in both the neonatal intensive care unit and postdischarge (ie, home) settings are summarized. A comprehensive search of peer-reviewed randomized controlled trials involving early interventions for infants and their mother published between 1993 and 2013 in the electronic databases PubMed, CINAHL, EMBASE, PsychINFO, and Cochrane was undertaken. Methodological quality was assessed using the PEDro scale to evaluate internal and external validity of the study. Twelve randomized controlled trials were included in the review, and all used some form of parenting education. The interventions had limited effects on maternal stress and mother-infant interaction and positive effects on maternal anxiety, depressive symptoms, and maternal coping. There were positive effects on infants' short-term outcomes for length of stay and breast-feeding rate. Positive and clinically meaningful effects of early interventions were seen in some physiological/psychological outcomes of mothers and preterm infants. It is important for nurses to foster close mother-infant contact and increase maternal competence during and after the infant's hospitalization period.

Psychometric evaluation of the nursing child assessment teaching (NCAT) scale in a community-based sample

The effect of the mother-child relationship on long-term child development has received research attention for decades. Because the quality and quantity of mother-infant interactions have been established as important predictors of the child's development, early identification of areas in the relationship requiring support and intervention is essential for promoting positive child outcomes. The Nursing Child Assessment Teaching Scale (NCAT) is an instrument long used to quantify the quality of interaction in the mother-child relationship during the first 36 months of a child's life. While the NCAT has been shown to be a reliable and valid instrument, limited evidence exists of the theoretical congruence between the Barnard Model it is based on and the NCAT scale. The psychometric properties of the NCAT scale and subscales were examined using item response theory in relation to characteristics of interactions in the Barnard Model using data collected during a clinic visit at 12 months of infant age in a sample of mothers and children (N = 1,121 dyads) from a community-based sample in Shelby County, TN. In this secondary analysis, descriptive statistics, reliabilities, and factor loadings for the NCAT were obtained using confirmatory factor analysis and augmented to form multiple indicators, multiple causes models, linking demographic predictors of the mothers and children to the NCAT subscales. Results supported scale abbreviation and theoretical congruence with the Barnard Model, which may provide researchers and practitioners with a more concise, reliable way of measuring maternal-child interaction in community settings.

Parenting Stress and Maternal-Child Interactions Among Preschool Mothers From the Philippines, Korea, and Vietnam: A Cross-Sectional, Comparative Study

BACKGROUND

To promote child development, parenting stress, and maternal-child interactions among mothers of various nationalities must be understood. The purpose of this study was to investigate maternal-child interactions according to the mother's nationality among married immigrant mothers from the Philippines, Vietnam, and Korea.

METHOD

This study employed a descriptive, cross-sectional design. Inclusion criteria were mothers who had children of preschool age.

RESULTS

A total of 348 mothers were interviewed: 142 Korean mothers, 84 immigrant mothers from the Philippines, and 122 immigrant mothers from Vietnam. Parenting stress ( p < .001) and maternal-child interactions ( p = .023) differed according to the mother's nationality.

CONCLUSIONS

By delineating the nurturing characteristics of each country, the results of this study can help immigrant mothers develop maternal-child relationships that aid culturally congruent adjustment to their new culture.

IMPLICATIONS FOR PRACTICE

The characteristics of maternal-child interactions according to the mother's nationality may inform parent education in multicultural societies.

Efficacy or Chaos? Parent-Child Interaction Therapy in Maltreating Populations: A Review of Research

Child abuse remains a serious and expensive social problem in the United States. Few evidence-based treatments (EBTs) exist for at-risk families and/or maltreating families where neglect or abuse has occurred, limiting the ability of social service agencies to comply with legislative mandates to use EBTs with clients. One promising intervention, parent-child interaction therapy (PCIT), has been tested in 11 separate trials with this population. This review of research on PCIT with abusive adults found that overall PCIT is an appropriate, efficacious intervention method to prevent future maltreatment by targeting parenting skills and child externalizing behaviors. These findings must be taken with caution, since the key factor to determine efficacy is completion of treatment, and all the studies involved showed significant problems with sample attrition. While the current studies are promising, there is a need for research that focuses on measuring parental sensitivity and attachment levels, explores use in the foster and adoptive communities, and studies that use tertiary subjects to serve as unbiased reporters of perceived levels of behavioral changes.

The health consequences of child mental health problems and parenting styles: unintentional injuries among European schoolchildren

OBJECTIVE

Unintentional injury is the leading cause of death for schoolchildren. We assessed the association between externalizing psychopathology, parenting style, and unintentional injury in European children in the community.

METHODS

Data were drawn from the School Children Mental Health in Europe project and included 4517 schoolchildren across seven diverse European regions. Past-year injuries serious enough to seek medical attention were reported by mothers. Child mental health problems were assessed using validated measures and reported by the mothers, teachers, and children. Parenting styles were based on The Parenting Scale and the Parent Behaviors and Attitudes Questionnaire.

RESULTS

Children with attention-deficit/hyperactivity symptoms and oppositional defiant symptoms had a higher risk of injury compared to other children whether based on parent report (OR=1.47, 95% C.I. 1.2-1.9), teacher report (OR=1.36, 95% C.I. 1.1-1.7), or parent and teacher report combined (OR=1.53, 95% C.I. 1.1-2.1). Children who self-reported oppositional symptoms also had higher risk of injury (OR=1.6, 95% C.I. 1.1-2.4). Low-caring behavior of parents increased the risk of injury (OR=1.4, 95% C.I. 1.1-1.9).

CONCLUSION

Unintentional injury is a potential adverse health consequence of child externalizing problems. Interventions to improve parent-child relationships and prevention as well as focused treatment for externalizing problems may reduce the burden of injury.

Key components of early intervention programs for preterm infants and their parents: a systematic review and meta-analysis

BACKGROUND

Preterm infants are at greater risk for neurodevelopmental disabilities than full term infants. Interventions supporting parents to improve the quality of the infant's environment should improve developmental outcomes for preterm infants. Many interventions that involve parents do not measure parental change, nor is it clear which intervention components are associated with improved parental outcomes. The aim of this review was to categorize the key components of early intervention programs and determine the direct effects of components on parents, as well as their preterm infants.

METHODS

MEDLINE, EMBASE, CINAHL, ERIC, and Cochrane Database of Systematic Reviews were searched between 1990 and December 2011. Eligible randomized controlled trials (RCTs) included an early intervention for preterm infants, involved parents, and had a community component. Of 2465 titles and abstracts identified, 254 full text articles were screened, and 18 met inclusion criteria. Eleven of these studies reported maternal outcomes of stress, anxiety, depressive symptoms, self-efficacy, and sensitivity/responsiveness in interactions with the infant. Meta-analyses using a random effects model were conducted with these 11 studies.

RESULTS

Interventions employed multiple components categorized as (a) psychosocial support, (b) parent education, and/or (c) therapeutic developmental interventions targeting the infant. All interventions used some form of parenting education. The reporting quality of most trials was adequate, and the risk of bias was low based on the Cochrane Collaboration tool. Meta-analyses demonstrated limited effects of interventions on maternal stress (Z = 0.40, p = 0.69) and sensitivity/responsiveness (Z = 1.84, p = 0.07). There were positive pooled effects of interventions on maternal anxiety (Z = 2.54, p = 0.01), depressive symptoms (Z = 4.04, p <.0001), and self-efficacy (Z = 2.05, p = 0.04).

CONCLUSIONS

Positive and clinically meaningful effects of early interventions were seen in some psychosocial aspects of mothers of preterm infants. This review was limited by the heterogeneity of outcome measures and inadequate reporting of statistics. IMPLICATIONS OF KEY FINDINGS: Interventions for preterm infants and their mothers should consider including psychosocial support for mothers. If the intervention involves mothers, outcomes for both mothers and preterm infants should be measured to better understand the mechanisms for change.

Reliability of the assessment of mother-infant sensitivity-chinese version for preterm and term taiwanese mother-infant dyads

PURPOSE

The objectives of this study were to translate and modify the Assessment of Mother-Infant Sensitivity scale into a Chinese version (modified AMIS-C) and to examine its reliability with preterm and term Taiwanese mother-infant dyads.

METHOD

A total of 241 mother-infant pairs (179 preterm dyads and 62 term dyads) were prospectively recorded and their behaviour in feeding assessed using the modified AMIS-C when infants were at 4 and 6 months corrected age. A subset of the sample was used for interrater reliability testing, and the whole sample was used for assessment of internal consistency.

RESULTS

Interrater reliability was high for the modified AMIS-C section and total scores (intra-class correlation coefficients=0.91-0.99). Internal consistency was good to excellent for the maternal section and total score (α=0.71-0.86) and was fair to good for the infant and dyadic section score (α=0.44-0.75).

CONCLUSIONS

The modified AMIS-C scale is a clinically feasible and reliable instrument for assessing mother-infant interaction of preterm and term dyads during early infancy.

Furthering the understanding of parent-child relationships: a nursing scholarship review series. Part 5: parent-adolescent and teen parent-child relationships

PURPOSE

The purpose of this paper is to examine nursing's contribution to understanding the parent-adolescent and the teen parent-child relationships.

CONCLUSION

Relationships between parents and adolescents may reflect turmoil and affect adolescents' health and development. The social and developmental contexts for teen parenting are powerful and may need strengthening. Several interventions to help teen mothers interact sensitively with their infants have been developed and tested.

PRACTICE IMPLICATIONS

Nurse researchers have begun to provide evidence for practitioners to use in caring for families of adolescents and teen parents to acquire interaction skills that, in turn, may promote optimal health and development of the child.

Furthering the understanding of parent-child relationships: a nursing scholarship review series. Part 4: parent-child relationships at risk

PURPOSE

The purpose of this integrative review is to synthesize nursing scholarship on parent-child relationships considered fragile because of parent-child's chronic condition or occurrence within a risky context.

CONCLUSIONS

Most reviewed studies demonstrated negative effects of risk conditions on parent-child relationships and documented importance of child, parent, and contextual variables. Studies were predominately single investigations. Varying theoretical perspectives complicated interpretation. Mainly White, middle-class, and small samples limited generalizability. Important areas for further research were identified.

PRACTICE IMPLICATIONS

Nurse researchers identified factors that may interfere with the parent-child relationship. Nurses are in a position to support families under these circumstances.

Furthering the understanding of parent-child relationships: a nursing scholarship review series. Part 1: Introduction

PURPOSE

Understanding the parent-child relationship is fundamental to nursing of children and families. The purpose of this integrative review is to explore nursing scholarship published from 1980-2008 concerning parent-child relationships. Study approaches are examined, critiqued, and future directions for research identified.

CONCLUSIONS

A historical review of nursing research is presented and methods described as an introduction to a review series of the parent-child relationship.

IMPLICATIONS

Definition and explication of the parent-child relationship is a first-step in understanding factors amenable to nursing intervention. A clear definition of the concept of parent-child relationship will support further study using appropriate theoretical frameworks, and enable development and testing of supportive nursing interventions.

Furthering the understanding of parent-child relationships: a nursing scholarship review series. Part 2: Grasping the early parenting experience--the insider view

PURPOSE

The purpose of this integrative review is to systematically and critically synthesize nursing scholarship on parents' perspectives of the parent-child relationship during infancy.

CONCLUSION

Research has shown that the process of establishing the parent-child relationship is highly individualized and complex. Numerous barriers and facilitators influencing this relationship have been identified that are relevant to nursing.

PRACTICE IMPLICATIONS

Nurses have an important opportunity to positively affect the developing parent-infant relationship. Screening parents for depression and providing parents with resources and support are key nursing interventions supporting the parent-infant relationship.