Parent-Child Interactions: A Home Visitor’s Guide

Home visitation is based on the knowledge that early life experiences estab-
lished by parent-child interactions play a major role in the developmental
outcomes for children. Home visitation, by its nature, provides an opportu-
nity to assess and enhance the parent-child interactions in the natural con-
text of the family home and community. Home visitors in essence have the
“Ensuring the optimal view to observe and influence the development of positive parent-
Quality, child interactions. The tool kit, Parent-Child Interactions: A Home Visitor’s
Accountability Guide, provides home visitors with tips and tools to make the most of the
and opportunity to observe and influence parent-child interactions.
Sustainability
of Home Positive Parent-Child Interactions
Visitation Programs”
Positive parent-child interactions are powerful protective factors for children.
The hallmark of these positive interactions are characterized as
• child focused
• responsive
• warm
• sensitive
and are coupled with the following:
• clear expectations
• limits
• logical consequences
• attention to safety

Infants send signals to their parents, crying when hungry or in discomfort, and
cooing to engage in emotional interactions. When parents respond in a warm,
caring manner to an infant’s signals, the infant quickly learns to rely on the par-
ent. When an infant coos for the affection of the parent and the parent responds
with positive affect, the parent and child form an emotional bond.1 Healthy at-
tachment or emotional bonds between the parent and child play a central role in
regulating the infant’s or child’s experience of hunger, discomfort, and stress.
The parental response optimally will assist the infant or child from hunger to
satisfied, from discomfort to comfort, and from “stress to stress recovery.”1

Positive parent-child interactions are the basis from which children are able to
explore and experience the world of relationships, objects, cause and effect, and
problem solving. As the child explores and learns, the parent-child relationship
Contact Information: functions as a safe and secure base and as a source of comfort for the develop-
AHVNA Phone: 780-429-4787 ing child.1
www.ahvna.org
Email: [email protected]

Alberta Home Visitation Network Association — Parent-Child Interactions: A Home Visitor’s Guide 03/09
Page 1
 These positive interactions create resilient children by fostering
• trust
• security
• curiosity
• autonomy
• belief in child’s abilities

Parent-child interactions significantly influence the child’s

• physical growth

“Ensuring the • behaviour patterns

Quality, • social-emotional development

Accountability • early language formation

and • literacy

Sustainability • academic outcomes

of Home
Recent research by Schore (2001) demonstrated that “infant brain develops in
Visitation Programs”
response to regular social interaction with a caregiver.”

Purpose of Observing Parent-Child Interactions

The purpose of observing parent-child interactions is to determine both the

strengths and challenges in the interplay between parent and child. Positive parent
-child interactions entail “warm parental support that incorporates behaviours that
convey: supportive presence; acceptance; positive affect; sensitivity; and, respon-
siveness to the child’s needs” .2

Goals to enhance positive parent-child interactions are developed from observa-

tions and discussions with the parent. The aim is to facilitate a process that
• offers support, guidance, teaching, and coaching
• invites struggling or frustrated parents to believe in their capabilities to
positively interact with their infant or child

Assessing the scope of home visitation services

The observation of parent-child interactions can determine if the needs of the par-
ent and child are beyond the scope of home visitation services. For example, par-
ents that have significant mental health concerns—depression, substance abuse or
dependence, anxiety, personality disorder, post traumatic stress syndrome, or de-
lusions—may experience reduced capacities to respond appropriately to their in-
fant or child.

Contact Information:
AHVNA Phone: 780-429-4787 Cohn and Tronick (1989) revealed that infants as young as three months will react
www.ahvna.org to simulated depression by their mother. These infants responded to their still-
Email: [email protected] faced mothers, who were simulating depression, with “heightened distress levels,
increased protests and gaze aversion when they observed the non-responsive face

Alberta Home Visitation Network Association — Parent-Child Interactions: A Home Visitor’s Guide 03/09
Page 2
 of their mother. Mothers suffering from depression may interact with their infant in
a rough or intrusive manner or the parent-child interaction may be characterized by
fear, helplessness, withdrawal, or low levels of responsiveness.” 4
Reduced parental
sensitivity to the infant’s cries may set in motion a pattern of negative parent-child
interactions with both parent and child experiencing frustration and distress.

A second example where additional expertise may be needed is when a parent is not
able to perceive a child as a separate individual with separate needs. Parents who
are unable to perceive their child’s needs as separate from their own may describe
their child as demanding and difficult or may feel rejected by their infant. These
parents may respond to their feelings by rejecting both the child and the needs of
“Ensuring the the child.
Quality,
Accountability Infants are not able to understand the thoughts, feelings, and experiences of their
and parents, nor are they able to decide to go against their parents’ wishes to be diffi-
Sustainability cult. Parents that misunderstand or place motives to their infant’s behaviour may be
of Home at greater risk for neglect or mistreatment of their infant or child.
Visitation Programs”
A major role of the home visitor is to assess for situations that require services be-
yond home visitation. The role of the home visitor then becomes one of facilitating
referrals to other community services, such as Children’s Services or a family doctor.

Parental Perception in Developing Parent-Child Interactions

Parental perceptions are key to the development of parent-child interactions.4 Fer-

rier-Lynn and Skouteris (2008) indicate “a parent’s perceptions of [his or her] own
well-being, social support, and relationship to the role of being a parent” strongly
influences parent-child interactions. Research by Schiffman and Omar (2003) dem-
onstrated that in general, “mothers in difficult circumstances (i.e., those with low
education level, little support, multiple chronic problems, or high stress) tend to
have interactions that are less than optimal.” Negative perceptions about their own
well-being may invite the belief that the child’s needs are just too great and the
parent does not have the energy to respond to every cry or need.

Parental perceptions about a lack of social support from their spouse, family, and
friends are also related to negative parent-child interactions. Parents who are pre-
occupied with the stress of a difficult relationship may experience the needs of their
child as an additional and overwhelming stress. This situation can be even more
problematic if one or both parents have unrealistic expectations about how the birth
of a child was to improve a difficult relationship. These parents may experience ad-
ditional disappointment if the demands of parenting do not provide the desired re-
ward of a changed relationship or emotional state.
Contact Information:
AHVNA Phone: 780-429-4787 Several studies have revealed a “relationship between low parenting self-efficacy
www.ahvna.org
Email: [email protected] and compromised developmental outcome for children related to socio-emotional
development and school achievement.”4 Self-efficacy is the belief in one’s ability to

Alberta Home Visitation Network Association — Parent-Child Interactions: A Home Visitor’s Guide 03/09
Page 3
 perform a specific task. Low self-efficacy specific to parenting can translate into de-
creased or limited attempts to
• vocalize and make eye contact
• invest emotional energy to show warmth and responsiveness
• teach language and social skills
• set boundaries and logical consequences

Observation Guidelines for Parent-Child Interactions

“Ensuring the Developmental stages and ages

Quality,
Observation takes into consideration the stage and developmental tasks of the
Accountability
infant or child. The parent-child relationship is a dynamic relationship that adapts
and
to meet the developmental needs of the child. What is required from a parent
Sustainability when the infant is one month of age will not be the same as when the child is two
of Home years of age. Home visitors are encouraged to use the Ages and Stages Develop-
Visitation Programs” mental Fact Sheets at http://ohioline.osu.edu/asc-fact/index.html as a guide to
observing parent-child interactions.

Strengths and challenges

Observations of parent-child interactions are essential for determining both the

strengths and challenges in their interactions. Appendices I, II, and III have been
developed to assist home visitors in their observations of the parent-child rela-
tionship. Ainsworth and Bell (1975) identified the responsiveness of the parent or
primary caregiver as a reinforcement mechanism for infants and children. Ains-
worth, (1969) identified five variables as central to “high quality parent-child rela-
tionships:
• responding sensitively and empathically to the infant’s signals
• providing frequent physical contact
• allowing the infant freedom to explore
• helping the infant derive a sense of consequence of his or her
actions
• engaging in mutual enjoyable and reciprocal activities.”

Beliefs, attitudes, and expectations

Interviewing parents about their beliefs, attitudes, and expectations about the
parent-child relationship provides the context for understanding patterns that
emerge between the parent and child. The process of asking questions and en-
gaging in reflective conversations about the parent’s beliefs, attitudes, and expec-
tations are central to understanding the context for creating change or enhancing
Contact Information: parent-child interactions. Appendix IV is a list of questions that home visitors can
AHVNA Phone: 780-429-4787
use to bring forth these reflective conversations and to further assess the parent-
www.ahvna.org
Email: [email protected] child interactions.

Alberta Home Visitation Network Association — Parent-Child Interactions: A Home Visitor’s Guide 03/09
Page 4
 Appendix I
Home Visitation Observations of
Parent-Child Interactions
Infant and Is the parent able to meet each need Is the parent responding in a
Child according to the developmental stage timely and appropriate
Needs of the infant or child? manner? Comments
Physical Feeding schedule is regular and
includes proper nutrition
Sleep schedule is adequate and
regular
“Ensuring the Clothing is appropriate, dry, clean,
Quality, and comfortable
Accountability Parent responds to discomfort or
distress expressed by the infant or
and child
Sustainability Parent comments on what the infant
of Home or child likes or dislikes in terms of
Visitation Programs” the infant’s physical needs
Medical issues are addressed
including regular check- ups with
family doctor or pediatrician
Home environment is safe
Parent encourages or provides
opportunities for the infant and child
to develop physical skills such as
grasping, holding, throwing,
dropping, crawling, climbing,
walking, etc.
Emotional Parent initiates eye contact and
smiling
Parent initiates touch, holding, baby
massage, cuddling, and rocking
Parent initiates talking, singing, or
story telling
Parent attempts to soothe the infant
or child if the infant or child is upset
Parent takes time to be playful with
their infant or child
Parent comments on their infant’s or
child’s likes or dislikes in terms of
affection
Intellectual Parent talks to the infant or child
Infant or child is able to see
interesting objects with bright colors
Parent provides toys and objects for
the infant or child to touch and play
Contact Information: with
AHVNA Phone: 780-429-4787 Parent initiates teachable moments
www.ahvna.org such as counting objects, naming
Email: [email protected] objects, animals, etc.
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Alberta Home Visitation Network Association — Parent-Child Interactions: A Home Visitor’s Guide 03/09
Page 5
 Parent reads to the child, teaches
rhymes and songs, enables
colouring, etc.
Parent takes time to be playful with
their infant or child and uses play as
an opportunity to let the child
explore and learn
Parent comments on what their infant
or child likes or dislikes to play with,
such as favorite games, songs, toys,
“Ensuring the etc.
Quality, Social Parent provides opportunities for the
Accountability infant or child to interact with others
and initially through listening and
Sustainability observation by the infant
Parent takes time to be playful with
of Home
their infant or child
Visitation Programs” With increased mobility, the child
has the freedom to initiate
interactions by turning to hear a
familiar voice, searching for faces,
smiling, crawling to others,
vocalizing to get someone’s
attention, etc.
Parent responds with positive
reinforcement to the infant and
child’s increased social cues and
interactions
Parent comments on what their infant
or child likes or dislikes in terms of
social interactions

Contact Information:
AHVNA Phone: 780-429-4787
www.ahvna.org
Email: [email protected]
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Alberta Home Visitation Network Association — Parent-Child Interactions: A Home Visitor’s Guide 03/09
Page 6
 Appendix II
Home Visitation Parent-Child Interaction
Observation Checklist
The parent-child interaction screening checklist is to assist home visitors observe the overall strengths
and challenges of the parent-child relationship. Home visitors are encouraged to use the following
questions as a guideline for these observations.

1. Is the parent aware of the infant’s or child’s physical needs?

___Yes ___No ___Occasionally
“Ensuring the Comments: Strengths or Challenges
Quality,
Accountability
and
Sustainability
2. Is the parent aware of potential safety issues with the infant or child?
of Home ___Yes ___No ___Occasionally
Visitation Programs”
Comments: Strengths or Challenges

3. Does the parent respond appropriately to the infant’s or child’s physical need? Responding
appropriately means being able to match a parenting response to what the infant or child
needs.
___Yes ___No ___Occasionally

Comments: Strengths or Challenges

4. Does the parent show warmth, sensitivity, and acceptance towards the infant or child?
___Yes ___No ___Occasionally

Comments: Strengths or Challenges

5. Does the parent perceive and accurately read the infant’s or child’s cues and communication?
___Yes ___No ___Occasionally

Comments: Strengths or Challenges

Contact Information:
AHVNA Phone: 780-429-4787
www.ahvna.org
Email: [email protected]
Click here to Download a Word .DOC version of these Appendices

Alberta Home Visitation Network Association — Parent-Child Interactions: A Home Visitor’s Guide 03/09
Page 7
 6. Is the parent aware of the infant’s or child’s psychological needs?
___Yes ___No ___Occasionally

Comments: Strengths or Challenges

7. Does the parent respond by reinforcing the infant’s or child’s exploration of the world of
objects?
___Yes ___No ___Occasionally
“Ensuring the
Quality, Comments: Strengths or Challenges
Accountability
and
Sustainability
of Home 8. Is the parent able to delay personal needs to respond to the infant’s or child’s needs?
Visitation Programs” ___Yes ___No ___Occasionally

Comments: Strengths or Challenges

9. Is the parent able to invest emotional energy and sensitivity into the care of the infant or child?
___Yes ___No ___Occasionally

Comments: Strengths or Challenges

10. Is the parent able to tolerate frustration or confusion when caring for the infant or child?
___Yes ___No ___Occasionally

Comments: Strengths or Challenges

11. Does the parent see the needs of the infant or child as separate from personal adult needs?
___Yes ___No ___Occasionally

Comments: Strengths or Challenges

Contact Information:
AHVNA Phone: 780-429-4787
www.ahvna.org
Email: [email protected]
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Alberta Home Visitation Network Association — Parent-Child Interactions: A Home Visitor’s Guide 03/09
Page 8
 12. Does the parent take the time to understand the infant’s or child’s behaviour in order to offer
support?
___Yes ___No ___Occasionally

Comments: Strengths or Challenges

“Ensuring the 13. Does the parent initiate responses or actions that apply to the child’s needs?
___Yes ___No ___Occasionally
Quality,
Accountability Comments: Strengths or Challenges
and
Sustainability
of Home
Visitation Programs”
14. Is the parent preoccupied with other stressors?
___Yes ___No ___Occasionally

Comments: Strengths or Challenges

15. Is this parent possibly experiencing depression, anxiety, or other mental health issues?
___Yes ___No ___Occasionally

Comments: Strengths or Challenges

Contact Information:
AHVNA Phone: 780-429-4787
www.ahvna.org
Email: [email protected]
Click here to Download a Word .DOC version of these Appendices

Alberta Home Visitation Network Association — Parent-Child Interactions: A Home Visitor’s Guide 03/09
Page 9
 Appendix III
Home Visitation Parent-Child Interaction
Goals Checklist

The following is a list of goals related to the parent-child relationship. There is space below
this list for home visitors to add additional goals.

1. To enhance parents’ understanding of child development ages and stages

“Ensuring the
Quality, 2. To increase parents’ understanding of their role to ensure the infant’s or child’s
physical needs are met
Accountability
and 3. To increase parents’ understanding of their role to ensure their infant’s or child’s
needs for affection are met
Sustainability
of Home 4. To increase parents’ understanding of their role to ensure that their infant’s or child’s
Visitation Programs” belonging and social needs are met

5. To increase parents’ understanding of their role to ensure that their infant’s or child’s
intellectual needs are met

6. To increase parents’ sensitivity to their infant’s or child’s cues or signals

7. To address stress that is impacting parents’ ability to respond to their infant’s or

child’s needs

8. To enhance parents’ skills and confidence to foster positive parent-child interactions

9. To refer parents to a medical doctor to screen for possible depression or any mental
health concerns

10. Other. Please specify.

____________________________________________________________________

____________________________________________________________________

11. Other. Please specify.

____________________________________________________________________

____________________________________________________________________

12. Other. Please specify

___________________________________________________________________

___________________________________________________________________
Contact Information:
AHVNA Phone: 780-429-4787
www.ahvna.org
Email: [email protected]
Click here to Download a Word .DOC version of these Appendices
Alberta Home Visitation Network Association — Parent-Child Interactions: A Home Visitor’s Guide 03/09
Page 10
 Appendix IV
Home Visitation Parent: Questions for Exploring
Parent-Child Interactions
The following questions are designed to assist home visitors to understand the
beliefs, attitudes, and expectations that a parent has about interacting with their
infant or child. These are not exhaustive but rather are meant to be examples
for exploring the parent-child relationship. You may choose to use one or two
of these questions during a session as a way to explore the parent-child rela-
tionship.
“Ensuring the
Quality, Rollnick and Miller (1983) stress that it is important not to rush these discus-
Accountability sions. Using simple open-ended questions and reflective listening may feel
and “inefficient”, but it is the most effective method for engaging parents in the de-
Sustainability cision to make a change for themselves and their child. It is important to match
your language to that of the parent. Do NOT use words like “problem” or
of Home
“concern” unless the parent does.
Visitation Programs”
Parenting Role and Confidence of Parent
1. What do you most enjoy or like about being a mother/father?
2. What is the most difficult or challenging part about being a mother/father?
3. Has it turned out to be about the right time to have a baby? How so?
4. Tell me about what it is like caring for a newborn.
5. How well do you believe you are coping with your new role of caring for
your baby?
6. What things do you worry about when it comes to being a parent?
7. How do you feel about being alone with your baby?
8. What concerns do you have about caring for your baby?
9. How often does your baby fuss or cry?
10. What is it like for you when your baby cries or fusses?
11. What have you found to be the best way to respond to your baby when
he/she cries or fusses?
12. What do you believe is the best method for responding to your infant or
child?
13. Do you ever feel confused, stressed, or anxious about being a parent once
in a while?
14. Overall, how confident are you in your new role: extremely, very, somewhat,
most of the time, not at all.
15. What advice would you give to other new moms?

Contact Information:
AHVNA Phone: 780-429-4787
www.ahvna.org
Email: [email protected]
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Alberta Home Visitation Network Association — Parent-Child Interactions: A Home Visitor’s Guide 03/09
Page 11
 Beliefs and Expectations About Parenting

16. When you were pregnant, what did you think it would be like to be a parent?
17. Is being a parent what you expected it to be? Explain.
18. Did you think that having a child would change your life for the better or
worse?
19. How did you think it would change your life?
20. How has being a parent changed your life?
21. What kinds of things are most important for you to know as a parent?
22. What kinds of things are most important for you to do as a parent?
“Ensuring the 23. What has changed in your life since you became a parent?
Quality, 24. When you think about your own parents, in what ways do you want to be
Accountability like them?
and 25. When you think about your own parents, in what ways do you want to be
Sustainability different than they were?
of Home 26. What would you do that is the same as your parents did?
Visitation Programs” 27. What would you do differently than your parents did?

Well-being of Parent and Social Support

28. Do you feel comfortable with change?
29. How do you deal with unexpected change?
30. Do you have any stressors or worries right now?
31. Tell me about your health and energy level at this time. Do you have any
health concerns at this time?
32. How often do you see your doctor?
33. Are you getting enough rest? When are you able to rest?
34. Is there anyone that helps you out once in a while?
35. When you are sick, who helps you?
36. Who supports you as a parent?
37. Do you have someone you can call when you need advice or support?

Contact Information:
AHVNA Phone: 780-429-4787
www.ahvna.org
Email: [email protected]
Click here to Download a Word .DOC version of these Appendices

Alberta Home Visitation Network Association — Parent-Child Interactions: A Home Visitor’s Guide 03/09
Page 12
 References

1. DelCarmen-Wiggins, R. & Carter, A. (2004). Handbook of Infant, Toddler, and Pre-

school Mental Health Observation. (1st ed.). Oxford University Press.

2. Schore, A. (2001). Effects of a secure attachment relationship on right brain develop-

ment, affect regulation, and infant health. Infant Mental Health Journal, 22:1-2,
7-66.

3. Cohn, J. & Tronick, E., (1989). Specificity of Infants Response to Mother’s Affective
“Ensuring the Behavior. Journal of the American Academy of Child and Adolescent Psychia-
Quality, try, 24:4, 242-248.
Accountability
4. Ferrier-Lynn, M. & Skouteris, H. (2008). Parent cognitions and parent-infant interac-
and tion: the relationship with development in the first 12 months. Australian Jour-
Sustainability nal of Early Childhood. Vol,33 No. 2 June 2008 pp 17-26
of Home 5. Schiffman, R. & Omar, M. (2003). Mother-infant interaction in high risk, low income
Visitation Programs” families. The American Journal of Maternal/Child Nursing. 28:4, 246-251.

6. Ainsworth, M. & Bell, S. (1975). Mother-infant interactions and the development of

competence. Grant Foundation New York; Office of Child Development
(DHEW). Washington, DC.

7. Ainsworth, M. (1969). Object relations, dependency, and attachment: A theoretical

review of the infant-mother relationship. Child Development, 40:4, 969-1023.

8. Rollnick, S. & Miller, W. (1983). Practical Strategies in Motivational Interviewing.

Handout.

Contact Information:
AHVNA Phone: 780-429-4787
www.ahvna.org
Email: [email protected]
Click here to Download a Word .DOC version of these Appendices

Alberta Home Visitation Network Association — Parent-Child Interactions: A Home Visitor’s Guide 03/09
Page 13