Parent-Child Early Relational Assessment Research Articles

Latent profiles of dyadic parent–child interaction and associations with triadic family interaction in early childhood

AbstractObjectiveThis longitudinal study examined latent profiles of parent–child interaction and their associations with triadic family interaction.BackgroundA child's development is significantly influenced by early family relationships. Family systems theory emphasizes the interrelations between family subsystems, such as parent–child and parent–parent relationships, as well as the family as a whole. However, few studies have examined the relationship between each parent–child dyad and triadic family interaction.MethodFathers and mothers were separately videotaped interacting with their child (n = 120) at 4 and 18 months and assessed using the Parent–Child Early Relational Assessment. Triadic family interaction was evaluated at 18 months using the Family Alliance Assessment Scale within a Lausanne Trilogue Play setting.ResultsFour latent profiles of parent–child interaction were identified. Dyadic interaction that was characterized by reciprocity, positive affect, and low negativity was associated with higher family coordination. However, interaction characterized by a lack of reciprocity, negativity, and dyadic tension was related to less coordinated triadic family interaction.ConclusionsWell‐functioning parent–child interaction contributes to higher‐quality triadic family interaction. In contrast, challenges in early father–child interaction, including emotional distance, a lack of positive paternal involvement, and limited mutual engagement, are linked to lower‐quality triadic family interaction.ImplicationsThis study highlights the importance of supporting early parent–child relationships to promote well‐functioning and coordinated triadic family interaction, and the inclusion of fathers in interventions aiming to improve family dynamics.

Skin-to-Skin Contact at Birth for Very Preterm Infants and Mother-Infant Interaction Quality at 4 Months

Good-quality parent-infant interactions have protective effects on infant socio-emotional and behavioral development. These interactions are especially critical for very preterm infants at risk of vulnerabilities related to immaturity. Skin-to-skin contact (SSC) has been found to improve mother-preterm infant interaction behaviors, but few studies exist regarding its benefits when initiated immediately after birth. To determine the effect of immediate SSC at birth for very preterm infants on mother-infant interaction quality at 4 months of corrected age. This secondary analysis used data from the Immediate Parent-Infant Skin-to-Skin Study (IPISTOSS), a randomized clinical trial conducted between April 1, 2018, and June 30, 2021, at 3 neonatal units in Sweden and Norway. Participants included very preterm infants (28-33 gestational weeks of age) and their parents. Four-month follow-up was concluded in December 2021. Data analyses were performed on March 16 and September 18, 2023. Infants were allocated to standard incubator care or SSC with either parent initiated at birth and continued throughout the first 6 hours after birth. The primary outcome was mother-infant interaction quality as measured with the Parent-Child Early Relational Assessment (PCERA), based on video recordings of a 5-minute free-play situation with mother-infant dyads at 4 months of corrected age. A multilevel regression analysis was performed. This analysis included 71 infants (31 twins [44%]) and 56 mothers. Infants had a mean (SD) gestational age of 31 weeks 3 (1.3) days, and more than half were male (42 [59%]); mothers had a mean (SD) age of 32 (4.9) years. There were 37 infants allocated to standard care and 34 to SSC with either parent after birth. During the first 6 hours after birth, fathers provided more SSC than mothers, with a median (IQR) of 3.25 (2.25-4.5) and 0.75 (0-2.5) hours, respectively. A statistically significant difference in 1 of 5 PCERA subscales (subscale 3: infant positive affect, communicative and social skills) was observed, with higher-quality mother-infant interaction in the SSC group at 4 months (Cohen d = 0.67 [95% CI, 0.17 to 1.17]; P = .01). This effect remained significant when adjusting for primiparity, child sex, and observation setting. In this study of the effect of immediate parent-infant SSC after very preterm birth, SSC was beneficial for the mother-infant relationship. These findings suggest that immediate SSC should be supported in the clinical setting. ClinicalTrials.gov Identifier: NCT03521310.

The effects of a music enrichment program on parent-infant interactions during mealtime: A randomized controlled trial

BackgroundParent-child interactions are linked to childhood obesity. Music enrichment programs enhance parent-child interactions and may be a strategy for early childhood obesity prevention. ObjectiveWe implemented a 2-year randomized, controlled trial to assess the effects of a music enrichment program (music, n = 45) vs. active play date control (control, n = 45) on parent-child interactional quality and infant weight status. MethodsTypically developing infants aged 9-to 15-months were enrolled with a primary caregiver in the Music Together ® or a play date program. Participants attended once per week group meetings for 12 months and once per month group meetings for an additional 12 months. Parent-child interaction was measured using the Parent Child Early Relational Assessment (PCERA) at baseline, month 6, 12, and 24. We used a modified intent-to-treat mixed model regression to test group differences in parent-child interactions and Weight for length z-score (zWFL) growth trajectories were modeled. ResultsThere were significant differential group changes across time for negative affect during feeding (group*month; p = 0.02) in that those parents in the music group significantly decreased their negative affect score compared with the control group from baseline to month 12 (music change = −0.279 ± 0.129; control change = +0.254 ± 0.131.; p = 0.00). Additionally, we also observed significant differential group changes across time for parent intrusiveness during feeding (group*month; p = 0.04) in that those parents in the music group significantly decreased their intrusiveness score compared with the control group from month 6 to month 12 (music change = −0.209 ± 0.121; control change = 0.326 ± 0.141; p = 0.01). We did not find a significant association between any of the changes in parental negative affect and intrusiveness with child zWFL trajectories. ConclusionParticipating in a music enrichment program from an early age may promote positive parent-child interactions during feeding, although this improvement in the quality of parent-child interactions during feeding was not associated with weight gain trajectories.

Parental Coping, Representations, and Interactions with Their Infants at High Risk of Cerebral Palsy.

The aim of this study is to describe parental coping, representations, and interactions during the time of inclusion in the Small Step early intervention program for infants at high risk of cerebral palsy (CP) in Norway (ClinicalTrials.gov: NCT03264339). Altogether, 11 infants (mean age 4.8 months, SD: 1.5) and their parents (mothers: n = 10, fathers: n = 9) were included. Parental coping was assessed using the Parenting Stress Index-Short Form (PSI-SF) and the Hospital Anxiety and Depression Scale (HADS). Parental representations and parent-infant interactions were assessed using the Working Model of the Child Interview (WMCI) and the Parent-Child Early Relational Assessment (PCERA). Parents' PSI-SF and HADS scores were within normal range; however, 26.7% showed symptoms of stress, 52.6% showed symptoms of anxiety, and 31.6% showed symptoms of depression above the cut-off. WMCI results indicate that 73.7% of the parents had balanced representations. For PCERA, the subscale Dyadic Mutuality and Reciprocity was of concern, while two other subscales were in areas of strength and three subscales in some concern areas. There were no differences between mothers and fathers. Most of the parents had balanced representations, some had mental or stress symptoms and many were struggling with aspects of the parent-infant interaction. This knowledge could be useful when developing more family-centered interventions.

Caregiver-Child Interaction in Children Placed into Different Types of Russian Families following an Institutional Intervention

The current study examined whether interventions in St. Petersburg, Russian Federation, institutions for infants (Baby Homes) that increased caregiver sensitivity (Training Only) or both caregiver sensitivity and consistency (Training plus Structural Changes: T + SC) versus care as usual (No Intervention: NoI), and the type of post-institutional (PI) families (Relatives versus Non-Relatives) in relation to the length of institutionalization would be associated with caregiver-child interaction advantages in the families. The Parent-Child Early Relational Assessment (Clark, 1985) method was used to assess the caregiver-child interactions at the stages of ≤24 months (n = 55), and 25-48 months of family placement (n = 48). Results suggest that at the stage of 24 months several interactional characteristics were better in families with children from T + SC than from NoI, especially the longer time children spent in these BH, and in families of Non-Relatives than Relatives. At 25-48 months, children in Non-Relative families displayed more Activity and Quality of Exploratory Play than in Relative families. Overall, these results suggest that at ≤24 months in PI families, advantages in caregiver-child interaction might be associated with better institutional caregiving and the type of families, whereas at 25-48 months it might be related only to the type of families.

Tele-care intervention performed by parents involving specific task- environment- participation (STEP protocol) for infants at risk for developmental delay: protocol of randomized controlled clinical trial

BackgroundWith the implementation of social distancing due to the Covid-19 pandemic, many at-risk infants are without therapy. An alternative mode of therapy in this situation is tele-care, a therapy in which assessments and interventions are carried out online, in the home environment. We describe a tele-care protocol involving parent delivered task and context specific movement training, participation and environmental adaptation for infants at risk for developmental delay.MethodsRandomized controlled trial. Infants at risk, with 3 to 9 months corrected age, will be included, and randomized into two groups: control group (conventional guidelines) and experimental group (task, environment and participation in context-specific home program). Infants will be assessed for motor capacity (Infant Motor Profile and Alberta Infant Motor Scale); participation (Young Children’s Participation and Environment Measure) and environment factors (Parent-Child Early Relational Assessment; Affordances in the Home Environment for Motor Development). The intervention period will be 10 weeks, and evaluations will be carried out before and after that period. All the assessment and intervention procedures will be carried out online, with instructions to parents for home therapy. The statistical analysis will be guided according to the distribution of the data, and a significance level of 5% will be adopted. All ethical approvals were obtained by the Ethics Committee of the University of São Carlos (Case number 31256620.5.0000.5504). The protocol will follow the SPIRIT statement. Findings will be disseminated in peer-reviewed publications and presented at national and international conferences.DiscussionThe results of this study will describe the effectiveness of a home intervention, focusing on specific activities, participation and environmental changes. These results will support the implementation of a remote protocol, with lower financial costs and focused on the particularities of the family. This type of care model can possibly help public policies to ensure equal access to evidence-based quality healthcare.Trial registrationBrazilian Clinical Trials Registry: RBR8xrzjs, registered September 1, 2020.

Взаимосвязь показателей взаимодействия детей и близких взрослых с возрастом и длительностью проживания детей в доме ребенка и замещающих семьях

According to data from scientific literature, children who experience living in child institutions (or baby homes) with social and emotional deprivation are significantly behind their peers in development, but after moving to a foster family (FF), this gap can lessen. Further published information shows, there is evidence that age of a child and time characteristics in the form of length of stay in an institution or in family play a significant role in “catching up”. The aim of this research was to study the relationship of the age of children, as well as length of stay in the baby home (BH) and in a FF with indicators of caregiver-child interaction at both stages (1) in the BH before transfer to post-institutional care and (2) after transfer to FF. The study involved 21 children with experience of institutionalization (the average age of children at the assessment in the BH was 21.6 ± 12.7 months; at the foster families stage was 49.8 ± 16.7 months) and their caregivers (personnel of BH and substitute parents in FF). The quality of caregiver-child interaction was studied using the PCERA (The Parent - Child Early Relational Assessment) method based on analysis of video recordings of caregiver-child free play. The results obtained in the BH before transfer to post-institutional care indicate the presence of a positive relationship between individual caregiver and child indicators of interaction, as well as the overall total indicator of interaction with the age of children at the time of assessment. The indicator of interaction on the part of children "Positive emotions, eye contact" is associated with the age at which children entered the BH. After the transition of children to FF, most of the indicators on the part of children are associated with the age at which they entered the BH, while “Emotional stability, absence of negative affect, compliance” shown by the children is associated with the age of transition to FF. The data obtained in the work are discussed from the point of view of the influence of the social and emotional experience of children on the indicators of their interaction with the caregivers.

Fathers’ prenatal attachment representations and the quality of father–child interaction in infancy and toddlerhood.

Despite the strong evidence that fathers have a crucial role in child well-being, very little is known about the development of the father-child relationship from prenatal to postnatal period. In this longitudinal study, the fathers' prenatal attachment representations (n = 129), between 29 and 32 gestational weeks, were assessed with the Working Model of Child Interview, and the father-child interaction was analyzed with the Parent-Child Early Relational Assessment at 4 and 18 months after the birth. The results showed that fathers' prenatal balanced attachment representations were associated with more positive paternal behaviors compared to fathers with disengaged attachment representations when the child was 4 months old, but not when the child was 18 months old. In addition, positive changes occurred in the interaction quality between 4 and 18 months in all three groups of representation categories (balanced, disengaged, distorted), which offers an optimistic view of the evolving nature of the father-child relationship. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Improving the mother-infant relationship following postnatal depression: a randomised controlled trial of a brief intervention (HUGS).

Postnatal depression (PND) disrupts the crucial mother-infant relationship on which optimal child development depends. However, few well-evaluated, brief mother-infant interaction interventions exist. This randomised controlled trial (RCT) aimed to evaluate the effect of a 4-session, group-based mother-infant interaction intervention ('HUGS'), compared to a control playgroup, both following cognitive-behavioural therapy for PND, on mother-infant relationships and early child development. It was hypothesised that dyads receiving the HUGS intervention would show larger improvements than control dyads. Mothers (n = 77; M age = 32years) diagnosed with major or minor depressive disorder using the Structured Clinical Interview for the DSM-IV participated with their infants (<12months). Primary outcomes were observed mother-infant interactions using the Parent Child Early Relational Assessment (ERA) and maternal parenting stress using the Parenting Stress Index (PSI). Data were collected at baseline, post-PND treatment, post-HUGS intervention and 6-month post-HUGS follow-up. Seventy-four percent of HUGS dyads attended at least half of the HUGS sessions (≥2). Significant group differences emerged at the 6-month follow-up (but were not significant immediately post-HUGS). At 6-month follow-up, HUGS dyads showed significantly improved parental positive affective involvement and verbalisation (ERA; F1, 47 = 4.96, p = .03, ηp2 = .10) and less impaired bonding (F1, 45 = 4.55, p = .04, ηp2 = .09) than control dyads. No differences were found on the PSI or on child development outcomes. Both groups improved substantially (around 30 points) on the PSI following PND treatment, so that average scores were below the clinically significant threshold when beginning HUGS and the control playgroup. Findings suggest that incorporating HUGS intervention following PND treatment is effective for improving mother-infant relationships. A longer-term follow-up and larger sample size may be needed for improved mother-infant relationships to show an impact on observable child developmental outcomes. Registered with the Australian New Zealand Clinical Trials Registry (ACTRN12612001110875).

Mothers with and without bipolar disorder and their infants: group differences in mother-infant interaction patterns at three months postpartum

BackgroundWomen with bipolar disorder (BD) have a high risk of illness relapse postpartum. The risk coincides with the period when mother-infant interactions are evolving. We compared mother-infant interactions in dyads where the mothers have BD with dyads where the mothers have no mental disorder. The association between concurrent affective symptoms of BD mothers and interaction quality was investigated.MethodsTwenty-six women with BD and 30 comparison women with infants were included. The Parent-Child Early Relational Assessment (PCERA) was used to assess maternal behaviour, infant behaviour and dyadic coordination in interactions at 3 months postpartum. The Inventory of Depressive Symptomatology and Young Mania Rating Scale were used to assess affective symptoms of BD mothers at the time of interaction.ResultsThere were significant group differences with medium to large effect sizes (0.73–1.32) on five of six subscales within the three interactional domains. Most interactional concerns were identified in dyadic coordination. No significant associations were found between maternal symptom load and interaction quality within the BD sample. Forty-six percent of the BD mothers experienced a mood episode within 0–3 months postpartum.ConclusionsThe present study identified challenges for mothers with BD and their infants in “finding” each other in interaction at 3 months postpartum. If sustained, this interaction pattern may have a long-term impact on children’s development. We suggest interventions specifically focusing on sensitising and supporting mothers to read infants’ cues on a micro-level. This may help them to respond contingently and improve dyadic coordination and synchronicity.

Oxytocin trajectories and social engagement in extremely premature infants during NICU hospitalization

Extremely premature infants, born 28 weeks gestation or less, are at high risk for impaired socioemotional development, due in part to exposure to early stressful social experiences that alter brain development. Understanding mediators that link experience with outcomes is necessary to assess premature infant responses to social experiences that are critical to brain development. The hormone oxytocin (OT), released during supportive interactions, has potential as a biomarker of the premature infant's responses to social experiences. The purpose of this study was to examine associations among infant plasma OT trajectories and maternal-infant social engagement behaviors during initial hospitalization. This study also examined demographic correlates of engagement behaviors in mothers and infants. Plasma from 28 extremely premature infants, born gestational ages 25–28 6/7 weeks, was collected at 14 days of life, then weekly until 34 weeks. Social engagement behaviors were measured by the Parent-Child Early Relational Assessment during a videotaped feeding when the infant was receiving one-quarter full oral feeds. Maternal-infant demographics were extracted from the medical record. Higher infant plasma OT was associated with lower infant social engagement, but no associations were found with maternal social engagement. Infant social engagement was positively related to maternal social engagement. Maternal parity was related to maternal social engagement, and infant demographics did not predict infant social engagement. The significant, yet negative, association between infant OT and engagement provides support for the measurement of OT as a neurobiological antecedent to infant social behaviors. Finally, this research suggests that during the earliest period of infant socio-behavioral development, premature infants are behaviorally reactive to the social engagement behaviors of their mothers.

Perinatal stress, anxiety, and depression: Effects of a MBCP intervention on mother-infant interaction

IntroductionTransition into parenthood is a demanding phase in life and exposes the becoming parents to vulnerability for depression, anxiety and stress. Perinatal mental health problems are a major public health issue and many women suffering from depression during their first year after delivery. High levels of stress during pregnancy are associated with adverse psychological and physiological outcomes for the infant and parents. There seems to be an intergenerational transmission of mental health from parent to infant. The current study evaluated the effectiveness of mindfulness intervention during pregnancy in reducing depression symptoms, anxiety and perceived stress in parents-to-be.ObjectivesAssess whether the mindfulness will improve interaction between mother-infant at 12 months.MethodsPerceived stress scale and Edinburgh postnatal depression scale used to measure stress and depression during pregnancy. Parent child early relational assessment assessed mother-infant interaction.ResultsInhibited parent-infant relationships were more common in the control group comparing to the mindfulness intervention group. This is in line with previous research on periantal depression, anxiety, and stress, showing more dysfunctional dyads. A depressed mother has reduced capability to be alert to her baby's signals, which is necessary for appropriate parent-infant relationship to occur. The cumulative effect of impaired parent-infant relationship is a “depressed dyad” of mother and infant.ConclusionMindfulness intervention reduced depressive symptoms, anxiety, and perceived stress in pregnant women. At 12 months mother-infant relationship assessment, the mindfulness intervention group dyads showed a more attuned mother-infant interaction.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Early Preterm Infant Feeding Behaviors in Adolescent and Adult Mothers

# Background: Adolescent mothers may find the transition to motherhood to be overwhelming when compared to adult mothers. The adaptiveness of mother and infant feeding behaviors may greatly influence the quality of adolescent mothers\' feeding interactions when compared to adult mothers. # Purpose: To examine the adaptiveness of early maternal and infant feeding behavior between adolescent mothers and adult mothers. # Method: In this secondary analysis, six adolescent mothers (\< 20 years old) and six adult mothers were videotaped while feeding. The mothers were observed 3 times: when the infants were in the hospital, 1 month old, and 4 months old. The videotapes were coded using four scales of the Parent-Child Early Relational Assessment (PCERA). The two maternal scales were Positive Affective Involvement and Sensitivity/Responsiveness (PAISR) and Regulation of Affect and Behavior (RAB). The two infant scales were Infant Positive Affect, Communication, and Social Skills (IPACS) and Infant Regulation of Affect and Behavior (IRAB). The dyads were videotaped just before hospital discharge and at one and four months corrected age. The Wilcoxon signed-rank test was used to examine the difference in the PCERA between the two groups. # Results: Adolescent mothers had a significantly lower score on the PAISR before hospital discharge (p-value 0.005) and at one month corrected age (p-value 0.008) than adult mothers. Adolescent mothers also had a significantly lower score on the RAB before hospital discharge, 1 and 4 months corrected age than adult mothers. There were no significant differences in IPACS and IRAB of infants of adolescent and adult mothers. # Conclusion: Clinicians need to be aware of the differences in sensitivity that occur.

A Norwegian prospective study of preterm mother–infant interactions at 6 and 18 months and the impact of maternal mental health problems, pregnancy and birth complications

ObjectivePregnancy, birth and health complications, maternal mental health problems following preterm birth and their possible impact on early mother–infant interaction at 6 and 18 months corrected age (CA) were explored....

Patterns of mother–infant interaction from 3 to 12 months among dyads with substance abuse and psychiatric problems

The aim of this study was to investigate the development of mother–infant interaction patterns from 3 to 12 months among three groups of mother–baby pairs recruited during pregnancy: one group from residential substance abuse treatment (n=28), a second group from psychiatric outpatient treatment (n=22), and a third group from well-baby clinics (n=30). The mother–infant interaction at 3 and 12 months was assessed by the Parent–Child Early Relational Assessment (PCERA), which consists of maternal, child and dyadic subscales (Clark, 2006). Linear mixed effects models were used to analyze group differences and the changes in mother–infant interaction from 3 to 12 months.At 3 months, pairwise comparisons showed that the group with psychiatric problems had significantly more difficulties in the mother–infant interaction than the two other groups. The group with substance abuse problems was not significantly different from the two other groups. At 12 months, the mother–infant pairs in the substance abuse group showed significantly more relational disturbances than the non-clinical pairs, as well as a poorer affective quality of interaction than the dyads in the group with psychiatric problems. Analysis of change from 3 to 12 months showed that difficulties in the interaction increased among the mother–baby pairs in the substance abuse group, while improvements were displayed in the two other groups. These results underline that mother–infant pairs at double risk due to maternal substance abuse and other non-optimal factors, are in need for long-term follow up in order to prevent the development of negative interactional patterns.

Maternal-infant interaction and autonomic function in healthy infants and infants with transposition of the great arteries.

The quality of maternal-infant interaction is a critical factor in the development of infants' autonomic function and social engagement skills. In this secondary data analysis, relationships among infant and maternal affect and behavior and quality of dyadic interaction, as measured by the Parent-Child Early Relational Assessment, and infant autonomic function, as measured by heart rate variability, were examined during feeding at 2 weeks and 2 months of age in 16 healthy infants and in 15 infants with transposition of the great arteries (TGA). Contrary to previous research, at 2 weeks infant age, mothers of infants with TGA had significantly higher scores in affect and behavior than did mothers of healthy infants. The affect and behavior and quality of dyadic interaction of infants with TGA also did not differ from that of healthy infants. Although infants' social engagement skills did not differ by health condition (TGA or healthy), these skills did differ by parasympathetic nervous system function: infants better able to suppress vagal activity with challenge had more positive and less dysregulated affect and behavior, regardless of health status. These findings suggest that maternal-infant interactions for some cardiac disease subgroups may not differ from healthy dyads. Additional research is required to identify both healthy and ill infants with delayed autonomic maturation and to develop and test interventions to enhance critical interactive functions.

Early intervention to protect the mother-infant relationship following postnatal depression: study protocol for a randomised controlled trial.

BackgroundAt least 13% of mothers experience depression in the first postnatal year, with accompanying feelings of despair and a range of debilitating symptoms. Serious sequelae include disturbances in the mother-infant relationship and poor long-term cognitive and behavioural outcomes for the child. Surprisingly, treatment of maternal symptoms of postnatal depression does not improve the mother-infant relationship for a majority of women. Targeted interventions to improve the mother-infant relationship following postnatal depression are scarce and, of those that exist, the majority are not evaluated in randomised controlled trials. This study aims to evaluate a brief targeted mother-infant intervention, to follow cognitive behavioural therapy treatment of postnatal depression, which has the potential to improve developmental outcomes of children of depressed mothers.Methods/DesignThe proposed study is a two-arm randomised controlled trial with follow-up to 6 months. One hundred participants will be recruited via referrals from health professionals including maternal and child health nurses and general practitioners, as well as self-referrals from women who have seen promotional materials for the study. Women who meet inclusion criteria (infant aged <12 months, women 18+ years of age) will complete the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders-IV-TR Axis I Disorders. Those with a clinical diagnosis of current major or minor depressive disorder and who do not meet exclusion criteria (that is, currently receiving treatment for depression, significant difficulty with English, medium to high suicide risk, current self-harm, current substance abuse, current post-traumatic stress disorder, current manic/hypomanic episode or psychotic symptoms) will be randomised to receive either a 4-session mother-infant intervention (HUGS: Happiness Understanding Giving and Sharing) or a 4-session attention placebo playgroup (Playtime) following a 12-session postnatal depression group treatment programme. Primary outcome measures are the Parenting Stress Index (self-report measure) and the Parent-child Early Relational Assessment (observational measure coded by a blinded observer). Measurements are taken at baseline, after the postnatal depression programme, post-HUGS/Playtime, and at 6 months post-HUGS/Playtime.DiscussionThis research addresses the need for specific treatment for mother-infant interactional difficulties following postnatal depression. There is a need to investigate interventions in randomised trials to prevent detrimental effects on child development and make available evidence-based treatments.Trial registrationAustralia and New Zealand Clinical Trials Register: ACTRN12612001110875. Date Registered: 17 October 2012.Electronic supplementary materialThe online version of this article (doi:10.1186/1745-6215-15-385) contains supplementary material, which is available to authorized users.

Maternal behavior and infant physiology during feeding in premature and term infants over the first year of life.

Little is known about the relationship between maternal behavior and the stability of premature infants' physiologic responses during feeding. In a secondary data analysis, we examined relationships between quality of maternal behavior and cardiorespiratory physiology during feeding in 61 premature and 53 term infants at four times over the first year of life. Measures included heart rate (HR), respiratory rate (RR), and oxygen saturation; Child Feeding Skills Checklist; and Parent-Child Early Relational Assessment. Birthweight, gestational age, and neurodevelopmental risk were covariates. Quality of maternal behavior did not predict infants' physiologic response to feeding. However, birthweight was related to infant feeding physiology among all infants over the first year of life. Stress during fetal life, which may lead to impaired intrauterine growth and low birthweight, may have longitudinal effects on cardiorespiratory functioning of premature infants. Research is needed to further investigate the biological pathways by which maternal-infant interaction supports behavioral and physiologic feeding outcomes of premature infants.

Parental behaviour and children's creation of imaginary companions: A longitudinal study

This longitudinal study examined whether parenting quality, parental behaviours and children's temperament at 6 months of age predicted children's creations of imaginary companions (ICs) at 44 months of age. At six months, parenting quality and parental behaviours were measured using the Parent-Child Early Relational Assessment, and the frequency of mental-state references made during mother–infant interactions was recorded. Temperament was assessed using the Revised Infant Temperament Questionnaire. Parents then completed questionnaires assessing whether their children had ICs at 44 months of age. The results revealed that only the approach characteristic of temperament marginally predicted children's IC status. Results of the parental measures showed that parents of children with ICs were more likely to attribute mental states to their child and to refrain from intruding in their child's behaviours than parents of children without ICs. The results indicated that parental behaviours are important for children's creation of ICs.

Autonomic nervous system function, child behavior, and maternal sensitivity in three-year-old children with surgically corrected transposition

ObjectivesExplore relationships among autonomic nervous system (ANS) function, child behavior, and maternal sensitivity in three-year-old children with surgically corrected transposition of the great arteries (TGA) and in children healthy at birth. BackgroundChildren surviving complex congenital heart defects are at risk for behavior problems. ANS function is associated with behavior and with maternal sensitivity. MethodChild ANS function (heart rate variability) and maternal sensitivity (Parent–Child Early Relational Assessment) were measured during a challenging task. Mother completed the Child Behavior Checklist. Data were analyzed descriptively and graphically. ResultsChildren with TGA had less responsive autonomic function and more behavior problems than healthy children. Autonomic function improved with more maternal sensitivity. ConclusionAlterations in ANS function may continue years after surgical correction in children with TGA, potentially impacting behavioral regulation. Maternal sensitivity may be associated with ANS function in this population. Continued research on relationships among ANS function, child behavior, and maternal sensitivity is warranted.