Effects of Pediatric Anticipatory Guidance on Mothers of Young Children.

Provision of anticipatory guidance to parents during well-child visits is a defining component of pediatric primary care. Using nationally representative data from the 2000 U.S. National Survey of Early Childhood Health, this study addressed the questions of whether, how, and what mothers of children below age 3 with different ethnic/racial background could benefit from anticipatory guidance. Structural equation modeling results showed that across ethnic/racial groups, guidance was directly associated with decreased maternal stress and directly and indirectly associated with effective parenting practices in child development, discipline, and safety. Moreover, guidance was consistently associated with decreased stress (effect size = .159/.123/.252) and increased effective parenting practices in child development (total effect = .090/.179/.296), discipline (total effect = .079/.138/.111), and safety (total effect = .186/.204/.229) in White/Black/Latino groups, respectively. Finally, whereas guidance was directly associated with child safety in all groups, it was indirectly contributed to child development and discipline via maternal stress in the Latino group only.

Maternal life stress and health during the first 3 years postpartum.

Health problems may occur in mothers and can persist during the postpartum. Life event stress (LES) is a risk factor for poor maternal health. We examined the relations of LES and rise in LES over time to maternal health during the first three years postpartum. We used data from 1,364 mothers obtained between 1991 and 2007 in the U.S. National Institute of Child Health and Human Development Study of Early Child Care and Youth Development. Information on maternal sociodemographics and early postpartum health was collected 1 month after childbirth. Maternal reports on health status and LES were obtained at 6, 15, 24, and 36 months postpartum. Latent growth curve analyses were performed, with maternal sociodemographics and early postpartum health as covariates for which statistical adjustment was made. Maternal health declined steadily in a linear pattern with marked individual differences, whereas maternal LES increased gradually in a linear pattern. Moreover, faster maternal health decline was associated with poorer early health at 1 month postpartum, greater exposure to LES at 6 months postpartum, and faster rise in LES exposure over time. Decline in maternal health may be explained at least in part by the deleterious effects of exposure to stressful life events.

Association Between Night Waking and Child Health During the First 3 Years of Life.

OBJECTIVE: Night awakening is a common concern for parents and professionals in early childhood and a risk factor for child growth and development. This study examined the concurrent and longitudinal associations of night awakening with child health and illness during the first 3 years of life. METHODS: Longitudinal data from 1364 infants in the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development were used in this study. At ages 6, 15, 24, and 36 months, mothers reported on the frequency of their child's night awakening in the past week, overall health, and occurrences of illness. Information on demographic factors, including child sex and ethnicity/race, maternal education, and family income as well as child breastfeeding status was obtained at 1 month. Structural equation modeling, including latent growth curve modeling, was performed. RESULTS: Age-related changes in weekly frequency of night awakening and overall child health were characterized by curvilinear patterns between 6 and 36 months. Although more frequent night awakenings were associated with poorer health at 6 months, a faster decline in night awakenings was associated with a slowed health decline over time. Furthermore, more frequent night awakenings were concurrently associated with more occurrences of illness at ages 6, 15, and 24 months. The association between night awakening and illness dissipated by 36 months. CONCLUSION: Night awakening is concurrently and longitudinally associated with poorer health and more illnesses in early childhood.

Early gesture, early vocabulary, and risk of language impairment in preschoolers.

BACKGROUND: Gesture precedes vocabulary development and may be an early marker of later language impairment. AIMS: Using data from the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development, this study examined the contribution of children's (N=1064) early gestures and early vocabularies to their risk of language impairment in preschool years. METHODS AND PROCEDURES: At age 15 months, maternal reports on children's use of gestures and vocabulary comprehension and production skills were measured using the MacArthur Communicative Development Inventories. At age 3 and 4.5 years, children's language skills were assessed using the Reynell Developmental Language Scale and Preschool Language Scale-3, respectively. OUTCOMES AND RESULTS: After controlling for child, maternal, and family sociodemographic factors, children at later risk for language impairment were found to exhibit significantly less early gesture use and vocabulary skills relative to their typically developing peers. Early use of gestures was also significantly correlated with early vocabulary skills. CONCLUSIONS AND IMPLICATIONS: The effect of early gesture on children's later risk of language impairment was indirect and mediated by early vocabulary production. Early gesture may have the potential to serve as an early diagnostic tool and play a role in early intervention.

Intervention effects on emotion regulation in preterm infants with very low birth weight: A randomize controlled trial.

Preterm infants are at risk for emotional difficulties and behavioral problems. This study was aimed to investigate the effects of a clinic-based intervention program (CBIP) and a home-based intervention program (HBIP) compared with a usual care program (UCP) on emotion regulation to stress in preterm infants with very low birth weight (VLBW, birth weight <1500 g). A total of 178 VLBW preterm infants had been previously randomly assigned to receive one of three interventions (57 in CBIP, 63 in HBIP and 58 in UCP). The CBIP and HBIP contained identical child-, parent- and dyad-focused interventions that were provided to infants during hospitalization and were respectively delivered at clinics and at home at PMA 36-38 and 40 weeks, and 1, 2, 4, 6, 9, 12 months of corrected age. All infants were prospectively observed for behavioral reactivity and regulation in response to experimentally evoke stress evoked by a toy-behind-barrier procedure at 12, 18, and 24 months of corrected age. Their cognitive and language abilities, and mothers' responsiveness were also assessed at 12 months as potential covariates. Compared to the UCP-group infants, the HBIP-group infants exhibited shorter durations of visual orientation to a toy (adjusted difference [95% CI]=-1.60 [-3.07 to -0.13], p=0.03), and the CBIP-group infants exhibited shorter durations of avoidance (adjusted difference [95% CI]=-0.84 [-1.57 to -0.10], p=0.03) from 12 to 24 months of corrected age. The CBIP and HBIP showed no difference in the stress reactivity from the UCP, however. These results suggest that comprehensive interventions incorporating child-, parent- and dyad-focused services enhanced VLBW preterm infants' emotion regulation in response to stress at toddler age.

Linking Family Economic Hardship to Early Childhood Health: An Investigation of Mediating Pathways.

OBJECTIVES: The underlying mechanisms through which family economic adversity influences child health are less understood. Taking a process-oriented approach, this study examined maternal mental health and investment in children, child health insurance, and child healthcare as mediators linking family economic hardship (FEH) to child health. METHODS: A structural equation modeling was applied to test the hypothesized mediating model. RESULTS: After adjustment for sociodemographic risk factors, results revealed: (1) a significant direct path linking FEH to poor child health (effect size = .372), and (2) six significant mediating pathways (total effect size = .089). In two mediating pathways, exposures to FEH undermined mothers' mental health: in the first pathway poor maternal mental health led to decreased parental investment, which, in turn, contributed to poor child health, whereas in the second pathway the adverse effect of poor maternal mental health was cascaded through child unmet healthcare need, which resulted in poor child health. One pathway involved child insurance status, where the effect of FEH increased the likelihood to be uninsured, which led to unmet healthcare need, and, in turn, to poor health. Three pathways involved preventive care: in one pathway FEH contributed to poor preventive care, which led to unmet healthcare need and then to poor health; in the other two pathways where poor preventive care respectively gave rise to decreased investment in children or poor maternal mental health, which further contributed to poor child health. CONCLUSIONS: Results suggest that the association between FEH and children's health is mediated by multiple pathways.

Collaborative Mother-Toddler Communication and Theory of Mind Development at Age 4.

Focusing on social pragmatics, this longitudinal study investigated the contribution of mother-toddler collaborative communication to theory of mind (ToM) development at age 4. At age 2½, 78 toddlers' (42 boys) and their mothers were observed during pretend play. At age 4, children were tested using 4 false belief understanding tasks. Both mothers and toddlers engaged in more collaborative (inform, guide/request, and support/confirm) than non-collaborative communication acts. Other-focused collaborative acts of support/confirm by mothers and toddlers predicted children's false belief understanding, even after controlling for 5 covariates. In addition, as active agents in their own ToM development, the contribution of toddlers' collaborative acts to false belief understanding was independent of their mothers. Finally, the way toddlers and their mothers co-constructing their communication mattered. Only when toddlers engaged in high levels of collaborative acts, the mothers' high levels of collaborative acts demonstrated a positive effect on children's ToM development. The applied implications of these findings were discussed.

A randomized controlled trial of clinic-based and home-based interventions in comparison with usual care for preterm infants: effects and mediators.

This study examined the effects and mediators of a clinic-based intervention program (CBIP) and a home-based intervention program (HBIP) compared with usual care in very-low-birth-weight (VLBW) preterm infants on developmental and behavioral outcomes at 24 months of age (corrected for prematurity). In this randomized controlled trial, VLBW preterm infants received either CBIP (n=57), HBIP (n=63), or usual care (n=58) from hospitalization to 12 months. At 12 months, infant emotional regulation was assessed using the toy-behind-barrier procedure and dyadic interaction was observed during free play. At 24 months, infant developmental and behavioral outcomes were assessed using the Bayley Scales of Infant and Toddler Development- 3rd edition and the Child Behavior Checklist for Ages 1.5-5, respectively. Compared with infants under usual care, the CBIP-group infants showed higher cognitive composite scores (difference, 95% confidence interval (CI)=4.4, 0.8-7.9) and a lower rate of motor delay (odds ratio (OR), 95% CI=0.29, 0.08-0.99); the HBIP-group infants had lower sleep problem scores (difference, 95% CI=-1.4, -2.5 to -0.3) and a lower rate of internalizing problems at 24 months (OR, 95% CI=0.51, 0.28-0.93) (all p<.05). The CBIP's effect on cognitive outcome was attenuated when maternal or dyadic interactive behavior was considered; whereas the HBIP's effect on sleep and internalizing behavior was attenuated when duration of orientation to a toy or object was considered. In conclusions, interventions enhanced the cognitive, motor, and behavioral outcomes of VLBW preterm infants. The effects on cognitive and behavioral outcomes might be mediated by early-improved mother-infant interaction and infant emotional regulation, respectively.

Effects of social games on infant vocalizations*.

The aim of the present study was to examine the contextual effects of social games on prelinguistic vocalizations. The two main goals were to (1) investigate the functions of vocalizations as symptoms of affective arousal and symbols of social understanding, and (2) explore form-function (de)coupling relations between vocalization types and game contexts. Seventy-one six-month-olds and sixty-four twelve-month-olds played with their mothers in normal and perturbed tickle and peek-a-boo games. The effects of infant age, game, game climax, and game perturbation on the frequency and types of infant vocalizations were examined. Results showed twelve-month-olds vocalized more mature canonical syllables during peek-a-boo and more primitive quasi-resonant nuclei during tickle than six-month-olds. Six- and twelve-month-olds increased their vocalizations from the set-up to climax during peek-a-boo, but they did not show such an increase during tickle. Findings support the symptom function of prelinguistic vocalizations reflecting affective arousal and the prevalence of form-function decoupling during the first year of life.

The effect of in-hospital developmental care on neonatal morbidity, growth and development of preterm Taiwanese infants: a randomized controlled trial.

INTRODUCTION: Intervention studies of developmental care for preterm infants in Western societies have shown early but unsustainable effects on child outcomes, however only a limited of studies have examined if developmental care interventions produce similar effects in Eastern cultural contexts. AIMS: To examine the effectiveness of in-hospital developmental care on neonatal morbidity, growth and development of preterm infants with very low birth weight (VLBW; birth weight<1500 g) in Taiwan. METHODS: One hundred and seventy-eight VLBW preterm infants were randomly assigned to the clinical trial during hospitalization at three hospitals in Taiwan; the control group received five sessions of standard child-focused developmental care and the intervention group received five sessions of child- and parent-focused developmental care. Sixty-two normal term infants were also included as a comparison group. Infants were examined for morbidity, growth and developmental outcomes at term age. RESULTS: At study entry, more infants in the intervention group were twins or multiples than those in the control group (29% vs. 16%, p=0.05). After adjusting for birth set, the intervention group had lower incidences of stage II-III retinopathy (odds ratio [OR]=0.34 [95% confidence interval (CI): 0.15-0.79]; p=0.01) and feeding desaturation (OR=0.32 [95% CI: 0.10-1.00]; p=0.05) and had greater daily weight gains (difference=2.0 g/day [95% CI: 0-4.0 g/day]; p=0.05) as compared with the control group. However, the intervention and control groups did not differ in any of the neurodevelopmental measures. CONCLUSIONS: In-hospital developmental care has short-term benefits for Taiwanese VLBW preterm infants in reducing the risk of retinopathy and feeding desaturation as well as in enhancing weight gains at term age.

Stress and health-related well-being among mothers with a low birth weight infant: the role of sleep.

This U.S.A.-based study examined the quantitative and qualitative characteristics of sleep, as well as the role of sleep, in the association of stress with depression, fatigue, and health-related quality of life (H-QOL) among mothers with a low-birth-weight, preterm infant in the neonatal intensive care unit at early postpartum. Fifty-five first-time mothers kept a sleep diary and filled out a battery of questionnaires. The wrist actigraphy method was also applied to collect information on maternal sleep. We tested a path model, with sleep disturbance and depression mediating the effect of stress on health-related well-being. Results showed that the majority of the study participants were stressed, depressed, fatigued, and at risk for poor physical and mental health. Poor sleep quality as perceived by mothers was significantly associated with their stress, fatigue, and poor mental and physical H-QOL. A cascading effect was found in the path model where maternal stress contributed to poor sleep quality and depression, which in turn contributed to poor mental H-QOL. In addition, poor sleep quality was associated with fatigue, which in turn contributed to poor physical and mental H-QOL. The underlying neurobiological mechanisms through which sleep affects the stress-health relation are discussed. The implications of sleep for intervention and prevention are also addressed.

Severity of bronchopulmonary dysplasia and increased risk of feeding desaturation and growth delay in very low birth weight preterm infants.

Oral feeding has been reported to compromise breathing among preterm infants with bronchopulmonary dysplasia (BPD) during hospitalization or shortly after discharge. However, limited information was available concerning whether preterm infants with BPD remain vulnerable to feeding and growth insufficiency after a longer term of follow-up. The purpose of this study was therefore to examine the effect of severity of BPD on pulse oxygen saturation (SpO(2)) during feeding and growth in very low birth weight (VLBW) preterm infants during infancy. Seventy-two preterm infants with VLBW and 15 term infants were prospectively examined their growth and SpO(2) during feeding at 2, 4, and 6 months of corrected age. The severity of BPD was graded in VLBW infants according to the American National Institutes of Health consensus definition. In comparison to VLBW infants with mild BPD and term infants, VLBW infants with severe BPD showed significantly lower mean levels of SpO(2) during feeding at 2-6 months corrected age (P < 0.05). Those with severe BPD further exhibited higher rates of growth delay (weight < 10th percentile) throughout the study period. Among VLBW infants, severe BPD had an adverse relation with subsequent weight measures after adjustment for medical and demographic confounding variables (beta = -904 g, P = 0.03). The consensus BPD definition is useful to identify those preterm infants who are at greater risk of feeding desaturation and growth delay during infancy and close monitoring of SpO(2) during feeding should be advised.

Reliability of the assessment of mother-infant sensitivity-chinese version for preterm and term taiwanese mother-infant dyads.

PURPOSE: The objectives of this study were to translate and modify the Assessment of Mother-Infant Sensitivity scale into a Chinese version (modified AMIS-C) and to examine its reliability with preterm and term Taiwanese mother-infant dyads. METHOD: A total of 241 mother-infant pairs (179 preterm dyads and 62 term dyads) were prospectively recorded and their behaviour in feeding assessed using the modified AMIS-C when infants were at 4 and 6 months corrected age. A subset of the sample was used for interrater reliability testing, and the whole sample was used for assessment of internal consistency. RESULTS: Interrater reliability was high for the modified AMIS-C section and total scores (intra-class correlation coefficients=0.91-0.99). Internal consistency was good to excellent for the maternal section and total score (α=0.71-0.86) and was fair to good for the infant and dyadic section score (α=0.44-0.75). CONCLUSIONS: The modified AMIS-C scale is a clinically feasible and reliable instrument for assessing mother-infant interaction of preterm and term dyads during early infancy.

Two-month-olds' attention and affective response to maternal still face: a comparison between term and preterm infants in Taiwan.

Maternal still face is a robust experimental procedure designed to examine infants' sensitivity to social contingency and reactivity to its violation. To extend earlier research on the still-face effect on term infants in Western cultures, the present study compared Taiwanese term and preterm infants' attention and affective response to and recovery from a modified maternal still-face procedure that used an additional still-face reengagement sequence at 2 months of age (corrected age for preterm infants). Infants' gaze and facial affect were coded from videos. Results showed that preterm infants were as sensitive as term infants to the interruption to social contingency. Both groups of infants reacted with decreased gaze and positive affect across episodes, together with a decreased latency to gaze aversion and an increased latency to positive affect. Both term and preterm infants also demonstrated a W-shaped pattern of decline-followed-by-recovery in their latency to negative affect. However, compared to term infants, preterm infants became distressed faster and stayed in a negative affective state longer after the first exposure to maternal still face. Effects of prematurity on infant attention and affect regulation were discussed. Implications of preterm infants' heightened affective negativity to mild stress for intervention studies were also addressed.

Separation anxiety in first-time mothers: infant behavioral reactivity and maternal parenting self-efficacy as contributors.

This short-term longitudinal study examined the contribution of infant behavioral reactivity and maternal parenting self-efficacy to first-time mothers' (total n=32) separation anxiety. Infants' behavioral reactivity indexed by gaze and facial affect were observed in the conditions of routine play and maternal still face at 3 months. Mothers reported their self-perceived parenting efficacy at 3 months and separation anxiety at 6 months. Results revealed that infants' frequent gazing at their mother, greater negative affect, and less positive affect observed during the still face, but not during the routine play, contributed to heightened maternal separation anxiety. In addition to a direct link between low maternal parenting self-efficacy and high maternal separation anxiety, maternal parenting self-efficacy buffered against the impact of infant negative reactivity on maternal separation anxiety. The role of infant reactivity and maternal self-efficacy in parenting was discussed.

Effects of normal and perturbed social play on the duration and amplitude of different types of infant smiles.

Different types of smiling varying in amplitude of lip corner retraction were investigated during 2 mother-infant games--peekaboo and tickle--at 6 and 12 months and during normally occurring and perturbed games. Using Facial Action Coding System (FACS), infant smiles were coded as simple (lip corner retraction only), Duchenne (simple plus cheek raising), play (simple plus jaw drop), and duplay (Duchenne plus jaw drop). In addition, again using FACS, the amplitude of lip corner retraction was coded on a 5-point scale. Rather than a single smile expression that differs only in amplitude, the authors found a complex family of different smile expressions differing in their duration and amplitude as a function of game, setup versus climax of the game, and perturbation. Both type of smiling and amplitude of smiling appear to be controlled independently by the infant in relation to the context. These findings reveal systematic and context-specific nuances in infant smiles in the 2nd half of the first year.

MLL is fused to EB1 (MAPRE1), which encodes a microtubule-associated protein, in a patient with acute lymphoblastic leukemia.

We have shown that the EB1 (MAPRE1) gene, at 20q11.2, is fused to MLL in an adult patient with pro-B acute lymphoblastic leukemia. Southern blot analysis indicated that a rearrangement of the MLL gene was involved in the chromosomal abnormality. cDNA panhandle polymerase chain reaction (PCR) identified the fusion transcript, in which MLL exon 6 was fused in-frame with EB1 exon 5. The presence of the MLL-EB1 and the reciprocal EB1-MLL fusion transcripts was verified by reverse-transcription PCR. EB1 is the first gene on chromosome 20 found to fuse with MLL. The genomic break junctions of MLL-EB1 and EB1-MLL were amplified by long-distance PCR. Sequencing of the break junctions revealed that multiple DNA breaks had occurred and that the DNA fragments flanked by these breaks had been duplicated, deleted, or inverted. Nontemplate DNA segments of 2 bp also were detected at the breakpoints on derivative chromosomes 11 and 20. These features indicate that this translocation likely resulted from the DNA damage-repair pathway. EB1 is a microtubule-associated protein that interacts with the colorectal adenomatous polyposis coli tumor-suppressor protein and plays important roles in regulating microtubule dynamics, cell polarity, and chromosome stability. Immunofluorescence staining demonstrated that the MLL-EB1 fusion proteins were localized in the nuclei.

Social regulatory effects of infant nondistress vocalization on maternal behavior.

This study investigated the social regulatory function of infant nondistress vocalization in modulating maternal response. Thirteen infants and their mothers were observed weekly in a face-to-face interaction situation from 4 to 24 weeks. After the occurrences and the speech quality of infant nondistress vocalization were identified, maternal contingent responses to these vocalizations were also coded. Each responsive action was further classified by the change processes involved. Results showed that it was the occurrence of infant nondistress vocalization rather than its speech quality that regulated maternal verbal response concurrently and that infant nondistress vocalization was more likely to be synchronized with maternal facial expression and touch than with head movements. Developmentally, significant individual differences were found in the linear growth patterns of overall maternal response and within the individual modalities when responding to speechlike vocalizations.

Stability and transitions in mother-infant face-to-face communication during the first 6 months: a microhistorical approach.

In this study the authors attempted to unravel the relational, dynamical, and historical nature of mother-infant communication during the first 6 months. Thirteen mothers and their infants were videotaped weekly from 4 to 24 weeks during face-to-face interactions. Three distinct patterns of mother-infant communication were identified: symmetrical, asymmetrical, and unilateral. Guided by a dynamic systems perspective, the authors explored the stability of and transitions between these communication patterns. Findings from event history analysis showed that (a) there are regularly recurring dyadic communication patterns in early infancy, (b) these recurring patterns show differential stabilities and likelihoods of transitions, (c) dynamic stability in dyadic communication is shaped not only by individual characteristics (e.g., infant sex and maternal parity) but also by the dyad's communication history, and (d) depending on their recency, communication histories varying in temporal proximity exert differential effects on the self-organization processes of a dyadic system.

First-time mothers' perceptions of efficacy during the transition to motherhood: links to infant temperament.

This investigation examined associations between pre- and postnatal reports of 1st-time mothers' depression, anxiety, and marital quality and postnatal reports of infant temperament and changes in feelings of efficacy. Maternal efficacy measured prenatally was associated with concurrent measures of depression, anxiety, marital conflict, and levels of previous child-care experience. Mothers' perception of infant temperament postnatally accounted for a significant proportion of variance in postnatal reports of maternal efficacy. Although individual differences in women's feelings of efficacy were fairly stable, significant increases in maternal efficacy were also observed over time. Findings suggest that 1st-time mothers' beliefs about their ability to perform nurturing routines may changes from a global sense of self-competence to more differentiated perceptions of nurturing efficacy.