Quality of mother-infant attachment and pediatric health care use.

The relationship between infant pediatric care use in the first year of life and the quality of mother-infant attachment at 1-year of age was examined. Fifty-six mother and infant pairs were classified by the Ainsworth Strange Situation procedure as securely (n = 17) or anxiously attached (n = 39). Pediatric records for the first 12 months of life were reviewed for frequency and type of visit, diagnoses, treatment, and symptoms prompting the care visit. Anxiously attached infants used acute care services (walk-in and emergency room) significantly earlier and more often than infants with a secure attachment. Use of acute care services began at a mean age of 3.8 months for the anxiously attached infants compared with 6.5 months for the securely attached. Differences in utilization persisted through the year. Mean acute care use in the anxiously attached infants was 3.6 visits compared with 1.9 visits for the securely attached. Acute care use was associated with a variety of common infant illnesses in both groups. In contrast, there was no difference in the use of well-baby care (mean 6 visits). Utilization and attachment status were independent of birth or prenatal difficulties. High cumulative use of pediatric care during the first year of life may identify infant and mother pairs who are experiencing strain in their interactions and relationship. Early recognition would provide an opportunity for comprehensive assessment and preventive intervention in the pediatric setting.