Mother-infant responsiveness: timing, mutual regulation, and interactional context.

Mutual regulation during the naturalistic interaction of 150 mothers and their 4-month-old infants was investigated from a dynamic systems perspective. Microanalyses of a wide range of behaviors and analysis of contingencies indicated that a 3-s time period best captured contingencies. Both mothers and infants communicated primarily through vocal signals and responses, although maternal touches and infant looks also elicited responses. Although more expressive mothers did not have infants who behaved similarly, levels of contingent responsiveness between partners were significantly associated and occurred within distinct behavioral channels, suggesting coregulated interactional processes in which contingently responsive mothers shape their infants' communications toward mutual similarity. Mothers were more influential than infants over object play, whereas infants were more influential than mothers over expressive behavior. Interactional context consistently influenced contingent responsiveness; there was less mutual responsiveness when the infant was exploring, being held, or looking.

Pediatric resident and faculty knowledge of the Denver II.

OBJECTIVE: To assess knowledge of the Denver II, the revised developmental screening tool recommended by the American Academy of Pediatrics, in residents and faculty, and to evaluate a teaching intervention for incoming postgraduate year 1 (PGY-1) trainees. DESIGN: A cross-sectional test of knowledge for all subjects and pretesting and posttesting of the incoming PGY- 1 trainees. SETTING: University of Texas-Houston Medical School Department of Pediatrics. PARTICIPANTS: Faculty (n = 9) and residents (n = 78), including an intervention group (n = 45), of incoming PGY-1 trainees over 2 years. INTERVENTIONS: Postgraduate year 1 trainees in both 1994 through 1995 and 1995 through 1996 viewed the Denver II training videotape on entry into a continuity clinic. Trainees were encouraged to perform Denver II evaluations on at least 1 appropriate patient at each pediatric clinic session and had access to Denver II support materials. MAIN OUTCOME MEASURES: Scores on the Denver II Proficiency Written Test, self-reported measures of comfort, and number of Denver II evaluations performed. RESULTS: The mean (SD) test scores for incoming, preintervention PGY-1 trainees (n = 45) (41.3 [9.6]) did not differ from scores for outgoing PGY-1 trainees (n = 13) (38.5 [10.4]) who had not received the intervention. Postintervention PGY-1 test results were significantly improved (59.4 [10.6]) (P<.001). Test scores for upper-level residents who had participated in the developmental pediatrics rotation (n = 14) were better (55.3 [9.31), but all scored below passing. Residents who had not yet participated in the developmental pediatrics rotation (n = 19) and members of the general pediatric faculty (n = 9) had scores similar to those of PGY-1 trainees (40.9 [13.4] and 39.0 [15.1], respectively). CONCLUSIONS: Residents had a greater knowledge of the Denver II after completing a developmental pediatrics rotation. Our intervention produced significant improvement in PGY-1 trainees' knowledge, raising it to levels similar to those of upper-level residents exposed to developmental pediatrics. Faculty were not expert in using the Denver II.

Mothers and fathers of children with Down syndrome: parental stress and involvement in childcare.

Parental stress was examined in socioeconomically matched samples of mothers and fathers of children with Down syndrome and typically developing children. Parents of children with Down syndrome perceived more caregiving difficulties, child-related stress (distractibility, demandingness, unacceptability), and parent-related stress (incompetence, depression, health problems, role-restriction) than did parents of typically developing children. For the combined groups of parents, mothers' stress was associated with children's caregiving difficulties; fathers' stress, with children's group status (Down syndrome, typically developing). Mothers who reported more responsibility for childcare perceived more difficulties with health, role restriction, and spousal support. Fathers who reported more responsibility for childcare perceived fewer difficulties with attachment and parental competence. Partner stress was associated both with mothers' and with fathers' stress.

Weight change in adolescents who used hormonal contraception.

PURPOSE: (a) To compare weight change at 1 year between adolescents 13-19 years old who were using either depot medroxyprogesterone acetate (DMPA) or oral contraceptives (OC), and (b) to determine if age, baseline body mass index (BMI), race/ethnicity, or weight gain at 3 months predicted which subjects would gain excessive weight. METHOD: The setting was a Planned Parenthood Teen Clinic with chart review of variables of interest. Excessive weight was defined as weight gain > 10%. RESULTS: Baseline variables were similar in the two groups, except that DMPA users (n = 44) had a greater mean BMI (t test, p = .05) than OC users (n = 86). Mean (standard deviation) and median weight gains at 1 year were 3.0 (4.5) and 2.4 kg in the DMPA users and 1.3 (3.9) and 1.5 kg in the OC users (difference in medians not significant, Wilcoxon rank sum test, p = .10). Fifty-six percent of DMPA and 70% of OC users lost weight or gained < 5% of their baseline weight (p = .17, Fisher exact test); 25% of DMPA users and 7% of OC users gained > 10% of their baseline weight (p = .006). Age, baseline BMI, or race/ethnicity did not affect the likelihood that either group would gain > 5% or > 10% of their baseline weight. Of adolescents who gained > 5% of baseline weight at 3 months, 13 of 14 (93%) gained even more weight at 12 months. CONCLUSIONS: The majority of adolescents who used hormonal contraception for 1 year lost weight or gained < 5% of baseline weight. DMPA users were more likely than OC users to gain > 10%. Subjects who gained > 5% of baseline weight at 3 months were at high risk (93%) of gaining even more weight by 1 year.

PIP: This study aims to compare weight change after 1 year between adolescents aged 13-19 years who were using either depot medroxyprogesterone acetate (DMPA) or an oral contraceptive (OC). It also seeks to determine whether age, baseline body mass index (BMI), race/ethnicity, or weight gain at 3 months predicted which subjects would gain excessive weight (defined as weight gain 10%). A total of 2883 charts were reviewed for all clients attending the Planned Parenthood Teen Clinic in Texas. In the results, 56% of DMPA and 70% of OC users lost weight or gained 5% of their baseline weight; whereas 25% of DMPA users and 7% of OC users gained 10% of their baseline weight. Furthermore, age, baseline BMI, or race/ethnicity did not affect the likelihood of weight gain in both groups. The findings indicated that most adolescents who used hormonal contraception for 1 year lost weight or gained 5% of their baseline weight. DMPA users were more likely to gain 10% of their baseline weight compared to OC users. Subjects who gained 5% of baseline weight at 3 months were at high risk (93%) of gaining even more weight by 1 year.

The structure of mother-child play: young children with Down syndrome and typically developing children.

This study explored developmental changes and effects of Down syndrome on mothers' structuring of their children's play. Mothers and their young children with Down syndrome (n = 28) were compared with socioeconomically matched samples of mothers and their mental age-matched (n = 28) and chronological age-matched (n = 28) typically developing children. Mothers of typically developing children exhibited more object demonstrations with their developmentally younger children, who exhibited less object play. Mothers of children with Down syndrome were more directive and supportive than were mothers of younger and older typically developing children, who did not differ in their frequencies of these behaviors. More maternal supportive object behavior was associated with more object play and vocalization by children with Down syndrome. Mothers and children in all 3 groups were contingently responsive to their partners' behavioral signals.

Cognitive development of preterm low birth weight children at 5 to 8 years old.

Prematurity and low birth weight have been considered to be important risk factors for cognitive development during early childhood; however, it has been suggested that the developmental delays disappear with age. Eighty-one preterm (< 38 weeks) low birth weight (< 2500 g) children between 5 and 8 years old from the Children of the National Longitudinal Survey of Youth were compared with individually matched full-term normal birth weight children to investigate the catch-up delays in cognitive functioning including language and mathematics skills. Preterm children showed a significant delay in cognitive functioning only until 6 years old. Regression analyses showed that environmental factors accounted for more variation in cognitive development than did perinatal factors. In support of a transactional model, preterm children exhibited a self-righting tendency during their early childhood so that eventually environmental influences overshadowed biological influences.

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.

A survey of the structure and function of pediatric continuity clinics.

Continuity clinic is a mandated part of all accredited pediatric residency programs, yet there are minimal guidelines regarding structure and function. In 1988, we surveyed 101 residency programs, asking them to describe their continuity clinic experience. Eighty-seven residency programs (86%) responded to the 40-item questionnaire. The results showed clinics to be similar in many aspects, with consistent emphasis on developmental issues and anticipatory guidance. Areas of concern included lack of monitoring of the patient panel (31% did not monitor), excess care for chronic diseases or handicapping conditions (mean, 22% of patients), and lack of training in telephone advice (43% provided no such training).