The mother-child interaction and clinical judgment during acute pediatric illnesses

Objectives: For acutely ill children living in less than optimal environmen ts, mothers and pediatricians may have a heightened perception of illness s everity, a lower specificity of clinical judgments, and a tendency to over- utilize resources. We examined the mother-child interaction in order to und erstand the relation of less optimal environments to clinical judgment and resource use. Study design: At the 2-week and 6-, 15-, and 24-month well child visits of 316 children, the mother-well child interaction was assessed by using the B iringen's Emotional Availability Scales (EAS). Data were gathered regarding maternal depression and sense of competence, infant temperament, maternal social support, life events, the home environment, and demographics. At ill visits, the mother-ill child interaction was assessed by using the EAS, an d mothers and pediatricians independently assessed illness severity using t he Acute Illness Observation Scales. Resource use during the illness was ev aluated. Results: One thousand nine hundred eight-three acute illnesses were assesse d. A less optimal mother-child interaction was significantly (P < .05 for a ll comparisons) associated with poorer reliability of mothers' judgments, l ower specificity of mothers' judgments (71% vs 85%) and pediatricians' judg ments (92% vs 97%), and greater use of resources (eg, for hospitalizations, 2.6% of visits vs 0.7%). Adverse maternal, infant, and demographic charact eristics were associated with a less optimal mother-well child (r = 0.68) a nd mother-ill child (r = 0.80) interaction, a heightened perception of illn ess severity, and greater resource use. Conclusion: Less optimal environments adversely affect the mother-child int eraction; a poor mother-child interaction is correlated with low specificit y of clinical judgment and over-utilization of resources.