Parental caregiving and developmental outcomes of infants of mothers with HIV

Background: All infants exposed to human immunodeficiency virus (HIV) prenatally, even those who do not become infected, are at risk for developmental problems because of poverty, prenatal substance abuse, and maternal illness. Objectives:The purpose was to describe the development of infants of mothers with HIV and to determine, using hierarchical linear models, the longitudinal effects of child characteristics, parental caregiver characteristics, family characteristics, and parenting quality on development. Methods: Eighty-one infants born to women with HIV and their primary parental caregivers were followed-up until 18 to 24 months of age; 53 infants were always cared for by their biologic mothers, 16 were always cared for by kin or foster parents, and 12 had primary caregiver changes. Predictor variables and developmental outcomes were obtained at enrollment and 6, 12, 18, and 24 months. Results: Mental development and adaptive behavior scores decreased over age. Infants with changes in their primary caregiver had lower motor and adaptive behavior scores than infants remaining with consistent caregivers. Higher mental, motor, and adaptive behavior scores were associated with more positive attention and more negative control, whereas better language abilities were associated only with more positive attention. Child, maternal, and family characteristics had lesser effects. HIV-infected infants and infants of mothers with more education had lower mental, motor, and adaptive behavior scores. Male gender and more family conflict were associated with lower motor and adaptive behavior scores. Infants from smaller families had lower mental scores. Conclusions: Because both parenting quality and consistency of the primary caregiver influenced developmental outcomes, interventions with the mothers of these infants need to focus both on improving the quality of parenting and reducing the frequency of primary caregiver changes.