Are former late-preterm children at risk for child vulnerability and overprotection?

Abstract

Background

Parent perception of child vulnerability (PPCV) and parent overprotection (POP) are believed to have serious implications for age appropriate cognitive and psychosocial development in very low birth weight preterm children.

Aim

With recent concerns about suboptimal developmental outcomes in late-preterm children, this study was aimed at examining the relationship between history of late-preterm birth (34-36 6/7 weeks gestation), and PPCV, POP, and healthcare utilization (HCU).

Study design

This was a cross-sectional observational design.

Participants

Study participants were mothers of 54 healthy singleton children recruited from community centers including Women and Children Clinics (WIC), primary care clinics and daycare centers in the upper Midwest region.

Outcome measures

Outcome measures included Forsyth Child Vulnerability Scale (CVS), Thomasgard Parent Protection Scale (PPS) scores, and healthcare utilization (HCU). Potential covariates included history of life-threatening illness, child and maternal demographics, and maternal stress and depression using the Center for Epidemiologic Studies Depression Scale (CESD).

Results

HCU (p = 0.02) and the PPS subscales of supervision (p = 0.003) and separation (p = 0.03) were significant predictors of PPCV in mothers of 3–8years old children with late-preterm history. Age of the child (p = 0.008) and CVS scores (p = 0.005) were significant predictors of POP. Maternal age (p = 0.04), stress (p = 0.04), and CVS scores (p = 0.003) were significant predictors of HCU. Dependence, a subscale of the PPS, correlated with the child's age and gender even after controlling for age.

Conclusion

History of late-preterm did not predict MPCV, MOP, or HCU in healthy children. Future research is needed in larger more diverse samples to better understand causal relationships and develop strategies to lessen risks of MPCV and MOP.

Introduction

Late-preterm infants (LPIs) born between 34 and 36 6/7 weeks gestation account for 70% of all singleton preterm births in the United States [1]. Although risk of adverse outcomes remains lower in the LPI than the very preterm infants (infants less than 1500 g) and the majority of late-preterm (LP) neonates enjoy an uneventful medical history, a significant percentage of LPIs experience re-hospitalization, neonatal complications, and are reported to have learning, behavioral, and developmental problems later in life [2], [3], [4]. Factors leading to such suboptimal outcomes in LPIs are not fully understood.

Parent perception of child vulnerability to illness and injury, which is not substantiated by objective vulnerability, and parent overprotection are believed to be risk factors for later child developmental and behavioral problems in low birth weight preterm children [5], [6], [7]. Mothers of infants born prematurely (< 37 weeks gestation) have multiple risk factors for parent perception of child vulnerability including pregnancy complications,[8] maternal depression,[8] neonatal jaundice,[9] infant feeding difficulties and crying behavior, and prolonged neonatal hospitalization [5], [10], [11], [12].

Maternal anxiety and post partum depression as well as lower maternal satisfaction and sense of well being are believed to be associated with increased maternal perception of child vulnerability [12], [13], [14]. Increased stress and anxiety caused by the elevated risk of mortality and morbidity in the preterm neonate may have an everlasting influence on how a mother perceives and interacts with her child [10]. Although a late-preterm neonate may not be as critically ill as the very preterm neonate, the delivery of a late-preterm neonate is often preceded by maternal complications and maternal hospitalization which leaves the mother vulnerable to adverse prenatal and perinatal experiences. Such experiences may alter the coping and parenting skills of the late-preterm mother, and therefore predispose her to increased perceptions of child vulnerability and overprotection [2], [11], [12]. Later in life, children who are perceived by their parents as vulnerable are reported to also be more likely to have cognitive and behavior problems, lower levels of activity, difficult parent child interactions, psychosomatic illness, disproportionate use of healthcare services, suboptimal developmental outcomes, and school underachievement [2], [10], [12], [15], [16].

Because of increased concerns about risk of developmental and behavioral problems in LP children, and because parent perception of child vulnerability and parent over could potentially contribute to this risk, this study was undertaken to 1) Examine the relationship between history of late-preterm birth and maternal perception of child vulnerability and maternal overprotection, 2) Identify demographic and psychosocial factors associated with increased maternal perception of vulnerability and maternal overprotection, and 3) determine if healthcare utilization is higher in late-preterm children and whether maternal perception of child vulnerability and overprotection predicts higher healthcare utilization in this population.