Mother-child interactions and the associations with child healthcare utilization in low-income urban families.
Studies have demonstrated that low-income families often have disproportionately high utilization of emergency department (ED) and hospital services, and low utilization of preventive visits. A possible contributing factor is that some mothers may not respond optimally to their infants' health needs, either due to their own responsiveness or due to the child's ability to send cues. These mother-child interactions are measurable and amenable to change. We examined the associations between mother-child interactions and child healthcare utilization among low-income families. We analyzed data from the Nurse-Family Partnership trial in Memphis, TN control group (n = 432). Data were collected from child medical records (birth to 24 months), mother interviews (12 and 24 months postpartum), and observations of mother-child interactions (12 months postpartum). We used logistic and ordered logistic regression to assess independent associations between mother-child interactions and child healthcare utilization measures: hospitalizations, ED visits, sick-child visits to primary care, and well-child visits. Better mother-child interactions, as measured by mother's responsiveness to her child, were associated with decreased hospitalizations (OR: 0.51; 95% CI: 0.32, 0.81), decreased ambulatory-care-sensitive ED visits (OR: 0.65, 95% CI: 0.44, 0.96), and increased well-child visits (OR: 1.55, 95% CI: 1.06, 2.28). Mother's responsiveness to her child was associated with child healthcare utilization. Interventions to improve mother-child interactions may be appropriate for mother-child dyads in which child healthcare utilization appears unbalanced with inadequate primary care and excess urgent care. Recognition of these interactions may also improve the care clinicians provide for families.
Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA. margaret_holland@urmc.rochester.edu
Margaret L
ML
Holland
Byung-Kwang
BK
Yoo
Harriet
H
Kitzman
Linda
L
Chaudron
Peter G
PG
Szilagyi
Helena
H
Temkin-Greener
D002648:Child; D002662:Child Health Services / Q000706:statistics & numerical data*; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D016015:Logistic Models; D009034:Mother-Child Relations; D009035:Mothers / Q000523:psychology; D009819:Office Visits / Q000706:statistics & numerical data*; D011203:Poverty; D011314:Preventive Health Services / Q000706:statistics & numerical data*; D014505:Urban Population