Use of the Pediatric Infant Parent Exam: Screening Maternal-Infant Interactional Synchrony During Well-Infant Visits

Maternal-infant interactional synchrony is a dyadic interaction between mother and infant that provides an observable mutually regulated pattern of contingent reciprocal rhythm as each member makes behavioral adjustments to maintain a balance in the system (Leclere et al., 2014). Reciprocal synchronous interaction results in greater maternal sensitivity and more secure infant attachment. A major anticipatory need has been identified to screen for altered maternal-infant interaction early in life to identify at risk dyads and guide appropriate interventions to ameliorate maladaptive patterns. Nurses are well suited to screen early maternal-infant interactional synchrony as a component of well-baby visits via direct observation of the dyad. A psychometrically sound instrument for use during clinic visits would satisfy such a need. One instrument that was found to be desirable for use in an outpatient clinic setting is the Pediatric Infant Parent Exam (Fiese, Poehlmann, Irwin, Gordon, Curry-Bleggi, 2001).

The purpose of the dissertation study was to determine the interrater reliability, overall impression, and scoring of typicality of the interaction and time required for nurses’ use of the Pediatric Infant Parent Exam (PIPE) to screen the interaction of a convenience sample of 50 mother-infant dyads during a well-baby visit in a clinic setting. After IRB consent was obtained, the PI and three pediatric clinical nurses completed training based on the PIPE manual. The research assistant identified English speaking mother-infant dyads using the pediatric clinic as a medical home. Infants were between six and nine months of age. Exclusion criteria were infants with congenital anomalies, fever or illness. On reporting for the scheduled well-baby visits, Mothers who expressed an interest received further information about the study. Once they expressed an interest in participation, informed consent was obtained and the one time brief observations were carried out in the private exam room by the PI and pediatric clinical nurse. A book was presented to each dyad who participated. Raw scores were transformed with SAS, version 9.3 and analyzed using Cohen’s kappa. The kappa was 0.809 and the weighted kappa was 0.840 for cumulative paired ratings of the various stages of the PIPE while the “overall synchrony” ratings did not meet the assumption of symmetric distribution making any kappa analysis questionable at best. As to the “judgement of typicality”, kappa was 0.666. Two of the pediatric clinical nurses rated use of the Pediatric Infant Parent Exam as “somewhat easy” while one nurse rated the instrument as “easy to use”. The time for scoring the observation ranged from 60 to 202 seconds with a mean of 90.57 seconds, a median of 67.5 seconds, and a standard deviation of 44.13 seconds.

Early identification of dyads at risk can expedite early treatment thereby creating a more favorable developmental trajectory for the maternal-infant dyad. The use of the PIPE offers one instrument to assist in this process. Nurses in an outpatient clinic used the instrument in screening maternal-infant interactional synchrony with outcomes to suggest the additional use by others who attend to infants early in life.