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poster
The first months after birth is a critical time for the maternal-infant relationship. A new and growing group of infants that has rarely been studied are those with life-threatening health problems who are dependent on technology and hospitalized for many months. Mothers of these medically fragile infants must cope with the challenges inherent in establishing their relationship with their infant within the context of their infant's serious illness, uncertain outcome, technological treatments, and long hospitalizations. Research is complicated by the lack of clarity regarding how to conceptualize and measure the process of maternal role development. The aim of this paper is to describe the conceptualization of and methodological procedures used to study the process of maternal role attainment in mothers of medically fragile infants. Participants were 83 infants and their mothers. The mean age of mothers was 28, mean education level was 12 years, and about half were minority. The 25 fullterm and 58 preterm infants had a variety of serious health problems such as bronchopulmonary dysplasia, congenital heart disease, and gastrointestional disorders. Maternal role attainment was defined as the process by which a mother achieves an identity as a parent, establishes their presence with the child, and becomes competent in caregiving. Maternal Identity (MI) was the degree to which the mother felt like she was a mother. It was measured only at enrollment using the Maternal Identity Scale: Critically Ill Infant. Cronbach's alpha was .85. Maternal Presence (MP) and Maternal Competence (MC) were assessed at enrollment, 6, and 16 months using a triangulation of approaches--ratings of semi-structured maternal interviews and observational data --1-hour naturalistic observations (NO) of mother-infant interaction and the HOME inventory. Variables for each construct were hypothesized a priori based on the conceptualizations of maternal role attainment but internal consistency reliabilities for each construct were used in making final decisions regarding variables for composite scores. MP, the amount of physical closeness with the infant, was measured using a composite score that incorporated 3 interview ratings 96level of interacting with the child, and providing normal and illness-related care; and amount of 4 mother-child interactions from NO--holding, body contact, interaction, and involvement. Cronbach's alphas were .61, .78 and .51 over time. MC, the quality and effectiveness of parenting, was measured using a composite score that included 4 interview rating items97picked up on behavioral cues, advocated for child, supported child, and provided stimulation; 4 NO behaviors97amount of talk, positive, interacting, and playing; and 6 subscales from the HOME. Cronbach's alphas were .63, .81, and .79 over time. MI developed in the early months of life; higher identity was related to being married. MP decreased over time as the infants matured and health improved but was higher over time for infants who were less alert. MC was higher in married and more educated mothers. Helping mothers develop their identity as a mother, encouraging them to get close to their infant through behaviors such as holding and touching, and helping them develop maternal caregiving skills such as bathing and feeding is important in the development of their maternal role.
poster
Mothers often have difficulty developing a maternal role with medicallyfragile infants, those infants with prolonged life-threatening chronicillnesses. The 3 components of maternal role attainment--maternal identity,presence and competence--may each be affected. The purpose was to examinethe extent to which maternal role attainment, when maternal education andchild illness severity were controlled, influences the quality of themother-child relationship. Sixty-seven mothers of medically fragile infants completedquestionnaires, interviews, and observations of feeding their infants every1-2 months during hospitalization, 1 month after discharge, and at 6, 12,and 16 months. The mothers had a mean age of 27 years and mean educationallevel was 13 years. Most (55%) were married; 54% were white, 34% wereblack, and 12% were Asian, Native American, or Hispanic. The infants were58% boys. Their mean birthweight was 2040 grams and ranged from 510 to4120. Infant diagnoses included severe congenital heart disease,bronchopulmonary dysplasia, severe gastrointestional disorders, congenitalanomalies of the airway, and neurologic disorders. Maternal identity, thedegree to which the mother reported feeling she was her infant's mother, wasassessed with a self-report measure. Maternal presence, the amount ofphysical closeness with the infant, was a composite score that combined thematernal reports from the interview of interacting with the infant, normalcaregiving, and illness-related caregiving with 4 behaviors from theobservation--holding, body contact, interaction, and uninvolvement(reversed). Parental competence, the effectiveness of parenting, was acomposite score of maternal interview reports (observing child behavioralcues, advocating for her child, and providing stimulation), observationalbehaviors (talking, expressing positive affect, playing with the child, andinteracting while the child was awake), and 6 HOME sub-scales. The quality of the mother-child relationship at 16 months was determinedfrom ratings of maternal sensitivity during videotapes of mother-infantplay; interviewer ratings of amount of maternal involvement with the infant,quality of normal caregiving and illness-related caregiving throughout thestudy; and maternal perceptions of the child--vulnerability and degree ofease reading infant cues. Mixed general linear models were calculated foreach maternal-child relationship variable with maternal role attainmentvariables, maternal education, and child illness severity (amount oftechnology dependence and Bayley MDI) as predictors. Maternal sensitivitywas related only to parental competence. Involvement was inversely relatedto presence and technology dependence. Quality of normal caregiving wasbetter with greater competence and maternal education. Quality ofillness-related caregiving was positively related to competence andnegatively related to presence. Mothers perceived their child to be morevulnerable and child cues are being more difficult to read if they had lowercompetence and the child was more technologically dependent. Thus, thequality of the relationship between mothers and their medically fragileinfants are influenced more by the level of parental role attainment,particularly parental presence and competence, than by the child's illnessseverity. Interventions with this vulnerable population need to focus onhelping mothers develop their maternal role.
poster
Introduction: Previous research has indicated that length of interpregnancy interval may be related to perinatal outcomes in a subsequent pregnancy. Although perinatal health initiatives in West Virginia have increased access to prenatal care, lowered maternal risk behaviors and reduced infant mortality, the state's percent of newborns at-risk for postneonatal mortality (PNM) has remained unchanged. The purpose of this study was to determine if there was a relationship between interpregnancy interval and PNM risk in a subsequent child.Methods: A total of 3,505 women (5l% primigravid) gave birth to single gestation infants in the index year 1992, and subsequently during 1993-95. Excluded were women with multiple gestation pregnancies and women who had subsequent pregnancies resulting in abortion or fetal loss. The Sheffield Birth Score (SBS) is a significant predictor of PNM risk and it was applied to all newborns. Infants with a High Score (HS SBS > 530) were at significantly greater risk for PNM (p <0.0001) than infants with a Low Score (LS SBS<530). Each index year birth was matched to the occurrence of a subsequent live birth. Using birth certificate data, interpregnancy intervals were computed and partitioned into 6 interval groups: 0- 3 months, 4-6 months, 7-9 months, 10-12 months, 13-24 months, and > 25 months. The mean interpregnancy interval was not significantly different between primigravid and multigravid women.Results: A multiple stepwise regression analysis of factors shown to be related to PNM risk indicated that length of interpregnancy interval, maternal smoking and maternal education were all related to the SBS (p<.01). After adjusting for maternal smoking and maternal education, a multivariate analysis of covariance indicated that interpregnancy interval remained significantly related to the subsequent birth of a HS infant (p <.01). Overall, the infants who were the products of the longest interpregnancy interval (>25 months) were at significantly lower PNM risk than the infants from all five of the other intervals.Discussion: It was demonstrated that interpregnancy interval is significantly related to the subsequent infant's risk for PNM, and this finding remained when maternal smoking and education were held constant. These findings emphasize the significance of preconception planning and suggest lengthening interpregnancy intervals as one strategy to reduce PNM risk. These findings also imply responsibilities that may reside with pediatric health providers as they counsel mothers of newborn infants. Such responsibilities include the providers' willingness to address family planning issues, their success in finding methods for increasing interpregnancy intervals, and their resourcefulness for providing health care services to women of reproductive age, regardless of pregnancy status.
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Coordinated and consistent visual tracking has been shown to be difficult for somechildren with minor motor involvement and learning disorders. This study was part of a largerone designed to investigate patterns using a variety of measures with potential for earlyidentification of abilities among biologically-at-risk infants. Thirty infants (HR) with perinatal complications that can affect the CNS were compared,at 5-7 months corrected ages, with 48 infants (NBH) with normal birth histories. Mostlypreterm, HR subjects averaged 32 weeks gestation and 28 days hospitalization. Subject groups(all AGA infants) were similar on all demographic variables. SES was wide-ranged andaveraged middle class. Measures included the Bayley Motor Scale, devised gross motor (GM)and fine motor (FM) scales from Bayley items, observed fussiness and soothability during theTest of Sensory Functions in Infants (TSFI) (DeGangi, 1989), and the Revised InfantTemperament Questionnaire (RITQ). Measures of ocular motor ability included the TSFItracking item (OMT) and refined scoring of horizontal eye movement during the TSFI circularmotion items involving vestibular input (OMV). The RITQ was additionally scored usingstandard deviation categories. Inter-observer reliabilities were mostly in the low .90's. Analysesinvolved t-tests, ANCOVA's, Chi2's, and Pearson correlations. Age was partialed out for allanalyses as appropriate mainly involving the devised GM and FM scales. Variables didn'tsignificantly correlate with sex or SES. Results indicated the presence of a significant direct relationship between the two ocularmotor items. Neither of these items, nor the Bayley or derived scales, differentiated subjectgroups. Percentages of HR subjects with low scores on tracking and on responses to circularmovement were two to three times as great as those for the NBH group. For the HR group only,infants whose tracking (OMT) was not smooth (and/or didn't involve midline crossing) weremore likely to have lower scores on the Bayley (and on both GM and FM scales, the latterapproaching significance). Several significant correlations for temperament occurred among HRsubjects whereas those for the NBH group were very few and dissimilar. HR infants with poorlyintegrated tracking were more likely to fuss during TSFI items (involving touch, textured objects,and movement) and to be reported as more withdrawing, sensitive to stimuli, and impersistent onthe RITQ (and st. dev. categories). HR infants with less optimal OMV responses were morelikely to be reported as negative in mood. Discriminant analyses will be done to help to further clarify relationships among thesevariables unique to the HR group. Our results are suggestive of patterns seen among olderchildren with learning, attentional, and regulatory disorders. The temperamental qualities aresometimes seen in combination with soft neurological signs involving gross and fine motor andocular motor abilities. Follow-up studies are needed to determine the predictive validity of thecurrent findings.
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Through repeated interactions which are both dynamic and bidirectional innature, infants form expectations about the social world and their role init. As language develops and play becomes more social, infants use moreverbal signals to communicate. There is evidence to suggest that girlsmature faster than boys in this respect. Initiating behaviours, whichrequire infants to form social goals and signal their interest, have beenused to assess social competence in both normative and risk dyads (Landryet al., 1997). The present study examined the development ofattention-seeking behaviours across the first years of life and theaffective quality of these interactions in mother-infant dyads from ahigh-risk sample.While much of the research conducted on risk has used concurrent orretrospective designs, longitudinal and prospective studies can bestexamine the continuity of risk over time and across generations (Luthar &Zigler, 1991). The original participants from the present project wereclassified in childhood as highly aggressive, socially withdrawn, orneither (comparison group). They have been closely followed over the pasttwenty years, and those who have become parents provide a uniqueopportunity to investigate the trajectories of risk and resilience foroffspring.A subsample of 52 mothers and their offspring aged 12-42 months (21 boys,31 girls) participated. A free play period (4 minutes) preceded andfollowed an interference task (3 minutes), during which mothers wereasked to complete a questionnaire while their infants continued to playbeside them. Verbal and non-verbal attention-seeking behaviors, infantlaughter, and maternal behaviour preceding the interference task werecoded from videorecords by observers blind to maternal risk status. Infant age, sex, and maternal risk status were all found to influencedyadic behaviours during play. Verbal attention-seeking strategies wereused more by older infants and mothers were also more likely to give theseinfants an explanation preceding the interference task. Girls made moreverbal bids for attention in free play, and were less likely to resistmothers during the interference task. Mothers identified as highlyaggressive and withdrawn in childhood had infants who laughed less duringthe observations, suggesting that the emotional nature of theirinteractions differ significantly from those of the other dyads in oursample.Consistent with the increasing social nature of their play and a greaterfacility with language, the older infants in our study sought maternalattention more often, used more verbal strategies, and had mothers whowere more likely to explain the disruption in their play before theinterference task. Gender effects suggest different trajectories forsocial development and, consistent with studies of school-age offspring inthis sample, it is the boys whose mothers were both aggressive andwithdrawn in childhood that seem to be most vulnerable. Our findingsunderscore the value of studying infants' developing communicative andaffective displays within a play context, and also have directimplications for the dynamics of early interactions and the transfer ofrisk between high-risk mothers and their infants.