The Socio-Communicative Development of Preterm Infants Is Resistant to the Negative Effects of Parity on Maternal Responsiveness

In a longitudinal study, infants 6-18 months of age were observed in their homes playing with their mothers and with peers. Of primary concern was how they coordinated their attention to people and objects. Observations were coded using a state-based scheme that included a state of coordinated joint engagement as well as states of person engagement, object engagement, onlooking, and passive joint engagement. All developmental trends observed were similar regardless of partner: person engagement declined with age, while coordinated joint engagement increased. Passive joint engagement, object engagement, and onlooking did not change with age. However, the absolute amount of some engagement states was affected by partner: both passive and coordinated joint engagement were much more likely when infants played with mothers. We conclude that mothers may indeed support or "scaffold" their infants' early attempts to embed objects in social interaction, but that as attentional capabilities develop even quite unskilled peers may be appropriate partners for the exercise of these capacities.

Maternal-newborn contact enhances organization of the infant's physiological systems, including stress reactivity, autonomic functioning, and sleep patterns, and supports maturation of the prefrontal cortex and its ensuing effects on cognitive and behavioral control. Premature birth disrupts brain development and is associated with maternal separation and disturbances of contact-sensitive systems. However, it is unknown whether the provision of maternal-preterm contact can improve long-term functioning of these systems. We used the Kangaroo Care (KC) intervention and provided maternal-newborn skin-to-skin contact to 73 premature infants for 14 consecutive days compared with 73 case-matched control subjects receiving standard incubator care. Children were then followed seven times across the first decade of life and multiple physiologic, cognitive, parental mental health, and mother-child relational measures were assessed. KC increased autonomic functioning (respiratory sinus arrhythmia, RSA) and maternal attachment behavior in the postpartum period, reduced maternal anxiety, and enhanced child cognitive development and executive functions from 6 months to 10 years. By 10 years of age, children receiving KC showed attenuated stress response, improved RSA, organized sleep, and better cognitive control. RSA and maternal behavior were dynamically interrelated over time, leading to improved physiology, executive functions, and mother-child reciprocity at 10 years. These findings are the first to demonstrate long-term effects of early touch-based intervention on children's physiologic organization and behavioral control and have salient implications for the care practices of premature infants. Results demonstrate the dynamic cascades of child physiological regulation and parental provisions in shaping developmental outcome and may inform the construction of more targeted early interventions. Copyright © 2014 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.

Few studies document how parents adapt to the experience of a very low-birth-weight (VLBW; 36 weeks, >2500 g). Standardized, normative self-report measures of maternal psychological distress, parenting stress, family impact, and life stressors. Mothers of VLBW infants (high risk, n = 122; low risk, n = 84) had more psychological distress than mothers of term infants (n=123) at 1 month (13% vs 1%; P = .003). At 2 years, mothers of low-risk VLBW infants did not differ from term mothers, while mothers of high-risk infants continued to report psychological distress. By 3 years, mothers of high-risk VLBW children did not differ from mothers of term children in distress symptoms, while parenting stress remained greater. Severity of maternal depression was related to lower child developmental outcomes in both VLBW groups. The impact of VLBW birth varies with child medical risk status, age, and developmental outcome. Follow-up programs should incorporate psychological screening and support services for mothers of VLBW infants in the immediate postnatal period, with monitoring of mothers of high-risk VLBW infants.