Exploring the Link Between Mothers' Spiritual Well-Being and Positive Parenting in the Turkish Context: The Role of Mindful Parenting

This cross-sectional study examined the role of mindful parenting in the association between spiritual well-being and positive parenting behaviors among mothers of typically developing children. The sample comprised 381 mothers of children aged 4-17 years. We collected the data using the Three-Factor Spiritual Well-Being Scale (SWBS-3), the Mindfulness in Parenting Questionnaire (MIPQ), and the Multidimensional Assessment of Parenting Scale (MAPS). We tailored our analysis through the subscales of the SWBS-3 (transcendence, harmony with nature, and anomie) to control the contamination effects of other psychological constructs (e.g., meaning and connectedness) on the measurement of spiritual well-being. The correlation analysis yielded significant results, indicating a relationship between the SWBS-3 subscales and mothers' mindful parenting skills (i.e., being in the moment with the child and mindful discipline) and positive parenting practices. Moreover, the mediating effect analysis revealed that mindful parenting skills assumed diverse roles in the relationship between transcendence, harmony with nature, and anomie and positive parenting practices. The findings were then addressed in the context of the existing literature.

Parenting stress in infancy was associated with neurodevelopment in 24-month-old children with congenital heart disease

AIM

Having a child with congenital heart disease (CHD) is stressful for parents, but research on the impact this stress can have on child development has been lacking. We investigated the associations between parenting stress when children were infants and neurodevelopmental outcomes in toddlers with CHD.

METHODS

This study was carried out at the Neurocardiac Clinic at the Sainte-Justine University Hospital in Montréal, Canada. Patients born from 2012 to 2019 and followed up to 24 months of age were recruited. Parenting stress levels were measured when the child was 4-6 months and 24 months and the child's neurodevelopment was assessed at 24 months. Multiple linear regressions analyses were carried out.

RESULTS

We studied 100 children (56% boys) with CHD. Most of the parenting stress scores were below the clinical threshold. However, they accounted for a significant part of the variance in the children's cognitive (15%-16%), receptive language (14%-15%) and gross motor outcomes (15%-18%). They had no impact on the children's expressive language or fine motor outcomes.

CONCLUSION

Higher parenting stress was associated with poorer neurodevelopmental outcomes in toddlers with CHD. Early screening of parenting stress in CHD clinics is necessary to provide individualised intervention for parents and optimise neurodevelopmental outcomes in children.

The who, when, and why of pacifier use

BACKGROUND

Social and familial consequences of pacifier use remain poorly understood. The present study attempts to shed more light on the characteristics of parents using pacifiers with their infants and to explore how pacifier use affects perceptions of infant emotionality, maternal stress, and parental efficacy.

METHODS

The study sample consisted of 428 mothers (range: 17-49 years) of infants (0-36 months) who completed a comprehensive questionnaire assessing infant and parent characteristics as well as parenting practices and pacifier use. We compared attitudes toward pacifiers, parenting stress, children's levels of reactivity and self-regulation, and maternal efficacy among Pacifier Users, Never-Users, and families that Tried-Pacifiers.

RESULTS

The reported results reveal benefits of pacifier use for the family relationships, namely reduced parenting stress (p = 0.018), better parent-child dynamics (p < 0.001), and more positive perceptions of child's affectivity (p = 0.006), which are all important aspects of infant development.

CONCLUSION

Our findings highlight developmental benefits of pacifier use, a practice that is known to have both positive and negative long-term consequences for healthy child development. It is, therefore, important for health professionals to have discussions about the pros and cons of pacifier use with parents.

IMPACT

The study provides novel insights into how and why mothers use pacifiers and into the psychological consequences of this practice. We found pacifier use is associated with less maternal stress, better mother-child dynamics, and more positive perceptions of child's affectivity. Our findings document developmental benefits of pacifier use adding a new perspective to the debate on pacifiers. Doctors, health visitors, pediatric nurses, and midwives may consider this evidence when advising parents on pacifier use.

A biopsychosocial model of NICU family adjustment and child development

BACKGROUND

Although infants in Neonatal Intensive Care Units (NICU) are at risk for developmental impairments and parents are at risk for emotional distress, factors that explain outcomes remain unknown. Here, we developed the first biopsychosocial model to explain family adjustment after NICU discharge.

METHODS

Participants included 101 families at The Children's Hospital of Philadelphia Neonatal Follow-Up Program who had been discharged 1.5-2.5 years prior. We gathered data using validated assessments, standardized assessments, and electronic medical records.

RESULTS

Our structural equation model, informed by the Double ABC-X Model, captured the dynamic relationships among infant, parent, couple, and family factors. Infant medical severity, posttraumatic stress, couple functioning, and family resources (e.g., time, money) were key for family adjustment and child development.

CONCLUSIONS

Interventions that target parental posttraumatic stress, couple dynamics, parental perception of time for themselves, and access to financial support could be key for improving NICU family outcomes.

The effect of the COVID-19 pandemic on infant development and maternal mental health in the first 2 years of life

We investigated how exogenous variation in exposure to the COVID-19 pandemic during the first year of life is related to infant development, maternal mental health, and perceived stress. Ninety-three socioeconomically diverse pregnant women were recruited before the pandemic to participate in a longitudinal study. Infants ranged in age at the beginning of lockdown (0-9.5 months old), thus experiencing different durations of pandemic exposure across the first year of life. The duration of pandemic exposure was not associated with family demographic characteristics, suggesting it captured exogenous variability. We tested associations between this exogenous variation in pandemic exposure and child and family outcomes. We also examined whether mother-reported disruptive life events were correlated with child and family outcomes. We found no association between duration of pandemic exposure in the first year of life and infant socioemotional problems, infant language development, or maternal mental health and perceived stress symptoms, at 12 or 24 months. However, we found that self-reported exposure to pandemic-related disruptive life events predicted greater maternal depression, anxiety, and perceived stress at 12 months, and greater depression and anxiety at 24 months. Socioeconomic status did not moderate these associations. These findings suggest cautious optimism for infants raised during this period.

A Population-Based Study of Associations Among Child Screen Media Use, Social-Contextual Factors, and School Readiness

OBJECTIVE

Results of studies examining relations between child media use and school readiness have been inconsistent. Importantly, studies often focus on a single outcome domain (e.g., academic, social, or behavioral), making the comparison of relative importance difficult; fail to account for confounding variables; and fail to investigate social-contextual moderators. This study investigated relations among child media use exposure, social-contextual factors, and multiple domains of school readiness in preschool-aged children.

METHODS

Multivariate regression analyses were used to examine relations between child media use and 3 domains of school readiness (early learning, social-emotional skills, and self-regulation), controlling for demographic and social-contextual factors, and to investigate differential susceptibility by examining family income and 4 social-contextual factors (sleep, exposure to adverse childhood events, frequency of shared reading, and parent stress) as moderators in a large US population-based sample (N = 9323) of 3 to 5 year olds.

RESULTS

After controlling for confounding variables, higher screentime was negatively related to children's social-emotional skills and self-regulation, but less so for early learning. Effect sizes were small. The relation between screentime and self-regulation was significantly moderated by family income, such that the relation was stronger for children from low-income backgrounds. No other evidence of significant moderation was found.

CONCLUSION

Results add to evidence that the relation between screen media use and outcomes in young children is likely complex. Future work should prioritize examining impacts of screen media use on social and behavioral functioning to further inform the evaluation of relative benefits and costs of child screen media use.

Associations among stress and language and socioemotional development in a low-income sample

Stress has been linked with children's socioemotional problems and lower language scores, particularly among children raised in socioeconomically disadvantaged circumstances. Much of the work examining the relations among stress, language, and socioemotional functioning have relied on assessments of a single dimension of maternal stress. However, stress can stem from different sources, and people may appraise stressors differently. Taking a dimensional approach, this manuscript characterizes stress in multiple ways: as an overall composite; across the constructs of psychological appraisal vs. environmental stressors; and the independent contributions of a variety assessments. Data are from 548 mother-infant dyads (M = 13.14 months, SD = 2.11) who served as the control group for a poverty reduction clinical trial. Mothers completed questionnaires regarding the different types of stresses they may have experienced, as well as their children's language and socioemotional development. Results indicate that, collectively, higher maternal report of stress is associated with lower reports of children's socioemotional and language development. In addition, maternal psychological appraisals of stress were associated with both socioemotional and language development, whereas reports of environmental stressors were only associated with socioemotional development. Together, these findings suggest that maternal reports of stress are associated with lower maternal report of child development among low-income children.

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.

Parenting Styles and Child's Well-Being: The Mediating Role of the Perceived Parental Stress

In the last decades, consensus from laymen, scholars, and policy-makers has emphasized the role of child-parent relationships to promote child’s development and positive well-being. Parenting style was claimed as one of the crucial factors for the child’s positive adjustment. The main aim of the present study was to investigate the relationships between authoritative and authoritarian parenting styles and child’s difficulties. The mediational role of parent’s perception of a difficult child on the above mentioned relation was taken into account. The study was carried out on a sample of 459 couples including mothers (n = 459) and fathers (n = 459) of children aged 2 to 10 years old who filled in the Parenting Styles & Dimensions Questionnaire short version, the Strengths and Difficulties Questionnaire, and the Parenting Stress Index-short form. Main findings indicated that authoritative style was associated with less child’s maladjustment, while the authoritarian one showed the opposite association. These relationships were partially mediated by the perception of a difficult child, which partially explained the link between parenting style and child’s problems. Above and beyond the role of parent’s perception as a difficult child, parenting styles had an important effect on child’s difficulties. Future studies should replicate these results with other samples, use the spouse version of the parenting styles, control the effect of socio-economic status and other variables related to family functioning, as well as to consider the child’s perception regarding parents’ parenting style.

Paternal Sensitivity and Children's Cognitive and Socioemotional Outcomes: A Meta-Analytic Review

In a series of meta-analyses, paternal sensitivity was associated with children's (age range: 7 months-9 years) overall cognitive functioning (N = 3,193; k = 23; r = .19), including language skills (k = 9; r = .21), cognitive ability (k = 9; r = .18), and executive function (k = 8; r = .19). Paternal sensitivity was not associated with children's overall socioemotional functioning (N = 2,924; k = 24; r = -.03) or internalizing problems, but it was associated with children's emotion regulation (k = 7; r = .22) and externalizing problems (k = 19; r = -.08). In the broad cognitive functioning, executive function, broad socioemotional functioning, and externalizing problems meta-analyses, child age was a significant moderator.

Associations Between Parenting Stress, Language Comprehension, and Inhibitory Control in Children With Hearing Loss

Purpose Parenting stress has been studied as a potential predictor of developmental outcomes in children with normal hearing and children who are deaf and hard of hearing. However, it is unclear how parenting stress might underlie at-risk spoken language and neurocognitive outcomes in this clinical pediatric population. We investigated parenting stress levels and the shared relations between parenting stress, language comprehension, and inhibitory control skills in children with and without hearing loss (HL) using a cross-sectional design. Method Families of children with HL (n = 39) and with normal hearing (n = 41) were tested. Children completed an age-appropriate version of the Concepts & Following Directions subtest of the Clinical Evaluation of Language Fundamentals and the NIH Toolbox Flanker Test of Attention and Inhibitory control. Caregivers completed the Parenting Stress Index-Short Form 4. Results Parenting stress levels were not significantly different between parents of children with and without HL. A significant negative association was observed between parenting stress and our measure of language comprehension in children with HL. A negative association between parenting stress and inhibitory control skills was also found in families of children with HL, but not hearing children. The parenting stress-inhibitory control relationship was indirectly accounted for by delayed language comprehension skills in children with HL. Conclusion Even at moderate levels of parenting stress similar to parents of children with normal hearing, increases in parenting stress were associated with lower scores on our measures of language comprehension and inhibitory control in children with HL. Thus, parenting stress may underlie some of the variability in at-risk pediatric HL outcomes.

Recruitment and retention of fathers with young children in early childhood health intervention research: a systematic review and meta-analysis protocol

BACKGROUND

Fathers are under-represented in research and programs addressing early childhood health and development. Recruiting fathers into these interventions can be hampered for multiple reasons, including recruitment and retention strategies that are not tailored for fathers. The primary aim of this systematic review and meta-analysis is to determine the effectiveness of recruitment and retention strategies used to include fathers of children (from conception to age 36 months) in intervention studies. The secondary aim is to investigate study-level factors that may influence recruitment and retention.

METHODS

We will conduct searches for scholarly peer-reviewed randomized controlled trials, quasi-experimental studies, and pre-post studies that recruited fathers using the following databases: MEDLINE (Ovid), EMBASE (Ovid), PsycINFO (Ovid), and CINAHL. English-language articles will be eligible if they recruited self-identified fathers of children from conception to age 36 months for health-promoting interventions that target healthy parents and children. Two reviewers will independently screen titles/abstracts and full texts for inclusion, as well as grading methodological quality. Recruitment and retention proportions will be calculated for each study. Where possible, we will calculate pooled proportional effects with 95% confidence intervals using random-effects models and conduct a meta-regression to examine the impact of potential modifiers of recruitment and retention.

DISCUSSION

Findings from this review will help inform future intervention research with fathers to optimally recruit and retain participants. Identifying key factors should enable health researchers and program managers design and adapt interventions to increase the likelihood of increasing father engagement in early childhood health interventions. Researchers will be able to use this review to inform future research that addresses current evidence gaps for the recruitment and retention of fathers. This review will make recommendations for addressing key target areas to improve recruitment and retention of fathers in early childhood health research, ultimately leading to a body of evidence that captures the full potential of fathers for maximizing the health and wellbeing of their children.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42018081332.

Language Skills in Children Born Preterm (<30 Wks' Gestation) Throughout Childhood: Associations With Biological and Socioenvironmental Factors

OBJECTIVE

To examine the individual and collective contribution of biological and socioenvironmental factors associated with language function at 2, 5, 7, and 13 years in children born preterm (<30 weeks' gestation or <1250 g birth weight).

METHODS

Language function was assessed as part of a prospective longitudinal study of 224 children born preterm at 2, 5, 7, and 13 years using age-appropriate tools. Language Z-scores were generated based on a contemporaneous term-born control group. A selection of biological factors (sex, small for gestational age, bronchopulmonary dysplasia, infection, and qualitatively defined brain injury) and early socioenvironmental factors at age 2 years (primary income earner employment status and type, primary caregiver education level, English as a second language, parental mental health history, parent sensitivity and facilitation, and parent-child synchrony) was chosen a priori. Associations were assessed using univariable and multivariable linear regression models applied to outcomes at each time point.

RESULTS

Higher primary caregiver education level, greater parent-child synchrony, and parent sensitivity were independently associated with better language function across childhood. Socioenvironmental factors together explained an increasing percentage of the variance (9%-18%) in language function from 2 to 13 years of age. In comparison, there was little evidence for associations between biological factors and language function, even during early childhood years.

CONCLUSION

This study highlights the importance of socioenvironmental factors over biological factors for language development throughout childhood. Some of these socioenvironmental factors are potentially modifiable, and parent-based interventions addressing parenting practices and education may benefit preterm children's language development.

Parenting Behavior and Child Language: A Meta-analysis

CONTEXT

Early language development supports cognitive, academic, and behavioral success. Identifying modifiable predictors of child language may inform policies and practices aiming to promote language development.

OBJECTIVE

To synthesize results of observational studies examining parenting behavior and early childhood language in typically developing samples.

DATA SOURCES

Searches were conducted in Medline, Embase, PsycINFO, Web of Science, and Dissertation Abstracts (1967 to 2017).

STUDY SELECTION

Studies had 1 of 2 observational measures of parenting behavior (i.e., sensitive responsiveness or warmth) and a measure of child language.

DATA EXTRACTION

Data from 37 studies were extracted by independent coders. Estimates were examined by using random-effects meta-analysis.

RESULTS

Two meta-analyses were conducted, which examined (1) the association between sensitive-responsive parenting and child language (k = 36; r = 0.27; 95% confidence interval: 0.21 to 0.33); and (2) the association between parental warmth and child language (k = 13; r = 0.16; 95% confidence interval: 0.09 to 21). The pooled effect size for the association between sensitive responsiveness and child language was statistically higher than that of warmth and child language. The association between sensitive responsiveness and child language was moderated by family socioeconomic status (SES): effect sizes were stronger in low and diverse SES groups compared with middle to upper SES groups. Effect sizes were also stronger in longitudinal versus cross-sectional studies.

LIMITATIONS

Results are limited to typically developing samples and mother-child dyads. Findings cannot speak to causal processes.

CONCLUSIONS

Findings support theories describing how sensitive parenting may facilitate language and learning.

Examining the associations between children's receptive language skills and developmental domains in the United States and Turkey

This study examined the relations between receptive language development and other developmental domains of preschoolers from low-income families, through an inter-cultural perspective involving the United States and Turkey. A total of 471 children and their caregivers participated in Turkey, while 287 participated in the United States. Children's development was assessed using the Ages and Stages Questionnaire for both samples. Different versions of the Peabody Picture Vocabulary Test were used for Turkish and US samples, to measure receptive language development. Results revealed similar patterns, with some differences, between the two countries. Receptive language predicted only communication and personal-social scales in the Turkish sample, while the US children's receptive language skills were associated with communication, problem solving, personal-social, and fine and gross motor development scales. These results were discussed in the context of each country, and the comparative conclusions contribute to the extant literature by illustrating the importance of language for three domains.

Enfoque desde la violencia perinatal: visita del padre a su hijo prematuro durante su hospitalización

Este trabajo reflexiona sobre la participación del padre en las unidades de neonatología, comprendiendo que ser padre/madre de un recién nacido pretérmino es complejo, estresante y puede llenar de temores, ansiedad e incertidumbre. En el contexto actual, se tiende a recargar el rol de cuidado en la madre, lo que limita las oportunidades de participación del padre. El análisis se centra en las experiencias del servicio de neonatología de un hospital de Santiago de Chile, Chile, y en una revisión de la literatura sobre el papel de los padres y su participación en este contexto.

NICU infant health severity and family outcomes: a systematic review of assessments and findings in psychosocial research

Many infants (7-15%) spend time in the neonatal intensive care unit (NICU) and continue to experience medical issues after discharge. Family psychological responses range widely depending on burden of care, access to resources, and parental characteristics. The current systematic review examined how infant health severity is assessed and related to family psychological (e.g., mental health) and social (e.g., parent-infant attachment) outcomes. Seventy articles were deemed relevant. Infant health was operationalized in several ways including validated assessments, indices of infant health (e.g., diagnosis, length of stay), or novel measures. Parents of infants with increased medical complications reported greater family impact, increased stress, and more intrusive parenting style. A validated assessment of infant health that utilizes parent report is warranted to allow for more accessible and easily disseminated research across medical centers. Understanding NICU infant health severity and family outcomes can be used to identify families at risk for negative psychosocial sequelae.

Relationship between mother-infant mutual dyadic responsiveness and premature infant development as measured by the Bayley III at 6 weeks corrected age

BACKGROUND

The quality of mother-preterm infant interaction has been identified as a key factor in influencing the infant's later development and language acquisition. The relationship between mother-infant responsiveness and later development may be evident early in infancy, a time period which has been understudied.

AIM

Describe the relationship between mother-infant mutual dyadic responsiveness and premature infant development.

DESIGN

This study employed a secondary analysis of data from the 6-week corrected age (CA) follow-up visit of the Hospital-Home Transition: Optimizing Prematures' Environment (H-HOPE) study, a randomized clinical trial testing the efficacy of a mother- and infant- focused intervention for improving outcomes among premature infants.

SUBJECTS

Premature infants born between 29 and 34 weeks gestational age and their mothers who had social-environmental risks.

OUTCOME MEASURES

At 6-weeks corrected age, a play session was coded for the quality of mutual responsiveness (Dyadic Mutuality Code). Development was assessed via the Bayley Scales of Infant and Toddler Development, 3rd edition.

RESULTS

Of 137 mother-infant dyads, high, medium and low mutual responsiveness was observed for 35.8%, 34.3% and 29.9%, respectively. Overall motor, language and cognitive scores were 115.8 (SD = 8.2), 108.0 (7.7) and 109.3 (7.9). Multivariable linear models showed infants in dyads with high versus low mutual responsiveness had higher scores on the motor (β = 3.07, p = 0.06) and language (β = 4.47, p = 0.006) scales.

CONCLUSION

High mutual responsiveness in mother-premature infant dyads is associated with significantly better language development and marginally better motor development.

Parent participation in the neonatal intensive care unit: Predictors and relationships to neurobehavior and developmental outcomes

OBJECTIVE

To 1) define predictors of parent presence, any holding, holding in arms, and skin-to-skin care in the NICU and 2) investigate the relationships between parent participation and a) early neurobehavior and b) developmental outcomes at age 4 to 5years among preterm infants.

METHODS

Eighty-one preterm infants born ≤32weeks estimated gestational age were prospectively enrolled within one week of life in a level III-IV NICU. Parent (maternal and paternal) presence and holding (including holding in arms and skin-to-skin care) were tracked throughout NICU hospitalization. Neurobehavior at term equivalent age and development at 4 to 5years were determined using standardized assessments.

RESULTS

The median number of days per week parents were documented to be present over NICU hospitalization was 4.0 (IQR=2.4-5.8) days; days held per week 2.8 (IQR=1.4-4.3) days [holding in arms days per week was 2.2 (IQR=1.2-3.2) days and parent skin-to-skin care days per week was 0.2 (IQR=0.0-0.7) days]. More parent presence was observed among mothers who were Caucasian, married, older, or employed and among those who had fewer children, familial support and provided breast milk (p<0.05). More holding was observed in infants with fewer medical interventions (p<0.05) and among those who were Caucasian, had a father who was employed, had fewer children and family support (p<0.05). More parent holding in the NICU was related to better reflex development at term age (p=0.02). More parent skin-to-skin care was related to better infant reflexes (p=0.03) and less asymmetry (p=0.04) at term and better gross motor development (p=0.02) at 4-5years.

DISCUSSION

Social and medical factors appear to impact parent presence, holding, and skin-to-skin care in the NICU. Parent holding is related to better developmental outcomes, which highlights the importance of engaging families in the NICU.

FATHER-CHILD INTERACTIONS AT 3 MONTHS AND 24 MONTHS: CONTRIBUTIONS TO CHILDREN'S COGNITIVE DEVELOPMENT AT 24 MONTHS

The quality of father–child interactions has become a focus of increasing research in the field of child development. We examined the potential contribution of father–child interactions at both 3 months and 24 months to children's cognitive development at 24 months. Observational measures of father–child interactions at 3 and 24 months were used to assess the quality of fathers’ parenting (n = 192). At 24 months, the Mental Developmental Index (MDI) of the Bayley Scales of Infant Development, Second Edition (N. Bayley, 1993) measured cognitive functioning. The association between interactions and cognitive development was examined using multiple linear regression analyses, adjusting for paternal age, education and depression, infant age, and maternal sensitivity. Children whose fathers displayed more withdrawn and depressive behaviors in father–infant interactions at 3 months scored lower on the MDI at 24 months. At 24 months, children whose fathers were more engaged and sensitive as well as those whose fathers were less controlling in their interactions scored higher on the MDI. These findings were independent of the effects of maternal sensitivity. Results indicate that father–child interactions, even from a very young age (i.e., 3 months) may influence children's cognitive development. They highlight the potential significance of interventions to promote positive parenting by fathers and policies that encourage fathers to spend more time with their young children.

Impact of maternal prenatal and parental postnatal stress on 1-year-old child development: results from the OTIS antidepressants in pregnancy study

Perinatal psychological stress has been associated with unfavorable maternal and neonatal outcomes. We aimed to assess the impact of perinatal stress on infant development at 1 year of age. We recruited pregnant women calling North American Teratogen Information Services or attending outpatient clinics at CHU Sainte Justine (Montreal) between 2008 and 2010 and their spouses. To be part of our study, women had to be (1) >18 years of age, (2) <15 weeks of gestational age at recruitment, (3) living within 250-km radius of Montreal, and (4) taking antidepressants or non-teratogenic drugs. Stress was assessed using the telephone-administered four-item perceived stress scale during pregnancy in mothers and at 2 months postpartum in both parents. Child development at 1 year of age was evaluated with the Bayley III scales. Socio-demographic and potential confounders were collected through telephone interviews. Multivariable linear regression models were built to assess the association between perinatal parental stress and child development. Overall, 71 couples and their infants were included. When adjusted for potential confounders, maternal prenatal stress was positively associated with motor development (adjusted β = 1.85, CI 95 % (0.01, 3.70)). Postpartum maternal and paternal stresses were negatively associated with motor and socio-emotional development, respectively (adjusted β = -1.54, CI 95 % (-3.07, -0.01) and adjusted β = -1.67, CI 95 % (-3.25, -0.10), respectively). Maternal and paternal postnatal stress seems to be harmful for the motor and socio-emotional development in 1-year-old children. No association was demonstrated between parental stress and cognitive, language, and adaptive behavioral development. However, prenatal maternal stress appears to improve motor skills.

Relationship Churning and Parenting Stress Among Mothers and Fathers

Researchers have documented the consequences of relationship instability for parenting stress but have given little attention to within-partner relationship instability. In this study, the authors used data from the Fragile Families and Child Wellbeing Study (N = 3,544) to estimate the association between within-partner relationship instability (known as churning or on-again/off-again relationships) and parenting stress. First, they found that by the focal child's 5th birthday about 16% of biological parents experience churning. Second, compared to being stably together with or stably separated from the child's other parent, churning is associated with greater parenting stress for both mothers and fathers. Because parenting stress is the same or higher among churners compared to their counterparts who stably separate, this suggests that, more than a change in partner, relationship instability-whether within or across relationships-is tied to parenting stress.

Early Maternal Reflective Functioning and Infant Emotional Regulation in a Preterm Infant Sample at 6 Months Corrected Age

OBJECTIVE

This study investigated the influence of maternal reflective functioning (RF) on 6-month-old infants' emotional self-regulating abilities in preterm infant-mother dyads.

METHODS

25 preterm (gestational age 28-34.5 weeks) infants' affect, gaze toward mother, and self-soothing behaviors (thumb-sucking and playing with clothing) were measured during the still-face procedure at 6 months corrected age. Maternal RF was measured at 7-15 days post-delivery using the Parent Development Interview.

RESULTS

Infants with high RF mothers showed the most negative affect during the still-face episode (M = 21.33s, SE = 5.44), whereas infants with low RF mothers showed the most negative affect in the reunion episode (M = 18.14s, SE = 3.69). Infants with high RF mothers showed significantly more self-soothing behaviors when distressed (Ms > 14.5s) than infants with low RF mothers (Ms < 1s), p's < .01.

CONCLUSION

Maternal RF was associated with infants' self-regulating behavior, providing preliminary evidence for the regulatory role of maternal RF in preterm infants' emotion regulation capacity.

Effect of Skin-to-Skin Holding on Stress in Mothers of Late-Preterm Infants: A Randomized Controlled Trial

PURPOSE

To examine the effect of skin-to-skin care (SSC) on stress perception between mothers who provided SSC to their late-preterm born infants and mothers who provided blanket holding.

DESIGN AND METHODS

This was a longitudinal 2-group randomized controlled trial of 40 infant-mother dyads recruited from a level 3 neonatal intensive care unit in the upper Midwest.

OUTCOME MEASURE

Maternal stress was measured using the Parental Stressor: Neonatal Intensive Care Unit (PSS: NICU) scale pre- and post-SSC intervention. Demographic and other mother and infant covariates were extracted from medical records. Physiologic stability was measured by the Stability of the Cardiorespiratory System in Preterm Infants (SCRIP) score. Study personnel used daily logs to track frequency and duration of SSC and holding sessions.

RESULTS

The intervention and the control groups had similar pre- (mean ± standard deviation, 2.34 ± 0.86 for SSC and 2.94 ± 0.87 for holding) and post-intervention (mean ± standard deviation, 2.55 ± 0.95 for SSC and 2.78 ± 0.90 for holding) overall stress scores. Hours of SSC holding positively correlated with the change in stress scores for the entire scale (r = 0.58; P = .001), and for infant appearance (r = 0.58; P = .001) and parent role alteration (r = 0.48; P = .02) subscales. This relationship remained significant after controlling for the infant's length of stay and SCRIP score.

IMPLICATIONS FOR PRACTICE

Mothers who provide SSC may experience more stress related to a more facilitated progression in the mother and infant relationship.

IMPLICATIONS FOR RESEARCH

The relationship between increased stress and the number of hours of SSC holding warrants further investigation.

Positive Parenting Practices, Health Disparities, and Developmental Progress

OBJECTIVE

To describe interactive activities between parents and young children in a nationally representative sample. We hypothesized that the frequency of participation in interactive activities would be different across economic strata and would be associated with developmental delay.

METHODS

Children 4 to 36 months of age were identified by using The National Survey of Children's Health 2011-2012. Interactive caregiving practices were reported by poverty status. Developmental concerns were derived from caregiver responses and scoring of the Parents Evaluation of Developmental Status. Multivariable logistic regressions with weighting were used to explore the effect of interactive practices on risk for developmental delay across poverty levels. Covariates including age, gender, insurance type, maternal education, parenting stress, and ethnicity were adjusted in the models.

RESULTS

In our sample (n = 12,642), caregivers with the lowest income versus highest income reported lower participation in reading (33% vs 64%; P < .0001), singing or telling stories (52% vs 77%, P < .0001), and taking their child on an outing (13% vs 22%, P < .0001). Less frequent participation in interactive activities during the week were associated with increased risk of developmental delay among low-income families (Reading odds ratio [OR] 1.57, 95% confidence interval [CI] 1.15-2.13; Singing songs/Telling Stories OR 1.66, 95% CI 1.15-2.40; Outings OR 1.48, 95% CI 1.11-1.97).

CONCLUSIONS

Despite evidence emphasizing the protective effects of supportive parenting practices on early child development, our work demonstrates significant disparities in parenting practices that promote early child development between economically advantaged and disadvantaged parents. Innovative population-level strategies that enrich parenting practices for vulnerable children in early childhood are needed.

What patterns of postpartum psychological distress are associated with maternal concerns about their children's emotional and behavioural problems at the age of three years?

Mothers experiencing psychological distress in the postpartum period may have difficulties parenting their children. Inconsistent and unresponsive parenting may increase the risk of later emotional and behavioural problems in children. The purpose of this study was to identify how maternal psychological characteristics cluster at eight weeks postpartum, and whether these clusters were associated with maternal-reported child emotional and behavioural problems at the age of three years, as measured by the Parents' Evaluation of Developmental Status (PEDS) questionnaire. In a longitudinal pregnancy cohort (N = 647), three clusters of postpartum psychological characteristics were identified. Contrary to expectations, mothers with the greatest psychological distress did not report concerns about their child's emotional and behavioural problems; rather, they reported concerns about global developmental delay. These findings suggest that infants of mothers experiencing postpartum psychological distress should receive additional follow-up to reduce the risk for global developmental delay.

Maternal responsiveness predicts child language at ages 3 and 4 in a community-based sample of slow-to-talk toddlers

BACKGROUND

Maternal responsiveness has been shown to predict child language outcomes in clinical samples of children with language delay and non-representative samples of typically developing children. An effective and timely measure of maternal responsiveness for use at the population level has not yet been established.

AIMS

To determine whether a global rating of maternal responsiveness at age 2 years predicts language outcomes at ages 3 and 4 in a community sample of slow-to-talk toddlers.

METHODS & PROCEDURES

In an Australian population-based study, at child age 1:6 years, 301 slow-to-talk toddlers (scoring ≤20th percentile on a parent-reported expressive vocabulary checklist) were invited to take part in a 15-min free-play video of mother-child interaction at 2:0 years. Each free-play video was rated for maternal responsiveness using a five-point global rating scale, where 1 is 'very low' responsiveness and 5 is 'very high' responsiveness. Language skills were measured at 3:0 years using PLS-4 and at 4:0 years using the CELF-P2.

OUTCOMES & RESULTS

In adjusted linear regression models (potential confounders: gender, maternal education, socioeconomic status) maternal responsiveness strongly predicted receptive, expressive and total language standard scores at ages 3 (coefficient = 5.9, p < 0.001; coefficient = 5.4, p < 0.001; coefficient = 6.2, p < 0.001, respectively) and 4 years (coefficient = 4.6, p < 0.001; coefficient = 3.1, p = 0.004; coefficient = 4.0, p < 0.001, respectively).

CONCLUSIONS & IMPLICATIONS

Slow-to-talk toddlers of mothers with higher global ratings of responsiveness have higher language scores at 3 and 4 years of age. This global measure of maternal responsiveness could be further developed as a clinical tool for identifying which slow-to-talk toddlers are most in need of early intervention.

Maternal behaviors promoting language acquisition in slow-to-talk toddlers: prospective community-based study

OBJECTIVE

To determine, in a community-based sample of slow-to-talk toddlers, the extent to which specific maternal responsive behaviors at 24 months predict child language at 24 and 36 months.

METHODS

Mother-child dyads were recruited for this prospective longitudinal study from 3 local government areas spanning low, middle, and high socioeconomic status in Melbourne, Australia. At child age 18 months, 1138 parents completed a 100-word expressive vocabulary checklist; the 251 (22.1%) children scoring ≤20th percentile were then followed up to comprise this study.

PREDICTORS

Six maternal responsive behaviors (imitations, interpretations, labels, expansions, supportive directives and responsive questions) were derived from mother-child free-play videos collected at 24 months of age and coded using the Observer XT system.

OUTCOMES

Expressive and receptive language measured at 24 and 36 months of age (Preschool Language Scale-4), blind to maternal responsiveness ratings.

RESULTS

Two hundred and twenty-six of the 251 (90.0%) mother-child dyads were followed up at 36 months. In confounder-adjusted linear regression analyses, expansions, imitations, and responsive questions were strongly associated with better receptive and expressive language at 24 and 36 months. Labels unexpectedly predicted poorer expressive language at 36 months. Expansions were the only maternal behavior that predicted improvement in language between 24 and 36 months.

CONCLUSIONS

Maternal responsive behaviors, particularly expansions, offer promise in enhancing early language learning in slow-to-talk toddlers. Parent-child interactions characterized by frequent use of maternal labels at 24 months could also be a predictive marker of those slow-to-talk toddlers at greater risk of persistent language problems.

Father-involvement in a refugee sample: relations between posttraumatic stress and caregiving

Despite increased attention to the role of fathers within families, there is still a dearth of studies on the impact of trauma on father-involvement. This study investigates the quantity of father-involvement and the influence of posttraumatic stress on the quality of involvement in a refugee and asylum seeker population. Eighty refugees and asylum seekers and their young children (aged 18-42 months) were recruited. Measures included assessment of parental trauma (Harvard Trauma Questionnaire), quantity and quality of involvement (quantity of caregiving and Emotional Availability Scales), and perception of the father-child relationship (interview). The results show that fathers were less involved in caregiving tasks and play activities than mothers. No parental gender differences were found on each of the Emotional Availability Scales. Traumatic stress symptoms negatively affected the perception and the actual quality of parent-child interaction (sensitivity, structuring, nonhostility). Nevertheless, almost all fathers described their relationship with their child as good and their child as very important to them. As the quality of father-involvement is of importance to the development of the child, traumatized fathers are as much in need of clinical intervention as mothers. Despite the impact of posttraumatic stress, refugee fathers clearly are involved in the lives of their children. Mechanisms such as a deliberate withdrawal when stressed and compensation might enable affected fathers to step into the interaction when needed, raise the quality of involvement with their child, and diminish the negative impact of stress resulting from trauma and migration.

Mother-infant interaction improves with a developmental intervention for mother-preterm infant dyads

While premature infants have a high need for positive interactions, both infants and their mothers are challenged by the infant's biological immaturity. This randomized clinical trial of 198 premature infants born at 29-34 weeks gestation and their mothers examined the impact of the H-HOPE (Hospital to Home: Optimizing the Infant's Environment) intervention on mother-premature infant interaction patterns at 6-weeks corrected age (CA). Mothers had at least 2 social environmental risk factors such as minority status or less than high school education. Mother-infant dyads were randomly assigned to the H-HOPE intervention group or an attention control group. H-HOPE is an integrated intervention that included (1) twice-daily infant stimulation using the ATVV (auditory, tactile, visual, and vestibular-rocking stimulation) and (2) four maternal participatory guidance sessions plus two telephone calls by a nurse-community advocate team. Mother-infant interaction was assessed at 6-weeks CA using the Nursing Child Assessment Satellite Training-Feeding Scale (NCAST, 76 items) and the Dyadic Mutuality Code (DMC, 6-item contingency scale during a 5-min play session). NCAST and DMC scores for the Control and H-HOPE groups were compared using t-tests, chi-square tests and multivariable analysis. Compared with the Control group (n = 76), the H-HOPE group (n = 66) had higher overall NCAST scores and higher maternal Social-Emotional Growth Fostering Subscale scores. The H-HOPE group also had significantly higher scores for the overall infant subscale and the Infant Clarity of Cues Subscale (p < 0.05). H-HOPE dyads were also more likely to have high responsiveness during play as measured by the DMC (67.6% versus 58.1% of controls). After adjustment for significant maternal and infant characteristics, H-HOPE dyads had marginally higher scores during feeding on overall mother-infant interaction (β = 2.03, p = 0.06) and significantly higher scores on the infant subscale (β = 0.75, p = 0.05) when compared to controls. In the adjusted analysis, H-HOPE dyads had increased odds of high versus low mutual responsiveness during play (OR = 2.37, 95% CI = 0.97, 5.80). Intervening with both mother and infant is a promising approach to help premature infants achieve the social interaction patterns essential for optimal development.

Rethinking stress in parents of preterm infants: a meta-analysis

BACKGROUND

With improved medical outcome in preterm infants, the psychosocial situation of their families is receiving increasing attention. For parents, the birth of a preterm infant is generally regarded as a stressful experience, and therefore many interventions are based on reducing parental stress. Nevertheless, it remains unclear whether parents of children born preterm experience more stress than parents of term-born children, which would justify these interventions. This meta-analysis provides a comprehensive account of parental stress in parents of preterm infants, from birth of the infant through to their adolescence. Mean levels of stress in specific domains of family functioning were investigated, and stress levels in parents of preterm and term infants, and fathers and mothers of preterm infants, were compared. Furthermore, we investigated moderators of parental stress.

METHODS AND FINDINGS

A random-effects meta-analysis was conducted including 38 studies describing 3025 parents of preterm (<37 wk) and low birth weight (<2500 g) infants. Parental stress was measured with two parent-reported questionnaires, the Parenting Stress Index and the Parental Stressor Scale: Neonatal Intensive Care Unit. The results indicate that parents of preterm-born children experience only slightly more stress than parents of term-born children, with small effect sizes. Furthermore, mothers have slightly more stress than fathers, but these effect sizes are also small. Parents report more stress for infants with lower gestational ages and lower birth weights. There is a strong effect for infant birth year, with decreasing parental stress from the 1980s onward, probably due to increased quality of care for preterm infants.

CONCLUSIONS

Based on our findings we argue that prematurity can best be regarded as one of the possible complications of birth, and not as a source of stress in itself.

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.

Behavioral feeding problems and parenting stress in eosinophilic gastrointestinal disorders in children

BACKGROUND

Children with eosinophilic gastrointestinal disorders (EGID) and their families are asked to adhere to dietary restrictions which can present significant daily challenges. However, little is known about child and family functioning and adaptation and the impact of psychosocial functioning (e.g., behavioral feeding problems) on adherence to dietary restrictions in this pediatric population.

METHODS

We conducted a gender- and age-matched case-control study wherein parents of children with EGID and healthy control children completed measures of behavioral feeding problems, parenting stress, and adherence to prescribed dietary restrictions.

RESULTS

Children with EGID (n = 92) have significantly higher levels of behavioral feeding problems than healthy controls (n = 89; t = 5.7, p < 0.001; t = 7.9, p < 0.001). In particular, younger children demonstrated higher levels of behavioral feeding problems than older children. While behavioral feeding problems were not predictive of adherence to dietary restriction recommendations, they were positively associated with parenting stress.

CONCLUSIONS

The study results indicate that, for families caring for a child with EGID, higher levels of behavioral feeding problems are associated with parent maladjustment or dysfunction. A multidisciplinary treatment team is needed to provide comprehensive psychosocial and feeding evaluations and treatment in EGID families.

Buffering boys and boosting girls: The protective and promotive effects of Early Head Start for children's expressive language in the context of parenting stress

Children's characteristics, including gender, influence their development by eliciting differential responses from their environments, and by influencing differential responses to their environments. Parenting-related stress, associated with poverty environments, negatively influences children's language, likely through its impact on parent-child interactions, but may impact boys' and girls' development differently. Early intervention represents one tool for supporting development in at-risk toddlers, but gender-differences in effects of intervention are rarely described. The current studies assessed the effects of Early Head Start (EHS) on children's productive vocabulary in the context of parenting stress and examined gender differences in program effects on vocbulary. Data were from the national EHS Research and Evaluation (EHSRE) study (Study 1, N = 3,001), and from a dataset associated with one EHSRE site (Study 2, N = 146) where additional data on productive vocabulary were collected. Study 1 found that at 24 months of age, the EHS program protected girls' productive vocabulary from the negative effects of parenting stress, but had little impact on boys' vocabulary. In Study 2, the local EHS site promoted girls' vocabulary development over time from 14 to 36 months despite the negative effects of parenting stress, and protected boys' vocabulary from the negative parenting stress effects. These results suggest differential ways in which at-risk toddlers are affected by early intervention.

The effectiveness of video interaction guidance in parents of premature infants: a multicenter randomised controlled trial

Background

Studies have consistently found a high incidence of neonatal medical problems, premature births and low birth weights in abused and neglected children. One of the explanations proposed for the relation between neonatal problems and adverse parenting is a possible delay or disturbance in the bonding process between the parent and infant. This hypothesis suggests that due to neonatal problems, the development of an affectionate bond between the parent and the infant is impeded. The disruption of an optimal parent-infant bond -on its turn- may predispose to distorted parent-infant interactions and thus facilitate abusive or neglectful behaviours. Video Interaction Guidance (VIG) is expected to promote the bond between parents and newborns and is expected to diminish non-optimal parenting behaviour.

Methods/design

This study is a multi-center randomised controlled trial to evaluate the effectiveness of Video Interaction Guidance in parents of premature infants. In this study 210 newborn infants with their parents will be included: n = 70 healthy term infants (>37 weeks GA), n = 70 moderate term infants (32–37 weeks GA) which are recruited from maternity wards of 6 general hospitals and n = 70 extremely preterm infants or very low birth weight infants (<32 weeks GA) recruited by the NICU of 2 specialized hospitals. The participating families will be divided into 3 groups: a reference group (i.e. full term infants and their parents, receiving care as usual), a control group (i.e. premature infants and their parents, receiving care as usual) and an intervention group (i.e. premature infants and their parents, receiving VIG). The data will be collected during the first six months after birth using observations of parent-infant interactions, questionnaires and semi-structured interviews. Primary outcomes are the quality of parental bonding and parent-infant interactive behaviour. Parental secondary outcomes are (posttraumatic) stress symptoms, depression, anxiety and feelings of anger and hostility. Infant secondary outcomes are behavioral aspects such as crying, eating, and sleeping.

Discussion

This is the first prospective study to empirically evaluate the effect of VIG in parents of premature infants. Family recruitment is expected to be completed in January 2012. First results should be available by 2012.

Trail registration number

NTR3423

High prevalence/low severity language delay in preschool children born very preterm

OBJECTIVE

To examine the language development at corrected age 4 years of a regionally representative cohort of children born very preterm (VPT). Of particular interest was the identification of biological and socioenvironmental risk and protective factors that influence VPT children's early language development.

METHOD

Data were collected as part of a prospective longitudinal study of 110 VPT (VPT: ≤ 33 weeks gestation) and 113 full-term children (full term: 37-41 weeks gestation) born in Canterbury, New Zealand from 1998 to 2000. At corrected age 4 years, all children were assessed with the preschool version of the Clinical Evaluation of Language Fundamentals. Extensive information was also collected about children's family social background, perinatal health, childrearing environment, education/intervention exposures, and neurodevelopmental progress from birth to age 4.

RESULTS

At the age of 4 years, VPT children were characterized by poorer receptive and expressive language development than full-term children. These differences persisted after exclusion of children with neurosensory impairment as well as statistical adjustment for the effects of social risk. Within the VPT group, the key predictors of children's overall language development were family social risk at birth (p =.05), severity of white matter abnormalities on neonatal magnetic resonance imaging (p =.49), observed parent-child synchrony (p =.001), and concurrent child cognitive ability (p =.001). Together, these factors accounted for 45% of the variance in children's total Clinical Evaluation of Language Fundamentals-Preschool scores.

CONCLUSION

By preschool age, children born VPT show early emerging mild to moderate language delays that are likely to affect their school success and longer-term developmental progress. Findings highlight the importance of potentially modifiable factors such as early brain injury and parenting quality in predicting the language outcomes of children born VPT.

Stability, Continuity, and Similarity of Parenting Stress in European American Mothers and Fathers across their Child's Transition to Adolescence

OBJECTIVE: Experiencing some degree of parenting stress is virtually unavoidable, particularly as children enter early adolescence and assert their independence. In this study, we examined how parenting stress attributed to the parent, the child, or the dyad changed in mean level and relative standing across their child's transition to adolescence. We also compared mothers and fathers from the same families in terms of parenting stress and explored how one parent's stress affected the other parent's stress. DESIGN: Participants included 222 European American parents (111 mothers and 111 fathers), assessed when their children were 10 and 14 years old. RESULTS: Parenting stress was highly stable from 10 to 14 years. Total parenting stress increased across time, and was attributable to stress due to increased parent-child dysfunctional interaction, not parental distress or stress due to child behavior. Mothers and fathers agreed moderately in their relative standing and in the average levels of parenting stress in the three different domains of parenting stress at each time point. Mothers' and fathers' stress across domains were sometimes related. CONCLUSIONS: Mothers' and fathers' increased parenting stress across their child's transition to adolescence seems to derive from parent-child interaction rather than qualities of the parent or the child per se. Finding ways to maintain parent-child communication and closeness may protect parents and families from increased stress during this vulnerable time.