Use of a behavioural programme in the first 3 months to prevent infant crying and sleeping problems. Enhancing infant development and parent-practitioner interaction with the Brazelton Neonatal Assessment Scale. Enhancing reciprocity between mother and neonate. Patient education: effects of two teaching methods upon parental retention of infant feeding practices. The role of an early intervention on enhancing the quality of mother-infant interaction. Effect of a consultation teaching behaviour modification on sleep performance in infants: a randomised controlled trial. Effectiveness of prenatal and postnatal instruction in postpartum care. Effectiveness of postpartum education received by certified nurse-midwives' clients at a university hospital. An intervention program for families with irritable infants. Promoting awareness: the mother and her baby. Effect of early postpartum teaching on primiparas' knowledge of infant behavior and degree of confidence. The effects of postnatal health education for mothers on infant care and family planning practices in Nepal: a randomised controlled trial. Effect of teaching on primiparas' perceptions of their newborn. Effects of parent training on infant sleeping patterns, parents' stress, and perceived parental competence. Increasing the protection of newborn infants in cars. First-time mothers' selection of infant supine sleep positioning. A behavioral-educational intervention to promote maternal and infant sleep: a pilot randomized, controlled trial. Early intervention using Brazelton training with middle-class mothers and fathers of newborns. An intervention to increase father involvement and skills with infants during the transition to parenthood. Maternal role competence.
To assess the effectiveness of a behavioural programme introduced in the first 3 months of age in preventing infant crying and sleeping problems. Two issues were addressed: (i) which elements of the behavioural programme would parents implement; and (ii) whether the behavioural programme was more effective in reducing infant crying and encouraging night-time sleeping than an educational intervention or the routine services.
                Mothers and newborns were assigned at random to the behavioural programme (n = 205), educational intervention (n = 202), or control (n = 203) group. Behaviour diaries kept before randomization and at 3, 6, 9 and 12 weeks of age were used to measure implementation of the interventions and infant behaviour, including crying and sleeping. Crying and sleeping problems were followed up using questionnaire measures at 9 months of age.
                The educational intervention did not change parental care behaviour. One element of the behavioural programme, a focal feed between 10 PM and midnight, was not implemented. A second element, stretching of interfeed intervals after 3 weeks of age, was implemented initially, but not maintained at older ages. The third element, which asked parents to emphasise day and night differences in the environment, and to settle their babies in the cot and minimise interaction at night, was carried out by more parents in the behavioural group than in the other groups. This led to an increase of around 10% in the number of babies who slept for 5 or more hours at night (a definition of sleeping through the night) at 12 weeks of age. Fewer behavioural programme parents sought help for crying and sleeping problems between 3 and 9 months of age.
                The behavioural programme produced a modest increase in the number of infants who slept through the night by 12 weeks of age. The results are discussed in relation to other findings, which bear on the programme's adoption for routine health-care policy and practice. Studies performed in low socioeconomic populations have shown that the demonstration of a newborn's developmental capacity to his mother during the first few days post partum enhances subsequent mother-infant interactions. This study was undertaken to determine whether demonstrating the Brazelton Neonatal Assessment Scale to white middle-class mothers would result in similar outcomes. Mothers of 75 neonates were randomly assigned to either an experimental group or to one of two control groups. Direct observation, subjective assessment of mother-infant interactions, and maternal questionnaires were used 1 and 3 months later to assess outcomes on several dimensions. Mothers in the experimental group spent more time playing with, talking to, and looking at their infants than did those in either control group, and were less likely to use feeding as a method of interacting with their infants. Experimental group mothers also were more likely to ask developmentally related questions. However, no differences were found in most indices of maternal-infant interaction used. The results of this study and a review of the literature indicate that the recommendation that such a demonstration be performed with all neonates must be weighed against the other methods available for enhancing infant development and healthy parent-child interaction. Thirty mothers of newborn infants were assigned to one of three equal-sized treatment groups to assess the effects on maternal responsiveness of an early intervention designed to familiarize mothers with the capabilities and individual characteristics of their infants. Mothers in one treatment group observed the administration of the Brazelton Neonatal Behavior Assessment Scale to their infants, were given an explanation of each item on the scale, and were told their infants' responses. Mothers in a second group were given the same individualized explanations about the scale items and their infants' responses, but did not observe the events. A third group of mothers, which served as control group, received individual instruction on infant furnishings. Maternal responsiveness was enhanced significantly in the "show-and-tell" group but not in the "tell-only" group. Parallel effects on infant responsiveness were also observed. ' The purpose of this study was to test a strategy for improving patient's retention of discharge teaching.
                A pretest-posttest experimental design was used. Forty postpartum women were randomly assigned to a group. All subjects received infant feeding instruction until they reached criterion on the Infant Feeding Questionnaire. The experimental group received additional instruction on the same material (overlearning). The two groups were compared 2 weeks later on the same questionnaire. Mean scores were compared by a t-test, demographic variables were correlated to outcomes, and effect of race or culture was analyzed by ANOVA.
                The pretest showed no significant difference between the groups. Posttest scores were significantly higher for the experimental group. The mother's education was the only demographic variable that was correlated to the results.
                Mothers who receive overlearning beyond the mastery level retain significantly more of the material. The study examines an intervention designed to influence mothers' sensitive responsiveness toward their infant by presenting information about the newborn's competence to interact and promoting affectionate handling and interaction with the infant. Thirty-six primiparous mothers and their newborn infants participated in the study. On day 2/3 after delivery, mother-infant dyads were assigned to either: (1) an experimental group that received an intervention program designed to enhance mother-infant interaction; or (2) a control group that was presented with an intervention that emphasized basic caregiving skills. One month later an observation was undertaken in the home to assess mother-infant synchronous and asynchronous co-occurrences during free-play and infant bathing. The enhancement group showed a reliably greater frequency of co-occurrences involving vocal exchanges, looking to the partner, and physical contact. There also were differences in mothers' responsiveness to infant crying and involuntary responses. The findings show that even a modest videotaped early intervention can enhance mothers' sensitive responsiveness to the infant. To evaluate the effect of a behaviour modification program, taught to parents in a single visit to a trained nurse, in improving sleep performance in newborn infants, Australia.
                Randomised controlled trial.
                268 families with normal newborn infants in the community, recruited between October 1996 and March 1997 from birth notices published in a South Australian daily newspaper.
                A 45-minute consultation with a nurse 2-3 weeks after the birth, including a tutorial discussion on normal sleep patterns in newborn infants, supported by retained written material and, for infants with weight gain < 30 g daily, referral to their usual postnatal care provider.
                Hours of daytime sleep (0600-1800), night sleep (1800-0600) and total sleep per 24 h; and number of daily records with total sleep >/= 15 h per 24 h, assessed by 7-day sleep diary at ages 6 and 12 weeks.
                268 families returned at least one sleep diary (137/171 intervention, 131/175 control), recording 3273 days. Two intervention infants were referred for low weight gain. Total sleep time was 15 h or more per 24 h on 62% of recorded days in the intervention group, compared with 36% in the control group (P < 0.001). At 6 weeks of age, intervention infants slept a mean 1.3 h per day more than control infants (95% CI, 0.95-1.65), comprising a mean 0.5 h more night sleep (95% CI, 0.32-0.69) and 0.8 h more daytime sleep (95% CI, 0.56-1.07). At 12 weeks, intervention infants slept a mean 1.2 h per day more (95% CI, 0.94-2.14), comprising 0.64 h more night sleep (95% CI, 0.19-0.89) and 0.58 h more daytime sleep (95% CI, 0.39-1.03). There was no significant difference in crying time between the groups.
                A single consultation supported by written material in the first 3 weeks of a child's life improves sleep performance at 6 weeks of age. This improvement is maintained at 3 months. nan This pilot study's objective was to determine the effectiveness of postpartum education received by midwifery clients at the University of New Mexico Hospital. The authors of the study randomized 100 women following delivery to two groups. Group one, n = 55, received written postpartum instructions only. Group two, n = 45, received oral instructions by the certified nurse-midwife in addition to the written instructions. Both groups answered a written questionnaire after the teaching. Analyses were carried out on 100 posttest scores. Mean test scores for group one was 17.9 out of a possible score of 20. Mean score for group two was 18.3. No significant difference was detected between these two mean scores. A 95% confidence interval for the difference between mean scores was -1.9 to 1.1 (P > .05). Reliability of instrument was established via the Kuder-Richardson formula 21. This conservative estimate of internal consistency yielded r = .50. The authors found that oral instructions by the certified nurse-midwife did not significantly increase the knowledge of primiparas as evidenced by posttest results. However, results must be interpreted cautiously for three reasons: low reliability of the instrument, the small difference between groups, and the sample size. The need to determine how best to approach postpartum education is imperative in this era of early hospital discharge. A certified nurse-midwife's time may be better spent focusing on individual concerns rather than on a set teaching agenda. Alternative opportunities such as postpartum home visits need to be explored as a means of providing support and guidance to new mothers. To describe and evaluate a home-based nursing intervention program, the REST routine, which incorporates the use of infant behavior assessment, pattern recognition, individualized infant schedules, specific management strategies, and parent education and support.
                A two-site clinical trial was conducted on 164 healthy full-term infants with excessive unexplained irritability or colic. Infants between the ages of 2 to 6 weeks were randomized to routine care or a home-based intervention program (n = 121). A third group (n = 43) of infants too old at entry for randomization (mean age = 10.4 weeks) were entered into a posttest-only group.
                Infants in the REST routine treatment group cried 1.3 hours per day on average following the intervention program as compared to the control group crying 3 hours per day (p = .02). Infant irritability was resolved (< 1 hour) in 62% of the treatment group while only in 29% of the control group at the time of the 8-week follow-up visit (p = .04).
                Families in both the treatment and control groups reported benefiting from a nurse visiting in their home to inquire about their infant and their well-being. Options for individualizing the program for those most in need of intensive home visiting and other delivery modes for the intervention are areas for further investigation. This study considered the problem of how to increase a mother's awareness of her infant's behavior and her own behavior as a beginning step toward the promotion of quality interaction between mother and infant. The impact of informing 108 mothers of term infants and 32 mothers of preterm infants about: (a) neonatal interactive, motoric, state control, and response to stress behavior patterns; and (b) maternal behaviors to enhance and support infant behavior was tested with four groups. In describing the behavior that occurred during a feeding session, mothers in two treatment groups reported significantly more of their own behavior than that of their neonate. They more closely resembled the trained observers' report of the behavior than did mothers in two control groups. Recommendations include incorporating an educative treatment in plans of nursing care for mothers and infants and further research to determine the optimal timing and long-term effects of such an intervention. The purpose of this experimental study was to determine the effectiveness of teaching primiparous mothers about infant behavior. Experimental mothers (n = 17) received a teaching intervention representative of the Brazelton Neonatal Behavioral Assessment Scale when their infants were 2 weeks old; contrast mothers (n = 16) completed a Newborn Information Checklist about infant behavior at home two weeks postnatally; control mothers (n = 13) received neither teaching nor a checklist. At a 4-week postnatal office visit, experimental mothers had more knowledge about infant behavior than either the contrast or control mothers. There was no difference among the groups regarding maternal confidence in interpreting behavioral cues of their own infant. Contrast mothers reported wanting information about topics included in the teaching intervention. To evaluate impact of postnatal health education for mothers on infant care and postnatal family planning practices in Nepal.
                Randomised controlled trial with community follow up at 3 and 6 months post partum by interview. Initial household survey of study areas to identify all pregnant women to facilitate follow up.
                Main maternity hospital in Kathmandu, Nepal. Follow up in urban Kathmandu and a periurban area southwest of the city.
                540 mothers randomly allocated to one of four groups: health education immediately after birth and three months later (group A), at birth only (group B), at three months only (group C), or none (group D).
                Structured baseline household questionnaire; 20 minute, one to one health education at birth and three months later.
                Duration of exclusive breast feeding, appropriate immunisation of infant, knowledge of oral rehydration solution and need to continue breast feeding in diarrhoea, knowledge of infant signs suggesting pneumonia, uptake of postnatal family planning.
                Mothers in groups A and B (received health education at birth) were slightly more likely to use contraception at six months after birth compared with mothers in groups C and D (no health education at birth) (odds ratio 1.62, 95% confidence interval 1.06 to 2.5). There were no other significant differences between groups with regards to infant feeding, infant care, or immunisation.
                Our findings suggest that the recommended practice of individual health education for postnatal mothers in poor communities has no impact on infant feeding, care, or immunisation, although uptake of family planning may be slightly enhanced. To determine if a relationship exists between structured, informative in-home teaching concerning infant behavior and primiparous mothers' perceptions of their newborn, 30 primiparas completed Broussard's Neonatal Perception Inventories I and II. The sample--30 women between the ages of 18 and 30 who had had no chronic disorders and had experienced normal pregnancy, labor, delivery, and postpartal course--was deliberately selected from a 489-bed community teaching hospital; 15 women were assigned randomly to a control group and 15 to an experimental group. All participants completed NPI I on their first or second postpartum day. Experimental participants received structured, informative teaching concerning infant behavior two to four days after discharge. All subjects were again visited at one month to complete NPI II. Data were analyzed by t test; significance was set at p = .05. No significant difference was found between the groups in NPI I perceptions. On NPI II a significantly positive change in perception was found for the experimental group, but not for the control group. First-time parent couples from childbirth classes were randomly assigned to a four-session training group (n = 29) or a control group (n = 31). Members of the training group were taught behavioral strategies to promote healthy, self-sufficient sleep patterns in their infants, whereas the control group received the same amount of personal contact without the behavioral training. Six sleep variables were derived from a daily infant sleep diary completed by parents at two time points. Results show that at age 6-9 weeks, infants in the training group displayed significantly better sleeping patterns than did control infants. Training group parents awakened and responded less often to infant signaling and reported greater parental competence. By contrast, control group parents indicated increased stress over time. Recently the American Academy of Pediatrics instituted a major campaign ("The First Ride--A Safe Ride") in order to encourage all parents to use an infant restraint seat for their newborn's first ride in an automobile--the ride home from the hospital. In the present study the effect of the behavior of the hospital staff on parents' use of infant restraint seats was examined. This study involved 30 mother-infant pairs who were selected sequentially from an obstetrics unit and randomly assigned to two groups. A control group was discharged from the obstetrics unit with no particular emphasis on car safety and no loaner restraint seat available. An experimental group was offered a loaner restraint seat at the time of discharge, with a staff person demonstrating how to put the infant into the restraint seat, how to carry the infant in the seat out to the car, and how to fasten the restraint seat in the automobile with the auto lap belt. Correct use of the loaner restraint seat on the first ride home was observed in 67% of the experimental mothers and in none (0%) of the control mothers. Although this difference was no longer significant at four- to six-week follow-up this study points out the short-term impact that hospital staff can have on the parents' use of restraint seats. Additional techniques are needed to maintain parents' use of restraint seats throughout childhood. The incidence of Sudden Infant Death Syndrome (SIDS) has decreased dramatically since the inception of the "Back to Sleep" campaign initiated by the American Academy of Pediatrics in 1992. However, that decrease has leveled off and many new parents cease to follow the recommendation to place their infants in the supine position for sleep between 1 and 3 months of age, the peak age for the incidence of SIDS. Shortened hospital stays for new mothers and the overwhelming amount of required patient teaching dictate the need to find the best method of instruction. The purpose of this study was to determine if a one-on-one teaching intervention improved the effectiveness of patient education and led to an increase in the desired behavior of placing the infant to sleep in the supine position. A quantitative experimental approach was used to examine the difference in compliance of supine infant positioning. Participants were drawn from a convenience sample of 61 primiparous women between the ages of 18 and 35 years with random assignment to either the experimental or control group. Compared to mothers in the control group, mothers in the experimental group demonstrated greater compliance in selecting supine sleep position in the first week home from the hospital and on the day of follow-up 6 weeks later. However, no difference in "usual position" was reported at 6 weeks and for the night previous to follow-up. Maternal and infant sleep are significant health concerns for postpartum families. The results of previously published studies have indicated that behavioral-educational strategies promote infant sleep, but these reports relied on parental report and did not include maternal sleep. This pilot study of a maternal-infant sleep intervention evaluated feasibility, acceptability, and effects on sleep and other outcomes in the early postpartum period.
                Randomized controlled trial with concealed-group allocation.
                Hospital postpartum unit with home follow-up.
                First-time mothers and their infants randomly assigned to sleep intervention (n = 15) or control group (n = 15).
                The sleep intervention included a 45-minute meeting with a nurse to discuss sleep information and strategies, an 11-page booklet, and weekly phone contact to reinforce information and problem solve. The control group received a 10-minute meeting during which only maternal sleep hygiene and basic information about infant sleep were discussed, a 1-page pamphlet, and calls at weeks 3 and 5 to maintain contact without provision of advice.
                Questionnaires were completed at baseline and 6 weeks; sleep diaries and mother and infant actigraphy were completed at 6 weeks. The mothers in the sleep intervention group averaged 57 minutes more nighttime sleep, and fewer rated their sleep as a problem, as compared with the mothers in the control group. Infants in the sleep intervention group had fewer nighttime awakenings and had maximum lengths of nighttime sleep that were, on average, 46 minutes longer than those in the control group.
                A behavioral-educational intervention with first-time mothers in the early postpartum period promotes maternal and infant sleep. Further evaluation of the intervention in a larger, more diverse sample is needed. The purpose of this study was to test the effectiveness of the Brazelton exam as a parent education tool for mothers and fathers. 42 middle-class families with firstborn, healthy, full-term infants were randomly assigned to one of three groups: father treatment, mother treatment, and control. The target parents in the treatment groups were taught to perform the Brazelton exam on their own infant, with attention being drawn to the infant's most positive interactive and physical abilities. Questionnaire and observational data were collected in the hospital and at 4 weeks postpartum. These included measures of knowledge of infant behavior, confidence in parenting ability, satisfaction with the infant, and behavior with the infant. The results showed that treatment parents scored higher in knowledge about infants, at both the early and the 4-week periods. Also, treatment fathers were more involved in caretaking with their infants at 4 weeks than were control fathers. More modest treatment effects were shown for confidence and satisfaction measures. No behavioral treatment effects were found during a 10-min observation of parent-infant interaction. This study examined whether a group educational intervention during the transition to parenthood can enhance the quality of father-child interaction and increase father involvement with their children. A randomized experimental design was used to evaluate an 8-session program with 165 couples who were first-time parents, beginning during the second trimester of pregnancy and ending at 5 months postpartum. Outcomes were assessed with time diaries, coded observations of parent-child play, and self-reports of fathers and mothers. The intervention had positive effects on fathers' skills in interacting with their babies and their involvement on work days but not home days. It is concluded that a relatively brief intervention during the transition to parenthood can improve fathering, and possible reasons for differential effects on areas of parenting are explored.
                Copyright (c) 2006 APA, all rights reserved. nan
The benefits of educational programs to participants and their newborns remain unclear. Education on sleep enhancement appears to increase infant sleep and education about infant behaviour potentially enhances mothers' knowledge; however more and larger, well-designed studies are needed to confirm this.