Develop. Med. Child Neurol. 1979, 21, 474-482
Neonatal Behavior of Infants of Adolescent Mothers Robert J. Thompson, Jr. Mary W . Cappleman Kathleen A . Zeitschel
Introduction Adolescent mothers less than 19 years of age (especially those under 15) and their offspring are a high-risk group for obstetric, pediatric, social, educational and psychological problems. Medical problems include increased frequencies of toxemia, anemia, abruptio placentae, cephalo-pelvic disproportion (in mothers less than 15 years of age), contracted pelvis, prolonged and/or premature labor, prematurity, low-birthweight infants and prenatal and infant mortality (Battaglia et al. 1963, Braen and Forbush 1975, Klerman 1975, Dott andFort 1976). Infantsof adolescent mothers are more likely to be underweight and shorter in stature, and later to be deficient in reading and to exhibit behavioral or ‘acting out’ difficulties (Oppel and Royston 1971). They also have less satisfactory psychological, intellectual and neurological development than infants of older mothers (Lobl et al. 1961, Braen and Forbush 1975). The increased incidence of low birthweight is of further concern because it is related to lower intellectual functioning (Lobl et al. 1961; Weiner et al. 1965, 1968; ScarrSalapatek and Williams 1973).
The social problems and consequences among the mothers include dropping out of school, precipitous marriage, divorce, occupational and financial difficulties, suicide (Braen and Forbush 1975), failure to develop adequate mothering skills (Klein 1975), and additional pregnancies in rapid succession (Braen and Forbush 1975, Duenhoelter et al. 1975). These present other causes for concern because of the increase in mortality rates as a function of birth order in adolescent mothers (Klerman 1975). Evidence exists that under optimal conditions of high quality antenatal care the medical risk to adolescent mothers and their infants need not be appreciably greater than for the maternal population as a whole (Dott and Fort 1976). However, often such care is not available; moreover, adolescent mothers use prenatal services much less than older women, making fewer visits and starting later in pregnancy (Dott and Fort 1976). The magnitude of the problem is indicated by the increase in both the birth rate within this high-risk group and the number of teenage women (Braen and Forbush 1975, Duenhoelter et al. 1975,
Correspondence to R.J. Thompson, Jr., Ph.D., Division of Medical Psychology, Duke University Medical Center, 2213 Elba Street, Durham, North Carolina 27705.
474
ROBERT J . THOMPSON, JR.
MARY W. CAPPLEMAN
McAnarney 1975), by the increase among teenage women in the prevalence of premarital intercourse, by the decline in age at first intercourse, and by the gap between first intercourse and first use of contraception (Zelnick and Kantner 1977). The Duke Developmental Evaluation Center is attempting to foster better development in a group of infants of adolescent mothers through a homebased early intervention project, to educate the mothers in infant stimulation techniques. To gain a better appreciation of the subtle as well as the gross consequences of adolescent motherhood on infant development, we have used the Brazelton Neonatal Assessment Scale to assess infants of adolescent mothers and infants of older mothers. The Brazelton Scale (Brazelton 1973) has been found to be a good predictor of later functioning, without a high falsepositive rate (Tronick and Brazelton 1975), sensitive to mild dysfunction of the central nervous system during the neonatal period (Tronick and Brazelton 1975), to cultural-racial group differences (Brazelton and Collier 1969, Freedman and Freedman 1969), to maternal and neonatal abnormalities such as low birthweight (Scarr-Salapatek and Williams 1973, Als et al. 1976), and to mild drug effects (Tronick et al. 1976). The scale is also clinically useful in suggesting management approaches and monitoring changes in behavior over time (Soule et al. 1974). The behavior items and dimensions of the scale enable a precise description of the infants of adolescent mothers to be made, as well as a delineation of their differences from infants of older mothers, and a consideration of the ‘stimulus value’ of the infant and the characteristic response patterns they elicit from these young mothers (Lewis and Rosenblum 1974).
KATHLEEN A. ZEITSCHEL
Method Two groups of babies were studied: 30 infants of black adolescent mothers (under 18 years old at delivery) and 30 infants of black older mothers (over 18 at delivery), born at Duke University Medical Center between April 1976 and September 1977. Because of age-dependent differences in education and occupation, both groups of mothers were considered to have similarly low socioeconomic status on the basis that all were unable to pay for their hospital care. Selection criteria were: gestational age between 37 and 42 weeks; an Apgar score of 7 or above at five minutes; weight equal to or above the 10th percentile for gestational age; physical examination within normal limits; and no over-riding complications of pregnancy, labor or delivery*. Gestational age was determined by an obstetrician, using a delivery-due date projected from the last menstrual period. Significant doubts about the accuracy of the date were resolved by using the Dubowitz scoring system (Dubowitz and Dubowitz 1977). The standard nursery procedures at the time of this study did not provide an opportunity for rooming-in and were the same, regardless of age, for all the mothers. If the infants’ condition at birth was stable, the mothers were allowed to see and hold them in the delivery room for approximately 30 minutes: the infants were then transported to the nursery, where they remained until 12 hours of age. Thereafter the mothers could have the infants in their room ‘on demand‘, depending upon the availability of sufficient staff in the nursery. Infants were taken to the mothers’ rooms at 9am and remained until 2pm, and again at 5pm *Subsequent to inclusion in the study, it was determined that one infant of an adolescent mother was slightly less than the 10th percentile for weight, and another had a physical examination within normal limits but with decreased muscle tone.
475
1979, 21
DEVELOPMENTAL MEDICINE A N D C H I L D NEUROLOGY.
study were single and delivering their first child, there were obviously significant differences in marital status (p
Neonatal Behavior of Infants of Adolescent Mothers Robert J. Thompson, Jr. Mary W . Cappleman Kathleen A . Zeitschel
Introduction Adolescent mothers less than 19 years of age (especially those under 15) and their offspring are a high-risk group for obstetric, pediatric, social, educational and psychological problems. Medical problems include increased frequencies of toxemia, anemia, abruptio placentae, cephalo-pelvic disproportion (in mothers less than 15 years of age), contracted pelvis, prolonged and/or premature labor, prematurity, low-birthweight infants and prenatal and infant mortality (Battaglia et al. 1963, Braen and Forbush 1975, Klerman 1975, Dott andFort 1976). Infantsof adolescent mothers are more likely to be underweight and shorter in stature, and later to be deficient in reading and to exhibit behavioral or ‘acting out’ difficulties (Oppel and Royston 1971). They also have less satisfactory psychological, intellectual and neurological development than infants of older mothers (Lobl et al. 1961, Braen and Forbush 1975). The increased incidence of low birthweight is of further concern because it is related to lower intellectual functioning (Lobl et al. 1961; Weiner et al. 1965, 1968; ScarrSalapatek and Williams 1973).
The social problems and consequences among the mothers include dropping out of school, precipitous marriage, divorce, occupational and financial difficulties, suicide (Braen and Forbush 1975), failure to develop adequate mothering skills (Klein 1975), and additional pregnancies in rapid succession (Braen and Forbush 1975, Duenhoelter et al. 1975). These present other causes for concern because of the increase in mortality rates as a function of birth order in adolescent mothers (Klerman 1975). Evidence exists that under optimal conditions of high quality antenatal care the medical risk to adolescent mothers and their infants need not be appreciably greater than for the maternal population as a whole (Dott and Fort 1976). However, often such care is not available; moreover, adolescent mothers use prenatal services much less than older women, making fewer visits and starting later in pregnancy (Dott and Fort 1976). The magnitude of the problem is indicated by the increase in both the birth rate within this high-risk group and the number of teenage women (Braen and Forbush 1975, Duenhoelter et al. 1975,
Correspondence to R.J. Thompson, Jr., Ph.D., Division of Medical Psychology, Duke University Medical Center, 2213 Elba Street, Durham, North Carolina 27705.
474
ROBERT J . THOMPSON, JR.
MARY W. CAPPLEMAN
McAnarney 1975), by the increase among teenage women in the prevalence of premarital intercourse, by the decline in age at first intercourse, and by the gap between first intercourse and first use of contraception (Zelnick and Kantner 1977). The Duke Developmental Evaluation Center is attempting to foster better development in a group of infants of adolescent mothers through a homebased early intervention project, to educate the mothers in infant stimulation techniques. To gain a better appreciation of the subtle as well as the gross consequences of adolescent motherhood on infant development, we have used the Brazelton Neonatal Assessment Scale to assess infants of adolescent mothers and infants of older mothers. The Brazelton Scale (Brazelton 1973) has been found to be a good predictor of later functioning, without a high falsepositive rate (Tronick and Brazelton 1975), sensitive to mild dysfunction of the central nervous system during the neonatal period (Tronick and Brazelton 1975), to cultural-racial group differences (Brazelton and Collier 1969, Freedman and Freedman 1969), to maternal and neonatal abnormalities such as low birthweight (Scarr-Salapatek and Williams 1973, Als et al. 1976), and to mild drug effects (Tronick et al. 1976). The scale is also clinically useful in suggesting management approaches and monitoring changes in behavior over time (Soule et al. 1974). The behavior items and dimensions of the scale enable a precise description of the infants of adolescent mothers to be made, as well as a delineation of their differences from infants of older mothers, and a consideration of the ‘stimulus value’ of the infant and the characteristic response patterns they elicit from these young mothers (Lewis and Rosenblum 1974).
KATHLEEN A. ZEITSCHEL
Method Two groups of babies were studied: 30 infants of black adolescent mothers (under 18 years old at delivery) and 30 infants of black older mothers (over 18 at delivery), born at Duke University Medical Center between April 1976 and September 1977. Because of age-dependent differences in education and occupation, both groups of mothers were considered to have similarly low socioeconomic status on the basis that all were unable to pay for their hospital care. Selection criteria were: gestational age between 37 and 42 weeks; an Apgar score of 7 or above at five minutes; weight equal to or above the 10th percentile for gestational age; physical examination within normal limits; and no over-riding complications of pregnancy, labor or delivery*. Gestational age was determined by an obstetrician, using a delivery-due date projected from the last menstrual period. Significant doubts about the accuracy of the date were resolved by using the Dubowitz scoring system (Dubowitz and Dubowitz 1977). The standard nursery procedures at the time of this study did not provide an opportunity for rooming-in and were the same, regardless of age, for all the mothers. If the infants’ condition at birth was stable, the mothers were allowed to see and hold them in the delivery room for approximately 30 minutes: the infants were then transported to the nursery, where they remained until 12 hours of age. Thereafter the mothers could have the infants in their room ‘on demand‘, depending upon the availability of sufficient staff in the nursery. Infants were taken to the mothers’ rooms at 9am and remained until 2pm, and again at 5pm *Subsequent to inclusion in the study, it was determined that one infant of an adolescent mother was slightly less than the 10th percentile for weight, and another had a physical examination within normal limits but with decreased muscle tone.
475
1979, 21
DEVELOPMENTAL MEDICINE A N D C H I L D NEUROLOGY.
study were single and delivering their first child, there were obviously significant differences in marital status (p
