Infant Carrying As an Intervention to Promote Mother-Infant Attachment: Evidence from an RCT with Teen Moms

Background: Young mothers are at higher risk for child maltreatment and neglect and are more likely to experience difficulty bonding with their baby compared to other mothers: Their babies are more likely to have a difficult temperament (e.g., born premature, prenatal exposure to substance use) and they are less likely to have the resources required to cope with heightened infant crying and infant sleep dis-regulation. Close proximity to infants increases mothers’ awareness of her infants’ needs (e.g.,  hunger) and also promotes the neuropeptide oxytocin, which is associated with maternal behavior (e.g., affectionate touch, positive affect during mother-infant interactions, and “motherese”). Limited research on infant carrying (i.e., holding or carrying a baby in a cloth carrier that is worn on the body) indicates that frequent close physical contact increases maternal responsiveness and promotes secure attachment between mothers and their infants. The purpose of this study is to assess the potential use of infant carrying practices as an effective and cost-effective intervention to improve mother-infant attachment in a sample of teen mothers.

Methods: Seventy-four mothers (M=19.2 years, SD=2.3; 40.6% Hispanic; 40%<=11^th grade) participated in Healthy Families or Teen Outreach Pregnancy Services programming and were randomly assigned to the intervention condition (n=36; received an infant carrier and were told to use the carrier for at least one hour daily) or the control condition (n=38; received a baby book set). In-home assessments were conducted at 2-4 weeks postpartum (W1), and 3- (W2) and 6- (W3) months later. At each wave, mother’s completed the postpartum bonding questionnaire (25 items, e.g., “I resent my baby”) and open-ended semi-structured interview questions about attachment (e.g., “how has your relationship with your baby changed since he/she was born?”). At W3, mothers and babies (n=17 intervention, n=17 control) participated in the Still-Face Paradigm to assess observed mother-infant interactions (2 minutes interaction, 2 minutes still-face, 2 minutes reunification). Videos were coded for observed infant and mother engagement behaviors based on Tronick’s scoring systems, including facial expressions, direction of gaze, and vocalizations. A meta-analysis review supports positive associations between the still-face task and secure attachment at one year.

Results: Repeated measures ANOVA indicated that compared to the control condition, infants in the intervention condition spent significantly less time in protest and object/environment engagement, and mothers in the intervention condition spent significantly more time in social positive engagement and in exaggerated positive engagement (moderate to large effect sizes). Mothers in the intervention condition reported fewer postpartum bonding difficulties at W2, and qualitative responses coded at W3 indicated that the most notable benefit of using infant carriers was for bonding (followed by to soothe/calm their baby and convenience).

Conclusions and Implications: Promoting the use of infant carriers is a cost-effective and culturally relevant practice for many mothers. Preliminary results hold promising policy implications for the promotion of infant carriers and the practice of infant carrying as an effective tool at promoting infant attachment and ultimately reducing child maltreatment.