Comparison of Maternal Perceptions of Preterm and Fullterm Infants

We compared maternal attitudes and feelings in two groups of mother–infant dyads: 25 mothers with preterm newborns (M=30.9 weeks of gestational age) and 25 mothers with fullterm newborns (M=39.7 weeks of gestational age). Both groups were matched for infant sex, age (corrected in preterms) and birth order as well as for maternal age and education. Semi-structured interviews were used to collect data on maternal attitudes and feelings about pregnancy and the first contacts with the newborn. Mothers completed rating scales to indicate the specific behavioural problems they perceived in their infants at 6 weeks and 3 months of (corrected) age. Observations of infant responses to visual and/or auditory stimuli were made at 6 weeks and 3 months in a laboratory setting. At 3 months, each infant was administered the Bayley Scale of Mental Development. There were no differences in maternal attitudes and feelings between the two groups of mothers prior to the birth. However, significant differences appeared after birth and indicated increased anxiety in mothers of preterm infants. Significantly more 6-week-old preterm infants were perceived by their mothers as irritable and to cry more than fullterm infants. At the age of 3 months, both groups of infants differed only in terms of irritability. Differences between the two groups of mother–infant dyads, age-related changes in these differences and relationships between maternal evaluations and the laboratory-based assessments are discussed in the context of contrasts in the stability of behavioural regulation in preterm and fullterm infants.     

Early maternal stimulation and the development of cognitive competence and attention of preterm infants

The aim of the study was to investigate the relationship between several dimensions of maternal interactive behaviours, and cognitive development and attention in preterm infants. Of special interest was the question of whether high levels of maternal stimulation and activity may have negative consequences for the development of preterm infants. Sixty-six preterm infants and their mothers were followed longitudinally and videotaped in interaction situations at home, at the infant age of 6, 9 and 12 months. Mothers behaviours were scored on involvement, sensitive responsiveness, non-intrusiveness and level of activity. Moreover, infant cognitive status was assessed at 6, 12 and 24 months of age, using the Bayley Scales of Infant Development. Infant ability in problem solving and attention were assessed in two problem solving tasks at 18 and 24 months of age. The results showed that infant cognitive status at 12 and 24 months was best predicted by maternal involvement and infant responsiveness. No significant relationships were found between maternal interactive behaviours and infant ability in problem solving and attention. More importantly, there was no indication that high levels of maternal stimulation or intrusiveness may have a negative impact on later cognitive development and attention in preterm infants. © 1998 John Wiley & Sons, Ltd.     

A comparison of dyadic interactions and coping with still‐face in healthy pre‐term and full‐term infants

Pre‐term birth has a significant impact on infants' social and emotional competence, however, little is known about regulatory processes in pre‐term mother‐infant dyads during normal or stressful interactions. The primary goals of this study were to investigate the differences in infant and caregiver interactive behaviour and dyadic coordination of clinically healthy pre‐term compared to full‐term infant‐mother dyads and to examine pre‐term infants' capacity for coping with stress using the face‐to‐face still‐face paradigm (FFSF). Fifty mother‐infant dyads, including 25 pre‐term infants and 25 full‐term infants were videotaped during the FFSF. All infants were 6–9 months of age (corrected for gestational age in the pre‐term group). Infant and maternal socio‐emotional expressivity and self‐regulatory behaviours were coded and measures of dyadic coordination (Matching, Reparation Rate, and Synchrony) were calculated. There were no significant differences in infant and caregiver socio‐emotional behaviours between the two groups and both groups demonstrated the still‐face (SF) effect and the reunion effect. There was a difference in self‐regulatory behaviour. Pre‐term infants were more likely than full‐term infants to use distancing (e.g., by turning away, twisting, or arching) from their mothers during the FFSF. Additionally, during the Reunion episode of the FFSF pre‐term infants showed more social monitoring compared to full‐term infants. Regardless of the birth status, the dyads showed less coordination and a slower rate of reparation during the Reunion episode than during the Play episode. The higher proportion of distancing in the pre‐term group and the increase in social monitoring suggest that even in normal interactions pre‐term infants may experience a higher level of stress and have less capacity for self‐regulation compared to the full‐terms and that pre‐term infants appear to use a compensatory strategy of increased social monitoring to cope with the stress of renegotiating the interaction during Reunion. The findings suggest that pre‐term infants have different regulatory and interactive capacities than full‐term infants.     

Maternal recollected anxiety and mother–infant interaction in preterm infants

This study focused on the relationship between maternal recollected anxiety and the quality of mother–preterm infant interaction. In a observational study, 52 mothers and their preterm infants were videotaped at home in a standardized object–play interaction situation, at the infant's age of 6 months. Observations concentrated on different aspects of maternal behavior, including sensitive responsiveness, involvement, level of activity, and intrusiveness. Mothers were interviewed about their experiences during the period of neonatal intensive care and were, on the basis of their answers, divided into high‐anxiety and low‐anxiety mothers. In general, and independent of the infant's current interactive behavior and medical status, high‐anxiety mothers were more intrusive and more active during interaction with their infants than were mothers who recalled little or no anxiety during the postnatal period. ©1999 Michigan Association for Infant Mental Health.     

Infant touching behaviour during mother–infant face‐to‐face interactions

The study of infant communication during mother–infant interactions has largely focused on infants' distal behaviours, while neglecting their more proximal behaviours, such as touch. Yet, touch is an important modality through which infants and mothers communicate; it is also a vital means through which infants self‐regulate and explore their surroundings. The present study was designed to investigate the touching behaviours of 44, 51/2‐month‐old, healthy, full‐term infants during face‐to‐face mother–infant interactions. A still‐face (SF) procedure was used in order to examine differences in the types and locations of infant touch across normal and perturbed interaction periods, when mothers exhibit changes in their emotional availability. Results revealed that infant touch varied with changes in maternal availability. During the SF period, when mothers were unavailable, infants used more active, soothing, and reactive tactile behaviours (stroke, finger, pat, and pull), and they spent more time touching themselves. In contrast, infants used mostly passive touch (static) during the Normal periods, when their mothers were available. They also spent a significant portion of time touching their mothers. The variations in infant touch across periods suggest that infants communicate their affective states through touch. The findings also support the regulatory and exploratory roles of infant touch, especially during periods of maternal unavailability. Copyright © 2007 John Wiley & Sons, Ltd.     

Expression of negative affect during face‐to‐face interaction: a double video study of young infants' sensitivity to social contingency

The purpose was to assess infants' sensitivity to social contingency, taking affective state into account, during face‐to‐face interaction with the mother in a double video set‐up. Infants' behaviour during three sequences of live face‐to‐face interaction were compared to two sequences where the interaction between the infant and the mother was set out of phase, by presenting either the infant or the mother with a replay of their partners' behaviour during earlier live interaction. We found a significant negative correlation between the infant's degree of negative affect and the average time of looking at the mother during the live sequences. A median split was calculated to separate the infants into a high‐negative‐affect group and a low‐negative‐affect group on the basis of their emotional responses during the experiment. The low‐negative‐affect infants looked significantly more at their mothers than other foci during the live but not the replay sequences, while the high‐negative‐affect infants did not show this difference. The results suggest that 2–4‐month old infants are able to distinguish between experimental distortion of contingent aspects in live and replay sequences, but that this effect of the replay condition may not be shown by moderate to highly distressed infants. Our findings underline the importance of taking infants' emotional state into account in experiments intended to assess their capacity for intersubjective communication. Copyright © 2006 John Wiley & Sons, Ltd.     

Impact of mother interactive style on infant affect among babies exposed to alcohol in utero

This study examined the ability of infants prenatally exposed to alcohol to regulate their affect during and after a stressor. Specifically, the Still‐Face Paradigm (Tronick, Als, Adamson, Wise, ' Brazelton, 1978) was used as a stress induction paradigm to assess both mother‐infant interaction and infant self‐regulation. In addition to the mothers' interactive style, the effect of mothers' drinking during and after pregnancy on the infant was explored. Participants were 76 six‐month‐old infants and their mothers. Infant affect and maternal interaction style was coded second‐by‐second for the 6 min of the Still‐Face Paradigm. Results indicated that infants whose mothers made fewer attempts at engaging them during the play portion of the still‐face (e.g., either watched their infant or paid minimal attention to their infant) showed greater negative affect in contrast to infants whose mothers played in an interactive manner. A gender effect was found among female infants. That is, female infants whose mothers drank more during pregnancy showed greater negative affect. The study demonstrates the possibility of early identification of negativity in infants with prenatal alcohol exposure. The impact of mother‐child relationship on emotional regulation of infants prenatally alcohol exposed may be a target of future intervention and further study.     

Infant irritability and early mother–infant reciprocity patterns

This study investigated how various forms of neonatal irritability (at 3 days) and irritability at 10 weeks are related to reciprocal interactions between mothers and their infants. Fifty‐six fullterm, first‐born male infants were examined using the Neonatal Behavioral Assessment Scale (NBAS‐K) at 3 days postpartum. Each infant was rated for irritability to aversive stimuli, general irritability, consolability and responsiveness to visual–auditory stimuli. At 10 weeks of age, during a home visit, mother–infant reciprocity was scored for gaze, smile, vocalization and hold behaviors. Based upon maternal reports and behavioral observations, infant irritability was scored at 10 weeks using the NBAS‐K scoring system. Findings revealed that: (1) there were two distinct forms of reciprocity: social and physical; (2) general irritability at 3 days was negatively related to reciprocal hold interaction and positively related to reciprocal social interaction at 10 weeks, and (3) neonatal irritability to aversive stimuli (at 3 days) was positively related to subsequent reciprocal social interaction. Regression analyses showed that neonatal variables were the foremost predictors of reciprocal hold at 10 weeks. Findings are discussed in terms of (1) the need to differentiate between social and physical behavioral patterns, and (2) time‐lag effects with respect to mother–infant interactions. Copyright © 1999 John Wiley & Sons, Ltd.     

Mutual touch during mother–infant face-to-face still-face interactions: Influences of interaction period and infant birth status

Contact behaviours such as touch, have been shown to be influential channels of nonverbal communication between mothers and infants. While existing research has examined the communicative roles of maternal or infant touch in isolation, mutual touch, whereby touching behaviours occur simultaneously between mothers and their infants, has yet to be examined. The present study was designed to investigate mutual touch during face-to-face interactions between mothers and their 5½-month-old fullterm (n = 40), very low birth weight/preterm (VLBW/preterm; n = 40) infants, and infants at psychosocial risk (n = 41). Objectives were to examine: (1) how the quantitative and qualitative aspects of touch employed by mothers and their infants varied across the normal periods of the still-face (SF) procedure, and (2) how these were associated with risk status. Mutual touch was systematically coded using the mother–infant touch scale. Interactions were found to largely consist of mutual touch and one-sided touch plus movement, highlighting that active touching is pervasive during mother–infant interactions. Consistent with the literature, while the SF period did not negatively affect the amount of mutual touch engaged in for mothers and their fullterm infants and mothers and their infants at psychosocial risk, it did for mothers and their VLBW/preterm infants. Together, results illuminate how both mothers and infants participate in shaping and co-regulating their interactions through the use of touch and underscore the contribution of examining the influence of birth status on mutual touch.     

The development of reaching behavior in low-risk preterm infants

This longitudinal study investigated the development of reaching behavior in the seated position in preterm infants at the ages of 5–7 months by analyzing kinematic variables (straightness and adjustment indexes, movement unit, mean and final velocities). The correlation between kinematic variables and grasping was verified. The participants were nine low-risk preterm infants with no cerebral lesions. Ten fullterm infants served as control. In both groups, kinematic variables remained unchanged over age, except for the adjustment index, which was higher at 6 months in the preterm group. Successful grasping increased in both groups over age and it was shown to be negatively correlated with mean velocity in the preterm infants. At the ages of 6 and 7 months, preterms showed lower mean and final velocities and higher adjustment index when compared with fullterms. The relative constancy in the kinematic variables suggests that, after having explored the action possibilities during the acquisition phase, the infants selected an adaptative pattern to perform the reaching movements. Slower movements and greater adjustments may be functional strategies of preterms to achieve successful grasps.     

Patterns of psychological distress in mothers of preterm infants

Mothers of preterm infants experience significant psychological distress, with elevated levels of inter-correlated depressive, stress, anxiety and post-traumatic stress symptoms. In a sample of racially and ethnically diverse mothers of preterm infants, we identified differing patterns of psychological distress during infant hospitalization and examined the effect of these psychological distress patterns on longitudinal trajectories of each psychological distress measure and on maternal perceptions of the child over the first year of the infant's life. Mothers of preterm infants (N = 232) completed five questionnaires assessing depressive symptoms, anxiety, post-traumatic stress symptoms, stress due to infant appearance, and stress due to parental role alteration during enrollment during the neonatal hospitalization, discharge, and at 2, 6, and 12 months of age adjusted for prematurity. Latent class analysis on the enrollment psychological distress variables allowed us to identify five sub-groups of mothers exhibiting similar patterns of psychological distress, differing primarily in degree and type: low distress, moderate distress, high NICU-related distress, high depressive and anxiety symptoms, and extreme distress. These classes continued to show different longitudinal trajectories for the psychological distress measures through 12 months corrected age. Mothers in the extreme distress class and, to a lesser degree, mothers in the high depressive and anxiety symptom class remained at risk of significant psychological distress one year after discharge and had less positive perceptions of their child (greater worry and higher perceptions of child vulnerability). In conclusion, distinctive sub-groups of mothers during hospitalization had different patterns of psychological distress throughout the 12-month period and may require different interventions in the NICU.     

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.     

Early interactive behaviours in preterm infants and their mothers: Influences of maternal depressive symptomatology and neonatal birth weight

The study evaluated the quality of preterm infant–mother interactions, considering severity of birth weight (ELBW and VLBW) and maternal depression, compared to full term babies. 69 preterm infants (29 ELBW and 40 VLBW) and 80 full-term (FT) infants and their mothers were recruited. At 3 months of corrected age, the quality of mother–infant interaction was evaluated through Global Rating Scales; moreover, infant level of development and maternal depression were assessed through Griffith Development Mental Scales and Edinburgh Postnatal Depression Scale. Results showed adequate sensitivity in preterm infants’ mothers and higher involvement with their infants, compared to full term mothers, but ELBW ones exhibited an intrusive interactive pattern and a higher prevalence of depressive symptoms. The study underlined the relevance of paying special attention to both ELBW infants and their mothers, in order to support the parenting role and the co-construction of early interactions.     

Early home intervention and socio-emotional development of preterm infants

In the present study, the effects of developmental intervention and parent-infant interaction intervention on the social competence and emotional development of preterm infants were assessed. The results suggest that early home intervention focused on the infant's development facilitates social competence and adaptation, whereas intervention focused on the parent-infant interaction resulted in greater emotional security on the part of the infant. Social competence during the second year of life was predicted by social competence at 8 months and emotional security at 12 and 16 months. These findings have implications for early identification of infants at risk of later socio-emotional difficulties and intervention with dysfunctional mother-infant dyads.     

Dyadic and triadic skills in preterm and full term infants: a longitudinal study in the first year

This longitudinal study examined dyadic and triadic skills in 26 preterm and 31 full term infants at 3, 6 and 9 months of age. In dyadic interaction, infants engaged with a stranger in face-to-face play interrupted by a still-face episode. In triadic interaction, infants interacted with the adult stranger as she coordinated gaze between the infant and object. Both groups were sensitive for non-contingency in both dyadic and triadic interactions. There were significant group and developmental differences for dyadic and triadic competencies. Compared to full term infants, preterms made less positive elicits during the still-face at 6 months and followed gaze less at 9 months of age. Six-month dyadic skills and 9-month triadic competencies were positively related in preterm and full term infants.     

Dyadic co-regulation,affective intensity and infant's development at 12 months: A comparison among extremely preterm and full-term dyads

Extremely low gestational age children (ELGA, born below 28 weeks of GA) represent the most at-risk preterm group in terms of survival, developmental sequelae and rates of impairment and cognitive delays. However, the impact of an extremely preterm birth on mother–infant co-regulation and affective intensity which may affect early infant's development has not been investigated. Based on a relational dynamic system approach, our study aimed to investigate the quality of co-regulation and affective intensity during spontaneous play interaction in 20 mother–infant ELGA dyads compared to 20 full-term (FT) dyads at 12 months (corrected age for ELGA infants). Relationships between the quality of dyadic co-regulation and the infant's level of cognitive, motor and language development were also investigated. The quality of dyadic co-regulation was assessed using the Revised Relational Coding System (R-RCS) by Fogel et al. (2003), the mothers’ and infants’ affective intensity was coded using a coding system by Lunkenheimer, Olson, Hollenstein, Sameroff, and Winter (2011). Infants’ development was assessed using the Bayley Scales (BSID-III, 2006). With respect to FT dyads, ELGA dyads were characterised by less frequent symmetric and more frequent unilateral co-regulation patterns and by less positive and more neutral affective intensity of both infants and mothers. Cognitive, motor and language scores were lower in ELGA infants than in FT infants. Symmetrical co-regulation was related to motor scores in ELGA infants, and to cognitive scores in FT infants. Our findings contribute to the literature by demonstrating the difficulties of ELGA mother–infant dyads at 12 months in sharing the symmetric co-regulation and positive affective intensity and how symmetric co-regulation is strictly related to motor development in ELGA infants. Based on these findings, intervention programmes to foster joint attention, active involvement and positive affective intensity in ELGA dyads and infants’ development in the first year of life should be designed.     

Maturation constrains the effect of exposure in linking language and thought: evidence from healthy preterm infants

The power of human language rests upon its intricate links to human cognition. By 3 months of age, listening to language supports infants’ ability to form object categories, a building block of cognition. Moreover, infants display a systematic shift between 3 and 4 months – a shift from familiarity to novelty preferences – in their expression of this link between language and core cognitive processes. Here, we capitalize on this tightly‐timed developmental shift in fullterm infants to assess (a) whether it also appears in preterm infants and (b) whether it reflects infants’ maturational status or the duration of their postnatal experience. Healthy late preterm infants (N = 22) participated in an object categorization task while listening to language. Their performance, coupled with that of fullterm infants, reveals that this developmental shift is evident in preterm infants and unfolds on the same maturational timetable as in their fullterm counterparts.     

Cortisol reactivity and negative affect among preterm infants at 12 months during a mother-infant interaction task

The purpose of this study was to investigate correlates of preterm (PT) infant’s cortisol reactivity and the association to infant negative affect, during a mother-infant interaction procedure. Participants included 48 infants born prematurely (gestational age < 37 weeks) and their mothers, assessed when infants were 12 months old corrected for prematurity. The examined variables comprised both neonatal and environmental dimensions including maternal interactive behavior. Infant negative affect and maternal interactive behavior were assessed with a standardized mother-infant interaction task. A baseline infant saliva sample was collected before the interaction began, and a second sample after the interaction episodes ended. Results revealed that decrease of infant’s cortisol concentration was significantly associated with the exposure to more sensitive, and less intrusive maternal behaviors. However, once controlled for neonatal risk, family SES and maternal psychological distress, the associations were rendered non-significant. Although the association between cortisol reactivity and negative affect trended toward significance, maternal intrusiveness was the only significant predictor of observed infant negative affect. Findings suggest the importance of primary relational experiences on PT infants' early regulatory competencies.     

The melody of surprise: maternal surprise vocalizations during play with her infant

Two groups of mothers and their infants (24 infants, mean age=3.5 months and 24 infants, mean age=5.5 months) were video‐ and audio‐taped in their homes while playing with a Jack‐in‐the‐box. The mean fundamental frequency of spontaneous surprise exclamations of mothers when opening the toy were analysed, and infant and maternal facial expressions of surprise were coded in three regions of the face. A t‐test established that significantly more of the older children in comparison with younger children showed surprise (t=?2.96, df=46, p<0.005, 2‐tailed). Twenty‐nine per cent of the younger infants, in comparison with 67% of the older children showed facial expressions of surprise. A t‐test of maternal pitch height (Hz) indicated that mothers exclaimed in surprise with a higher pitch when the child did not show a surprise facial expression (mean=415.61 Hz) in comparison with the child showing surprise (mean=358.97 Hz; t=2.9, df=46, p=0.006, 2‐tailed). A multiple regression established that infant's expression was a stronger predictor of maternal vocal pitch than was the age of the infant. These results are discussed in terms of maternal use of emotional expressions as ‘social signals’. Copyright © 2002 John Wiley & Sons, Ltd.