The efficacy of massage on short and long term outcomes in preterm infants

Purpose

Premature infants lack the tactile stimulation they would have otherwise experienced in the womb. Infant massage is a developmentally supportive intervention that has been documented for several decades to have a positive effect on both full term and preterm infants. The purpose of this study was to assess the short and long term benefits of massage on stable preterm infants.

Methods

A quasi experimental design was used, 66 infants were recruited from two university hospitals with tertiary level NICUs; 32 infants received the massage therapy by their mothers. Data collection by a researcher blind to the infants’ group assignments included weight at discharge, pain responses on the PIPP scale at discharge, length of stay in hospital, neuro-developmental outcome (Bayley scores) and breastfeeding duration at 12 months corrected age.

Results

Infants who were massaged had significantly lower scores on the PIPP after a heel-stick compared to before the massage and had lower PIPP scores at discharge compared to the control group. Massaged infants had higher cognitive scores at 12 months corrected age. Weight gain, length of stay, breastfeeding duration and motor scores did not differ between groups.

Conclusion

Stable preterm infants benefit from massage therapy given by their mothers and may be a culturally acceptable form of intervention to improve the outcomes of preterm infants.     

Psychological Sequelae in Parents of Extreme Low and Very Low Birth Weight Infants

The current study evaluated the psychological sequelae in 66 parents of extreme low and very low birth weight infants (mean weight of 842 g). Parents who had given birth within a 3-year period prior to the study were chosen from the archives of a neonatal ward and surveyed regarding posttraumatic stress, coping strategies, and social support. Thirty-five percent of the parents reported that their child had a handicap. Twenty percent of the women met the criteria of posttraumatic stress disorder (PTSD) at the time of the study, and an additional 10% met the criteria for a subclinical PTSD diagnosis. Female gender, handicap of the child, general distress during hospitalization, distressing contact with hospital staff, experienced distress at homecoming, and emotional coping, explained 72% of the degree of traumatization. Psychological support and intervention is recommended during the hospital stay of a premature infant who has a handicap and after the homecoming to prevent the development of chronic PTSD and reduce the associated distress.     

The effects of exercise on body satisfaction and affect

This research used ecological momentary assessment to examine the effects of exercise on state body dissatisfaction and affect in 33 undergraduate females with high trait body dissatisfaction and 28 with low trait body dissatisfaction who exercised at least three times weekly. Trait body dissatisfaction was investigated as a moderator of the effects of exercise as well as different motivations for exercise. Results indicated all participants experienced lower state body dissatisfaction and negative affect and greater positive affect post-exercise. Trait body dissatisfaction moderated the association between motivations and exercise effects. Appearance and weight motivations were related to higher state body dissatisfaction for all individuals. Fitness and health motivations were related to higher state body dissatisfaction for high trait body dissatisfied individuals and lower state body dissatisfaction for low trait body dissatisfied individuals. Thus, although exercise has positive effects on body dissatisfaction and affect for high frequency exercisers, their exercise motivations impact these effects.     

Association of maternal interaction with emotional regulation in 4- and 9-month infants during the Still Face Paradigm

This study used the Still Face Paradigm to investigate the relationship of maternal interaction on infants' emotion regulation responses. Seventy infant-mother dyads were seen at 4 months and 25 of these same dyads were re-evaluated at 9 months. Maternal interactions were coded for attention seeking and contingent responding. Emotional regulation was described by infant stress reaction and overall positive affect. Results indicated that at both 4 and 9 months mothers who used more contingent responding interactions had infants who showed more positive affect. In contrast, mothers who used more attention seeking play had infants who showed less positive affect after the Still Face Paradigm. Patterns of stress reaction were reversed, as mothers who used more attention seeking play had infants with less negative affect. Implications for intervention and emotional regulation patterns over time are discussed.     

Contextual determinants of anger and other negative expressions in young infants

Two experiments examined how different frustration contexts affect the instrumental and emotional responses of 4- to 5-month-old infants. Three different frustrating contexts were investigated: loss of stimulation (extinction), reduction in contingent stimulation (partial reinforcement), and loss of stimulus control (noncontingency). In both experiments, changes in arm activity and facial expressions of anger and sadness coded according to the Maximally Discriminative Facial Movement Coding System (MAX) were the measures of frustration. Both experiments showed that (a) arm responses increased when the contingent stimulus was lost or reduced but decreased when control of the stimulus was lost under noncontingency, (b) MAX-coded anger, but not MAX-coded sad or blends of anger and sad, was associated with frustration, and (c) the pattern of anger and arm responses varied with the frustration context. When contingent stimulation was lost or reduced, both anger and arm responses increased, but when expected control was lost under noncontingency, arm responses decreased while anger increased.     

Anxiety and vulnerability in parents following the death of an infant

Empirical data on the subjectively reported anxiety reactions of 117 parents who lost an infant at birth or daring the first year of life are presented. From a retrospective survey conducted 1 to 4 years after the death it was evident that parents experienced a great deal of anxiety following the death of their child. Parents who experienced a sudden death in the home reported the strongest anxiety, but other parents who lost their child in hospital at birth or thereafter also experienced strong anxiety. The anxiety for surviving children and later-born children was extensive. In all areas mothers experienced more anxiety than fathers. More intense and longer grief in one's partner, the perceived lack of support from others, being older, and being a female were significantly correlated with anxiety. The results are interpreted as a confirmation that parents who lose their children experience a fundamental change in their beliefs about their family's future security. Better training of health personnel is required to secure an adequate follow up of families that lose a child.     

Contextual basis of maternal perceptions of infant temperament

To elucidate the differential saliency of infant emotions to mothers across interactive contexts, the authors examined the moderating role of observed infant affect during interactions with mother in the relation between maternal and laboratory-based ratings of infant temperament. Fifty-nine developmentally healthy 9-month-old infants were judged for degree of infant positive, infant negative, and mother-infant mutually positive affect during the course of object-focused and routine home-based activities with mother. Mothers completed the Infant Behavior Questionnaire (M. K. Rothbart, 1981), and infants underwent the Laboratory Temperament Assessment Battery (H. H. Goldsmith & M. K. Rothbart, 1999). Results revealed that maternal and observer ratings of infant negativity converged when infants manifested high degrees of negative affect during routine home-based activities. Maternal and observer ratings of infant positivity converged when infants experienced low mutually positive affect during play. These findings support the hypothesis that maternal perceptions are based on mothers' experiences with their infants but that the salience of infant temperamental characteristics to mothers varies across emotion and interactive context.     

The Relationship Between Enjoyment and Affective Responses to Exercise

Exercise-related affective changes are well documented across a variety of settings and populations. In addition to the stimulus properties of exercise itself, social environmental factors are thought to influence affective responses. One factor that may be associated with psychological responses to exercise is enjoyment. Individuals who enjoy exercise may exhibit more positive affective responses compared to those who enjoy exercise less. The purpose of this study was to examine whether exercise enjoyment was related to affective changes associated with an acute bout of exercise in a naturalistic setting. Study 1 used a categorical approach to assess affect and sampled college-aged female group fitness participants. Study 2 was based on a dimensional affect conceptualization and sampled corporate fitness participants. Across both studies, results revealed a significant decrease in negative affect and increase in positive affect following exercise. Enjoyment was positively related to increases in positive affect but unrelated to changes in negative affect.     

Motor training at 3 months affects object exploration 12 months later

The development of new motor skills alters how infants interact with objects and people. Consequently, it has been suggested that motor skills may initiate a cascade of events influencing subsequent development. However, only correlational evidence for this assumption has been obtained thus far. The current study addressed this question experimentally by systematically varying reaching experiences in 40 three‐month‐old infants who were not reaching on their own yet and examining their object engagement in a longitudinal follow‐up assessment 12 months later. Results revealed increased object exploration and attention focusing skills in 15‐month‐old infants who experienced active reaching at 3 months of age compared to untrained infants or infants who only passively experienced reaching. Further, grasping activity after – but not before – reaching training predicted infants’ object exploration 12 months later. These findings provide evidence for the long‐term effects of reaching experiences and illustrate the cascading effects initiated by early motor skills.     

Meaning gained versus meaning lost: The effects of meaning salience on anxiety and depression during the coronavirus pandemic

People who have meaningful lives generally experience less anxiety and depression. Meaning salience, or the awareness of the meaning in one's life, is believed to partially explain this relationship. However, in times of isolation, what might be most salient to people are the meaningful aspects of their lives that have disappeared. This study seeks to understand how making gained versus lost meaning salient affects anxiety and depression. Participants either wrote for 5 minutes about how their life gained meaning (n = 29) or lost meaning (n = 30) due to the coronavirus restrictions, or about music (i.e., the control condition; n = 32). Those who wrote about gained meaning experienced less momentary anxiety than those who wrote about lost meaning. In addition, meaning salience moderated the relationship between meaning and both anxiety and depression. Those who wrote about gained meaning appeared to exhibit a positive relationship between meaning in life (MIL) and both anxiety and depression, while those who wrote about lost meaning exhibited negative relationships. In all, this suggests that meaning salience is not always positive and that researchers and practitioners should consider how making positive meaning salient may be more beneficial than a general focus on MIL.     

Dynamic emotional messages differentially affect 6-month-old infants’ attention to eyes and gaze cues

Infants often experience interactions in which caregivers use dynamic messages to convey their affective and communicative intent. These dynamic emotional messages may shape the development of emotion discrimination skills and shared attention by influencing infants’ attention to internal facial features and their responses to eye gaze cues. However, past research examining infants’ responses to emotional faces has predominantly focused on classic, stereotyped expressions (e.g., happy, sad, angry) that may not reflect the variability that infants experience in their daily interactions. The present study therefore examined forty-two 6-month-old infants’ attention to eyes vs. mouth and gaze cueing responses across multiple dynamic emotional messages that are common to infant-directed interactions. Overall, infants looked more to the eyes during messages with negative affect, but this increased attention to the eyes during these message conditions did not directly facilitate gaze cueing. Infants instead showed reliable gaze cueing only after messages with positive and neutral affect. We additionally observed gender differences in infants’ attention to internal face features and subsequent gaze cueing responses. Female infants spent more time looking at the eyes during the dynamic emotional messages and showed increased initial orienting and longer looking to gaze-cued objects following positive messages, whereas male infants showed these gaze cueing effects following neutral messages. These results suggest that variability in caregivers' communication can shape infants’ attention to and processing of emotion and gaze information.     

Infant physiological regulation and maternal risks as predictors of dyadic interaction trajectories in families with a preterm infant

This longitudinal study examined predictors of rates of growth in dyadic interaction quality in children born preterm who did not experience significant neurological findings during neonatal intensive care unit (NICU) hospitalization. Multiple methods were used to collect data from 120 preterm infants (48% girls, 52% boys) and their mothers. Infant heart rate variability (HRV), gestational age, neonatal health, feeding route, and maternal socioeconomic (SES) risks were assessed at NICU discharge (mean of 36 weeks postconception). Mother-child interactions were observed at 4, 9, 16, and 24 months postterm and analyzed with hierarchical linear modeling. On average, children's quality of play, interest, and attention increased over time while their dysregulation and irritability decreased, whereas average maternal positive affect and involvement declined in quality (ps < .05), although there was individual variation in rates of change. Mothers of infants with higher postfeeding HRV (i.e., vagal regulation) exhibited less decrease in positive affect and involvement between 4 months and 24 months, compared with mothers of infants with lower HRV (p < .05). Although infants with higher postfeeding HRV showed less positive affect and communication at 4 months, they exhibited significantly greater increases in positive affect and social competence and decreases in dysregulation and irritability between 4 months and 24 months, compared with infants with lower HRV (ps < .05). Dyads experiencing more SES risks showed less optimal interactions at 4 months; this difference remained as children grew older (ps < .05). Results have implications for our understanding of social development in preterm infants.     

Factors affecting jail detention of defendants adjudicated incompetent to proceed

The movement of defendants through the legal process who have been adjudicated incompetent to proceed is little studied, yet it is important. The purpose of this study was to provide empirical data regarding factors that affected the amount of time defendants adjudicated incompetent to proceed and ordered to undergo hospitalization remained in jail while awaiting transfer to a state hospital. Statewide data collected in Florida between July 2005 and June 2008 were used to determine the lengths of time incompetent defendants spent at certain stages in the legal process. The addition of forensic bed capacity following media attention and litigation resulted in a significant decrease in the amount of time defendants adjudicated incompetent to proceed waited in jail for transfer to a state hospital for treatment. The amount of time it took for completed commitment orders to be submitted to the state mental health authority by the Clerks of Court of each county accounted for a meaningful portion of days defendants spent in jail awaiting transfer to a state hospital, with considerable variation across counties with respect to waiting times. These findings reflect how various stakeholders can affect the amount of time defendants spend in jail while awaiting hospitalization. These issues are discussed in the context of controversy related to Florida's forensic mental health system, as well as issues related to the political process and funding of the state's mental health authority.     

Relations between behavioral reactivity at 4 months and attachment classification at 14 months in a selected sample

Attachment at 14 months of age was examined in a sample of infants who had been selected for high or low levels of positive or negative affective reactivity and motor activity at 4 months of age. The type of early emotional reactivity was not clearly associated with attachment security or insecurity. The proposal of Belsky and Rovine [Belsky, J., & Rovine, M. (1987). Temperament and attachment security in the strange situation: An empirical rapprochement. Child Development, 58, 787–795] that infants classified as B3/B4 or C1/C2 are temperamentally more negatively reactive than those classified as A1/A2 or B1/B2 was supported. Compared with infants who showed high levels of positive affect and infants who scored low on affective reactivity, infants who showed high levels of negative affect in response to stimulation at 4 months of age were significantly more likely to be classified as B3/B4 or C1/C2 in the Strange Situation at 14 months of age. These findings are discussed in the context of prior inconsistent findings about the relations between temperament and groups of attachment sub-classifications. The role of different methods of assessing temperament and the importance of selected samples in clarifying such relations is discussed.     

Social conditioning and its proper control procedures.

In Expt I, eight infants received response-contingent social stimulation, while another eight infants received response-independent social stimulation. Both groups' vocalization rates similarly increased from baseline to stimulation periods and decreased from stimulation to extinction periods. In Expt II, 12 infants were given continuous social stimulation (elicitation treatment) for one period, and, in a second period, stimulation was withheld for 5 sec contingent upon each vocalization (omission treatment). Response rates were similar for both periods, and rates decreased when social stimulation was removed (mobile treatment). In both studies social stimulation increased vocalization rates and rate of responding was insensitive to the programmed contingency. There were, however, fewer “bursts” of responses with the negative and positive contingencies as compared with response-independent stimulation.     

Robust patterns and individual variations: Stability and predictors of infant behavior in the still-face paradigm

In the present study we examined key issues regarding infant behavior in the still-face paradigm (SFP) in terms of individual variations, stability, and predictors. The sample consisted of 115 mothers and infants, with assessments at ages 3 and 6 months, including observations of maternal and infant behavior in the SFP, and parent reports of infant temperament. Both robust patterns and individual variations in infant SFP behaviors were found, with only a minority of infants showing the expected patterns for negative affect and gaze. Infant behavior patterns showed no stability from age 3 to 6 months, and infant gaze was related to more pronounced behavior changes across the SFP. Maternal sensitivity in the SFP baseline was related to some aspects of infant SFP behavior. Consistent with the differential susceptibility hypothesis, in infants with a more difficult temperament maternal sensitivity predicted a more pronounced expected pattern of changes in infant positive affect across the SFP, whereas this was not the case for infants with a more easy temperament.     

Sequelae of cesarean and vaginal deliveries: psychosocial outcomes for mothers and infants

Mother-infant dyads grouped according to whether the infants had been delivered vaginally (n = 74) or by planned (n = 37) or unplanned cesarean (n = 56) were compared on psychosocial outcomes at 4 and 12 months postpartum. Hypotheses were that unplanned cesarean delivery would be related to less optimal outcomes and that this relationship would be mediated by mother's appraisal of the delivery and would attenuate over time. No delivery-related differences in mother-infant interactions were found at 4 or 12 months postpartum with one exception: Women low in neuroticism who delivered by unplanned cesarean showed less positive affect toward their infants at 4 months than did women high in neuroticism who delivered by unplanned cesarean or women in any other group. There was some evidence of the mediating role of maternal appraisal of the delivery on these effects. In general, the results indicate little cause for concern about the quality of mother-infant interactions following cesarean deliveries.     

Infant–mother social referencing interactions: Description and antecedents in maternal sensitivity and infant irritability

The purpose of the study was to describe naturally occurring infant and maternal behaviours in terms of social referencing in a stranger wariness situation, and to explore antecedents to such behaviouts in early maternal sensitivity and infant irritability. One hundred and ten 10-months-old infants and their mothers were videotaped. Infant social referencing behaviour was defined as puzzled looks directed at mother's face after the infant had discovered the stranger. Almost half of the infants looked with a puzzled expression at their mothers immediately after discovering the stranger, and a majority of the mothers sent a positive message back to the infants. Twenty per cent of the infants never looked at their mothers and 20% of the mothers did not respond when their infants turned to them. Infants whose mothers had responded positively to the referencing look showed positive responses to the stranger to a higher degree than infants who did not reference or those who were not responded to. Antecedents to infant and mother interactive behaviours were sought in maternal sensitivity (general sensitivity, physical contact, responsiveness, intrusiveness, response to distress, and effectiveness in comforting) and in infant irritability as observed when the infants were 4 months old. It was found that infants who did not reference their mothers for information at 10 months had experienced less sensitive mothering 6 months earlier and had also shown more irritability.     

Visual experience influences 12-month-old infants' perception of goal-directed actions of others

In the present study, we investigated whether infants' own visual experiences affected their perception of the visual status of others engaging in goal-directed actions. In Experiment 1, infants viewed video clips of successful and failed goal-directed actions performed by a blindfolded adult, with half the infants having previously experienced being blindfolded. The results showed that 12-month-old infants who were previously blindfolded preferred to look longer at the demonstrator's successful actions, whereas no such preference was observed in 8-month-old infants. In Experiment 2, infants watched the same 2 actions when the adult demonstrator was not blindfolded. The responses of 12-month-old infants were the opposite of those observed in Experiment 1: they showed a preference for the failed actions. These findings suggest that previous experience influenced the subsequent perception of others' goal-directed actions in the 12-month-old infants. We favor the interpretation that the preference for the successful actions in the 12-months-old infants provided with blindfolded experience demonstrates the influence of perceptual experience on considering the visual status of others engaging in goal-directed actions.