Angela Underdown

Tactile stimulation in physically healthy infants : results of a systematic review

Touch establishes powerful physical and emotional connections between infants and their caregivers, and plays an essential role in development. The objective of this systematic review was to identify published research to ascertain whether tactile stimulation is an effective intervention to support mental and physical health in physically healthy infants. Twenty‐two studies of healthy infants with a median age of six months or less met our inclusion criteria. The limited evidence suggests that infant massage may have beneficial effects on sleeping and crying patterns, infants’ physiological responses to stress (including reductions in serum levels of norepinephrine and epinephrine, and urinary cortisol levels), establishing circadian rhythms through an increase in the secretion of melatonin, improving interaction between mother‐infant dyads in which the mother is postnatally depressed, and promoting growth and reducing illness for limited populations (i.e. infants in an orphanage where routine tactile stimulation is low). The only other evidence of a significant impact of massage on growth in infants living in families was obtained from a group of studies regarded to be at high risk of bias which we have reported separately. There is no evidence of a beneficial effect on infant temperament, attachment or cognitive development. There is, therefore, some evidence of benefits on mother‐infant interaction, sleeping and crying, and on hormones influencing stress levels. In the absence of evidence of harm, these findings support the use of infant massage in the community, particularly in contexts where infant stimulation is poor. Further research is needed, however, before it will be possible to recommend universal provision.

Promoting the social and emotional health of children: where to now?

In advanced industrial societies such as the UK, the burden of disease is shifting from physical to mental health problems - emotional and behavioural problems currently being the major cause of disability in children. Evidence concerning the role of parents in promoting children’s social and emotional health, in conjunction with the benefits of supporting parents in this role, has focused attention on the need for greater clarity concerning the role of both parents and governments in supporting and protecting children’s social and emotional health. This paper examines the evidence base concerning children’s social and emotional development and suggests some steps that may be necessary to ensure the future promotion of children’s social and emotional health.

Pilot RCT of the use of video interactive guidance with preterm babies

Abstract Objective: To assess the potential of video interaction guidance (VIG) to increase sensitivity in parents of preterm infants. Background: Parental sensitivity has been identified as explaining some but not all of the capacity of full-term infants for later affect-regulation via its impact on the infant’s attachment system. Video interaction guidance (VIG) appears to be a promising intervention to improve parental sensitivity. Methods: A pilot randomised control trial was undertaken of the effectiveness of VIG in improving parental sensitivity using the CARE-Index as a primary outcome measure. Secondary outcomes included parenting stress, depression and anxiety, and post-traumatic stress. Data were collected at baseline and post-intervention, and analysed on an intent-to-treat basis, using analyses of covariance. Results: Thirty-one parents of an infant born at 32 weeks or less gestation were recruited from a city neonatal intensive care unit (NICU). The results show large but non-significant differences favouring the intervention group for both parental sensitivity (d = 0.86; p = 0.069) and infant cooperativeness (d = 0.78; p = 0.10). There were also medium to large non-significant differences favouring the intervention group for depression (d = 0.33; p = 0.41), anxiety (d = 0.38; p = 0.30), and parenting stress (d = 0.87; p = 0.14). There was no difference between groups in the proportion of parents with post-traumatic stress disorder (RR: 1.05; 95% CI: 0.85–1.37). Conclusion: VIG appears to be a promising intervention with which to increase parental sensitivity in parents of preterm infants, but additional components explicitly targeting parental trauma may also be needed.

Systematic review of parenting programs for preterm and low birthweight infants on enhancing parent-infant interaction by improving parental sensitivity

Background and Aims Parental sensitivity has been identified as being important to the infants developing central nervous system and capacity for affect regulation. However, this can be compromised in parents of preterm and low birthweight (LBW) infants, as a result of stress associated with giving birth to a preterm of low birthweight baby, and the associated processes (eg, threat of death; extended hospitalised; intrusive procedures etc. A number of interventions have been developed to improve parent-infant interaction by improving parental sensitivity, and the aim of this review was to synthesise evidence about the effectiveness of such interventions. Methods Key biomedical and social science databases were searched from 1990 to 2010. Only randomised controlled trials (RCTs) of interventions directed at parents of preterm (>37 weeks) and /or LBW (<2500 kg) infants. Included studies were critically appraised using standardised criteria. Data were not combined in a meta-analysis due to the presence of clinical heterogeneity, and a narrative summary is provided. Outcome measures: Parental sensitivity and/or parent-infant interaction. Results Eleven RCTs were included evaluating interventions aimed at promoting human touch (n=4), improving parent education (n=3) or that comprised multiple components (n=4). All included studies had numerous threats to internal and external validity (eg, poor allocation concealment; lack of intention-to-treat analysis and high dropout). The results suggest that six interventions had a significant impact on improving either parental sensitivity or parent-infant interaction (including two multi-component; two parent education and two touch-based programmes). The remaining five studies showed no evidence of benefit. Conclusion There is limited evidence from a number of medium-quality RCTs suggesting that interventions delivered to parents of preterm or LBW infants can improve maternal sensitivity and/or parent-infant interaction. Further research is needed to identify whether improved parental sensitivity leads to improved parent-infant interaction.