Maternal sensitivity: a concept analysis

Development of temperamental regulation of infants at 6 and 24 months: Associations with maternal soothing and distress

Background and Aims

In the neurobiological theory of attention, the orienting network mainly supports the temperamental regulatory function in infancy, with soothing methods such as visual attention distraction influencing its development. The attention distraction method chosen for soothing is thought to be influenced by maternal sensitivity, which has been found to decrease with poor maternal mental health. We hypothesize that the degree of maternal distress may affect the choice of attention distraction soothing method. Further, individual differences in being soothed by attention distraction will be associated with the temperamental regulation function in infancy/toddlerhood.

Method

Structural equation modeling (SEM) was conducted on longitudinal data at 6 and 24 months on a sample (N = 1892) drawn from the sub-cohort of the Japan Environment and Children's Study (JECS). Temperament was examined through the short Infant Behavior Questionnaire-Revised (Japanese version) and the Early Childhood Behavior Questionnaire (Japanese version). Distress in caregivers was measured through the Kessler Psychological Distress Scale (Japanese version) at prenatal and 1-year-postnatal stages. Individual differences in using visual distraction soothing methods were also measured using tailor-made items.

Results

Postnatal maternal distress at 12 months was negatively related to the tendency to use visual attention distraction as a soothing method (β = -0.06, p = 0.006) at 24 months. When we applied the subscale of the temperamental regulatory factor in SEM, the more the mothers chose the distraction method for soothing, i.e., the more the toddlers experienced it, the higher their attention shifting scores (β = 0.07, p = 0.002).

Conclusion

The findings support the view that caregivers' choice of method for distracting offspring's attention from distress may be associated with the development of self-regulation during infancy and toddlerhood.

Parent-Child Interactions May Help to Explain Relations Between Parent Characteristics and Clinically Observed Child Autistic Behaviours

The importance of supporting parent-child interactions has been noted in the context of prodromal autism, but little consideration has been given to the possible contributing role of parental characteristics, such as psychological distress. This cross-sectional study tested models in which parent-child interaction variables mediated relations between parent characteristics and child autistic behaviour in a sample of families whose infant demonstrated early signs of autism (N = 103). The findings suggest that associations between parent characteristics (psychological distress; aloofness) and child autistic behaviours may be mediated by the child's inattentiveness or negative affect during interactions. These findings have important implications in developing and implementing interventions in infancy which target the synchrony of parent-child interaction with the goal to support children's social communication development.

Effects of Face-to-Face Education Followed by Mobile Messaging to Primiparas on Maternal-Neonatal Care, Breastfeeding, and Motherhood Experience: A Randomized Controlled Trial

OBJECTIVE

This study aims to investigate the effectiveness of education on breastfeeding and basic maternal-neonatal care and mobile message support given to primiparous women in the postpartum period on breastfeeding and motherhood experiences.

METHODS

This prospective randomized controlled study was conducted in a hospital located in a city in Turkey, with 130 primiparous patients in the postpartum period (65 individuals in the experimental group and 65 individuals in the control group). Participants in the experimental group were provided with education on breastfeeding and basic maternal-neonatal care at the hospital, and mobile messages were sent with the same content as an education program for six weeks after discharge.

RESULTS

Mean scores of the breastfeeding self-efficacy (58.95 vs. 54.87; P<.05) and breastfeeding attitude (60.80 vs. 57.55; P<.05) are significantly higher in the experimental group compared to the control group. Similarly, the mean score of satisfaction with the motherhood experience is significantly improved in the experimental group compared to the control group (22.95 vs. 26.46; P<.05). It was determined that 89.2% of the women in the experimental group were still breastfeeding; 93.8% of them did not have nipple problems, and 60% of them did not use a bottle or pacifier in the six-month postpartum period (P<.05).

CONCLUSION

Education on breastfeeding and basic maternal-neonatal care given in the early postpartum period and mobile messages sent for six weeks after discharge may help to improve breastfeeding self-efficacy, breastfeeding attitude, and maternal experience satisfaction among primiparous women.

Diagnosis of peripartum depression disorder: A state-of-the-art approach from the COST Action Riseup-PPD

BACKGROUND

Peripartum depression (PPD) is a major depression disorder (MDD) episode with onset during pregnancy or within four weeks after childbirth, as defined in DSM-5. However, research suggests that PPD may be a distinct diagnosis. The goal of this study was to summarize the similarities and differences between PPD and MDD by synthesizing the current research on PPD diagnosis concerning different clinical features and give directions for improving diagnosis of PPD in clinical practice.

METHODS

To lay the groundwork for this narrative review, several databases were searched using general search phrases on PPD and its components of clinical diagnosis.

RESULTS

When compared to MDD, peripartum depression exhibits several distinct characteristics. PPD manifests with a variety of symptoms, i.e., more anxiety, psychomotor symptoms, obsessive thoughts, impaired concentration, fatigue and loss of energy, but less sad mood and suicidal ideation, compared to MDD. Although PPD and MDD prevalence rates are comparable, there are greater cross-cultural variances for PPD. Additionally, PPD has some distinct risk factors and mechanisms such as distinct ovarian tissue expression, premenstrual syndrome, unintended pregnancy, and obstetric complications.

CONCLUSION

There is a need for more in-depth research comparing MDD with depression during pregnancy and the entire postpartum year. The diagnostic criteria should be modified, particularly with (i) addition of specific symptoms (i.e., anxiety), (ii) onset specifier extending to the first year following childbirth, (iii) and change the peripartum onset specifier to either "pregnancy onset" or "postpartum onset". Diagnostic criteria for PPD are further discussed.

Severity of developmental delay and parenting behavior in toddlers with neurodevelopmental disabilities

Introduction

The presence of a neurodevelopmental disability (ND) represents an adverse condition for child's development and parent-child relationship, and it is reasonable to assume that the severity of delay may influence parenting behavior. Previous research, however, did not specifically address this issue.

Methods

This cross-sectional study compared parental behaviors of mothers of toddlers with moderate/severe or mild/borderline developmental delay and mothers of toddlers with typical development, while considering maternal emotional states. A total of 88 dyads with children aged between 12 and 47 months participated in a 10-min video-recorded interaction then coded with the PICCOLO, a validated observation checklist that assesses four dimensions of parenting: affection, responsiveness, encouragement, and teaching. The mothers also fulfilled two standardized questionnaires assessing parental stress and presence of depressive symptoms. MANOVA and MANCOVA models were used to explore between-group differences in specific parenting dimensions, also considering parental stress.

Results

Mothers of toddlers with ND were less responsive than the comparison group, while the presence of a moderate/severe developmental delay specifically affected teaching behaviors. No differences emerged for affection and encouragement behaviors. Importantly, although mothers of toddlers with moderate/severe ND reported higher child-related dysfunctional interaction stress, this did not directly affect parenting behaviors.

Discussion

These findings highlight how the presence of a disability and the severity of developmental delay can affect specific dimensions of parenting (i.e., responsiveness, teaching) and might inform clinical practice and research on early parental interventions.

The effect of antenatal education on expectant mother's childbirth attitudes, maternal role attainment, and self-confidence levels

We aim to determine the effect of antenatal education on the attitudes of expectant mothers toward birth, maternal role attainment and self-confidence levels. We carried out this quasi-experimental, non-randomized, prospective study in a hospital located in Istanbul, in the pre- and post-education model. Women in the education group (EG = 60) attended 6 weeks of education. Women in the control group (CG = 60) participated in a periodic follow-up visit. We collected the data using Childbirth Attitudes Questionnaire (CAQ), Pharis Self-Confidence Scale (PSCS), and Semantic Differential Scale-Myself as Mother (MMS). We made three measures in total: in the first visit, after six weeks and in the sixth week postpartum. We found the mean scores of second measurement of CAQ, PSCS, third measurement of MMS statistically significant in favor of EG (p < 0.05). Antenatal educations positively affect childbirth attitude, maternal role attainment and self-confidence levels.

Changes in patterns of Early Mother-Child Interaction: A longitudinal study of the first 18 months of life

OBJECTIVE

The main objective of the present longitudinal study is to describe the progression of early adult-child interactions between the first and second years of life. Changes identified in interactions are described, focusing on both the qualitative aspects of maternal responses, as well as maternal response latency to the child's behavior using a microanalytical methodology that collected data on maternal and child behavior in real-time without losing sight of the temporal dimension.

PARTICIPANTS

This study examined 52 mother-child dyads from intact families that presented no psychological, social, or biological risk factors at 6, 12 and 18 months of age.

INSTRUMENT

CITMI-R (early mother-child interaction coding system, revised edition) was used to assess early mother-infant interactions during free play sessions between mother and child the.

RESULTS

The results indicate that some components of maternal sensitivity improve as children progress towards the second year of life, detecting an increase in sensitive maternal behavior and a decrease in intrusive behavior in the evolutive observed period; moreover, regarding latency of maternal response, we observed that mothers of older children give more time for their children to explore, which stimulates autonomy. Finally, the implication of these results for intervention directed to optimizing early adult-child interactions are addressed.

Preterm infant cues during breastfeeding and its measurement: A scoping review

Background

Preterm infants display certain behaviors to communicate their needs, known as preterm infant cues. However, the existing research on preterm infant cues primarily draws from studies conducted on bottle-fed infants rather than breastfed infants.

Objective

This study aimed to investigate the concept of preterm infant cues during breastfeeding and its appropriate instruments.

Design

A scoping review.

Data Sources

The articles published up to January 2022 were searched from multiple sources from EBSCOhost Web, namely CINAHL Plus with Full Text, MEDLINE, ERIC, and E-Journals.

Review Methods

The articles retrieved for this review were screened using PICO (Population, Intervention, Comparison, and Outcomes) format. Preferred Reporting Items for Systematic Reviews (PRISMA) checklist was used in selecting the articles, and Joanna Briggs Institute Critical Appraisal was utilized by two independent authors to assess the articles' quality. A descriptive method was used to analyze the data.

Results

The initial review stage found 183 potential articles, but only four satisfied the criteria. The notion of preterm infant cues during breastfeeding is centered on the actions of preterm infants while positioned on their mother's chest. These feeding cues are identifiable before, during, and after breastfeeding and include cues for hunger, self-regulation, stress, satiation, approach, avoidance, and sucking quality. To effectively recognize these cues, tools such as the Preterm Infants Cues Coding System (PFCCS), Infant Driven Scale (IDS), Newborn Individualized Developmental Care and Assessment Program (NIDCAP), and Preterm Breastfeeding Behavior Scale (PIBBS) can be utilized.

Conclusion

The study findings highlight the importance of recognizing preterm infant cues during breastfeeding to facilitate proper feeding and developmental care. Observational studies have proven to be an effective means of observing these cues during breastfeeding. By leveraging the cues identified in this review alongside tools such as PFCCS, IDS, NIDCAP, and PIBBS, nurses can accurately interpret preterm infants' breastfeeding cues in neonatal care settings of all levels. This, in turn, can aid in developing care plans that promote better feeding ability outcomes.

History of "Serve and Return" and a Synthesis of the Literature on its Impacts on Children's Health and Development

Parent/caregiver sensitivity and responsiveness are important for children's health and development. The "serve and return" metaphor was created to help providers and caregivers understand the importance of sensitive and responsive early caregiving. In this review, we explain the concept of "serve and return", outline historical and theoretical principles that culminated in this metaphor, highlight parent and child constructs associated with "serve and return" interactions, and synthesize literature on sensitive and responsive caregiving and children's health and developmental outcomes. Nurses and other healthcare professionals in public policy, clinical, community, education, and research roles need knowledge of "serve and return" interactions.

Preterm Birth and Other Measures of Infant Biological Vulnerability: Associations with Maternal Sensitivity and Infant Cognitive Development

INTRODUCTION

Low birth weight (LBW), biological vulnerability that includes preterm birth (PTB) and small for gestational age (SGA), is associated with reduced maternal sensitivity ("making accurate inferences about an infant's physical and emotional needs and responding appropriately") and impaired infant cognitive development. However, research does not examine if preterm birth, SGA, or both drive these associations. This study separated these measures of biological vulnerability to examine associations of LBW, PTB, and SGA with maternal sensitivity and infant cognitive development (controlling for maternal depression, breastfeeding, and demographic covariates).

METHODS

The sample included 6900 9-month-old infants from the Early Childhood Longitudinal Study-Birth Cohort and used birth certificate data, maternal interviews, assessments of maternal sensitivity and infant cognitive development. Multiple linear regressions examined LBW, PTB, and SGA associations with concurrent measures of maternal sensitivity and infant cognition.

RESULTS

Of the biological vulnerabilities, preterm birth had the strongest negative association with maternal sensitivity (F_1,6450 = 29.48 versus 15.33 and 5.51, ps < .001) and infant cognitive development (F_1,6450) = 390.65 versus 248.02 and 14.43, ps < .001). In the final regression model, preterm birth and maternal sensitivity were uniquely associated with infant cognitive development (R² = .05, p < .001), after controlling for maternal depression, breastfeeding, and demographics.

CONCLUSION

In this nationally representative infant sample infants, PTB had a stronger negative association with both maternal sensitivity and infant cognitive development in comparison to SGA or LBW. The LBW designation combines infants born preterm with SGA infants, potentially minimizing differences in developmental outcomes of PTB and SGA infants.

Maternal postpartum anxiety and the development of infant attachment: The effect of body sensations on infant attachment

BACKGROUND

Knowledge about the influences of maternal postpartum anxiety disorders (PAD) on infant development is limited. Aim of this present study is to evaluate the influence of PAD on infant attachment.

METHODS

In a longitudinal study, self-reported anxiety symptoms of N = 70 mothers (N = 28 with PAD diagnosed according to the DSM-IV, N = 42 controls) were examined in the postpartum period and one year later. Infants' attachment was observed in the Strange Situation Test (SST) at the age of 12-24 months.

RESULTS

Results indicate a strong relationship between PAD and infant attachment: infants of mothers with PAD were significantly more likely to be classified as insecure or disorganized than infants of control mothers. Logistic regression analysis led to a significant model with 76.8 % correct classification of infant attachment dependent on the maternal fear of anxiety associated body sensations (OR = 4.848) in the postpartum period. Including maternal sensitivity and interaction behavior, only maternal intrusiveness was additionally associated with infant attachment (ρ = 0.273, p < .05; OR = 45.021, p = .153).

LIMITATIONS

Participants were highly educated. Different anxiety disorders included led to a heterogenous sample. Generalization is diminished. Maternal sensitivity was measured on a global scale, and body tension was self-reported.

CONCLUSIONS

PAD plays a crucial role in the development of infant attachment. Interaction-focused interventions, helping mothers to decrease intrusiveness, and body-focused interventions, helping mothers to deal with their fear of anxiety symptoms, might be promising pathways to buffer the influence of PAD on infant attachment.

Caregiver sensitivity supported young children's vocabulary development during the Covid-19 UK lockdowns

Previous studies have shown that caregivers' sensitive, responsive interactions with young children can boost language development. We explored the association between caregivers' sensitivity and the vocabulary development of their 8-to-36-month-olds during COVID-19 when family routines were unexpectedly disrupted. Measuring caregivers' sensitivity from home interaction videos at three timepoints, we found that children who experienced more-sensitive concurrent interactions had higher receptive and expressive vocabularies (N=100). Children whose caregivers showed more-sensitive interactions at the beginning of the pandemic showed greater expressive vocabulary growth six (but not 12) months later (n=58). Significant associations with receptive vocabulary growth were not observed. Our findings highlight the importance of sensitivity at a time when other positive influences on language development were compromised.

BAMBI: A new method for automated assessment of bidirectional early-life interaction between maternal behavior and pup vocalization in mouse dam-pup dyads

Vital early-life dyadic interaction in mice requires a pup to signal its needs adequately, and a dam to recognize and respond to the pup's cues accurately and timely. Previous research might have missed important biological and/or environmental elements of this complex bidirectional interaction, because it often focused on one dyadic member only. In laboratory rodents, the Pup Retrieval Test (PRT) is the leading procedure to assess pup-directed maternal care. The present study describes BAMBI (Bidirectional Automated Mother-pup Behavioral Interaction test), a novel automated PRT methodology based on synchronous video recording of maternal behavior and audio recording of pup vocalizations, which allows to assess bidirectional dam-pup dyadic interaction. We were able to estimate pup retrieval and pup vocalization parameters accurately in 156 pups from 29 dams on postnatal days (PND) 5, 7, 9, 11, and 13. Moreover, we showed an association between number of emitted USVs and retrieval success, indicating dyadic interdependency and bidirectionality. BAMBI is a promising new automated home-cage behavioral method that can be applied to both basic and preclinical studies investigating complex phenotypes related to early-life social development.

Maternal caring ability with the preterm infant: A Rogerian concept analysis

AIM

To analyze the concept of maternal caring ability for a preterm infant to develop an operational definition.

BACKGROUND

Each year, many newborns are born preterm and admitted to the neonatal intensive care unit (NICU). Although their mothers are prepared for discharge home by the staff, it is difficult to identify an operational definition of their maternal caring ability for the preterm infant.

DESIGN

Concept analysis.

DATA SOURCES

Searches used PubMed, as the primary health-related literature, ProQuest, Science Direct, CINHAL, web of science, Scopus, and Google Scholar. Keywords caring ability, mother, and preterm infant were used to analyze the development of the concept from 1965 to 2020.

METHODS

Rogers' and Knafl's evolutionary approach has been used to explain the concept of maternal caring ability for the preterm infant.

RESULTS

The combined searches yielded 23,291 documents published in English. After the screening process, 43 documents were selected. The Graneheim and Lundman analysis method was used to identify the themes related to the attributes of maternal caring ability. Findings showed the caring ability to have four antecedents (maternal characteristics, support systems, infant characteristics, and the illness severity), four attributes (knowledge and skill in neonatal care, self-efficacy, sensitivity, responsibility, and problem-solving), and three consequences (parental adjustment, improving infant growth and development, and improving parent-infant relationships).

CONCLUSION

The caring ability of the mother of a preterm infant is grounded in an adequate knowledge of caregiving needs of a preterm infant, high caregiving skills, a sense of self-efficacy, problem-solving, sensitivity, and responsibility.

Automated procedure to assess pup retrieval in laboratory mice

All mammalian mothers form some sort of caring bond with their infants that is crucial to the development of their offspring. The Pup Retrieval Test (PRT) is the leading procedure to assess pup-directed maternal care in laboratory rodents, used in a wide range of basic and preclinical research applications. Most PRT protocols require manual scoring, which is prone to bias and spatial and temporal inaccuracies. This study proposes a novel procedure using machine learning algorithms to enable reliable assessment of PRT performance. Automated tracking of a dam and one pup was established in DeepLabCut and was combined with automated behavioral classification of "maternal approach", "carrying" and "digging" in Simple Behavioral Analysis (SimBA). Our automated procedure estimated retrieval success with an accuracy of 86.7%, whereas accuracies of "approach", "carry" and "digging" were estimated at respectively 99.3%, 98.6% and 85.0%. We provide an open-source, step-by-step protocol for automated PRT assessment, which aims to increase reproducibility and reliability, and can be easily shared and distributed.

Does breastfeeding account for the association between maternal sensitivity and infant cognitive development in a large, nationally representative cohort?

Background

Previous research has established that exposure to high maternal sensitivity is positively associated with advances in infant cognitive development. However, there are many fixed and modifiable factors that influence this association. This study investigates whether the association between maternal sensitivity and infant cognitive development in the first year of life is accounted for by other factors, such as breastfeeding, maternal depressive symptoms, maternal alcohol use, infant birth weight or demographic covariates.

Methods

Using data from the Early Childhood Longitudinal Study-Birth (ECLS-B) Cohort, a nationally representative sample of U.S. born children, multi-variable regression analyses was used to examine whether breastfeeding, maternal depressive symptoms and alcohol use were associated with maternal sensitivity, as measured by the Nursing Child Assessment Teaching Scale (NCATS), and with infant cognitive development, as measured by the Bayley Scales of Infant Development, Short Form, Research Edition, after controlling for demographic covariates (infant sex, maternal age, education, race/ethnicity, income, parity, family structure) and infant birth weight.

Results

Breastfeeding, depressive symptoms and alcohol use were not associated with maternal sensitivity scores after controlling for demographic covariates and infant birth weight. However, breastfeeding (β = .079, p < .001), depressive symptoms (β = −.035, p < .05), and maternal sensitivity (β = .175, p < .001) were each significantly associated with infant cognitive development scores, even after controlling for demographic covariates and birthweight (R² = .053, p < .001). The association between maternal sensitivity and infant cognitive development did not attenuate after adjusting for breastfeeding. Instead, both sensitivity and breastfeeding independently contributed to higher infant cognitive development scores.

Conclusion

Maternal sensitivity and breastfeeding are separate means to advancing infant cognitive development. This study is significant because it is the first to examine breastfeeding, maternal depressive symptoms and alcohol use together, upon the association between maternal sensitivity and infant cognitive development, after adjusting for demographic covariates and infant birthweight. Maternal sensitivity, a measurable quality, advances infants’ cognitive development. Moreover, sensitivity and breastfeeding had independent effects upon cognitive development after controlling for multiple fixed and modifiable covariates. Understanding factors impacting the association between sensitivity and infant cognitive development provide avenues for developing more effective parenting interventions.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12887-022-03133-4.

Adapting to Uncertainty: A Mixed-Method Study on the Effects of the COVID-19 Pandemic on Expectant and Postpartum Women and Men

Detrimental biopsychosocial effects of the COVID-19 pandemic on populations have been established worldwide. Despite research indicating that the transition to parenthood is a vulnerable period for maternal and paternal health, an in-depth examination of the specific challenges the pandemic poses for new mothers and fathers is still lacking. Using a mixed-method design, we investigated individual and relational well-being of women and men who were expecting their first child during the first months of the COVID-19 pandemic in Portugal and its associations with contextual, individual, and relational factors. Adults older than 18 (n = 316, 198 women) from early pregnancy to 6-months postpartum completed a cross-sectional online survey assessing sociodemographic, individual (depression, anxiety, perceived stress), and relational (dyadic adjustment, perceived social support) self-report measures. From those, 99 participants (64 women) responded to an open-ended question and reported perceived changes in their couple's relationship due to the pandemic. Men responding during strict lockdown measures reported significantly higher levels of perceived stress relative to those men who were not under lockdown. Overall, women reported higher levels of depression and greater social support than men. Qualitative analyses resulted in two main themes: Individual Changes and Relational Changes. These themes aggregate personal concerns and experiences (e.g., worsening of mental health, uncertainty about the future, lack of freedom) interrelated with relational issues (e.g., increased togetherness, avoidance of physical contact, and increased availability for parenthood during lockdown). The prevalence of negative effects (58.6%) exceeded the described positive effects (28.3%), and 13.1% described both positive and negative effects of the pandemic. Current findings offer grounds for important evidence-based strategies to mitigate the potential adverse effects of the current pandemic on new mothers' and fathers' individual and relational well-being.

The porridge-like framework: A multidimensional guidance to support parents of children with developmental disabilities

Parents of children with developmental disabilities face many daily challenges that can lead to emotional and affective problems, difficulties in caregiving, and partial mental representations about themselves and their children. The multi-faceted nature of these parents' needs requires a multi-component approach that should include the analysis of priority support goals and the planning of tailored therapeutic actions. Despite different types of validated interventions are available, the choice of the most appropriate strategy to pursue a family-centered approach to support parents of infants with developmental disabilities is not obvious. In this scenario, we propose a multi-dimensional model, the porridge-like framework of parenting. It considers three interrelated domains in parents' experience - affective (A), behavioral (B), and cognitive (C) aspects - that are intertwined with the specific degree of the child's impairment (D). This ABCD model may provide professionals with pragmatically valid guidance to plan and deliver family-centered healthcare interventions. By covering the multi-dimensional nature of parenting challenges, it provides clinicians with conceptual categories to recognize the specific needs and to choose the most suitable therapeutic action to address them. In addition, it aims to promote an ethical approach to family-centered rehabilitation for children with developmental disabilities, maximizing the potentials of a collaborative assessment approach.

Using Co-design to Explore How Midwives Can Support the Emerging Mother-Infant Relationship During the Early Postnatal Period: Protocol for a Mixed Methods Study

BACKGROUND

The postnatal period can be a challenging time for women, with mothers experiencing a range of emotions. As a woman transitions to motherhood, she adjusts to a new sense of self and forms a new relationship with her infant. Becoming a mother is a complex cognitive and social process that is unique for each woman and is influenced and shaped by culture. The emerging mother-infant relationship is a significant factor in maternal well-being and infant development, with the bond between the mother and her baby being critical to the development of secure attachment. It has been recognized that the strength of this relationship is the main predictor of how well a child will do throughout life. There has been a global focus on the importance of the first 1000 days, with Australia identifying this as a national priority. Midwives are ideally placed to support mothers during the development of the mother-infant relationship, providing care through the early postnatal period, which has been identified as a sensitive period for the development of the mother-infant relationship.

OBJECTIVE

The aim of this study is to explore how midwives can support the emerging mother-infant relationship in the context of cultural diversity and develop an appropriate co-designed intervention in the early postnatal period.

METHODS

This study will use a mixed method approach, specifically the exploratory sequential design (intervention development variant). This study will be undertaken in 3 phases: 1 qualitative phase, which is followed by 2 quantitative phases. Phase 1 will include a scoping review to explore interventions that have influenced the development of the mother-infant relationship, and then, interviews will be undertaken with women exploring their early experiences of motherhood, followed by 3 co-design workshops. The workshops will engage with multilevel stakeholder representatives where, through partnership and participation, they will propose and develop an intervention to support the emerging mother-infant relationship. Phase 2 will develop and pilot 2 purpose-designed evaluation surveys to evaluate the co-designed intervention from the perspective of both mothers and midwives. Phase 3 will implement and evaluate the co-designed intervention using pre- and postmeasures and feedback from the purpose-designed surveys.

RESULTS

Phase 1 has commenced and is expected to be completed by August 2021. Phase 2 is expected to be completed by September 2021, with phase 3 commencing in October 2021. The study will be completed by March 2023.

CONCLUSIONS

The results of this study will be shared with a variety of audiences and will contribute to the body of knowledge on the mother-infant relationship, potentially improving the understanding of this relationship for women and midwives. This may result in improved strategies for care, with mothers benefiting from enhanced experience and satisfaction during the early postnatal period.

Disrupted mothering in Iranian mothers with breast cancer: a hybrid concept analysis

Background

Defining the disrupted mothering would contribute to developing strategies to support mothers with breast cancer. The aim of this study was to analyze the concept of mothering disruption using a hybrid model.

Methods

The Hybrid method for concept analysis was implemented consisting of three phases: theoretical, fieldwork, and final analysis. In the theoretical phase, the literature was searched using electronic databases including PubMed, ScienceDirect, Scopus, ProQuest, Google Scholar, CINAHL, Wiley, Ovid, Magiran, and SID from 2000 to 2020. Any quantitative or qualitative studies published in English or Persian, which were focused on mothering disruption in mothers with breast cancer were included in the study. In the phase of fieldwork, 20 mothers were interviewed to explore the aspects of mothering disruption. The interviews were transcribed and analyzed with conventional content analysis. In the final phase, an overall analysis of the two previous phases was performed.

Results

In the theoretical phase, the following attributes were determined: “disturbance in maternal identity and roles”, “maternal insensitivity and unresponsiveness: disconnection physically and psychologically”, “the career disruption process” and “biographical disruption”. The fieldwork phase explored three themes including “the unbalance between multiple roles”, “role failure”, and “reduced maternal sensitivity”. The final synthesis yielded that the main integrated elements of mothering disruption are “disease as threating maternal role and identity”, “inability to interpret and respond to child behaviors and needs”, and “support for transitioning from being patient toward maternal competency”.

Conclusion

With a deeper understanding of the term ‘disrupted mothering’ or ‘mothering disruption’, healthcare providers will have a foundation to improve cancer care, deliver effective communication and help such mothers cross this disruption and achieve restoration of their mothering role. Future research is needed to validate this concept and explore connections with health outcomes.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12905-021-01346-w.

Togetherness, beyond the eyes: A systematic review on the interaction between visually impaired children and their parents

BACKGROUND

Parent-child interaction is essential to promote adaptive emotional, cognitive, and social development. The majority of previous research on parent-child interaction is largely dependent on face-to-face exchanges that require the interactive partners to visually recognize reciprocal communicative bids. Therefore, previous findings in the field can only partially apply to the early interactive patterns occurring between visually impaired infants and their parents. The present study was aimed to systematically review the available evidence on parent-child interaction in the context of developmental visual impairment.

METHODS

Fourteen papers were finally selected after literature search on PubMed and Scopus. Data synthesis was focused on three core topics: visually impaired children's contribution to the interaction, parental caregiving behaviors with visually impaired children, and the association between parents' behaviors and the developmental outcomes of children with visual impairment.

RESULTS

Visually impaired children may exhibit reduced reactivity to maternal stimuli and less-than-optimal levels of interactive initiations in social exchanges. Parents of children with visual impairment may use more descriptive communicative acts and greater directiveness compared to mothers of sighted counterparts. Specific caregiving behaviors (e.g., responsiveness and goal setting) of parents of children with visual impairment may significantly support language and socio-emotional development as well as sensorimotor integration.

DISCUSSION

Children with visual impairment may be less responsive and they may produce less clear communicative bids while interacting with their parents. Their parents may face specific challenges while engaging with them and they may become increasingly directive and intrusive. Nonetheless, even in the presence of visual impairment, the quality of parental caregiving behaviors appears to play a potential preventive role in the face of children's socio-emotional and cognitive outcomes. These results suggest that early interventions focused on parent-child interactions are especially needed in this population.

The temporal dimension in the understanding of maternal sensitivity in caregiver-infant interactions: The 'Early Mother-Child Interaction Coding System'

Caregiver-child interaction is known to play a central role in children's socioemotional development, yet the diversity of measures commonly used to evaluate it call into question the nature of the construct being assessed. Contingency within caregiver-child interactions has been identified as a key dyadic process that requires taking a temporal perspective to evaluating interactions. The Early Mother-Child Interaction Coding System is a psychometrically sound measure that sequentially code the flow of interactive and non-interactive behaviours within a caregiver-infant system. Its use of the framework of nonlinear dynamical systems (NDS) expands our understanding of contingent caregiver-infant dyadic behaviour.

Parental Sensitivity and Responsiveness as Mediators Between Postpartum Mental Health and Bonding in Mothers and Fathers

Background: There is a lack of studies that examine the complex relationship between parental mental health, parental sensitivity and responsiveness, and parent-infant bonding. This study aimed to test whether parental sensitivity and responsiveness were mediators between postpartum mental health (depression, anxiety, and stress) and parent-infant bonding in mothers and fathers. Method: Mothers (n = 427) and fathers (n = 170) of infants aged up to 1-year-old participated in an online study. The parents completed questionnaires on depression (Edinburgh Postnatal Depression Scale, EPDS), anxiety and stress (Depression, Anxiety, and Stress Scale, DASS-21). Parent-infant bonding was measured by Postpartum Bonding Questionnaire (PBQ) that has three components: Impaired bonding (PBQ1), Anxiety about care and parental distress (PBQ2), and Lack of enjoyment and affection with infant (PB3Q). Parental sensitivity was measured as the number of correct recognitions of infant facial expressions (City Infant Faces Database, CIFD). Responsiveness was measured as a self-report with two subscales of responsiveness and non-responsiveness (Maternal Infant Responsiveness Instrument, MIRI). Results: The path analysis showed that the model had a good fit to the data. Parental sex was a significant moderator, indicating different paths in mothers and fathers. In mothers, responsiveness and non-responsiveness were significant mediators between depression symptoms and three dimensions of bonding. In fathers, only non-responsiveness was a significant mediator between anxiety and PBQ3. Although recognizing infant facial expressions directly affected PBQ3 in mothers (but not in fathers), it was not a significant mediator between mental health and bonding. Conclusion: Higher levels of parental mental health problems (depression and anxiety) were associated with lower levels of parental responsiveness, which is, in turn, related to poor parent-infant bonding. Prevention and intervention programs should be offered for both mothers and fathers, focusing on postpartum mental health promotion and enhancing responsiveness in infant care.

A ESCUTA PSICANALÍTICA DA FAMÍLIA FRENTE AO DIAGNÓSTICO DE AUTISMO DA CRIANÇA

RESUMO: Este trabalho investiga a escuta da família face ao diagnóstico de autismo da criança. Realizou-se a construção de caso clínico de uma família composta pelo casal parental, o filho adolescente, e Ícaro, três anos de idade, diagnosticado com autismo. A discussão do caso é ancorada nas premissas teóricas da clínica de família e enfatiza o tom afetivo melancólico que se estabelece em uma relação particular com o diagnóstico. A escuta do grupo familiar permitiu acessar a função psíquica que o diagnóstico pôde assumir à medida que passou a servir de barreira defensiva ao sofrimento e ao desamparo frente às perdas vivenciadas pela família.

The Early Years Home Learning Environment - Associations With Parent-Child-Course Attendance and Children's Vocabulary at Age 3

Although many studies investigated the effects of the home learning environment (HLE) in the preschool years, the constructs that underlie the HLE in the years before the age of three and its effects on language development are still poorly understood. This study therefore investigated the dimensionality of the HLE at age two, its relation to the attendance of low threshold parent-child-courses, and its importance for children's vocabulary development between age 2 and 3 years against the background of differing family background characteristics. Using data from 1,013 children and their families of the Newborn Cohort of the German National Educational Panel Study, structural equation modeling analyses showed that (1) quantitative and qualitative aspects of the early HLE, i.e., the frequency of stimulating activities, and the quality of parent-child-interactions should be differentiated; (2) that family background variables are differentially associated with the HLE dimensions and (3) that attendance at parent-child courses enriches both aspects of the HLE which in turn (4) are related to the children's vocabulary development. Our results highlight the need to differentiate aspects of the early HLE to disentangle which children are at risk in terms of which stimulation at home and the possibility to enrich the HLE through low threshold parent-child courses.

A guided participation nursing intervention to theraupeutic positioning and care (GP_Posit) for mothers of preterm infants: protocol of a pilot randomized controlled trial

Background

In the NICU, interventions intended to enhance maternal sensitivity are indicated in order to optimize preterm infant development and long-term mother-infant attachment. A novel nursing intervention was developed following a theory-oriented methodology and is based upon the guided participation theory for mothers to participate in their preterm infant's therapeutic POSITioning and care (GP_Posit). The primary objective of this study is to evaluate the feasibility and acceptability of (i) the study design; and (ii) the experimental GP_Posit nursing intervention during NICU hospitalization. The secondary objective is to estimate the preliminary effects of GP_Posit on maternal and preterm infant outcomes.

Methods

A pilot parallel-group randomized clinical trial (RCT) was designed where mother-preterm infant dyads are being recruited and randomized to a control group (usual care) or experimental group (GP_Posit intervention). Data collection includes feasibility and acceptability data as well as preliminary effects on maternal sensitivity and infant neurodevelopment. Ethical approval from the University Hospital ethical board was obtained in January 2018 (2017-1540).

Discussion

Data collection for this pilot study is expected to end in 2020. Results of this pilot study will inform about the feasibility and acceptability of the study design and GP_Posit intervention, a nursing intervention having the potential to favor maternal sensitivity and infant neurodevelopment in the NICU and guide the elaboration of a large-scale RCT.

Trial registration

clinicaltrial.gov, NCT03677752. Registered 19 September 2018.

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.

Video feedback for parental sensitivity and attachment security in children under five years

BACKGROUND

Children who are securely attached to at least one parent are able to be comforted by that parent when they are distressed and explore the world confidently by using that parent as a 'secure base'. Research suggests that a secure attachment enables children to function better across all aspects of their development. Promoting secure attachment, therefore, is a goal of many early interventions. Attachment is mediated through parental sensitivity to signals of distress from the child. One means of improving parental sensitivity is through video feedback, which involves showing a parent brief moments of their interaction with their child, to strengthen their sensitivity and responsiveness to their child's signals.

OBJECTIVES

To assess the effects of video feedback on parental sensitivity and attachment security in children aged under five years who are at risk for poor attachment outcomes.

SEARCH METHODS

In November 2018 we searched CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, nine other databases and two trials registers. We also handsearched the reference lists of included studies, relevant systematic reviews, and several relevant websites SELECTION CRITERIA: Randomised controlled trials (RCTs) and quasi-RCTs that assessed the effects of video feedback versus no treatment, inactive alternative intervention, or treatment as usual for parental sensitivity, parental reflective functioning, attachment security and adverse effects in children aged from birth to four years 11 months.

DATA COLLECTION AND ANALYSIS

We used standard methodological procedures expected by Cochrane.

MAIN RESULTS

This review includes 22 studies from seven countries in Europe and two countries in North America, with a total of 1889 randomised parent-child dyads or family units. Interventions targeted parents of children aged under five years, experiencing a wide range of difficulties (such as deafness or prematurity), or facing challenges that put them at risk of attachment issues (for example, parental depression). Nearly all studies reported some form of external funding, from a charitable organisation (n = 7) or public body, or both (n = 18). We considered most studies as being at low or unclear risk of bias across the majority of domains, with the exception of blinding of participants and personnel, where we assessed all studies as being at high risk of performance bias. For outcomes where self-report measures were used, such as parental stress and anxiety, we rated all studies at high risk of bias for blinding of outcome assessors. Parental sensitivity. A meta-analysis of 20 studies (1757 parent-child dyads) reported evidence of that video feedback improved parental sensitivity compared with a control or no intervention from postintervention to six months' follow-up (standardised mean difference (SMD) 0.34, 95% confidence interval (CI) 0.20 to 0.49, moderate-certainty evidence). The size of the observed impact compares favourably to other, similar interventions. Parental reflective functioning. No studies reported this outcome. Attachment security. A meta-analysis of two studies (166 parent-child dyads) indicated that video feedback increased the odds of being securely attached, measured using the Strange Situation Procedure, at postintervention (odds ratio 3.04, 95% CI 1.39 to 6.67, very low-certainty evidence). A second meta-analysis of two studies (131 parent-child dyads) that assessed attachment security using a different measure (Attachment Q-sort) found no effect of video feedback compared with the comparator groups (SMD 0.02, 95% CI -0.33 to 0.38, very low-certainty evidence). Adverse events. Eight studies (537 parent-child dyads) contributed data at postintervention or short-term follow-up to a meta-analysis of parental stress, and two studies (311 parent-child dyads) contributed short-term follow-up data to a meta-analysis of parental anxiety. There was no difference between intervention and comparator groups for either outcome. For parental stress the SMD between video feedback and control was -0.09 (95% CI -0.26 to 0.09, low-certainty evidence), while for parental anxiety the SMD was -0.28 (95% CI -0.87 to 0.31, very low-certainty evidence). Child behaviour. A meta-analysis of two studies (119 parent-child dyads) at long-term follow-up found no evidence of the effectiveness of video feedback on child behaviour (SMD 0.04, 95% CI -0.33 to 0.42, very low-certainty evidence). A moderator analysis found no evidence of an effect for the three prespecified variables (intervention type, number of feedback sessions and participating carer) when jointly tested. However, parent gender (both parents versus only mothers or only fathers) potentially has a statistically significant negative moderation effect, though only at α (alpha) = 0.1 AUTHORS' CONCLUSIONS: There is moderate-certainty evidence that video feedback may improve sensitivity in parents of children who are at risk for poor attachment outcomes due to a range of difficulties. There is currently only little, very low-certainty evidence regarding the impact of video feedback on attachment security, compared with control: results differed based on the type of measure used, and follow-up was limited in duration. There is no evidence that video feedback has an impact on parental stress or anxiety (low- and very low-certainty evidence, respectively). Further evidence is needed regarding the longer-term impact of video feedback on attachment and more distal outcomes such as children's behaviour (very low-certainty evidence). Further research is needed on the impact of video-feedback on paternal sensitivity and parental reflective functioning, as no study measured these outcomes. This review is limited by the fact that the majority of included parents were mothers.

Relative effects of breastfeeding intention and practice on maternal responsiveness

Our objective was to examine the differential effects of antenatal breastfeeding intention (BI) and breastfeeding practice (BP) on maternal postnatal responsiveness. We conducted a secondary analysis of longitudinal data from a subsample of 962 mother-infant dyads from a U.K.-based birth cohort study the Avon Longitudinal Study of Parents and Children. Exposures were BI and BPs measured at 32 weeks of gestation and 18 months' postpartum. The outcome was maternal responsiveness assessed at 12 months' postpartum. We used logistic regression analyses unadjusted and adjusted for confounders. Intention to breastfeed was associated with increased odds of postnatal maternal responsiveness independent of BP, adjusted odds ratio (OR) = 2.34, 95% CI [1.42, 3.86]. There was no evidence that BP was an independent predictor of maternal responsiveness, OR = 0.93, 95% CI [0.55, 1.57]. Life-course epidemiology analyses demonstrated that maternal responsiveness is most positive when both BI and BP are present. This is the first population-based study to provide evidence that BI during pregnancy is more strongly associated with maternal postnatal responsiveness than is BP. Further research is needed to understand the determinants of BI in pregnancy and its relationships with maternal responsiveness.

Sexual well-being and perceived stress in couples transitioning to parenthood: A dyadic analysis

Background/Objective

The transition to parenthood encompasses several psychological and relational changes that might contribute to couples’ high levels of stress postpartum. Although common across the postpartum, couples’ sexual changes are frequently overlooked.

Method

We surveyed 255 mixed-sex new parent couples to examine the associations between sexual well-being—sexual satisfaction, desire, and postpartum sexual concerns—and perceived stress postpartum. Couples completed self-report questionnaires assessing perceived stress and sexual well-being.

Results

For both mothers and fathers, greater sexual satisfaction was associated with their partners’ lower perceived stress and, for fathers, this was also associated with their own lower perceived stress. For mothers, greater partner-focused sexual desire was associated with their own lower perceived stress whereas, for fathers, greater partner-focused sexual desire was associated with their partners’ higher perceived stress. In addition, greater solitary sexual desire and postpartum sexual concerns were associated with both parents’ own higher perceived stress.

Conclusions

This study highlights the association between sexual well-being and couples’ postpartum stress, suggesting that more positive sexual experiences are linked to lower perceptions of stress across this vulnerable period. Couples’ sexual well-being may be an important target for interventions aimed at helping postpartum couples cope with stress.

Maternal nurturing experience affects the perception and recognition of adult and infant facial expressions

The perception and recognition of facial expressions are crucial for parenting. This study investigated whether and how maternal nurturing experience and trait anxiety influence the perception and recognition of infant and adult facial expressions. This was assessed by comparing the performance of primiparous mothers (n = 25) and non-mothers (n = 28) on an emotional face perception task. Trait anxiety was measured using the Japanese version of the State-Trait Anxiety Inventory (STAI). We found that mothers had higher recognition accuracy for facial expressions, but only of adults, not infants. Moreover, as trait anxiety increased, so did mothers’ sensitivity in perceiving facial expressions of both infants and adults. These findings suggest that maternal nurturing experience does enhance the recognition of adult emotional expressions, and an optimal level of maternal trait anxiety may enhance mothers’ sensitivity toward infants’ and adults’ emotional signals.

Maternal sensitivity is associated with configural processing of infant's cues in preterm and full-term mothers

BACKGROUND

Prematurity may affect mother-infant bonding and alter maternal sensitivity to infant's cues. Efficient perception of infants' facial and bodily cues is a crucial aspect of maternal sensitivity and may be challenged by prematurity, as infants' signals may not be easily intelligible. However, it is still unexplored how premature birth impacts the maternal ability to perceive infants' signals.

AIMS

To investigate whether prematurity influences the perceptual sensitivity of mothers to infants' cues and, in particular, the configural processing of the faces and bodies of familiar and unfamiliar infants.

STUDY DESIGN

The inversion effect paradigm was used to evaluate the configural vs. detail-based processing of the face and body of own or others' infants. Preterm mothers were compared to full-term mothers with either low or high maternal sensitivity.

PARTICIPANTS

Forty-three healthy full-term and twenty-one preterm mothers of infants aged about six months.

OUTCOME MEASURES

Maternal sensitivity during dyadic interaction, gestational age, accuracy and reaction time in a delayed matching-to-sample task of upright vs. inverted body and face stimuli (i.e., inversion effect).

RESULTS

Preterm mothers were found to be less sensitive than the full-term ones. Higher maternal sensitivity during dyadic interaction was associated with lower inversion effect for unfamiliar as compared to own infants' bodies. However, preterm mothers and full-term mothers with low sensitivity showed comparable inversion effect in perceiving unfamiliar infants' faces or bodies.

CONCLUSIONS

Preterm birth per se does not directly affect body configural processing, but it may be associated to reduced maternal sensitivity, ultimately leading to a less refined perception of own infant's cues.

Evaluating Caregiver Sensitivity to Infants: Measures Matter

The significance of caregiver sensitivity for child development has been debated among scholars, not least due to sensitivity's inconsistent predictive value over time and across contexts. A lack of uniformity in the definition of sensitivity contributes to this debate, but shortfalls of inter-tool concordance and construct validity in the instruments used to assess sensitivity may also be at issue. This study examines correspondences among four established standardized measures of caregiver sensitivity in independent classifications of the same sample of mothers of infants. 50 European American mother- infant dyads of diverse SES were independently assessed with three observational caregiver sensitivity measures: the Emotional Availability Scales (EAS; Biringen, 2008), the Parent Child Interaction - Nursing Child Assessment Feeding Scale (PCI-NCAFS; Oxford & Findlay, 2015), and the Maternal Behaviour Q-Sort (MBQS; Moran, Pederson & Bento, 2009). Ratings were juxtaposed with classifications of the same sample based on the original Ainsworth Maternal Sensitivity Scales (AMSS; Ainsworth, 1969). The EAS, NCAFS, and MBQS related to the AMSS, but large proportions of variance were unshared. Researchers and clinicians should be cautious when assuming that popular observational assessment instruments, commonly believed to measure a generic construct of caregiver sensitivity, are interchangeable, as these measures may evaluate different features of sensitivity to infants.

From Uganda to Baltimore to Alexandra Township: How far can Ainsworth's theory stretch?

INTRODUCTION

After extensive observation of mother-infant dyads in two diverse contexts, Ainsworth developed the construct of maternal sensitivity to explain the nature of mother-infant interactions that lead to infant attachment security. She believed this construct to be universally applicable. Since Ainsworth's publications, her theory has been adapted and extended, particularly by theorists working in North American and Western European countries. These developments have been largely uninterrogated in relation to their universal cultural relevance, despite the fact that parenting practices differ greatly across cultural groups. Those who have begun to interrogate the cultural universality of current conceptualisation of maternal sensitivity highlight important areas of cultural disagreement.

METHOD

This article provides a critical theoretical argument regarding the cultural universality of maternal sensitivity, extending comment to the cultural and contextual relevance of developments in its operationalisation.

RESULTS

Particular aspects of current theoretical and operational use of the construct of maternal sensitivity that are potentially culturally specific (as opposed to culturally universal) are noted, namely the inclusion of positive affect, the centrality of parent-infant play, verbal responsiveness, the inclusion of learning in parent-infant interactions and the shift towards a more proactive (rather than reactive) role for the parent in parent-infant interactions.

CONCLUSION

This article suggests that the evolution of the concept of maternal sensitivity has failed to account for cultural differences.

Do mothers enjoy playing sensitively with their infants?

BACKGROUND

Early sensitive caregiver-infant interactions form an important foundation for infant development. Although mutual enjoyment is thought to motivate proximity and continued interactions, there is no empirical evidence that mothers enjoy interacting and behaving sensitively. Research to date has focused on the influence of stable/pathological maternal negative emotions on parenting, with parenting often assessed on one occasion only. Therefore, little is known about what accounts for the variability in sensitivity across interactions.

OBJECTIVES

The objective of the present study was to evaluate what makes sensitivity reinforcing to typical mothers and thus more likely to be repeated. We hypothesised that 15- to 28-week-old infants' positive and active engagement would mediate the relationship between their mothers' sensitivity and change in emotion state from pre- to post-interaction.

METHOD

Using a naturalistic, repeated-measures design, 390 unique interactions from 49 mothers (mean age: M = 29.90 years, SD = 5.41) and their infants (25 female; mean age: M = 22.53 weeks, SD = 3.77) were rated using the Global Rating Scales of Mother-Infant Interaction. Mothers completed measures of their own mood (Profile of Mood States - 15) before and after each interaction.

RESULTS

Mothers reported feeling slightly less negative and more vigorous after interacting with their infants. The more sensitively they behaved, the more engaged their infants were and the more vigorous the mothers felt thereafter. Infant engagement did not mediate the relationship between sensitivity and change in negative emotion or in vigour.

CONCLUSIONS

Results suggest that upon behaving sensitively, mothers feel more vigorous regardless of their infants' engagement.

Infancy and Caring

Caregivers at an institution for motherless infants in rural Tanzania participated in focus group interviews and participant observations. This paper aims at describing how they perceive infancy, caring and sensitivity in their everyday context. It adds knowledge from Tanzania about institutional infant care and the concept of sensitivity in caregiving, based on an approach sensitive to culture and context. The main result is that the caregivers are most concerned with fulfilling the infants’ physical needs. They defined infants’ social and emotional needs in a variety of ways and gave accounts about what sensitivity in caring for infants meant in their context. They also described their workload, their burdens and their strengths, and demonstrated shortcomings in fulfilling the infants’ social and emotional needs. Interventions to promote emotional and social support in addition to fulfilling physical needs are crucial.

Exploring Cascading Effects of Multimodal Communication Skills in Infants With Hearing Loss

Infants and toddlers with hearing loss (HL) are at risk for developing communicative delays that can have a substantial lasting effect. Understanding child characteristics that may be targeted in early intervention is essential to maximizing communicative outcomes in children with HL. Among the most malleable predictors of communication skills include maternal responsivity, gestures, and vocalizations. The purpose of this study was to examine the relationship among maternal responsivity, prelinguistic communication skills and expressive vocabulary in children with HL. Based upon the results we propose a theoretical cascading model of communicative outcomes for children with HL such that gesture use may be associated with future vocalizations which may in turn be related to long-term spoken language outcomes. This exploratory model may be supported by the underlying transactional model of bidirectional language development that occurs through maternal sensitivity in the first two years of life. Additionally, parents of children with HL may be less likely to respond to a single mode of communication than to a combination of modes. This exploratory study provides a theoretical framework by which multimodal communication development in infants and toddlers with HL may be better understood, and suggests hypotheses for future research and implications for intervention practice.

Relationship among Emotional Clarity, Maternal Identity, and Fetal Attachment in Pregnant Women with Gestational Diabetes Mellitus

PURPOSE

The purpose of this study was to examine the relationship among emotional clarity in emotional intelligence, maternal identity, and fetal attachment to measure how emotional clarity and maternal identity impact on fetal attachment and to determine mediating effects of maternal identity in pregnant women at the time of diagnosis with gestational diabetes mellitus (GDM).

METHODS

This study used a correlational survey design. 88 pregnant women with GDM completed a study questionnaire of emotional clarity, maternal identity, and fetal attachment immediately after the diagnosis of GDM. Data were analyzed Mann-Whitney U test, and ANOVA with Duncan test, Pearson correlation, three-step regressions to test mediating effect, and Sobel test.

RESULTS

The emotional clarity was positively related with maternal identity and fetal attachment. It affected maternal identity with 21.9% of explained variance. The emotional clarity and the maternal identity were significant predictors of fetal attachment by 57.7% of explained variance. The maternal identity mediated the relationship between emotional clarity and fetal attachment.

CONCLUSION

The results suggest that a nursing program to enhance the emotional clarity and the maternal identity needs to be developed as an effective strategy to improve fetal attachment.

Effectiveness of an internet-based education on maternal satisfaction in NICUs

OBJECTIVE

This study was conducted to evaluate the effect of internet-based education on the satisfaction of the mothers of the preterm neonates in the NICUs.

METHODS

This quasi-experimental study was conducted on 80 mothers of preterm neonates hospitalized in the NICUs of two hospitals in Iran during 9 months. The mothers were assigned in two groups as cases and controls. The satisfaction level of the mothers was evaluated by using WBPL-Revised¹ in both groups on the first and tenth day of the study. Mothers in the case group received the educational program available at www.iranlms.ir/myinfant for 10days. After 10days, the satisfaction level of the mothers in both groups was measured by questionnaire again.

RESULT

the satisfaction of the mothers increased in both groups after this intervention. However, comparison of the mean scores revealed that the satisfaction of the mothers in the case group increased significantly following the intervention (P<0.001).

CONCLUSION

Considering the benefits of internet-based education, its utilization in mothers education programs in NICUs is recommended.

PRACTICE IMPLICATIONS

The results of this study show nurses in the NICU is a way to improve communication and education to parents of infants hospitalized in NICU.