Parenting and Prematurity: Understanding Parent Experience and Preferences for Support

Infants born very preterm are at risk of developmental and behavioural problems and their parents are at risk of psychological distress and compromised parenting. This study has two key aims: (1) to identify, from the parents’ own perspective, the unique aspects of parenting an infant born very preterm and (2) to assess parent preferences for support including opinions of a new, tailored parenting intervention, Prem Baby Positive Parenting Program (Triple P). A qualitative approach was taken with focus groups of 18 parents of infants born preterm and a thematic analysis conducted. Parents identified several unique aspects of parenting an infant born preterm including: difficulty coping with the stress of hospitalisation; institutionalisation to the hospital environment; a lack of preparation for the transition to parenthood; grief; isolation; getting into “bad parenting habits” of overnurturance and a lack of certainty about developmental expectations. Parents preferred parenting support that is tailored to parents of infants born preterm, has flexible delivery, enhances coping skills and the spousal relationship and is sensitive to the emotional context of parenting an infant born preterm. Understanding the experiences and the preferences of parents of infants born preterm is an important step in tailoring parenting interventions to fit their needs.     

Effects of an early intervention on maternal post-traumatic stress symptoms and the quality of mother–infant interaction: The case of preterm birth

Preterm birth may represent a traumatic situation for both parents and a stressful situation for the infant, potentially leading to difficulties in mother–infant relationships. This study aimed to investigate the impact of an early intervention on maternal posttraumatic stress symptoms, and on the quality of mother–infant interactions, in a sample of very preterm infants and their mothers. Half of the very preterm infants involved in the study (n = 26) were randomly assigned to a 3-step early intervention program (at 33 and 42 weeks after conception and at 4 months’ corrected age). Both groups of preterm infants (with and without intervention) were compared to a group of full-term infants. The impact of the intervention on maternal posttraumatic stress symptoms was assessed 42 weeks after conception and when the infants were 4 and 12 months of age. The impact of the intervention on the quality of mother–infant interactions was assessed when the infants were 4 months old. Results showed a lowering of mothers’ posttraumatic stress symptoms between 42 weeks and 12 months in the group of preterm infants who received the intervention. Moreover, an enhancement in maternal sensitivity and infant cooperation during interactions was found at 4 months in the group with intervention. In the case of a preterm birth, an early intervention aimed at enhancing the quality of the mother–infant relationship can help to alleviate maternal post-traumatic stress symptoms and may have a positive impact on the quality of mother–infant interactions.     

Is the Triple P-Positive Parenting Program Acceptable to Parents from Culturally Diverse Backgrounds?

Behavioural parenting programs are an effective intervention for behavioural and emotional problems in children, however these programs have low utilisation rates by culturally diverse parents. We examined the cultural acceptability of program materials, preferences for delivery methods, and barriers to use of the Triple P-Positive Parenting Program. One hundred and thirty seven parents watched a video outlining the 17 strategies in Triple P and read through a tip sheet before completing a series of questionnaires. Results revealed that parents found the strategies highly acceptable, highly useful, were very likely to use the strategies and reported currently using the strategies often. They also rated the program materials as very culturally appropriate and identified group, seminar, television, and individual as the most preferred delivery methods. Parents identified location and timing of services, financial cost, and competing work commitments as the most frequently cited barriers to accessing a parenting intervention. The findings of this study suggest that elements of parenting programs may not be contributing to the low rates of access among culturally diverse parents. These findings highlight the need for more research addressing variables that may contribute to increasing culturally diverse parents’ access of behavioural parenting programs.     

Developmental effects of an intervention for preterm infants of teenage mothers

Since preterm infants and infants born to teenage mothers are noted to be at risk for developmental delays, a group of infants who were both preterm and born to teenage mothers was provided a sensorimotor exercise intervention program for the first year of infancy. The development of these infants was compared to the development of preterm infants without intervention and term infants of teenage mothers as well as term and preterm infants of adult mothers to determine the degree to which developmental delays were prevented. The intervention infants showed more optimal growth, cognitive development, temperament and play behaviors during interactions with their mothers across the first year of development.     

Parenting of low birth weight infants: A review of issues and interventions

Factors that may adversely affect parenting of low birth weight infants, including infant characteristics, parental emotional responses to premature birth, and patterns of parent-infant interaction, are reviewed. In addition, intervention studies designed to improve infant developmental outcomes through influencing parenting behaviors are examined. There was great diversity in theoretical frameworks, in timing of onset and frequency of interventions, and in measurement of outcomes. The interventions that were most effective in influencing behaviors and infant developmental outcomes were those in which there were multiple long-term contacts with parents and/or those that actively involved them in the intervention. The specific theoretical framework upon which the interventions were based appeared to be of less importance in influencing results. In order to increase our knowledge and ability to provide costeffective programs, there is a need to focus attention and data collection efforts on the process and intermediary steps of intervention as well as on outcome measures. There is also a need to improve our ability to recruit and retain those families who are most at risk for parenting and infant developmental problems including those with very low birth weight infants, those whose infants have serious perinatal complications, and those with indications of high social risk such as poverty-level incomes and problems of substance abuse.     

Maternal attachment representations after very preterm birth and the effect of early intervention

Objective

For very preterm infants the mother-infant relationship may be compromised. Maternal attachment representations 18 (corrected) months after very preterm birth and the effect of the post-discharge Infant Behavioral Assessment and Intervention Program (IBAIP) were studied. The IBAIP is designed to assist parents to support and enhance their infant's regulatory competence and development. The intervention consisted of 6-8 home visits during the first 8 months after birth.

Method

Seventy-eight mothers of very preterm infants (<32 weeks and/or <1500 g) were interviewed, who participated in a randomized controlled trial: 41 from the intervention group and 37 from the control group. Maternal attachment representations were assessed with the Working Model of the Child Interview (WMCI). The interviews resulted in a classification of the attachment representations into balanced or non-balanced.

Results

30% of the mothers had non-balanced attachment representations. Qualitative content analysis of the answers showed that negative feelings when first seeing their baby and negative or ambivalent feelings in the first weeks at home with their baby are related to non-balanced attachment representations. The WMCI revealed no differences between the intervention and control group.

Conclusion

Early support for mothers of very preterm born infants to develop a healthy mother-infant relationship is recommended especially for mothers who report negative first experiences.     

Is level of prematurity a risk/plasticity factor at three years of age?

Children born preterm have poorer outcomes than children born full-term, but the caregiving environment can ameliorate some of these differences. Recent research has proposed that preterm birth may be a plasticity factor, leading to better outcomes for preterm than full-term infants in higher quality environments. This analysis uses data from two waves of an Irish study of children (at 9 months and 3 years of age, n = 11,134 children) and their caregivers (n = 11,132 mothers, n = 9998 fathers) to investigate differences in how caregiving affects social, cognitive, and motor skills between full-term, late preterm, and very preterm children. Results indicate that parental emotional distress and quality of attachment are important for child outcomes. Both being born very preterm and late preterm continue to be risk factors for poorer outcomes at 3 years of age. Only fathers’ emotional distress significantly moderated the effect of prematurity on infants’ cognitive and social outcomes—no other interactions between prematurity and environment were significant. These interactions were somewhat in line with diathesis stress, but the effect sizes were too small to provide strong support for this model. There is no evidence that preterm birth is a plasticity factor.     

Conscious Parenting: A Qualitative Study on Swedish Parents’ Motives to Participate in a Parenting Program

Triple P is a parenting program that aims to prevent behavioral, emotional, and developmental problems in children. Because Triple P is a new parenting program in Sweden, it is important to see how parents felt about the intervention. The aim of this study was to find out why parents of preschool children chose to participate in Triple P in Sweden, what they thought of the Triple P curriculum, and how the program related to their parenting philosophy in general. This is a qualitative study using semi-structured interviews with seven mothers and three fathers who participated in Triple P. The interviews were transcribed verbatim and were analysed using Malterud’s method of Systematic Text Condensation. Parents chose to participate in Triple P for several reasons: they wanted to learn more about the intervention; they had specific problems that they sought help for; or they felt encouraged to participate due to advertisements and recommendations from friends. Of the Triple P curriculum, the participants especially enjoyed the “directed discussion” technique, the positive reinforcement sections, and the instructions on how to communicate effectively with their child by staying calm, close, and maintaining eye contact. It was important for many of the parents to feel validated and respected, and they liked having discussions with the preschool teacher rather than being told what to do. Parents in this Swedish sample generally liked and selectively used the strategies they learned from participating in Triple P, depending on how well these fit with their own parenting experiences and philosophy.     

Increasing parenting self-efficacy: The Fussy Baby Network® intervention

High levels of infant crying place families at risk for disrupted relationships, parenting stress, and even for child maltreatment. We conducted an evaluation of the Fussy Baby Network^® (FBN), a program supporting families struggling with infant crying and related concerns. The study contrasted 29 families who sought help from FBN with 27 families with excessively crying infants who did not seek services. Researchers measured parenting self-efficacy, depression, and stress in each group before and after the intervention. Results from hierarchical multiple regression analysis indicated greater improvements over time in parenting self-efficacy for parents receiving FBN services. Furthermore, the greater improvements in parenting self-efficacy in the intervention group were not directly attributable to reductions in infant crying. These findings provide preliminary evidence that the FBN approach may be effective at boosting the confidence of parents struggling with caring for their infants. Future research with larger samples with baseline equivalence and stronger research designs should explore this intervention further. This study also suggests that interventions for families with excessively crying infants should move beyond the focus of reducing infant crying to a broader strategy of supporting parents and strengthening relationships between parents and their infants to build parenting capacity.     

Mother's attachment representations of their premature infant at 6 and 18 months after birth

The effects of premature birth on attachment have generally been examined from the infant's perspective. There is a lack of data concerning parental attachment representations toward a premature child. Because of the psychological stress engendered in parents confronted with a premature birth, we hypothesized that their attachment representations would be altered during the first months after the hospital discharge. Fifty families with a premature infant (25–33 gestation weeks) and a control group of 30 families with a full‐term infant participated to the study. Perinatal risks were evaluated during hospitalization. To assess mothers' representations of their infant, the Working Model of the Child Interview (WMCI, Zeanah & Benoit, 1995 & Benoit, Zeanah, Parker, Nicholson, & Coolbear, 1997) were administered when their children were 6 and 18 months old. The severity of the perinatal risks was found to have an impact on the mothers' attachment representations. At six months, only 20% of the mothers of a prematurely born infant (30% at 18 months) had secure attachment representations, vs. 53% for the control group (57% at 18 months). Furthermore, mothers of low‐risk premature infants more often had disengaged representations, whereas distorted representations were more frequent in the high‐risk group of premature children. These findings suggest that the parental response to a premature birth is linked to the severity of postnatal risks. The fact that secure attachment representations are affected in mothers of low‐risk infants just as much as they are in mothers of high‐risk infants points to the need to conduct further studies aimed at evaluating whether preventive intervention for both low‐risk and high‐risk premature will be helpful.     

Predicting infant maltreatment in low-income families: the interactive effects of maternal attributions and child status at birth

Maternal attributions and child neonatal status at birth were assessed as predictors of infant maltreatment (harsh parenting and safety neglect). The population included low-income, low-education families who were primarily Hispanic. Child maltreatment during the 1st year of life (N = 73) was predicted by neonatal status (low Apgar scores, preterm status), as moderated by mothers' attributions. The highest levels of maltreatment were shown within dyads that included a mother with low perceived power and an at-risk infant. Partial support was found for maternal depressive symptoms as mediators of harsh parenting among at-risk infants. It is suggested that lack of perceived parental power constrains investment in protective relationships and fosters sensitization to potential threat.     

Attentiveness of mothers and fathers to their baby's cries

Thirty-two mother-father-infant triads participated in a study to examine whether parents' responsiveness to their own infant's distress was affected by the infant's birth order and gender. After separating from their 10- to 11-month-old baby, one parent from each family (16 mothers and 16 fathers) was selected to hear cries that were attributed to the child. Consistent with previous findings regarding physiological reactions to crying and observations of caretaking behavior, first-time parents gave quicker and more frequent attention to their infants than did multiporous parents. Speedy intervention was related to the amount of caretaking responsibilities that parents reported they assumed and to the age at which parents believed that their infant first recognized them. The results demonstrate the importance of caretaking for promoting parental sensitivity to infant signals.     

The role of maternal responsiveness in predicting infant affect during the still face paradigm with infants born very low birth weight

There is limited empirical literature addressing infants' response to a standardized stressor with infants born very low birth weight (VLBW). The purpose of this study was to assess the relative strength of maternal responsiveness in predicting infant affect in response to the Still Face (SF) paradigm in a cross‐sectional cohort of ethnically diverse infants born VLBW and their mothers (N = 50; infants 6–8 months old). Infant affect and maternal responsiveness were coded in 1‐s intervals while dyads participated in the SF. In addition, perinatal medical status, developmental status, and infant temperament were assessed. Findings revealed that positive infant affect during and after the SF stressor were strongly associated with baseline infant positive affect and maternal responsiveness at the reunion episode, respectively. In contrast, when predicting negative infant affect during and after the SF stressor, prior infant negative affect was strongly and uniquely significant. Infant positive affect, negative affect, and maternal responsiveness were not significantly associated with gender, infant perinatal medical history, developmental status, or temperament. Future research is warranted to determine how these findings relate to infants' stress reactions in naturalistic settings and if relationship‐focused interventions may reverse infant negative emotionality, enhance positive emotionality, and thereby improve self‐regulation and longer term social and cognitive developmental outcomes in medically at‐risk infants.     

The Role of Parenting Programmes in the Prevention of Child Maltreatment

Child maltreatment is a major worldwide concern and continuing high rates of abuse demand action. This article examines the role of parenting programmes as a strategy to prevent child maltreatment in the population as a whole and also as a targeted intervention for parents who have abused, or are at risk of abusing, their children. We argue that a blend of universal and targeted interventions is needed to reduce the prevalence of child maltreatment. Parenting interventions that concurrently target positive parenting and effective child management skills, dysfunctional parental attributions, and increasing parents' capacity to regulate their emotions are particularly useful. A variant of the Triple P—Positive Parenting Program, known as Pathways Triple P, is discussed to illustrate the value of this approach. Contextual factors that need to be addressed in working with child protection cases are also discussed. The role of training and supervision is discussed in the context of disseminating evidence‐based parenting programmes, and future directions for research are presented.     

Sleep and Attachment in Preterm Infants

Infants born preterm are at elevated risk for socioemotional difficulties; however, factors contributing to this risk are largely understudied. Within the present study, we explored infant sleep as a biosocial factor that may play a role in infant socioemotional development. Within a prospective longitudinal design, we examined parent‐reported sleep patterns and observed parenting quality as predictors of infant–mother attachment in 171 infants born preterm. Using structural equation modeling, we examined main effect and moderator models linking infant sleep patterns and parenting with attachment security. Sleep patterns characterized by more daytime sleep and positive/responsive parenting predicted infant attachment security. Parent‐reported nighttime sleep patterns were unrelated to attachment in this sample of infants born preterm. These results indicate that daytime sleep and parenting quality may be important for emerging attachment relationships in infants born preterm.     

Stepping Stones Triple P: An RCT of a Parenting Program with Parents of a Child Diagnosed with an Autism Spectrum Disorder

Whilst the Triple P Positive Parenting Program has a large evidence base (Sanders, Clinical Child and Family Psychology Review 2:71–90, 1999; Sanders, Journal of Consulting and Clinical Psychology 68:624–640, 2000) and preliminary evidence indicates that Stepping Stones Triple P is also efficacious (Roberts, Journal of Clinical Child and Adolescent Psychology, 35(2):180–193, 2006), to date Stepping Stones has not been evaluated with the ASD population. Fifty-nine families with a child with ASD aged between 2 and 9 participated in this randomized controlled trial. The results demonstrate significant improvements in parental reports of child behaviour and parenting styles with the treatment effects for child behaviour, parental over reactivity and parental verbosity being maintained at follow-up 6 months later. Further, the results suggest significant improvements in parental satisfaction and conflict about parenting as well as a sleeper effect for parental efficacy. The results indicate that Stepping Stones Triple P is a promising intervention for parents of children with ASD. Limitations and future research are also addressed.     

Read your baby: A follow-up intervention program for parents with NICU infants

An intervention model designed to provide education and support to parents of sick or preterm infants throughout their first year of life is described. The intervention focused on helping parents communicate more skillfully with their infant and encouraging parents to maximize their infant's participation in the family system. Seventeen medium-risk infants received intervention; another seventeen served as controls. Independent evaluations of all families at 12 months adjusted age revealed that intervention babies were significantly advanced on Bayley Scales of Infant Development and Mastery Motivation tasks and that their mothers viewed them as easier to care for and less irritable.     

The influence of infant irritability on maternal sensitivity in a sample of very premature infants

The relationship between maternal sensitivity and infant irritability was investigated in a short‐term longitudinal study of 29 very preterm infants. Infant irritability was assessed at term with the Brazelton NBAS, the Mother and Baby Scales (MABS) and the Crying Pattern Questionnaire (CPQ). Maternal sensitivity was assessed by nurses' ratings in the neonatal care unit and at three months during mother–infant interaction observation. Cross‐lagged panel analysis indicated that neonatal irritability did not influence sensitivity at 3 months nor did maternal sensitivity in the newborn period lead to reduced irritability at 3 months. Both irritability and maternal sensitivity showed moderate stability over time (r = 0.55 and r = 0.60, respectively). It is concluded that in early infancy maternal sensitivity shows little influence on infant irritability in very preterm infants. Copyright © 2003 John Wiley & Sons, Ltd.     

Early interactions and the socioemotional development of deaf infants

Studies of the early face-to-face interactions and later attachment behaviours between infants and their caregivers are reviewed, with a particular focus on implications for deaf infants. Since the majority of deaf infants are born to hearing parents, it is to be expected that many parental responses will rely on vocalizations which are inaccessible to the deaf infant. Are other sensory modalities enhanced or used in a compensatory manner by hearing parents so as to make their communication with a deaf infant more effective? Is the deaf infant's heightened need for visual and tactile input adequately met during normal interactions with their caregivers? Does the deaf infant develop the same strategies for signalling distress and coping with separation as does the hearing infant? Although the research literature on this population is sparse, there are beginning to be more reports addressing these questions as early identification becomes increasingly possible. Therefore, this paper will cover issues of the role of eye contact and mutual coordination in early interactions, compensatory parenting behaviours from the perspective of the ‘intuitive parenting’ model, and precursors to later attachment behaviours in deaf infants.     

“Ghosts in the Nursery:” Infant sleep and sleep‐related cognitions of parents raised under communal sleeping arrangements

In an experiment of nature, a normal cohort of parents who were raised under communal sleeping arrangements (CSA) in Israeli kibbutzim are raising their infants at home under home‐based family sleeping arrangements. The present study focused on exploring the links between the early sleep experiences of CSA parents and their present sleep‐related beliefs and behaviors. In particular, the study assessed whether the cognitions of CSA parents regarding infant sleep differ from cognitions of parents who were raised under home‐based family sleeping arrangements. Furthermore, parental soothing methods and infant sleep patterns were compared. One hundred forty‐one families participated in this study. The children's ages ranged between 4.5 to 30 months. Parental cognitions were evaluated by two questionnaires. Infant sleep was assessed by a questionnaire and by daily parental reports. As expected, CSA parents were more likely than were control parents to: (a) interpret infant night wakings as a sign of distress and (b) actively soothe their infants at bedtime, co‐sleep with them, and report more night wakings of their infants. These findings support the hypothesis that early childhood sleep‐related experiences of parents (“Ghosts in the Nursery”) influence their parental sleep‐related cognitions that in turn affect infant sleep patterns.