A longitudinal study of the growth and development of prematurely and maturely born children part v. Patierns of maternal care (a study of child rearing in Scotland)

Abstract

This paper describes different patterns of child rearing in the first two years of life in an unselected group of premature and maturely born infants born in Edinburgh hospitals. Comparison with all births in Edinburgh during the same period suggests that of working class mothers nearly one-half observed standards of household management and child care which approximate closely to those found in middle class homes, and that in approximately one working class home in 10 standards appear to be definitely below the level required for good health and normal development of the young child. The incidence of prematurely born infants is highest in these poor homes and, as previous papers have shown (Drillien, 1958, 1959a, b), the proportion of undersized, retarded children, who suffer from frequent ill health, is also highest in this group. Contrary to the findings of other investigators, which are summarized by Illingworth (1953), no striking advantage could be demonstrated for breast feeding, as opposed to bottle feeding, in similar types of home. The reported lower incidence of infection in breast fed babies (e.g. Robinson, 1951) is almost certainly due largely to the predominance of better type mothers in the breast fed group. Underfeeding appeared to be commoner in breast fed babies, especially in the poorer working class homes. National Dried Milk was the food of choice for the majority of bottle fed babies, and even in the poorest homes most mothers sterilized bottles and teats regularly, no doubt as a result of supervision and instruction from health visitors. The incidence of gastro-intestinal infection was low in all types of home in the first six months and reached a peak in the second half of the first year when the child was being introduced to solids. There was no evidence that behaviour problems in the first two years were any less common in babies who had been breast fed. There was, however, a marked association between behaviour problems and over-anxiety in the mother. It seems likely that the contented baby is the satisfied baby, whether breast or bottle fed, and that the contented baby is more likely to produce a contented, confident mother, who is calm in her handling. Hytten, Yorston and Thomson (1958) studied a group of 106 primiparae and found that mothers who continued to lactate for three months were more often unwell and worried than those who abandoned breast feeding soon after leaving hospital, and conclude that there is little justification for pressing the mother to continue when she is either unwilling or apparently unable to breast feed efficiently. Apart from the incidence of breast feeding, the most marked differences in feeding habits in the best and worst homes were the later age of weaning to mixed feeding and finally stopping bottle feeds in the latter; a predominance of starchy foods at 1 year; lack of variety and lower intake of protein, fruit and vegetables in the second year of life. No evidence could be obtained from the sample that early toilet training has an adverse effect on the child at a later date, once it is recognized that the rigid, over-conscientious and over-anxious mother is more likely to practise rigorous toilet training. Behaviour problems of all types were much commoner in the children of these mothers, whether or not there had been early toilet training. A significantly higher incidence of resistance to potting was found in boys, who also were significantly later in acquiring sphincter control. The incidence of prolonged feeding battles and sleeping problems was five times as high in the children of mothers previously noted as being overanxious. Sleeping problems were also much more common inpoorer homes and seemed to be associated with the lack of regular routine at bed-time, rather than with inadequate accommodation. Other behaviour problems, notably excessive temper and timidity, were also found most frequently in the poorest homes, and in good homes where the mother was over-anxious.