Early Human Development 86 (2010) 689–693

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Early Human Development

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Good parenting: Making a difference

Marjorie Smith ⁎Thomas Coram Research Unit, Institute of Education, University of London, 20 Bedford Way, London, WC1H 0AL, UK

⁎ Tel.: +44 207 612 6946; fax: +44 207 612 6927.E-mail address: m.smith@ioe.ac.uk.

0378-3782/$ – see front matter © 2010 Elsevier Irelanddoi:10.1016/j.earlhumdev.2010.08.011

a b s t r a c t

a r t i c l e i n f o

Keywords:ParentingChild developmentMother–child relations

The relevance of the quality of parenting to outcomes for children is reviewed, as well as research findings onthe important dimensions of parenting in the early years. Some of the limitations of current parentingresearch are outlined. The contributory parent and child factors that mediate outcomes are identified, andthe ways in which they interact in a bi-directional and dynamic process to determine the quality of parentingand the parent–child relationship. This information is applied to the task of parenting neonates and infants,and interventions are identified that indicate the scope and type of improvements or enhancements toparenting capacity that can be achieved. Particular issues and problems relating to the parenting of neonatesor infants with special needs are briefly discussed, as well as promising initiatives to enable the care of illbabies to be more relationship-based and family centred.

Ltd. All rights reserved.

© 2010 Elsevier Ireland Ltd. All rights reserved.

1. Introduction

The science of parenting and field of parenting research is still arelatively young one — perhaps not quite a neonate or young infant,but certainly still in early childhood. Until quite recently, apart from afew books on childrearing, mostly written by paediatricians, parentswere left to bring up their children with the help and support of theirmothers, sisters or close friends if they were lucky, but without theadvice or intervention of either ‘experts’ or the state. We should notforget that on the whole most parents did remarkably well, and theirchildren thrived.

In the last thirty or so years, the situation has changed markedly,with a huge proliferation of advice and ‘expertise’ now available toparents in the form of books, articles in popular magazines, and morerecently, internet resources and television programmes. The quality,as well as the reliability and validity of much of the informationavailable to parents have been questionable.

In the UK and elsewhere, the last few decades have also beencharacterised by increasing governmental interest and interventionsin parenting, which up to that point had been seen as something doneby parents ‘behind closed doors’, and not in normal circumstances thedomain or concern of the state. The increase in interest in parentingwas partly a response to the marked demographic and social changesthat had occurred, resulting in families that were more diverse andcomplex, and concerns about the impact of fatherless families,perceived to be linked with a rise in antisocial behaviour in childrenand young people, and the rapidly growing number of stepfamilies. Atthe same time, growing awareness of child abuse and neglect, and a

number of high profile cases and child deaths, underpinned a desire tounderstand and address the causes of abusive or negligent parenting.One consequence was a rapid development of parenting programmes,that is, interventions designed to impact positively on children byenhancing parenting through education or skills-based activities.These changes, along with the desire that interventions should beevidence-based, have all been stimulants for the increase in researchon parenting.

Academic knowledge of parenting is still very much a developingfield, with a number of different, and to a certain extent competing,theoretical and research approaches being pursued simultaneously. Ithas recently been suggested that these can be integrated andcoordinated by viewing parenting as comprising a number of differentdomains, which individually link to different aspects of outcomes forchildren [1]. This conception offers the possibility of differences in thequality of parenting between domains, suggesting that there is nosuch thing as a ‘good’ or ‘bad’ parent, since parents may be good atsome aspects of parenting and less good, or poor, in other domains.Despite the developing complexity of the field, there is now areasonably robust and consistent body of knowledge on the importantdimensions of parenting in the early years — which are the focus ofthis review.

This paper will briefly reviewwhat is known about parenting fromboth a theoretical and practical viewpoint, with a particular focus onthe early years, and how parents can and do make a difference to theoutcomes for their children. Some of the main limitations of parentingresearch will be identified. A second section of the paper will addressmore specifically what is known about the parenting of neonates andbabies. Information on interventions to improve parenting andmake adifference to children is included in each of these sections. A final shortsection of the paperwill identify someof the considerations relevant toparenting applied to neonates or babies with special needs.

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The predominant emphasis in what follows is on the role of themother as the parent—butmost of it is equally applicable to fathers, andothers who might care for the child. Since the focus is on the femaleparent, for simplicity (and equity) the infant or child is generallyreferred to in the masculine tense.

2. What we know about good parenting

Becoming a parent constitutes a major life transition for mostpeople. Parenting starts before or during pregnancy, and is a lifelongendeavour — once a parent, you never cease to be a parent. Parentswant the best for their children: they want them to be healthy andthrive, and to be secure, but do not always know how best to achievethese aims. It could be said that the quality of parenting is the mostimportant variable in a child's life. The effects of variations in parentingcan be tracked in children's health, behaviour andwell being, aswell asin their intelligence and educational attainment. Cohort studies haveshown that these effects are lifelong, affecting health andwell being inadulthood, aswell as life trajectories in terms of employment, and theyreplicate into future generations, since it is clear that how one isparented determines, to some extent, how one parents.

Early parenting researchers, who tended to focus on socialisation,observed that while they could not identify any effects of most specificaspects of child rearing, parental warmth/affection and parentalcontrol were key qualitative dimensions of parenting associated withpositive outcomes for children [2]. This important finding, thatoutcomes were generally better for children of mothers who werewarm and responsive, at the same time as being appropriatelycontrolling, has not changed, although more is now known about themediating factors that contribute to make this situation possible.

It is clear, for example, that to parent well requires a well parent. Amother who is depressed or stressed is unlikely to be as sensitive orresponsive to her child's needs as one who is not. Depressed motherstend to be less attentive to their children and to have an intrusive andinsensitive style of interaction, which disrupts infant bonding.Similarly, parental stress, whether as a result of factors such aspoverty or poor housing, or more directly related to child factors suchas challenging child behaviour or an ill child, has the impact ofdisrupting parenting and parent–child relationships. The parent'sown experience of being parented, and the expectations and attitudesthey bring to it are also important influences in shaping parenting [3].Ecological models of parenting, such as those of Belsky [4], weredeveloped to understand the causes of abusive or neglectfulparenting. These models, originally proposed by Bronfenbrenner toexplain child development, identified how the different ‘layers’ of theenvironment around the child interacted to shape development.Belsky identified that the determinants of parenting were similarlymulti-factorial and multi-layer, with individual, historical, social andcontextual factors combining to shape parenting. He proposed thatparenting was a buffered system where sources of stress or difficulty,such as a difficult baby, could be balanced by parenting supports, suchas a supportive partnership or a strong social support network.Inadequate buffering, or an imbalance between accumulated riskfactors and support or compensatory factors, would lead to abusive orneglectful parenting.

Although parenting was viewed as a unidirectional process ofparental influence and impact on the child, more recent conceptionsof parenting acknowledge the impact of the child, and the child'sbehaviour, on the parent, and recognise parenting as a transactionaland dynamic process with both the parent and child as active ‘agents’in the dynamic relationship [5]. The dynamic aspects of parentingacknowledge that parenting is a cumulative process, with concurrentbehaviour being a product of past behaviour and interactions, and thisapplies to both the parent and the child. It is known that parentsrespond to boy and girl children differently from birth or before, andthat parents adapt their parenting to the age of the child, but other

characteristics of the child, such as their temperament and behaviour,are important factors in determining how they are parented and in theparent /child relationship. From birth, some babies will be easier toparent than others, in that they are appropriately responsive andreactive to stimulation; their behaviour is predictable and they areeasy to ‘read’ as they provide unambiguous cues to their state.Although temperament is genetically determined to some extent, ithas also been found that difficult temperament in the child is partlypredicted by higher levels of prenatal stress in the mother [6].

Genetic or biological determinants, and interactions betweenheritable aspects, such as maternal sensitivity and child susceptibility,must be added to the list of potential determinants of parenting. Putsimply, some children are easier to parent than others, but equallysome parents are better than others at parenting ‘challenging’children. In the same way that ‘readability’ is an important attributeof the infant's temperament, the mother's ability to read her infant,and attune to his needs and to behave in predictable ways – hersensitivity and responsiveness to the infant – are the most importantaspects of the early relationship, and are reflected in later attachmentsecurity and in the child's developmental progress. There is evidence,for example, that antisocial behaviour, a focus of much researchattention, has its origins in infancy. The combination of difficulttemperament and emotion regulation problems in the child, and aninsensitive mother, is associated with early attachment and relation-ship problems, and predicts later behaviour problems in the child.

Genomic research has demonstrated that there are geneticinfluences on dynamic aspects of the parent child relationship, aswell as on outcomes. For example, there is evidence suggesting thatsome parents may be more sensitive than others to the normal dailystresses of parenting. Explorations of gene-environment interactionshave focused on genetic vulnerability or sensitivity, and on investi-gating whether some children are particularly sensitive to the qualityof their parenting, or specifically vulnerable to poor or negativeparenting. The potential importance of gene x environment interac-tions has been demonstrated in relation to children's susceptibility topoor parenting in the form of maltreatment, where boys with aparticular genotype (a low-activity MAOA genotype) have beenshown to be significantly more likely to develop antisocial behaviourin adulthood (85% did), in contrast to those with high MAOA activity,where childhood maltreatment did not confer any additional risk ofconduct disorder or convictions for violent crime in adulthood [7].

While recent behaviour-genetic studies do not undermine theimportance of parenting quality, they also emphasise the added factorof the susceptibility or sensitivity of some children to their parenting,and of some parents to their children's behaviour [8].

2.1. Limitations of parenting research

Much of the research that has been conducted has been problemfocussed, following a deficit model, so there is more information on thenegative and negligent aspects of parenting, for example, contrastingthe outcomes of abusive or dysfunctional parenting with ‘good enoughparenting’, and much less information about optimal parenting. This isstill a feature of current research on gene-environment interactions,where much of the attention has been on children's susceptibility tonegative parenting experiences, and less on whether some children areparticularly sensitive to the quality of their parenting, whether negativeor positive. This is an importantdistinction as it offers thepossibility thatchildren who are potentially at risk may have the risk ameliorated bypositive parenting experiences, but also suggests that some childrenmay be resilient to less than good enough parenting [9]. If parentingoutcomes are viewed in terms of the match and mesh of thevulnerability, or the lack of it, of the child, and the sensitivity, or lackof it, of the parent, an easy child with a sensitive mother is likely toflourish, while the outcomes are likely to be poor for a child with adifficult or vulnerable temperament and an unresponsive or insensitive

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mother. The questions then relate to the outcomes for children withdifficult or vulnerable temperaments who receive sensitive parenting,and for the easy children with insensitive parents. A further questionrelates to the impact over time of the child on the parenting – andwhether a difficult child is likely to impact negatively on initiallysensitive parenting – it is easy to imagine this is the case if the parentbecomes depressed, for example; and whether an easy child can overtime ‘enhance’ the sensitivity of the parenting they receive from aninitially insensitive parent.

A further limitation of parenting research is that the large majorityof parenting research has focussed on mothering, and only recentlyhas there been an increase in interest in the role and responsibilities offathers as parents [10]. It remains the case thatmost of what is writtenabout parenting and parents should be translated as mothering andmothers.

Another limitation of research on parenting is the predominantfocus on ‘majority’ parenting in the white Anglo Saxon populationswithin which most of the research has been conducted. As aconsequence, there is much less knowledge about cultural influenceson parenting, or variations in parenting in different ethnic groups orfamily types. Such evidence as there is suggests that parentingattitudes and values are to some extent culturally determined, anddiffer systematically between different groups, and these are reflectedin parenting styles, with successful parenting being specific to theculture and context in which the family lives. This is consistent withthe finding that for certain aspects of parenting, such as parentalcontrol, parenting practices are differentially associated with positiveoutcomes in different groups — for example, in contrast to the whitepopulation, more authoritative and controlling styles of parentingappear to be associated with better outcomes for black boys in highrisk neighbourhoods [11].

2.2. Interventions to improve parenting

There is good evidence that parents can, and do, change theirbehaviour on the basis of advice or teaching, to improve outcomes fortheir children. This evidence comes from both large scale initiatives,such as national campaigns (discussed further in the next section), aswell as from systematic evaluations of parenting programmes. Itremains the case, however, that the majority of the many programmeinitiatives designed to change parenting behaviour have not beensystematically or rigorously evaluated. Evidence of effectiveness is oftenbased on parents' perceptions that they or their children have beenhelped in some way, and few evaluations have independently assessedoutcomes for children. Such evidence as there is suggests that skills-based programmes, where the programme is video-based, or behaviouris modelled and parents can practice their parenting skills, are generallysomewhat more effective at changing parenting behaviour thanprogrammes that are solely educational or advice-based. Neverthelessit is clear that parenting skills can be enhanced through both educationand skills-based interventions with parents [12].

One evaluated example of a video-based social learningprogramme, the Webster Stratton ‘Incredible years’ programme, hasbeen demonstrated to be effective in improving parents' skills andhelping parents of toddlers and young children to cope moreeffectively with children's behaviour problems. Although not neces-sarily the primary aim of the programme, it is probable that one of themechanisms of action of programmes such as this is the development,in parallel with the development of their parenting skills, of themothers' confidence in their effectiveness as parents. These changesthen operate mutually to improve the parent–child relationship.

Despite the programme's apparent effectiveness, engagement ratesin this and comparable parenting programmes tend to be relatively low,and attrition rates high. This is likely to reflect the fact that programmestend to conform to awhitemiddle classmodel of parenting andmay notbe perceived as suitable or appropriate bymothers from other ethnic or

social groups. The bias is particularly evident in the lack of suitableprogrammes that effectively engage ‘hard to reach’ families, and areexperienced asuseful andnon-stigmatisingby thosewhoare deemed to‘need’ help and support with parenting. Attrition rates also suggest thatadvice or information that does not ‘fit’ with the parent's attitude andaspirations, and model of parenting, is not acceptable or useful and willbe ignored. This is consistent with research showing that if healthvisitors provided advice on weaning that was at odds with mothers'beliefs onweaning (often based on advice from their ownmothers), themothers simply stopped seeing thehealth visitor. The implication is thatadvice or information must start from a base of understanding andacknowledging the parent's beliefs and attitudes.

An evaluated example of a successful programme for ‘high risk’parents is the UK-developedMellow Parenting programme, for familieswith children aged under five years who are experiencing stress andrelationship problems with their children. The programme wasdesigned for parents who may themselves have had negativeexperiences of parenting, with histories of abuse or emotionaldeprivation, and aims to empower parents to find better ways ofrelating to their own children. It has been shown to be successful inachieving positive changes both for attending parents and theirchildren. This is a good demonstration of the fact that positive changesin parenting behaviour that impact on children and the parent–childrelationship can be achieved, even inmulti-problem families where theparents themselves have no experience or model of good parenting.

3. Parenting neonates and in infancy

The human infant is wholly dependent on its carers, normally itsparents, and so infancy is the time that the task of parenting is at itsmost demanding, requiring the highest level of parental interaction.The mother–child relationship will start before birth with themother's expectations of her child and anticipations of parenting,but the early stages of the development of the post-birth relationshipand the quality of parenting in this period of rapid child developmentare also crucial, as relationships and patterns of reciprocal interactionsdeveloped at this point determine relationship trajectories for thefuture, as well as contributing to later outcomes for the child. Positiveand rewarding early experiences, for both the mother and infant, willbe reinforcing of, and contribute to subsequent experience, so thehistory of the relationship and interactions will determine futureinteractions and relationships. A mother who spends time with hernew infant, looking at him and talking to him, and is rewarded by analert and responsive baby, is then reinforced to engage more with herbaby – and similarly her infant is reinforced in looking at his mother,in a reciprocally reinforcing cycle – to develop a relationshipdescribed as one of “intricate patterns of synchronous interactionsand sensitive mutual understandings” [3].

All new mothers must face the task of parenting with sometrepidation and anxiety, but this will gradually be dissipated bydeveloping confidence in their ability to copewith the task of parenting.Successful early experience and the feeling of being able to meet theinfant's needs will enhance the mother's feelings of confidence andcompetence as a parent. Getting to know their new person andbecoming ‘the expert’ on their infant will increase the parent'sconfidence, and sense of empowerment, as will learning and feelingthat how they behave and interact with their infant matters, and willmake a difference to the child and to the child's future development. Thegradual development of confidence and competence as a parent willalso act to enhance the parent–child relationship and make it morerewarding for both parent and child.

The extent towhich themother is empathetic or child-centred is alsorelevant to child outcomes from birth, or before birth. This involvesrecognising the infant or child as an independent person with feelingsand wishes of their own, and responding to and respecting these. Themother who talks to her infant or young child, and directs his attention

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to things that she feels might interest him, and seeks his ‘opinion’ onwhich clothes he will wear or which toys he would like to play with, isbehaving in a child-centred way.

Although the first relationship is likely to be with the mother, andassociated with feeding, this pattern of developing relationships andinteractions with the infant, and sense of competency and empow-erment as a parent will apply to the father and other carers. Whilebeyond the scope of this review, it is relevant to note that at the sametime as developing a relationship with, and learning to parent theirnewborn child, the relationship between the father and mother islikely to be undergoing profound changes as both adjust to their newroles as parents, as well as partners. Tiredness, sleep deprivation andchanges to routine and lifestyle may also impact on the parents'relationship. If they also impact negatively on the parent's mentalhealth, they are likely also to affect the relationship with the child andparent's ability to parent.

3.1. Improving the parenting of infants

Although in general skills-based programmes appear to be moresuccessful in changing parenting (as discussed above), education andadvice clearly have a part to play in improving parenting of infants,particularly for newparents. A powerful example of a successful advice-based change is the ‘Reduce the Risk’ campaign, advising parents toplace their infants on their backs to sleep and not to overheat them. Theinitiative, introduced in England in 1991, and promoted by midwives,health visitors and others, has reduced the numbers of sudden infantdeaths by over 70%. As with other health messages, the take-up andimpact has been variable across social groups, and a result of the verymarked reduction in the numbers of sudden infant deaths has been anincrease in their social patterning,with the largemajority of deaths nowoccurring in the most disadvantaged families. Another example ofachieving change at the national level was the initiative, originating inAustralia, to raise parents' awareness of the dangers of shaking babies,and to provide models of alternative behaviours. Education basedprogrammes to enhance the safely of children in the home havegenerally been successful.

Evidence on other interventions for parents in the early stages ofparenting is patchy and more mixed. Interventions that have beenevaluated and appear to be effective are some home visiting programmessuch as FamilyNurse Partnership for newyoungmothers, theCommunityMothers programme for socially disadvantaged mothers, and home andcentre based programmes such as the New Parent Information Network(NEWPIN) which aims to improve parenting through improving themother's mental health and social support.

The Community Mothers' programme uses a ‘buddying’ model topair experienced mothers with disadvantaged new mothers from thesame location, and has been found to be beneficial in improving bothmothers' health outcomes and a range of health and developmentaloutcomes for children. (It is of note that a comparable interventioninvolving health visitors rather than non-professionals, did not achievethe same positive results.) An important element common to theseeffective programmes appears to be the establishment of relationshipsof trust between the provider and recipient. Through these sociallysupportive relationships,mothers'mental health is improved and stresslevels reduced, and they are enabled to become more sensitive andresponsiveparents. Although somewhat intangible andhard tomeasurerobustly, interventions that increase parents' feelings of confidence andcompetence – to bemore empowered as parents – appear also to makethemmore child-centred and tofind the taskof parentingmore fulfillingand enjoyable.

4. Parenting neonates or babies with special needs

Whether it is an anticipated event or not, parents of neonates withspecial needs face a number of specific challenges and problems in early

parenting. For babies with birth defects or delivery complications, earlyparenting is likely to becomplicatedby theparents' feelings of lossof theperfect child they had envisaged, guilt, disappointment or regret, whichmaymake themother reluctant to see or interact with her baby. Parentsof preterm or very low birth weight (VLBW) infants may experiencesimilar feelings, as well as anxiety and stress about their infant'scondition. While their infant is in a Neonatal Special Care Unit (NICU)parents may feel that they are not ‘real’ parents, or that parenting is ‘onhold’, with consequent feelings of disempowerment and detachmentfrom their child.

In contrast with typically developing neonates, preterm or VLBWinfants are, and continue to be for many months, less interactive andresponsive, aswell as showing increased gaze aversion and lower levelsof attending to the mother's face. This in itself presents challenges toparenting and can seem to make the infant less rewarding to interactwith,whichmaynecessitate teaching theparent to attune to the infant'scues, and how to ‘listen’ to their baby.

The challenge for those with the (medical) care of the child is tofacilitate the development of parent–child bonding and enable theparents to parent as far as is possible. A number of initiatives have beenreported to make NICUs more relationship-based and family centred,and to enable parents to take a more active parenting role. Theseinclude facilitating periods of skin to skin contact between the motherand child (‘kangaroo care’), babymassage by parents, and ‘chatting’ asa clinical tool to facilitate the involvement and empowerment ofmothers in the NICU. The results of these initiatives suggest that theyare safe and often beneficial for babies [13], aswell as being effective inenhancing bonding and the mother–infant relationship; improvingthe mother's mental health and reducing anxiety; increasing thesensitivity of mothers to their infants' cues; in empowering mothers,and increasing their confidence as parents and in caring for their child.

The importance and benefits of good parenting for children born atVLBW are evident from follow up studies, showing that cognitiveoutcomes for children who consistently experienced higher levels ofmaternal responsiveness in infancy and the preschool period followedcomparable trajectories at ten years to those born at term. Those bornat VLBW who experienced lower levels of maternal responsiveness,higher levels of intrusiveness and more negativity, did poorly [14].

5. Conclusions

Parents can, and do make a different to the outcomes for theirchildren, but children's behaviour, and more specifically theirtemperament, also impacts on parents and how they behave towardstheir children. Better outcomes in the early stages of parenting areassociated with sensitive and responsive parenting. This is facilitatedby the parent having good mental health and social support, and notbeing unduly stressed, and a child who is appropriately responsiveand reactive to stimulation and interaction. Where these conditionsare not met, there is evidence that interventions can be effective inimproving the mother–child relationship through enhancing themother's responsiveness and child centeredness, as well as her senseof competence and confidence as a parent.

References

[1] Grusec JE, Davidov M. Integrating different perspectives on socialisation theoryand research: a domain-specific approach. Child Dev 2010;81:687–709.

[2] Maccoby E.E., Martin J.A. Socialization in the context of the family: parent–childinteraction. In: Hetherington E.M. (ed) and Mussen P H (series ed). Handbook ofChild Psychology (vol. 4) Socialization, personality and social development. NewYork: Wiley 1983; 1–101.

[3] Bornstein MH. Parenting infants. In: Bornstein MH, editor. Handbook of Parenting:Children and Parenting, Vol. 1. NJ: Lawrence Erlbaum: Mahwah; 2002. p. 3–44.

[4] Belsky J. The determinants of parenting: a process model. Child Dev 1984;55:83–96.[5] Kuczynski L. Beyond bidirectionality: bilateral conceptual frameworks for

understanding dynamics in parent–child relations. In: Kuczynski L, editor.Handbook of Dynamics in Parent–Child Relations. Thousand Oaks, CA: Sage;2003. p. 3–24.

693M. Smith / Early Human Development 86 (2010) 689–693

[6] Huizink AC, Robles de Medina PG, Mulder EJH, Visser GHA, Buitelaar JK.Psychological measures of prenatal stress as predictors of infant temperament.J Am Acad Child Adolesc Psychiatry 2002;41:1078–85.

[7] Caspi A, McClay J, Moffitt TE, Mill J, Martin J, Craig IW, et al. Role of genotype in thecycle of violence in maltreated children. Science 2002;297:851–4.

[8] Pluess M, Belsky J. Children's differential susceptibility to effects of parenting. FamSci 2010;1:14–25.

[9] Bakermans-Kranenburg MJ, van IJzendoorn MH. Parenting matters: family sciencein the genomic era. Fam Sci 2010;1:26–36.

[10] Lamb ME. The history of research on father involvement. Marriage Fam Rev2000;29:23–42.

[11] Deater-Deckard K, Dodge KA. Externalizing behaviour problems and disciplinerevisited: nonlinear effects and variation by culture, context and gender. PsycholInquiry 1997;8:161–75.

[12] Smith M. Early interventions for young children and their parents in the UK. In:McAuley C, Pecora P, Rose W, editors. Enhancing the well being of children andfamilies through effective interventions — International Evidence for Practice.London: Jessica Kingsley; 2006. p. 46–57.

[13] Hussey-Gardner B, Famuyide M. Developmental interventions in the NICU: whatare the developmental benefits? NeoReviews 2009;10:113–20.

[14] Smith KE, Landry SH, Swank PR. The role of early maternal responsiveness insupporting school-aged cognitive development for children who vary in birthstatus. Pediatrics 2006;117:1608–17.