Journal Article

What Parents Know Matters: Parental Knowledge at Birth Predicts Caregiving Behaviors at 9 Months

The Journal of Pediatrics | January 24, 2020
Christy Y. Y. Leung, PhD, and Dana L. Suskind, MD


To examine the mediating role of socioeconomically disadvantaged parents’ knowledge of early cognitive and language development at the first postpartum visit in the relation between education and caregiving behaviors at 9 months.

Study design

Parental knowledge was assessed at the 1-week newborn visit (n = 468); anticipatory guidance received and desired at 1-month (n = 212) and 6-month (n = 191) visits were reported; and caregiving behaviors toward infants during a teaching task were observed at 9-month visit (n = 173).


We found substantial variation in knowledge and caregiving behaviors. Parents who had more knowledge of infant development at 1 week were more likely to respond to cues (r = 0.18; P < .05) and foster social-emotional (r = 0.17; P < .05) and cognitive growth (r = 0.20; P < .05) at 9 months. Importantly, the indirect effect of education on cognitive growth fostering at 9 months through knowledge at 1 week was significant, controlling for primary language and number of other children in the home (infancy: b = 0.06; B = 0.07; SE = 0.04; 95% CI, 0.007-0.165; early childhood: b = 0.04; B = 0.06; SE = 0.03; 95% CI, 0.008-0.152). Open-ended responses indicated that anticipatory guidance in the first 6 months focused on infant physical growth; however, parents did not request additional anticipatory guidance from their pediatricians.


This study sheds light on the importance of promoting parental knowledge about cognitive and language development to foster parental cognitive stimulations and language inputs during the first year of life. This study highlights the important role of anticipatory guidance on cognitive and language development during the earliest well-child visits and the need to better understand parental baseline knowledge to tailor anticipatory guidance to the family strengths and needs. (J Pediatr 2019;-:1-9).