Matching between maternal knowledge about infant development and care for children under one year old

Abstract Objective: to analyze maternal knowledge about infant development and its matching to the care offered to children during their first year of life. Method: a longitudinal and prospective study, in the stages of pregnancy and of the child’s 12th/13th month of life. Interviews were applied to 121 women in a Brazilian city, based on 21 items selected from the Knowledge of Infant Development Inventory, related to the first year of life. Calculation of rates of correct answers was used, as well as regression by Ordinary Least Squares and White’s standard error. Results: the participants who answered correctly more aspects have more years of study, are older and present high family incomes. When the “having a partner or not” variable was considered, the correct answers presented a discrete fluctuation. Regarding the themes, there were more correct answers to aspects about health, safety and infant development milestones. Primiparous mothers were more likely to wean, overprotect and have children using electronic devices, and less likely to seek information about child care. Conclusion: there was matching between some maternal knowledge and execution of child care. The connection between them is relevant to indicate in detail the unknowns and uncertainties and to improve positive knowledge, contributing to promoting early childhood development.


Introduction
The first years of life are fundamental and cover important variables for human development, such as the family environment and its characteristics, stimuli, practices and interactions (1)(2) . Diverse scientific evidence suggests the importance of parental caregivers in everyday life and needs to support them, in order to favor a healthy early childhood and adequate development (3)(4)(5) .
Absence of attentive and affective care in early childhood can impair learning and memory, affecting both physical and socio-emotional health (4)(5) , increasing the chances of unfavorable outcomes for infant development and making it difficult to reach the child's potential.
Parental interventions for children under two years of age in low-and middle-income countries have been identified as valuable, highlighting that more in-depth research studies are necessary, integrating responsive care and environmental risk factors (6) .
In general, the mother is recognized as the closest parental figure to perform the child's everyday care, although parental contexts have been increasingly discussed regarding maternal overload, partnership status and gender, socioeconomic tensions related to the provision of child care (7) . The maternal perception about the first years of life is important, and it was found that the mothers' knowledge is more focused on the physical aspects (8) .
In the context of infant development, maternal knowledge focuses on motor aspects, with gaps in cognitive, socio-emotional and parental interaction skills with the child (9) . Studies based on the Knowledge of Infant Development Inventory (KIDI), an instrument used to measure knowledge about infant development, found lower schooling levels associated with a lower range of knowledge (10) and higher scores of knowledge in older mothers, with higher instruction levels and better economic incomes (11) .
In this survey, knowing whether aspects of healthy

Method Study type
A longitudinal and prospective study conducted in two stages in a health district from a Brazilian municipality in the inland of São Paulo.

Data collection locus
In both stages, the interviews were individual by means of home visits (HVs).

Period
The survey of the number of pregnant women occurred with the support from the teams of units with

Sample
A total of 529 participants in their last gestational trimester were identified. In all, 110 did not meet the inclusion criteria, 173 were removed due to the exclusion criteria and 26 refused to participate, resulting in 220 eligible women to comprise the sample. However, 43 participants were excluded due to discontinuity criteria and 56 were considered as losses for not being found to conduct the HVs.

Selection criteria
The inclusion criteria were the followings: i) pregnant women in the last trimester of pregnancy, of usual risk, over 18 years of age; and ii) registered and undergoing follow-up in a unit with FHS, in the area covered by the health district. The exclusion criteria were as follows: i) risk pregnancies, ii) women deprived of their freedom or hospitalized, and iii) not speaking Portuguese. Regarding the discontinuity criteria, the following were established: i) change in the coverage area of the health district in question, and ii) mothers' decision to withdraw their participation. Those women who were not found after three attempts to conduct the HV were considered as losses.

Participants
Pregnant women/mothers were the central participants of the study, with data collection with the same participant in the last trimester of pregnancy www.eerp.usp.br/rlae 3 Gondim EC, Scorzafave LGDS, Santos DD, Henrique NCP, Pereira FM, Mello DF.
(pregnant woman) and between the 12 th and 13 th month after birth of the child (mother). They accounted for a total of 121 participants.  (12) .

Study variables
KIDI has 75 questions that address aspects going from birth to 6 years old age. In the current research, 21 questions from KIDI were selected, related to the child' first year of life. In each of the 21 questions, the participants had the option of answering "I agree", "I disagree" or "I'm not sure", the last option when the participant mentioned indecision and/or not knowing how to choose the "I agree" or "I disagree" statement.
Assignment of correct of incorrect answers refers only to the "I agree" and "I disagree" options.

Data collection
In the pregnancy stage, a structured interview was conducted with application of a questionnaire on sociodemographic, economic and obstetric aspects to characterize the participants, as well as topics on infant development, based on KIDI items.
In the second stage, between the child's 12 th and 13 th month of life, a questionnaire was applied regarding

Data treatment and analysis
In the descriptive statistics analysis, the relative frequency of the variables investigated was calculated.
The "maternal knowledge" variable was considered as dependent and the others, as independent. Calculation of the rates of correct answers on infant development was used, as well as regression by Ordinary Least Squares (OLS) and White's robust standard error.  Considering the group of participants and the compilation of all 21 questions addressed, the mean of correct answers is 62.9%. As for the number of questions, the correct answers were more expressive in the range from 11 to 15 questions (61.2%) and less expressive from 16 to 21 questions (20.6%) and from 1 to 10 questions (18.2%).    adopting a 5% significance level (p-value ≤ 0.05). Table 4 shows the results of the analysis performed. maternal schooling (15) . A study (21)  Confidence in maternal knowledge itself is discussed (22) , inquiring whether knowledge acquisition is linked to informal knowledge, coming from parental experiences or from the offer in formal education.

Ethical aspects
In the current research, in relation to the search for knowledge about infant development, the most explored information sources were via the Internet. A study emphasizes that the sources refer to whom mothers turn for information, being pointed out that, first and most often, they access family and friends, complementing the search with personal social network advice and formal sources of health professionals and programs (17) .
A study pointed out that parental knowledge has a significant association in the child's cognitive, motor, socioemotional and language dimensions from the perspective of developmental achievements (23) . Family contexts with higher incomes seek more information and present better levels regarding stimulation of the children, such as playing, telling stories and reading books together (24) .
A review study (25) reinforces that positive interactions between mothers and term infants showed beneficial effects, including sleep organization, temperature and heart rate regulation, improvement of crying and cramps, socio-emotional development, speech opportunities and quality of attachment. In the first year of life, the children that live with mothers that have communicative skills obtain higher verbalization scores at 36 months old (26) .
Children exposed to positive emotional expressiveness at home present higher socio-emotional competence levels than those whose parental caregivers avoid focusing on emotional experiences (27) . Another aspect is the socialization style of the maternal emotions related to the variation in the child's empathy (28) .
The   (11,14) , similarly to the results of this research, as the participants tend to err less the higher their schooling level and age group.
The correlation between maternal schooling and rates of correct answers in KIDI (15) suggests that more years of study are an indicator for greater ability to understand infant development. A number of studies highlight that the more educated mothers are, the greater is the tendency to seek information about parental skills (16) , as well as that mature mothers explore information about parenting more seriously than younger mothers and are more likely to have friends with babies, making it possible to learn from them (17) . It was also studied that women who achieve more formal education tend to have children with more opportunities by inserting them in early childhood education, as a way of transmitting educational advantages through the generations (18) .
In relation to the KIDI domains, other research studies (19)(20)  increasingly, it is fundamental for adults to understand that brain development is shaped in early childhood and that parenting requires an increase in knowledge (17) .
The relevance of parental knowledge implies identifying more details about its contexts and vulnerability situations, whether they are emotionally more exhausted, distracted and less attentive, or coherent and sensitive to their children (5) . Such nuances can be addressed in home programs by strategies developed by health professionals, for satisfactory responses, especially in more disadvantaged areas (29)(30) .
The interface between poverty and infant development is extremely relevant. A study found that one in ten children belonging to low-income families has deprivation related to life (lack of items to live) and to the child itself (for example, lack of children's books) (31) , showing a connection with deprivation for full development. Circumstances vulnerable to infant development, including poverty, low maternal schooling and child abuse, represent major challenges in the face of socioeconomic disparities in several countries (32) .
The prevalence of suspected developmental delay and inequalities in early childhood in low-and middle-income countries requires a fruitful movement to meet sustainable development goals, requiring inclusive, equitable and good quality learning opportunities for all (33) .

Parental interventions already evaluated display fidelity
to Primary Health Care, with positive impacts on mental, emotional and behavioral health outcomes for parental caregivers and children (5,32) . Interventions in this field point to the importance of parenting preparedness from pregnancy, as well as the promotion of infant development with investments in the training of health professionals (34) .
As for the limitations of this study, the identification of knowledge about infant development centered on the The approximation between parental knowledge and experiences and the care effectively provided is extremely important to monitor gaps in understanding and recognize the demands of the skills development process for and of the child, as well as the aspects regarding health and safety in childhood.
There is emphasis on the need to increase health professionals' performance and early childhood education for parental support, based on diverse scientific evidence and on actions that minimize the unknowns and uncertainties about integral development in early childhood, in order to suppress fake news and reduce harms to children and families.