Interaction therapy for preterm infants and their parents

Attatchment and interaction between parents and infants are key components in infant development. Parents with preterm infants face challenges that might interfere with parental responsiveness and sensitivity to infant cues. Early preventative interventions that include components promoting responsiveness and positive interaction are used to stimulate development in infants born prematurely.


What systematic reviews are there on the effects of early interaction interventions on preterm infants and their parents?

Identified literature

Table 1. Systematic reviews with low/medium risk of bias
Included studies Population/Intervention Outcome
O’Hara et al 2019 [4]
22 studies, 3 on preterm population Population:
Children <5 years old at risk of poor outcomes.
N total=1 889 parent-child dyads or family units (n=17 –237), of which n=294 parent-preterm infant dyads
Video feedback on parental interaction with child
Primary Outcomes:
Parental outcomes
Parental sensitivity
Parental reflective functioning Attachment security
Parental stress
Parental anxiety
Secondary Outcomes:
Child outcomes
Child mental health
Child physical and socioemotional development
Child behaviour
Authors' conclusion:
“The findings of this review point to moderate-certainty evidence that video feedback may be an effective method of improving maternal sensitivity in a range of mother-infant-dyads. Although we aimed to identify evidence for all children aged 4 years 11 months or under, most included studies focused on infants. The results appear to be consistent across study populations with the exception of two studies, which targeted parents of children at high risk of autism and parents with intellectual disabilities respectively. There was also limited evidence of its use with fathers. There was, in addition, high consistency across the different settings in which video feedback was delivered (e.g. home; community settings such as family centres; and hospital or residential settings.)
In terms of practice, these findings suggest that video feedback can be provided to parents with wide-ranging challenges and in almost any setting. The findings do not currently support the use of video feedback to improve any other outcomes (e.g. parental reflective functioning, child behaviour or attachment.”
Spittle et al 2015 [5]
58 articles on 25 studies Population:
Preterm infants <37 weeks gestational age (23–37 weeks or <1000g–2500g)
N total =3 615 (n=10 to n=985)
Early developmental interventions targeting prevention of motor and cognitive impairment, provided post hospital discharge.
Child outcomes
Infant cognitive and motor development
Authors' conclusion:
“Interventions with a component that focused on the parent-infant relationship had a greater impact on cognitive outcomes at infancy and preschool age when compared with interventions that focused on infant development or parent support alone.”
“The current review has demonstrated diminishing effects of early developmental interventions over time. These diminishing effects support the need for further intervention around school age possibly targeted towards school readiness.”
Benzies et al 2013 [1]
18 articles, 15 different interventions Population:
Preterm infants <37 weeks gestational age and/or low birth weight <2 500g; and their parents.
N total =3 356 (n=23 to n=985)
Preventative interventions involving parents and including at least one session in the community (home or clinic).
Parental outcomes
Depressive symptoms
Sensitivity/responsiveness in interaction with infant
Authors' conclusion:
“As a result of early interventions for mothers of preterm infants, positive and clinically meaningful effects were seen for anxiety, depressive symptoms and self-efficacy. To our knowledge, this review was the first to categorize components of early interventions and link them to maternal outcomes. These components were parent psychosocial support, parenting education, and therapeutic developmental support for the infant. Some form or parenting education was used in all interventions. Interventions that included psychosocial support resulted in better outcomes for mothers of preterm infants.”
“It is clear that no one intervention component is consistently associated with improved parent outcomes.”
Evans et al 2014 [2]
17 articles on 16 studies, 18 different interventions Population:
Preterm infants <37 weeks gestational age with no major congential abnormalities; and the infants’ mothers.
N total =1 940 (n=16 to n=327)
Parenting interventions where mother-infant relationship quality outcomes are reported.
Mother-Infant relationship
Mother-infant dyadic outcomes
Maternal relationship outcomes
Infant relationship outcomes
Authors' conclusion:
“Consistent with attachment theory, this systematic literature review identified that interventions promoting cue-based, responsive care, improves the mother-preterm infant relationship which may enhance the infant’s later development.”
Herd et al 2014 [3]
12 articles on 5 studies, 5 different interventions Population:
Parents of preterm infants with no congenital abnormalities.
Birthweight <1000g–2500g or <28 weeks to<36 weeks gestational age.
N total =1 654 (n=118 to n=985)
Preventative parenting interventions designed to enhance parenting skills.
Child behaviour
Authors' conclusion:
“Within the 12 articles identified for this systematic review, there were five preterm parenting interventions that assessed child behavior: the IHDP, the MITP, the MITP-M, the Portage Program (from the APIP), and the VIBeS Plus Program. All these studies designated child behavior as a primary or secondary outcome. While the meta-analysis indicated a small, but significant, effect favoring intervention groups, there is some evidence that the IHDP improves behavior up to 3 years of age, the VIBeS Plus program up to 4 years and the MITP-M up to 5 years. There was no evidence that the Portage Program improved child behavior. The VIBes Plus program reported a durable effect on behavior, reporting a medium treatment effect for a reduction in externalizing behavior at 2 years and a small treatment effect at 4 years. The MITP-M (Nordhov et al, 2012) also revealed a durable effect on behavior, reporting a small treatment effect at 2 years and moderate effect at 5 years.”
“The MITP-M and the VIBeS Plus Program achieved more durable behavior outcomes using a shorter intervention and lower dosage than did the other preterm parenting interventions.”


  1. Benzies KM, Magill-Evans JE, Hayden KA, Ballantyne M. Key components of early intervention programs for preterm infants and their parents: a systematic review and meta-analysis. BMC Pregnancy Childbirth 2013;13:S10-S10
  2. Evans T, Whittingham K, Sanders M, Colditz P, Boyd RN. Are parenting interventions effective in improving the relationship between mothers and their preterm infants? Infant Behavior and Development 2014;37:131-54.
  3. Herd M, Whittingham K, Sanders M, Colditz P, Boyd RN. Efficacy of preventative parenting interventions for parents of preterm infants on later child behavior: A systematic review and meta-analysis. Infant Ment Health J 2014;35:630-41.
  4. O'Hara L, Smith ER, Barlow J, Livingstone N, Herath NI, Wei Y, et al. Video feedback for parental sensitivity and attachment security in children under five years. Cochrane Database Syst Rev 2019;11:CD012348.
  5. Spittle A, Orton J, Anderson PJ, Boyd R, Doyle LW. Early developmental intervention programmes provided post hospital discharge to prevent motor and cognitive impairment in preterm infants. Cochrane Database Syst Rev 2015;2015.

SBU Enquiry Service Consists of structured literature searches to highlight studies that can address questions received by the SBU Enquiry Service from Swedish healthcare or social service providers. We assess the risk of bias in systematic reviews and when needed also quality and transferability of results in health economic studies. Relevant references are compiled by an SBU staff member, in consultation with an external expert when needed.

Published: 1/30/2020
Contact SBU:
Report no: ut202002
Registration no: SBU 2019/625