Nursing Child Assessment Satellite Training Research Articles

Canadian Mothers More Responsive Than Cambodian Peers in a Cross-Cultural Assessment of a Breastfeeding Interaction in the First 6 Months: A Preliminary Assessment

ObjectivesHuman milk is the sole recommended food for infants for the first 6 months of life. Although determinants and rates of exclusive breastfeeding differ greatly between high- and low-and-middle-income countries, little is known about whether breastfeeding practices, such as feeding responsiveness, differ across cultures. Responsive feeding practices are based on the cues and responses of a caregiver and infant, and are associated with more intuitive eating patterns later in life. This preliminary assessment aims to assess the responsiveness of the maternal-child interactions during breastfeeding of infants less than 6 months old cross-culturally, in both a high- and lower-middle income country. MethodsThis preliminary analysis includes 10 mother-infant dyads from Nova Scotia, Canada, who have been age-matched (±4 days) to 10 Cambodian dyads recruited in Kampong Thom province, Cambodia. In both settings, a breastfeeding session was video-recorded in the participant’s home and videos scored using the validated, 76-item Nursing Child Assessment Satellite Training (NCAST) Caregiver/Parent-Child Interaction Feeding Scale. ResultsInfants were between 13 and 23 weeks old, and in both groups were 40% firstborn and 40% male. Cambodian mothers (27.3 ± 3.4 years) were significantly younger than Canadian (32.0 ± 2.3; p = 0.002), and the average length of feed in Cambodia was significantly shorter (5.5 ± 1.6 min v. 7.3 ± 1.3 min; p = 0.02). There was no significant difference between Canadian and Cambodian total NCAST scores. However, Canadian mothers scored significantly higher on three of the four maternal NCAST subscales; subscale I (sensitivity to infant’s cues, p = 0.03), subscale III (social-emotional growth fostering, p = 0.01), and subscale IV (cognitive growth fostering, p = 0.02) There were no significant differences in scores for NCAST subscales measuring infant’s clarity of cues or responsiveness to their mother. ConclusionsThese preliminary results indicate differences in feeding responsiveness on the part of mothers during breastfeeding in Canada and Cambodia and could inform future programs to optimize the maternal-child feeding interaction. Funding SourcesMSVU Internal Grant, Canadian Institute for Health Research, Research Nova Scotia.

Family Integrated Care (FICare): Positive impact on behavioural outcomes at 18 months

BackgroundChildren born very preterm demonstrate behavioural challenges due to clinical factors, exposure to the high stress environment of intensive care, and separation from parents during neonatal hospitalization at a critical stage in development. Family Integrated Care (FICare) significantly reduced parent stress and anxiety, and improved neonatal outcomes. AimsTo examine the impact of FICare on behavioural outcomes at 18–21 months corrected age (CA), and assess possible mediation through parenting or infant growth. Study design and methodsA prospective cohort study enrolling infants under 33 weeks gestation and parents from the FICare cluster randomized controlled trial. Primary outcome was behaviour assessed by the Infant Toddler Social Emotional Assessment (ITSEA). Parent child variables were measured with the Nursing Child Assessment Satellite Training (NCAST), Parenting Stress Index (PSI) and infant growth. ResultsSubjects included 123 FICare infants and 62 standard care controls evaluated at 18–21 months CA. FICare infants demonstrated lower ITSEA Dysregulation, indicating better self-regulation skills, compared with the control group (T-score 41.7 vs 46.6, p < 0.01). At 12 months CA, the NCAST Child subtotal score was higher and the PSI-Child Domain score was lower in FICare infants than non-FICare infants. The PSI-Child domain was identified as a possible mediator of FICare on child behaviour (mediation effect 1.28, −2.96–0.02, p = 0.044). ConclusionFICare in the NICU has a sustained effect on child behaviour, improving self-regulation at 18–21 months CA.

Exploration of Responsive Feeding During Breastfeeding Versus Bottle Feeding of Human Milk: A Within-Subject Pilot Study.

Background: Responsive feeding promotes optimal feeding patterns and growth trajectories. Breastfeeding is thought to facilitate responsive feeding, but research to date has been limited to comparing formula-feeding and breastfeeding dyads. Using a within-subject approach, we aimed to assess maternal responsiveness to infant cues during two human milk feeding sessions differing by feeding modality (breastfeeding versus bottle feeding). Materials and Methods: Nine mother-infant dyads (infants ≤6 months) were recruited from the Halifax Regional Municipality, Nova Scotia, from April to May 2018. Two human milk-feeding sessions, directly from the breast and from a bottle, were video-recorded in participants' homes, then scored using the validated Nursing Child Assessment Satellite Training (NCAST) Caregiver/Parent-Child Interaction Feeding Scale. The second half of feeding sessions were coded for infant satiation cues. Results: All women earned a college degree or higher, and were partnered. Mothers were aged mean ± standard deviation 33.2 ± 4.0 years; infants were 14.6 ± 6.9 weeks old and six (67%) were female. Mothers were more sensitive to infant cues during breastfeeding (NCAST Maternal Sensitivity to Cues sub-scale score, 15.0 ± 1.0) than bottle feeding (13.4 ± 1.6; p = 0.016). There was a significantly longer latency from feeding session midpoint to the first satiation cue during breastfeeding (minutes:seconds; 3:00 ± 1:53 versus 0:45 ± 1:18 bottle feeding, p = 0.038). There was no difference in the number of infant cues by feeding modality. Conclusions: Despite the small sample with high socioeconomic status, this pilot study highlights differences in maternal responsiveness to infant cues by feeding modality with human milk, which warrants further investigation.

Caregiving and infants' neurodevelopment in rural Costa Rica: Results from the Infants’ Environmental Health Study (ISA)

Early caregiving is one of the strongest influences on children’s development, and among the most significant modifiable environmental factor. The aim of this study was to explore the association between quality of caregiver-infant interactions and neurodevelopment of infants living in banana-growing communities in rural Costa Rica characterized as having environmental toxic exposures. Home visits were conducted with 94 caregiver-infant dyads from the Infants’ Environmental Health Study (ISA), living within Matina county, Limón province. One-year infant neurodevelopmental outcomes were assessed using the Bayley Scales of Infant and Toddler Development®, Third Edition (Bayley-III). Quality of caregiver-infant interaction was assessed with a standardized observational task: Nursing Child Assessment Satellite Training Teaching scale (NCATS) at around two years of age. Multiple regression analyses examined associations between components of caregiver-infant interactions and neurodevelopmental outcomes, adjusting for mancozeb and manganese exposure and other potential confounders. Compared to NCATS normative data for U.S. Hispanic mothers, 35% of the sample had overall caregiving interaction scores ≤10th percentile cut-off, indicating less than optimal interactions. Higher quality of caregiver-infant interaction was associated with higher expressive communication ability in infants [ß = 0.03 (95% CI: 0.01, 0.06)], controlling for pesticide exposure and confounders. Aspects of caregiving such as stimulation and growth-fostering of infants were most strongly associated with language outcomes. Results suggest an association between positive caregiving on language development for infants living in a rural agricultural area in Costa Rica, and highlight aspects of caregiving that could be targeted to improve resilience of these children who live in vulnerable conditions.

Infant hunger and satiety cues during the first two years of life: Developmental changes of within meal signalling

Overfeeding in infancy may lead to overweight and obesity in later childhood. Mothers are advised to “tune in” to their infant's hunger, appetite and satiation cues to prevent overfeeding. The present study aimed to 1) assess stability and change in infant hunger and satiety cues (first two years of life) taken at six monthly intervals; 2) track the expression of appetite cues during the course of a meal (beginning, middle and end). Thirty-eight women (mean age 35.3 + 3.7 years) participated in the study. Mothers were within a normal weight range (BMI = 22 + 3.3 kg/m2), most were married (N = 35; 95%) and for most this was not their first child. After an initial investigation (T1) follow-up visits took place every six months with filmed meals involving solid foods. A typical meal contained foods high in protein and carbohydrate plus cooked vegetables. Films were viewed and communication cues (engagement indicating appetite and disengagement indicating satiation) identified and recorded by appearance using the NCAST (Nursing Child Assessment Satellite Training). Coding included the frequency and time at which each cue appeared. Results showed that infants were more likely to communicate potent engagement cues such as babbling, mutual gaze and looking at mother with age. None of the disengagement cues showed any significant main effects of time of follow up. Most, not all, feeding cues were stable across the segment of the feed and did not show a simple linear change across the meal, rather this appeared to develop with age. Raising awareness of these cues with mothers may encourage more responsive and positive mealtime interactions.

Nursing Child Assessment Satellite Training Parent-Child Interaction Scales: Comparing American and Canadian Normative and High-Risk Samples

PurposeMany nurses rely on the American Nursing Child Assessment Satellite Training (NCAST) Parent-Child Interaction (PCI) Teaching and Feeding Scales to identify and target interventions for families affected by severe/chronic stressors (e.g. postpartum depression (PPD), intimate partner violence (IPV), low-income). However, the NCAST Database that provides normative data for comparisons may not apply to Canadian families. The purpose of this study was to compare NCAST PCI scores in Canadian and American samples and to assess the reliability of the NCAST PCI Scales in Canadian samples. MethodsThis secondary analysis employed independent samples t-tests (p < 0.005) to compare PCI between the American NCAST Database and Canadian high-risk (families with PPD, exposure to IPV or low-income) and community samples. Cronbach's alphas were calculated for the Canadian and American samples. ResultsIn both American and Canadian samples, belonging to a high-risk population reduced parents' abilities to engage in sensitive and responsive caregiving (i.e. healthy serve and return relationships) as measured by the PCI Scales. NCAST Database mothers were more effective at executing caregiving responsibilities during PCI compared to the Canadian community sample, while infants belonging to the Canadian community sample provided clearer cues to caregivers during PCI compared to those of the NCAST Database. Internal consistency coefficients for the Canadian samples were generally acceptable. ConclusionsThe NCAST Database can be reliably used for assessing PCI in normative and high-risk Canadian families. Practical implicationsCanadian nurses can be assured that the PCI Scales adequately identify risks and can help target interventions to promote optimal parent-child relationships and ultimately child development.

Maternal weight status and responsiveness to preterm infant behavioral cues during feeding

BackgroundParental obesity is highly predictive of child obesity, and preterm infants are at greater risk of obesity, but little is known about obese and non-obese mothers’ responsiveness to preterm infant cues during feeding. The relationship between maternal weight status and response to preterm infant behavioral cues during feeding at 6-weeks corrected age was examined.MethodsThis secondary analysis used data from a randomized clinical trial. Maternal weight was coded during a play session. Mother-infant interaction during feeding was coded using the Nursing Child Assessment Satellite Training Feeding Scale (NCAST). We used multivariate linear regressions to examine NCAST scores and multivariate logistic regressions for the two individual items, satiation cues and termination of feeding.ResultsOf the 139 mothers, 56 (40.3%) were obese, two underweight women were excluded. Obese mothers did not differ from overweight/normal weight mothers for overall NCAST scores, but they had higher scores on response to infant’s distress subscale (mean = 10.2 vs. 9.6, p = 0.01). The proportion of infants who exhibited satiation cues did not differ by maternal weight. Obese mothers were more likely than overweight/normal weight mothers to terminate the feeding when the infant showed satiation cues (82.1% vs. 66.3%, p = 0.04, adjusted OR = 2.31, 95% CI = 0.97, 5.48).ConclusionsLimitations include lack of BMI measures and small sample size. Additional research is needed about maternal weight status and whether it influences responsiveness to preterm infant satiation cues. Results highlight the need for educating all mothers of preterm infants regarding preterm infant cues.Trial registrationNCT02041923. Feeding and Transition to Home for Preterms at Social Risk (H-HOPE). Registered 15 January 2014.

Enhancing Sensitivity in Adolescent Mothers: Does a Standardised, Popular Parenting Intervention Work with Teens?

This community pilot study was designed to evaluate a small group intervention, Right From The Start (RFTS), in terms of the benefits it provides to adolescent mothers specifically. The effectiveness of the programme was examined in the areas of maternal sensitivity, parenting confidence, parenting stress, and postnatal depression. RFTS has been found as effective as home-visiting in improving maternal sensitivity among adult mothers. This research aimed to study whether similar results could be obtained in a population of adolescent mothers. Eleven adolescent mothers participated in this group intervention, and four of them completed it entirely. Mothers were recruited through an early parenting centre where they were videotaped during a five-minute feeding session. Maternal sensitivity was coded pre and post intervention using the Nursing Child Assessment Satellite Training Parent Child Interaction scale. In addition, the Beck Depression Inventory, the Parenting Stress Index, and the Toddler Care Questionnaire were used. In a paired-samples, two-tailed t-test, overall maternal sensitivity significantly improved between pre and post group intervention (p = 0.048). Maternal depression, stress, and parental confidence did not show significant improvements post intervention. In conclusion, RFTS may be helpful to even very young mothers within some domains of parenting. Clinical implications and limitations are discussed. Further research is required before conclusions about the effectiveness of this programme can be generalised.

Caregiver-infant interactions in the context of prenatal environmental health exposures in rural Costa Rica

<h2>Abstract</h2><h3>Background</h3> Early caregiving is one of the strongest influences on children's development, yet it has not been studied in the context of prenatal neurotoxin exposure. Epigenetic studies show that maternal nurturing promotes positive development in young rats who experienced prenatal environmental adversity. We explore the quality of caregiver-infant interactions in infants with prenatal pesticide exposure in banana-growing areas in rural Costa Rica. <h3>Methods</h3> Home visits were conducted during field trips in October, 2012, and April, 2013, with a random subsample of 94 caregiver-infant dyads, living within Matina county, Limón province. Quality of caregiver-infant interaction was assessed with a standardised task of parent-child interaction (Nursing Child Assessment Satellite Training [NCAST]), which was piloted in the study population before its use. Interactions were videotaped and coded by two trained raters. Results were compared with the NCAST normative sample of US-Hispanic mothers. <h3>Findings</h3> Primary caregivers were on average 27·9 years of age (SD 10·2) and 88% of the caregivers were biological mothers. The mean age of children at time of assessment was 21·2 months (SD 3·5) and 60% were male. Compared with US-Hispanic mothers, 35% of our sample showed overall interaction scores at or below the 10th percentile cut-off score, indicating less than optimum interactions. <h3>Interpretation</h3> This description of caregiving behaviours in a high-risk sample of infants with prenatal pesticide exposure, along with ongoing analyses examining associations between caregiving and infant neurodevelopmental outcomes, have important implications for early intervention work with this population and with other populations having environmental and concomitant risks. <h3>Funding</h3> York University and the Lillian Wright Foundation.

Mother–infant interaction improves with a developmental intervention for mother–preterm infant dyads

While premature infants have a high need for positive interactions, both infants and their mothers are challenged by the infant‘s biological immaturity. This randomized clinical trial of 198 premature infants born at 29–34 weeks gestation and their mothers examined the impact of the H-HOPE (Hospital to Home: Optimizing the Infant's Environment) intervention on mother–premature infant interaction patterns at 6-weeks corrected age (CA). Mothers had at least 2 social environmental risk factors such as minority status or less than high school education. Mother–infant dyads were randomly assigned to the H-HOPE intervention group or an attention control group. H-HOPE is an integrated intervention that included (1) twice-daily infant stimulation using the ATVV (auditory, tactile, visual, and vestibular-rocking stimulation) and (2) four maternal participatory guidance sessions plus two telephone calls by a nurse-community advocate team. Mother–infant interaction was assessed at 6-weeks CA using the Nursing Child Assessment Satellite Training–Feeding Scale (NCAST, 76 items) and the Dyadic Mutuality Code (DMC, 6-item contingency scale during a 5-min play session). NCAST and DMC scores for the Control and H-HOPE groups were compared using t-tests, chi-square tests and multivariable analysis. Compared with the Control group (n=76), the H-HOPE group (n=66) had higher overall NCAST scores and higher maternal Social-Emotional Growth Fostering Subscale scores. The H-HOPE group also had significantly higher scores for the overall infant subscale and the Infant Clarity of Cues Subscale (p<0.05). H-HOPE dyads were also more likely to have high responsiveness during play as measured by the DMC (67.6% versus 58.1% of controls). After adjustment for significant maternal and infant characteristics, H-HOPE dyads had marginally higher scores during feeding on overall mother–infant interaction (β=2.03, p=0.06) and significantly higher scores on the infant subscale (β=0.75, p=0.05) when compared to controls. In the adjusted analysis, H-HOPE dyads had increased odds of high versus low mutual responsiveness during play (OR=2.37, 95% CI=0.97, 5.80). Intervening with both mother and infant is a promising approach to help premature infants achieve the social interaction patterns essential for optimal development.

Integrated Mother–Premature Infant Intervention and Mother–Infant Interaction at 6‐Week Corrected Age

Objective To examine whether an integrated intervention for mother–premature infant dyads relates to more positive mother–infant interaction at 6‐week corrected age (CA). Design Prospective randomized clinical trial. Setting Two community hospital neonatal intensive care units. Sample The sample included (N = 142) otherwise healthy infants, 29‐ to 34‐week gestational age at birth, whose mothers reported at least two of 10 social‐environmental risk factors, for example, poverty, minority status. Methods Mother–infant dyads were randomly assigned to a control group or the H‐HOPE group, which provided an integrated intervention that included twice‐daily infant stimulation using the auditory, tactile, visual, and vestibular rocking stimulation and four maternal participatory guidance sessions by a nurse‐community member team. Mother–infant interaction was assessed at 6‐week CA using the Nursing Child Assessment Satellite Training–Feeding Scale (NCAST, 76 items) and the Dyadic Mutuality Code (DMC, six‐item contingency scale during a 5‐minute play session). The control and H‐HOPE groups were compared using chi‐square tests to assess the proportion with high DMC scores, and t‐tests and multivariable linear regression to assess Overall NCAST and Maternal and Infant NCAST subscores. Results The H‐HOPE group (n = 66) trended toward higher NCAST scores overall as well as the Social‐Emotional Growth Fostering Subscale than the control group (n = 76). H‐HOPE infants had significantly higher scores for the overall infant subscale (p = .05) and the Clarity of Cues Subscale. The H‐HOPE dyads were also more likely to have high responsiveness per the DMC (67.6% vs. 58.1% of controls). After adjustment for trait anxiety and infant morbidity scores, H‐HOPE dyads had marginally higher scores on overall mother–infant interaction during feeding than controls (β = 2.03, p = .06). Conclusion/Implications for Nursing Practice H‐HOPE infants presented clearer behavioral cues and had higher mutual responsiveness with their mothers during play. Intervening with mother and infant is a promising approach to help premature infants achieve the social interaction patterns essential for optimal development. To examine whether an integrated intervention for mother–premature infant dyads relates to more positive mother–infant interaction at 6‐week corrected age (CA). Prospective randomized clinical trial. Two community hospital neonatal intensive care units. The sample included (N = 142) otherwise healthy infants, 29‐ to 34‐week gestational age at birth, whose mothers reported at least two of 10 social‐environmental risk factors, for example, poverty, minority status. Mother–infant dyads were randomly assigned to a control group or the H‐HOPE group, which provided an integrated intervention that included twice‐daily infant stimulation using the auditory, tactile, visual, and vestibular rocking stimulation and four maternal participatory guidance sessions by a nurse‐community member team. Mother–infant interaction was assessed at 6‐week CA using the Nursing Child Assessment Satellite Training–Feeding Scale (NCAST, 76 items) and the Dyadic Mutuality Code (DMC, six‐item contingency scale during a 5‐minute play session). The control and H‐HOPE groups were compared using chi‐square tests to assess the proportion with high DMC scores, and t‐tests and multivariable linear regression to assess Overall NCAST and Maternal and Infant NCAST subscores. The H‐HOPE group (n = 66) trended toward higher NCAST scores overall as well as the Social‐Emotional Growth Fostering Subscale than the control group (n = 76). H‐HOPE infants had significantly higher scores for the overall infant subscale (p = .05) and the Clarity of Cues Subscale. The H‐HOPE dyads were also more likely to have high responsiveness per the DMC (67.6% vs. 58.1% of controls). After adjustment for trait anxiety and infant morbidity scores, H‐HOPE dyads had marginally higher scores on overall mother–infant interaction during feeding than controls (β = 2.03, p = .06). H‐HOPE infants presented clearer behavioral cues and had higher mutual responsiveness with their mothers during play. Intervening with mother and infant is a promising approach to help premature infants achieve the social interaction patterns essential for optimal development.

Early Participation in a Prenatal Food Supplementation Program Ameliorates the Negative Association of Food Insecurity with Quality of Maternal-Infant Interaction

AbstractFood insecurity is detrimental to child development, yet little is known about the combined influence of food insecurity and nutritional interventions on child development in low-income countries. We proposed that women assigned to an early invitation time to start a prenatal food supplementation program could reduce the negative influence of food insecurity on maternal-infant interaction. A cohort of 180 mother-infant dyads were studied (born between May and October 2003) from among 3267 in the randomized controlled trial Maternal Infant Nutritional Interventions Matlab, which was conducted in Matlab, Bangladesh. At 8 wk gestation, women were randomly assigned an invitation time to start receiving food supplements (2.5 MJ/d; 6 d/wk) either early (~9 wk gestation; early-invitation group) or at the usual start time (~20 wk gestation; usual-invitation group) for the government program. Maternal-infant interaction was observed in homes with the use of the Nursing Child Assessment Satellite Training Feeding Scale, and food-insecurity status was obtained from questionnaires completed when infants were 3.4–4.0 mo old. By using a general linear model for maternal-infant interaction, we found a significant interaction (P= 0.012) between invitation time to start a prenatal food supplementation program and food insecurity. Those in the usual-invitation group with higher food insecurity scores (i.e., more food insecure) had a lower quality of maternal-infant interaction, but this relationship was ameliorated among those in the early-invitation group. Food insecurity limits the ability of mothers and infants to interact well, but an early invitation time to start a prenatal food supplementation program can support mother-infant interaction among those who are food insecure.

Maternal factors and experiences associated with observed parenting behavior in mothers attending a residential parenting program.

Parents experiencing early parenting difficulties often seek support through parenting programs. Characteristics of mothers seeking parenting support and information at an early parenting center in Victoria, Australia and the relationships between these factors and parenting behavior were explored using an observational measure of parent-child interaction. Participants were 43 mothers and children attending a 5-day residential parenting program at the Queen Elizabeth Centre. Maternal and sociodemographic data as well as an observational mother-child interaction task from the Nursing Child Assessment Satellite Training Parent Child Interaction Teaching scale were completed and scored on the first day of the program. Certain maternal factors and experiences were associated with observed parenting behavior. Poorer maternal sleeping quality, unplanned pregnancy and preterm birth were all associated with less optimal parenting behavior in certain domains. Findings are discussed with reference to the impact of past experiences around pregnancy and birth as well as the current context and well-being of mothers attending early parenting centers.

Infants’ persistence and mothers’ teaching as predictors of toddlers’ cognitive development

This study examined the relative contributions of infants’ persistence and mothers’ teaching at 6 and 14 months to infants’ cognitive development at 14 months in a sample of 65 low-income mother–infant dyads. Infants’ persistence was assessed from a videotaped persistence task at 6 months and from the Behavior Record Scale of the Bayley Scales of Infant Development, 2nd ed. (BSID II) at 14 months. Mothers’ teaching was assessed from a videotaped teaching interaction at 6 and 14 months using the Nursing Child Assessment Satellite Training (NCAST) teaching scale. Cognitive development at 14 months was based on the Mental Scale, BSID II. Infants’ persistence at both ages and mothers’ teaching at 6 months each explained unique variance in infants’ cognitive status at 14 months. Persistence appears to be a stable quality that can be measured early on, and both infants’ early persistence and mothers’ teaching are direct pathways to cognitive status at the start of the second year.

Breastfeeding, Sensitivity, and Attachment

Our goal was to test the hypothesis that breastfeeding is associated with enhanced infant-mother attachment and its antecedent maternal sensitivity. Breastfeeding intent and practice were assessed by questionnaires administered to 152 mothers between 32 weeks of gestation and 12 months postpartum. Early maternal sensitivity was measured by the Sensitivity to Cues subscale of the Nursing Child Assessment Satellite Training Feeding Scale at 3 months, and quality of the mother-infant interaction was measured by the Nursing Child Assessment Satellite Training Feeding Scale at 6 months. Security of attachment was evaluated by the Ainsworth Strange Situation at 12 months. A direct relationship between attachment security and breastfeeding practice was not identified. The quality of the mother-infant interaction at 6 months, rather than the type of feeding, predicted security of attachment. However, mothers who chose to breastfeed displayed greater sensitivity in dyadic interactions with their infants 3 months postnatally than those who chose to bottle feed, and intended breastfeeding duration prenatally correlated with sensitivity 3 months postpartum. Although a path analysis failed to demonstrate contributions of early breastfeeding duration to either sensitivity or security, it did substantiate a significant path between prenatal breastfeeding intent and attachment security mediated by sensitivity. In addition, multivariate analyses revealed that early sensitivity among breastfeeding mothers was an independent predictor of the duration of any and exclusive breastfeeding during the first year. Although the quality of the dyadic interaction in infancy, rather than feeding type, is predictive of attachment security, mothers who choose to breastfeed display enhanced sensitivity during early infancy that, in turn, may foster secure attachment. Among breastfeeding mothers, higher sensitivity is associated with longer duration of breastfeeding during the first postpartum year. These findings suggest a link between attachment security and breastfeeding.

Caregiver–Child Interaction in Infants and Toddlers Born Extremely Premature

Infants born extremely premature are increasing in incidence and survival rates. This longitudinal study examined caregiver-child interaction in a new generation of extremely premature infants. Caregiver-child interaction and child developmental status were assessed in 41 primary caregivers and their infants at three periods (9-13 and 21-25 months adjusted age and 33-36 months chronological age). Caregiver interaction was stable over the three ages and significantly lower than cross-sectional comparison samples randomized from the Nursing Child Assessment Satellite Training computer database. Caregiver interaction was related to later child interaction but not developmental status. Implications for intervention and developmental surveillance are discussed.

Supporting adolescent mothers and their children through a high school-based child care center and parent support program*1

Introduction: A pilot study was conducted of adolescent parents and their children at a high school-based child care center to examine the influence of the program on parental competence, parent-child interaction, and child development. Method: A convenience sample of 18 urban adolescent mothers with children was interviewed at the end of one academic year. Mothers completed the Maternal Self Report Inventory (MSRI; short form) and the Parenting Daily Hassles Scale (PDHS). Parent-child teaching interactions were rated with the Nursing Child Assessment Teaching Scale (NCATS), and the Michigan Early Developmental Profile (MEDP) was used to evaluate child developmental outcomes. Results: Mothers reported positive scores on the MSRI and PDHS. NCATS observations indicated ratings significantly higher when compared (assuming unequal variances) with a group matched for age range and length of time in school of adolescent mothers from the Nursing Child Assessment Satellite Training (NCAST) national database. The MEDP indicated that 77% of the children assessed were within normal limits for all domains (fine motor, cognition, language, gross motor, and self care). Discussion: The results of this pilot study indicate that adolescent mothers and their young children in the sample benefited from the educational and support services offered at a school-based child care and parent support program. Further study is indicated to test the strength and duration of the effects. J. Pediatr Health Care. (2003). 17, 109-117.

Supporting adolescent mothers and their children through a high school-based child care center and parent support program

Introduction: A pilot study was conducted of adolescent parents and their children at a high school-based child care center to examine the influence of the program on parental competence, parent-child interaction, and child development. Method: A convenience sample of 18 urban adolescent mothers with children was interviewed at the end of one academic year. Mothers completed the Maternal Self Report Inventory (MSRI; short form) and the Parenting Daily Hassles Scale (PDHS). Parent-child teaching interactions were rated with the Nursing Child Assessment Teaching Scale (NCATS), and the Michigan Early Developmental Profile (MEDP) was used to evaluate child developmental outcomes. Results: Mothers reported positive scores on the MSRI and PDHS. NCATS observations indicated ratings significantly higher when compared (assuming unequal variances) with a group matched for age range and length of time in school of adolescent mothers from the Nursing Child Assessment Satellite Training (NCAST) national database. The MEDP indicated that 77% of the children assessed were within normal limits for all domains (fine motor, cognition, language, gross motor, and self care). Discussion: The results of this pilot study indicate that adolescent mothers and their young children in the sample benefited from the educational and support services offered at a school-based child care and parent support program. Further study is indicated to test the strength and duration of the effects. J. Pediatr Health Care. (2003). 17, 109-117.

Maternal postpartum behaviors and mother-infant relationship during the first year of life

Objective: To assess the hypothesis that maternal postpartum behaviors toward the newborn may predict the quality of the maternal-infant relationship during the first year. Design: Prospective, non-randomized, longitudinal cohort study of 174 maternal-infant dyads. Methods: A Postpartum Parenting Behavior Scale (PPBS) was formulated to measure clearly defined observed maternal behaviors toward the infant shortly after birth. The quality of the maternal-infant relationship was assessed at 6 months after birth with the Nursing Child Assessment Satellite Training (NCAST) Feeding Scale and at 12 months after birth with the NCAST Teaching Scale and Ainsworth Strange Situation. Results: The PPBS score correlated significantly with the Feeding Scale score (r =.27, P <.005) and with the Teaching Scale score (r =.23, P <.01). Mothers whose infants were later classified as securely attached in the Ainsworth Strange Situation had higher PPBS scores than mothers of infants classified as insecurely attached (mean ± SD: 5.18 ± 1.51 vs 4.63 ± 1.69, respectively, P <.05). In regression models adjusting for social and demographic factors, the PPBS remained a significant predictor of the Feeding Scale score, the Teaching Scale score, and security of attachment. Conclusions: Maternal behaviors in the immediate postpartum period may aid in predicting quality of the maternal-infant relationship during the subsequent 12 months, suggesting the potential for early identification of suboptimal parenting. (J Pediatr 2001;138:905-9)

Assessing father-infant interactions using the NCAST teaching scale: a pilot study.

The purpose of this pilot study was to gather preliminary data on father-infant dyads using the Nursing Child Assessment Satellite Training (NCAST) Teaching scale, a parent-infant interaction measure, to determine whether and how fathers score differently than mothers from normative samples. Interactions between first-time father (N = 15) and their infants, 3 months to 6 months of age, during the instruction of an unfamiliar play activity were rated using the NCAST Teaching scale. Scores were compared both with a normative database (N = 2,123) of mother-infant dyads and with a subsample (n = 34) of the normative database to control for demographic variables, including the age, gender, and birth parity of the child and the age, education, marital status, and ethnicity of the parent. The fathers scored significantly lower on items related to fostering the infants' cognitive growth than the mothers in the normative database. However, the infants in this study provided clearer behavioral cues and were more responsive to their fathers than the infants in the normative sample. These findings were also true for the subsample comparison. The fathers also scored significantly lower than the normative subsample on items measuring their ability to foster the social and emotional growth of their infants. There may be important differences in the interactions of father-infant dyads compared with mother-infant dyads, but further research with a larger, more representative sample of fathers on this parent-infant interaction measure is warranted to support this. The development of normative scores for fathers and their infants is recommended to accurately interpret father-infant interactions when administering the NCAST Teaching scale.