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 influence of prematurity,maternal anxiety,and infants' neurobiological risk on mother–infant interactions

In this study, we investigated how the birth of a very low birth weight preterm (VLBW) infant influences the mother–infant interaction at 3 months. We also focused on the impact of the infant's neurobiological risk and maternal anxiety, and their interaction. The comparison of the VLBW preterm sample (n = 79) with an external full‐term sample (n = 35) showed mother–infant interactions of the families with the preterm infant to be more vocally responsive during the interaction, but less facially responsive during the interaction. Additionally, higher levels of maternal anxiety were associated with preterm infants being less facially responsive in interaction with their mother. While neurobiological risk of the infant played a part in this association, with higher risk infants also being less facially responsive, the relationship with maternal anxiety and the mother–child interaction was stronger. How these findings may influence therapeutic interventions is discussed.     

The impact of prenatal serotonin reuptake inhibitor (SRI) antidepressant exposure and maternal mood on mother–infant interactions at 3 months of age

Exposure to maternal depression increases risks for altered mother–infant interactions. Serotonin reuptake inhibitor (SRI) antidepressants are increasingly prescribed to manage antenatal maternal illness. The impact of SRIs on early mother–infant interactions was unknown. Three-month-old infants of 32 depressed mothers treated with SRI medications during pregnancy and 43 non-medicated mothers were studied. Using an established face-to-face mother–infant interaction paradigm, dyad interactions were studied with and without a toy. Videotaped sessions yielded 4 measures: maternal sensitivity, dyadic organization, infant readiness to interact, and maternal interruptive behaviors. Even with prenatal SRI treatment, depressed mothers interrupted their infants more during toy play. In the absence of prenatal SRI treatment, maternal postnatal depression adversely influenced infant behavior. Higher levels of maternal depression symptoms at 3 months predicted poorer infant readiness to interact during the toy session. Conversely, in the SRI-exposed group, higher prenatal depression scores predicted greater infant readiness to interact at 3 months. Increased infant readiness with SRI exposure suggests a “fetal programming effect” whereby prenatal maternal mood disturbances shaped a future response to a postnatal depressed maternal environment.     

Effects of maternal postpartum depression in a well‐resourced sample: Early concurrent and long‐term effects on infant cognitive,language, and motor development

This study examined early and long‐term effects of maternal postpartum depression on cognitive, language, and motor development in infants of clinically depressed mothers. Participants were 83 mothers and their full‐term born children from the urban region of Copenhagen, Denmark. Of this group, 28 mothers were diagnosed with postnatal depression three to four months postpartum in a diagnostic interview. Cognitive, language, and motor development was assessed with the Bayley Scales of Infant and Toddler Development third edition, when the infants were 4 and 13 months of age. We found that maternal postpartum depression was associated with poorer cognitive development at infant age four months, the effect size being large (Cohen's d = 0.8) and with similar effects for boys and girls. At 13 months of age infants of clinical mothers did not differ from infants of non‐clinical mothers. At this time most (79%) of the clinical mothers were no longer, or not again, depressed. These results may indicate that maternal depression can have an acute, concurrent effect on infant cognitive development as early as at four months postpartum. At the same time, in the absence of other risk factors, this effect may not be enduring. The main weaknesses of the study include the relatively small sample size and that depression scores were only available for 35 of the non‐clinical mothers at 13 months.     

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.     

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.     

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.     

Are parenting interventions effective in improving the relationship between mothers and their preterm infants?

Aim

To systematically review the efficacy of parenting interventions in improving the quality of the relationship between mothers and preterm infants.

Method

Randomized or quasi-randomized controlled trials (RCT) of parenting interventions for mothers of preterm infants where mother–infant relationship quality outcomes were reported. Databases searched: The Cochrane Library, PubMed, CINAHL, PsycINFO and Web of Science.

Results

Seventeen studies met the inclusion criteria, 14 with strong methodological quality. Eight parenting interventions were found to improve the quality of the mother–preterm infant relationship.

Conclusions

Heterogeneity of the interventions calls for an integrated new parenting program focusing on cue-based, responsive care from the mother to her preterm infant to improve the quality of the relationship for these mother–preterm infant dyads.     

Motherhood in adolescent mothers: Maternal attachment,mother–infant styles of interaction and emotion regulation at three months

Early motherhood is considered a risk factor for an adequate relationship between mother and infant and for the subsequent development of the infant. The principal aim of the study is to analyze micro-analytically the effect of motherhood in adolescence on the quality of mother–infant interaction and emotion regulation at three months, considering at the same time the effect of maternal attachment on these variables. Participants were 30 adolescent mother–infant dyads compared to 30 adult mother–infant dyads. At infant 3 months, mother–infant interaction was video-recorded and coded with a modified version of the Infant Caregiver Engagement Phases and the Adult Attachment Interview was administered to the mother. Analysis showed that adolescent mothers (vs. adult mothers) spent more time in negative engagement and their infants spent less time in positive engagement and more time in negative engagement. Adolescent mothers are also less involved in play with their infants than adult mothers. Adolescent mother–infant dyads (vs. adult mother–infant dyads) showed a greater duration of negative matches and spent less time in positive matches. Insecure adolescent mother–infant dyads (vs. insecure adult mother–infant dyads) demonstrated less involvement in play with objects and spent less time in positive matches. To sum up adolescent mother–infant dyads adopt styles of emotion regulation and interaction with objects which are less adequate than those of dyads with adult mothers. Insecure maternal attachment in dyads with adolescent mothers (vs. adult mother infant dyads) is more influential as risk factor.     

Maternal perceptions of and sensitivity toward very low birthweight infants with and without postnatal headmolding

To explore the attractiveness of VLBW infants with postnatal headmolding, 29 mothers of VLBW infants and 29 mothers of full-terms rated complimentary photographs of VLBW newborns with postnatal headmolding, VLBW newborns without postnatal headmolding, and full-term newborns. In a second study, facial conformation and infant attractiveness were assessed to determine the degree to which babyish head-shapes and infant attractiveness differed between VLBW and full-term infants. Finally, infant history, measures of facial conformation, and infant attractiveness ratings were regressed on maternal responsiveness scores. Overall, mothers rated photographs of VLBW newborns with postnatal headmolding as less cute; however, mothers of VLBW infants rated photographs of VLBW newborns with postnatal headmolding as more cute than did mothers of full-term infants. During the second half of the first year of life, VLBW infants had narrower mouths, their eyes were closer to the sides of the face, and there was a tendency for VLBW infants to have narrower heads; however, overall attractiveness ratings of VLBW and full-term infants did not differ. More babyish head shape (wider head shape, more babyish facial features) significantly predicted maternal responsiveness to infant cues in a freeplay session. Findings demonstrate that VLBW newborns with postnatal headmolding are more vulnerable to negative evaluations of perceived attractiveness, differences in head shape are evident in the second half of the first year of life, and babyish headshape may be one factor that affects the degree to which infants are able to elicit sensitive maternal responses.     

Risks and realities: dyadic interaction between 6-month-old infants and their mothers in opioid maintenance treatment

A number of studies point to methadone exposure in utero as a possible risk factor in the developing mother–infant relationship in the first year of life. This study is part of a larger, national follow-up of 38 infants prenatally exposed to methadone or buprenorphine and 36 comparison, low-risk infants. The aim of the present paper is to assess the quality of mother–infant relationship when the infants are 6 months old. Videotaped mother–infant interactions were rated in a global scale (NICHD). Maternal and infant contributions collapsed into the variables “infant style” and “maternal style” showed that the only factor making significant contribution to the outcome measure “dyadic mutuality” was maternal style. The importance of group membership (exposed versus non-exposed), was reduced when controlling for maternal drug use prior to opioid maintenance treatment (OMT), maternal depression and parenting stress as well as infants’ developmental status and sensory-integrative functions. This suggests that prediction of dyadic mutuality should be based on individual characteristics rather than group characteristics. These results support previous research findings that methadone and buprenorphine use per se does not have direct influence on the quality of early mother–infant relationship, but tailored follow-up procedures targeting drug-free pregnancies and parenting support are beneficial for women in OMT and their children.     

Joint attention in term and preterm infants at 12 months corrected age: the significance of gender and intervention based on a randomized controlled trial

This study tested the effects of optimized neonatal mother–infant transactions on joint attention performance at 12 months. Surviving infants <2000 g from a geographically defined area were randomly assigned to a preterm intervention (n = 71) or preterm control group (n = 69). Comparisons were made between preterm groups, secondary with a term group (n = 75). Joint attention was measured using the Early Social Communication Scales. Preterm intervention infants scored significantly higher than preterm control infants on elements Initiating Joint Attention (p < 0.05), Initiating Object Requests (p < 0.05), and Responding to Social Interaction (p < 0.0005). Intervention was not associated with performance on elements Responding to Joint Attention, or on Responding to Requests. ELBW infants scored significantly lower than VLBW and LBW infants on imperative functions. Girls outperformed boys on all communication elements. An intervention implemented during the neonatal period can be of advantage for certain aspects of joint attention performance in preterm infants.     

Synchrony,complexity and directiveness in mothers’ interactions with infants pre- and post-cochlear implantation

This study investigated effects of profound hearing loss on mother–infant interactions before and after cochlear implantation with a focus on maternal synchrony, complexity, and directiveness. Participants included two groups of mother–infant dyads: 9 dyads of mothers and infants with normal hearing; and 9 dyads of hearing mothers and infants with profound hearing loss. Dyads were observed at two time points: Time 1, scheduled to occur before cochlear implantation for infants with profound hearing loss (mean age = 13.6 months); and Time 2 (mean age = 23.3 months), scheduled to occur approximately six months after cochlear implantation. Hearing infants were age-matched to infants with hearing loss at both time points. Dependent variables included the proportion of maternal utterances that overlapped infant vocalizations, maternal mean length of utterance, infant word use, and combined maternal directives and prohibitions. Results showed mothers’ utterances overlapped the vocalizations of infants with hearing loss more often before cochlear implantation than after, mothers used less complex utterances with infants with cochlear implants compared to hearing peers (Time 2), and mothers of infants with profound hearing loss used frequent directives and prohibitions both before and after cochlear implantation. Together, mothers and infants adapted relatively quickly to infants’ access to cochlear implants, showing improved interactional synchrony, increased infant word use, and levels of maternal language complexity compatible with infants’ word use, all within seven months of cochlear implant activation.     

Infant behaviors influence mothers’ provision of responsive and directive behaviors

Mother–infant interactions are important to infant development because they are predictive of infants’ social, cognitive, and language development (0070 and 0150). Because maternal responsive and directive behaviors are associated with differential infant outcomes, it is important to investigate influences on mothers’ provision of responsive and directive behaviors. Yet, the dyadic interaction literature is predominantly unidirectional from maternal behavior to infant outcomes. Therefore, the current study examined infant initiating behaviors and consequent maternal responses in a sample of 26 13-month-old infants and their mothers, videotaped during 5 min of free-play. Findings revealed that infants produced a variety of initiatives, and that these different infant initiatives prompted differential patterns of maternal responsive versus directive behaviors. Further, results of analyses of divergent types of maternal directive behaviors – Responsive Directives, ReDirectives, and Intrusive Directives – also may help clarify major discrepancies in the current literature regarding the positive and negative effects of maternal directiveness.     

Face-to-face interaction in term and preterm infants

Previous research has found that mothers of preterm infants work harder in a face-to-face situation with their infants than mothers of term infants. Data have also revealed that preterm infants are less responsive than term infants in a social interaction. To date, there have been few studies that have attempted to determine the range of facial expressive cues that preterms may be emitting or the possible physiological basis for this behavior. In an attempt to investigate these questions, preterm and term infants were observed in a face-to-face situation. Prior to the session, three minutes of resting EKG was recorded. The infant's facial behavior was coded with a discrete facial action coding system. Maternal behavior was also coded. Measures of heart rate as well as short and long term variability were computed. Results revealed no differences in facial lability or in facial expressiveness between term and preterm infant. In addition, there were no differences in maternal behavior to either term or preterm. There were, however, reliable contingent relationships between facial expression of the infant and maternal behavior. In addition, there was a significant association between short term variability (vagal tone) and infant facial behavior.     

Maternal concepts and expectations regarding a preterm infant

The objective of the present study was: (a) to identify the concerns, verbally expressed, of 50 mothers regarding their preterm infants (PT) and then compare their verbal expression with those of 25 mothers of full-term infants (FT); and (b) to correlate the mothers' verbal expressions with maternal and infant variables. The following instruments were used to compose and characterize the sample: Structure Clinical Interview for DSM III-R Non-Patient (SCID/NP), State-Trait Anxiety Inventory (STAI), Beck Depression Inventory (BDI), and medical charts. Results showed that there was no difference between groups in term of mothers' expectations and conceptualizations; both groups exhibited predominantly positive expectations and concepts. In comparison with FT mothers, PT mothers verbally expressed more feelings and reactions predominantly negative or conflicting in relation to infant birth. Higher levels of maternal anxiety and depression in the PT Group were correlated with more verbal expressions about negative or conflicting emotions. In addition, lower birth weight, higher neonatal risk and longer length of stay in intensive care nursery of the infants were related with more negative or conflicting concepts by the mothers.     

The mediating role of maternal responsiveness in some longer term effects of postnatal depression on infant development

We hypothesized a mediating role for low maternal responsiveness in certain child developmental deficits found previously to be associated with postnatal depression. Forty depressed inpatients and 48 control (non-depressed) mothers and their infants were followed until 42 months postpartum. Mother–infant interactions were impaired at 6 months postpartum in the depressed group. Subsequent cognitive deficits were found in children's Full Scale IQ on the Wechsler Preschool Primary Scale of Intelligence (Revised) at 42 months of age. Statistical modeling of the mediation hypothesis confirmed that these effects were overwhelmingly explained by lowered maternal responsiveness at 6 months. Similarly, increased temperamental difficulties were apparent in children of depressed mothers but were not correlated with maternal responsiveness. Male infants of depressed mothers were disproportionately vulnerable (compared to females) to impaired cognitive abilities associated with maternal depression. The data concur with previous work and provide empirical support for the theoretical prediction that early disturbances of the mother–infant interaction will mediate some developmental deficits in the children of depressed mothers.     

Perceived mother‐infant relationship difficulties in postnatal depression

Postnatal depression has been associated with mother–infant relationship difficulties, but there has been less research in clinical populations. This study aims to identify characteristics of reported mother–infant relationship difficulties in mothers with postnatal depression who had been referred to a tertiary Mother and Baby Service. Forty‐one mothers with postnatal depression completed self‐report and interview measures with regards to their mental state, social adversity, and perceptions on their relationship with their infants. Almost one‐third of mothers (31.7%) reported severe difficulties, including rejection of the infant and maternal pathological anger. A low birth weight and maternal dissatisfaction towards their social role were found to be significantly related to perceived mother–infant interaction difficulties. Self‐reports correlated satisfactorily with interview schedules. A significant proportion of mothers reported difficulties in relating to their infants which can be reliably identified by means of the self‐report measures used. Copyright © 2004 John Wiley & Sons, Ltd.     

Responsive parenting: establishing early foundations for social, communication, and independent problem-solving skills

Mothers whose infants varied in early biological characteristics (born at term, n = 120; born at very low birth weight [VLBW], n = 144) were randomized to a target group (n = 133) or developmental feedback comparison group (n = 131) to determine whether learning responsive behaviors would facilitate infant development. The target condition included videotaped examples, problem-solving activities, and mothers' critique of their own behaviors through video procedures across 10 home visits. All target versus comparison mothers showed greater increases across multiple responsiveness behaviors observed in 4 assessments conducted across 6-13 months of age; changes in emotionally supportive behaviors were strongest for target mothers of infants born at VLBW. Increased maternal responsiveness facilitated greater growth in target infants' social, emotional, communication, and cognitive competence, supporting a causal role for responsiveness on infant development. Although benefits were generally comparable across risk groups, aspects of social and emotional skills showed greater change for those born at VLBW. Evidence for responsiveness as a multidimensional construct was provided as well as the importance of different aspects of responsiveness mediating the effect of the intervention on different infant skill domains.     

The association between maternal interaction and infant cortisol stress reactivity among preterm and full term infants at 4 months adjusted age

The purpose of this study was to assess the association between maternal interactive behavior and infant cortisol stress reactivity in response to the Still Face paradigm (SF) in a cohort of four-month old infants (adjusted age) born preterm (<32 weeks gestation, N = 22) compared with infants born full term (>37 weeks gestation, N = 28). Infant cortisol reactivity was calculated as area under the curve (AUC) from baseline to the third cortisol sample (30 min post-SF) using the trapezoidal rule, while the percent of time mothers spent using a contingent interaction style was measured (0–100%) during episodes 1 (Play; baseline), 3 (Reunion#1), and 5 (Reunion#2) while mother-infant dyads participated in the SF paradigm. We hypothesized that because infants born preterm are at increased risk for dysregulation, they would show, compared to full-term infants, a blunted stress response, involving under-responsiveness. We found blunted cortisol stress reactivity among the preterm infants. We also found that mothers of preterm infants demonstrated less contingent maternal interaction during Renion#1 of the SF; and that contingent maternal interaction at Reunion#2 of the SF was protective against cortisol stress reactivity in response to the SF. However, we did not find that the influence of maternal interaction on cortisol reactivity was moderated by gestational age group (full term vs preterm): the association between contingent maternal interaction and stress reactivity was similar for both gestational groups across episodes. In order to improve self-regulation and longer term social and cognitive developmental outcomes in medically at-risk infants, future research is warranted to determine how these findings relate to infants’ stress reactions in naturalistic settings, and the directionality and temporal relationship between cortisol stress responses and maternal interactive behavior.