Maternal Sleep-Related Cognitions and Infant Sleep: A Longitudinal Study From Pregnancy Through the 1st Year

Infant sleep is a major source of concern for many parents. The aims of this longitudinal study were to assess: (a) the development of sleep patterns among infants, (b) the development of maternal cognitions regarding infant sleep, and (c) the relations between these domains during the 1st year of life. Eighty-five mothers were recruited during pregnancy and completed a questionnaire aimed at assessing maternal sleep-related cognitions. After delivery (at 1, 6, and 12 months) sleep was assessed using actigraphy and sleep logs, and maternal cognitions were reassessed. The findings demonstrated significant predictive and concomitant links between maternal cognitions and infant sleep. Maternal soothing behaviors mediated the relations between these domains.     

Prenatal Cocaine Exposure and Infant Cortisol Reactivity

This study examined the effects of prenatal cocaine exposure on infant hypothalamic–pituitary–adrenal axis activity and reactivity at 7 months of infant age. Participants were 168 caregiver–infant dyads (87 cocaine exposed, 81 not cocaine exposed; 47% boys). Maternal behavior, caregiving instability, and infant growth and behavior were assessed, and children's saliva was sampled before, during, and after standardized procedures designed to elicit emotional arousal. Results revealed cocaine-exposed infants had a high amplitude trajectory of cortisol reactivity compared to non-cocaine-exposed infants. Infant gender and caregiving instability moderated this association. The findings support a dual hazard vulnerability model and have implications for evolutionary-developmental theories of individual differences in biological sensitivity to context.     

Non-organic failure to thrive: Implications of placement through analysis of videotaped interactions

This paper presents 6-month follow-up on a group of 16 infants hospitalized during the first months of life for non-organic failure to thrive (N-O FTT) and their mothers. Eight of these infants were placed in foster care and eight were returned home with their parents following hospitalization. The effects of placement on infant outcomes were examined through comparison of developmental scores and weight percentile changes, and the implications of foster care placements for mother-infant interactions were examined through analysis of patterns of interaction in videotaped sessions of feeding and play six months after hospital discharge. This analysis snowed that (1) mothers in both groups failed to make significant progress in resolving their own emotional or psychological conficts through treatment available; (2) weight and developmental status of the infants did not improve as expected in either group, and finally that (3) the patterns of interaction between mother and infant showed little change over time, and, regardless of placement at home or in foster care, remained concerning.     

Non-organic failure to thrive: Decision for and videotaped evaluations

Infants hospitalized for non-organic failure to thrive in the first six months of life are in a life-threatening situation and are already at risk for poor bonding with mother. In light of this, the meaning and use of foster care and how this separation affects the developing mother-child relationship are the issues addressed through examination of 16 cases in which 8 of the infants were placed in foster care and 8 discharged home after the failure to thrive hospitalization. This paper examines (1) maternal histories of pregnancy, labor and delivery and the neonatal status of placed and non-placed infants; (2) the developmental and weight status of placed children; (3) the nature of the decision criteria for after-hospital care; and (4) the mother-infant relationship at initial intake in terms of mother's report of events and observations of feeding and play interactions during a videotaped assessment process. The study found that the interactions between mother and infant in those situations which required foster care were clearly more dysfunctional when compared to those in which the baby was discharged home to mother. Babies in the two groups were comparable in weight status at the time of hospitalization although babies in foster placement had slightly lower scores on the Bayley Scales. Maternal histories of pregnancy, labor, and delivery were similar for the two groups as were the birth and neonatal histories of the infants.     

Measurement of infant difficultness.

The Infant Characteristics Questionnaire (ICQ) was developed as a short, factor-analytic screening device for difficultness. Responses of 322 mothers of 4-6-month-old infants suggested that they regard the fussy, hard-to-soothe, labile infant as difficult. Mother report on the ICQ, particularly on the main fussy-difficult factor was found to have adequate reliability over time and convergence with the Carey Survey of Temperamental Characteristics, with father report on the ICQ, and, to a lower degree, with home data collected by independent observers. It was also found that mother characteristics may affect perceptions of infant difficultness: multiparous, extraverted mothers tended to rate their infants as easy.     

Sleep/wake states of preterm infants: stability, developmental change, diurnal variation, and relation with caregiving activity

Using time-lapse video, we recorded the sleep/wake states of 95 preterm infants, born under 1500 g and cared for in three hospitals, for three 24-hr periods at 33 and 35 weeks conceptional age. The videotapes were scored in 5-min epochs for quiet sleep (QS); active sleep (AS); wakefulness (Wa); bout lengths of QS (QSBL), AS (ASBL), and waking (WaBL); nursing/caregiving periods (Crgv); bout lengths of Crgv (CrgvBL); and time out of the crib (OOC). The infants' sleep showed significant individual differences at each age, over age, and from day to nighttime. They showed developmental changes in QS, AS, Wa, and QSBL. QS and QSBL were positively related to caregiving time; ASBL was related to maternal age; and QS was related to gestational age and birth weight. Thus, very low birth weight preterm infants show marked stability and developmental change in the organization of the sleep/wake states from a very early age, and their states are related to demographic variables as well as temporal measures of caregiving.     

Longitudinal predictors of developmental status and social interaction in premature and full-term infants at age two

This investigation involved the longitudinal assessment of 30 mother-preterm and 40 mother-full-term dyads from birth to 2 years of age. Measures of maternal attitudes, maternal perception of the infant, and parental functioning were obtained at 1 and 8 months of infant age. Mother-infant interactions were observed at 4, 8, 12, and 24 months. Infant cognitive, motor, and language development was assessed at 4, 12, and 24 months. Results indicated that by age 2 years, no group differences were apparent on any child development, mother-child interaction, or maternal attitudinal measures; the lone exception was that preterms were significantly poorer in motor skills. This similarity in functioning at age 2 years was in marked contrast to earlier findings of major group differences at 12 months. Correlational and regression analyses indicated that the developmental and social interaction outcomes were predicted by different factors in the two groups; moreover, whereas 40%-60% of the variance in preterm infants' social and cognitive outcomes could be accounted for, only 15%-30% was accounted for in the full-term group. These results are discussed in terms of compensatory mechanisms that may characterize the parenting of high-risk infants, and of the applicability of transactional models of development.     

Longitudinal associations between marital instability and child sleep problems across infancy and toddlerhood in adoptive families

This study examined the longitudinal association between marital instability and child sleep problems at ages 9 and 18 months in 357 families with a genetically unrelated infant adopted at birth. This design eliminates shared genes as an explanation for similarities between parent and child. Structural equation modeling indicated that T1 marital instability predicted T2 child sleep problems, but T1 child sleep problems did not predict T2 marital instability. This result was replicated when models were estimated separately for mothers and fathers. Thus, even after controlling for stability in sleep problems and marital instability and eliminating shared genetic influences on associations using a longitudinal adoption design, marital instability prospectively predicts early childhood sleep patterns.     

Modalities of Infant–Mother Interaction in Japanese,Japanese American Immigrant,and European American Dyads

Cultural variation in relations and moment‐to‐moment contingencies of infant–mother person‐oriented and object‐oriented interactions were compared in 118 Japanese, Japanese American immigrant, and European American dyads with 5.5‐month‐olds. Infant and mother person‐oriented behaviors were related in all cultural groups, but infant and mother object‐oriented behaviors were related only among European Americans. Infant and mother behaviors within each modality were mutually contingent in all groups. Culture moderated lead–lag relations: Japanese infants were more likely than their mothers to respond in object‐oriented interactions; European American mothers were more likely than their infants to respond in person‐oriented interactions. Japanese American dyads behaved like European American dyads. Interactions, infant effects, and parent socialization findings are set in cultural and accultural models of infant–mother transactions.     

First-time mothers' selection of infant supine sleep positioning

The incidence of Sudden Infant Death Syndrome (SIDS) has decreased dramatically since the inception of the "Back to Sleep" campaign initiated by the American Academy of Pediatrics in 1992. However, that decrease has leveled off and many new parents cease to follow the recommendation to place their infants in the supine position for sleep between 1 and 3 months of age, the peak age for the incidence of SIDS. Shortened hospital stays for new mothers and the overwhelming amount of required patient teaching dictate the need to find the best method of instruction. The purpose of this study was to determine if a one-on-one teaching intervention improved the effectiveness of patient education and led to an increase in the desired behavior of placing the infant to sleep in the supine position. A quantitative experimental approach was used to examine the difference in compliance of supine infant positioning. Participants were drawn from a convenience sample of 61 primiparous women between the ages of 18 and 35 years with random assignment to either the experimental or control group. Compared to mothers in the control group, mothers in the experimental group demonstrated greater compliance in selecting supine sleep position in the first week home from the hospital and on the day of follow-up 6 weeks later. However, no difference in "usual position" was reported at 6 weeks and for the night previous to follow-up.     

Coping and Psychological Distress in Mothers of Very Low Birth Weight Young Children

Objective. This study sought to increase understanding of relations among coping strategies, sociodemographic variables, and psychological distress in mothers of high-risk (HR) and low-risk (LR) very low birth weight (VLBW; < 1,500g) infants. Design. The sample (N = 199) consisted of 77 mothers of HR VLBW infants, 43 mothers of LR VLBW infants, and a control group of 79 mothers of healthy, term infants. Data were collected with self-report questionnaires at birth and at 24 months postpartum. Relations among infant medical risk, multiple birth, maternal race, social class, and maternal coping were investigated. Hierarchical regression analyses were used to identify predictors of maternal psychological distress and to determine whether coping differentially moderated maternal psychological distress across groups. Results. Infant medical risk, social support, and maternal coping independently predicted maternal psychological distress. Mothers of HR VLBW infants reported significantly greater psychological distress than mothers of LR VLBW or term infants. Greater use of avoidant and express emotions coping predicted higher psychological distress for all mothers. Greater use of humor coping had a buffering effect, reducing distress only for mothers of HR VLBW infants. Maternal coping scores were related to maternal race and social class, rather than to severity of infant medical risk. Conclusions. Sociocultural sources of resiliency, as well as biological risk factors, should be considered when developing strategies to enhance coping and parenting in HR populations.     

Why screen newborns for cocaine: service patterns and social outcomes at age one year.

OBJECTIVE: To compare baseline characteristics, service provision, and child placement for infants exposed to cocaine in utero based on postnatal screening results. METHODS: We studied a retrospective cohort of 40 consecutive drug-exposed, but seemingly healthy term infants who underwent urine drug screening in the newborn nursery of a community hospital. Using clinical and service agency data, two cocaine-exposed cohorts were compared (a) screen-positive at birth (n = 22) versus (b) screen-negative at birth (n = 18). RESULTS: Both cocaine-exposed groups had similar infant birth weights, levels of paternal involvement, maternal ages, gravidity, parity, and lengths of gestation. Mothers in both groups had similar histories of prostitution, poor home environment, drug use, and prenatal drug rehabilitation. Mothers of screen-positive infants were more likely than mothers of screen-negative infants to have other children in foster care (27% vs. 6%, p = .07), to have experienced previous interventions by child protective services (CPS) (55% vs. 17%, p < .01), to have had no prenatal care (32% vs. 6%, p = .09), and fewer prenatal visits (4.7 vs. 8.6, p = .02). Compared to screen-negative infants, more screen-positive infants were referred to a high-risk infant tracking program (91% vs. 6%), referred to CPS (100% vs. 33%), placed outside the mother's home (50% vs. 22%), and had their mothers referred to drug rehabilitation (36% vs. 11%), (p < .01 for each). By 1 year of age, support services differed little between exposed cohorts. However, 6 of 22 screen-positive infants were in foster care and 3 were placed for adoption, while only 1 of the 18 screen-negative infants was in foster care and only 1 had been placed for adoption. There were no services available in this community to provide coordinated or comprehensive services or drug treatment specific to the needs of drug using mothers and drug exposed infants. CONCLUSIONS: Despite similarities between cocaine-exposed infants cared for in a normal newborn setting (with and without positive urine drug screens at birth), differences in referral services were noted. More striking than these differences was that services for families with drug-exposed infants are inadequate to even meet the needs of those families in our setting deemed to be at highest risk. Neonatal drug screening needs to be paired with effective services.     

Reliable Individual Differences in Preterm Infants' Excitation Management

2 large independent cohorts of preterm infants ranging between 32 weeks and term were given a neurobehavioral assessment (the NAPI) that measures, among other things, individual differences in excitation management. This assessment, which has high test-retest reliability and developmental and clinical validity, presents each infant with an identical sequence of events. Infant reactions to the standard stimulation provided by this assessment were used as measures of differential excitability. The results showed that over a period of weeks, preterms were highly self-consistent in their reactions. Highly reliable individual differences between infants were also seen. The self-consistencies and individual differences were independent of the infants' prior medical complications. With very few exceptions, these results replicated over the 2 independent cohorts. The individual consistencies and differences in excitation management found in this study might predispose children to later differences in temperament.     

Victim, perpetrator, family, and incident characteristics of infant and child homicide in the United States Air Force

OBJECTIVE: The present study describes factors related to fatal abuse in three age groups in the United States Air Force (USAF). METHOD: Records from 32 substantiated cases of fatal child abuse in the USAF were independently reviewed for 60 predefined factors. RESULTS: Males were over-represented in young child victims (between 1 year and 4 years of age) and child victims (between 4 years and 15 years of age) but not in infant victims (between 24 hours and 1 year of age). African-American infant victims and perpetrators were over-represented. Younger victims were more likely to have been previously physically abused by the perpetrator. Perpetrators were predominantly male and the biological fathers of the victims. Infant and young child perpetrators reported childhood abuse histories, while child perpetrators reported the highest frequency of mental health contact. Victims' families reported significant life stressors. Families of young child victims were more likely divorced, separated, or single. Incidents with infants and young children tended to occur without witnesses; incidents with child victims tended to have the victim's sibling(s) and/or mother present. Fatal incidents were more frequent on the weekend, in the home, and initiated by some family disturbance. CONCLUSIONS: Differences among groups in factors related to infant and child homicide across age groups may assist in the development of more tailored abuse prevention efforts and may also guide future investigations.     

The social ecology and early parenting of Caucasian adolescent mothers

Social characteristics, maternal behaviors, and the home environments of Caucasian adolescent and nonadolescent mothers were investigated in a sample of 50 primiparous low- and middle-class women and their 4-month-old infants. The mothers were interviewed about their child-care network and about stressful life events that may have occurred since the infant's birth. The HOME inventory was completed and videotapes of 2 hours of home observations were coded to assess maternal proximity, verbalizations, activity, and physical contact with the infant. Interview data indicated that adolescent mothers relied more frequently on other teenagers and other network members for help in child care than nonadolescent mothers. In addition, they also received more frequent support from their mothers and less frequent help from their partner's and partner's mother and siblings than nonadolescent mothers. During the home visit, they were less verbal with their infants and scored significantly lower on the Responsiveness and Maternal Involvement subscales as well as on the total HOME inventory; these results were replicated on subgroups matched for socioeconomic status, emphasizing the unique social context and parenting practices of teenage mothers.     

Differences on Bayley's infant behavior record for a sample of high-risk infants and their controls

3 groups of high-risk newborns and their controls were assessed at 92 weeks post-conceptional age using Bayley's Infant Behavioral Record (IBR). The 3 groups of high-risk infants were those who weighed 1,500 grams or less at birth and required no ventilator therapy, those weighing 1,500 grams or less at birth who required ventilator therapy, and newborns weighing more than 1,500 grams at birth who required ventilator therapy. Controls were healthy term infants matched for 7 socioeconomic and demographic variables. The first principal component of the IBR ratings for the 3 groups of high-risk infants and the controls were similar. All 3 groups of high-risk infants received less desirable IBR ratings on most items than their controls. In addition, there were some differences among high-risk groups; ventilated infants regardless of birth weight received the lowest ratings reflecting overall performance on the IBR, very low birthweight, ventilated newborns were more likely to receive ratings characterizing an overly active infant with a short attention span, and very low birth-weight, never-ventilated infants were most likely to be rated as happy but passive and delayed. The differences between the high-risk infants and controls in large part resulted from infants who were also delayed in terms of their mental and motor development.     

Infant – Mother Attachment among the Dogon of Mali

This study of mothers and infants from the Dogon ethnic group of Mali, West Africa examined three attachment hypotheses: (1) that infant attachment security is linked to the quality of mother-infant communication, (2) that mothers of secure infants respond more sensitively to their infants than do mothers of insecure infants, and (3) that infant disorganization is linked to maternal frightened or frightening behaviors. Participants were 27 mother-infant pairs from a rural town and 15 mother-infant pairs from two agrarian villages; infants ranged in age from 10 to 12.5 months at the first assessment. The distribution of the Strange Situation classifications was 67% secure, 0% avoidant, 8% resistant, and 25% disorganized. Infant attachment security was significantly related to the quality of mother-infant communication as observed in a well-infant exam. The correlation between infant attachment security ratings and maternal sensitivity (assessed in the home) was modest and approached significance. Mothers of disorganized infants had significantly higher ratings of frightened or frightening behaviors. Maternal sensitivity predicted little of the variance in infant security; however, the addition of the frightened/frightening variable in the regression equation tripled the explained variance. The findings are discussed in light of Dogon childrearing practices and key tenets of attachment theory.     

Risk factors for infant maltreatment: a population-based study

CONTEXT: Of the approximately 900,000 children who were determined to be victims of abuse or neglect by US child protective services in 2002, the birth-to-3 age group had the highest rate of victimization (1.6%) and children younger than 1 accounted for the largest percentage of victims (9.6%). OBJECTIVE: To identify perinatal and sociodemographic risk factors associated with maltreatment of infants up to 1 year of age. DESIGN AND SETTING: Observational cohort study. PARTICIPANTS: 189,055 children born in 1996 in Florida. MAIN OUTCOME MEASURE: Infant maltreatment, defined as a verified report of abuse, neglect, or threatened harm that occurred between day 3 of life and 1 year. RESULTS: 1,602 children (.85%) of the 1996 birth cohort had verified instances of maltreatment by age 1. Of 15 perinatal and sociodemographic variables studied, 11 were found to be significantly related to infant maltreatment. Five factors had adjusted relative risks (RR) of two or greater: Mother smoked during pregnancy (RR 2.8); more than two siblings (RR 2.7); Medicaid beneficiary (RR 2.1); unmarried marital status (RR 2.0); low birth weight infant (RR 2.0). Infants who had four of these five risk factors had a maltreatment rate seven times higher than the population average. CONCLUSIONS: Data on nearly all risk factors found to be significantly associated with infant maltreatment are available on the birth certificate. Such information can be incorporated into a population-based risk-assessment tool that could identify subpopulations at highest risk for infant maltreatment. Because resources are limited, these groups should be given priority for enrollment in child abuse prevention programs.     

Continuity of individual differences in the mother-infant relationship from six to thirteen months

The current study searched for continuities in mother-infant interaction observed at home, maternally perceived infant difficultness, and infant developmental competency. Also assessed were the possible moderator variables of maternal report of satisfaction with adjustment to the infant and background characteristics, for example, SES, presence of other young children, and infant gender. 128 dyads were assessed at ages 6 and 13 months. Many of the variables used to evaluate continuity were composites based on factor analysis. Bivariate correlations between 6- and 13-month variables produced a complex picture. In broad overview, as predicted by the prior literature, they indicated some degree of stability for mother variables and markedly less for the infant variables. Canonical correlation analysis yielded 3 significant canonical variates, producing a more integrated picture. The dimensions of continuity revealed by these variates were (1) Affectionate, Intellectually Stimulating Mothering, which had modest-to-moderate links to the indexes of infant competence; (2) Infant Temperamental Difficultness, which was determined mainly by consistency in mother report on 2 age-adjusted versions of the Infant Characteristics Questionnaire but which also contained loadings for objectively observed infant fussing, crying, and social demandingness; and (3) an unnamed dimension which resembles a pattern of intense involvement, both positive and negative, seen in older, clinically referred families.     

Infant Temperament: Stability by Age,Gender, Birth Order,Term Status,and Socioeconomic Status

Two complementary studies focused on stability of infant temperament across the 1st year and considered infant age, gender, birth order, term status, and socioeconomic status (SES) as moderators. Study 1 consisted of 73 mothers of firstborn term girls and boys queried at 2, 5, and 13 months of age. Study 2 consisted of 335 mothers of infants of different gender, birth order, term status, and SES queried at 6 and 12 months. Consistent positive and negative affectivity factors emerged at all time points across both studies. Infant temperament proved stable and robust across gender, birth order, term status, and SES. Stability coefficients for temperament factors and scales were medium to large for shorter (< 9 months) interassessment intervals and small to medium for longer (> 10 months) intervals.