Within-individual relationships between mother-to-infant bonding and postpartum depressive symptoms: a longitudinal study.

BACKGROUND: Although the importance of the dynamic intra-individual relationship between mother-to-infant bonding and postpartum depressive symptoms has been widely recognized, the complex interplay between them is not well understood. Furthermore, the potential role of prenatal depressive symptoms and infant temperament in this relationship remains unclear. This study aims to examine the bidirectional influence of mother-to-infant bonding on postpartum depressive symptoms within individuals and to elucidate whether prenatal depressive symptoms and infant temperament would influence deviations from stable individual states. METHODS: Longitudinal data were collected from 433 women in early pregnancy. Of these, 360 participants completed the main questionnaires measuring impaired mother-to-infant bonding and postpartum depressive symptoms at least once during the postpartum period. Data were collected at early and late pregnancy and several postpartum time points: shortly after birth and at one, four, ten, and 18 months postpartum. We also assessed prenatal depressive symptoms and infant temperament. A random-intercept cross-lagged panel model was used. RESULTS: Within-individual variability in mother-to-infant bonding, especially anger and rejection, significantly predicted subsequent postpartum depressive symptoms. However, the inverse relationship was not significant. Additionally, prenatal depressive symptoms and difficult infant temperament were associated with greater within-individual variability in impaired mother-to-infant bonding and postpartum depressive symptoms. CONCLUSIONS: The present study demonstrated that the within-individual relationship between mother-to-infant bonding and postpartum depressive symptoms is likely non-bidirectional. The significance of the findings is underscored by the potential for interventions aimed at improving mother-to-infant bonding to alleviate postpartum depressive symptoms, suggesting avenues for future research and practice.

The CARING study: Examining biological, behavioral, and genetic mechanisms in the intergenerational transmission of toxic stress.

When children experience extreme or persistent stressors (e.g., maltreatment, housing insecurity, intimate partner violence), prolonged elevation of the stress-response system can lead to disrupted development of multiple physiological systems. This response, known as toxic stress, is associated with poor physical and mental health across the life course. Emerging evidence suggests that the effects of toxic stress may be transmitted through generations, but the biological and behavioral mechanisms that link caregivers' childhood history with the health of the children they care for remain poorly understood. The purpose of this report is to describe the research protocol for The CARING (Childhood Adversity and Resilience In the Next Generation) Study, a cross-sectional study of caregivers with children aged 3-5 years designed to (1) examine the intergenerational transmission of toxic stress and protective factors; (2) explore three hypothesized pathways of transmission: parenting, daily routines, stressors, and supports; and (3) explore the extent to which genotypic variation in candidate genes related to caregiving and stress contribute to caregivers' and children's susceptibility to the effects of early childhood experiences (i.e., gene × environment interactions). We expect that findings from this study will provide critical data needed to identify targets for precision health interventions, reduce health disparities related to toxic stress, and prevent cycles of adversity among families at risk.

Social support buffers the impact of pregnancy stress on perceptions of parent-infant closeness during the COVID-19 pandemic.

Pregnant individuals and parents have experienced elevated mental health problems and stress during COVID-19. Stress during pregnancy can be harmful to the fetus and detrimental to the parent-child relationship. However, social support is known to act as a protective factor, buffering against the adverse effects of stress. The present study examined whether (1) prenatal stress during COVID-19 was associated with parent-infant closeness at 6 months postpartum, and (2) social support moderated the effect of prenatal stress on the parent-infant relationship. In total, 181 participants completed questionnaires during pregnancy and at 6 months postpartum. A hierarchical linear regression analysis was conducted to assess whether social support moderated the effect of stress during pregnancy on parent-infant closeness at 6 months postpartum. Results indicated a significant interaction between prenatal stress and social support on parents' perceptions of closeness with their infants at 6 months postpartum (ß = .805, p = .029); parents who experienced high prenatal stress with high social support reported greater parent-infant closeness, compared to those who reported high levels of stress and low social support. Findings underscore the importance of social support in protecting the parent-infant relationship, particularly in times of high stress, such as during the COVID-19 pandemic.

Individuos y progenitores en estado de embarazo experimentan elevados problemas de salud mental y estrés durante el COVID­19. El estrés durante el embarazo puede ser dañino para el feto y perjudicial para la relación progenitor­niño. Sin embargo, es sabido que el apoyo social actúa como un factor de protección, sirviendo como agente amortiguador contra los adversos efectos del estrés. El presente estudio longitudinal examinó si 1) el estrés prenatal durante el COVID­19 se asociaba con la cercanía madre­infante a los seis meses después del parto, y 2) el apoyo social moderaba el efecto del estrés prenatal en la relación madre­infante. Un total de 181 participantes completaron cuestionarios durante el embarazo y a los seis meses después del parto. Un análisis de regresión lineal jerárquico se llevó a cabo para evaluar si el apoyo social moderaba el efecto del estrés durante el embarazo en cuanto a la cercanía progenitor­infante a los seis meses después del parto. Los resultados indicaron una interacción significativa entre el estrés prenatal y el apoyo social sobre las percepciones que los progenitores tenían de la cercanía con sus infantes a los seis meses después del parto (ß = .805, p = .029); los progenitores que experimentaron un alto estrés prenatal con un alto apoyo social reportaron una mayor cercanía progenitor­infante, comparados con aquellos que reportaron altos niveles de estrés y bajo apoyo social. Los resultados subrayan la importancia del apoyo social para proteger la relación progenitor­infante, particularmente en épocas de alto estés, tal como durante la pandemia del COVID­19.

Les personnes enceintes et les parents font l'expérience de plus grands problèmes de santé mentale et de plus de stress durant la crise du COVID­19. Le stress durant la grossesse peut être néfaste pour le foetus et vient au détriment de la relation parent­enfant. Cependant l'on sait que le soutien social est un facteur de protection, faisant tampon face aux effets adverses du stress. Cette étude longitudinale a examiné si 1) le stress prénatal durant le COVID­19 était lié à la proximité mère­nourrisson à six mois postpartum, et 2) le soutien social a modéré l'effet du stress prénatale sur la relation mère­nourrisson. En tout 181 participants ont rempli des questionnaires durant la grossesse et à sic mois postpartum. Une analyse de régression linéaire hiérarchique a été faite pour évaluer si le soutien social a modéré l'effet du stress durant la grossesse sur la proximité parent­nourrisson à six mois postpartum. Les résultats ont indiqué une interaction importante entre le stress prénatal et le soutien social sur les perceptions des parents de la proximité avec leurs nourrissons à six mois postpartum (ß = ,805, p = ,029); les parents qui ont fait l'expérience d'un stress prénatal élevé avec un soutien social élevé ont signalé une plus grande proximité parent­nourrisson, comparé à ceux ayant signalé des niveaux de stress élevés et un faible soutien social. Les résultats soulignent l'importance du soutien social dans la protection de la relation parent­nourrisson, particulièrement en temps de stress élevé, comme durant la pandémie de COVID­19.

Associations between maternal postpartum depression and infant temperament in treatment-seeking mothers prior to and during the COVID-19 pandemic.

It remains unclear how the COVID-19 pandemic has affected the mother-infant relationship and associations between maternal postpartum depression (PPD) and offspring temperament. This study examined the impact of the pandemic on these links and how maternal ratings of the mother-infant relationship mediated associations between PPD and infant temperament in a sample of treatment-seeking mothers in Ontario, Canada before and during the COVID-19 pandemic. Mothers with infants <12 months of age and Edinburgh Postnatal Depression Scale scores ≥10 enrolled in two separate randomized controlled trials of 1-day cognitive behavioral therapy-based workshops for PPD conducted before COVID-19 (n = 392) and during the pandemic (n = 403). Mothers reported on depressive symptomatology, infant temperament, and the mother-infant relationship. Maternal PPD was associated with more infant negative affectivity and mother-infant relationship difficulties. While associations between PPD and infant-focused anxiety were stronger during COVID-19, the pandemic did not otherwise affect associations between PPD and infant temperament. Mediation analyses suggested that aspects of the mother-infant relationship mediated associations between PPD and infant negative affectivity. Findings highlight the importance of detecting PPD and intervening to potentially improve outcomes for mothers and their children.

Maternal Knowledge of Oral Health During Pregnancy and Childbirth.

OBJECTIVE: This cohort study was to investigate maternal knowledge of the oral health of woman and children during pregnancy and after childbirth, and the associated factors. METHODS: Groups of women participating in a public prenatal dental care programme in Brazil were assessed, in two different stages. In the first stage, pregnant women were assessed for their own oral health. In the second stage, after childbirth, women were assessed for the oral health of their child. The examiner assigned a maternal knowledge score to the questionnaires, considering the ideal alternatives within the context of oral health promotion as correct answers. Statistical analysis included the Kruskal-Wallis and multiple linear regression tests, considering a level of significance of P < 0.05. RESULTS: Ninety-eight women were included in the study, with a mean age 26.27 years (SD 6.51). In the regression analysis, the maternal knowledge score was associated with the presence of myths about oral health (P < 0.01), the children first dental appointment in the first year of life (P = 0.07), the presence of a non-nutritious sucking habit (P < 0.01), considering dental treatment to be important during pregnancy (P < 0.01), and having been instructed on oral health during pregnancy (P < 0.01) and after the children birth (P = 0.02). CONCLUSION: This study suggests that the women showed a regular score of knowledge about their oral health and that of their children, as they still believed in some myths about oral health and the risks of dental treatment during pregnancy. Women who received guidance on oral health in pregnancy and after birth showed higher knowledge of their oral health and that of their children, demonstrating the importance of carrying out health promotion actions during pregnancy and the first years of the child's life.

Mothers' and Children's Mental Health During the COVID-19 Pandemic Lockdown: The Mediating Role of Parenting Stress.

The present study, carried out during the first peak of the COVID-19 outbreak in Italy, aimed at investigating the mental health of mothers and children during the nationwide lockdown. More specifically, the study investigated children's depression and mothers' individual distress and parenting stress, in comparison with normative samples. The mediating effect of mothers' parenting stress on the relationship between mothers' individual distress and children's depression was also explored. Finally, the study analyzed whether children's biological sex and age moderated the structural paths of the proposed model. A sample of 206 Italian mothers and their children completed an online survey. Mothers were administered self-report questionnaires investigating individual distress and parenting stress; children completed a standardized measure of depression. Mothers' individual distress and parenting stress and children's depression were higher than those recorded for the normative samples. Mothers' parenting stress was found to mediate the association between mothers' individual distress and children's depression. With respect to children, neither biological sex nor age emerged as significant moderators of this association, highlighting that the proposed model was robust and invariant. During the current and future pandemics, public health services should support parents-and particularly mothers-in reducing individual distress and parenting stress, as these are associated with children's depression.

Assessing mother-infant bonding: reliability of the recorded interaction task.

OBJECTIVE: This study examined the intra- and inter-rater reliability of the Recorded Interaction Task (RIT); a novel tool to assess mother-infant bonding via observational methods. BACKGROUND: Mother-infant bonding describes the reciprocal early emotional connection between mother and infant. Whilst various tools exist to assess mother-infant bonding, many incorrectly confuse this construct with mother-infant attachment. Further, available tools are limited to those that employ self-report methods, thus may reflect perceived behaviour, rather than actual behaviour. The RIT is a novel tool for observational assessment of mother-infant bonding. A standard interaction between mother and infant is recorded, and later assessed against specified bonding-related behaviours. Before its use in research, reliability testing must be undertaken to ensure the RIT may be used consistently. METHODS: The RIT was administered to 15 mother-infant dyads. Participant recordings were assessed by three trained raters at two time points, using the RIT observation scoring sheet. Intra-rater reliability was determined by comparing scores at each time point for each rater. Inter-rater reliability was determined by assessing reliability of scores at the first time point. RESULTS: Strong intra-rater reliability (ICC >0.86) and fair inter-rater reliability (ICC = 0.55) were observed. CONCLUSION: The current findings support the RIT's potential to reliably assess mother-infant bonding.

"A service we know was missing": bridging the gap between referral to admission for women with moderate-severe perinatal mental health disorders at an Australian psychiatric mother-baby unit.

OBJECTIVES: Service demand at Australian psychiatric mother-baby units is high. This project aimed to test a model of care providing step up/step down support to women with moderate-severe perinatal mental health disorders awaiting hospital admission. METHOD: A multi-disciplinary team was convened to provide pre-admission assessment and support to women waiting for admission, as well as post-discharge support as needed. RESULTS: 108 referrals were managed between April - November 2021. With appropriate assessment and/or support in place, half of the women referred (n = 54/108) were removed from the waitlist and avoided hospital admission. Service capacity indicators suggest a positive impact on referral numbers managed each week, as well as admissions per month. CONCLUSION: The tested model of care appears to have successfully improved service capacity; however longer term data is recommended to determine the sustainability of the trend towards increased capacity, and the acceptability of the model of care from a consumer perspective.

Processing of infant emotion in mothers with mood disorders and implications for infant development.

BACKGROUND: Atypical neurocognitive responses to emotional stimuli are core features of unipolar depression (UD) and bipolar disorder (BD). For mothers with these mood disorders, this may influence interactions with their infants and consequently infant development. The study aimed to investigate psychophysiological and cognitive responses to infant emotional stimuli, and their relation to mother-infant interaction and infant development, in mothers with BD or UD in full or partial remission. METHODS: Four months after birth, mothers' cognitive responses to emotional infant stimuli were assessed with computerized tasks, while their facial expressions, galvanic skin responses (GSR), gazes, and fixations were recorded. Infant development and mother-infant interactions were also assessed. RESULTS: We included 76 mothers: 27 with BD, 13 with UD, and 36 without known psychiatric disorders, and their infants. Mothers with BD and UD were in full or partial remission and showed blunted GSR and spent less time looking at infant stimuli (unadjusted p values < 0.03). Mothers with BD showed subtle positive neurocognitive biases (unadjusted p values<0.04) and mothers with UD showed negative biases (unadjusted p values < 0.02). Across all mothers, some measures of atypical infant emotion processing correlated with some measures of delays in infant development and suboptimal mother-infant interaction (unadjusted p values<0.04). CONCLUSIONS: Mothers with mood disorders in full or partial remission showed atypical cognitive and psychophysiological response to emotional infant stimuli, which could be associated with mother-infant interactions and infant development. The study is explorative, hypothesis generating, and should be replicated in a larger sample. Investigation of the long-term implications of reduced maternal sensitivity is warranted.

Mother-infant interactions with infants with congenital visual impairment and associations with longitudinal outcomes in cognition and language.

BACKGROUND: This study investigated mother-infant interactions, including maternal maintaining of infant attentional focus and sensitivity, with infants with congenital severe and profound visual impairment (VI) and the association with developmental trajectories from one to three years. METHOD: Fifty-five infants and mothers were video-recorded playing together with a standard set of toys at Time 1 (T1) mean age 12.95 months (8.13-17.05 months). Maintain was categorized as the mother following and maintaining the child's focus, and Sensitivity, the mother's responsiveness and contingency to infant behaviour. Vision level was measured using the Near Detection Scale. Cognition and language were measured at T1, 12 months later (T2) and 24 months later (T3) using the Reynell-Zinkin Scales. RESULTS: Cross-sectional analyses showed that mothers of infants with severe VI (basic form vision) produced higher rates of Maintain compared to those with children with profound VI (light perception at best). Linear mixed-effects models examining developmental progression from T1 to T3 (controlling for vision level) showed an average increase of 5 DQ points (CI 95%: 1.03-9.08) in verbal comprehension for higher Sensitivity. No significant findings were found for Maintain. CONCLUSIONS: The findings suggest that mother-infant interactions (maternal Maintain) are associated with level of vision at infancy, but only maternal Sensitivity has a long-term positive association with advances in verbal comprehension from infancy to about three years. They highlight the need for incorporating strategies related to parent-infant interactions, including increased sensitivity, into early intervention for children with visual impairment.

Interactive association of maternal education and peer relationship with oppositional defiant disorder: an observational study.

BACKGROUND: The objectives of this research were to gain insights on the interactive effects, by measuring familial and peer-related risk factors in youths with oppositional defiant disorder (ODD). METHODS: Participants were college students recruited nationwide, with age between 18 and 25. Through the consensus of expert meetings, a set of questionnaires were used to evaluate the familial status, participant's peer group conditions, high-risk environment of illicit substance use, and oppositional symptoms. The logistic regression was performed to see the independent and interactive risk factors for ODD. RESULTS: A total of 981 subjects were enrolled. Six variables significantly associated with ODD at the multivariate logistic regression, including male, night division, poor academic performance, high risk environment, peer with illicit substance use and high maternal education level. High maternal education exerted independent protective effect on the development of ODD (adjusted odds ratio, aOR = 0.65, 95% CI = 0.44-0.99). Peer with illicit substance use was more likely to associate with ODD in the low maternal education group. The 2-way interactive effect of maternal education and peer with substance use on the development of ODD was OR = 4.96 (2.96, 8.31). CONCLUSION: The present study highlights the influence of maternal education level to ODD and its interaction with peer of illicit substance use. Our findings imply that the familial attachment and peer interaction are essential stages for the development of human behavior. TRIAL REGISTRATION: The research protocol was reviewed and approved by the ethical review committee of National Taiwan University Hospital (number 201505057RINC ) and registered at clinical trial systems at National Taiwan University. In addition, subjects' information was anonymous and de-identified prior to any analysis.

Perinatal depression screening in Australia: A position paper.

Perinatal depression can have enduring adverse effects on women and their children and families, incurring substantial ongoing economic and personal costs. A significant proportion of the cost of perinatal depression relates to adverse impacts on the child, most likely mediated through impairment to the mother-infant relationship. In recognition of this problem, Australia has invested in routine perinatal depression screening. Our previous research produced convergent findings suggesting that expected benefits for children have not yet been realised through perinatal depression screening. We question the potential of including a measure of personality in current perinatal depression screening for identifying maternal mental health problems and suboptimal mother-infant relationships. This paper reviews our previous research findings within the broader context of perinatal depression screening. We propose a position, that perinatal depression screening in Australia should be redesigned to more precisely detect vulnerable mother-infant relationships, parenting, maternal mental health, and infant psychosocial and psychological development. Practice change to appropriately target antenatal interventions may more efficiently improve both maternal and child outcomes, thereby contributing to greater efficiency and cost savings for the health system.

When a common language is missing: Nurse-mother communication in the NICU. A qualitative study.

AIMS AND OBJECTIVES: To explore how communication in neonatal intensive care units (NICUs) between immigrant mothers and nurses take place without having a common language, and how these mothers experience their NICU stay. BACKGROUND: Admission of infants to NICU affects both parents and infants. Immigrant mothers constitute a vulnerable hospital population in need of culturally, linguistically and individually tailored information. DESIGN AND METHODS: The study had a qualitative design reported according to the COREQ criteria. Eight mothers who spoke neither Scandinavian nor English went through individual semi-structured interviews. Six mother-nurse interactions were observed, and eight nurses' experiences were explored through focus-group interviews. All interviews were audio recorded and transcribed verbatim. The analysis was thematic and hermeneutic in character. RESULTS: Interpreters were present during the consultations with the physicians, but rarely during the daily nurse-mother interactions. Nurses focused on daily routines, infant care guidance and mother-infant attachment. The mothers learned through demonstrations and hands-on guidance. Language barriers made it difficult to assess the mothers' understanding, but the mothers expressed that they felt adequately included in the care of their infant and well informed and guided. Even so, both mothers and nurses expressed desire to use interpreters more regularly. The pictorial communication boards available lacked important vocabulary needed in neonatal nursing contexts and their use furthermore interrupted the mother-nurse conversation. CONCLUSION: Body language, simple words, guesswork, trial and error characterised the nurse-mother interaction. The nurses adopted various communication strategies to help the mothers understand and give them a voice. Competent interpreters were used during meetings with physicians, but not during daily bedside guidance and information giving by nurses. RELEVANCE TO CLINICAL PRACTICE: Knowledge of immigrant mothers' and nurses' communication strategies and how both parties think, feel and act to overcome communication problem is necessary to improve clinical practice and reduce communication barriers.

Maternal mental health modifies the association of food insecurity and early child development.

We examined the association between household food insecurity and early child development and whether or not maternal depression and anxiety modifies this association. The cross-sectional study included 468 mother-infant pairs recruited at primary health centers of the Federal District, Brazil. Mothers answered a questionnaire that evaluated early child development (outcome), household food insecurity (independent variable), maternal depression and trait anxiety (effect modifiers). Variables were collected with validated questionnaires for the Brazilian population. Pearson's χ2 test and logistic regression analyses were conducted. Infants who lived in a moderate or severe food insecure household had 2.52 times (95% confidence interval [CI] [1.13, 5.65]) the odds of having early child development delays compared with infants in secure households. Maternal depression and anxiety modified the strength of association between household food insecurity and early child development, which is an innovative finding. Among infants with depressed mothers, those experiencing mild (adjusted odds ratio [aOR] 3.33, 95% CI [1.17, 9.46]) and moderate/severe household food insecurity (aOR 10.13, 95% CI [2.18, 47.10]) had higher odds of having early child development delays, compared with infants in food secure households. Among infants with both anxious and depressed mothers, these associations were even stronger for mild (aOR 4.69, 95% CI [1.41, 15.59]) and moderate/severe household food insecurity (aOR 16.07, 95% CI [2.70, 95.66]). In conclusion, household food insecurity is a risk factor for early child development delays, and this association is modified by maternal depression and anxiety. Future studies should evaluate the impact of intervention packages that address maternal depression and anxiety and household food insecurity on preventing early child development delays.

The Effectiveness of an App-Based Nurse-Moderated Program for New Mothers With Depression and Parenting Problems (eMums Plus): Pragmatic Randomized Controlled Trial.

BACKGROUND: Postnatal depression and caregiving difficulties adversely affect mothers, infants, and later childhood development. In many countries, resources to help mothers and infants are limited. Online group-based nurse-led interventions have the potential to help address this problem by providing large numbers of mothers with access to professional and peer support during the postnatal period. OBJECTIVE: This study tested the effectiveness of a 4-month online group-based nurse-led intervention delivered when infants were aged 2 to 6 months as compared with standard care outcomes. METHODS: The study was a block randomized control trial. Mothers were recruited at the time they were contacted for the postnatal health check offered to all mothers in South Australia. Those who agreed to participate were randomly assigned to the intervention or standard care. The overall response rate was 63.3% (133/210). Primary outcomes were the level of maternal depressive symptoms assessed with the Edinburgh Postnatal Depression Scale (EPDS) and quality of maternal caregiving assessed using the Parenting Stress Index (PSI; competence and attachment subscales), the Parenting Sense of Competence Scale (PSCS), and the Nursing Child Assessment Satellite Training Scale. Assessments were completed at baseline (mean child age 4.9 weeks [SD 1.4]) and again when infants were aged 8 and 12 months. RESULTS: Outcomes were evaluated using linear generalized estimating equations adjusting for postrandomization group differences in demographic characteristics and the outcome score at baseline. There were no significant differences in the intervention and standard care groups in scores on the PSI competence subscale (P=.69) nor in the PSCS (P=.11). Although the group by time interaction suggested there were differences over time between the EPDS and PSI attachment subscale scores in the intervention and standard care groups (P=.001 and P=.04, respectively), these arose largely because the intervention group had stable scores over time whereas the standard care group showed some improvements between baseline and 12 months. Mothers engaged well with the intervention with at least 60% (43/72) of mothers logging-in once per week during the first 11 weeks of the intervention. The majority of mothers also rated the intervention as helpful and user-friendly. CONCLUSIONS: Mothers reported that the intervention was helpful, and the app was described as easy to use. As such, it appears that support for mothers during the postnatal period, provided using mobile phone technology, has the potential to be an important addition to existing services. Possible explanations for the lack of differences in outcomes for the 2 groups in this study are the failure of many mothers to use key components of the intervention and residual differences between the intervention and standard care groups post randomization. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12616001732471; http://www.ANZCTR.org.au/ACTRN12616001732471.aspx (archived on WebCite as http://www.webcitation.org/77zo30GDw).

Is the caregivers' oral health related to dental caries in children or adolescents? A systematic review.

OBJECTIVES: This systematic review aimed to evaluate evidence on the relation between the caregivers' oral health condition and dental caries prevalence in their offspring. MATERIALS AND METHODS: Scientific literature was searched in PubMed, Scopus, LILACS, Web of Science, the Cochrane Library databases, and Grey Literature. Observational studies were included if mentioning oral health conditions in caregivers and dental caries in offsprings. The internal validity of the selected articles was judged by two evaluators according to a previously published guideline based on eight questions (1 point each). Studies included were divided into low methodological quality (1-3 points), moderate (4-6 points), or high (7-8 points) according to the quality assessment. The GRADE approach was used to assess the quality of evidence provided by the selected studies. RESULTS: Initially, 12.458 records were recovered, of which 54 full-text articles were evaluated. Hand search added 5 records, but after application of the exclusion criteria, only 16 articles which met the adopted eligibility criteria remained. Critical assessment scored one study as low, 10 moderate, and 5 with high validity. Most of the studies plotted correlations between the variables (12) while 4 studies compared DMFT (3) or ICDAS (1) scores between caries-active/caries-free children with caries experience in caregivers. Regarding the main study question, 15 studies (93.7%), containing 5704 caregivers and 5467 children/adolescents, found a significant relationship between mothers/caregivers and children's/adolescents' caries prevalence; one study found this relationship only for individuals showing active caries and one study did not disclose any relationship between caries prevalence in caregivers-children's/adolescents' pairs. The overall evidence was, however, qualified as low due to problems in the imprecision of the included studies. CONCLUSIONS: Caregivers' oral health may be considered as an important risk marker in children's and adolescent's caries prevalence. CLINICAL RELEVANCE: Assuming the contribution of caregivers' oral health conditions on dental caries in their offspring may help to establish control measures for such prevalent disease in the family environment.

The link between child temperament and low-income mothers' and fathers' parenting.

Numerous studies have shown that children's temperamental characteristics impact the quality and quantity of parent-child interactions. However, these studies have largely focused on middle-class samples, have not compared multiple domains of parenting across mothers and fathers, and have not considered the possibility of nonlinear associations between temperament and parenting. The present study addresses these gaps by examining the potentially nonlinear role of two temperamental characteristics-negative emotionality and sociability-in predicting the quality and quantity of low-income mothers' and fathers' parenting. Data were drawn from the Early Head Start Research and Evaluation Project, a study of low-income children and families. Results indicated that whereas parenting quality was somewhat impaired when children were temperamentally vulnerable (low sociability, high negativity), parents increased parenting quantity with the same vulnerable children. There was some evidence that parents were most reactive to children who scored either very high or very low on negative emotionality and sociability in both parenting domains. Patterns also suggest that mothers were more reactive to sociability, and fathers to negative emotionality.

Numerosos estudios han mostrado que las características del temperamento de los niños tienen un impacto sobre la calidad y cantidad de interacciones entre progenitor y niño. Sin embargo, estos estudios se han enfocado por la mayor parte en grupos muestras de clase media, no han comparado múltiples dominios de crianza que incluyan tanto a las mamás como a los papás, y no han considerado la posibilidad de asociaciones no lineales entre el temperamento y la crianza. El presente estudio trata estos vacíos al examinar el potencialmente no lineal papel de dos características del temperamento - la negativa emocionalidad y sociabilidad - para predecir la calidad y cantidad de interacciones de crianza de mamás y papás de bajos recursos económicos. Los datos se obtuvieron del Proyecto de Investigación y Evaluación de Comienzo Temprano (Early Head Start - EHS), un estudio de niños y familias de bajos recursos económicos. Los resultados indicaron que mientras que la calidad de la crianza se vio de alguna manera afectada cuando los niños eran temperamentalmente vulnerables (baja sociabilidad, alta negatividad), los progenitores aumentaron la cantidad de las interacciones en la crianza con los mismos niños vulnerables. Se dio alguna evidencia de que los progenitores reaccionaban más con los niños cuyos puntajes eran muy altos o muy bajos en la negativa emocionalidad y sociabilidad en ambos dominios de la crianza. Los patrones también sugieren que las mamás reaccionaron más en cuanto a la sociabilidad y los papás a la negativa emocionalidad.

De nombreuses études ont montré que les caractéristiques du tempérament des enfants impactent la qualité et la quantité des interactions parent-enfant. Cependant, ces études ont largement porté sur des échantillons de classes moyennes, et n'ont pas comparé de multiples domaines de parentage entre les mères et les pères, et n'ont pas non plus considéré la possibilités d'associations non-linéaires entre le tempérament et le parentage. Cette étude aborde ces fossés en examinant le rôle potentiellement non-linéaire de deux caractéristiques du tempérament - l'émotivité négative et la sociabilité - en prédisant la qualité et la quantité de parentage de mères et de pères issus de milieux socioéconomiques défavorisés. Les données ont été tirées du Projet de Recherche et d'Evaluation du programme américain de Early Head Start (EHS), une étude d'enfants et de familles de milieux socioéconomiques défavorisés. Les résultats ont indiqué qu'alors que la qualité de parentage était plus ou moins dépréciée lorsque les enfants étaient vulnérables d'un point de vue du tempérament (sociabilité faible, négativité élevée), les parents augmentaient la quantité de parentage avec les mêmes enfants vulnérables. On a pu établir que les parents étaient plus réactifs envers les enfants ayant des scores soit très élevés soit très bas pour ce qui concerne l'émotivité négative et la sociabilité dans les deux domaines de parentage. Les patterns suggèrent aussi que les mères étaient plus réactives à la sociabilité et les pères à l'émotivité négative.

Is Mastery Motivation a Mediator of Relations between Maternal Teaching Behavior and Developmental Abilities in Children with Global Developmental Delay?

Aims: Mastery motivation refers to a child's persistent attempts to solve problems and learn skills. The purpose of this longitudinal study was to examine whether children's mastery motivation-mediated relationships between early maternal teaching behavior and later developmental abilities in children with global developmental delay (GDD). Methods: Fifty-six dyads of mothers and their children with GDD (aged 24-42 months) were assessed two times, at study entry and 6-months later. Maternal teaching behaviors were assessed using the Nursing Child Assessment Teaching Scale. Children's developmental abilities and mastery motivation were measured using the Comprehensive Developmental Inventory for Infants and Toddlers and the revised Individualized Moderately Challenging Mastery Tasks, respectively. A Pearson correlation matrix was used to propose hypothetical models, and path analysis was used to examine the mediation effect. Results: Mastery motivation significantly mediated the relationship between maternal teaching behavior and children's cognitive, fine motor, and gross motor abilities 6 months later. Conclusions: Mothers' teaching predicted their children's development directly and also indirectly through the child's mastery motivation. The findings support the importance of the quality of mothers teaching behaviors and the mastery motivation of children with GDD on development.

Prolonged Breastfeeding and Dental Caries In Children In the Third Year of Life.

PURPOSE: To assess the association between long-term breastfeeding and dental caries in children during the third year of life. STUDY DESIGN: This retrospective longitudinal study consisted of children who were followed-up by the Maternal and Child Public Oral Health Program. Information regarding socio-economic class, demographic status, daily frequency of sucrose intake, breastfeeding duration and oral hygiene were collected with the aid of a questionnaire. Information on dental caries in the children was collected from dental records. Negative binomial regression models were used to assess the association between breastfeeding duration and dental caries. RESULTS: We included a total of 325 children in the study. The incidence of dental caries was found to be 12.92%. Even after adjustments, children who were breastfed for a period ≥24 months were more likely to have dental caries, when compared with children who were not breastfed or were breastfed for less than 6 months. Children who had a higher frequency of sucrose intake and those with dental plaque were more likely to have dental caries. CONCLUSION: In this study, a greater incidence of dental caries was found in children who were breastfed for a period ≥ 24 months..

Study protocol: intervention in maternal perception of preschoolers' weight among Mexican and Mexican-American mothers.

BACKGROUND: Childhood obesity is a public health issue negatively affecting children's physical and psychosocial health. Mothers are children's primary caregivers, thus key players in childhood obesity prevention. Studies have indicated that mothers underestimate their children's weight. If mothers are unaware of their children's weight problem, they are less likely to participate in activities preventing and treating excess weight. The "Healthy Change" intervention is designed to change maternal perception of child's weight (MPCW) through peer-led group health education in childcare settings. METHODS/DESIGN: The "Healthy Change" is a multicenter two-arm randomized trial in four centers. Three centers are in Mexican States (Nuevo Leon, Tamaulipas, and Zacatecas). The fourth center is in San Antonio, Texas, USA. A total of 360 mother-child pairs (90 pairs per center) are to be randomly and evenly allocated to either the intervention or the control group. Intervention group will receive four-session group obesity prevention education. Control group will receive a four-session personal and food hygiene education. The education is delivered by trained peer-mother promotoras. Data will be collected using questionnaires and focus groups. The primary outcome is a change in proportion of mothers with accurate MPCW. Secondary outcomes include change in maternal feeding styles and practices, maternal self-efficacy and actions for managing child excessive weight gain. McNemar's Test will be used to test the primary outcome. The GLM Univariate procedure will be used to determine intervention effects on secondary outcomes. The models will include the secondary outcome measures as the dependent variables, treatment condition (intervention/control) as the fixed factor, and confounding factors (e.g., mother's education, children's gender and age) as covariates. Sub-analyses will be performed to compare intervention effects on primary and secondary outcomes between the samples from Mexico and Texas, USA. Qualitative data will be analyzed through analysis of inductive content. A combined coding model will be developed and used to code transcripts using the NVivo software. DISCUSSION: Healthy Change intervention could help change MPCW, an initial step for obesity prevention among preschoolers. This study presents a first of its kind intervention available in Spanish and English targeting Mexican and Mexican-American mothers in Mexico and USA. TRIAL REGISTRATION: ISRCTN12281648.