Pridham Karen, Melby Janet N, Brown Roger, Clark Roseanne
Helen Denne Schulte Professor Emerita, University of Wisconsin-Madison School of Nursing. H6/293 Clinical Science Center, 600 Highland Ave., Madison, WI 53726-4054.
Parent Sci Pract. 2010;10(1):18-42. doi: 10.1080/15295190903014596.
Because little is known about the role of family problem-solving processes in the development of mothers' competencies in feeding a very low birth-weight (VLBW) infant, we explored the contribution made by the competence in negotiating displayed by a mother and family member as they jointly problem solve infant-care issues. The infant's neonatal biomedical condition, maternal depressive symptoms, and family poverty status may also contribute to feeding competencies. DESIGN: A sample of 41 mothers of VLBW infants from 2 longitudinal studies who were observed during feeding at 1 and 8 months infant postterm age, with a family member of their choosing, participated in a dyadic problem-solving exercise. We assessed maternal feeding competencies with the Parent-Child Early Relational Assessment (Clark, 1997) and dyadic negotiating competence using an observational scale from the Iowa Family Interaction Rating Scales (Melby & Conger, 2001). We classified infant condition through medical record audit. Maternal depressive symptoms were assessed with the Center for Epidemiologic Studies-Depression (CES-D) Scale (L. S. Radloff, 1977), and family poverty status was determined through the mother's report of family income. RESULTS: Mothers' feeding competencies, structured into 2 factors, Parental Positive Affective Involvement, Sensitivity, and Responsiveness (PPAISR) and Parental Negative Affect and Behavior (PNAB, scored in the direction of low negativity) were stable from 1 to 8 months, accounting for the entire set of predictor variables. Neonatal biomedical condition had no effect on either PPAISR or PNAB; depressive symptoms were negatively associated with PNAB at 8 months; poverty status negatively predicted both PPAISR and PNAB at 1 and 8 months; and negotiating competence of the mother-family member dyad was positively associated with PNAB at 1 month. CONCLUSIONS: Evidence that family poverty status and dyadic negotiating competence were both associated with maternal feeding competencies supports inclusion of these family-level variables in a model of feeding competencies. A mother's negotiating competence with another family member who takes a responsible role in infant care may support maternal feeding competencies during a VLBW infant's early weeks when parenting patterns are forming.
由于对于家庭解决问题的过程在极低出生体重(VLBW)婴儿母亲喂养能力发展中所起的作用了解甚少,我们探讨了母亲与家庭成员在共同解决婴儿护理问题时所展现的协商能力的贡献。婴儿的新生儿生物医学状况、母亲的抑郁症状以及家庭贫困状况也可能对喂养能力产生影响。
从两项纵向研究中选取了41名极低出生体重婴儿的母亲作为样本,她们在婴儿足月后1个月和8个月进行喂养时被观察,且有一名她们选择的家庭成员参与了二元解决问题练习。我们使用亲子早期关系评估量表(Clark,1997)评估母亲的喂养能力,使用爱荷华家庭互动评定量表(Melby & Conger,2001)中的观察量表评估二元协商能力。通过病历审核对婴儿状况进行分类。使用流行病学研究中心抑郁量表(CES-D量表,L. S. Radloff,1977)评估母亲的抑郁症状,并通过母亲报告的家庭收入确定家庭贫困状况。
母亲的喂养能力分为两个因素,即父母积极情感投入、敏感性和反应性(PPAISR)以及父母消极情感和行为(PNAB,低分表示低消极性),从1个月到8个月保持稳定,占所有预测变量。新生儿生物医学状况对PPAISR或PNAB均无影响;抑郁症状在8个月时与PNAB呈负相关;贫困状况在1个月和8个月时对PPAISR和PNAB均有负向预测作用;母亲 - 家庭成员二元组的协商能力在1个月时与PNAB呈正相关。
家庭贫困状况和二元协商能力均与母亲喂养能力相关的证据支持将这些家庭层面的变量纳入喂养能力模型。在育儿模式形成的极低出生体重婴儿早期几周,母亲与在婴儿护理中承担责任的另一名家庭成员的协商能力可能有助于支持母亲的喂养能力。