Mental health articles

Relationship between the premature infant and caregiver
Many researchers of prematurity have looked at the relationship between the
infant and her caregiver and the effect of prematurity on that relationship. The interaction between parent and infant, and caregiver responsivity, is a key
component of the child’s final intellectual and behavioural outcome.
It has been noted, for instance, that the mothers of premature infants show
continuing anxiety and lack confidence in their caregiving, at least in their
infant’s first year (Mayes et al., 2002). It is hypothesised that premature infants,
who are often erratic in their behaviour and are less attentive, make it difficult
for the parents to read their infant’s needs and respond appropriately to facilitate
the infant achieving regulation. Parents who have risk factors of their own, for
example, drug addiction or no social supports, will have more difficulty focusing
on the often difficult to interpret needs of their infant. Also, the trauma of a
premature birth may often awaken earlier traumatic experiences of the parent,
which will interfere with the parent’s capacity to be sensitively attuned to the
premature infant’s needs.
Montrasio (1997) discusses the inherent and possible difficulties of a
premature birth or illness in infancy and the possible consequences on the
relationship. Montrasio states ‘every infant, and a premature child more than
other children, can be competent only to the extent that the caregiving context
is responsive to the reflexive self-functioning in the child’. Minde (2000) refers to ‘process studies’ (p. 182), which acknowledge that
many events and interactions interweave to determine outcomes for premature
infants. This is a very important point to note. The recent work by Brisch et al.
(2003) indicates that for the high-risk, VLBW infants the quality of attachment
could be influenced by cerebral risk factors and neurodevelopment. Without
intervention, the mother’s responsiveness to her infant with serious neurological
disability was not sufficiently protective to ensure a secure attachment.
On the other hand, where the attachment classification of the infant at 14
months was identified as disorganised, this was independent of the premature
infant’s neurological profile, indicating that this pattern of attachment was more
likely to be as a consequence of infant–mother interaction than of neurological
impairment.
Another recent study (Keren, Feldman, Eidelman, Sirota & Lester, 2003)
examined the relationship between mothers’ representations of their infants,
pregnancy and premature birth and mother–infant interactions. The authors
found that mothers with positive maternal representations of their premature
infants, the pregnancy, birth process and experience in the NICU, a factor
labelled ‘Readiness for Motherhood’ (as obtained from a semi-structured
interview), had more optimal interactions with their babies in the NICU than
mothers with negative representations. Better maternal adaptation to the
infant’s signals and maternal positive touch were negatively related to maternal
depression. The maternal negative representations factor of ‘Maternal Rejection’
predicted the interaction behaviour, ‘Infant Withdrawal’. Maternal rejection included items such as unplanned pregnancy and negative first reaction to
pregnancy, revealing that maternal negative attitudes towards the infant started
well before the infant was born and were later linked to negative perceptions of
the born baby.
Keren et al. (2003) found that the infant’s medical condition did not affect the
mother’s level of anxiety or depression, but was an important factor in the
parent’s representations. Mothers of high-risk infants scored less on readiness
for motherhood, touched their infants less often and were less adaptive to their
infants than the mothers of low-risk infants. The infant’s medical condition did
not affect the negative attitudes as depicted in the maternal rejection factor that
were linked more to prenatal representations.
These findings stress the importance of obtaining the parents’ narrative
about their baby to determine those at risk of having difficulties in their
interactions with their infant and depression. It also confirms that the sickest
infants were vulnerable to less optimal interactions with their parents.

Tags: infant