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Parental Protection of Extremely Low Birth Weight Children at Age 8 Years

Wightman, Aaron BA; Schluchter, Mark PhD; Drotar, Dennis PhD; Andreias, Laura MD, MS; Taylor, H Gerry PhD; Klein, Nancy PhD; Wilson-Costello, Deanne MD; Hack, Maureen MB, ChB

Journal of Developmental & Behavioral Pediatrics: August 2007 - Volume 28 - Issue 4 - p 317-326
doi: 10.1097/DBP.0b013e3180330915
Original Article

Objective: To examine parent protection and its correlates among 8-year-old ELBW children compared with normal birth weight (NBW) controls.

Methods: The population included 217 eight-year-old ELBW children born 1992–1995 (92% of the surviving birth cohort; mean birth weight, 811 g; mean gestational age, 26.4 weeks) and 176 NBW controls. The primary outcome measure, the Parent Protection Scale (PPS), included a total score and four domains including Supervision, Separation, Dependence, and Control. Multivariate analyses were performed to examine the predictors of parental protection and overprotection.

Results: After adjusting for socioeconomic status (SES), race, sex, and age of the child, parents of ELBW children reported significantly higher mean total Parent Protection Scale scores (31.1 vs 29.7, p = .03) than parents of NBW children and higher scores on the subscale of Parent Control (8.0 vs 7.5, p = .04). These differences were not significant when the 36 children with neurosensory impairments were excluded. Parents of ELBW children also reported higher rates of overprotection than controls (10% vs 2%, p = .001), findings that remained significant even after excluding children with neurosensory impairments (8% vs 2%, p = .011). Multivariate analyses revealed lower SES to be associated with higher total Parent Protection Scale scores in both the ELBW (p < .001) and NBW (p < .05) groups. Additional correlates included neurosensory impairment (p < .05) and functional limitations (p < .001) in the ELBW group and black race (p < .05) and maternal depression (p < .01) in the NBW group. Lower child IQ was significantly associated with higher PPS scores only in the neurosensory impaired subgroup of ELBW children.

Conclusions: Longer term follow-up will be necessary to examine the effects of the increased parent protection on the development of autonomy and interpersonal relationships as the children enter adolescence.

From the Department of Pediatrics, Case Western Reserve University, Cleveland, OH.

Received May 2006; accepted January 2007.

Supported by grants RO1 HD39756 and M01 RR00080, General Clinical Research Center of the National Institutes of Health. A.W. was supported by a Crile Fellowship.

Address for reprints: Maureen Hack, M.B. Ch.B., Division of Neonatology, Suite 3100, Rainbow Babies and Children’s Hospital, University Hospitals of Cleveland, 11100 Euclid Avenue, Cleveland, OH 44106-6010; e-mail:

© 2007 Lippincott Williams & Wilkins, Inc.