Intimate Partner Violence in the First 2 Years of Life: Implications for Toddlers' Behavior Regulation.

Intimate partner violence (IPV) is prevalent in families with young children and challenges their healthy development. This study examined characteristics of IPV (e.g., mother- vs. partner-perpetrated, types and severity) and investigated potential effects of IPV on toddlers' behavioral regulation in a sample of families at risk for IPV. We also examined whether maternal depression and child-rearing attitudes and behavior would moderate IPV-child behavior links. These questions were addressed in a sample ( N = 400) of first-time adolescent mothers and their toddlers (1-2 years of age). Families were visited in their homes; data were collected via maternal report and observations. Partner- and self-perpetrated IPV was assessed using the Conflict Tactics Scale questionnaire; child behavior regulation was measured using the Brief Infant-Toddler Social and Emotional Assessment questionnaire. Approximately 80% of families experienced psychological aggression; almost one third reported physical assault in the past year. Both physical and psychological IPV were associated with greater toddler behavior problems. Neither maternal depression, mothers' attitudes about corporal punishment, nor nonhostile interaction moderated IPV-behavior problem links, though mothers' reports of maltreating behavior did. Among children whose mothers did not use corporal punishment/physical violence, IPV did not differentially affect behavior problems. Children whose mothers used corporal punishment/physical violence with them showed behavior problems in the context of IPV (severe psychological aggression). Results underscore the importance of exposure to IPV during the first year of life, and the prevalence of IPV perpetrated by both mothers and their partners in families with adolescent mothers.

Limiting home visiting effects: maternal depression as a moderator of child maltreatment.

OBJECTIVE: To test, with a sample of adolescent mothers (16-20 at childbirth) and their first-born infants/toddlers (average age 1 year), whether the impact of a home visiting (HV) child maltreatment prevention program was moderated by maternal depression. METHODS: The study design was a randomized controlled trial of Healthy Families Massachusetts, a statewide child maltreatment prevention program. A total of 707 first-time mothers were randomly assigned to the HV or control group. The HV group received visits from paraprofessional home visitors. Mothers in the control group were referred to other service providers. The outcome variable consisted of state Child Protective Services reports of child abuse and neglect (mother or other person as perpetrator). Maternal depression was assessed by maternal report (Center for Epidemiologic Studies-Depression questionnaire). RESULTS: A considerable proportion of families had child maltreatment reports (30% of sample) and maternal depression (38% had clinically significant symptoms). Most maltreatment was neglect. Among control group mothers, reports of maltreatment did not vary according to depressive symptoms. For HV mothers, probability of reports varied with levels of depressive symptoms. Nonsymptomatic HV mothers were less likely to have a child who was reported for maltreatment compared with HV mothers who endorsed clinical levels of depressive symptoms. CONCLUSIONS: The prevalence of maternal depressive symptoms in this sample, and the link between depression and child maltreatment prevention program effectiveness, suggest that home visitors be alert to maternal depression. Programs also should be aware of possible surveillance effects related to maternal depression.

Neonatal weight loss at a US Baby-Friendly Hospital.

Few if any studies have examined weight loss among term newborns by weighing infants daily for the first week of life. Perhaps because so few data exist, there is no standard in the United States for normal newborn weight loss. Our objective was to investigate normal newborn weight loss among infants born in a US Baby-Friendly hospital, by weighing infants daily for the first week of life. Using a prospective cohort design, infants born at an urban Boston, MA, hospital were enrolled within 72 hours of delivery and weighed daily for the first week of life. In hospital, infant weight was obtained from the medical record; post discharge, a research assistant visited the home daily and weighed the baby. All feeds in week 1 of life were recorded. Birth-related factors potentially affecting weight loss were abstracted from the medical record. Complete data were collected on 121 infants. Mean weight loss was 4.9% (range=0.0% to 9.9%); 19.8% (24 of 121) of infants lost >7% of their birth weight; no infant lost >10%. Maximum percent weight loss was significantly associated with feeding type: exclusively and mainly breastfed infants lost 5.5%, mainly formula-fed infants lost 2.7% and exclusively formula-fed infants lost 1.2% (P<0.001). Type of delivery and fluids received during labor were not associated with weight loss. Clinical practices at a Baby-Friendly hospital, which support and optimize breastfeeding, appear to be associated with only moderate weight loss in exclusively and mainly breastfed infants.

Hospital Education in Lactation Practices (Project HELP): does clinician education affect breastfeeding initiation and exclusivity in the hospital?

BACKGROUND: A woman's decision to breastfeed may be influenced by her health care practitioners, but breastfeeding knowledge among clinicians is often lacking. Project HELP (Hospital Education in Lactation Practices) was an intensive education program designed to increase breastfeeding knowledge among health care practitioners. The purpose of this study was to determine whether educating practitioners affected breastfeeding initiation and exclusivity rates at hospitals with low breastfeeding rates. METHODS: Between March 31, 2005, and April 24, 2006, we taught courses at four Massachusetts hospitals with low breastfeeding rates. Each course consisted of three, 4-hour teaching sessions and was offered nine times. The training, taught by public health professionals, perinatal clinicians, and peer counselors, covered a broad range of breastfeeding-related topics, from managing hyperbilirubinemia to providing culturally competent care. Medical records of infants born before and after the intervention were reviewed to determine demographics and infant feeding patterns. RESULTS: Combining data from all hospitals, breastfeeding initiation increased postintervention from 58.5 to 64.7 percent (p = 0.02). An overall increase in exclusive breastfeeding rates was not statistically significant. In multivariate logistic regression for all hospitals combined, infants born postintervention were significantly more likely to initiate breastfeeding than infants born preintervention (adjusted OR 1.32, 95% CI 1.03-1.69). CONCLUSIONS: Intensive breastfeeding education for health care practitioners can increase breastfeeding initiation rates.

Factors associated with exclusive breastfeeding among Latina women giving birth at an inner-city baby-friendly hospital.

Latina women living in the United States initiate breastfeeding at high rates, but their exclusivity is low. We examined factors associated with exclusive breastfeeding prior to discharge among 349 healthy Latina women giving birth at a Baby-Friendlytrade mark hospital in Massachusetts in 2004 to 2005. Factors associated with exclusive breastfeeding included maternal age <25 years (P = .017), US-born mother (P = .023), and having a Birth Sister(sm) (doula) ( P = .030). In multivariate logistic regression analysis, maternal age <25 years (adjusted odds ratio [AOR] 2.29; 95% confidence interval [CI], 1.28-4.10), US-born mother (AOR 3.16; 95% CI, 1.20-8.29), and Birth Sister involvement (AOR 2.16; 95% CI, 1.18-3.97) remained positively associated with exclusive breastfeeding. Compared with women who gave 4 or more formula feeds, women who gave only 1 to 3 formula feeds were more likely to have a Birth Sister (AOR 1.95; 95% CI, 1.05-3.63), to deliver vaginally (AOR 3.05; 95% CI, 1.32-7.05), and to delay the first formula feed (AOR 1.04; 95% CI, 1.02-1.06).

Accuracy of breastfeeding data on the Massachusetts birth certificate.

In 2003, the question, "Is the infant being breastfed at discharge?" was added to the US standard certificate of live birth. In Massachusetts, this was adapted to, "Are you breastfeeding or do you intend to?" In 2004-5, we compared the mother's answer to the birth certificate question in 2 hospitals, with her infant's feeding record. At Hospital A, 94.8% (290/306) of birth certificate responses matched the record. At (Baby-Friendly) Hospital B, 79.8% (185/232) matched. At the Baby-Friendly hospital, 17.2% (40/232) of women stated intent to formula feed on the birth certificate but breastfed postpartum. No significant sociodemographic differences existed between women whose answers matched or did not match. Although breastfeeding is a desirable health behavior, mothers did not overstate intent. The assumption that a prenatal feeding decision is an independent predictor of breastfeeding practice may be flawed. In the Baby-Friendly hospital, many women apparently made the decision postpartum.

A practical intervention to increase breastfeeding initiation among Cambodian women in the US.

Cambodians have the lowest breastfeeding initiation rate of any racial/ethnic group in Massachusetts. One barrier to breastfeeding is a lack of hospital foods that allow women to follow a traditional diet postpartum. We examined whether a culturally acceptable menu for new Cambodian mothers would increase breastfeeding initiation in the hospital. After a staff training program on breastfeeding, and the creation of a Cambodian menu, initiation rates increased significantly more in Cambodians than in non-Cambodians. Pre intervention, breastfeeding initiation was 16.7% (2/12) among Cambodians, compared to 60.6% (106/175) among non-Cambodians (P = 0.003). Post intervention, there was no significant difference between breastfeeding initiation rates among Cambodian women (66.7%; 8/12) compared to non-Cambodians (68.9%; 104/151) (P = 0.874).

Patterns of emotional availability among young mothers and their infants: A dydaic, contextual analysis.

The aim of this study was to examine patterns of emotional availability among 80 young mothers (under 21 years at their child's birth) and their infants, and to identify contextual and individual factors associated with different patterns of emotional availability. To operationalize the dyadic aspect of emotional availability, cluster analysis of the Emotional Availability Scales, third edition (EAS; Biringen, Robinson, & Emde, 1998) was conducted on mother and infant scales simultaneously. Four distinct groups of emotional availability patterns emerged, reflecting synchrony and asynchrony between maternal and child behavior: (a) low-functioning dyads, (b) average dyads, (c) average parenting/disengaged infants, and (d) high-functioning dyads. Further analyses revealed that mothers in different clusters differed on outcomes such as depressive symptomatology, social support, and relationships with their own mothers. The clusters and the variables related to them demonstrate the various challenges in integrating the dual tasks of adolescent and parenting development among young mothers. The clinical implications of these patterns of emotional availability and live context are discussed.