Objectives: To determine the influence of maternal sensitivity on infant feeding problems in very preterm/very low birth weight (VP/VLBW) and full-term (FT) infants.Methods: Longitudinal study of 178 infants (73 VP/VLBW and 105 FT). Feeding problems and maternal sensitivity were assessed at term, 3 and 18 months. A cross-lagged path model was tested to assess the longitudinal associations.Results: The direction of the association between maternal sensitivity and feeding problems differed among VP/VLBW and FT infants. In VP/VLBW infants, higher feeding problems at term and 3 months were associated with less maternal sensitivity at 3 months (β = -0.27, p < 0.05) and at 18 months (β = -0.36, p < 0.05), respectively. In FT infants, a reciprocal relationship of feeding problems and maternal sensitivity over time was found. Feeding problems at 3 months were associated with decreased maternal sensitivity at 18 months (β = -0.32, p < 0.05) while decreased maternal sensitivity at 3 months was related to increased feeding problems at 18 months (β = -0.25, p < 0.05).Conclusions: Feeding problems are frequent in VP/VLBW infants and subsequently are associated with poorer maternal sensitivity. In FT infants, poorer levels of maternal sensitivity were both predicted by feeding problems but also were associated with more feeding problems over time.Keywords: feeding, maternal sensitivity, preterm birth, infancy.
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INTRODUCTIONFeeding problems are a major concern during infancy and toddlerhood with a prevalence rate of approximately 20% to 30%. 1 The earlier the onset of these problems, the more severe and persistent the consequent eating problems tend to be. Parent-infant relationships have most often been studied in those referred for feeding problems.11 The observed maladaptive interactions in such dyads may be the result of the feeding problems 12,13 and do not allow any conclusions that these have been their precursors.Longitudinal studies identified family factors 2,14 or maternal negative emotionality 15 as precursors of persisting feeding problems, however, these were all based on parent selfreports rather than direct observations of mother-infant interaction. We are aware of two prospective studies that observed maternal sensitivity and feeding problems over time, one of which revealed no longitudinal influence of maternal sensitivity on feeding problems at 10 months and 2 years of age; 16 the other study showed that maternal mind-mindedness at 6 months, which may predict maternal sensitivity, was related to positive feeding behaviors at 1 year of age. 9 There is thus a surprising lack of prospective cross-lagged designs to disentangle the currently unclear direction of associations between infant feeding problems and maternal sensitivity over time. This study investigated, firstly, whether VP/VLBW infants have more feeding problems in infancy compared to FT infants and whether there are any differences in between the groups in maternal sensitivity. Secondly, the direction of the association between maternal sen...