1. Beal, Judy A. DNSc, PNP, RN
  2. Freda, Margaret Comerford EdD, RN, CHES, FAAN

Article Content

Choo, J., Holditch-Davis, D., & Belyea, M. (2004). Journal of Pediatric Nursing, 19(3), 163-175.


The maternal-child relationship has been studied extensively in both full-term and premature infants. The association between maternal-child interaction and attachment has been well-established for many years. Research has also concluded that mothers of premature infants demonstrate fewer positive interactions and less social interaction than mothers of full-term infants, and that developmental disability and illness severity is also related to the quality and quantity of interaction and to the developmental outcomes of children. This descriptive, comparative study of 53 mothers and 3-year-old premature children dyads used the theoretical framework of Barnard, Bee, and Hammond (1991) and Bronfenbrenner (1989), which postulates that interaction between the mother and infant is a dynamic system that is modulated by several factors, including personal characteristics such as maternal education, age, and ethnicity, as well as the environment. All of the participants were part of a larger study exploring the relationship between prematurity and developmental outcomes. This is a common practice of researchers where smaller, focused spin-off studies are generated from larger, more expansive studies. Several valid and reliable instruments were used to collect data for this smaller study: naturalistic observation of mothers and children in home and daycare settings, the HOME (Home Observation for Measurement of the Environment) Inventory, the NBRS (Neurobiological Risk Score), IQ (Stanford-Binet Intelligence Scale), and PEET (Pediatric Extended Examination at Three) assessment of language delay. The sample dyads were divided into two groups based on gender and ethnicity. After controlling for maternal education and illness severity, mothers demonstrated more positive interactions toward girls, and White mothers also had more positive interactions and scored better on the HOME subscales of maternal responsivity, understanding of child behavior, and appropriateness of stimulation. These findings are well-supported in the literature, clearly support the theoretical framework, and point to the necessity for enhanced nursing interventions targeting poor, non-White mothers and mothers of children with severe disability/illness.


Comment by Judy Beal




1.Barnard, K. E., Bee, H. L., & Hammond, M. A. (1984). Developmental changes in maternal interactions with term and preterm infants. Infant Behavior and Development, 7, 101 - 113.


2.Bronfenbrenner, U. (1989). Ecological system theory. Child Development, 6, 187 - 249. [Context Link]