The Mother–Infant Feeding Relationship Across the First Year and the Development of Feeding Difficulties in Low‐Risk Premature Infants

Although feeding problems are common during infancy and are typically accompanied by relational difficulties, little research observed the mother–infant feeding relationship across the first year as an antecedent to the development of feeding difficulties. We followed 76 low‐risk premature infants and their mothers from the transition to oral feeding in the neonatal period to the end of the first year. Prior to hospital discharge, microlevel patterns of maternal touch and gaze were coded during feeding and nonfeeding interactions, global patterns of maternal adaptation were assessed, and infants' neurobehavioral status was tested. Psychomotor development was evaluated at 4 months. At 1 year, feeding difficulties were determined on the basis of maternal interview and direct observations of feeding interactions. Mothers of infants who exhibited feeding difficulties at 1 year showed less affectionate touch and gaze during nonfeeding interactions and more gaze aversion and lower adaptability during feeding interactions already in the neonatal period. Infants with feeding difficulties demonstrated poorer psychomotor performance at 4 months. Feeding interactions of infants with feeding difficulties at 1 year were characterized by higher maternal intrusiveness, lower infant involvement, and greater infant withdrawal. Less maternal affectionate touch and lower maternal adaptation in the neonatal period, poor infant psychomotor skills, and higher maternal intrusiveness and lower infant involvement at 1 year predicted feeding difficulties. The findings underscore the role of the relational components across the first year in the development of feeding difficulties.     

Maternal Cocaine Use and Infant Behavior

This study examined the impact of maternal cocaine use and associated risk factors such as polysubstance use, maternal functioning, and caregiving on affect regulation during infancy. Participants were 45 mother‐infant dyads (19 cocaine exposed and 26 control infants) recruited at birth. Observations and maternal reports of infant behavior were obtained at 2 and 7 months of age, along with measures of pre‐ and postnatal substance use, maternal functioning, and caregiving stability. Maternal cocaine use accounted for significant variance in infant positive affect at 2 months. Other substance use and gestational age predicted infant distress to novelty and arousal during developmental assessments. At 7 months, the impact of prenatal cocaine exposure on infant affect regulation was mediated by postnatal alcohol use and caregiving stability. These findings, if replicated, suggest that 1 pathway to later problem behavior reported among substance‐exposed children may be through early regulatory problems and the quality of postnatal caregiving.     

Comparison at 32–37 Weeks Postconception of Infants Born 1983–1989 and 1995–2004 on the Neurobehavioral Assessment of the Preterm Infant

In spite of numerous recent outcome studies of extremely low birth weight (ELBW) infants, no data exist on their development prior to term. In this study we traced and compared the neurobehavioral development of 251 ELBW (< 1,000 g) and 240 low birth weight (LBW; 1,000 g–2,500 g) preterms born between 1995 and 2004 from 32 to 37 weeks postconceptional age (PCA), using the Neurobehavioral Assessment of the Preterm Infant (NAPI Korner & Thom, 1990). Compared to the original NAPI cohort of 521 infants (born 1983–1989), the ELBW and LBW infants were at higher medical risk, displayed weaker motor development, a tighter scarf sign and popliteal angle at all or most PCAs, and a weaker cry at older PCAs; they did not differ in irritability and percent asleep ratings. Few differences were noted between the ELBW and LBW groups. Research is now needed to determine whether the 1995 to 2004 NAPI values of ELBW and LBW infants at 32 to 37 weeks PCA are predictive of later outcome of high‐risk preterms.     

Predicting Maternal Resolution of Preterm Birth at One Month Corrected Age

Early maternal resolution with preterm birth was assessed at one month corrected age (CA), and potential maternal and infant characteristics that may be associated with early resolution were examined. Fifty‐five mothers of preterm infants (≤34 weeks) participated. Data regarding pregnancy, prenatal risk, delivery, infant's medical risk, maternal well‐being status, and infant's early developmental status were collected. Resolution was examined using the Reaction to Diagnosis Interview (RDI). A total of 38.2% of the mothers were classified as resolved. Only completion of antenatal corticosteroids (ACS) treatment and high prenatal risk significantly predicted maternal resolution. Early maternal resolution of preterm birth is associated with early knowledge regarding the preterm birth.     

Presence and Quality of Touch Influence Coregulation in Mother–Infant Dyads

The first major goal of this study was to determine whether touch would enhance mother—infant coregulation in ordinary, nonstressful face‐to‐face interactions. In an experimental manipulation of presence versus absence of touch in face‐to‐face interactions between 79 mothers and their 3.5‐month‐old infants, results indicated that when touch is prohibited, relaxed and mutually attuned coregulation (asymmetrical coregulation) decreases. Contrary to expectations, coactive and mutually attuned coregulation (symmetrical coregulation) increased during prohibited touch, but this finding was qualified by a significant interaction between touch and order. The second major goal of this study was to question the assumption that the presence of touch should exert uniform effects on mother—infant interactions despite likely individual differences in the way touch is practiced. We assessed affectionate touch and stimulating touch in the touch condition of the experiment. Results indicated that the decrease in symmetrical coregulation during touch was primarily explained by those dyads that practiced more affectionate and less stimulating touch, indicating that affectionate touch is inversely related and stimulating touch is directly related to infant activity level.     

Neurobehavioral Consequences of Prenatal Exposure to Smoking at 6 to 8 Months of Age

Between 400,000 and 800,000 infants are born in the United States each year to women who smoked cigarettes during their pregnancy. Whereas the physical health consequences to infants of prenatal exposure to smoking are well established, the early neurobehavioral consequences are less well understood. This study investigated the neurobehavioral consequences of prenatal exposure to smoking using an epidemiologically derived sample of 454 infants who were drawn from a larger sample of 1,292 infants whose families were recruited at birth. Results indicated that, on average, infants who were exposed to higher levels of prenatal smoking exhibited less positive affect and greater irritability. Moreover, among male infants, elevated levels of prenatal exposure to smoking were associated with lower levels of approach, gross motor movement, reactivity, and attention. There was no evidence that the effects of prenatal exposure to smoking on infant neurobehavioral functioning were mediated by physical growth parameters (infant weight and head circumference) that are also known to be affected by prenatal exposure to smoking.     

Child‐Care Usage and Mother‐Infant “Quality Time”

Mothers' time‐use patterns were compared in families in which infants spent more than 30 hours per week in child care (In‐Care group; n= 143) versus 0 hours per week (At‐Home group; n= 183) from birth to 6 months of age. In‐Care group mothers spent about 12 fewer hours per week interacting with their infants, for about 32% less time; fathers of these infants were more involved in caregiving. The groups did not differ in the quality of mother‐infant interaction. In the In‐Care group, quantity of interaction was related to greater separation anxiety and concerns about effects of maternal employment. Time‐use data were not related to child outcomes at 15 months of age. Results suggest that the effect of extensive time spent apart on the quantity and quality of mother‐infant interaction may be smaller than anticipated.     

Infant Nutrition and 12 and 18 Months Secure Base Behavior: An Exploratory Study

A notable omission in studies of developmental links to early nutritional deficiencies is infant attachment. In those few studies investigating associations between infant nutrition and attachment, nutrition was defined solely by physical growth, and infants had moderate–severe growth retardation. In this study, we utilized multiple markers of infant nutrition. Our sample consisted of 172 12‐month‐old Peruvian infants and their mothers from low‐income families, with a follow‐up assessment on 77 infants at 18 months. Infants were not severely malnourished, but did have micronutrient deficiencies. Anthropometry, dietary intake, and iron status were used as measures of infant nutrition. Based on infant behavior in a structured laboratory situation, Q‐sort techniques were used to rate three attachment markers: infant secure base behavior, interaction quality, and negative emotionality with mother. At 12 months, infant weight was positively related to interaction quality. At 18 months, infant iron status was positively related to secure base behavior. This pattern of findings remained even after statistically controlling for family socioeconomic status and maternal education. Our findings indicate that infant nutritional status is associated with markers of infant attachment and these associations are not restricted just to severely malnourished infants.     

Early childbearing and later economic well-being

In a study of 1268 women, aged 20-24 in 1968, who were surveyed in 1968 and reinterviewed in 1973 and 1975 as part of the National Longitudinal Surveys of the Labor Market Experience of Young Women, the economic situation of the women at age 27 was compared for those who had given birth to a child during their teen years with those who did not bear a child until after age 18. The effects on economic status of early childbearing were primarily negative and operated indirectly through intervening variables such as, decreased educational levels and higher fertility rates. For each year a birth was postponed, annual earnings at age 27 were increased by $197. Surprisingly, women who had a child at age 15 or 16 experienced fewer negative economic effects at age 27 than those who had a child at age 17 or 18; perhaps the younger girls continued to live with their parental family and remained in school while the slightly older girls left the parental family and dropped out of school. The negative economic effects at age 27 for black women who bore a child at an early age were less pronounced than for white women. Policy makers should be aware of these long-term negative economic effects of early childbirth and efforts should be made 1) to increase child care programs which enable young mothers to continue their schooling; 2) to provide family planning services to young mothers who are at greater risk of subsequently having large families; 3) to encourage young mothers to remain living with their parental family; and 4) to provide additional training and job counseling for young mothers. Tables depict 1) mean and standard deviations for 50 sociodemographic variables for women who were less than 19 at first birth and for women who were 19 or older at first birth; 2) estimated structural equations for the total sample, for whites only, for blacks only, for those 19 years or older at first birth, and for those less than 19 years of age at first birth; and 3) effect on economic well-being at age 27 of delaying birth by one year by age at first birth and by race.     

Infants' Transitions out of a Fussing/Crying State Are Modifiable and Are Related to Weight Status

Currently, about 10% of infants have a weight for length greater than the 95th percentile for their age and sex, which puts them at risk for obesity as they grow. In a pilot obesity prevention study, primiparous mothers and their newborn infants were randomly assigned to a control group or a Soothe/Sleep intervention. Previously, it has been demonstrated that this intervention contributed to lower weight‐for‐length percentiles at 1 year; the aim of the present study was to examine infant behavior diary data collected during the intervention. Markov modeling was used to characterize infants' patterns of behavioral transitions at ages 3 and 16 weeks. Results showed that heavier mothers were more likely to follow their infants' fussing/crying episodes with a feeding. The intervention increased infants' likelihood of transitioning from a fussing/crying state to an awake/calm state. A shorter latency to feed in response to fussing/crying was associated with a higher subsequent weight status. This study provides preliminary evidence that infants' transitions out of fussing/crying are characterized by inter‐individual differences, are modifiable, and are linked to weight outcomes, suggesting that they may be promising targets for early behavioral obesity interventions, and highlighting the methodology used in this study as an appropriate and innovative tool to assess the impact of such interventions.     

Maternal Caregiving Moderates the Relation Between Temperamental Fear and Social Behavior with Peers

Temperament works in combination with a child’s environment to influence early socioemotional development. We examined whether maternal caregiving behavior at infant age 9 months moderated the relation between infant temperamental fear (9 months) and observations of children’s social behavior with an unfamiliar peer at age 2 in a typically developing sample of 155 children. When infants received lower quality maternal caregiving, temperamental fear was inversely related to observed social engagement and aggression. These relations were nonsignificant when infants received higher quality maternal caregiving. Findings indicate that variations in temperamental fear may predict individual differences in future peer interactions, but sensitive, nonintrusive caregiving behaviors can attenuate these associations.     

The effects of domestic violence during pregnancy on maternal and infant health

The present study examined the impact of domestic violence on maternal and infant health by assessing maternal health during pregnancy and infant health at two months postpartum. Two hundred and two women (68 battered and 134 non-battered) were recruited from the community and completed both pregnancy and 2-month postpartum interviews. Results revealed that domestic violence during pregnancy was associated with numerous health problems for mothers and infants including more health problems during pregnancy, more likelihood of premature labor, later entrance into prenatal care, lower infant birth weight, greater utilization of health care resources, and more prenatal substance use. After income was controlled, the relationship between violence and timing of prenatal care and infant birth weight became nonsignificant. Maternal social support was found to protect against the effects of violence for several health outcomes. The current findings suggest the need for domestic violence screening during pregnancy, as well as clinical interventions for battered, pregnant women in order to prevent serious physical and emotional problems for both mothers and their infants.     

Cognitive function in toddlers with congenital heart disease: The impact of a stimulating home environment

Infants born with congenital heart disease (CHD) are at increased risk of neurodevelopmental difficulties in childhood. The extent to which perioperative factors, cardiac physiology, brain injury severity, socioeconomic status, and home environment influence early neurodevelopment is not clear. Sixty-nine newborns with CHD were recruited from St Thomas’ Hospital. Infants underwent presurgical magnetic resonance imaging on a 3-Tesla scanner situated on the neonatal unit. At 22 months, children completed the Bayley Scales of Infant and Toddler Development-3rd edition and parents completed the cognitively stimulating parenting scale to assess cognitive stimulation at home. Level of maternal education and total annual household income were also collected. Hospital records were reviewed to calculate days on the intensive care unit post-surgery, time on bypass during surgery, and days to corrective or definitive palliative surgical intervention. In the final analysis of 56 infants, higher scores on the cognitively stimulating parenting scale were associated with higher cognitive scores at age 22 months, correcting for gestational age at birth, sex, and maternal education. There were no relationships between outcome scores and clinical factors; socioeconomic status; or brain injury severity. Supporting parents to provide a stimulating home environment for children may promote cognitive development in this high-risk population.     

Infants’ Biological Sensitivity to the Effects of Maternal Social Support: Evidence Among Mexican American Families

The identification of infants who are most susceptible to both negative and positive social environments is critical for understanding early behavioral development. This study longitudinally assessed the interactive effects of infant vagal tone (respiratory sinus arrhythmia; RSA) and maternal social support on behavioral problems and competence among 322 low‐income Mexican American mother–infant dyads (infants: 54.1% female) and explored sex differences. Infant RSA was calculated from resting HR data at 6 weeks of age. Mothers reported on general social support, partner support, and family support at 6 months, and infant behavioral problems and competence at 1 year. Two‐way interactions (RSA × support source) were evaluated to predict behavioral problems and competence, adjusting for covariates. Results indicated higher competence among infants with lower RSA whose mothers reported higher general support or higher partner support. Interactive effects on behavior problems of RSA with maternal partner or family support were only found for female infants: Girls with higher RSA showed more behavior problems when mothers reported low support, but fewer problem levels in the context of high support. Our results suggest that infant RSA is an important moderator of the effects of the early social environment on early development.     

Vocal Coordination During Early Parent–Infant Interactions Predicts Language Outcome in Infant Siblings of Children with Autism Spectrum Disorder

This study examined vocal coordination during mother–infant interactions in the infant siblings (high‐risk infants; HR) of children with autism spectrum disorder (ASD), a population at heightened risk for developing language delays (LDs). Vocal coordination between mothers and HR infants was compared to a group of low‐risk (LR; no first‐ or second‐degree relative with ASD) dyads and used to predict later language development. Nine‐month‐old infants were video‐taped at home playing with their mothers, and interactions were coded for the frequency and timing of vocalizations. Percent infant simultaneous speech was predictive of later LD, and dyads with LD infants were less coordinated with one another in average latency to respond than dyads with non‐delayed (ND) infants. The degree of coordination between mothers and infants on this variable predicted a continuous measure of language development in the third year. This research underscores the importance of understanding early development in the context of interaction.     

Predicting Patterns of Regulatory Behavior in the Still‐Face Paradigm at 3 Months

The current study addressed two aims: (1) to describe different patterns of infant regulatory behavior during the Face‐to‐Face Still‐Face (FFSF) paradigm at 3 months of age and (2) to identify specific, independent predictors of these patterns from an a priori set of demographic, infant (e.g., temperament), and maternal (e.g., sensitivity) variables. Analyses were based on data collected for 121 mother–infant dyads assessed longitudinally in the newborn period and again at 3 months. In the newborn period, infants’ neurobehavior was evaluated using the Neonatal Behavioral Assessment Scale (NBAS) and mothers reported on their caregiving confidence and their newborns’ irritability and alertness. At 3 months, mothers reported on their infant's temperament, and mother–infant interactions were videotaped during free play and the FFSF. Three patterns of infant regulatory behavior were observed. The most common was a Social‐Positive Oriented Pattern, followed by a Distressed‐Inconsolable Pattern, and a Self‐Comfort Oriented Pattern. Results of multinomial logistic regression indicated that categorical assignment was not associated with demographic or infant characteristics, but rather with dyadic regulatory processes in which maternal reparatory sensitivity played a crucial role.     

Trajectories of Parenting During Infancy: The Role of Infant Temperament and Marital Adjustment for Mothers and Fathers

Although it is well accepted that parents greatly impact infant development, it is less clear which factors impact change in quantity and quality of parenting across infancy. This longitudinal study (N = 120 families) investigated how infant temperament and marital adjustment related to trajectories of mother and father involvement and sensitivity across infancy using multilevel models. Parental involvement (caregiving and play), infant temperament (surgency, negative affectivity, regulation), and marital adjustment were assessed from questionnaires when the infant was 3, 5, 7, 12, 14, and 20 months of age; parental sensitivity was coded from two episodes of the Still‐Face Paradigm in early infancy (3, 5, and 7 months). On average, mothers showed higher levels of caregiving, play, and sensitivity than fathers. Mother caregiving, play, and sensitivity increased over time. Father caregiving and play also increased over time, whereas sensitivity did not change with age. Happier marriages were related to increased play for both mothers and fathers. Infant surgency was also significantly related to caregiving, play, and sensitivity trajectories for mothers but not fathers. Findings are discussed in relation to parenting roles and family dynamics.     

Patterns of positivity: Positive affect trajectories among infants of mothers with a history of depression

This study examined positive affect (PA) trajectories over the first year of life among infants of mothers with a history of depression (N = 191) as well as predictors (i.e., maternal prenatal and postpartum depression symptoms, maternal parenting behaviors) of those trajectories. Infant PA was observed in play and feeding tasks during laboratory visits at 3, 6, and 12 months of age; parenting behaviors were observed at 3 months. Mothers completed questionnaires regarding their symptoms of depression throughout the prenatal period and during the first 3 months postpartum. Growth curve analyses indicated that infant PA increased across time, and this finding replicated across both the play and feeding tasks, though increases slowed over time. Neither maternal prenatal nor postpartum depression symptoms predicted infants' PA trajectories, but mothers' PA, positive parenting, and disengaged parenting were associated with infant PA during the play task. Our finding that infant PA increased over the first year postpartum suggests PA trajectories among infants of mothers with a history of depression may be indices of resilience, despite risks associated with their mothers' history of depression. Furthermore, this study highlights parenting behaviors that may be important targets of prevention and early intervention efforts to bolster infant PA.     

Families by Adoption and Birth: II. Mother-Infant Cognitive Interactions

Adopted children are more likely to develop learning and school adjustment problems than are their nonadopted peers, despite that learning potential appears to be comparable in the two groups. In an effort to explain this phenomenon, the present study examined cognitive behavior repertoires in mothers and their healthy 5-month-old first infants during their normal daily routine in families by adoption and by birth. Two areas of functioning, vocal/verbal communication and exploration, were examined. Infants and mothers in both groups were similar in the frequency and ranking of a full array of age-appropriate cognitive behaviors. Both groups of babies experienced rich and comparable opportunities for the development of language competence. In the exploratory realm, group differences emerged for some infant measures; infants by birth were in an alert state and mouthed objects more than infants by adoption. Examination of the linkages among infant behaviors and between mothers and infants suggested that while mothers by birth and adoption provided comparable opportunities for exploration, infants by birth were engaging in exploratory behavior to a somewhat greater extent.     

Effects of Maternal Responsiveness on Infant Responsiveness and Behavior in the Still‐Face Task

The effects of maternal responsiveness on infant responsiveness and behavior in the Still‐Face Task were longitudinally examined through infants' first 3 months. Maternal vocal responsiveness and infant vocal and smiling responsiveness significantly increased when infants were 2 months of age. Mothers showed continuity of individual differences in vocal responsiveness from the infants' newborn period. Maternal responsiveness predicted infant responsiveness within and across sessions. Compared with infants with low‐responsive mothers, infants with high‐responsive mothers were more attentive and affectively engaged during the Still‐Face Task from 1 month of age. Infants with high‐responsive mothers discriminated between the task phases with their smiling at 1 month, a month before infants with low‐responsive mothers did so. Infants in both groups discriminated between the phases with their attention and nondistress vocalizations throughout their first 3 months. Results suggest that maternal responsiveness influences infant responsiveness and facilitates infants' engagement and expectations for social interaction.