Michael W. Yogman

Theory and research in behavioral pediatrics

Eight contributions address: material cocaine use and neonatal outcome; nonorganic failure to thrive; understanding and controlling violence; the role of school in prosocial development; lateralization of function; lateralized behavior organization during infancy; parent-infant interaction; and manu

Father involvement and cognitive/behavioral outcomes of preterm infants

OBJECTIVE To assess the independent effect of father involvement on intellectual and behavioral outcome of 985 low birth weight preterm infants followed longitudinally from birth to age 3 years as part of the Infant Health and Development Program. METHOD The sample for this study is drawn from eight urban sites, composed largely of ethnically diverse and relatively disadvantaged families. On the basis of a combined score for fathers stable presence in the home and amount of play with the infant, we defined extreme groups of high-involvement fathers (33%, n = 305) and low-involvement fathers (16%, n = 148), with the remainder as a middle group (51%). RESULTS Most fathers played a meaningful role as play partner with their high-risk infants. Approximately 75% of fathers were reported to play with the baby every day at 12 (peak), 24, and 36 months. Fathers who were black, younger, had teenage mothers as companions, or were from low-income families were less involved with their infants. For black fathers, low family income was significantly associated with low father involvement. Within the black ethnic subgroup only, higher father involvement was associated with improved cognitive outcome. Mean IQ for the high-involvement subgroup was 6.00 points higher than for the low-involvement group even after adjusting for family income, neonatal health, treatment group status, and paternal age. CONCLUSION Father involvement enhances cognitive outcome in black families and may have implications for intervention.

Growth status and growth rates of a varied sample of low birth weight, preterm infants: A longitudinal cohort from birth to three years of age

To obtain follow-up growth data on a large sample of low birth weight, preterm infants, 985 infants were monitored longitudinally in an eight-site collaborative program until 3 years of age, corrected for prematurity. The growth of 608 of these infants was described previously through 1 year of age. In the full sample, 149 infants weighed less than or equal to 1250 gm at birth, 474 between 1250 and 2000 gm, and 362 between 2000 and 2500 gm. Thirty-three percent were white, 53% were black, and 11% were Hispanic. Weight, length, and head circumference were measured at birth and at 40 weeks and 4, 8, 12, 18, 24, 30, and 36 months gestation-corrected age in at least 862 infants each time. Descriptive statistics and estimated growth rates for all growth variables and a body mass index (height in kilograms per square meter), plotted by sex and birth weight group, demonstrated growth patterns lower than published standards for term infants of the same age and sex. These patterns of growth differed by birth weight group. Little catch-up was noted by the 36-month examination for gestation-corrected age for any birth weight group. We conclude that low birth weight, preterm infants have different patterns of growth than term infants during the first 3 years of life, even with plotting corrected for gestational age.

Growth patterns of low birth weight preterm infants: A longitudinal analysis of a large, varied sample

To obtain growth data on a large sample of low birth weight preterm infants, we monitored 608 infants longitudinally in an eight-site collaborative program. Ninety-nine infants weighed less than or equal to 1250 gm at birth, 289 between 1250 and 2000 gm, and 220 infants between 2000 and 2500 gm. Thirty-four percent were white, 52% black, and 14% Hispanic. Weight, height, and head circumference were measured at birth and at 40 weeks and 4, 8, and 12 months of gestation-corrected age on at least 553 infants each time. Descriptive statistics for all growth variables and a body mass index (kilograms per square meter), plotted by sex and birth weight group, demonstrated growth patterns lower than published standards for term infants of the same age and sex. These patterns of growth differed by birth weight group. No catch-up growth was noted by the 12-month examination (gestation-corrected age) for any birth weight group. We conclude that low birth weight preterm infants have different patterns of growth than term infants during the first year of life, even with plotting corrected for gestational age.

Games fathers and mothers play with their infants

Both fathers and mothers successfully engaged their infants one to six months of age in interactive games in a laboratory play situation. Both parents played almost one game per minute with their infants. Mother played more conventional limb movement games and more distal, visual, attention maintaining games while fathers played more proximal, arousing, idiosyncratic limb movement games with their infants. Interactive games with parents even during the first six months of infancy provide differential experiences for the infant. These games may have developmental significance in selectively facilitating the acquisition of social and cognitive skills.

Development of the Father-Infant Relationship

Until recently, our theories and empirical studies of infant social development largely ignored the father. The father’s role with young infants was considered to be mainly indirect, supporting the mother, who was biologically adapted to be the infant’s caregiver. This chapter will review recent studies that suggest that the father’s role with young infants is far less biologically constrained than once thought. In what way biologically based sex differences constrain the social interactions of fathers with their infants must await future research, but such constraints now seem far more subtle than once believed. Wide variability in the behavior and roles of the two parents challenges many of the stereotypes of the father as incompetent or uninvolved with the infant and leaves ample opportunity for wide variations in the way parents and their infants relate to each other.

Diet and sleep patterns in newborn infants.

Sleep behavior is modulated by serotonergic neurons within the brain, and the synthesis and release of serotonin by such neurons is thought to be influenced by the availability of tryptophan, the amino acid precursor of serotonin. We investigated the effects on the sleep patterns of newborn infants of variations in diet designed to affect tryptophan availability. Twenty healthy newborns (two to three days of age) were randomly assigned to receive a feeding consisting either of tryptophan in 10 per cent glucose or valine in 5 per cent glucose (valine competes with tryptophan for entry into the brain). Sleep patterns during the three hours after this feeding were compared with those after a feeding of routine formula (Similac). The infants fed tryptophan entered active sleep 14.1 minutes sooner than they did after Similac, and entered quiet sleep 20 minutes sooner. Those fed valine entered active sleep 15.8 minutes later than they did after Similac, and entered quiet sleep 39 minutes later. The differences between the tryptophan and valine groups were significant (P less than 0.01 for active sleep and P less than 0.005 for quiet sleep). We conclude that variations in the composition of the diet may influence sleep behavior in newborns.

Promoting Optimal Development: Screening for Behavioral and Emotional Problems

By current estimates, at any given time, approximately 11% to 20% of children in the United States have a behavioral or emotional disorder, as defined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Between 37% and 39% of children will have a behavioral or emotional disorder diagnosed by 16 years of age, regardless of geographic location in the United States. Behavioral and emotional problems and concerns in children and adolescents are not being reliably identified or treated in the US health system. This clinical report focuses on the need to increase behavioral screening and offers potential changes in practice and the health system, as well as the research needed to accomplish this. This report also (1) reviews the prevalence of behavioral and emotional disorders, (2) describes factors affecting the emergence of behavioral and emotional problems, (3) articulates the current state of detection of these problems in pediatric primary care, (4) describes barriers to screening and means to overcome those barriers, and (5) discusses potential changes at a practice and systems level that are needed to facilitate successful behavioral and emotional screening. Highlighted and discussed are the many factors at the level of the pediatric practice, health system, and society contributing to these behavioral and emotional problems.

Fathers' roles in the care and development of their children: The role of pediatricians

Fathers’ involvement in and influence on the health and development of their children have increased in a myriad of ways in the past 10 years and have been widely studied. The role of pediatricians in working with fathers has correspondingly increased in importance. This report reviews new studies of the epidemiology of father involvement, including nonresidential as well as residential fathers. The effects of father involvement on child outcomes are discussed within each phase of a child’s development. Particular emphasis is placed on (1) fathers’ involvement across childhood ages and (2) the influence of fathers’ physical and mental health on their children. Implications and advice for all child health providers to encourage and support father involvement are outlined.

Early Infant Social Interaction with Parents and Strangers

Abstract This paper extends the observations of early mother-infant face-to-face interaction to situations in which infants 1 to 6 months of age interact with fathers and strangers. Videotaped records of these laboratory interactions were scored second by second. We saw differences in the behavior of both infants and adults in these interactions. Even infants less than 2 months of age behaved distinctively with the different adults in these settings. Infants showed more positive affective displays with both parents than with strangers. The implications of these findings for the theoretical understanding of the infants affective development as well as for public health concerns are discussed.