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Post-discharge responsive parenting programmes

Authors

Koldewijn K, Wolf MJ, Pierrat V, van Wassenaer-Leemhuis A, Wolke D

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Target group

Infants born very preterm or those infants with risk factors (see preamble of TEG Follow-up & continuing care), parents and their families

User group

Healthcare professionals, neonatal units, hospitals, follow-up teams, and health services

Statement of standard

All very preterm infants and their families are offered preventive responsive parenting support after discharge home.

Rationale

The strong influence of early experience and environmental influences on brain architecture makes the first years of life a period of both opportunity and vulnerability for development. (1)

Particularly the consistency of responsive interactions between children and their parents is of pivotal influence, because it affects both the developmental process of the infant’s brain, as well as the adult’s transition to parenthood. (1,2)

In very preterm parent-infant dyads, difficulties in responsive interactions may easily occur, as more than half have multiple mild developmental problems. The infants may be less responsive and explorative, and have more feeding and sleeping difficulties and/or experience more stress and disorganisation. (3) The problems may be bidirectional, as risk factors like depression or chronic stress are more common in parents of preterm infants and may impede the parental neurobiological and psychological changes that support responsive parenting under normal conditions. (2,4)

Consequently, very preterm infants may need more sensitive/responsive parenting, at a time when the parents themselves are often under additional stress. The first postnatal year offers a window of opportunity, because at this early stage, the brains of both the preterm infant and parent are particularly receptive to interventions that address responsive parenting. (2,5) Therefore, supporting both parents and the parent-child relationship is recommended (‘two generation approach’) to enhance infant developmental opportunities. (6)

Benefits

Short-term benefits
N/A

Long-term benefits

  • Improved motor and cognitive development, behaviour, self-regulation, and wellbeing (7–15)
  • Less referral for paramedical support (7–15)
  • Improved health, sleeping, eating and early communication between infant and parent (consensus)
  • Improved parental wellbeing and parent-child interactions (12,16–20)
  • Less parenting stress (19,21,22)

Components of the standard

Component Grading of evidence Indicator of meeting the standard
For parents and family    
1. Parents are informed by healthcare professionals about responsive parenting support after discharge. (23–27) A (High quality)
B (High quality)
Patient information sheet
       
2. Intervention to support the parent-infant relationship starts in hospital and continues in the home environment. (1,2,23–27) (see TEG Infant- & family-centred developmental care) B (High quality) Guideline, parent feedback
       
3. Parents contribute to reports of developmental progress as equal partners with healthcare professionals. B (Moderate quality) Clinical records, parent feedback
       
For healthcare professionals    
4. A guideline on early post-discharge responsive parenting programmes is adhered to by all healthcare professionals. B (High quality) Guideline
       
5. Continuous professional development in a responsive parenting programme, based on evidence or best practice is attended by all responsible healthcare professionals. (7,10,23–27) A (High quality)
B (High quality)
Training documentation
       
For neonatal unit, hospital, and follow-up team    
6. A guideline on early post-discharge responsive parenting programmes is available and regularly updated. B (High quality) Guideline
       
7. Continuous professional development in a responsive parenting programme, based on evidence or best practice is ensured. (7,10,23–27) A (High quality) 
B (High quality)
Training documentation
       
For health service    
8. A national guideline on early post-discharge responsive parenting programmes is available and regularly updated. B (High quality) Guideline
       
9. Appropriate funding for early post-discharge responsive parenting programmes is provided. (23–27) B (High quality) Audit report
       
10. Uptake of early post-discharge responsive parenting programmes is monitored. B (High quality) Audit report
       

Where to go

Further development Grading of evidence
For parents and family  
  • Consider post discharge parenting programmes for other vulnerable groups of children, starting with moderately preterm infants. (23–27)
B (High quality)
For healthcare professionals  
  • Consider extensions of evidence-based post-discharge intervention programmes at other critical periods in the development of a preterm child. (23–29)
A (Moderate quality) 
B (High quality)
For neonatal unit, hospital, and follow-up team  
  • Include a minimum dataset in the follow-up programmes to better assess the impact of post-discharge intervention programmes on development.
B (Moderate quality)
For health service  
  • Encourage studies that develop more individualised responsive parenting programmes. (30)
B (Moderate quality)
   

Getting started

Initial steps
For parents and family
  • Parents are informed by healthcare professionals about anticipatory guidance on the transition to parenthood and are asked about their own wellbeing.
For healthcare professionals
  • Attend training on child development, parenting influences, and responsive parenting interventions.
For neonatal unit, hospital, and follow-up team
  • Develop and implement a guideline on follow-up including responsive parenting programmes for parents of very preterm infants.
  • Develop information material on positive responsive parenting.
  • Assess the availability of post-discharge intervention programmes and create a network between units to support parents.
  • Support healthcare professionals to participate in training on child development, parenting influences, and responsive parenting interventions.
  • Ensure appropriate healthcare professionals have extra time and knowledge needed to support parents and infants in responsive parenting programmes.
For health service
  • Develop and implement a national guideline on follow-up including responsive parenting programmes for parents of very preterm infants.
  • Raise awareness about the critical early years for infant development, and the need to give positive support to parents of preterm born children.
  • Encourage health systems and stakeholders to invest in training in responsive parenting.
 

Description

Key features of programmes to support parenting are:

Parents receive inspiring information on the child’s behavioral signals and small next developmental steps.

  • Pro-active information is known as a strong protective factor. Strengthening parental understanding of environmental influences on early brain development, providing inspiring information on the infant’s behavioral signals and taking small next steps may help parents in their mediating task, these may promote appropriate developmental expectations.
  • In addition, knowledge of the sensitive periods in brain development enables parents to support their child’s age-specific development and needs at any time in order to thrive in an optimal way.

Parents are supported through ‘strength-based’ intervention suggestions.

  • Responsive parenting programmes that have a strength-based approach focus on reinforcing the strengths and resources that already exist in the infant and parent. A positive approach helps parents to respect and enjoy their child’s behavioral efforts and skills, and gives the satisfaction to be able to help their child; it may support parental self-efficacy and confidence in themselves and their child.

Parents learn about the transition to parenthood and their own wellbeing.

  • Pro-active information about the transition to parenthood and psycho-education during the sensitive period of the neurobiological transition to parenthood may enhance a positive feed-forward loop: parental wellbeing supports parents’ sensitivity and responsive interactions, which is reflected in more structural growth and activity in the reward and motivational circuits in their brain. This appears significant, as these changes are also associated with more sensitive and caring maternal and paternal behaviors.

Sources

  1. Timing_Quality_Early_Experiences-1.pdf [Internet]. [zitiert 22. Juni 2018]. Verfügbar unter: http://developingchild.harvard.edu/wp-content/uploads/2007/05/Timing_Quality_Early_Experiences-1.pdf
  2. Watamura S, Kim P. Two Open Windows: Infant and Parent Neurobiologic Change [Internet]. The Aspen Institute; 2015 [zitiert 16. Juli 2018]. Verfügbar unter: https://ascend.aspeninstitute.org/resources/two-open-windows-infant-and-parent-neurobiologic-change-2/
  3. Bilgin A, Wolke D. Regulatory Problems in Very Preterm and Full-Term Infants Over the First 18 Months. J Dev Behav Pediatr JDBP. Mai 2016;37(4):298–305.
  4. Pace CC, Spittle AJ, Molesworth CM-L, Lee KJ, Northam EA, Cheong JLY, u. a. Evolution of Depression and Anxiety Symptoms in Parents of Very Preterm Infants During the Newborn Period. JAMA Pediatr. 1. September 2016;170(9):863–70.
  5. Spittle A, Treyvaud K. The role of early developmental intervention to influence neurobehavioral outcomes of children born preterm. Semin Perinatol. 2016;40(8):542–8.
  6. Shonkoff JP, Fisher PA. Rethinking evidence-based practice and two-generation programs to create the future of early childhood policy. Dev Psychopathol. November 2013;25(4 Pt 2):1635–53.
  7. Koldewijn K, van Wassenaer A, Wolf M-J, Meijssen D, Houtzager B, Beelen A, u. a. A neurobehavioral intervention and assessment program in very low birth weight infants: outcome at 24 months. J Pediatr. März 2010;156(3):359–65.
  8. Van Hus J, Jeukens-Visser M, Koldewijn K, Holman R, Kok JH, Nollet F, u. a. Early intervention leads to long-term developmental improvements in very preterm infants, especially infants with bronchopulmonary dysplasia. Acta Paediatr Oslo Nor 1992. Juli 2016;105(7):773–81.
  9. Van Hus JWP, Jeukens-Visser M, Koldewijn K, Geldof CJA, Kok JH, Nollet F, u. a. Sustained developmental effects of the infant behavioral assessment and intervention program in very low birth weight infants at 5.5 years corrected age. J Pediatr. Juni 2013;162(6):1112–9.
  10. Nordhov SM, Rønning JA, Dahl LB, Ulvund SE, Tunby J, Kaaresen PI. Early intervention improves cognitive outcomes for preterm infants: randomized controlled trial. Pediatrics. November 2010;126(5):e1088-1094.
  11. Landsem IP, Handegård BH, Ulvund SE, Tunby J, Kaaresen PI, Rønning JA. Does An Early Intervention Influence Behavioral Development Until Age 9 in Children Born Prematurely? Child Dev. Juli 2015;86(4):1063–79.
  12. Landsem IP, Handegård BH, Ulvund SE, Kaaresen PI, Rønning JA. Early intervention influences positively quality of life as reported by prematurely born children at age nine and their parents; a randomized clinical trial. Health Qual Life Outcomes. 22. Februar 2015;13.
  13. Wu Y-C, Hsieh W-S, Hsu C-H, Chang J-H, Chou H-C, Hsu H-C, u. a. Intervention effects on emotion regulation in preterm infants with very low birth weight: A randomize controlled trial. Res Dev Disabil. Januar 2016;48:1–12.
  14. Habersaat S, Pierrehumbert B, Forcada-Guex M, Nessi J, Ansermet F, Müller-Nix C, u. a. Early stress exposure and later cortisol regulation: Impact of early intervention on mother–infant relationship in preterm infants. Psychol Trauma Theory Res Pract Policy. 2014;6(5):457–64.
  15. Olafsen KS, Rønning JA, Handegård BH, Ulvund SE, Dahl LB, Kaaresen PI. Regulatory competence and social communication in term and preterm infants at 12 months corrected age. Results from a randomized controlled trial. Infant Behav Dev. Februar 2012;35(1):140–9.
  16. Kaaresen PI, Rønning JA, Tunby J, Nordhov SM, Ulvund SE, Dahl LB. A randomized controlled trial of an early intervention program in low birth weight children: outcome at 2 years. Early Hum Dev. März 2008;84(3):201–9.
  17. Landsem IP, Handegård BH, Tunby J, Ulvund SE, Rønning JA. Early intervention program reduces stress in parents of preterms during childhood, a randomized controlled trial. Trials. 4. Oktober 2014;15:387.
  18. Borghini A, Habersaat S, Forcada-Guex M, Nessi J, Pierrehumbert B, Ansermet F, u. a. Effects of an early intervention on maternal post-traumatic stress symptoms and the quality of mother-infant interaction: the case of preterm birth. Infant Behav Dev. November 2014;37(4):624–31.
  19. Ravn IH, Smith L, Lindemann R, Smeby NA, Kyno NM, Bunch EH, u. a. Effect of early intervention on social interaction between mothers and preterm infants at 12 months of age: a randomized controlled trial. Infant Behav Dev. April 2011;34(2):215–25.
  20. Meijssen D, Wolf M-J, Koldewijn K, Houtzager BA, van Wassenaer A, Tronick E, u. a. The effect of the Infant Behavioral Assessment and Intervention Program on mother-infant interaction after very preterm birth. J Child Psychol Psychiatry. November 2010;51(11):1287–95.
  21. Meijssen DE, Wolf MJ, Koldewijn K, van Wassenaer AG, Kok JH, van Baar AL. Parenting stress in mothers after very preterm birth and the effect of the Infant Behavioural Assessment and Intervention Program. Child Care Health Dev. März 2011;37(2):195–202.
  22. Nordhov SM, Kaaresen PI, Rønning JA, Ulvund SE, Dahl LB. A randomized study of the impact of a sensitizing intervention on the child-rearing attitudes of parents of low birth weight preterm infants. Scand J Psychol. Oktober 2010;51(5):385–91.
  23. The Importance of caregiver-child interactions for the survival and healthy development of young children | Attachment Theory | Caregiver [Internet]. Scribd. [zitiert 22. Juni 2018]. Verfügbar unter: https://www.scribd.com/document/117815507/The-Importance-of-caregiver-child-interactions-for-the-survival-and-healthy-development-of-young-children
  24. March of Dimes, PMNCH, Save the Children, WHO. Born Too Soon: The Global Action Report on Preterm Birth. [Internet]. World Health Organization; 2012. Verfügbar unter: http://www.who.int/pmnch/media/news/2012/201204_borntoosoon-report.pdf
  25. UNICEF – 2015 – For every child, a fair chance the promise of equ.pdf [Internet]. [zitiert 22. Juni 2018]. Verfügbar unter: https://www.unicef.org/publications/files/For_every_child_a_fair_chance.pdf
  26. Building Core Capabilities for Life.pdf [Internet]. [zitiert 22. Juni 2018]. Verfügbar unter: https://46y5eh11fhgw3ve3ytpwxt9r-wpengine.netdna-ssl.com/wp-content/uploads/2016/03/Building-Core-Capabilities-for-Life.pdf
  27. Britto PR, Lye SJ, Proulx K, Yousafzai AK, Matthews SG, Vaivada T, u. a. Nurturing care: promoting early childhood development. The Lancet. 7. Januar 2017;389(10064):91–102.
  28. Landry SH, Smith KE, Swank PR, Guttentag C. A Responsive Parenting Intervention: The Optimal Timing Across Early Childhood For Impacting Maternal Behaviors And Child Outcomes. Dev Psychol. September 2008;44(5):1335–53.
  29. Flierman M, Koldewijn K, Meijssen D, van Wassenaer-Leemhuis A, Aarnoudse-Moens C, van Schie P, u. a. Feasibility of a Preventive Parenting Intervention for Very Preterm Children at 18 Months Corrected Age: A Randomized Pilot Trial. J Pediatr. September 2016;176:79-85.e1.
  30. From Best Practices to Breakthrough Impacts.pdf [Internet]. [zitiert 22. Juni 2018]. Verfügbar unter: https://46y5eh11fhgw3ve3ytpwxt9r-wpengine.netdna-ssl.com/wp-content/uploads/2016/05/From_Best_Practices_to_Breakthrough_Impacts-4.pdf

November 2018 / 1st edition / next revision: 2023

Recommended citation

EFCNI, Koldewijn K, Wolf MJ et al., European Standards of Care for Newborn Health: Post-discharge responsive parenting programmes. 2018.

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