It's no great secret that the more caring parents are, the better the kids do – but prematurely born children tend to be more sensitive to the nature of their nurture, Israeli scientists report.
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Caring for prematurely born children is a modern conundrum applying to more and more people each year. Human fertility patterns have been changing, with a possible decline in male fertility and an increasing tendency to have children later in life, at least in the west. The upshot is that more children are being born preterm, meaning before 37 weeks of pregnancy (the normal human pregnancy term is 40 weeks).
These days 11% of all births worldwide are preterm, say scientists at Ben-Gurion University of the Negev. Not only are preterm infants more likely to die; many suffer later neurological and social disabilities. A study in Norway found that about 40 percent of children born before 37 weeks have attentional and adaptive problems throughout elementary school.
Premature babies reach the world with underdeveloped biological systems. But observations led to the conclusion that premature babies who were (relative to other preemies) organically healthy, were just as susceptible to later emotional, behavioral and developmental difficulties.
If the premature birth in and of itself was not the key factor, what was?
Traumatizing neonatal care
The thought arose among Israeli scientists at the Ben-Gurion University of the Negev that the care-giving environment might be involved - from the traumatic stay in the neonatal intensive care unit with its intense medical treatments, to the "premature parenting" of the unready mom and dad.
"Prematurity is a surprise to the parents too," explains Dr. Naama Atzaba-Poria of the Department of Psychology at Ben-Gurion University of the Negev and Soroka University Medical Center. "The parents are essentially also being born ahead of time."
The research, headed by Noa Gueron-Sela, the lead author of the paper, with Gal Meiri and Kyla Marks of Soroka and published in the Child Development Journal, demonstrated that, in normative families, positive care-giving in early life improves the odds for preterm children.
That sounds profoundly obvious. The thing is, premature children are more affected than "normally born" children to the early nurturing environment, the study showed.
Normative family, with stress
The study was done on 150 two-parent, low- to middle-income families who gave birth at Soroka in Be'er Sheva. About half of the infants involved in the study were premature (born at 28-34 weeks), but were essentially healthy, explains Atzaba-Poria – they had no significant medical complications. The control half of the study were children born full-term.
When the babies were six months old, the parents complete questionnaires, assessing their own emotional state (whether they felt depression and anxiety, and stress from parenting). The researchers also assessed the degree of family warmth and cooperation based on videotaped interactions of the parents and infants playing together.
Then, when the babies reached one year of age, the researchers assessed the infants’ cognitive and social competences.
Overall, preterm infants were more affected by the quality of the care-giving environment than their full-term counterparts.
Premature babies whose mothers reported low levels of maternal distress and who lived in warm, cooperative family relationships had similar cognitive outcomes to their normally-born peers. But if anything - these prematurely born children had better social abilities than their full-term peers, the researchers found.
Regarding full-term infants, the emotional distress reported by the mothers and the quality of the relationships within the family did not affect cognitive and social development.
At this point it bears noting that all the families involved fell into the category of "normative" – what issues they had (and who doesn't) did not fall within pathological categories: no domestic violence, substance abuse, or mental illness. Within the normal range of environmental functioning, families span a range from more-distressed to less-so (Atzaba-Poria explains: "Perfectly good functional families have tensions too. Nobody's perfect.")
So, premature babies are demonstrably more sensitive to nuances in the care-giving environment.
Why that is so, is anybody's guess. Atzaba-Poria suspects that at least part of the answer may lie with the trauma of neonatal care combined with the unreadiness of the parents to cope, not only with parenting but with the added stresses of having a premature infant.
“We found that preterm infants are particularly sensitive to both negative and positive effects of parenting on development,” stated Gueron-Sela. “While stressful parenting environments predicted low developmental outcomes, positive caregiving experiences buffered the negative effects of prematurity on babies’ cognitive development and promoted their social communication competencies."
Why might preemies who do get great care, show even better social development than their "normally" born peers?
"We think it may be because cognitive development, after all, has only so much potential," says Atzaba-Poria. "Even if you have the 'best' parents in the world, your IQ won't go any higher than a given point (your potential). Social potential Is not defined and depends heavily on nurturing parent/child relationships, so with premature children, who are apparently more sensitive, when they are nurtured properly – they can rise higher."
Meanwhile, in the Arctic
Supporting the Israeli study, researchers in Norway report that a brief training plan parents right after a premature child's birth can work wonders for the kids in later childhood.
The study was carried out on 72 prematurely born children at the University Hospital of North Norway and the Arctic University of Norway, Tromsø,.
The Mother-Infant Transaction Program (MITP) consisted of 11 one-hour sessions. After the program was completed, researchers received reports from parents and teachers about the children’s behavior through age 9.
The behavioral development of the 72 children born prematurely was compared with that of 74 children born prematurely who did not take part in the intervention, and 75 children who were born full term and also didn’t participate in the intervention.
At ages 7 and 9, the children whose parents took part in the intervention had significantly fewer attentional problems than the children born preterm whose parents didn’t participate in MITP, and they adapted more successfully to school, the study found.