Pediatricians can help immigrant mothers by explaining child development, NICHD study suggests

November 01, 2004

Groups of immigrant mothers from Japan and South America knew less about child development than did their European American counterparts, according to a study by researchers at the National Institute of Child Health and Human Development of the National Institutes of Health.

Such gaps in parenting knowledge, the authors wrote in the November issue of Pediatrics, could have a negative impact on children's development, with mothers possibly missing warning signs that their children need medical attention or early intervention services.

The authors added that pediatricians could assist parents who lack knowledge of child development by taking steps to educate them about the topic.

The study was conducted by Marc Bornstein, Ph.D., and Linda Cote, Ph.D., C.F.L.E., both of NICHD's Section on Child and Family Research.

The researchers pointed out, however, that the immigrant mothers knew as much about health practices concerning their children's physical safety as did the European American mothers.

"New parents have a need for accurate and helpful information about child development and pediatricians can help meet that need," said NICHD Director Duane Alexander, M.D. "In turn, parents who have an understanding of child development can provide pediatricians with information that will help them better serve pediatric patients."

In the article, the researchers wrote that study of child rearing practices among immigrants is extremely important because a large proportion of U.S. children come from immigrant families. The researchers cited a U.S. Census Bureau statistic that roughly 1 in 5 U.S. children, about 14 million in all, lives with at least 1 immigrant parent. The researchers added that they chose to study Asian and Latino mothers because those groups are currently the majority immigrant groups in the United States.

"Moreover, the Asian and Latino populations in the United States are expected to triple by mid-century, making it increasingly important that clinicians better understand Asian and Latino parents," the authors wrote.

The researchers recruited 114 mothers of 20-month-old children for the study. Of these, 38 were Japanese immigrants, 36 were South American immigrants, and 40 were 4th and 5th generation European Americans. The South American immigrant mothers largely were from Argentina, Peru, and Colombia. All of the women resided in the Washington, D.C., metropolitan area, were middle-class, of a similar age, and had comparable levels of education.

The researchers measured the women's knowledge of child rearing by having them fill out a survey form known as the Knowledge of Infant Development Inventory, or KIDI. The survey assesses knowledge of parental contributions to children's psychological and social development, normal developmental milestones, as well as knowledge of health and safety guidelines.

The researchers found that immigrant mothers tended to score lower on the test than did the European American mothers. Specifically, the researchers identified 18 questions that the immigrant mothers tended to answer incorrectly or to which they did not know the answers. Nearly all the questions with which the immigrant mothers experienced difficulty involved either child development or parent-child relationships.

For example, fewer than half of the immigrant mothers were aware that babies begin "babbling" around 5 months of age. Infant babbling, the stringing together of vowel and consonant sounds, is an important stage in the eventual development of language. Similarly, fewer than half of the immigrant mothers knew that an infant will begin to respond to his or her name at 10 months of age.

"A mother who is aware of when the onset of babbling should occur and the age at which an infant can respond to his/her name will be more likely to identify potential hearing problems and bring them to the attention of her pediatrician than a mother who is unaware of such markers," the authors wrote.

On another survey response, only about a third of the immigrant mothers knew that the average newborn cries for a total of about 1-2 hours out of every 24. Equal numbers of the immigrant mothers said they believed that 3 to 6 hours of crying out of 24 is normal as said they didn't know how much crying was normal. If parents believe long periods of crying is normal, the authors noted, then they might be less likely to respond to their infants if something is wrong.

"Knowledge of developmental milestones is important because it is widely agreed that early intervention is key to preventing long-term problems in children," the authors wrote. "If parents are unaware of what those milestones are, they will be less likely to recognize and raise problems with their pediatrician."

Similarly, lack of knowledge about what constitutes normal infant behavior may interfere with a mother's emotional relationship with her child, the authors wrote. For example, a mother, expecting an infant who likes to be cuddled, may instead have an infant who doesn't enjoy cuddling. The woman may feel that her mothering skills are to blame, when in fact it's normal for some babies to not enjoy being cuddled.

Drs. Bornstein and Cote pointed out that immigrant mothers did not differ significantly from the European American mothers in their answers to questions concerning children's physical health or safety. For example, the immigrant mothers knew that soft bedding material placed in the crib--such as pillows and loose blankets--increase an infant's risk for sudden infant death syndrome.

The researchers believe that the European American mothers in the study were more knowledgeable about child development because they were more likely to seek out written materials on child development than were their immigrant counterparts.

The study authors noted that pediatricians often do not talk with parents about child development or child rearing, and that parents do not ask their children's pediatricians for advice about these topics. They cited studies showing that 79 percent of mothers could use more information in at least one area of childrearing, and 53 percent could use more information in three or more areas.

Pediatricians who are aware of mothers' knowledge and expectations about their children's development will be better able to serve their patients' needs, Drs. Bornstein and Cote wrote.

To help parents learn about child development, pediatricians might make multilingual written or visual materials available in their waiting rooms, the authors wrote. A series of publications on child development has been developed by the American Academy of Pediatrics and Zero to Three, an organization that promotes healthy child development. The series, Healthy Minds: Nurturing Your Child's Development, can be downloaded free of charge at

The authors added that physicians lacking an adequate educational background in child development might consider asking a child development specialist to join their practices.

"Considering parental knowledge level and cultural background inevitably introduces a layer of complexity to the clinician's tasks, but to eschew or negate such considerations risks access to vital information about the child patient," the authors concluded.

NIH/Eunice Kennedy Shriver National Institute of Child Health and Human Development

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