Parenting very low birth weight children at school age: maternal stress and coping

Abstract

Objective: To compare severity and determinants of stress and coping in mothers of 8-year-old very low birth weight (VLBW) and term children varying in medical and developmental risk.

Study design: Three groups of mothers/infants were prospectively compared in a longitudinal study from birth to 8 years (110 high-risk VLBW, 80 low-risk VLBW, and 112 term). Maternal psychological distress, coping, parenting/marital stress, child health, and family impact were measured in the children at age 8 years.

Results: Mothers of VLBW children differed from term mothers, reporting less consensus with partners, more concern for their children's health, less parent-child conflict, and fewer years of education attained. Mothers of high-risk VLBW children experienced the greatest family and personal strains and used less denial and disengagement coping. The groups exhibited no differences in the sense of parenting competence, divorce rate, parenting/marital satisfaction, family cohesion, and psychological distress symptoms. Multiple birth, low socioeconomic status, and lower child IQ added to maternal stress.

Conclusions: VLBW birth has long-term negative and positive impacts on maternal/family outcomes related to the infant's medical risk.

Figure 1.

Child health by group risk status (GEE χ² = 49.5; df = 14; P < .0001). ^aHigh-risk < term (P = .007); ^bhigh-risk > term (P = < .002); ^clow-risk > term (P < .001); ^dhigh-risk > low-risk (P = .005).

Figure 2.

Mean scores on subscales within the Impact on Family Scale. MANCOVA adjusted for maternal education at 8 years, multiple birth, and total intrafamily strains subscale score, Wilks’ λ = .92 (F = 3.48; df = 6, 500; P < .003). ^aHigh-risk > term (P < .02); ^bhigh-risk > low-risk (P < .02); ^chigh-risk > term (P < .02).

Figure 3.

Mean scores on subscales in the Child Domain of the Parenting Stress Index (CDI). Mean CDI, 99.6 ± 19 for high-risk VLBW, 92.4 ± 27 for low-risk VLBW, 94.2 ± 21 for term (F = 5.9; P < .003). MANCOVA adjusted for maternal education at 8 years, multiple birth, and total intrafamily strains. CDI Wilks’ λ = .90 (F = 2.24; df = 12,490; P < .009). ^aHigh-risk > low-risk (P < .002); ^bhigh-risk > low-risk (P < .02), high-risk > term (P < .07); ^chigh-risk > low-risk (P < .02), high-risk > term (P < .04); ^dhigh-risk > low-risk (P < .03), high-risk > term (P < .03).