Nursing Child Assessment Feeding Scale Research Articles

Parent-infant interaction in the NICU: Challenges in measurement

BackgroundParent-infant interaction is poorly understood among high-risk dyads in NICU settings. No parent-infant interaction measures are specifically designed for preterm infants within the NICU nor account for the education NICU parents receive to tailor their interactions based on the infant's cues. AimTo improve our understanding of a measure of parent-infant interaction in the NICU, we investigated relationships between parent-infant interaction scores on the Nursing Child Assessment Feeding Scale (NCAFS) and 1) socio-demographic and medical factors, 2) parent mental health and confidence, and 3) enhanced parental education (delivered as part of the Supporting and Enhancing NICU Sensory Experiences program) on tailoring interactions based on the infant's cues. MethodTwenty-six preterm infants (born ≤32 weeks) had a video recorded oral feeding conducted by a parent in the NICU when the infant was 34–48 weeks postmenstrual age. A certified evaluator scored parent-infant interaction from the videos using the NCAFS. ResultsSeventeen (65 %) parent-infant dyads scored below the 10th percentile on the total NCAFS score. Despite it being well-understood that parent-infant interaction is related to sociodemographic factors and parental mental health, there were no relationships between these factors and NCAFS scores in this study. Dyads who received enhanced parent education (n = 15) had lower NCAFS scores than dyads receiving usual care (n = 11) (p = 0.01). ConclusionIt remains unclear if the standard measure of parent-infant interaction, NCAFS, captured positive and negative interactions in context of assessment of a high-risk dyad within the NICU setting. The utility of the NCAFS with preterm infants in the NICU was not supported by this study.

Effects of opaque, weighted bottles on maternal sensitivity and infant intake.

Caregivers' abilities to assess how much is in the bottle may lead to encouragement of infant bottle emptying and overfeeding. The present study assessed whether use of opaque, weighted bottles (as compared with conventional, clear bottles) improves feeding outcomes. Mothers with infants <32weeks of age (n=76) were assessed on two separate days. Mothers fed their infants from an opaque, weighted bottle on 1day and a clear bottle on the other; conditions were counterbalanced. Blinded raters certified in the Nursing Child Assessment Feeding Scale scored all videos to determine maternal sensitivity. Infant intake was assessed by weighing the bottle before and after each feeding, and feeding outcomes included infant intake (mL), intake per kilogram body weight (mL/kg), meal duration (min), and feed rate (mL/min). Mothers exhibited significantly greater sensitivity (p=0.041), fed their infants fewer millilitres per kilogram body weight (p=0.049), and fed their infants at a significantly slower rate (p=0.009) when using opaque compared with clear bottles. Infant clarity of cues was a significant moderator of effects of bottle type on intake per kilogram body weight (p=0.028): Infants who exhibited greater clarity of cues were fed less during the opaque versus clear conditions whereas infants who exhibited poorer clarity of cues were fed similar amounts during both conditions. Effects of bottle type were not moderated by bottle contents (expressed breast milk vs. formula). In sum, promotion of opaque, weighted bottles for infant feeding may be a pragmatic approach to improve the quality and outcome of bottle-feeding interactions.

Evaluating Caregiver Sensitivity to Infants: Measures Matter

The significance of caregiver sensitivity for child development has been debated among scholars, not least due to sensitivity's inconsistent predictive value over time and across contexts. A lack of uniformity in the definition of sensitivity contributes to this debate, but shortfalls of inter-tool concordance and construct validity in the instruments used to assess sensitivity may also be at issue. This study examines correspondences among four established standardized measures of caregiver sensitivity in independent classifications of the same sample of mothers of infants. 50 European American mother- infant dyads of diverse SES were independently assessed with three observational caregiver sensitivity measures: the Emotional Availability Scales (EAS; Biringen, 2008), the Parent Child Interaction - Nursing Child Assessment Feeding Scale (PCI-NCAFS; Oxford & Findlay, 2015), and the Maternal Behaviour Q-Sort (MBQS; Moran, Pederson & Bento, 2009). Ratings were juxtaposed with classifications of the same sample based on the original Ainsworth Maternal Sensitivity Scales (AMSS; Ainsworth, 1969). The EAS, NCAFS, and MBQS related to the AMSS, but large proportions of variance were unshared. Researchers and clinicians should be cautious when assuming that popular observational assessment instruments, commonly believed to measure a generic construct of caregiver sensitivity, are interchangeable, as these measures may evaluate different features of sensitivity to infants.

Hormonal and Neuromuscular Responses to Breastfeeding: A Pilot Study.

Difficult breastfeeding in the first weeks after birth may result in muscle tension in infants and activation of the maternal hypothalamic-pituitary-adrenal (HPA) axis and sympathetic nervous system (SNS). Our primary objective was to examine the feasibility of collecting neuroendocrine markers of maternal HPA axis and SNS activation (salivary cortisol and α-amylase [sAA]) and electromyographic (EMG) markers of infant distress during feeding in the first 2 weeks after birth. We also examined the relationships of these indices to each other and to mother-infant interactive behaviors during feeding. We recruited mothers in the postpartum unit of a teaching hospital and observed a feeding in the dyad's home. Cortisol and sAA were sampled before feeding, 10 min into feeding, at feeding end, and 20 min after feeding. Infant muscle activity was recorded continuously with an EMG data logger. We used the Nursing Child Assessment Feeding Scale to measure mother-infant interaction. The 20 mothers reported no disruption to breastfeeding and no change in infant behavior due to collection measures. Mean cortisol levels decreased significantly; there was no significant change in sAA levels. Relationships were found between interactive behavior and trends in neuroendocrine biomarkers. Longer bursts of infant muscle activity were associated with higher levels of maternal cortisol during feeding but not mother-infant interactive behaviors. Maternal salivary biomarkers and their association with feeding behaviors can be a useful tool for clinical longitudinal research beginning soon after birth. Infant EMG data may be useful for assessing maternal arousal.

Mothers With Perceived Insufficient Milk: Preliminary Evidence of Home Interventions to Boost Mother-Infant Interactions.

Perceived insufficient milk (PIM) is the primary reason for breastfeeding discontinuation globally. This study evaluated the short-term impact of mother-infant interactions through home interventions designed to overcome PIM as a result of the infant's behavior, delivered to 14 dyads of breastfeeding mothers and their full-term singleton infants. A single group, three-occasion prepost design was used. Mother-infant interactions were measured by the Nursing Child Assessment Feeding Scale (NCAFS) at 6, 13, and 27 days postpartum. There were significantly increased mother-infant interactions during intervention. Specifically, significant growth over the intervention occurred for mother's sensitivity to cues, cognitive growth fostering, infant's clarity of cues, and responsiveness to caregiver. The NCAFS total score was also significantly improved. Although modifications are required, the three home intervention sessions showed promise in improving mother-infant interactions during breastfeeding. Further investigation using a randomized experimental design is warranted.

Postdischarge Feeding Interactions and Neurodevelopmental Outcome at 1-Year Corrected Gestational Age

To determine the extent to which postdischarge feeding behaviors and interactions among caregiver-preterm infant dyads are associated with infant neurodevelopment at 1-year corrected gestational age (CGA). We studied 119 preterm infants born <34weeks gestation and <1750g at birth, and their caregivers, enrolled in the Collaborative Home Infant Monitoring Evaluation with in-person feeding assessments according to the Nursing Child Assessment Feeding Scale (NCAFS) at 39-59weeks postmenstrual age that completed Bayley Scales of Infant Development, Second Edition testing at 1year CGA. Mean±SD gestational age was 29.6±2.4weeks, and birth weight was 1260±320g. After adjustment for maternal and infant demographics, gestational age at birth, discharge and birth weight, mode of infant feeding, and caregiver type during the postdischarge NCAFS assessment, overall NCAFS scores were positively associated with higher 1-year CGA Bayleymental developmental index (MDI) scores (for each 1 SD increase in overall NCAFS score, MDI increased by 2.8 [95% CI 0.7, 4.9] points). Among individual NCAFS domains, strongest effects were seen for caregiver responsiveness to infant distress, such that, compared with dyads having domain scores of 11 (highest possible score), the adjusted mean difference in MDI was 8.3 points (95% CI -15.2, -1.4) lower among dyads with scores <9. Caregiver-preterm infant feeding interaction and caregiver responsiveness to preterm infant feeding distress were associated with preterm infant Bayley MDI at 1-year CGA. Caregiver-infant feeding interaction may represent a modifiable factor to improve the neurodevelopment of at-risk preterm infants.

Mindless feeding: Is maternal distraction during bottle-feeding associated with overfeeding?

Mindless eating, or eating while distracted by surrounding stimuli, leads to overeating. The present study explored whether “mindless feeding,” or maternal distraction during bottle-feeding, is associated with greater infant formula/milk intakes and lower maternal sensitivity to infant cues. Mothers and their ≤24-week-old bottle-feeding infants (N = 28) visited our laboratory for a video-recorded feeding observation. Infant intake was assessed by weighing bottles before and after the feedings. Maternal sensitivity to infant cues was objectively assessed by behavioral coding of video-records using the Nursing Child Assessment Feeding Scale. Maternal distraction was defined as looking away from the infant >75% of the feeding; using a mobile device; conversing with another adult; or sleeping. Twenty-nine percent (n = 8) of mothers were distracted. While differences in intakes for infants of distracted vs. not distracted mothers did not reach significance (p = 0.24), the association between distraction and infant intake was modified by two dimensions of temperament: orienting/regulation capacity (p = 0.03) and surgency/extraversion (p = 0.04). For infants with low orienting/regulation capacity, infants of distracted mothers consumed more (177.1 ± 33.8 ml) than those of not distracted mothers (92.4 ± 13.8 ml). Similar findings were noted for infants with low surgency/extraversion (distracted: 140.6 ± 22.5 ml; not distracted: 78.4 ± 14.3 ml). No association between distraction and intake was seen for infants with high orienting/regulation capacity or surgency/extraversion. A significantly greater proportion of distracted mothers showed low sensitivity to infant cues compared to not distracted mothers (p = 0.04). In sum, mindless feeding may interact with infant characteristics to influence feeding outcomes; further experimental and longitudinal studies are needed.

A pilot study comparing opaque, weighted bottles with conventional, clear bottles for infant feeding

It is hypothesized that the visual and weight cues afforded by bottle-feeding may lead mothers to overfeed in response to the amount of liquid in the bottle. The aim of the present pilot study was to test this hypothesis by comparing mothers' sensitivity and responsiveness to infant cues and infants' intakes when mothers use opaque, weighted bottles (that remove visual and weight cues) compared to conventional, clear bottles to feed their infants. We also tested the hypothesis that mothers' pressuring feeding style would moderate the effect of bottle type. Formula-feeding dyads (N = 25) visited our laboratory on two separate days. Mothers fed their infants from a clear bottle one day and an opaque, weighted bottle on the other; bottle-order was counterbalanced across the two days. Infant intake was assessed by weighing each bottle before and after the feeding. Maternal sensitivity and responsiveness to infant cues was objectively assessed using the Nursing Child Assessment Feeding Scale. Mothers were significantly more responsive to infant cues when they used opaque compared to clear bottles (p = .04). There was also a trend for infants to consume significantly less formula when fed from opaque compared to clear bottles (p = .08). Mothers' pressuring feeding style moderated the effect of bottle type on maternal responsiveness to infant cues (p = .02) and infant intake (p = .03). Specifically, mothers who reported higher levels of pressuring feeding were significantly more responsive to their infants' cues (p = .02) and fed their infants significantly less formula when using opaque versus clear bottles (p = .01); no differences were seen for mothers who reported lower levels of pressuring feeding. This study highlights a simple, yet effective intervention for improving the bottle-feeding practices of mothers who have pressuring feeding styles.

Breastfeeding, skin-to-skin contact, and mother-infant interactions over infants' first three months.

The effects of skin-to-skin contact (SSC) on the maintenance of mothers' decision to breastfeed, the effects of breastfeeding and SSC on mother-infant interactions, and whether maternal depressive symptoms mediate these effects were investigated over infants' first 3 months. When infants were 1 week, 1 month, 2 months, and 3 months of age, mothers in the SSC and control groups reported the type of infant feeding provided and completed the Edinburgh Postnatal Depression Scale (EPDS; J.L. Cox, J.M. Holden, & R. Sagovsky, 1987); mother-infant interactions were coded on the Nursing Child Assessment Feeding Scale (NCAFS; G. Summer & A. Spietz, 1994). Percentage of breastfeeding dyads in the SSC group was stable over the 3 months; yet, fewer dyads in the control group were breastfeeding at the 2- and 3-month visits than at the 1-week visit. Breastfeeding dyads had higher NCAFS Caregiver subscale scores, indicating more positive maternal interactions, at 1 week, 2 months, and 3 months. NCAFS scores did not differ for the SSC and control groups. EPDS scores did not mediate the effect of SSC on breastfeeding or breastfeeding on NCAFS Caregiver subscale scores.

The Relationship Among Skin‐to‐Skin Contact, Breastfeeding, and Mother–Infant Interaction: Implications for Nursing

Newborn Care Poster Presentation Objective To investigate the effect of mother–infant skin‐to‐skin contact (SSC) on the maintenance of breastfeeding over the first 3 months and the effect of breastfeeding on mother–infant interaction. Design Longitudinal quasi‐experiment. Setting Home visits in eastern Nova Scotia. Sample Seventy‐seven full‐term infants and their mothers were seen in their homes at 1 week, 1 month, 2 months, and 3 months. Methods Mothers in an SSC group were requested to provide SSC, no request for SSC was made to control group mothers. All mothers kept daily records of the SSC they provided. The SSC group mothers provided approximately 5 hours/day of SSC in the infants' first week and then more than 2 hours/day until the infants were 1 month old. Control group mothers provided little or no SSC. At each home visit, mothers reported whether they provided exclusive breastfeeding, partial breastfeeding, or no breastfeeding. Mother–infant interactions were assessed at each visit using the Nursing Child Assessment Feeding Scale (NSAFS). Results The SSC group mothers provided more SSC than control group mothers (week 1: SSC, M = 4.92 hours/day, control M = 0.48 hours/day; weeks 2‐4 SSC, M = 2.77 hours/day, control M = 0.19 hours/day). At 1 week, the percentage of breastfeeding dyads was similar in both groups (exclusive: SSC=77%, control=69%; exclusive + partial: SSC=81%, control=75%). The percentage of breastfeeding dyads (exclusive + partial) declined in the control group as the infants aged but remained stable in the SSC group. Breastfeeding dyads had significantly higher scores on the NCAFS Caregiver Scale, indicating more positive maternal interactions at 1 week, 2 months, and 3 months. Conclusion/Implications for Nursing Practice Though numerous studies have shown SSC to benefit newborns' physiological adjustment, few studies have investigated the effect of SSC on breastfeeding duration beyond the newborn period. In this study, SSC facilitated the maintenance of breastfeeding during the infants' early months, and breastfeeding was associated with increased positive maternal interactions. The findings imply the importance of the promotion of SSC to help mothers maintain the decision to breastfeed to the benefits of infants, mothers, and the developing mother–infant relationship. As providers of postpartum care, nurses are uniquely positioned to educate and support mothers in SSC and to influence broader public health policy about maternal–child health.

Http://www.omicsgroup.org/journals/survey-of-the-nurse-staffing-system-including-the-patient-classification-system-and-issues-2167-1168.S5-005.php?aid=12796

The study was an exploratory pilot study in which subjects consisted of adolescent mothers and their infants in Japan. Background: Japanese adolescents giving birth to their babies are increasing although only at a rate of 1.4%. They chose to give birth more often instead of abortion than in past years. In Japanese society, it is not easy for an adolescent to be recognized as a mother because their knowledge is not sufficient for parenting and they are not ready to be a mother. They usually need support to be a mother. Purpose: The study examined relationships among adolescent mother-infant interaction, maternal self-esteem, and parenting stress, which affect child development, in order to make recommendations for helping Japanese adolescent mothers in parenting. Methods: The subjects were 10 adolescent mothers and their infants aged 3–12 months (adolescent group) and 10 mothers whose mean age was 28.9 years, the same age range when Japanese women gave birth to their first baby (comparison group). This study examined differences in mother-infant interaction, self-esteem, and parenting stress between the adolescent and comparison groups. Results: Maternal self-esteem had a significant negative correlation with mother-infant interaction and parenting stress. Nursing Child Assessment Feeding Scale scores-especially the “Sensitivity to Cues” subscale-among the adolescent group were significantly lower than those of the comparison group. High parenting stress was influenced by difficulty in understanding about infant and a restraint coming from the parenting role. Conclusion: Delicately reading of child cues and promptly an appropriately responds to them make more attuned mother-infant relationships. The study suggested that adolescent mother-infant relationship has positive correlation of maternal self-esteem and parenting stress, informing recommendations for nurses to replace their negative selfimage of these youth with a positive one, which may ultimately lessen parenting stress.

Preterm birth and Assisted Reproductive Technology/ART: Maternal emotional wellbeing and quality of mother–newborn interaction during the first three months of life

ObjectiveAssisted Reproductive Technology (ART) and premature birth are stressful and difficult experiences for women. No research to date has examined the impact of ART on mother–child relationship in instances of preterm delivery. This study explored the psychological status of preterm infants' ART-mothers and the quality of mother–infant dyadic interaction, up to child age of three months (Corrected Age = CA). MethodForty-one ART-dyads and 53 Spontaneous Pregnancy (SP) dyads were enrolled. Mother and child were assessed at 5 to 7days after birth (T1), at child discharge from hospital (T2), at one month after discharge (T3); and at 3months CA (T4). The following measures were administered to the mothers: the Gordon Personal Profile Inventory, the Beck Anxiety Inventory, the Beck Depression Inventory, and the Parenting Stress Index S–F. Mother–child interaction was coded by using the Nursing Child Assessment Feeding Scale. ResultsAt childbirth, the control group mothers showed a higher level of anxiety than the ART-mothers did, but at T2, T3, T4, both groups' parenting stress levels were below threshold. Conversely, ART mothers more frequently provided suitable stimulation for their child's socio-emotional and cognitive development than the control group did. No significant between-group differences were observed in the mothers' capacity to respond to their children's distress, nor in sensitivity to child cues. Both infant groups showed equal ability to send clear signals and to respond to parent-provided care. ConclusionsART and SP mothers with premature infants showed no differences in degree of emotional burden experienced during the neonatal period. Yet, dyadic interaction was qualitatively better in ART dyads than in SP dyads.

Impact of mother's cognitive behavior intervention on premature infant-mother interaction

Objective To examine the impact of cognitive behavior intervention （CBI） on mother-infant interaction in the neonatal department. Methods Low-risk appropriate for gestational age premature infants with gestational age 28-36 weeks, who were admitted to the neonatal intensive care unit in our hospital between August 2007 and May 2008, and their mothers were assigned to intervention group and control group respectively. Intervention group mothers （n = 19）participated in CBI. Control group mothers （n= 19） were asked to read educational materials. Mothers in the intervention group, all received 4 times interventions and 2 h for each time. The CBI process include assessment, plan, implementation and evaluation. Mothers were educated for knowledge about appearance and behavioral characteristics of preterm infants and were guided about how to take care of their babies and participate in nursing care process. Mothers completed measures on mother-infant interaction （Nursing Child Assessment Feeding Scale, NCAFS） in the first follow-up after infant discharge. Results The results showed that the scores of NCAFS and total scores of the mothers in the intervention mother-infant dyads were 46.4 ± 8.5 and 35.8±6.3,higher than in the control group （42.7±5.9 and 33.3 ± 5.6）, respectively, but there were no statistic difference between the two groups （t = 1.55 and 1.28, P〉 0. 05）. The scores of ＂mother＇s response to distress＂ were significantly higher in the intervention mother-infant group （12. 2± 1.7） than in the control group （10.7±2.4）（t=2.10,P〈0.05）. Conclusions The levels of premature infant-mother interactions are low. CBI can improve mother＇s response to premature infant＇s distress. Further study is needed to investigate the effects of CBI in improving mother-infant interaction. Key words: Infant,premature Maternal behavior Early intervention （education）

Iron-Deficiency Anemia in Infancy and Mother-Infant Interaction During Feeding

This study was conducted to compare quality of mother-infant interaction during feeding in infants with or without iron-deficiency anemia (IDA). Infants and caregivers were screened at their 9- to 10-month-old health maintenance visits at an inner-city clinic in Detroit. Those who were full-term and healthy received a venipuncture blood sample to assess iron status. Of the 77 infants who met final iron status criteria, 68 infants and mothers were videotaped during feeding interaction at the Child Development Research Laboratory. The quality of mother-infant interaction during feeding was scored on the Nursing Child Assessment Feeding Scale. Twenty-five infants with IDA (hemoglobin [HB] <110 g/L and at least 2 abnormal iron measures) were compared to 43 nonanemic infants (HB > or = 110 g/L) using analysis of variance and general linear models with covariate control. Mothers of IDA infants responded with significantly less sensitivity to infant cues and less cognitive and social-emotional growth fostering behavior than mothers of nonanemic infants. The pattern of results was similar for scales of contingent behaviors. The magnitude of the differences in maternal ratings was large (0.8-1.0 SD after covariate adjustment). IDA infants were rated significantly lower on clarity of cues and overall (effect sizes 0.5 SD). IDA in infancy was associated with less optimal mother-infant interaction during feeding. Future interventions might target feeding interaction and consider effects on infant iron status and developmental/behavioral outcomes among IDA infants, as well as infant feeding practices per se.

Validity of the Nursing Child Assessment Feeding Scale During Toddlerhood

This study examined the validity of the Nursing Child Assessment of Feeding Scale (NCAFS) during toddlerhood, using a longitudinal design to assess the scale's convergence with the Toddler Snack Scale (TSS) between 12 and 36 months, and comparing videotaped interactions of 116 mother-toddler dyads. Differences between TSS mutuality classifications were found for the NCAFS subscales at each age. The pattern of mean scores followed expected directions at 12 and 36 months, but only two of the six NCAFS subscales maintained this pattern at 24 months. Significant differences were found between TSS mutuality classifications and NCAFS dyadic scores at each age. With one exception, "connected" and "marginal" dyads had consistently higher dyadic scores than dyads classified as "poor" in mutuality. There were no differences between connected and marginal dyads. The NCAFS does not appear to capture control-autonomy balance as well as the TSS, and a revision for toddlerhood may be needed.

Reliability of the Nursing Child Assessment Feeding Scale During Toddlerhood

The quality of the maternal-child feeding interaction has been proposed to be an important contributor to a child's being overweight, yet assessment of this proposition has been hindered by a lack of age-appropriate instrumentation. The primary aim of this study was to examine the reliability of the Nursing Child Assessment of Feeding Scale (NCAFS) if extended to use during toddlerhood. A longitudinal design was used to assess NCAFS reliability at 12, 24, and 36 months. The NCAFS was used to code videotaped feeding observations of 116 mother–toddler dyads collected as part of a larger study examining mother–child interactions and adaptations of toddlers. Reliability was explored through the assessment of interrater reliability, internal consistency of the various subscales and the scale as a whole, and stability of the scale measurements over time. At each age, interrater reliability was generally quite good whereas the NCAFS' internal consistency was low. Maternal contributions to feeding interaction quality were stable over time but dyadic and child contributions were not. The lower internal consistency estimates were likely due to relatively low levels of variance among the dyads within each age. Another probable contributor to diminished internal consistency was the attrition of several behavior items due to zero variance. Possible explanations for this restriction of variance and several approaches for improving the NCAFS internal consistency during toddlerhood are considered. With revision, the NCAFS could be useful in assessment of feeding interaction quality during the transition to toddlerhood when issues of control and autonomy become increasingly prominent.

Kangaroo mother care and mother-premature infant dyadic interaction.

The aim of this study was to investigate the psychological impact of Kangaroo Mother Care (KMC) on mother-infant bonding in cases of premature delivery. Examined variables were mother-infant relationships, maternal anxiety levels, and infant interactive signals. The KMC method requires that babies be undressed and held upright between their mother's breasts for a minimum of 1 hr a day, from birth until they are discharged from hospital. The present study examined 40 premature infants and their mothers, with 21 dyads experiencing KMC and 19 receiving traditional care (TC). Maternal emotional stress was assessed with the Parent Stress Index-Short Form questionnaire (Abidin, 1990), and mother-newborn interactive style was assessed with the Nursing Child Assessment Feeding Scale (Barnard, 1975). Results revealed a better mother-infant interactive style, a significant decrease in maternal emotional stress, and better infant ability to make requests and respond to parental interactive style in the KMC group.

Intervention for infants with brain injury: Results of a randomized controlled study

A randomized clinical trail (RCT) employed a 12-month individualized cognitive/sensorimotor stimulation program to look at the efficacy of the intervention on 62 infants with suspected brain injury. The control group infants received the State-funded follow-up program provided by the Los Angeles (LA) Regional Centers while the intervention group received intensive stimulation using the Curriculum and Monitoring System (CAMS) taught by public health nurses (PHNs). The developmental assessments and outcome measures were performed at 6, 12 and 18 months corrected age and included the Bayley motor and mental development, the Home, mother–infant interaction (Nursing Child Assessment Feeding Scale (NCAFS) and Nursing Child Assessment Teaching Scale (NCATS)), parental stress and social support. At 18 months, 43 infants remained in the study. The results indicate that the intervention had minimal positive effects on the Bayley mental and motor development scores of infants in the intervention group. Likewise, the intervention did not contribute to less stress or better mother–infant interaction at 12 or 18 months although there were significant differences in the NCAFS scores favoring the intervention group at 6 months. There was a significant trend, however, for the control group to have a significant decrease over time on the Bayley mental scores. Although the sample was not large and attrition was at 31%, this study provides further support to the minimal effects of stimulation and home intervention for infants with brain injury and who may have more significant factors contributing to their developmental outcome.

Effects of prenatal cocaine/polydrug use on maternal-infant feeding interactions during the first year of life.

The effects of prenatal cocaine use on quality of maternal-infant interactions were evaluated using the Nursing Child Assessment Feeding Scale (NCAFS). A total of 341 (155 cocaine using; 186 non-cocaine using) low socioeconomic, primarily African-American dyads were evaluated longitudinally at birth, 6.5, and 12 months. Group differences over time were examined, controlling for covariates, using a mixed-model linear approach. Women who used cocaine during pregnancy were less sensitive to their infants than non-cocaine-using women at 6.5 and 12 months. At 6.5 months, heavier prenatal cocaine users were less responsive to their infants than lighter users. In infants, prenatal cocaine exposure was related to poorer clarity of cues. There were no significant cocaine effects on maternal social-emotional growth fostering, cognitive growth fostering, or infant responsiveness to mother. Controlling for covariates, concentration of cocaine metabolites predicted maternal sensitivity to infant cues and infant clarity of cues at 1 year. Maternal cocaine use during pregnancy and other pre- and postnatal factors adversely affect maternal-infant interactions during the first year of life.

Family-Based Intervention to Enhance Infant–Parent Relationships in the Neonatal Intensive Care Unit

To examine how family-based interventions in the neonatal intensive care unit (NICU) may change parental knowledge and behaviors and decrease stress. Eighty-four high-risk mother-infant dyads were randomly assigned to two intervention and one control groups. Group 1 (n = 28) participated in a demonstration of infant reflexes, attention, motor skills, and sleep-wake states. Group 2 (n = 31) viewed educational materials. Group 3 (n = 25), controls, participated in an informal discussion. Parent-infant interactions (Nursing Child Assessment Feeding Scale) were videotaped. Mothers completed measures of stress (Parenting Stress Index) and knowledge of infant cues (Knowledge of Preterm Infant Behavior Scale). Mothers in both intervention groups evidenced greater knowledge and more contingent and sensitive interactions with their infants than did the control group. Stress also differed across groups, and all mothers reported scores above norms. In a high-risk sample, short-term, family-based NICU interventions may enhance mothers' knowledge, sensitivity, contingency, and stress.