Prenatal drug exposure and maternal and infant feeding behaviour

Abstract

Objective: To evaluate feeding difficulties and maternal behaviour during a feeding session with 1 month old infants prenatally exposed to cocaine and/or opiates. Methods: The study is part of the maternal lifestyle study, which recruited 11 811 subjects at four urban hospitals, then followed 1388 from 1 to 36 months of age. Exposure to cocaine and opiates was determined by maternal interview and meconium assay. At the 1 month clinic visit, biological mothers were videotaped while bottle feeding their infants. This sample included 364 exposed to cocaine, 45 exposed to opiates, 31 exposed to both drugs, and 588 matched comparison infants. Mothers were mostly black, high school educated, and on public assistance. Videotapes were coded without knowledge of exposure status for frequency, duration and quality of infant sucking, arousal, feeding problems, and maternal feeding activity and interaction. Results: No cocaine effects were found on infant feeding measures, but cocaine-using mothers were less flexible (6.29 v 6.50), less engaged (5.77 v 6.22), and had shorter feeding sessions (638 v 683 seconds). Opiate exposed infants showed prolonged sucking bursts (29 v 20 seconds), fewer pauses (1.6 v 2.2 per minute), more feeding problems (0.55 v 0.38), and increased arousal (2.59 v 2.39). Their mothers showed increased activity (30 v 22), independent of their infants' feeding problems. Conclusions: Previous concerns about feeding behaviour in cocaine exposed infants may reflect the quality of the feeding interaction rather than infant feeding problems related to prenatal exposure. However, opiate exposed infants and their mothers both contributed to increased arousal and heightened feeding behaviour.F eeding is not only essential for growth, but is a primary context for interactions between infants and their mothers in early infancy.1 2 Early identification of dyads at risk for poor feeding offers an opportunity to intervene in the future health and wellbeing of the infant.1 3 4 Evaluation of neonatal feeding has been approached in three ways: clinical reports of dysfunctional sucking, objective (computer assisted) measurement of sucking patterns, and assessments of mother-infant interaction during feeding. Several studies have reported sucking or feeding problems when infants were prenatally exposed to cocaine or opiates, 1 5-12 although these observations are controversial. [13][14][15] Inconsistent findings may reflect a failure to account for polydrug exposure and sociodemographic factors, 5 7-11 small sample sizes with inadequate power to detect subtle effects or low generalisability, 1 5 6 9 10 12 15 and convenience samples that are not representative of the larger population of drug involved dyads.5 9 Further, no study used methods that could evaluate sucking, symptoms, and mother-infant interaction in the same sample. The purpose of this study was to test the hypotheses that infants exposed to cocaine and/or opiates have abnormal sucking patterns and increased feeding problems and that their mothers are less re...

Infant colic and feeding difficulties

“…An examiner masked to group status was trained to reliability for the coding of infant feeding behaviours and maternal responsiveness using training tapes of infant feeding from a separate study that utilised the same procedure. [25][26][27] Intra-class correlations for the coder with the gold standard training tapes was 0.80. Three infant ratings (appropriateness of infant state for feeding, ease of feeding, and general responsiveness to their mothers) and seven maternal ratings (quality of physical contact, determination of feeding, tone of voice, attentiveness, confidence, delight, and appropriateness of feeding behaviour) were coded.…”

Assessment of infant cry: Acoustic cry analysis and parental perception

“…These constructs are indices of infant temperament, particularly well-articulated by Rothbarts' psychobiologic theory linking temperament to underlying autonomic processes [Rothbart et al, 1994]. One application of the constructs of reactivity and regulation to cry parameters is to categorize cry parameters by underlying biological processes into those measuring initial response to stimulation (reactivity) and those indicating regulatory processes of the respiratory system and the vocal track [Lester et al, 2002;LaGasse et al, 2003]. As shown in Table 6, either low or high reactivity can be atypical conditions, unlike poor regulation, which is usually unidirectional.…”

Prenatal cocaine and other substance exposure: Effects on infant autonomic regulation at 7 months of age

“…For instance, cocaine using mothers have been reported to display higher negative affect during interactions with their infants (Burns, Chetnik, Burns, & Clark, 1991a;Eiden, 2001;LaGasse et al, 2003), and be more disengaged and passive during mother-infant interactions (Gottwald & Thurman, 1994;Molitor, Mayes, & Ward, 2003). Maternal parenting behavior plays a critical role in helping children manage their arousal and keep distress within tolerable limits in infancy.…”