Relation between mother-child interaction upon the development of oral language of the preterm newborn
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Original Article
Relation between mother-child interaction upon the
development of oral language of the preterm newborn
A relação entre a interação mãe-criança no desenvolvimento da
linguagem oral de recém-nascidos prematuros
Beatriz Servilha Brocchi1, Maria Isabel da Silva Leme2
ABSTRACT RESUMO
Purpose: To verify relations between the oral language develop- Objetivo: Verificar o impacto da interação mãe-criança no desenvolvi-
ment of preterm children and the quality of mother-child interaction. mento da linguagem oral de crianças pré-termo, visto que a prematuri-
Methods: The subjects of this research were 20 mother and child dya- dade pode prejudicar esse processo. Métodos: Participaram da pesquisa
ds. An interview was conducted with the mother to obtain data about 20 díades de mães e filhos de 5 a 6 anos de idade, com diagnóstico de
birth and life conditions. The development of oral language of the prematuridade ao nascimento. Realizou-se anamnese com as mães e
children was assessed using a test that evaluates phonology, fluency, avaliação da linguagem oral das crianças. Resultados: As mães, em sua
vocabulary and pragmatics. Results: It was observed that the most part maioria, se consideraram como as principais cuidadoras de seus filhos
of mothers considered themselves the main caretaker and behavior´s e referiram ser mais importante controlar o comportamento e cuidar, do
control and care are more important the stimulus in dyadic relation. All que estimulá-los. As crianças, por sua vez, apresentaram desempenho
children scored bellow the expected for their age in the tests performed. abaixo do esperado para todos os testes realizados. Conclusão: Além
Conclusion: Besides the contribution of biological factors associated da contribuição dos fatores biológicos associados à prematuridade, esses
to prematureness, these results can be attributed to the quantity and resultados podem ser atribuídos à quantidade e à qualidade da interação
quality of mother-child interaction, since mothers informed to prioritize materno-infantil, visto que as mães informaram priorizar a obediência
obedience and good behavior more than stimulation of the development. e o bom comportamento mais que o estímulo ao desenvolvimento, na
educação dos filhos.
Keywords: Language; Mother-child interactions; Infant, Premature;
Psichology; Speech, Language and Hearing Sciences Descritores: Linguagem; Relações Mãe-Filho; Prematuro; Psicologia;
Fonoaudiologia
Research performed at Institute of Psychology, Universidade de São Paulo – USP – São Paulo (SP), Brazil.
(1) Post-graduation Program (Post-Doctorade) in Experimental Psychology, Institute of Psychology, Universidade de São Paulo – USP – São Paulo (SP), Brazil.
(2) Psychology Department, School and Human Development, Institute of Psychology, Universidade de São Paulo – USP – São Paulo (SP), Brazil.
Conflict of interests: No
Authors’ contribution: BSB principal investigator, elaboration of the study, elaboration of the schedule, literature review, data collection and analysis, drafting the
article, submission and process; MISL, tutor, elaboration of the study, elaboration of the schedule, data analysis, correction of the article, approval of the final version.
Correspondence adress: Beatriz Servilha Brocchi. R. Doutor Alberto Cerqueira Lima, 206/102, Taquaral, Campinas, Brazil, CEP: 13076-010.
E-mail: biaservilha@yahoo.com.br
Received: 11/1/2013; Accepted: 9/9/2013
ACR 2013;18(4):321-31 321Brocchi BS, Leme MIS
INTRODUCTION children, a positive relationship between the following aspects
has been verified: maternal responsiveness in the interactions
The importance of creative practices for the psychological with the child and receptive, expressive language on the part of
development of children, in what pertains to their intellect, the child, as well as adequate maternal conduction and social
sociability or affectivity has been well established(1). Likewise, and cognitive skills, mainly child autonomy(3).
the relationship between the quality of the child-family bond- There is evidence that mothers of premature children that
ing - especially the mother-child boding - and development present normal language development have manifested more
has also been established(2). However, a systematic literature sensitivity to their children’s clues and have more thoroughly
review(3) has found that research on regarding the influence stimulated their social and cognitive development than mothers
of such practices over the development of some aspects of whose children showed language issues. It was verified, thus,
language that are important for future schooling of premature that maternal responsiveness in the first four years of the child’s
babies, especially when they reach school age, is still rare. life has a positive impact over the receptive and expressive
The concept of ‘preterm newborn’ refers to babies that are language that the child displays at the age of four(3).
born before 37 full weeks of gestational age(4). The incidence Age-appropriate linguistic development was also correlated
of premature births in the world varies from 6% to 10%, and with less punishment, less restriction and mother making avai-
the highest rates are verified in developing countries. In Brazil, lable materials needed for playing. It is important to remember
the incidence is currently between 5% and 15%. The causes that preterm newborns tend to be delayed when it comes to
have not been fully determined, although some predisposing behavioral organization, which, in turn, might lead to less so-
factors have been isolated, such as primiparity, socioeconomic cial responsiveness, an important factor for the establishment
status, maternal nourishment, mothers’ age, interval between of the relationship with their mothers and other caretakers(11).
gestations, maternal illnesses, previous fetal death history, It is possible that, by virtue also of a lowered responsiveness,
low-weight and low-height mothers, fetal malformations, use that the language development of preterm babies is below
of tobacco, etc(4). average, with behaviors of different complexity coexisting,
Premature births are permeated by urgency and, therefore, as well as marked leaps in evolution. Environmental factors
might involve serious negative consequences, for both mother such as employment (which leads to more positive and safer
and baby, if skin-to-skin restrictions occur due to the immaturity surroundings), intellectual level and family income (higher
and instability of the baby. The mother, after the abrupt inter- income families tend to favor higher quality stimuli in the hou-
ruption of the birth, needs to cope with a great deal of conflicts, sehold) are considered important factors for the development
such as: birth-imposed separation; diminished responsiveness of language of preterm babies(3,10,12).
of the newborn due to the immaturity and precariousness of his Although the mother is considered to be the conducting
general conditions; sharing the baby with health professionals element of stimulation, when it comes to social ability in com-
and the possibility of the baby’s loss. This situation might municative exchanges, the infant’s responsiveness contributes
generate feelings on the mother such as guilt, frustration, in- to the maintenance and increased complexity of the social
competence and negative expectations, like anxiety, and these interaction(11). The child’s reduced adaptability to maternal
might influence the quality of the interactions that established intention may be related to attention problems once school
with the baby(5). Many other feelings might appear alongside the age is reached(3).
scenario of babies’ prematurity, such as the fear that the child As a result of the scenario described above it can be ob-
will not survive, that he will get sick easily or suffer long-term served that the development of language, in all its aspects
side effects(6-8). Thus, during hospitalization, the relationships (vocabulary, phonology, fluency, pragmatics, speech) is intrin-
are configured in a peculiar way between the baby, the hospital sically related to the social exchanges of the child with his/her
staff and the parents. environment, mostly with his/her mother figure, which presents
Preterm babies present a few peculiarities. The majority as both model and link between the child and the environment
of these infants present, for instance, good neuropsychomotor in which he/she lives. The interaction between the dyad beco-
evolution, but can, nevertheless, show some delay in such deve- mes even more important if involving premature children who
lopment(9). They will perform similar tasks as full-term babies, need accompaniment and stimuli so that their development is
even if a bit later. This delay will depend on the complications adequate to their chronological age, since they represent a risk
and the environment’s stimuli received by the baby, that might group for impairments in several aspects, such as linguistic
reduce or augment the resulting effects of prematurity(3,5,9,10). skills. Thus the importance of orientating the mother regarding
the baby’s stimulation, because the richer and more varied it
Prematurity and development is, the higher the probability of a positive effect on the child’s
development.
Regarding the influence that the mother-child interaction Considering the results of the literature review this research
exerts on development, as assessed in preschool and school age had the objective of characterizing the development of the oral
322 ACR 2013;18(4):321-31Mother-child and the language of the preterm
language of preschool age children who were preterm babies, interaction with the child, daily routines followed, availability for
and verify the influence of the mother-child interaction on the the child, type of activities undertaken, frequency at the daycare,
language development of these infants. what were her priorities regarding her child’s education and the
mother’s expectations regarding the child (Appendix 1). The
METHODS anamnesis was formulated so as to contemplate all aspects that
involve the matter of prematurity and the dyadic relationship
Subjects since birth, for example, maternal directivity and development.
A pilot test was conducted with two mothers, in order to adjust
Twenty dyads were included in this study (ten boys and the guide for the population studied.
ten girls), with ages ranging from 5 to 6 years old (mean age 5 In order to evaluate all aspects of children’s language, the
years and 5 months), and their respective mothers. They have child was submitted to a speech test called ABFW(13), which
all been admitted to a neonatal intensive care unit (NICU) at aims at the evaluation of language’s four aspects: phonology,
birth and were selected from exams and records registered in vocabulary, pragmatics and fluency. For the first two aspects,
the High Risk Ambulatory from the Hospital e Maternidade it was used an arrangement of figures from the same book,
Celso Pierro, where they were studied and followed since birth. which contained images with blank lines to be filled with the
From the identifying set of data regarding mother and child, correspondent names of animals, foods, furniture and utensils,
researchers invited the mothers to participate in the study along transports, colors, shapes and toys. There are, also, phonetically
with their children. balanced pictures, whose objective is to evaluate the phonologic
Inclusion criteria were: development of children. For the pragmatics and fluency tests
1. Premature birth occurred at the same hospital in which the a free, playful activity was proposed using various toys, such
study was developed; as a ball, dolls, fitting pieces etc.
2. Agreement, on the part of the mother, to participate in the Regarding the evaluation of the oral speech, the following
research and sign the Term of Consent; materials were used:
3. The child needed to have received a prematurity diagnosis - A book called “Tuca, Vovó e Guto”(14), as a tool for story
at birth, meaning a gestational age less than 37 weeks of retelling;
corrected age and a birthweight lower than 2,000 grams. - Action figure as a tool for the elaboration of an original
Age was corrected using the Capurro method and the New story after the observation of the figure;
Ballard score (for cases in which children had a gestational - Four figure logical sequence for the assortment and elabo-
age of 25 weeks); ration of a story out of the observed scenery (taken from
4. Hospitalization in the NICU; the game Sequências Lógicas – Brinquedos Inteligentes).
5. The child had been followed at the High Risk ambulatory
from the same hospital, since discharge; Procedures
6. Regularly attended a school from its local educational
district. The evaluation was conducted in a therapy room from the
Children with central nervous system (CNS) alterations Speech-Language Pathology Clinic of PUCCamp, according
were excluded from the research, as well as those with syn- to what was described in the project that was approved by the
dromes; those hearing or eye impaired; children that were born Ethics Committee from the same institution, in a threefold
at other hospitals; and children whose mothers, when invited, session: the first involved only the mother, in order to have the
have not agreed to participate in the research. Term of Consent signed, and, also, to realize the anamnesis. In
The evaluation of the preschoolers was undertaken out of the second session the following aspects of the child’s language
project’s approval by the Ethics Committee of the Pontifícia were evaluated: vocabulary, phonology and speech. The last
Universidade Católica de Campinas (PUCCamp) (parecer nº session was dedicated solely to the child’s play, so it could have
973/07). a free and spare time to engage in playful situations, in which
fluency and pragmatics were being evaluated.
Material All of the responses and participants’ behaviors, as observed
by the evaluator, were filmed and later on transcribed on the
In order to contemplate questions related to maternal-infant protocols.
health and maternal-child interaction, an anamnesis – containing
open questions with answers that were filled by the interviewer Analysis
– was elaborated. The anamnesis approached aspects which
were relative to identification data, family constitution, maternal The responses that were obtained in the anamnesis were
records and child records at birth. Regarding the hospitalization, grouped according to the questions that were made to the
some questions were made about the maternal feeling during her mothers (Chart 1).
ACR 2013;18(4):321-31 323Brocchi BS, Leme MIS
Chart 1. Response analysis that were obtained according to queries predecessor once there is a tendency to maintain the topic all
to the mother
along the narrative, even if it doesn’t hold a precise relationship
Household with the development of the story. Level 3 is characterized by
Participants Family Income Marital status
size the maintenance of the topic and of the event all along the nar-
S1 R$1,000,00 4 Married rative. However, since here the upshot holds no relation with
the events that were narrated, comprehension is jeopardized.
S2 R$1,200,00 5 Single
Level 4 is characterized by presenting a cohesive narrative
S20 R$ 800,00 4 Married
chain that is centered on a defined topic, and there is a strong
connection between events, characters and plot. It presents a
For the analysis of the speech’s structuring elements that straight relationship with the events that were narrated as the
were used by the children, it was considered: characters, topic story unfolded.
preservation, plot/main event and upshot, according to the According to the authors(15), the levels are differentiated
following classifications: according to the level of schooling in which the children are.
1. Maintenance of the main character: This way, levels 1 and 2 refer to the initial years of school,
C1: Undefined main character, with several characters appe- corresponding to ages 6 and 7, respectively.
aring through the story so that it isn’t possible to determine The oral language analysis was separated in four parts,
the main character; according to the exams applied. In the phonology exam, the
C2: Defined main character, but one that vanishes along focus of observation was to whether or not the child had per-
the story, however it may return just to disappear again or, formed any phonological change. In the occurrence of any
yet, be replaced by another. phonological changes, the phonologic processes that were
C3: Defined main character that’s kept all through the realized by the child during the test were analyzed, with the
narrative. It’s never replaced until the end of the story. objective of verifying it those were somewhat expected for the
2. Maintenance of the theme/topic along the narrative: child’s age. In the vocabulary test, it was verified, in each of
T1: Undefined topic, it is present in the beginning of the the semantics’ field that were evaluated, the usual designations,
story, but it is replaced along the narrative. the non-designations and the replacement processes. Later on,
T2: There is a topic in the beginning of the story that is there was an analysis of the outcomes, in terms of what was
replaced by another along the narrative, just to be brought expected and what was obtained, regarding the chronological
back at the end of the story. age of the child, according to the following classification:
T3: The topic remains the same all through the story. - Usual vocable designation (UVD): correct naming of the
3. Main event/plot: presented vocable;
E1: It is possible to observe the outline of an event, or the - Non designation (ND);
presence of multiple ones, without the existence of a main - Substitution processes (SP).
one. These are sequels of episodes or actions that aren’t Pragmatics was analyzed according to the communicative acts
correlated. realized by the subject, the communicative medium and the
E2: Several events, although it is hard to define which is the communicative functions that were utilized:
main one, even if there’s some relationship among them. - Communicate acts: the ones that start as soon as the inte-
E3: Presence of a main event, plot or problem situation raction adult-child, child-adult or child-object starts, and
which is central and defined, one that rules the entire story finish when the attention focus of child is shifted, or when
and the character’s actions. there is a change of turn.
4. Upshot that finishes and concludes the story: - Communicative medium: the communicative acts are divi-
U1: Lack of an upshot. The story is abruptly concluded. ded in three kinds: verbal (VE) – involve at least 75% of the
U2: There is an upshot that, however, doesn’t hold any link language’s phonemes – vocals (VO) – all others emissions
with the main event. and gestures – (G) – involve body and facial movements.
U3: Defined upshot and close linkage with the main event. - Communicative functions: For this test, it is observed
5. Production, Level: that, since 15 months of age, there is a balance between
L1: C1, C2 or C3; T1, E1, U1 gestural communication and the sum of vocalizations and
L2: C1, C2 or C3; T2; E1 or E2; U1 or U2 verbalizations. Moreover, the number of communicative
L3: C2 or C3; T3; E2 or E3; U2; acts expressed in a minute varies a lot between different
L4: C3; E3; T3; U3 individuals, in diverse situations and with different inter-
The Level 1 classification is characterized by stories in locutors. However, the communicative acts of the studied
which there is a change of topics and of events that are suc- strip were of approximately eight per minute.
ceeded in a disconnected manner, which compromises the text The last analysis concerned fluency. The typology of the
comprehensibility. Nevertheless, Level 2 is different from its disfluencies (normal and stuttering) was verified as well as
324 ACR 2013;18(4):321-31Mother-child and the language of the preterm
speech speed (word and syllables flow per minute) and rupture Out of the subjects, 85% have stated to be married, 10%
frequency (percentage of speech discontinuity and stuttering (two) were divorced and one of them was single. More than
disfluencies). The disfluencies’ typologies are divided in two half of them (70%) have attested that their pregnancies weren’t
aspects(13) (Chart 2). planned. However, almost all (93%) have accepted it willingly.
Almost all mothers have, as well, suffered some sort of in-
Chart 2. Disfluencies’ typology tercurrence along the pregnancy period, whence the premature
Normal disfluencies Stuttering disfluencies delivery they have had. Of those, 13 (65%) have had high blood
Hesitation Syllable repetition pressure, from which seven have presented pre-eclampsia.
Interjection Repetition of sounds Two mothers (10%) have related loss of amniotic fluid, two
have regularly smoked along the pregnancy period, only one
Revision Elongation
(5%) have presented bleeding and another, (5%) has worked
Non finished Word Blockade
strenuously all along the gestation period. None of the mothers
Word and/or sentence repetition Pause
knew that they would have premature deliveries.
Segment repetition Sounds’ or segments’ intrusion
It was observed that most of the deliveries (80%) occurred
through caesarian section, while only four of the mothers (20%)
According to the author, repetition of syllables, words, have had vaginal deliveries.
segments and phrases are expected in younger children (usu- Regarding the neonates, most were born with a birth weight
ally two, maximum three repetitions). Up to two seconds’ of less than 1,500 grams and, more than half with gestational
pauses are also expected. Generally, the normal disfluencies age (GA) between 27 and 30 weeks, which characterized them
exceed the stuttering disfluencies. The frequency of words is as extremely premature babies with low birth weight (LBW). In
of approximately 160 words per minute in adults, and this tax spite of their prematurity and LBW, most part of the children
is slightly inferior in preschoolers, and those are expected to has had Apgar scores over five in their first minute of life and
reach this limit in its school years. Regarding the syllable, the in their fifth minute. Almost half (45%) of the babies have pre-
tax for the adults is of, approximately, 212 syllables per minute sented intercurrences, such as infections and surgeries, during
and in preschoolers the articulatory speed remains around 170 their hospitalization period that lasted, in average, 39 days.
syllables per minute. Also in this aspect, the school subjects
are close to the results achieved by the adults, in school stage. Table 1. Gestational age, weight and Apgar score at birth
Regarding rupture frequency, the maximum discontinuity Weight, gestational age and Apgar score n %
percentage is of 15%, and the ruptures that are considered to
Newborn weighing up to 1.500 g 13 65
be stuttering cannot surpass 3%.
Newborn weighing between 1.500g and 2.570 g 7 35
The results of each of these tests were analyzed separately,
according to what was expected for the age, once their associa- Newborn 27 to 30 weeks old 9 45
tions with the data resultant to the anamnesis were verified. For Newborn 31 to 37 weeks old 11 55
such, Spearman’s rank correlation coefficient tests were used (in 1st minute of life, higher than 5 16 80
case that both variables were continuous) or Chi-squared tests 1 minute of life, lower than 5
st
4 20
of contingency (for two categorical variables). Furthermore, 5 minute of life, higher than 5
th
19 95
means tests were used to verify the difference between two (t
5th minute of life, lower than 5 1 5
test) or more than two (ANOVA) groups, according to one or
more dependent continuous variables. A 5% significance level
was adopted. A positive correlation was found between hospitalization
time and the Apgar scores in the first minute of life (rho=0.681,
RESULTS p=0.002) and in the fifth minute (rho=0.607, p=0.005).
Moreover, a negative correlation was found between hospital-
Regarding the anamnesis data, it was observed that the ization time and gestational age (GA) (rho= -0.768, p=0.001).
mother’s age range was between 26 and 47 years old, and the This has led to the finding that the smaller the Apgar score and
father’s age range was between 25 and 45 years old. Out of GA are, the longer is the child’s hospitalization time.
the surveyed mothers, 45% (nine) have attended elementary Most of the mothers (75%) have said to have experimented
school, but dropped out of it. Only 25% (five) have completed feelings of sadness, fear and despair, during their babies’ period
this educational level and 30% of the mothers (six) have gra- at the Neonatal Intensive Care Unit (NICU). The remaining
duated from high school. mothers have reported feeling confidence and trust during their
The family income ranged from R$450 to R$3,800, and hospitalization periods.
the average number of residents in each household was around More than half of the mothers (60%) have informed that
four people. they were the main caretaker of the baby, while 40% have told
ACR 2013;18(4):321-31 325Brocchi BS, Leme MIS
that they shared the nursing with others such as the grandmother Table 3. Oral production realized by the child
(15%), the caretaker (10%), the school (10%) or the father Oral production n %
(5%) of the child.
Has realized out of an action figure 8 40
Among the interviewed mothers that have informed they
Has not realized out of an action figure 12 60
were the main caretakers, it was verified that more than half
of them (60%) have disposed one or two periods to stay with Has realized out of a logical sequence 10 50
the child. The remaining ones have stated that they would take Has not realized out of a logical sequence 10 50
care of their children during the entire day (20%), or only on Has realized the sequence correctly 0 0
weekends and holidays (20%).
Has not realized the sequence correctly 20 100
Most mothers have mentioned that they performed some
Retold the story 6 30
type of playful activity with the child, such as playtime (85%),
taking for a walk (90%) and talking (70%). A small minority
(3%) reads children stories for their infants. children have properly retold the story of “Tuca, Vovó and Guto”.
Although more than half of the mothers have reported to not When the time of interaction between the mother and the
having received any type of orientation regarding the child’s child was compared with the oral speech of the latter, some
care, approximately the same proportion of them consider that differences were observed among the conducted tests. In the
rule abiding, obeying, playing and talking is what matters most retelling test, the value of rs=0.16 is a significant to the level of
in the education of a child. About half of the surveyed moth- pMother-child and the language of the preterm
half of the children studied have presented normal phonological compared to stuttering disfluencies (syllable repetitions, sound
development, have not presented unexpected changes for their repetitions). The average number of the first type was 6.8, and
age, a result that can be attributed to factors such as gestational the latter was 0.35. The average ratio of speech discontinuity
age and interaction time, that, the longer they are, the more they (DF) was of 3.57% and of stuttering disfluencies (DG) was of
favor the development of the child’s speech. 0.125%. The ratio of speech discontinuity cannot surmount
15%, while the ratio of stuttering disfluencies cannot surmount
Children’s performance on the vocabulary test 3%(13). According to the described results, it was found that all
children have obtained a performance that was expected for
No participant has obtained the expected outcome for its age their age and speech developmental stage.
in one or more aspects of the vocabulary test, like designations In regards to the speech speed (frequency of words per mi-
by usual vocable (UVD), non designations (ND) or substitution nute and frequency of syllables per minute) an average of 17.55
processes (SP). words per minute was verified, while the number of syllables
The comparison between the vocabulary results, time that per minute was of 28.96, in average. The performance of the
the mother allocates to activity with her children has shown participants group regarding this aspect was below what was
positive associations, which means that the more time spent expected for their age group, once the average of syllables per
by the mother with her children, the better her offspring’s minute for preschoolers is of approximately 170, a number that
vocabulary development will be. is much higher than the one verified by the studied children. A
When the vocabulary was compared with the oral speech positive correlation was observed between the interaction time
of the children, some positive associations were observed, to and speech speed of rs= -0.096, for pBrocchi BS, Leme MIS
with the child, even if it is a late one. This bond will affect, heard, and not properly characterizing a story.
effectively, the communicative and linguistic development of Even though some authors have reported(15), in their studies,
the child and its disruption – well in the first minutes of life that Levels 1 and 2 correspond to 6 and 7 years-old children
– might bring about consequences that will affect the child’s (the same age group as this study), a mere four participants
future development. have presented Level 2 in one of the two conducted composi-
Most part of the studied children has presented low birth tions. Two of these children have as their main caretakers its
weight and almost half of them were extremely premature ba- own mothers – and the remaining two are taken care by their
bies that spent between eight to 80 days hospitalized. Because grandmothers – that play with them and encourage them to
of the intercurrences that occurred at birth, the children are the reading, chiefly of fables, what has became, thus, one of
considered to be at risk, all of them being more prone to pre- their favored activities. Besides that, it has been found a direct
sent future disturbances and variations in their development (3). link between the oral speech and both interactional time and
These factors, added to other social and environmental risks, socioeconomic level of the studied mothers. In the analysis that
might potentialize the effects of such variations(16). was conducted, it has been observed that the higher the amount
This fact was proven through the conducted tests, in which of time the mother spent with her children, and the higher the
all the children performed below what was expected for their socioeconomic level of the family, the better it was the child’s
age, exception made to the test of oral speech verification. In performance in the proposed speech tests.
the phonology test, almost half of the subjects have presented The findings of some authors(23) justify this study’s own
phonological deviations, and most of these deviations were findings with relation to the vocabulary test, in which no
not expected for their present development. The phonological participant has presented the expected performance for their
deviation, characterized by spontaneous speech which was chronological age, which attests the importance of reading
unintelligible at ages four or older, might occur for various for the acquisition and development of vocabulary and, con-
reasons, encompassing biological, psychosocial, environmen- sequentially, for the development of language itself, once
tal and genetic reasons(18,19). In agreement with the authors that the reading time is a potentially rich opportunity for its
aforementioned, the biological factors (prematurity and low increment. Not only does the stories contain contextual clues
birth weight) have influenced effectively the phonological that help to decipher the meaning of unknown words, they
performance of children, once most part of those that presented also play a sociocultural role by helping children to organize
changes were diagnosed as extremely premature and with very the experiences that they’ve had and by stimulating their cre-
low birth weight (LBW). Moreover, the data that were found ativity by means of imaginary stories. Through these reports,
suggest that the interaction between the dyad mother-baby the positive association between vocabulary and oral speech
was always an important factor, considering the significant can be better understood, as presented in the data of this study,
correlation between both biological factors and mother-child once that a correlation between greater vocabulary and better
interaction. children speech was shown. In the verbal interaction adult-
Out of the data that were collected in the interviews, it was -child, the mother is a model for the child’s verbal development
observed that, although the mothers consider that what is most that adapts her verbalizations according to her infant’s verbal
important for their children is to talk and play – and they did capacity(24). The syntactic competence depends on the level
this with their kids, independently to the quantity of time they of the environment’s stimulation and on the presentation of
spent together – the mothers have prioritized the behavior. activities that might increment the grammatical organization
According to them, the adequate behavior favors a better living capacity of these children. The adults’ participation in the
in the school, with the family and friends. The mother-child activities of children until age six promotes social interaction,
playtime, as discussed by several authors(20,21) is an important which leads to a satisfactory linguistic development, something
stimulus for the socio-cognitive and linguistic development that can be proven by the positive association found between
factors of the child, once the mother offers emotional security the mother’s schooling and the vocabulary development level
so that the child can explore and represent, rather independen- of her child, which means that, the more years the mother has
tly, the environment, while offering emotional security and spent in school, the greater her child’s vocabulary will be(25).
transmitting a range of information to the child so as to aid in The lexical acquisition and development are also strongly
problem solving as well(22). influenced by the interactional process, since language occurs
This fact is directly related to all the tests that the children in the context in which one’s exposed to. The socio-pragmatical
have been submitted to in the present study. Regarding the oral aspects and the cognitive abilities are also fundamental to the
speech development, most part of the participants have not child’s lexical development(24). These aspects have also influen-
realized all the proposed oral compositions, either because it ced the performance that was verified in the pragmatics test, in
did not accept the activity (right in the moment of the evalua- which all children have presented scores that were well above
tion, the child was embarrassed or didn’t want to perform the what was expected for their age.
activity), or because it simply described what it had seen or The fact that the number of communicative acts was short
328 ACR 2013;18(4):321-31Mother-child and the language of the preterm
of what was expected for their age have influenced their fluency syntactic structures and adequate vocabulary, which might lead
test scores as well, in which the subjects have presented a word to better learning of reading and writing in the future.
per minute and syllable per minute flow that was also lower Rules of behavior and obedience are an important part of the
than what was expected for their age group. Children speak child’s education, but cannot be seen as a priority. The mother,
slower than adults, and a faster pace of speech is expected as both provider of knowledge and a safe harbor for her child
after their teenage years(26). This is due to the immaturity of during the activities and interactions, allows her child to develop
their neuromotor system, which is associated to the produc- socially, linguistically and behaviorally, and also provides her
tion of speech and to cognitive development(26). However, the child with more autonomy and security during these activities.
disfluencies that were observed were mostly normal typed; the The research described in these pages has focused on a
stuttering disfluencies’ ratio was something expected for the group of children that were diagnosed as prematures at birth
fluent speaker, and stuttering cases were not found among the and that had a low socioeconomic level. The impossibility of
study’s participants. The participants have presented themsel- the extension of the data reported here for other subjects from
ves as fluent speakers, with short or no periods of disfluency, the same population that was studied, either because it was not
characterized mainly by hesitations, interjections and word and possible to contact them for the convocation, or because they
sentence repetitions(26,27). just did not showed up on evaluation day, was one shortcoming
The findings that show the influence of pragmatics and of this study.
vocabulary over the fluency test performance, with the posi- The results reported here establish courses of action for
tive correlation between tests that was presented, means that future researches whose objective is to describe and compare
fluency will be better once the child’s vocabulary got greater the complexity of the language in different populations of
and the more communicative acts she produces. The greater children, which will allow (or not) the confirmation of the re-
the vocabulary, the more wide is the child’s speech, and, thus, lationship between the participants’ performance, prematurity
the child’s fluency. Since the studied children have presented and mother-child interaction.
a performance that was short to that which was expected in
those two tests, the development of the speech’s fluency was CONCLUSION
also jeopardized.
The findings of this research concur with the authors(16,28) The participants of this study have presented a performance
that have identified a delay in the linguistic development of which was below what was expected for their chronological
the premature child in comparison to the child that was born age for almost the entirety of the conducted tests. Three factors,
on term, mainly regarding the meaning language. Besides bio- together or associated, might justify the subjects’ performance:
logical factors resultant of the prematurity, the environmental biological factors such as prematurity, low birth weight and
ones that were related to this aspect have great importance, prenatal, perinatal or postnatal intercurrences; sociocultural
being able to contribute to the surmounting or preservation of factors, such as instruction level, socioeconomic level and fa-
the resultant difficulties. mily culture; and mother-child interaction, in which the mother,
Once this is known, it is this study’s suggestion that, early as the sociolinguistic model of her child, might attenuate the
on in pregnancy, the mothers receive support and orientation consequences of the aforementioned factors, provided that she
from a multiprofessional team regarding the development that establishes a stimulating interaction with the child.
is expected from a child and the possible stimulations that
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Appendix 1. Anamnesis
1. Identification Household residents:
Child’s name: Family income:
Date of birth: Preferred Health Center:
School: grade:
2. Maternal records
Father’s name: a) Marital status:
Date of birth: Age: b) Number of children
Natural of: c) Quantity of aborptions has suffered:
Education level attained: d) Your pregnancy was planned? How have you responded to the fact
Employment: that you were pregnant? How was the father responded?
e) Any health problems/ any other problems (besides physical ones)
Mother’s name: during gestation?
Date of birth: Age: f) Do you currently use any of the following: medicines/alcohol/tobacco/
Natural of: drugs/remedies?
Education level attained: g) Do you know of any disability or deficiency in your family? Any type
Employment: of chemical dependence?
h) Were you hospitalized during gestation?
Address: i) Type of delivery
Phone number: j) Prenatal Intercurrences
Household structure: k) Postnatal intercurrences
330 ACR 2013;18(4):321-31Mother-child and the language of the preterm
l) Have you ever had a premature baby before? w) Who’s the main caretaker of the child?
m) Did you know of any prematurity deliveries in your family or among x) Does the child stay with other people for some time?
your friends? y) How would you describe your care with your child nowadays?
z) You and the child’s father participate on na equal basis regarding
3. Child’s records the care of the child?
a) Hospitalization date:
b) APGAR score: 5. Daily acitvities and mother-child interaction
c) Birth weight aa) Do you talk with your child? What about?
d) Capurro bb) What do you do when your child decides to do something without
e) Diagnosis your help?
f) Intercurrences cc) How much time to you dispose for the child?
g) Medications dd) What are the activities that you mostly do with your child?
h) Surgeries ee) With whom the child talks to the most?
i) Hospitalization time ff) To which places do you usually take your child?
j) Feeding after hospitalization? gg) How would you describe your child’s personality?
k) There was any accompaniment after the hospitalization? Where? hh) During pregnancy, did you receive mostly orientations regarding
Which professionals were involved? baby care, baby stimulation or what to do to ensure that your child had
l) Motor development? a good behavior?
m) Speech and language development? ii) Who was responsible for orientating you regarding these aspects
n) Is undergoing any type of treatment? during pregnancy?
o) Hospitalizations? jj) What is more important to you in a child’s upbringing: teaching to follow
the rules, teaching how to be obedient or talking and playing? Why?
4. Mother-child hospitalization kk) What do you think is most important for a child: knowing how to
a) When did you know your baby was going to be born preterm? behave properly (with the family, in school) or being well developed
b) What did you expect to happen when you knew your baby was going for its age and having a good performance in school?
to be premature? ll) Do you forbid any type of activity because of the child’s health?
c) Did you receive any orientation and/or information regarding the mm) How is it the behavior of your child when it is with you? And
prematurity and how would a premature baby be? among others?
d) How did you feel during the baby’s hospitalization period? nn) (If it stays with a caretaker) What does this person that takes care of
e) What did you expect to happen during the hospitalization? the child values the most? Talking/playing, taking care of the cleanliness/
f) Did you receive any orientation during the hospitalization period? feeding or the child’s behavior?
From which professionals? oo) The fact that you work makes you to dedicate more to one activity
g) Have you talked to any other premature babies’ mothers? than to others when you are taking care of your child? If so, which one
h) Have you observed or observes any difference from your child in of these: Healthcare/hygiene/ talking/ playing or education/upbringing/
relation to other children? obedience?
i) Have you received orientations regarding how it is the development pp) Have you observed any difference in your way of educating after
of a child that was born on term? your child was born?
j) Did you breastfeed your child? For how long? qq) What do you do when your child does something that is wrong?
k) Did the child do or does anything differently than you expected? (E.g.: Hits, talks, yells, punishes, ignores)
l) The motor development (rolling, sitting, crawling, walking) of your child rr) Since when is the child in school?
is like you expected it to be? ss) How is the child’s performance at school?
m) When did your child start to babble (first sounds?) tt) What do you think it might be the reason for your child’s school
n) When did your child speak its first words? performance?
o) Around which age has your child started to speak more words and uu) How does the child feels regarding school?
form two words-sentences? vv) What does the school reports regarding your child?
p) Was your child always comprehended by peoples? ww) How’s the child’s behavior in school? And in the household? Does
q) Did your child express more through gestures or words? the child have any friends?
r) When did your child smile? When did your child start your child start xx) What are the child’s favorite pastimes and plays? With whom does
to differentiate you from other people? your child plays?
s) How would you describe the child as it is nowadays? (If participant yy) The child prefers to play alone or in group?
doesn’t understand: Did your child do anything that is different than zz) Your child prefers to play with younger, older or same aged children?
what you expected?) aaa) Do you play with your child? How’s playtime? Do you tell stories?
t) Is the child able to express itself with clarity? Do you think people Which ones?
understand her? bbb) Does your child watches TV? For how long each day? What does
u) Does your child change sounds in her speech? your child like to watch?
v) Does the child tells, invents and reports stories and facts? ccc) How does your child sleep? At what time? With whom?
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