Mothers' Willingness to Use Workplace Lactation Supports: Evidence from Formally Employed Mothers in Central Kenya.

Background: Formally employed mothers are vulnerable to early cessation of exclusive breastfeeding. Kenyan national policy requires employer-provided maternity benefits and workplace lactation supports. Objective: The objective of this study was to evaluate willingness to use nationally mandated workplace lactation supports among formally employed women in Kenya. Methods: We conducted a cross-sectional survey among 304 mothers of children ages ≤12 mo in Naivasha, Kenya, who were currently formally employed and employed before delivery of the most recent child to assess availability of and willingness to use current and potential future workplace lactation supports. Results: The most available reported workplace lactation supports were schedule flexibility to arrive late or leave early (87.8%) or visit a child to nurse during lunch (24.7%), followed by company-funded community-based daycare (7.6%). Few (<4.0%) reported the availability of lactation rooms, on-site daycares, transportation to breastfeed during lunch, refrigerators for expressed milk, or manual or electric breastmilk pumps. If made available, >80% of mothers reported moderate or strong willingness to use flexible schedules to arrive late or leave early, break during lunch, and transportation to visit a child to nurse. A moderate proportion reported strong willingness to use on-site daycares (63.8%), company-funded community-based daycare (56.9%), on-site lactation rooms (60.5%), refrigeration for expressed milk (49.3%), manual (40.5%), and electric pumps (27.6%). Mothers expressed fear of missing production targets and reported more willingness to use on-site compared with off-site daycare to save transportation time but noted concerns about chemical exposures and early arrival times with young infants. Hesitations regarding the use of on-site lactation rooms included concerns about privacy, milk identification and storage, and use and sharing of pumps. Conclusions: Flexible schedules were the workplace lactation supports in highest demand among formally employed mothers. Maternal willingness to use lactation rooms, refrigeration, and pumping equipment was moderate to low, suggesting sensitization may help to increase demand as the implementation of Kenyan policies moves forward.

A boa mãe lactante: percepções maternas sobre amamentação e desmame / The good breastfeeding mother: maternal perceptions about breastfeeding and weaning

Resumo A inexistência ou escassez de uma abordagem mais complexa da amamentação nos materiais oficiais de promoção ao aleitamento materno foi o mote do projeto de pesquisa que investigou percepções maternas sobre o ato de amamentar seus bebês e o processo de desmame e suas implicações para elas, seus filhos e famílias. Este artigo apresenta resultados da pesquisa citada, com base na análise de entrevistas com mulheres que desmamaram há, no máximo, dois anos. As experiências das mulheres são afetadas por modelos de maternidade contidos nos discursos oficiais pró-aleitamento materno e na mídia. Compartilhar aspectos raramente abordados ou silenciados nesses discursos permitiu que elas ressignificassem a experiência de amamentação, deslocando seus sentidos e, em alguma medida, transformando-os.

Abstract The absence or insufficiency of a more complex approach to breastfeeding in official breastfeeding promotion materials induced the research project that investigated maternal perceptions about the act of breastfeeding their babies and the weaning process and its implications for them, their children and families. This article presents the results of the aforementioned research, based on the analysis of interviews with women who weaned a maximum of two years ago. Women's experiences are affected by models of motherhood asserted by official discourses for breastfeeding and those that appear in the media. Sharing subjects seldom addressed or silenced in these discourses have helped them to reframe the breastfeeding experience, displacing their meanings and, to some extent, transforming them.

The influence of perinatal and maternal factors on physical growth at 12 months in prematurely born infants treated in the neonatal intensive care unit: A retrospective chart review and a prospective cohort study.

BACKGROUND: Growth retardation during the first year of life is frequently observed in prematurely born infants. Few reports have considered the effects of maternal emotional distress and perceptions of care burden on the outcomes of these infants. OBJECTIVES: This study investigated the physical growth trajectories of prematurely born infants treated in neonatal intensive care unit and determined the effects of perinatal factors, maternal emotional distress and perceptions of care burden on growth retardation at 12 months' corrected age. DESIGN: Retrospective chart review and prospective cohort study. SETTING: Single neonatal intensive care unit and follow-up outpatient clinics at a maternity and neonatal hospital. PARTICIPANTS: 288 mother-infant pairs in the retrospective chart review and 169 dyads in the prospective cohort study. METHODS: Medical records of prematurely born infants, perinatal factors and physical growth over a 1-year period were retrospectively reviewed. For the prospective study, mothers completed the Self-Rating Anxiety Scale, Perinatal Post-traumatic Stress Disorder Questionnaire, and Condition Management Effort Scale when infants reached 3 months' corrected age. The generalized linear mixed model was applied to explore effects of maternal emotional disorders and perceptions of care burden on growth retardation at 12 months' corrected age. RESULTS: The retrospective data showed 13.9%, 10.1%, and 10.1% retardation for head circumference, length, and weight, respectively. Birth weight was negatively associated with physical growth retardation. Delayed breastfeeding initiation, younger mothers, and lower 5-min Apgar score were associated with head circumference retardation. Male sex, higher gestational age, and delayed breastfeeding initiation were risk factors for length retardation; male sex, higher gestational age, and younger mothers for weight. The prospective study showed that head circumference, length, and weight retardation rates were 18.3%, 10.3%, and 16.3%, respectively. Male sex and birth weight, were still significant, while others were not. Moreover, alternative models based on these included factors revealed that maternal perceptions of a higher care burden was a risk factor for overall growth retardation and maternal post-traumatic stress disorder only for a weight problem. CONCLUSIONS: Physical growth remained a significant problem for prematurely born infants during the first year. This study identified perinatal factors, the level of maternal emotional distress, and perceptions of care burden were related to adverse infant's growth outcomes. Multidisciplinary interventions targeting maternal emotional distress and perceptions of care burden should be developed to promote the growth of prematurely born infants within the first 3 months after birth.

Percepções de mães de crianças com paralisia cerebral: um olhar sobre o passado e o futuro / Perceptions of mothers of children with cerebral palsy: a look at the past and the future / Percepciones de madre de niños com parálisis cerebral: una mirada sobre el pasado y el futuro

Objetivo: compreender as percepções de mães de crianças com paralisia cerebral acerca dos cuidados realizados e aprendizados vividos a partir desse diagnóstico. Método: utilizou-se Inventário Sociodemográfico, Sistema de Classificação da Função Motora Grossa e Roteiro de Entrevista. Participaram 13 mães de crianças entre 0 e 12 anos com diagnóstico de paralisia cerebral atendidas em um centro de referência especializado nas áreas de crescimento e desenvolvimento infantil da capital Belém-PA. Resultados: as mães relataram a importância dos aprendizados adquiridos, o processo de amadurecimento, os sofrimentos experimentados, as percepções acerca da felicidade e os desafios a serem vencidos. Conclusão: constatou-se que apesar das dificuldades, as mães percebiam-se realizadas com a construção dos intensos aprendizados acerca dos cuidados exigidos na paralisia cerebral

Objective: this study aimed to understand the perceptions of mothers of children with cerebral palsy about the care and learning they have experienced since this diagnosis. Method: sociodemographic Inventory, Gross Motor Function Classification System and Interview were used. Participants: 13 mothers of children between 0 and 12 years old with diagnosis of cerebral palsy attended at a specialized referral center in the areas of growth and child development in BelémPará. Results: The mothers reported the importance of acquired learning, the maturation process, the suffering experienced, the perceptions about happiness and the challenges to be overcome. Conclusion: it was observed that despite the difficulties, the mothers perceived themselves accomplished with the construction of intense learning about the care required in cerebral palsy

Objetivo: comprender las percepciones de madres de niños con parálisis cerebral acerca de los cuidados realizados y aprendidos vividos a partir de ese diagnóstico. Método: se utilizó Inventario Sociodemográfico, Sistema de Clasificación de la Función Motora Grossa y Ruta de Entrevista. Participaron 13 madres de niños entre 0 y 12 años con diagnóstico de parálisis cerebral atendidas en un centro de referencia especializado en las áreas de crecimiento y desarrollo infantil de la capital Belém-PA. Resultados: las madres relataron la importancia de los aprendizajes adquiridos, el proceso de maduración, los sufrimientos experimentados, las percepciones acerca de la felicidad y los desafíos a ser vencidos. Conclusión: se constató que a pesar de las dificultades, las madres se percibían realizadas con la construcción de los intensos aprendizajes acerca de los cuidados exigidos en la parálisis cerebral

Maternal perceptions about caesarean section deliveries and their role in reducing perinatal and neonatal mortality in the Upper West Region of Ghana; a cross-sectional study.

BACKGROUND: Maternal perceptions about caesarean section contribute to delayed presentation of women for emergency obstetric care. This increases the risks of perinatal and neonatal mortality and slows down the reductions needed to achieve the sustainable development goal (SDG) target of reducing neonatal mortality and ending new-born deaths. The aim of the study is to determine maternal perceptions about caesarean section deliveries and their role in reducing neonatal mortality at a regional and a district hospital in the Upper West Region of Ghana. METHODS: This descriptive study was carried out at two hospitals in the Upper West Region, the most rural region in Ghana, between 15th January and 29th June, 2018. Maternal perceptions were examined among antenatal care attendants at the Upper West Regional Hospital (UWRH) and St Joseph's Hospital Jirapa (SJH), a district hospital, using questionnaires administered by trained nurses. RESULTS: Altogether, 416 completed questionnaires were obtained, comprising 206 from expectant women attending the UWRH and 210 from SJH. Although the majority of women in this study preferred spontaneous vaginal delivery (87.4%, n = 348) to caesarean section, most of the respondents (n = 281, 73%) indicated their willingness to have a caesarean section if necessary. The main reason for not wanting a CS was the long recovery time (51.8%, n = 148). Almost half of women interviewed, representing 45.1% (180) did not know or feel that CS can promote child survival and about a fifth, 21.6% (85) believed that CS can have adverse effects on child survival. Factors associated with poor perception of CS included, no formal education, age less than 19 years and no employment. CONCLUSION: Majority of women in this study had a positive attitude towards the uptake of CS if it becomes necessary. Lack of formal education, age less than 19 years and unemployment are associated with poor maternal perception of CS. Education to improve the perception of CS as a promoter of child survival is necessary and to discourage perceptions that it causes adverse perinatal or neonatal outcome particularly in at risk populations.

Child weight status and accuracy of perceived child weight status as predictors of Latina mothers' feeding practices and styles.

This study focused on the relationship between low-income Latina mothers' perceptions of their preschool children's weight status and maternal feeding practices and styles, also considering the effects of actual child weight status and maternal concern about child weight. A total of 186 low-income Latina mother-child dyads participated. The vast majority of mothers underestimated the weight status of their child, but this varied by child weight status. Although only 30% of mothers of healthy weight children underestimated their child's weight status, 97% of mothers of overweight or obese children did so. No mother overestimated her child's weight status. Contrary to our hypotheses, in most cases, maternal perceptions of child's body weight were not related to maternal feeding styles, nor were many feeding practices predicted by concern about child weight. Instead, children's actual weight status was the strongest predictor of maternal feeding practices and feeding styles. Mothers of children with higher BMI z-scores reported higher levels of healthy eating guidance and responsiveness during feeding and lower levels of pressure to eat, food as reward, and using food to regulate the child's emotions. These mothers were more likely to show an indulgent and less likely to show an authoritarian feeding style. Concern about child weight did not account for any of these significant correlations. Maternal perceptions only mattered for restriction for weight purposes where there were independent effects of both perceived and actual weight status. Implications for understanding the development of child obesity in low-income, Latino populations are considered, along with recommendations for future research and for childhood obesity prevention programs.

Capturing Changes in HIV-Infected Breastfeeding Mothers' Cognitive Processes from Before Delivery to 5 Months Postpartum: An Application of the Pile-Sorting Technique in Haiti.

BACKGROUND: The cognitive processes involved in individuals' perceptions and prioritization of information, and how these change with experience or exposure to interventions, are rarely examined in the evaluation of nutrition interventions. Exclusive breastfeeding counseling is a common infant and young-child feeding intervention and is used to promote HIV-free survival in the prevention of mother-to-child transmission programs. However, it is often designed without adequate attention to the changes in mothers' perceptions over the course of their early breastfeeding experiences. OBJECTIVE: The aim of this study was to identify HIV-infected breastfeeding mothers' cognitive structure (their organization of messages and ideas) of infant feeding messages and to characterize whether their cognitive organization of infant feeding messages changed from pregnancy through the first 5 mo postpartum. METHODS: With the use of semistructured interviews and the cognitive mapping technique of pile sorting, we interviewed 30 HIV-infected breastfeeding mothers in Port-au-Prince, Haiti. We asked them to sort and rate 18 infant feeding messages 3 times (during pregnancy, 0- to 1-mo postpartum, and 3- to 5-mo postpartum). We analyzed their responses by using multidimensional scaling, property fitting, and partition analyses. RESULTS: At all 3 visits, we found consistency in women's cognitive mapping of messages. For example, mothers consistently differentiated messages pertinent for exclusive breastfeeding compared with those that pertained to other practices. However, subtle variations in mothers' cognition over time were also evident, particularly at 0- to 1-mo postpartum, when message proximity was tightly clustered compared with the earlier and later periods. CONCLUSIONS: We conclude that mothers share a common cognitive organization of infant feeding messages and that this organization changes over time. Attention to variations in cognition can support context-sensitive, patient-centered counseling by practitioners and improve the effectiveness of nutrition interventions. Pile sorting is an efficient, systematic technique to examine cognitive processes related to health and nutrition.

Caregiver perceptions of children's linear growth in Bangladesh: a qualitative analysis.

OBJECTIVE: To understand caregivers' perceptions of children's linear growth and to identify the cultural meanings and perceptions of risk associated with poor height attainment. DESIGN: Three investigators from Bangladesh conducted twelve focus group discussions. SETTING: The study was conducted in rural and slum settings in Bangladesh. SUBJECTS: Participants included mothers and alternative caregivers (n 81) who were recruited by household screening. No eligible, recruited subjects refused participation. RESULTS: Caregivers reported limited experience with growth monitoring services from the health system. Caregivers mainly use visual cues and developmental milestones to understand if children are growing properly, and recognize that children normally experience both weight gain and linear growth with age. Mothers expressed concern over children's malnutrition and short stature, but did not discuss children's failure to attain a 'growth potential' or distinguish inherited short stature from stunting. Caregivers interpret the consequences of poor height attainment as primarily social and economic and cite few health risks. CONCLUSIONS: Linear growth interpretation is determined more by community norms than by guidance from nutrition programming or the health system. Interventions to prevent or reduce linear growth failure may be perceived to have limited value where appropriate linear growth in children is determined by comparison to peers and siblings. Such perceptions may be significant barriers to programmes addressing stunting prevention in settings where many children are stunted. Efforts to raise awareness about the risks of linear growth faltering may need to consider delivering messages to caregivers that emphasize the social and economic consequences of stunting.

"Those who care much, understand much." Maternal perceptions of children's appetite: Perspectives from urban and rural caregivers of diverse parenting experience in Bangladesh.

Appetite in children is an important determinant of nutritional intake and growth. The information used by caregivers to understand children's appetite can help inform infant and young child feeding promotion and appetite assessment. We conducted a qualitative study to (a) explore maternal perceptions and responses to children's appetite and (b) to identify how these factors differ by type of caregiver, level of maternal experience, and urban versus rural context. We used purposive sampling to recruit mothers and alternate caregivers into 14 total focus group discussions (six to eight participants in each group; N = 95) in both urban and rural settings in Bangladesh. To understand children's appetite, caregivers monitor children's dietary patterns, emotional signs, and physical and verbal cues. Healthy appetite was observed by willingness to eat diverse foods, finish offered portions, and by acceptance of foods without excessive prompting. Child illness was cited for a cause of low appetite, which was manifested through fussiness, and avoiding commonly consumed foods. Mothers described a limited set of feeding practices (offering diverse foods, playing, and cheering children with videos) to encourage consumption when children lacked appetite. Mothers' stress related to work was noted as a barrier to identifying appetite cues. Urban mothers described a lower access to instrumental social support for child feeding but informational support than mothers in the rural setting. Understanding caregivers' perceptions of children's appetite may inform strategies to improve responsive feeding and tool development to assess changes in appetite as early indicators of change in health or nutrition status among high-risk children.

A influência da amamentação no desenvolvimento emocional infantil: as percepções das mães / The Influence of Breastfeeding on Child Emotional Development: Maternal Perceptions

Introdução: A amamentação pode influenciar no desenvolvimento emocional da criança pela intensa interação mãe-bebê. A interação intensa e contínua durante o ato de amamentar favorece o vínculo afetivo e pode tornar a criança mais autoconfiante, competente socialmente e cooperativa em seus relacionamentos interpessoais. Assim, conhecer as percepções das mães sobre a influência da amamentação no desenvolvimento emocional de seus filhos pode fornecer subsídios para intervenções de enfermagem que promovam o aleitamento materno e o desenvolvimento emocional das crianças. Elegeu-se como referencial teórico As Necessidades Essenciais das Crianças: o que toda criança precisa para crescer, aprender e se desenvolver. Objetivo: Descrever as percepções das mães a respeito da influência da amamentação no desenvolvimento emocional infantil. Método: Estudo qualitativo, de caráter exploratório e descritivo, com dois grupos focais com duas reuniões consecutivas cada, realizados no ambulatório do Centro Assistencial Cruz de Malta, São Paulo (SP), no período de setembro e outubro de 2017. Os critérios de inclusão foram: mulheres maiores de 18 anos, mães, com interesse em amamentação e desenvolvimento infantil. Os critérios de exclusão foram: mulheres que tiveram alguma complicação ou patologia durante a gestação, mães de crianças com problemas de saúde que dificultaram ou impediram a amamentação. As mães foram convidadas de quatro formas: presencialmente pelas pesquisadoras, antes ou após consultas de enfermagem de puericultura no ambulatório e nos horários de saída das crianças da creche do Centro Assistencial, telefonemas e mensagens de texto, estímulo imediatamente antes do início das reuniões para as mães que se encontravam em um dos serviços do Centro Assistencial, divulgação das próprias mães participantes. Participaram 13 mulheres, com idade de 18 a 43 anos, que amamentaram, amamentavam ou que possuíam forte desejo de amamentar. Nas reuniões, as mulheres foram convidadas a narrarem suas histórias pessoais sobre o aleitamento materno, sua interação com o bebê, como reconhecem o desenvolvimento emocional de seus filhos e as suas influências. Para a análise dos dados, utilizou-se a técnica de Análise de Conteúdo. A pesquisa foi aprovada pelo Comitê de Ética em Pesquisa da EEUSP. Resultados: Após análise dos dados, emergiram onze temas, compreendidos dentro de quatro categorias. As categorias foram: Conhecimentos e Percepções Maternas com temas Influência da Amamentação no Desenvolvimento Físico Infantil e Influência da Amamentação no Desenvolvimento Emocional Infantil; Elementos gerais do processo de amametar com temas Favoráveis: Apoio e Estímulo e Desfavoráveis: Censura à Amamentação em Público e Desfavoráveis: Angústia no Retorno ao Trabalho; Experiências Maternas com temas Dificuldades do Processo de Amamentar e Capacidade de Resiliência; Impacto das Orientações com temas Orientações que Incentivam e Apoiam a Amamentação, Orientações que Prejudicam a Amamentação, Falta de Orientações e Consequências e Relevância do Compartilhamento. Conclusão: Apesar das mães conhecerem sobre o desenvolvimento físico e motor, desconheciam o desenvolvimento emocional infantil e como a amamentação o influencia, mesmo afirmando que é importante para o estabelecimento de vínculo entre mãe e filho. Foram ressaltados elementos favoráveis e desfavoráveis para a prática da amamentação. Assim, valorizar o impacto da amamentação no desenvolvimento da criança pode se tornar outra estratégia de promoção ao aleitamento materno. As instituições e os profissionais devem estar melhor preparados para lidar com o desenvolvimento infantil de forma integral e abrangente, considerando que as emoções e o afeto são base para o desenvolvimento cognitivo e físico. Este trabalho contribui para evidenciar que profissionais, no atendimento de crianças e famílias, devem considerar suas necessidades essenciais, e compreender que as mães estão mobilizadas e sensibilizadas para promoverem o desenvolvimento emocional das crianças, inclusive amamentando.

Introduction: Breastfeeding can influence the childs emotional development through intense mother-baby interaction. The intense and continuous interaction during the act of breastfeeding favors the affective bond and can make the child more self-assured, competently socially and cooperative in their interpersonal relationships. Thus, to know the mothers' perceptions about the influence of breastfeeding on the emotional development of their children can provide subsidies for nursing interventions that promote breastfeeding and the emotional development of children. It was chosen as a theoretical reference: "The essential needs of children: What every child needs to grow, learn and develop.". Objective: To describe mothers' perceptions about the influence of breastfeeding on child emotional development Method: Qualitative study, of an exploratory and descriptive character, with two focal groups with two consecutive meetings each, performed at the ambulatory of the Centro Assistance Center of Malta, São Paulo (SP), in the period of September and October of 2017. The inclusion critererion were: Women over 18 years old, mothers, with an interest in breastfeeding and child development. The exclusion criterions were: women who had some complication or pathology during pregnancy, mothers of children with health problems that hindered or prevented breastfeeding. The mothers were invited in four ways: personally by the researchers; before or after nursing appointments of childcare in the ambulatory and in the schedules of the childrens of Centro Assistencials day care exit; phone calls and text messages; incentive immediately before the start of the meetings for the mothers who were in one of the services of the Assistance Center and disclosure of the participating mothers themselves. 13 women participated, aged 18 to 43 years, who breastfed, who were breastfeeding or who had a strong desire to breastfeed. In the meetings, women were invited to narrate their personal stories about breastfeeding, their interaction with the baby, how they recognize the emotional development of their children and their influences. For the analysis of the data, the technique of Content Analysis was used. The research was approved by the Committee of Ethics in Research of EEUSP. Results: After analysis of the data, eleven themes emerged, comprised within four categories. The categories were: "Maternal knowledge and perceptions" with themes "Influence of breastfeeding in child physical development" and "Influence of breastfeeding in child emotional development"; "General elements of the breastfeeding process" with themes "Favorable: support and stimulus" and "Unfavorable: censorship of breastfeeding in public" and "Unfavorable: anguish in return to work"; "Maternal experiences" with themes "Breastfeeding process difficulties" and "Resilience capacity"; "Impact of guidelines" with themes "Guidelines that encourage and support breastfeeding", "Guidelines that undermine breastfeeding", "Lack of guidelines and consequences" and "Relevance of sharing". Conclusion: Although mothers know about physical and motor development, they were unaware of the emotional development of children and how breastfeeding influences them, even stating that it is important for the establishment of a bond between mother and son. Favourable and unfavourable elements were emphasized for the practice of breastfeeding. Thus, to value the impact of breastfeeding on the child's development can become another strategy of promoting breastfeeding. Institutions and professionals should be better prepared to deal with child development in an integral and comprehensive way, considering that emotions and affection are the basis for cognitive and physical development. This work contributes to highlight that professionals, in the care of children and families, should consider their essential needs, and understand that mothers are mobilized and sensitized to promote the emotional development of children, including breastfeeding.

Do maternal perceptions of child eating and feeding help to explain the disconnect between reported and observed feeding practices?: A follow-up study.

Research demonstrates a mismatch between reported and observed maternal feeding practices. This mismatch may be explained by maternal cognitions, attitudes, and motivations relating to dyadic parent-child feeding interactions. These complex constructs may not be apparent during observations nor evidenced in self-report questionnaire. Therefore, the aim of this study was to use a qualitative approach to gain a more nuanced and contextualized understanding of (a) maternal perceptions of children's food intake control; (b) how parent-child mealtime interactions influence maternal feeding practices; and (c) ways in which mothers may promote healthy child eating and weight outcomes. Semistructured telephone interviews were conducted with 23 mothers (M = 38.4 ± 3.7 years of age) of preschool-aged children (M = 3.8 ± 0.6 years of age, 19 were normal weight, 14 were girls), who had previously completed child feeding questionnaire and participated in two home-based mealtime observations, 12 months apart. Interviews were recorded, transcribed, and themes extracted to create the database. Four major themes emerged: (a) Maternal confidence in children's ability to regulate food intake is variable; (b) Implementing strategies for nurturing healthy relationships with food beyond the dining table; (c) Fostering positive mealtime interactions is valued above the content of what children eat; and (d) Situation-specific practices and inconsistencies. Findings indicate that maternal feeding practices are shaped by both parent and child influences, and child feeding is mostly guided by controlling the family food environment, rather than by directly pressuring or restricting their child's eating. Results also highlighted the need for research to consider both parent and child influences on child feeding.

Social Emotional Factors Increase Risk of Postpartum Depression in Mothers of Preterm Infants.

OBJECTIVE: To examine the association of maternal mental health, perceptions of readiness at neonatal intensive care unit (NICU) discharge, and social risk factors with depressive symptoms 1 month postdischarge in mothers of early (<32 weeks), moderate (32-33 weeks), and late (34-36 weeks) preterm infants. A secondary objective was to compare depressive symptoms among mothers in all preterm groups. STUDY DESIGN: Mothers (n = 734) of preterm infants cared for >5 days in the NICU and participating in a Transition Home Program completed the Fragile Infant Parent Readiness Evaluation prior to discharge for perceptions of NICU staff support, infant well-being, maternal well-being (emotional readiness/competency), and maternal comfort (worry about infant). Mental health history and social risk factors were obtained. At 1 month postdischarge the Edinburgh Postnatal Depression Scale was administered. Group comparisons and logistic regression analyses were run to predict possible depression (Edinburgh Postnatal Depression Scale ≥10). RESULTS: Mothers of early, moderate, and late preterm infants reported similar rates of possible depression (20%, 22%, and 18%, respectively) 1 month after NICU discharge. History of mental health disorder, decreased perception of maternal well-being, decreased maternal comfort regarding infant, and decreased perception of family cohesion were associated with possible depression at 1 month postdischarge. CONCLUSIONS: Mothers with a previous mental health disorder and experiencing negative perceptions of self and infant at NICU discharge were at increased risk for depressive symptomatology 1 month postdischarge regardless of infant gestational age. Comprehensive mental health assessment prior to discharge is essential to identify women at risk and provide appropriate referral.

Maternal Perceptions Related to Eating and Obesity Risk Among Low-Income African American Preschoolers.

Objectives Health disparities are prevalent in the U.S., with low-income African American children suffering from high rates of obesity and related conditions. Better understanding of parental attitudes and barriers related to healthy eating and obesity risk is needed to suggest more effective intervention foci for this at-risk population. Methods African American caregivers of 3-5 year old children were recruited for focus groups and a questionnaire completion from two Head Start programs in a southeastern state of the U.S. The Social Cognitive Theory was utilized to develop a focus group guide. Focus group recordings were transcribed verbatim and analyzed using the comparative content analysis. Results Eight focus groups (all participants were mothers) yielded the following main themes: (1) general nutrition knowledge but common misconceptions about foods/beverages; (2) beliefs that meals have to include meat and starch and be home-cooked to be healthy; (3) desire to feed children better than their own parents; (4) lack of family support and child pickiness perceived as the greatest barriers to healthy eating; (5) awareness of family history of diseases; and (6) low concern about children's current diet and weight status. Over 25 % of mothers underestimated their child weight status. Conclusions Our findings highlight the importance of understanding maternal perspectives related to food, eating, and weight among low-income African American mothers of preschoolers. Nutrition educators should be aware of misconceptions and recognize that mothers might not perceive diet quality in early childhood as having strong impact on the child's future health and/or obesity risks.

Caregiver's Country of Birth Is a Significant Determinant of Accurate Perception of Preschool-Age Children's Weight.

BACKGROUND: One in four preschool-age children in the United States are currently overweight or obese. Previous studies have shown that caregivers of this age group often have difficulty accurately recognizing their child's weight status. The purpose of this study was to examine factors associated with accurate/inaccurate perception of child body mass index (BMI) among a multicultural sample of caregivers who were predominantly low-income and foreign-born. METHODS: A total of 980 caregivers (72% Hispanic, 71% born outside of the United States) of preschool-age children (N= 1,105) were asked if their child was normal weight, overweight, or obese. Answers were compared to actual child BMI percentile category via chi-square analysis. Logistic regression analysis was performed to assess predictors of accurate perception of child BMI percentile category. RESULTS: More than one third of preschoolers were either overweight (18.4%) or obese (16.5%). The majority (92%) of caregivers of an overweight/obese child inaccurately perceived that their child was in a normal BMI category. Overall, foreign-born caregivers were significantly less likely to accurately perceive their child's BMI percentile category versus U.S.-born caregivers (odds ratio [OR] = 0.65, 95% confidence interval [CI] = 0.48-0.88). Specifically, those born in South America (OR = 0.59, 95% CI = 0.36-0.98), Central America/Mexico (OR = 0.59, 95% CI = 0.41-0.85), and Caribbean Hispanic nations (OR = 0.54, 95% CI = 0.35-0.83) were significantly less likely to accurately perceive their child's BMI category versus U.S.-born caregivers. CONCLUSIONS: The results of this study suggest that foreign-born caregivers of U.S. preschool-age overweight/obese children in particular do not accurately perceive their child's BMI status. Health care professionals serving foreign-born caregivers may consider additional culturally appropriate healthy weight counseling for these families.

Habilidade de comunicação intencional de bebês: o que pensam as mães? / Babies' intentional communication ability: what the mothers think?

Este estudo investigou as percepções maternas acerca da habilidade comunicativa intencional infantil. Pesquisas destacam o impacto dessas percepções nas interações estabelecidas entre mãe e bebê e suas repercussões no desenvolvimento da linguagem e da cognição social infantil. Participaram do estudo 40 mães de bebês de 4 e 9 meses. Os resultados mostram variações nas percepções maternas quanto às habilidades de comunicação intencional dos bebês. Os relatos maternos sobre os bebês de 9 meses evidenciam o uso de recursos comunicativos intencionais expressos por vocalizações, alternância do olhar, e gesto de apontar. Discutem-se as implicações dessas percepções nas interações adulto-bebê, no desenvolvimento sociocomunicativo infantil e em contextos de desenvolvimento e educação infantil.(AU)

This study investigated maternal perceptions of infant intentional communicative ability. Researchs highlight the impact of these perceptions on the interactions established between mother and baby and their repercussions on language development and infant social cognition. The study included 40 mothers of babies aged 4 and 9 months. The results show variations in maternal perceptions about infants' intentional communicative abilities. Maternal reports about babies 9 months demonstrate the use of intentional communicative resources expressed by vocalizations, gaze alternation and pointing gesture. We discuss the implications of these perceptions in adult-child interactions, in child sociocomunicativo development and in contexts of child development and education.(AU)

Habilidade de comunicação intencional de bebês: o que pensam as mães? / Babies' intentional communication ability: what the mothers think?

Este estudo investigou as percepções maternas acerca da habilidade comunicativa intencional infantil. Pesquisas destacam o impacto dessas percepções nas interações estabelecidas entre mãe e bebê e suas repercussões no desenvolvimento da linguagem e da cognição social infantil. Participaram do estudo 40 mães de bebês de 4 e 9 meses. Os resultados mostram variações nas percepções maternas quanto às habilidades de comunicação intencional dos bebês. Os relatos maternos sobre os bebês de 9 meses evidenciam o uso de recursos comunicativos intencionais expressos por vocalizações, alternância do olhar, e gesto de apontar. Discutem-se as implicações dessas percepções nas interações adulto-bebê, no desenvolvimento sociocomunicativo infantil e em contextos de desenvolvimento e educação infantil...

This study investigated maternal perceptions of infant intentional communicative ability. Researchs highlight the impact of these perceptions on the interactions established between mother and baby and their repercussions on language development and infant social cognition. The study included 40 mothers of babies aged 4 and 9 months. The results show variations in maternal perceptions about infants' intentional communicative abilities. Maternal reports about babies 9 months demonstrate the use of intentional communicative resources expressed by vocalizations, gaze alternation and pointing gesture. We discuss the implications of these perceptions in adult-child interactions, in child sociocomunicativo development and in contexts of child development and education...

How much does your baby cry?: Expectations, patterns and perceptions of infant crying in Mexico

Background: A limited number of studies have examined infant crying patterns in less affluent societies, but none of them have been longitudinal in nature. The aim of this study was to describe reported infant crying patterns in a cohort of Mexican infants and examine how these are associated with crying-related maternal expectations, general perceptions and help-seeking behavior. Methods: Observational cohort study, 204 primiparous mothers and their infants, recruited at birth and visited in their homes at nine different time points from 1 to 24 weeks of infant age. Results: Mothers reported that their infants cried less than infants in other more affluent societies, although not less frequently. A previously reported evening clustering of crying was present, with a subtle 24-h crying peak emerging around 2 to 4 weeks. Having an expectation of an infant who will be difficult to soothe and/or an increased report of crying frequency were associated with perceptions of maternal anguish, which was associated with maternal concern and help-seeking behaviors related to crying. Conclusions: Similarities and differences were found in the crying patterns reported by mothers of Mexican infants and others previously studied. Expectations and reports of crying behavior were associated with maternal perceptions, which may have a role in reducing crying-related anguish and demand on health services.

How much does your baby cry? Expectations, patterns and perceptions of infant crying in Mexico.

BACKGROUND: A limited number of studies have examined infant crying patterns in less affluent societies, but none of them have been longitudinal in nature. The aim of this study was to describe reported infant crying patterns in a cohort of Mexican infants and examine how these are associated with crying-related maternal expectations, general perceptions and help-seeking behavior. METHODS: Observational cohort study, 204 primiparous mothers and their infants, recruited at birth and visited in their homes at nine different time points from 1 to 24 weeks of infant age. RESULTS: Mothers reported that their infants cried less than infants in other more affluent societies, although not less frequently. A previously reported evening clustering of crying was present, with a subtle 24-h crying peak emerging around 2 to 4 weeks. Having an expectation of an infant who will be difficult to soothe and/or an increased report of crying frequency were associated with perceptions of maternal anguish, which was associated with maternal concern and help-seeking behaviors related to crying. CONCLUSIONS: Similarities and differences were found in the crying patterns reported by mothers of Mexican infants and others previously studied. Expectations and reports of crying behavior were associated with maternal perceptions, which may have a role in reducing crying-related anguish and demand on health services.

Mãe, quero ficar contigo...: comportamentos de dependência do primogênito no contexto de gestação de um irmão / Mum, I want to stay with you...: firstborn's dependence behaviours in the context of a sibling's gestation

O estudo investigou os comportamentos de dependência do primogênito no contexto de gestação de um segundo filho. Participaram cinco primogênitos em idade pré-escolar e suas respectivas mães, no terceiro trimestre de gestação. Foi aplicado Teste das Fábulas nas crianças e realizadas entrevistas semi-dirigidas com as mães. Os resultados revelaram tendência de comportamento de dependência do primogênito. Observaram-se também comportamentos de independência, indicando ambivalência. Os resultados sugerem que a gestação do irmão constitui-se momento especial para a criança que tem que deixar de ser filho único e aprender a compartilhar os cuidados maternos. A investigação acerca das mudanças nas relações familiares e suas implicações para cada um dos membros são de fundamental importância para a compreensão do desenvolvimento humano. Este artigo contribui para a literatura existente que não tem contemplado especificamente em que medida o comportamento do primogênito é afetado pela existência de um irmão durante a gestação.

The study investigated the firstborn's dependence behaviors in the context of a second child's pregnancy. Five preschool firstborns and their respective mothers, in the third trimester of pregnancy, took part in the study. The Fables Test was used in order to assess children's perceptions, and a semi-structured interview in order to investigate mothers' perceptions. The results revealed a dependence behavior tendency in the firstborn. There were also independence behaviors suggesting ambivalence. The results indicate that a second child's pregnancy is a special moment for the firstborn who is no longer an only child and has to learn to share maternal care. The investigation concerning changes in family relationships and their implications for each family member are of fundamental importance for understanding human development. This article represents a contribution to the literature which has not studied the extent to which the firstborn's behavior is affected by the presence of a sibling already during pregnancy.