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    Severe preemies may have trouble bonding


    Compared with full-term infants, almost twice as many very-preterm/very-low-birth-weight (VP/VLBW) babies have disorganized attachment, according to a recent study.

    Investigators looked at 71 VP/VLBW (born at less than 32 weeks' gestation or weighing less than 3 pounds 5 ounces) infants and 105 full-term infants and their mothers. They assessed infant attachment using the Strange Situation Assessment at 18 months of age. They also looked at maternal sensitivity during the neonatal period; mother/infant interactions at 3 months; mother’s rating of the difficulty of her baby at 3 months; and infant development using the Bayley Scales.

    Most of the infants—61% of the VP/VLBW group and 72% of the full-term group—were securely attached to their caregivers, but 32% and 17%, respectively, were not. Although maternal sensitivity was predictive of attachment disorganization in full-term infants, infant’s distressing cry and development delay were the primary predictors of attachment problems in VP/VLBW babies, not maternal sensitivity.

    Infants with healthy attachments to their parents use their parents as a home base from which to explore the world. Those with disorganized attachment show conflict and contradiction in relating to their parents.

    Disorganized bonding in the preemies seems to stem from neurological impairment and not from abuse, neglect, or insensitivity on the part of parents, according to the researchers. In full-term infants, disorganized attachment can be a sign of parental neglect or abuse, so it is important for pediatricians to know the circumstances surrounding the birth of a child with bonding issues.

    For more information about developmental milestones in preemies, visit the American Academy of Pediatrics’ healthychildren.org.

    To get weekly clinical advice for today's pediatrician, subscribe to the Contemporary Pediatrics eConsult.


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