A Review of Research on Premature Infant-Mother Interaction

doi:10.1053/j.nainr.2006.12.002

Newborn and Infant Nursing Reviews

Volume 7, Issue 1, March 2007, Pages 49-55

https://doi.org/10.1053/j.nainr.2006.12.002 Get rights and content

Abstract

Premature infants do not often provide clear behavioral cues, making them difficult social partners. Mothers of premature infants have reported that interacting with their infant is frustrating and not very rewarding. Higher numbers of premature infants are currently surviving at younger gestational ages, but the number of premature infants that have developmental delays is not decreasing. These infants and their mothers need guidance and support for their early efforts to communicate with one another. Social interactions are considered to be important for many aspects of development. This article will review the literature on infant-mother interactions, explain the more recent findings, and provide recommendations for neonatal nurses working with premature infants and their families.

Section snippets

Importance of Interaction

Socialization is the means by which human beings learn to live and grow within families, cultures, and societies. Beginning with their first encounter after birth, infants and mothers engage one another through gazes and gestures, and this primary relationship is the basis for all future relationships. These early dyadic interactions, which are the most common experiences for young infants, serve four major functions. They help infants to acquire an understanding of social relationships and

Interaction Frameworks

Infant-mother interaction literature primarily stems from two major theoretical frameworks: attachment theory¹⁶ and the transactional model of Sameroff and Mackenzie.¹⁷ Attachment is defined as the affectionate tie of infants to their primary caregiver and is a biologically based desire for proximity.¹⁷ Attachment develops within the context of the infant and mother relationship and is influenced by the quality of interactions.¹⁸ Sensitive maternal behavior fosters secure attachment

Early Research on Premature Infant Interaction

A search was performed using the data bases Medline, PsyInfo, and CINAHL using keywords of mother-infant interaction, relationships, premature, and newborn with limiting factors of research. Fifteen studies, conducted since 1990, were selected for this review.

Most of the studies used a quasi-experimental design with a full-term control group. Other group comparisons involved assigning the preterm infants into high- or low-risk groups based on medical or diagnostic criteria or by gestational

Summary of the Research Findings

The research that has been conducted over the last 15 years has improved in observational techniques and has examined relationships of other factors that may affect infant-mother interaction (Table 1). Preterm infants continue to have less facial expression and less looking behaviors. Some studies are reporting increased vocalization with preterm infants, but these behaviors are less likely to be contingent on maternal behavior.35, 38 Mothers of preterm infants do not seem to display intrusive

Practice Implications

Many neonatal intensive care units have adopted a developmentally supportive care model to help protect infants from inappropriate and overstimulating encounters. Neonatal Individualized Developmental Care and Programs⁴³ has made caregivers more aware of individual needs and subtle behaviors of premature infants. Mothers of premature infants are now able to learn more about their infants' behavior and what to expect as cues, particularly approach or avoidance signals. Education for mothers and

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The research on NICU parent-infant interactions is not uniform, but some research has shown parents of very low birth weight (VLBW) infants are prone to look, smile, vocalize, and touch their infants less than parents of other newborn infants, as well as failing to coordinate their interactions to their infants' alert periods (Feldman and Eidelman, 2007). Some NICU parents have been described as more intrusive and controlling in their interactions with their infants, while others have been described as less engaged or responsive; these different reactions are likely based in parents’ differing emotional makeup, psychiatric issues, circumstances, level of support in the NICU, and at times might be compensatory reactions (Bozzette, 2007; Borghini et al., 2014; Beebe et al., 2018). VLBW infants whose parents show controlling and restrictive behavior have poorer cognitive, language, and social skills at 3 years of age (Landry et al., 1997).
Admission to the Neonatal Intensive Care Unit (NICU) is a psychologically and physically distressing event for infants. Preterm infants suffer from higher rates of depression and anxiety in childhood, adolescence, and adulthood, likely, at least in part, related to the experiences they have in the NICU. The parent-infant relationship is of paramount importance in determining the future trajectory of both the parent's and infant's mental health, and therefore it is critically important to both assess and support its development in the NICU. The challenges parents face in responding to their preterm, ill and fragile infants, and strategies to mitigate infant distress are outlined.
How stress can influence brain adaptations to motherhood
2021, Frontiers in Neuroendocrinology
Research shows that a woman’s brain and body undergo drastic changes to support her transition to parenthood during the perinatal period. The presence of this plasticity suggests that mothers’ brains may be changed by their experiences. Exposure to severe stress may disrupt adaptive changes in the maternal brain and further impact the neural circuits of stress regulation and maternal motivation. Emerging literature of human mothers provides evidence that stressful experience, whether from the past or present environment, is associated with altered responses to infant cues in brain circuits that support maternal motivation, emotion regulation, and empathy. Interventions that reduce stress levels in mothers may reverse the negative impact of stress exposure on the maternal brain. Finally, outstanding questions regarding the timing, chronicity, types, and severity of stress exposure, as well as study design to identify the causal impact of stress, and the role of race/ethnicity are discussed.
Maternal sensitivity is associated with configural processing of infant's cues in preterm and full-term mothers
2018, Early Human Development
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Another study has demonstrated that poor parenting (in substance-using mothers) is associated to reduced activity in emotion-processing areas during perception of infant's face and cry [31]. However, the relative lack of knowledge on the neurocognitive correlates of the perceptual aspects of maternal sensitivity is quite surprising considering the importance of an efficient perceptual processing of infant's signals, especially when these may not be easily intelligible, as reported in preterm infants [1,11,32]. A recent study has directly explored the association between maternal sensitivity and the refinement of maternal visuo-perceptual processes in perceiving infants' bodies and faces [33].
Prematurity may affect mother-infant bonding and alter maternal sensitivity to infant's cues. Efficient perception of infants' facial and bodily cues is a crucial aspect of maternal sensitivity and may be challenged by prematurity, as infants' signals may not be easily intelligible. However, it is still unexplored how premature birth impacts the maternal ability to perceive infants' signals.
To investigate whether prematurity influences the perceptual sensitivity of mothers to infants' cues and, in particular, the configural processing of the faces and bodies of familiar and unfamiliar infants.
The inversion effect paradigm was used to evaluate the configural vs. detail-based processing of the face and body of own or others' infants. Preterm mothers were compared to full-term mothers with either low or high maternal sensitivity.
Forty-three healthy full-term and twenty-one preterm mothers of infants aged about six months.
Maternal sensitivity during dyadic interaction, gestational age, accuracy and reaction time in a delayed matching-to-sample task of upright vs. inverted body and face stimuli (i.e., inversion effect).
Preterm mothers were found to be less sensitive than the full-term ones. Higher maternal sensitivity during dyadic interaction was associated with lower inversion effect for unfamiliar as compared to own infants' bodies. However, preterm mothers and full-term mothers with low sensitivity showed comparable inversion effect in perceiving unfamiliar infants' faces or bodies.
Preterm birth per se does not directly affect body configural processing, but it may be associated to reduced maternal sensitivity, ultimately leading to a less refined perception of own infant's cues.
Quality of caregiver-child play interactions with toddlers born preterm and full term: Antecedents and language outcome
2017, Early Human Development
Citation Excerpt :
It is important to note that even on this dimension, parents generally did not display aggression, hostility, or negativity; rather, they demonstrated subtle signs of control over their child's play. This finding is at odds with the conclusion of a review of 15 studies, which reported that maternal intrusiveness was not a salient characteristic of interactions between children born PT and their caregivers [41]. Differences here may relate to the nature of the scales rather than the parents.
Preterm birth may leave long-term effects on the interactions between caregivers and children. Language skills are sensitive to the quality of caregiver-child interactions.
Compare the quality of caregiver-child play interactions in toddlers born preterm (PT) and full term (FT) at age 22 months (corrected for degree of prematurity) and evaluate the degree of association between caregiver-child interactions, antecedent demographic and language factors, and subsequent language skill.
A longitudinal descriptive cohort study.
39 PT and 39 FT toddlers individually matched on sex and socioeconomic status (SES).
The outcome measures were dimensions of caregiver-child interactions, rated from a videotaped play session at age 22 months in relation to receptive language assessments at ages 18 and 36 months.
Caregiver intrusiveness was greater in the PT than FT group. A composite score of child interactional behaviors was associated with a composite score of caregiver interactional behaviors. The caregiver composite measure was associated with later receptive vocabulary at 36 months. PT-FT group membership did not moderate the association between caregiver interactional behavior and later receptive vocabulary.
The quality of caregiver interactional behavior had similar associations with concurrent child interactional behavior and subsequent language outcome in the PT and FT groups. Greater caregiver sensitivity/responsiveness, verbal elaboration, and less intrusiveness support receptive language development in typically developing toddlers and toddlers at risk for language difficulty.
Impact of neonatal risk and temperament on behavioral problems in toddlers born preterm
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Children born preterm are at risk for later developmental disorders. The present study examined the predictive effects of neonatal, sociodemographic, and temperament characteristics on behavioral outcomes at toddlerhood, in children born preterm. The sample included 100 toddlers born preterm and with very-low-birth-weight, and their mothers. Neonatal characteristics were evaluated using medical records. The mothers were interviewed using the Early Childhood Behavior Questionnaire for temperament assessment, and the Child Behavior Checklist for behavioral assessment. Multiple linear regression analyses were performed. Predictors of 39% of the variability of the total behavioral problems in toddlers born prematurely were: temperament with more Negative Affectivity and less Effortful Control, lower family socioeconomic status, and younger mothers at childbirth. Temperament with more Negative Affectivity and less Effortful Control and lower family socioeconomic status were predictors of 23% of the variability of internalizing behavioral problems. Additionally, 37% of the variability of externalizing behavioral problems was explained by temperament with more Negative Affectivity and less Effortful Control, and younger mothers at childbirth. The neonatal characteristics and stressful events in the neonatal intensive care unit did not predict behavioral problems at toddlerhood. However, temperament was a consistent predictor of behavioral problems in toddlers born preterm. Preventive follow-up programs could assess dispositional traits of temperament to provide early identification of preterm infants at high-risk for behavioral problems.
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ArticleA Review of Research on Premature Infant-Mother Interaction

Abstract

Section snippets

Importance of Interaction

Interaction Frameworks

Early Research on Premature Infant Interaction

Summary of the Research Findings

Practice Implications

Infant Behav Dev

Early Hum Dev

Infant Behav Dev

Infant Behav Dev

Mother-Infant interaction

Socialization

Dev Sci

Infant speech perception: a window on psycholinguistic development

Int J Psycholinguist

Preferences for infant-directed speech in the first month after birth

Child Dev

Emotional regulation: influences of attachment relationships

The nature of the child's ties

Brief report: birth status medical complications and social environment; Individual differences in development of preterm, very low birth weight infants

J Pediatr Psychol

The influence of early mother-child interaction on preschool cognitive and linguistic outcomes in a high risk group

Infant Ment Health

The rhythmic structure of mother-infant interaction in term and preterm infants

Child Dev

Mother-Infant affect synchrony as an antecedent of emergence of self control

Dev Psychol

The temporal coordination of early infant communication

Dev Psychol

The relation between coordinated interpersonal timing and maternal sensitivity in four month old infants

J Psycholinguist Res

Emotions and emotional communication in infants

Am Psychol

Pathways from prematurity and infant abilities to later cognition

Child Dev

Research strategies for capturing transactional models of develop the limits of the possible

Dev Psychopathol

Patterns of attachment

Prematurity: effects on parent infant interaction

J Pediatr Psychol

Article
A Review of Research on Premature Infant-Mother Interaction