Improving mother-infant interaction during infant feeding: A randomised controlled trial in a low-income community in South Africa

BACKGROUND

Maternal-infant feeding interactions are a primary context for engagement between mothers and their infants, and constitute a unique space in which reciprocity, attunement and maternal sensitivity can be expressed. Increasingly, research demonstrates the importance of the psychological and social nature of the feeding context, and how it may be affected by maternal mental state, feeding skills and sensitivity. As such, feeding interactions may provide useful contexts for observations of maternal sensitivity, reflecting well on day-to-day maternal sensitivity.

AIMS AND OBJECTIVES

This paper is a post hoc examination of the impact of an intervention on maternal sensitivity during a feeding interaction when the infants were 6 months old.

PARTICIPANTS

A total of 449 women consented to participate in the original intervention and were randomly assigned to the intervention or control groups. Mothers and infants were assessed during pregnancy, and then at 2, 6, 12 and 18 months of infant age. At the 6 month follow-up visit, 79% (354 out of 449) of the participants were retained. Post hoc analyses were conducted on the original sample to determine breastfeeding status. Sixty-nine percent of the women completed the feeding observation at the 6 months follow-up visit, of which 47% reported exclusively breastfeeding and 22% reported bottle-feeding.

RESULTS

Results demonstrated that during a feeding interaction, maternal sensitivity was significantly improved among non-breastfeeding mothers who received the intervention. Particularly, maternal responsiveness to infant cues and synchronous interactions was higher among non-breastfeeding intervention mothers compared to control group mothers. The results also show that non-breastfeeding mothers who received the intervention were significantly less intrusive in their interactions with their infants.

CONCLUSION

The intervention had particular beneficial effects for mothers who were not breastfeeding and suggest that the intervention offered a protective effect for non-breastfeeding mothers.

EARLY MALTREATMENT AND CURRENT QUALITY OF RELATIONAL CARE PREDICT SOCIOEMOTIONAL PROBLEMS AMONG INSTITUTIONALIZED INFANTS AND TODDLERS

The present study is focused on child socioemotional problems 6 months after institutionalization, by considering the putative predictive role of child maltreatment, of developmental functioning at admission and the following months, and of the quality of institutional relational care. Fifty institutionalized infants and toddlers participated in this study. Child developmental functioning (i.e., cognitive, language, and motor development) was assessed at admission to the institution (Wave 0), and 3 (Wave 1) and 6 months (Wave 2) thereafter. The quality of institutional relational care-operationalized in terms of caregivers' sensitivity and cooperation-was measured at Wave 2. Caregivers reported on the presence of disturbed socioemotional behaviors at Wave 2. Child gestational age, birth weight, age, and stunted growth at admission to the institution served as covariates. Results revealed significant associations between socioemotional difficulties and lower levels of motor development at Waves 0 and 1, child maltreatment, and less sensitive caregiving. A logistic regression showed that child maltreatment and caregiver insensitivity were the only significant predictors of disturbed socioemotional functioning by the end of 6 months of institutionalization.

A LONGITUDINAL EXAMINATION OF TODDLERS' BEHAVIORAL CUES AS A FUNCTION OF SUBSTANCE-ABUSING MOTHERS' DISENGAGEMENT

As a group, substance-abusing parents are at risk for maladaptive parenting. The association between substance abuse and parenting may result, in part, from parents' emotional disengagement from the parent-child relationship, which makes perceiving and responding to children's cues more challenging. In this study, we examined whether substance-abusing mothers' levels of disengagement from their relationship with their children (ages 2-44 months), operationalized in two different ways using parenting narratives (representational and linguistic disengagement), prospectively predicted children's engagement and disengagement cues during a structured mother-child interaction. Within a sample of 29 mothers, we tested the hypotheses that greater maternal disengagement at Time 1 would predict a decrease in children's engagement and an increase in children's disengagement at Time 2. Results indicated that representational disengagement predicted a decrease in children's engagement cues whereas linguistic disengagement predicted an increase in children's disengagement cues. Results provide partial support for a reciprocal, iterative process in which mothers and children mutually adjust their emotional and behavioral disengagement with one another.