Pediatricians Can Help Immigrant Mothers By Explaining Child Development, NICHD Study Suggests
Parents Need Child Development Information to Identify Problems
Groups of immigrant mothers from Japan and South America knew
less about child development than did their European American counterparts,
according to a study by researchers at the National Institute of
Child Health and Human Development of the National Institutes of
Such gaps in parenting knowledge, the authors wrote in the November
issue of Pediatrics, could have a negative impact on children’s
development, with mothers possibly missing warning signs that their
children need medical attention or early intervention services.
The authors added that pediatricians could assist parents who
lack knowledge of child development by taking steps to educate
them about the topic.
The study was conducted by Marc Bornstein, Ph.D., and Linda Cote,
Ph.D., C.F.L.E., both of NICHD’s Section on Child and Family
The researchers pointed out, however, that the immigrant mothers
knew as much about health practices concerning their children’s
physical safety as did the European American mothers.
“New parents have a need for accurate and helpful information
about child development and pediatricians can help meet that need,” said
NICHD Director Duane Alexander, M.D. “In turn, parents who
have an understanding of child development can provide pediatricians
with information that will help them better serve pediatric patients.”
In the article, the researchers wrote that study of child rearing
practices among immigrants is extremely important because a large
proportion of U.S. children come from immigrant families. The researchers
cited a U.S. Census Bureau statistic that roughly 1 in 5 U.S. children,
about 14 million in all, lives with at least 1 immigrant parent.
The researchers added that they chose to study Asian and Latino
mothers because those groups are currently the majority immigrant
groups in the United States.
“Moreover, the Asian and Latino populations in the United
States are expected to triple by mid-century, making it increasingly
important that clinicians better understand Asian and Latino parents,” the
The researchers recruited 114 mothers of 20-month-old children
for the study. Of these, 38 were Japanese immigrants, 36 were South
American immigrants, and 40 were 4th and 5th generation European
Americans. The South American immigrant mothers largely were from
Argentina, Peru, and Colombia. All of the women resided in the
Washington, D.C., metropolitan area, were middle-class, of a similar
age, and had comparable levels of education.
The researchers measured the women’s knowledge of child
rearing by having them fill out a survey form known as the Knowledge
of Infant Development Inventory, or KIDI. The survey assesses knowledge
of parental contributions to children’s psychological and
social development, normal developmental milestones, as well as
knowledge of health and safety guidelines.
The researchers found that immigrant mothers tended to score lower
on the test than did the European American mothers. Specifically,
the researchers identified 18 questions that the immigrant mothers
tended to answer incorrectly or to which they did not know the
answers. Nearly all the questions with which the immigrant mothers
experienced difficulty involved either child development or parent-child
For example, fewer than half of the immigrant mothers were aware
that babies begin “babbling” around 5 months of age.
Infant babbling, the stringing together of vowel and consonant
sounds, is an important stage in the eventual development of language.
Similarly, fewer than half of the immigrant mothers knew that an
infant will begin to respond to his or her name at 10 months of
“A mother who is aware of when the onset of babbling should
occur and the age at which an infant can respond to his/her name
will be more likely to identify potential hearing problems and
bring them to the attention of her pediatrician than a mother who
is unaware of such markers,” the authors wrote.
On another survey response, only about a third of the immigrant
mothers knew that the average newborn cries for a total of about
1-2 hours out of every 24. Equal numbers of the immigrant mothers
said they believed that 3 to 6 hours of crying out of 24 is normal
as said they didn’t know how much crying was normal. If parents
believe long periods of crying is normal, the authors noted, then
they might be less likely to respond to their infants if something
“Knowledge of developmental milestones is important because
it is widely agreed that early intervention is key to preventing
long-term problems in children,” the authors wrote. “If
parents are unaware of what those milestones are, they will be
less likely to recognize and raise problems with their pediatrician.”
Similarly, lack of knowledge about what constitutes normal infant
behavior may interfere with a mother’s emotional relationship
with her child, the authors wrote. For example, a mother, expecting
an infant who likes to be cuddled, may instead have an infant who
doesn’t enjoy cuddling. The woman may feel that her mothering
skills are to blame, when in fact it’s normal for some babies
to not enjoy being cuddled.
Drs. Bornstein and Cote pointed out that immigrant mothers did
not differ significantly from the European American mothers in
their answers to questions concerning children’s physical
health or safety. For example, the immigrant mothers knew that
soft bedding material placed in the crib such as pillows
and loose blankets increase an infant’s risk for sudden
infant death syndrome.
The researchers believe that the European American mothers in
the study were more knowledgeable about child development because
they were more likely to seek out written materials on child development
than were their immigrant counterparts.
The study authors noted that pediatricians often do not talk with
parents about child development or child rearing, and that parents
do not ask their children’s pediatricians for advice about
these topics. They cited studies showing that 79 percent of mothers
could use more information in at least one area of childrearing,
and 53 percent could use more information in three or more areas.
Pediatricians who are aware of mothers’ knowledge and expectations
about their children’s development will be better able to
serve their patients’ needs, Drs. Bornstein and Cote wrote.
To help parents learn about child development, pediatricians might
make multilingual written or visual materials available in their
waiting rooms, the authors wrote. A series of publications on child
development has been developed by the American Academy of Pediatrics
and Zero to Three, an organization that promotes healthy child
development. The series, Healthy Minds: Nurturing Your Child’s
Development, can be downloaded free of charge at http://www.zerotothree.org/healthyminds.
The authors added that physicians lacking an adequate educational
background in child development might consider asking a child development
specialist to join their practices.
“Considering parental knowledge level and cultural background
inevitably introduces a layer of complexity to the clinician’s
tasks, but to eschew or negate such considerations risks access
to vital information about the child patient,” the authors
The NICHD is part of the National Institutes of Health (NIH), the biomedical
research arm of the federal government. NIH is an agency of the U.S. Department
of Health and Human Services. The NICHD sponsors research on development, before
and after birth; maternal, child, and family health; reproductive biology and
population issues; and medical rehabilitation. NICHD publications, as well
as information about the Institute, are available from the NICHD Web site,
http://www.nichd.nih.gov, or from the NICHD Information Resource Center, 1-800-370-2943;