Decoding Parenting Style and Emotional Connection in Infants With Cerebral Palsy: A Prospective, Multicenter Study

To characterize parenting styles and observe parent-infant connection in infants with or at high risk for cerebral palsy (CP) during the first year, and to examine associations with infant neuromotor severity, age, and caregiver education.

A prospective cohort of 218 caregiver-infant dyads across 4 US sites was studied. Infants aged 3-13 months corrected age had a confirmed or high-risk for CP designation. Parenting style was measured using the Parenting Styles and Dimensions Questionnaire (PSDQ), and the observed parent-infant connection was assessed using the Welch Emotional Connection Screen (WECS). Neuromotor severity was classified using the Hammersmith Infant Neurological Examination (HINE) score (severe: <40, less severe: ≥40). Associations among parenting styles, connection outcomes, infant age, neuromotor severity, and maternal education were analyzed using linear regression, interaction models, and Spearman correlations.

Caregivers predominantly endorsed authoritative parenting (ie, high expectations with warmth, clear structure, and bidirectional communication) regardless of infant neuromotor severity, with authoritative scores significantly higher than authoritarian or permissive scores. Maternal education was positively associated with authoritative parenting and negatively associated with authoritarian parenting (ie, high expectations and control at the expense of responsivity and warmth); neuromotor severity and infant age were not associated with any parenting style measure. Observed parent-infant connection increased with age in infants with less severe neuromotor impairment but was attenuated or absent in those with greater impairment, particularly in child engagement domains (age × HINE interaction, P≤.033) yet caregiver connection remained stable and high across severity groups. Correlations between parenting style and observed connection were uniformly small and domain specific.

In infants with or at high risk for CP, parenting style is predominantly authoritative and more closely linked to caregiver education than to infant neuromotor severity. Observed parent-infant connection follows a severity-dependent trajectory in which age-related gains in infant engagement are attenuated with greater neuromotor impairment. These findings shift emphasis from broadly remediating parenting style toward supporting the dyadic processes most constrained by neuromotor impairment.