Arch Dis Child Fetal Neonatal Ed 99:F70-F75 doi:10.1136/archdischild-2013-303788
  • Original article

Very preterm/very low birthweight infants’ attachment: infant and maternal characteristics

  1. Tina Gutbrod3
  1. 1Department of Psychology, Lifespan Health and Wellbeing Group, University of Warwick, Coventry, UK
  2. 2Division of Mental Health and Wellbeing, Warwick Medical School, Coventry, UK
  3. 3Department of Psychology, University of Hertfordshire, Hatfield, UK
  1. Correspondence to Professor Dieter Wolke, Department of Psychology, Lifespan Health and Wellbeing Group and Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK; D.Wolke{at}
  • Received 1 February 2013
  • Revised 24 May 2013
  • Accepted 27 May 2013
  • Published Online First 21 June 2013


Objective To investigate whether there are differences in attachment security and disorganisation between very preterm or very low birthweight (VP/VLBW) (<32 weeks gestation or <1500 g birthweight) and full-term infants (37–42 weeks gestation) and whether the pathways to disorganised attachment differ between VP/VLBW and full-term infants.

Design The sample with complete longitudinal data consisted of 71 VP/VLBW and 105 full-term children and their mothers matched for twin status, maternal age, income and maternal education. Infant attachment was assessed with the Strange Situation Assessment at 18 months of age. Maternal sensitivity in the VP/VLBW and full-term samples was rated by neonatal nurses and community midwives in the neonatal period, respectively, and mother-infant interaction was observed at 3 months. Infant difficultness was assessed by maternal report at 3 months and infant's developmental status was assessed with the Bayley Scales (BSID-II).

Results Most VP/VLBW (61%) and full-term (72%) children were found to be securely attached. However, more VP/VLBW (32%) than full-term children (17%) had disorganised attachment. Longitudinal path analysis found that maternal sensitivity was predictive of attachment disorganisation in full-term children. In contrast, infant's distressing cry and infant's developmental delay, but not maternal sensitivity, were predictive of disorganised attachment in VP/VLBW children.

Conclusions A third of VP/VLBW children showed disorganised attachment. Underlying neurodevelopmental problems associated with VP/VLBW birth appear to be a common pathway to a range of social relationship problems in this group. Clinicians should be aware that disorganised attachment and relationship problems in VP/VLBW infants are frequent despite sensitive parenting.

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