High Risk Infants

High Risk Infants

Caesarean Section

Field, T., & Widmayer, S. (1980). Developmental follow up of infants delivered by Caesarean section and general anesthesia. Infant Behavior and Development, 3, 253-264.

Infants delivered by caesarean section and general anesthesia were compared with those delivered vaginally with local-regional or no anesthesia. Findings included the absence of neonatal behavior differences, and perhaps more interesting, the more optimal interaction and temperament ratings of the C-section group during follow up assessments. Results are discussed in the context of an emergency caesarean altering the mother’s perceptions of her infant.

Field, T., Dempsey, J., Ting, G., Hallock, N., Dabiri, C., & Shuman, H.H. (1982). Respiratory distress syndrome: Perinatal prediction of one year developmental outcome. Seminars in Perinatology, 6, 288-293.

A number of perinatal variables were entered into multivariate regression analyses to determine which variables predicted the one-year Bayley Mental and Motor scores of infants surviving the respiratory distress syndrome. A greater number of the RDS infants received low motor scores as opposed to low mental scores, suggesting that intervention efforts with this group might focus on the development of early sensorimotor skills.

Cocaine Exposed Infants

Eisen, L.,N., Field, T.,M., Bandstra, E.S., Roberts, J.P., Morrow, C.,Larson, S.K., & Steele, B. (1991). Perinatal cocaine effects on neonatal stress behavior and performance on the Brazelton scale. Pediatrics, 88, 477-480.

Newborns were assessed for the effects of maternal cocaine use on their performance on the Brazelton Neonatal Behavior Assessment Scale and on their stress behaviors during the Brazelton as tapped by the Neonatal Stress Scale. The cocaine-exposed newborns experienced more obstetric complications, had smaller head circumferences, showed more limited habituation abilities on the Brazelton Scale, and exhibited more stress behaviors than control newborns.

Scafidi, F., Field, T., Wheeden, A., Schanberg, S., Kuhn, C., Symanski, R., Zimmerman, E., & Bandstra E.S. (1996). Cocaine-exposed preterm neonates show behavioral and hormonal differences. Pediatrics, 97, 851-855.

A comparison between cocaine-exposed and non-cocaine-exposed preterm neonates suggested that the cocaine-exposed neonates were born to mothers who had higher parity and more obstetric complications. In addition, mothers of cocaine-exposed preterm neonates visited, touched, held, and fed their infants less frequently than mothers of nonexposed infants. The cocaine-exposed infants had smaller head circumferences at birth, spent more time in the neonatal intensive care unit, and had a greater incidence of periventricular-intraventricular hemorrhages. They also had inferior Brazelton cluster scores, including lower state regulation and range-of-state scores, and greater depression. During sleep-wake behavior observations, they showed difficulty maintaining alert states and self-regulating their behavior, and they spent more time in indeterminate sleep and had decreased periods of quiet sleep and increased levels of agitated behavior, including tremulousness, mouthing, multiple limb movements, and clenched fists. Finally, higher urinary norepinephrine, dopamine, and cortisol levels and lower plasma insulin levels were noted in the cocaine-exposed preterm neonates.

Failure to Thrive Infants

Goldstein, S., & Field, T. (1985). Affective behavior and weight changes among hospitalized failure to thrive infants. Infant Mental Health Journal, 6, 187-194.

The affective behavior and weight change of nonorganic failure-to-thrive, organic failure-to –thrive, and control infants were compared across their hospitalization. Among the failure-to –thrive infants, positive responses to stimulation at the initial assessment were related to weight loss across the hospitalization, while positive responses to the same stimulation at the middle assessment were related to weight gain. An increase in positive affect across hospitalization occurred only for the infants who gained weight. Paradoxically, the losers may have experienced hospital stimulation as less adequate than maternal stimulation, while the gainers may have experienced hospital stimulation as more adequate than home stimulation.

Feeding Instructions

Field, T. (1977). Maternal stimulation during infant feeding. Developmental Psychology, 13, 539-540.

Maternal stimulation during infant feeding was compared for groups of 4-month old bottle-fed and breast-fed normal and high-risk infants. There were no differences in the amounts of maternal stimulation of the breast and bottle-fed groups. The high-risk male infants received more stimulation during sucking periods but were also observably more disorganized in their feeding than other groups, suggesting that the mother’s sensitivity cannot be assessed independently of the infant’s responsivity.

Heart rate Variability

Woodson, R., Field, T., & Greenberg, R. (1983). Estimating neonatal oxygen consumption from heart rate. Psychophysiology, 20, 558-561.

The relationship between heart rate (HR) and oxygen consumption was investigated in a sample of low-risk, term neonates. Findings suggest that HR may provide a flexible, non-restrictive means of estimating neonatal oxygen consumption.

Zeskind, P.S., & Field, T. (1982). Neonatal cry thresholds and heart rate variability. Infant Behavior and Development, 51-60.

This study compared infants who required a single stimulus to induce crying with infants who required multiple stimulus applications on spectral and durational measures of infant crying, and measures of heart rate variability. In addition to showing a shorter cry duration and a more frequent occurrence of high pitched cry sounds, multiple stimulus infants showed a greater heart rate variance and range marked by both higher peaks and lower depths of HR activity. The findings were used to support a model of infant crying which suggests that increased thresholds and higher pitched cry sounds characteristic of the infant at–risk may be associated with processes affecting neonatal autonomic stability.

HIV Exposed Infants

Scafidi, F., & Field, T. (1997). Brief report: HIV exposed newborns show inferior orienting and abnormal reflexes on the Brazelton Scale. Journal of Pediatric Psychology, 22, 105-112.

Infants of HIV-positive and HIV-negative mothers were assessed on the Brazelton Neonatal Behavioral Assessment Scale. Infants exposed to HIV-positive mothers were disadvantaged from birth due to their mothers having obstetric complications and to the infants having orienting problems and abnormal reflexes on the Brazelton Newborn Scale. These problems may be early precursors of the later visual-spatial delays and hypertonicity noted in these infants.

Low Income Infants

Hossain, Z., Field, T., Pickens, J., Malphurs, J.& del Valle, C. (1997). Fathers’ care giving in low-income African-American and Hispanic-American families. Early Development and Parenting, 6, 73-82.

The present study assessed fathers’ and mothers’ relative involvement in infant care giving tasks in low-income African American and Hispanic American families. Analysis showed that involvement in childcare differed as a function of the gender of the parent. Fathers spent one half the time mothers did in care giving. However, fathers’ and mothers’ participation in care giving did not vary as a function of ethnic group. African American parents reportedly received more family support than Hispanic American parents. Although relationships were noted between age, income, education, length of marriage, social support, and involvement in infant care giving, these sociodemographic variables did not predict parents’ participation in childcare. The results are discussed in relation to the preconceived notion that low-income, minority fathers are `uninvolved’.

Postterm Infants

Field, T., Dabiri, C., Hallock, N., & Shuman, H. (1977). Developmental effects of prolonged pregnancy and the postmaturity syndrome. Journal of Pediatrics, 90, 836- 839.

The development of post term, post mature infants was compared to that of normal control infants during the first year of life. The post term, post mature infants had more prenatal complications and received lower Brazelton interaction and motor scores at birth. They scored lower on the Denver developmental scale and were rated “difficult” babies by their mothers. Their Bayley motor scores were equivalent to those of the control infants, but their mental scores were lower. Their mothers reported a higher incidence of illnesses and of feeding and sleep disturbances.

Field, T., Hallock, N., Ting, G., Dempsey, J., Dabiri, C., & Shuman, H. H. (1978). A first year follow-up of high-risk infants: formulating a cumulative risk index. Child Development, 49, 119-131.

Comparisons between normal term, preterm RDS, and post term post mature infants suggested that the groups differed across the first year of development. Although the post mature infants were not designated medically at risk at birth, they had experienced prenatal complications, performed poorly on the Brazelton neonatal assessments, had ‘difficult’ temperaments, were inattentive during mother-infant interactions, and received depressed Bayley mental scores. The RDS infants who were considered medically at risk due to their postnatal complications also performed poorly on the Brazelton, were rated as having difficult temperaments, were inattentive during mother-infant interactions, but received markedly lower Bayley motor than mental scores.

Field, T., Ting, G., & Shuman, H. H. (1979). The onset of rhythmic activities in normal and high risk infants. Developmental Psychobiology, 12, 97-100.

The onset of rhythmic activities was compared for 2 groups of high-risk infants (a preterm Respiratory Distress Syndrome and a post term post mature group) and a normal term group over their 1st year of life. Differences suggest that the onset dates for rhythmic activities are not affected by the perinatal complications of RDS or postmaturity, but are related to gestational age differences. A comparison of the 3 groups on Bayley 1st-year motor skills revealed group differences even after an adjustment for gestational age differences, suggesting that the development of motor skills, unlike the development of rhythmic activities, may have been affected by these perinatal complications.

Preterm Infants

Field, T.M., Hallock, N.F., Dempsey, J.R., & Shuman, H.H. (1978). Mothers’ assessments of term and preterm infants with Respiratory Distress Syndrome: Reliability and predictive validity. Child Psychiatry and Human Development, 9, 75 85.

Assessments of term and preterm RDS infants were made by mothers on an adaptation of the Brazelton scale. The mothers’ assessments were not significantly different from those assessments made by trained clinicians, and both mothers and clinicians assigned less optimal ratings to preterm infants. These findings suggest that mothers’ assessments are reliable and have some predictive validity during early infancy.

Field, T., Dempsey, J., & Shuman, H. H. (1979). Bayley behavioral ratings of normal and high risk infants: Their relationship to Bayley Mental Scores. Journal of Pediatric Psychology, 4, 277-283.

The Bayley Infant Behavior Record [IBR] was given to normal and high-risk infants at 8, 12 and 24 months. Correlations between the Primary Cognition Composite score and concurrent Bayley Mental scores were reliable at each age, and the Primary Cognition Composite score, particularly at 12 months, was an efficient predictor of 2- year Bayley Mental performance. These results suggest the value of assessing test-taking behaviors in both normal and high-risk infant groups.

Field, T., Greenberg, R., Woodson, R., Cohen, D., & Garcia, R.(1984). A descriptive study of facial expressions during Brazelton Neonatal Behavior Assessments. Infant Mental Health Journal, 5, 61-71.

The facial expressions of term and preterm neonates were recorded during the Brazelton Neonatal Behavior Assessment. Although the examiner’s face and voice were more effective than inanimate stimuli in eliciting positive expressions in term neonates, the reverse was true for preterm neonates. Thus facial expressions may provide additional information on the degree to which neonates experience stimulation as pleasant/unpleasant and on individual differences in responsiveness to physical and social stimulation.

Morrow, C., Field, T., Scafidi, F., Roberts, J., Eisen, L., Hogan, A.E., & Bandstra, E.S. (1990). Transcutaneous oxygen tension in preterm neonates during neonatal behavioral assessments and heelsticks. Journal of Developmental and Behavioral Pediatrics, 11, 312-316.

This study evaluated the effects of neonatal behavioral assessments and heelsticks on transcutaneous oxygen tension in preterm neonates. Observed changes during the behavioral assessments occurred in a small number of infants, primarily during the few test procedures administered to the infants outside of their isolettes. Accordingly, it is suggested that time outside the isolette and associated temperature changes may be more critical variables than the assessments per se.


Field, T., Vega Lahr, N., Scafidi, F., & Goldstein, S.(1987). Reliability, stability, and relationships between infant and parent temperament. Infant Behavior and Development, 10, 117 122.

Reliability, stability, and relationships between infant and parent temperament were assessed using infant adaptations of 2 childhood temperament inventories. Both scales were moderately reliable, stability was moderate for the 4- to 18 –month periods, and significant correlations were noted between mother and infant temperament ratings.

Field, T. (1989). Infancy risk factors and risk taking. Comments on Rauh’s paper. European Journal of Psychology of Education, 4, 175-176.

The Hellgard Rauh paper: Rauh is basically suggesting that a model of risk requires the incorporation of several concepts including stress and coping and in that context personality characteristic such as vulnerability/resilience. Vulnerability certainly impacts on the infant’s ability to cope with stress. Protective factors such as a nurturant environment are also part of the equation of predicting outcomes from early risk factors.