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Factors Affecting Parent-Child Relationships One Year After Positive Newborn Screening for Cystic Fibrosis or Congenital Hypothyroidism

Tluczek, Audrey PhD, RN, FAAN*; Clark, Roseanne PhD; McKechnie, Anne Chevalier PhD, RN, IBCLC; Brown, Roger L. PhD*,§

Journal of Developmental & Behavioral Pediatrics: January 2015 - Volume 36 - Issue 1 - p 24–34
doi: 10.1097/DBP.0000000000000112
Original Article

Objective: Examine factors that mediate parent-infant relationships 12 months after positive newborn screening (NBS).

Methods: We examined effects of infant diagnosis, parents' perceptions of child vulnerability and child attachment, parental depression and anxiety on parent-infant feeding interactions for 131 mothers and 118 fathers of 131 infants whose NBS and diagnostics confirmed cystic fibrosis (CF, n = 23), congenital hypothyroidism (CH, n = 35), CF carrier status (CF-C, n = 38), or healthy normal NBS (H, n = 35).

Results: Separate composite indicator structural equation models for mothers and fathers showed that neonatal diagnosis was not associated with increased anxiety or depression. In comparison with the healthy group, CF group parents reported higher perceptions of child vulnerability (p < .001, p = .002), and CF-C group fathers viewed their children as more attached (p = .021). High maternal perception of child vulnerability was associated with low perceptions of child attachment (p = .001), which was associated with task-oriented feeding behavior (p = .016, p = .029). Parental task-oriented feeding behavior was associated with less positive (p < .001, p < .001) and more negative interactions (p < .001, p = .001) with their infants. High paternal perception of child vulnerability was associated with negative parent interactions (p < .001). High parental affective involvement and verbalization was associated with high infant affective expressiveness, communicative skills, and social responsiveness (mothers' p < .001, fathers' p < .001). High parental negative effect and/or inconsistent and intrusive behavior were associated with infant dysregulation and irritability (mothers, p < .001, fathers, p < .001).

Conclusion: The severity of conditions identified through NBS can affect parents' perceptions of their child's vulnerability and attachment. Infant feeding problems in the context of chronic health conditions, like CF, could represent signs of more deeply rooted concerns regarding the parent-child relationship that merit additional clinical evaluation.

This article has supplementary material on the web site:

*School of Nursing, University of Wisconsin-Madison, Madison, WI;

Department of Psychiatry, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI;

School of Nursing, University of North Carolina-Chapel Hill, Chapel Hill, NC;

§Department of Family Medicine, University of Wisconsin-Madison, Madison, WI.

Address for reprints: Audrey Tluczek, PhD, RN, FAAN, School of Nursing, University of Wisconsin, 701 Highland Avenue, Madison, WI 53705; e-mail:

Supported by the National Institute of Child Health and Human Development (K23HD42098), the University of Wisconsin-Madison School of Nursing Research Committee, and the University of Wisconsin-Madison Graduate School.

Disclosure: The authors declare no conflict of interest.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

Received March , 2014

Accepted September , 2014

© 2015 by Lippincott Williams & Wilkins