Does Babywearing in Infancy Promote Secure Attachment into Early Childhood? Using Story Stems to Evaluate a Longitudinal RCT

Background: Young mothers are at higher risk for child maltreatment 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 babywearing (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 long-term impact of babywearing as an intervention to improve mother-child attachment in a sample of young mothers.

Methods: Seventy-four mothers (M=19.2 years, SD=2.3; 40.6% Hispanic; 40%<=11^th grade) representative of the Southwest US were randomly assigned in pregnancy to an intervention condition (n=36; an infant carrier) or a control condition (n=38; baby book set). In-home assessments were conducted at four time points: W1 (2-4 weeks postpartum), W2 (4-months), W6 (7-months), and W4 (3.5-4 years). At each wave, mothers completed self-report surveys (e.g., breastfeeding behaviors) and open-ended semi-structured interview questions (e.g., experiences with babywearing). At W4, children participated in an observational attachment assessment using five story stems from the MacArthur Story Stem Battery (warm-up birthday, spilled juice, climbing the rock, monster in the dark, and going on a trip). Videos were coded using the Attachment Focused Coding System for Story Stems (AFCS) by a certified coder (minimum weighted kappa = .70) on 9 dimensions: Supportive Mother, Supportive Father, Rejecting Mother, Rejecting Father, Attachment Avoidance Mother, Attachment Avoidance Father, Child Emotional Dysregulation, Child, Theme and Emotional Avoidance, and Resolution of Themes and Emotions.

Results: An independent t-test indicated that compared to the intervention condition, infants in the control condition had more rejecting mothers (M=1.58, SD=.32 vs M=1.31 SD=.44, d=.41) and fathers (M=1.29 SD=.42 vs M=1.62, SD=.42), d=42, p<.05 at W4. Mothers whose primary reason for babywearing in infancy was bonding had children with less rejecting mothers (r=-.43) and fathers (r=-.51), p <.05, and more hours of babywearing was predictive of less rejecting mothers, r=-.51, p<.05. A multiple regression analysis indicated a significant moderation effect of length of time breastfeeding with total number of babywearing hours: more babywearing and more weeks breastfeeding resulted in less avoidant mothers, F=4.22, p<.05, R²=.39, and fathers F=3.51, p<.05, R²=.35.

Conclusions and Implications: Babywearing is an effective, cost-effective, and culturally relevant practice that is effective at promoting secure, and preventing insecure, mother-child attachments. Preliminary results hold promising policy implications: Babywearing may be a potential mechanism to reduce the likelihood of child maltreatment among young mothers.