Sequential observation of infant regulated and dysregulated behavior following soothing and stimulating maternal behavior during feeding

Studying premature infants' responses and behaviors during feeding is an important means of understanding their capacities and limits for regulation and their vulnerability to dysregulation. Regulation is an ongoing process that manages stimulation in relation to moment-by-moment contextual demands so that successful functioning in physiologic, emotional, and behavioral domains is possible. When the demands and/or the individual's resources for successful regulation are inadequate, functioning is disrupted, and dysregulation—impaired or disrupted functioning-- may be observed in physiologic, emotional, and behavioral domains (Calkins & Hill, 2007; Cole, Michel, & Teti, 1994). Regulation processes, both internal to the infant as well as those involving the caregiver, who is usually the mother, are vital in achieving or maintaining successful functioning for full term or premature infants (Beebe & Lachmann, 1988; Browne & Talmi, 2012; Karoly, 1993; Kopp, 2001; Zhou, Chen, & Main, 2012). Infant regulation of feeding encompasses physiological parameters or status, social-emotional states, motoric movements, and the quality of behavioral responses to stimulation or soothing during a task such as feeding (Lowman, Stone, & Cole, 2006; National Research Council and Institute of Medicine, 2000; Zhou, et al., 2012). Conversely, dysregulation for a very young infant is observed in unmanaged or ungoverned physiological parameters or status, social-emotional states, motoric movements, and the quality of behavioral responses to stimulation or soothing that is less than optimal for adaptive functioning. Understanding infant regulation and dysregulation in the context of feeding, the condition with which it is associated, and its immediate outcomes may be important for promoting infant growth and development in the short and long term, particularly for prematurely born infants who may be vulnerable to dysregulation (Clark, Woodward, Horwood, & Moor, 2008; Poehlmann, et al., 2011; Spittle, et al., 2009). Although the qualities or features of regulation and dysregulation during feeding have been described and explored in very young, prematurely born infants (Thoyre, Shaker, & Pridham, 2005), little systematic study of the ongoing, real-time contribution of maternal feeding behavior to an infant's feeding behavior indicative of regulation or dysregulation is available. The purpose of this study was to describe maternal behaviors that occur before infant regulation or dysregulation at three times in early infancy and examine the patterns over time with their prematurely born infants. Theoretical Framework A concept of regulation, derived from biopsychosocial literature (Cole, Martin, & Dennis, 2004; Cole, et al., 1994; Schore, 1994), provided the theoretical underpinnings for this study. In the early months of a child's life, the mother is an extension of the infant's internal regulatory system (Beebe & Lachmann, 1988; Nugent, Blanchard, & Stewart, 2007) and must establish a connection with the infant. Making this connection requires the mother to read and understand the infant's cues and then respond to the infant's needs in a sensitive and timely manner. Over time, the mother must also provide the infant with opportunities to begin the process of self-regulation (National Research Council and Institute of Medicine, 2000). For example, when the infant is crying the mother may bring the infant's hands closer to his mouth so the infant can suck on his fingers in an effort to regulate (Lowman, et al., 2006). As the infant matures and develops capacities for regulation, including the capacity to wait or to tolerate frustration, the mother could give the infant the opportunity to attempt self-soothing behavior before intervening. Over time the infant learns to find his fingers on his own and self-regulate. During feeding at approximately 38 weeks postmenstrual age (PMA), infants are capable of regulating sucking, swallowing, and breathing in a coordinated manner (Bu'Lock, Wooldridge, & Baum, 1990). Postmenstrual age is the gestational age in weeks plus the age after preterm birth up to term age (Blackmon, et al., 2004). Between sucks, or during sucking pauses, very young infants are capable of very brief periods of social interaction including gazing at mother, a form of regulated behavior (Lavelli & Fogel, 2005). When premature infants' capacities for regulating sucking, swallowing, and breathing are exceeded, dysregulation is likely to be observed in signs of physiologic instability and dysfunctional motoric behavior. Through the dysregulated period, an infant expends energy needed for growth and socio-emotional development (McGrath & Braescu, 2004), and potentially develops dysfunctional processes of managing tasks or challenges such as those occurring during feeding (Thoyre, et al., 2005). The primary aim of this study was to describe infant regulated or dysregulated behavior that followed within 3 seconds of each of the two maternal types of behavior. Maternal behaviors selected for study included soothing and its contrasting behavior stimulating. A second aim was to explore the sequence of maternal behavior and infant regulation or dysregulation behavior that followed at three times--just before hospital discharge from the special care unit and at 1 and 4 months corrected age. Corrected age is the chronological age in weeks minus the number of weeks the infant was born before term (Blackmon, et al., 2004). Longitudinal study of the relationships among variables is important due to expected developmental maturation of the infant. A baseline assessment was done in the hospital just prior to the mother's full assumption of care. By 1-month corrected age, the mother will have had a chance to get to know her infant at home. At 4-months corrected age infants are often participating in the feeding in some way. This period allows an opportunity to observe the contribution of maternal soothing or stimulating behavior to infant regulation or dysregulation behavior from just before the mother assumes full responsibility of care to just before some of the responsibility of feeding is likely to be shifting to the infant.