Maternal depressive symptoms during pregnancy, and newborn irritability

Maternal depression is associated with a wide range of adverse outcomes for children, including poor mother-infant interactions at 3 months post-partum. The aim of this study is to determine whether maternal depressive symptoms during pregnancy are associated with neonatal neurobehavioral functioning, as measured by the Neurologic and Adaptive Capacity Scale. The study population consists of 1,123 mothers and their term infants who were participants in a larger study of maternal health and infant outcomes. Women were administered the Center for Epidemiologic Studies-Depression (CES-D) questionnaire for depressive symptoms during their pregnancy. Their infants were subsequently assessed by a pediatrician blind to their CES-D scores. The CES-D score was associated with unconsolability and excessive crying (p less than 0.01). The higher the mother's CES-D score, the more likely it was that the infant would be unconsolable or cry excessively. Mothers with CES-D scores at the 90th percentile were 2.6 times more likely to have unconsolable newborns, compared with women with CES-D scores at the 10th percentile (95% C.I. = 1.54, 4.23). When potentially confounding variables, such as cigarette smoking, alcohol, marijuana, and cocaine use, poor weight gain, income, birth weight, and other drug use, were controlled, the relationship between CES-D score and newborn unconsolability and excessive crying remain unchanged. The results of this study suggest that the relationship between early childhood problems and maternal depressive symptoms may be part of a sequence that starts with depressive symptoms during pregnancy.     

Depressive symptoms among rural Bangladeshi mothers: implications for infant development

OBJECTIVE: To examine how maternal depressive symptoms are related to infant development among low-income infants in rural Bangladesh and to examine how the relationship is affected by maternal perceptions of infant irritability and observations of caregiving practices. METHODS: Development was measured among 221 infants at 6 and 12 months with the Bayley Scales II. Mothers reported on their depressive symptoms and on perceptions of their infant's temperament, and a home visit was made to complete the HOME Inventory. RESULTS: Half (52%) the mothers reported depressive symptoms. In bivariate analyses, maternal depressive symptoms were related to low scores on the Bayley Scales. Infants whose mothers reported depressive symptoms and perceived their infants to be irritable acquired fewer cognitive, motor, and Orientation/Engagement skills between 6-12 months than infants whose mothers reported neither or only one condition. The relationship linking maternal depressive symptoms and perceived infant irritability with infant cognitive skills was partially mediated by parental responsiveness and opportunities for play in the home. CONCLUSIONS: The intergenerational risks of maternal depressive symptoms on infant development extend to rural Bangladesh and are accentuated when mothers perceive their infants as irritable. Mothers who report depressive symptoms and infant irritability may lack the capacity to provide responsive, developmentally-oriented caregiving environments.     

The effects of maternal social phobia on mother-infant interactions and infant social responsiveness

BACKGROUND: Social phobia aggregates in families. The genetic contribution to intergenerational transmission is modest, and parenting is considered important. Research on the effects of social phobia on parenting has been subject to problems of small sample size, heterogeneity of samples and lack of specificity of observational frameworks. We addressed these problems in the current study. METHODS: We assessed mothers with social phobia (N = 84) and control mothers (N = 89) at 10 weeks in face-to-face interactions with their infants, and during a social challenge, namely, engaging with a stranger. We also assessed mothers with generalised anxiety disorder (GAD) (N = 50). We examined the contribution to infant social responsiveness of early infant characteristics (neonatal irritability), as well as maternal behaviour. RESULTS: Mothers with social phobia were no less sensitive to their infants during face-to-face interactions than control mothers, but when interacting with the stranger they appeared more anxious, engaged less with the stranger themselves, and were less encouraging of the infant's interaction with the stranger; infants of index mothers also showed reduced social responsiveness to the stranger. These differences did not apply to mothers with GAD and their infants. Regression analyses showed that the reduction in social responsiveness in infants of mothers with social phobia was predicted by neonatal irritability and the degree to which the mother encouraged the infant to interact with the stranger. CONCLUSIONS: Mothers with social phobia show specific parenting difficulties, and their infants show early signs of reduced social responsiveness that are related to both individual infant differences and a lack of maternal encouragement to engage in social interactions.     

Association of maternal obesity and depressive symptoms with television-viewing time in low-income preschool children

BACKGROUND: Decreasing television (TV)-viewing time may improve child health and well-being. These viewing patterns are shaped during the preschool years. Because mothers play an important role in determining how much TV their preschool children watch, a better understanding is needed of the maternal factors that influence children's TV viewing. OBJECTIVE: To examine the relationship of depressive symptoms and obesity in low-income mothers with TV-viewing time in their preschool children. METHODS: Cross-sectional, self-administered survey of 295 low-income mothers of 3- and 4-year-old children (92% white) enrolled in the Vermont Special Supplemental Nutrition Program for Women, Infants, and Children. Mothers reported children's usual weekday and weekend-day TV-viewing time. Maternal depressive symptoms were measured with the Center for Epidemiologic Studies Depression Scale (CES-D). Maternal body mass index was calculated from self-reported height and weight measurements (weight in kilograms divided by height in meters squared). RESULTS: Children watched a mean of 2.2 +/-1.2 hours of TV per day. Those in the upper quartile of TV-viewing time (high TV viewers) watched 3 or more hours of TV per day. Of the mothers, 12% had both obesity (BMI > or =30) and depressive symptoms (CES-D score > or =16), 19% were obese only, and 18% had depressive symptoms only. Children were more likely to be high TV viewers if their mothers had clinically significant depressive symptoms (35% vs 23%; P =.03) or if their mothers were obese (35% vs 22%; P =.03). Forty-two percent of children were high TV viewers if the mother had both depressive symptoms and obesity, 30% if the mother had only depressive symptoms, 29% if the mother had only obesity, and 20% if the mother had neither depressive symptoms nor obesity (P =.06 overall; P for trend =.009 using the chi2 test). CONCLUSIONS: Among low-income preschool children, those whose mothers had either depressive symptoms or obesity were more likely to watch 3 or more hours of TV a day. Strategies to reduce TV viewing in young children should consider the role that maternal obesity and depressive symptoms may play in how preschool children spend their time.     

Postpartum mood disorders and maternal perceptions of infant patterns in well-child follow-up visits

AIMS: The aims of this study were to evaluate the associations between postpartum depressive symptoms and maternal perceptions of infant patterns with 1-year follow-up examinations, and to assess the impacts of treatment on these perceptions. METHODS: One hundred three mother-infant pairs were evaluated. Data on maternal reports of infant feeding, sleeping and temperament patterns were collected at each well-child visit. The Edinburgh Postpartum Depression Scale was used to assess depressive symptoms. A psychiatrist interviewed the mothers with depressive symptoms, and psychiatric treatments were administered accordingly. The associations between depressive symptoms and maternal perceptions at each visit were analyzed by taking into account the entire follow-up period. RESULTS: Thirty-five mothers (34%) scored within the clinical range of the EPDS during the follow-up period. Mothers with elevated depressive symptoms were more inclined to report infant cry-fuss, sleeping and temperamental problems through the follow-up. Such complains on infant cry-fuss and temperament problems and maternal sleeping problems improved after treatment in compliant mothers. The dropout rate was high (58.3%) in noncompliant mothers. CONCLUSION: Postpartum depressive symptoms may lead to negative maternal perceptions of infant patterns. Earlier management of these disorders and maternal compliance to psychiatric suggestions may provide a better care for the mother-infant pairs.     

Évaluer les difficultés interactives entre une mère déprimée et son bébé de 3 mois au moyen de l’échelle GRMII de Fiori-Cowley et Murray

Background and aim

Early detection of postnatal depression and mother–infant interactive difficulties are major issues not only for the emotional and cognitive development of the infant, but also for the implementation of early prevention of interactive disorders. This study examined the characteristics of mother–infant interactions in a free play situation, when infants were 3 months old, in case of maternal postnatal depression, and in a control group. The quality of interactions was assessed using the Global Ratings of Mother–Infant Interactions by Fiori–Cowley and Murray (GRMII).

Methods

The sample was composed of 90 mothers with their infants, including 39 mothers with postnatal depression and 51 without mood disorders. Affective disorder was assessed by the Montgomery and Asberg Depression Rating Scale (MADRS). Mothers and their 3-month-old infants were invited to play freely, in a room dedicated to parent–infant observation in the laboratory. Free play sequences were video recorded and a posteriori coded by two trained clinicians blind to maternal affective status, with the GRMII.

Results and conclusion

Analyses show that for all items of the GRMII, non-depressed mothers and their infant obtained higher scores i.e. better scores than depressed mothers and their infant. However, significance was evidenced only for 8 items of the grid: 3 on the maternal sensitivity scale, 2 on signs of depression, and 3 on the interactive dimension. Results thus show that at 3 months postpartum, depression appeared to have already affected interaction with the infant. Main differences were observed in mother's active engagement, acceptation, sensitivity and ability to provide adjusted responses to her infant. Analysis of maternal intrusiveness and remoteness did not yield significant findings, but conversely maternal sensitivity was negatively impacted. The GRMII appeared as an easy-to-use and objective tool to detect specificities of early depressed mother–infant interactions, adapted to a clinical setting. Early detection of interactive distortion gives a window of opportunity for a clinical intervention focused not only on maternal depressive symptoms, but also on the dyad itself.     

Interactive Effects of Infant Gestational Age and Infant Fussiness on the Risk of Maternal Depressive Symptoms in a Nationally Representative Sample

ObjectiveTo examine the interactive effects of gestational age and infant fussiness on the risk of maternal depressive symptoms in a nationally representative sample.MethodsOur sample included 8200 children from the Early Childhood Longitudinal Study, Birth Cohort. Gestational age categories were very preterm (VPT, 24–31 weeks), moderate/late preterm (MLPT, 32–36 weeks) and full term (FT, 37–41 weeks). Maternal depressive symptoms (categorized as nondepressed/mild/moderate-severe), from the modified Center for Epidemiological Studies Depression Questionnaire, and infant fussiness (categorized as fussy/not fussy) were assessed at 9 months from parent-report questionnaires. We examined the interactive effects of infant fussiness and gestational age categories and estimated adjusted odds ratios (aOR) and 95% confidence intervals (CI) of maternal depressive symptoms using multinomial logistic regression.ResultsInfant fussiness interacted with gestational age categories in predicting maternal depressive symptoms (P = .04), with severity varying by gestational age and infant fussiness. Compared with mothers of VPT infants without fussiness, mothers of VPT infants with fussiness had greater odds of mild depressive symptoms (aOR, 2.32; 95% CI, 1.19–4.53). Similarly, compared with mothers of MLPT and FT infants without fussiness, mothers of fussy MLPT and FT infants had greater odds of moderate-severe symptoms (aOR, 2.30; 95% CI, 1.40–3.80, and aOR, 1.74; 95% CI, 1.40–2.16, respectively).ConclusionsMothers of MLPT and FT infants with fussiness had increased odds of moderate-severe depressive symptoms, and mothers of VPT infants with fussiness had increased risk of mild symptoms. Early screening for infant fussiness in preterm and FT may help identify mothers with depressive symptoms in need of support.     

Early Channels of Mother-Infant Communication: Preterm and Term Infants

The impact of prematurity on the responsiveness of mothers and their 4-month-old infants was examined across three channels of communication: attentional, vocal and affective. Log-linear models were used to determine how the behavior of one partner was conditional upon the behavior of the other during home observations of 24 preterm and 24 term infants and their mothers. Visual attention was elicited by vocalization, and the onset of infant gaze was marked by a maternal smile. Mothers and infants responded to vocalizations with vocalizations, and mothers responded to smiles with smiles. Mothers of preterm infants were particularly responsive to their infants' signals within the attentional, vocal and affective channels. Preterm infants demonstrated correspondingly heightened responsiveness within the vocal and affective channels.     

Maternal depressive symptoms at 2 to 4 months post partum and early parenting practices

OBJECTIVE: To determine whether maternal depressive symptoms, reported when infants are 2 to 4 months old, are associated with mothers' early parenting practices. DESIGN: Secondary data analyses collected from the National Evaluation of Healthy Steps for Young Children. Data sources included newborn enrollment questionnaires and parent interviews when infants were 2 to 4 months old. Maternal depressive symptoms were assessed using the Center for Epidemiological Studies Depression Scale. SETTING: Twenty-four pediatric practices across the United States. PARTICIPANTS: A total of 5565 families enrolled in Healthy Steps; 4874 mothers (88%) completed 2- to 4-month interviews and provided Center for Epidemiologic Studies Depression Scale data; 17.8% of mothers reported having depressive symptoms. MAIN OUTCOME MEASURES: Ten parenting practices assessed in 3 domains: safety (sleep position and lowering water temperature), feeding (cereal, water, or juice; continuing breastfeeding), and practices to promote child development (showing books, playing with infant, talking to infant, and following 2 or more routines). RESULTS: Mothers with and without depressive symptoms reported similar uses of safety and feeding practices. Mothers with depressive symptoms had reduced odds of continuing breastfeeding (adjusted odds ratio [AOR], 0.73; 95% confidence interval [CI], 0.61-0.88), showing books (AOR, 0.81; 95% CI, 0.68-0.97), playing with the infant (AOR, 0.70; 95% CI, 0.54-0.90), talking to the infant (AOR, 0.74; 95% CI, 0.63-0.86), and following routines (AOR, 0.61; 95% CI, 0.52-0.72). CONCLUSION: Maternal depressive symptoms are common in early infancy and contribute to unfavorable parenting practices.     

The impact of very premature birth on the psychological health of mothers

BACKGROUND: The birth of a very premature infant is a critical event in the life of a family and studies have shown that mothers of these infants are at greater risk of psychological distress than mothers of full-term infants. STUDY DESIGN: A total population study of mothers of preterm infants born at less than 32-week gestation at a tertiary referral hospital. SUBJECTS AND METHODS: Sixty-two mothers of very preterm infants (<32 weeks) participated in the present study which examines correlates of maternal depressive symptomatology at 1 month following very premature birth. Information was obtained from structured questionnaires completed by mothers at 1 month after infant admission to neonatal intensive care. RESULTS: Forty percent of the mothers reported significant depressive symptoms on the Edinburgh Postpartum Depression Scale (EPDS). Logistic regression analysis indicated that high maternal stress resulted in an increased likelihood of depressive symptoms (OR 1.15, CI 1.04-1.26, p<0.01). Higher levels of maternal education (p<0.05), and increased perception of support from nursing staff (OR 1.06, CI 0.88-1.00, p<0.05) resulted in decreased likelihood of depressive symptoms. CONCLUSIONS: The birth and subsequent hospitalisation of a very premature infant evokes considerable psychological distress in mothers. These results have implications for policy development in order to enhance family centred care in the neonatal intensive care.     

Prenatal drug exposure and maternal and infant feeding behaviour

OBJECTIVE: To evaluate feeding difficulties and maternal behaviour during a feeding session with 1 month old infants prenatally exposed to cocaine and/or opiates. METHODS: The study is part of the maternal lifestyle study, which recruited 11 811 subjects at four urban hospitals, then followed 1388 from 1 to 36 months of age. Exposure to cocaine and opiates was determined by maternal interview and meconium assay. At the 1 month clinic visit, biological mothers were videotaped while bottle feeding their infants. This sample included 364 exposed to cocaine, 45 exposed to opiates, 31 exposed to both drugs, and 588 matched comparison infants. Mothers were mostly black, high school educated, and on public assistance. Videotapes were coded without knowledge of exposure status for frequency, duration and quality of infant sucking, arousal, feeding problems, and maternal feeding activity and interaction. RESULTS: No cocaine effects were found on infant feeding measures, but cocaine-using mothers were less flexible (6.29 v 6.50), less engaged (5.77 v 6.22), and had shorter feeding sessions (638 v 683 seconds). Opiate exposed infants showed prolonged sucking bursts (29 v 20 seconds), fewer pauses (1.6 v 2.2 per minute), more feeding problems (0.55 v 0.38), and increased arousal (2.59 v 2.39). Their mothers showed increased activity (30 v 22), independent of their infants' feeding problems. CONCLUSIONS: Previous concerns about feeding behaviour in cocaine exposed infants may reflect the quality of the feeding interaction rather than infant feeding problems related to prenatal exposure. However, opiate exposed infants and their mothers both contributed to increased arousal and heightened feeding behaviour.     

Genre du bébé et trouble de la personnalité borderline maternel : quel impact sur l’interaction mère-bébé à 3 mois du postpartum ?

Background and aim

This research aims to study mother-infant interactions at 3 months postpartum using the Still Face Face-to-Face Paradigm comparing two groups, mothers with borderline personality disorder and controls. We hypothesized that dyadic interactions with mothers afflicted with the disorder would be significantly different from those without psychopathology, and that these differences would vary according to infant gender.

Methods

Nineteen dyads of mothers with Borderline Personality Disorder and 41 with control mothers were filmed using the Still Face Paradigm. Behaviors of both partners were studied using microanalytic coding with the Maternal and Infant Regulation Scoring System.

Results and conclusion

Our analysis shows that both partners react to the stress induced by the Still Face episode (the paradigm is divided in three phases, 2 minutes of spontaneous interaction face-to-face, 2 minutes of maternal Still Face per se, and 2 minutes of reuniting interactive play). Infants of mothers with Borderline Personality Disorder show less gaze focused on mother than their control counterparts; infant girls regulate themselves more than boys and mothers with psychopathology demonstrate more tactile stimulation of their infants (touch, tickle, etc.). Our research illustrates how different dyadic adaptive mechanisms exist according to maternal psychopathology and infant gender, and suggests that as early as 3 months postpartum, infants are already trying to adapt to maternal functioning and dysfunctional interactions through self-regulatory mechanisms. This begs for further research exploring as precisely as possible interactive mechanisms both early in life and in longitudinal studies.     

No association between maternal psychological symptoms and infant outcome after pregnancy complicated by early-onset hypertensive disorders

Aim: The aim of this work was to study the effect of maternal psychological symptoms on infant development 1 year after early-onset hypertensive disorders of pregnancy.
Methods: All mothers were enrolled in the Pre-eclampsia, Eclampsia TRial Amsterdam. Mothers were asked to complete the 90-item Symptom Check List (SCL-90) at the corrected ages of their infants of 0, 3 and 12 months. The total sum score of these three checklists was calculated. Infants were examined at the corrected age of 12 months using the Bayley Scales of Infant Development (Mental Developmental Index [MDI] and Psychomotor Developmental Index [PDI] subscales). The Bayley scores were compared between infants of mothers with SCL-90 sum scores in the highest 25% and lowest 75%.
Results: For 141 mother–infant pairs (80%) all three SCL-90 checklists and Bayley scores were available. Mean gestational age was 32 weeks and 90% of the infants were growth restricted. The mean MDI was 87 in the highest 25% and 89 in the lowest 75% group. This was 79 versus 80 for the PDI.
Conclusion: In this population of high-risk growth-restricted infants born after a pregnancy complicated by early-onset hypertensive disorders, there is no additional impact of negative maternal psychological symptoms on infant development after 1 year.     

Vulnerable Baby Scale: development and piloting of a questionnaire to measure maternal perceptions of their baby's vulnerability

OBJECTIVES: To develop and provide initial data to validate a contemporary measure of maternal perceptions of infant vulnerability. METHODS: Questions that address current concerns of mothers regarding their young children (such as the risk of sudden infant death syndrome) were added to an existing Vulnerable Child Questionnaire. Questions not relevant to either current concerns or to young infants were removed. The modified questionnaire, along with standard measures of maternal anxiety and depressive symptoms, were administered to mothers of 39 healthy full-term babies, 17 mothers of 'medically fragile' babies and 19 mothers of jaundiced babies. Babies were approximately 12 weeks of age at the time of completion of the questionnaire. RESULTS: Three questions were removed from the questionnaire on the basis of poor item-total correlations, leaving the final version with 10 questions, scored on 1-5 rating scales. Cronbach alpha for the revised scale was 0.7. There was a significant difference (P = 0.002) in mean vulnerable baby scores between the control group and the 'medically fragile' group. There was a moderately strong correlation between vulnerable baby score and maternal state anxiety (r = 0.6) and a weaker correlation with maternal depressive symptoms (r = 0.3). CONCLUSIONS: The modified questionnaire has good internal consistency. The difference in mean scores between the three groups, and correlations with maternal anxiety and depressive symptoms, lend construct validity to the scale. The Vulnerable Baby Scale appears to be suitable for assessing maternal perceptions of the vulnerability of their young babies in clinical and research settings although further research, with larger samples, may be necessary to fully establish the scale's psychometric properties.     

The Nature of the Mother's Tie to Her Infant: Maternal Bonding under Conditions of Proximity, Separation, and Potential Loss

Attachment has generally been examined from the infant's perspective. We focused on mothers' post-partum thoughts and behaviors. Guided by an ethological approach, maternal bonding was examined under conditions of proximity, separation, and potential loss. Ninety-one mothers were interviewed: mothers of full-term infants who maintained continuous proximity to the infant, mothers of healthy premature infants who were separated from the infant, and mothers of very low birthweight infants who experienced potential loss and prolonged separation. Mothers of term infants reported medium-to-high levels of preoccupations with thoughts of infant safety and well-being. Preoccupations increased with separation (Group 2) and significantly decreased with impending loss (Group 3). Attachment behaviors and representations were the highest among mothers of term infants and declined linearly with the duration of mother-infant separation. Maternal trait anxiety and depression were related respectively to higher levels of preoccupations and reduced attachment behaviors and representations, independent of the infant medical condition and mother-child separation. Discussion focused on the comparability of maternal and infant attachment in relation to the neurobiological system underlying bond formation.     

The early social environment of premature and fullterm infants

The behaviors of 10 mothers of prematures and 29 mothers of fullterms were compared from 7-h observations made in the home when the infants were 2, 3, 4 and 5 weeks post-term. The observation day was divided into four mutually exclusive interactional contexts that together made up the total day: feeding time, changing or bathing time, time when the mother and infant were in physical contact but the mother was not caretaking, and time the infant was alone. Measures of ten maternal behaviors were also compared: moving, rocking, patting, caressing, talking, looking, engaging in vis-a-vis with the baby, holding or carrying, smiling or laughing, and stimulating the baby to suck. Mothers of prematures left their infants alone more and changed them less than mothers of fullterms. In addition, mothers of prematures moved their infants less often, talked to their infants less, looked at their infants less, and held their infants less. These results indicate that, over the 7-h day, prematures receive markedly less stimulation than fullterms. Since the neurobehavioral characteristics of premature and fullterm infants are known to differ, it is suggested that these differences in maternal behaviors may be in response to infant cues and appropriate for the infants.     

Prematurity, maternal posttraumatic stress and consequences on the mother-infant relationship

Objective

Premature birth is a stressful experience for parents. This study explores the links between maternal posttraumatic stress, maternal attachment representations of the infant and mother-infant dyadic interactions.

Methods

The study enrols 47 preterm (GA < 34 weeks) and 25 full-term infants. The Perinatal Posttraumatic Stress Disorder Questionnaire was administered to evaluate maternal posttraumatic stress symptoms. At 6 months of corrected age, maternal attachment representations of the infant were explored and coded with the Working Model of the Child Interview. Interactive characteristics were explored in a videotaped play session and coded with the Care Index.

Results

Full-term mothers were more likely to follow a “Cooperative” dyadic pattern of interaction with the infant and demonstrate Balanced representations of the infant. Preterm mothers with high posttraumatic stress symptoms were more likely to follow a “Controlling” dyadic pattern of interaction, with more Distorted representations. In contrast, preterm mothers with low posttraumatic stress symptoms were more likely to fall into a “Heterogeneous” group of patterns of dyadic interaction, with Disengaged representations. Interestingly, in Cooperative preterm dyads, only 23% of the mothers demonstrated Balanced representations, despite rates of 69% in full-term Cooperative dyads.

Conclusion

Premature birth affects both mother-infant interaction characteristics and maternal representations of attachment with the infant. In particular, a “Controlling” dyadic pattern was associated with high maternal posttraumatic stress symptoms and Distorted maternal representations. It is important to examine the impact of maternal posttraumatic stress on the parent-infant relationship in order to plan supportive, preventive interventions in the neonatal period.     

Mother's attachment concerns regarding spouse and infant's temperament as modulators of maternal separation anxiety

The modulators of maternal separation anxiety were examined in a longitudinal study with 97 mothers of infants from 3 to 9 months of age. The objective of the study was to examine the joint contribution of the mother's attachment concerns as related to her husband together with the perception of the infant's temperament to her concerns over separation from her child. Maternal worries about separation from 3-month-old infants predicted maternal separation anxiety when infants were 9 months old. Mother's attachment to her husband and her perception of her child's temperament further predicted maternal separation anxiety at 9 months over and above the worries at 3 months. Mothers who feared dependent relationships with their husbands experienced high levels of maternal separation anxiety. This tendency was particularly marked when the infant was perceived as adaptable at 3 months. In addition, secure mothers, namely, mothers low in fear of abandonment and in fear of being dependent, increased their maternal separation anxiety as a function of their infant's perceived unadaptability.     

Mother–infant interactions and infant intake during breastfeeding versus bottle‐feeding expressed breast milk

Bottle‐fed infants are at higher risk for rapid weight gain compared with breastfed infants. Few studies have attempted to disentangle effects of feeding mode, milk composition and relevant covariates on feeding interactions and outcomes. The objective of the present study was to compare effects of breastfeeding directly at the breast versus bottle‐feeding expressed breast milk on feeding interactions. Mothers with <6‐month‐old infants (n = 47) participated in two counterbalanced, feeding observations. Mothers breastfed their infants directly from the breast during one visit (breast condition) and bottle‐fed their infants expressed breast milk during the other (bottle condition). Masked raters later coded videos using the Nursing Child Assessment Parent–Child Interaction Feeding Scale. Infant intake was assessed. Mothers self‐reported sociodemographic characteristics, infant feeding patterns (i.e. percentage of daily feedings from bottles) and level of pressuring feeding style. Mother and infant behaviours were similar during breast and bottle conditions. Percent bottle‐feeding moderated effects of condition on intake (P = 0.032): greater percent bottle‐feeding predicted greater intake during the bottle compared with breast condition. Effects of feeding mode were not moderated by parity or pressuring feeding style, but, regardless of condition, multiparous mothers fed their infants more than primiparous mothers (P = 0.028), and pressuring feeding style was positively associated with infant intake (P = 0.045). Findings from the present study do not support the hypothesis that feeding mode directly impacts dyadic interaction for predominantly breastfeeding mothers and infants, but rather suggest between‐subject differences in feeding experiences and styles predict feeding outcomes for this population.