Key takeaways for caregivers

• Screens may be beneficial to but may also prove problematic for infants’ development.
• More than half of infants in a study on child development had been exposed to screens by six months and many had a screen in the room where they slept.
• Mothers reported using screens with infants for at least 1-3 hours a day and during daily activities, such as during meals, when going to sleep, while waiting, and to calm infants.
• Maternal stress did not predict the use of screens with infants, but moms’ educational level did.
• Research suggests that we need to learn from caregivers why they offer screens to their young children, as well as the need for increased guidance and resources for caregivers regarding exposure to and use of screen time.

Screen use can negatively affect caregiver-child attachment and children’s development

The popularity of cell phones, tablets, and other screens is undeniable and has changed our world, largely for the better. These media are instruments of daily life, helping us navigate both time and location.

Mothers’ self-reports of their perceived levels of stress did not predict whether a screen was provided. However, educational attainment did predict screen exposure.

They allow us to read on the move, serve as a form of entertainment, and connect us rapidly and easily with those around the corner and around the globe. Screen devices are everywhere, and exposure to them now extends beyond adults to include teenagers, tweens, and young children.

Yet while cell phones may help us connect, they may also serve to disconnect. The challenges of disconnection, or technoference, are revealed in adult relationships and, in similar ways, may be particularly disruptive for parents and other caregivers of young children.

Young children form an attachment to parents and caregivers, relying on them to satisfy needs for food, warmth, safety, and affection. By attending to a child’s cues, a parent is participating in the type of back-and-forth interactions that bolster development (Maccoby et al., 1983).

Research shows that the healthy development of a child depends in part on the consistency of these back-and-forth interactions, sometimes called serve and return. Considerable evidence shows that language, emotional, and cognitive development all begin in the small and unscripted interactions between caregiver and child.

But research also shows that screens may sometimes disrupt or interfere with this type of interaction between a parent and their child, and can result in changes in infants’ sleep, language, executive function, and attention.

Photo: Sunvani Hoàng. Pexels.

A study of mothers’ screen use with their infants

Given the importance of the back-and-forth relationship between caregivers and young children, we conducted a study to understand why some mothers give their infants screens and others do not. While mothers offer screens for many reasons, we studied whether mothers’ descriptions of their own stress levels and their educational attainment played a part.

Our study used data from an ongoing study seeking to understand how early experiences influence child development outcomes. Eighty-two mothers were invited to share their prenatal experiences with our team of researchers, completing surveys that asked, among other questions, about their levels of stress and their educational attainment. Our sample of mothers was diverse in terms of race, ethnicity, and educational attainment.

After giving birth, the mothers were contacted periodically until their child turned three years old. When the infant was six months old, mothers were invited to return with their child to the research lab. At this visit, mothers were asked if their child had been exposed to screens. If they answered yes, the moms were given a survey that asked about the ways the child had been exposed to screens, including questions about what they watched, with whom, and for how long.

Caregivers may not be fully aware that screens can disrupt parent-child interactions and children’s development.

Many infants are exposed to screens through daily activities

Forty-three of the six-month-olds had been exposed to screens, with 28 (70%) having a screen in the room where they slept. About a third of the infants were given a screen at mealtime, while going to sleep, and while waiting at the doctor’s office. About half of mothers reported offering a screen to calm their infant. More than half of moms reported providing a screen between 1-3 hours per day, and about a third reported providing a screen more than 3 hours per day.

Mothers’ self-reports of their perceived levels of stress did not predict whether they gave their infants a screen. However, moms’ educational attainment did predict screen exposure: Less maternal education was associated with mothers more often offering screens to their infants.

This information is important to consider when thinking about infants’ screen use but should be taken at face value. Our study was a small sample of mothers and infants. We did not talk with mothers about why they provided screens to their infants so we can only attempt to interpret their survey responses without knowing the full picture of these early experiences for children.

One possibility is that stress is felt universally by parents of infants and as such, was not a strong predictor of who might provide a screen. However, educational attainment is not equal or equitable among people in the United States, and it may serve as a marker of knowledge about screens or other characteristics that predict screen use.

Photo: pxfuel.

Educating parents about screen exposure and use is essential

Researchers need to understand more about why mothers offer screens to their infants. Caregivers may not be fully aware that screens can disrupt parent-child interactions and children’s development. They may be less prepared by people they encounter in health care or social service settings to consider screen exposure and use with their infants in the same way they consider, for example, feeding or providing safe sleeping conditions.

Given the findings from our study that screen use and daily care activities may be intertwined for some caregivers, personnel in health care and social services should facilitate these conversations with new parents.

We hope to continue research on this topic so we can better understand how parents’ educational level is related to social supports or services for mothers. We would also like to understand more fully how these supports for parents of infants might reduce the need to provide screens at certain times during the day (e.g., during meals, at bedtime, while waiting) and for extended periods of time.

If you are a caregiver with questions about screen exposure and use with your infant, visit the AAP website, where there are resources for caregivers, including guidelines on screen use for young children and their development. In addition, ask your pediatrician or other health care provider questions about age-appropriate screen use so you can learn how to navigate potentially stressful times when the distraction of a screen may seem helpful.

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• Mind-mindedness is the ability of parents to accurately read and label their children’s thoughts, feelings, and wishes.
• Both mothers’ and fathers’ mind-mindedness in the first years of children’s lives play an important role in children developing the ability to regulate their emotions and behaviors.
• Parents can cultivate mind-mindedness by paying close attention to their children’s behavior and taking time to reflect on and label their children’s thoughts, wishes, and emotions.

What is mind-mindedness?

I have vivid memories of the first weeks of motherhood, feeling anxious and confused about why my baby was crying. I wondered: Why is she crying? How is she feeling? Does she want something other than food? Maybe she just wants to be cuddled? As time passed, I began to understand my baby’s wishes and emotions more clearly. Talking to other new parents, I realized that parents differ in how much they can understand their children’s minds.

This ability of parents to think about their children as individuals with their own thoughts, feelings, and wishes, and to label these experiences in their interactions with them is called mind-mindedness. Parents with this ability accurately read their babies’ minds and label their mental states. This might involve reflecting on a child’s emotional experiences or verbalizing their wishes.

Photo: Egidijus Bielskis. Unsplash.

For example, when a child starts crying after their toy broke, a mind-minded parent might say, “You seem upset that your toy broke. You wanted to play with this toy.” In contrast, parents who misinterpret their children’s mental states (e.g., assuming the child is crying because they are tired and do not want to play anymore) demonstrate non-attuned mind-mindedness.

How does mind-mindedness help children?

Parental mind-mindedness plays an important role in the development of children’s self-regulation. Self-regulation is a critical skill that enables children to manage their emotions and behaviors in response to what a situation demands (Eisenberg, 2000; Kochanska, 1993). As children reach the age of four or five and begin school, the demands for self-regulation increase. Starting a these ages, children need to stay focused, pay attention to learning goals, and actively participate in learning in the classroom so self-regulation becomes especially important (e.g., Nota et al., 2004).

Boosting self-regulation

Self-regulation in preschool is not only important for later academic achievement – accumulating evidence suggests that it is also essential for children’s social adjustment and mental health. Preschool-age children who can adequately regulate their emotions and behaviors have more successful relationships with others, are more socially competent, have healthier life habits, and are at a lower risk for developing mental disorders (Robson et al., 2020).

The ability of parents to think about their children as individuals with their own thoughts, feelings, and wishes, and to label these experiences in their interactions with them is called mind-mindedness.

Several studies have examined the role of parental mind-mindedness in the development of self-regulation in infants and toddlers. They have shown that mothers’ and fathers’ mind-mindedness is associated with emerging self-regulation abilities in infancy and toddlerhood (Cheng et al., 2018; Gagné et al., 2018; Senehi et al., 2018; Zeegers et al., 2019). However, it remains unclear whether parental mind-mindedness at these ages plays an important role for self-regulation in preschoolers. This is especially important to determine since self-regulation at preschool age predicts various life outcomes.

The connection between parental mind-mindedness and preschoolers’ self-regulation

My colleagues and I set out to address this question. In our recent study (Nikolić et al., 2022), we investigated whether mothers’ and fathers’ mind-mindedness in the first three years of a child’s life predicts the development of self-regulation at four and a half years.

We predicted that appropriate mind-mindedness in parents would help children develop good self-regulation because children would learn about their inner states from parents who accurately reflect on and label their mental states (e.g., when a child is sad and the parents reflect on the child’s sadness, the child becomes aware of the feeling and starts to understand it). In contrast, non-attuned mind-mindedness in parents would hinder the development of self-regulation because children whose parents misinterpret their thoughts, wishes, and feelings may feel misunderstood and would not learn to understand their mental states from their parents.

Photo: Karolina Grabowska. Pexels.

We assessed mothers’ and fathers’ mind-mindedness in the first three years on multiple occasions by observing their interactions and conversations with their children during playtime. We then measured preschoolers’ self-regulation at the age of 4.5 in several ways. First, we asked parents about their perception of their children’s effortful control, or their capacity to voluntarily focus attention and suppress an inappropriate response or activate an appropriate response to adjust to a situation (Eisenberg, 2005). For example, the ability to prioritize sitting quietly and listening to the teacher over playing with a friend is an aspect of effortful control.

Second, the children completed behavioral tasks in the lab, where we asked them to keep their hands placed on a mat on the table while choosing a prize from a box filled with small toys or a box filled with candies (Kochanska et al., 1997). This task required children to follow instructions and inhibit a dominant response (i.e., touching or pointing to a toy or candy). Finally, we measured children’s heart rate variability during rest – a bodily response related to physiological regulation (Porges, 1997).

Mind-mindedness in the first three years of a child’s life

Both mothers’ and fathers’ mind-mindedness in the first three years of their children’s lives contributed significantly to their preschoolers’ self-regulation. Fathers who were more mind-minded with their babies and toddlers had children who were better at self-regulation when they started school. In contrast, mothers and fathers who were more non-attuned and often misinterpreted their children’s mental states had children who were less able to self-regulate when they started school.

Fathers who were more mind-minded with their babies and toddlers had children who were better at self-regulation when they started school.

These findings provide the first evidence that both mothers’ and fathers’ mind-mindedness in the early years matters for children’s self-regulation in preschool. They also emphasize the role of fathers’ attunement to their children’s mental states in early years for the development of self-regulation at preschool age.

How can parents cultivate mind-mindedness?

What does this mean for parents? While it may not be surprising that a strong parent-child bond has positive effects on a child’s socioemotional development, our study’s findings highlight the unique importance of both mothers and fathers in being mindful of their children’s internal experiences to promote self-regulation early in life.

Parents can pay close attention to their children’s behavior and cues, and take time to reflect on and label their children’s thoughts, wishes, and emotions. By doing so, parents can help their children develop an understanding of their own inner life, making self-regulation easier. And the best part? It is never too early to start this practice – even talking about mental states with your child before they can speak can help them develop this important life skill.

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• Mothers and fathers show similar patterns of brain activity when exposed to stimuli from their infant.
• The observed brain changes occur in areas involved with reward, motivation, and empathy, and are associated with hormonal changes in moms and dads.
• Brain systems may reflect parental potential available to human fathers and other mammalian fathers when they are more involved in caregiving.

Fathers’ brains respond when they are exposed to stimuli from their baby

The neurobiology of fatherhood in humans seems to be similar to the neurobiology of motherhood, involving two brain systems – a “motivational” system that refers to the drive to nurture offspring, and an “empathy” system that refers to the ability to understand the thoughts and feelings of others.

Fathers shown pictures of their own newborns experienced more activation of empathy and reward systems than when shown pictures of unknown newborns.

For example, brain responses of mothers and fathers to pictures or videos of their infants overlap. Increased activity is found in parts of the brain associated with reward, motivation, and empathy. In one study, increased activity in brain reward systems also correlated with the father’s active engagement in caregiving, as reported by the mother.

In another study, fathers shown pictures of their own newborns experienced more activation of empathy and reward systems than fathers shown pictures of unknown newborns. In another study, a new father’s self-reported positive thoughts about his infant correlated with reward system activation in response to his infant’s cries. Future research will look at other brain responses in fathers – to children’s laughter, speech, and movements.

Brain changes are connected to hormonal changes activated by involved parenting

There is growing evidence that these changes are linked with the hormones that are produced when fathers care for their children. The key difference between human mothers and fathers is the degree of variability in fatherhood. After birth, most mothers are actively involved in parenting, but fatherhood is activated only when circumstances require or allow it, and even then it is highly variable.

When fatherhood is activated, neural processes take place in fathers that are similar to those in mothers.

In societies with small family units living apart from extended family networks and in families with scarce resources, paternal involvement is necessary. When fatherhood is activated, neural processes take place in fathers that are similar to those in mothers. It is as if a parental potential resides in all humans and is activated when circumstances require.

In the wild, fathers are actively engaged in caring for their young in only 5% of mammalian species (e.g., some primates, rodents, and canids, in particular). As in humans, this paternal behavior involves similar brain processes as those involved with maternal behavior. But when animals are held in captivity and in non-natural conditions, fathers can become more active. This suggests that parental brain systems may exist in many male mammals, and that they can be activated when an active paternal role is desirable or possible.

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• Supportive fathers influence their children in significant ways, including the development of cognitive and social skills.
• The positive impact of fathers is greater when fathers’ relationships with mothers are strong and supportive.
• Fathers can help their children’s development through supportive and involved parenting and engaging activities, such as reading books and playing.

To fully understand the significance of a father’s influence on his children, we will explore four key areas:

1. Father-child attachment and later development
2. Father influence on a child’s achievements
3. Father influence on a child’s social skills
4. The mother-father relationship

1. Father-child attachment influences children’s later development

When there is a strong father-child attachment in the first two years, research shows a link with the child’s later social skills, cognitive skills (e.g., language, school achievement) and behavior. In this way, fathers influence their children’s futures.

These links between strong father-child attachment and later child development are greatest when fathers are more involved in parenting. This suggests that involved fathers have the potential to make a big difference in their child’s life.

Involved fathers have the potential to make a big difference in their child’s life.

2. Fathers have a significant influence on their child’s achievements

Fathers who provide primary care for their two-year-olds have children who achieve higher scores on academic tests. (The same is true of mothers.) Anne Martin and her team found that mothers and fathers who provided primary care for their children when they were two had five-year-olds with higher arithmetic and language scores.

Eirini Flouri and Ann Buchanan found that British children with more involved fathers had higher IQs at age seven than did children with less involved fathers. Other researchers have found similar associations at 11 years and 16 years.

Some researchers have worked to distinguish fathers’ influences on educational performance from the effects of other wider family and community influences. The links remain: Fathers who are supportive appear to promote their children’s language and cognitive development.

3. Fathers influence their children’s social skills

In a large British study, when mothers reported that fathers were involved with their seven-year-olds, the children were more likely to report being close to their fathers at 16 and to have less contact with police during adolescence. Other researchers have found even longer-lasting links – fathers’ involvement with their six-year-olds appeared to positively influence  the feelings of their offspring when they were in their 30s, more than 25 years later.

Photo: Mieke Campbell. Pexels.

High levels of paternal involvement in childhood also predict offspring’s social interaction styles in adulthood, as well as their married relationships, parenting skills, and mental health. The converse has also been shown – low paternal involvement and poor child-father attachments predict more psychological and social problems later.

Ross Parke and his colleagues found that a physically playful and affectionate father-son relationship predicted sons’ later popularity with peers. Other researchers have found that fathers who were more sensitive to their five-year-olds’ emotional states had more socially competent children three years later.

Researchers have examined whether fathers and mothers exert different influences on the social development of their children. It is very difficult to separate these influences from the many roles mothers and fathers play in different families. However, researchers have found that children who reported secure attachments to both their parents were more likely to report positive friendships than children who did not.

Mothers influence father-child relationships and fathers influence mother-child relationships.

4. The mother-father relationship influences children

The last 20 years have seen a lot of research on how family members influence the relationships of other family members with children. Studies suggest that mothers influence father-child relationships and fathers influence mother-child relationships.

A key influence on the father-child relationship is how supportive the mother is of this relationship, as well as the quality of the mother-father relationship.

The inverse is also true: Both the father and the mother-father relationship influence the mother-child relationship, but the influence is less. This may be because maternal behavior is framed by clearer conventions and role definitions, while fathers’ roles and behavior are more influenced by what mothers believe.

Mothers’ mental health also affects the father-child relationship, and fathers’ mental health affects the mother-child relationship. Sometimes the response can be compensatory. For example, when mothers suffer from postnatal depression, fathers often engage in more positive interactions with their babies.

Conclusion

The conclusion of this research is clear: A father who wants to be close to his children and positively influence their future should invest in relationships with both the children and their mothers.

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• Consider fathers’ health behaviors as well as mothers’,
• Assess and treat fathers’ mental health as well as mothers’,
• Treat family stress and attend to the couple relationship, and
• Provide access for fathers to family leave.

Much research focuses on how mothers-to-be influence babies’ health and development before and during pregnancy – touching on mothers’ environments, emotions, and behaviors. Mothers-to-be are often advised to alter their lifestyles accordingly.

Less attention is paid to fathers, but there is sufficient evidence to make a case for practice and policy to change in this regard.

This research review sets out seven ways fathers influence children’s development during pregnancy, providing a useful tool for planners of prenatal services and policies.

1. Epigenetic and genetic changes: Prior health behaviors

• Obesity is associated with epigenetic changes that predict restricted growth in childhood.
• Alcohol affects the sperm epigenome and is a risk factor for alcohol use and alcohol sensitivity in offspring.
• Fathers’ diabetes and fast-food consumption predict earlier births.

2. Epigenetic and genetic changes: Exposure to environmental toxins

• Exposure to workplace welding fumes is linked with higher prevalence of congenital abnormalities (Egyptian study).
• Fathers exposed to pesticides (e.g., nematocide, dibromochloropropane, ethylene dibromide) are more likely to have suboptimal sperm quality.

3. Epigenetic and genetic changes: Early life stress

• Children of fathers who survived the Holocaust and fathers with post-traumatic stress disorder show epigenetic differences, namely increased DNA methylation in a promoter region of the glucocorticoid receptor. These are linked with increased prevalence of psychiatric illness and reduced cortisol levels in the children.
• Studies of mothers have shown links between their exposure to disasters (e.g., natural disasters, terrorist attacks, COVID-19) and outcomes for their children. No such research exists for fathers but it would likely reveal similar links.

4. Neurobiological and hormonal changes

• First-time fathers with a higher prenatal testosterone level report less effective and positive parenting six months after the birth.
• First-time fathers with a higher prenatal oxytocin level endorse a more nurturing parenting philosophy after the child’s birth.

“This research review sets out seven ways fathers influence children’s development during pregnancy, providing a useful tool for planners of antenatal services and policies.”

5. Influences on expectant mothers’ health behaviors

• Alcohol use by an expectant father is linked to higher alcohol use by pregnant mothers (Ukrainian study).
• Expectant mothers engage more in prenatal health actions such as stopping smoking when their male partners do more caregiving (e.g., listening to baby’s heartbeat, purchasing items for baby, attending prenatal classes).

6. Influences on expectant mothers’ mental health

• A higher quality of couple relationship is associated with expectant mothers’ lower distress, which in turn is associated with more positive temperament of the baby (U.S. study).
• More relationship conflict correlates with greater incidences of medically complex births. Much research links prenatal stress in mothers to premature birth and low birth weight.
• Depression in expectant fathers correlates with depression in expectant mothers. Joint mental health symptoms in two parents prenatally predict the same symptoms in the parents 12 months after the birth, which in turn correlate with children’s executive function problems at 7-8 years (Finnish study).

7. Influences on mothers’ hormones

• A couple’s hormonal levels tend to synchronize and follow similar patterns. Lower testosterone levels in both expectant parents predict greater investment by the father in the parenting relationship after the birth.
• When cortisol levels are lower in both expectant parents, there is likely to be less conflict between them before birth and less depression on the part of the father after the birth.
• Hormonal changes in mothers can affect fetal development and children’s long-term social and emotional development.

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The researchers conclude: “The present study challenges the assumption that women are more suited to primary caregiving than men … fathers and mothers are equally competent at parenting in the primary caregiving role.”

Based on this finding, they recommend: “The high quality of parenting demonstrated by the primary caregiver fathers suggests that more fathers should be encouraged to be highly involved parents. To do so, policies facilitating this, such as shared parental leave and flexible work, including more part-time employment options, need to be widely promoted both by governments and by individual organizations.”

Previous research on primary caregiver fathers has often focused on gay fathers who became parents through adoption and surrogacy. These studies also found that children’s adjustment was positive. This study extends the research to heterosexual parent couples.

“The high quality of parenting demonstrated by the primary caregiver fathers suggests that more fathers should be encouraged to be highly involved parents.”

The study took place in the United Kingdom between 2017 and 2019,  and involved 41 primary caregiver fathers, 45 primary caregiver mothers, and 41 dual earner couples (both mother and father). The primary caregiver mothers and fathers had been the primary caregivers for at least 6 months, with children from 3 to 6 years old. Their partner was the primary wage earner; some primary caregivers (fathers more than mothers) were also employed part time or worked flexibly from home, but they spent more time caregiving than working. In the dual earner families, both parents were in paid employment and many worked full time. The families were mostly White and highly educated, and had no serious financial difficulties.

Through questionnaires and interviews, the researchers used previously tested measures to assess depression, anxiety, stress, social support, marital quality, the coparenting relationship, parental acceptance/rejection of the child, parenting quality, and children’s behavior. When assessing children’s behavior, the children’s preschool or schoolteacher also completed a questionnaire.

This research confirms a large body of earlier research showing that the parenting behaviors of fathers and mothers are similar, as is their influence on children’s development. Primary caregiver fathers typically describe their role in nurturing terms as fostering a close bond with their child.

In one study, compared to primary earner fathers, primary caregiver fathers showed higher emotional tone and their 12-month-olds showed more positive mood. In another study, very involved fathers had a more playful interaction style than the mothers, though both these mothers and fathers smiled more and imitated their child more than less-involved fathers. In other studies, primary caregiver mothers were more affectionate with their 3-month-olds and their 8- to 12-month-olds than primary caregiver fathers.

Other studies have found that primary caregiver fathers face particular social pressures – social isolation in a mother-dominated world of playgroups and playgrounds, the stigma of adopting a non-traditional role, and less social support. However, in this study, the fathers reported positive well-being. Perhaps the strong marital relationships and coparenting arrangements were enough to compensate for any additional social pressure.

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Involved, vigilant parenting is key to children developing the capacity to regulate their emotions and avoid poor mental health outcomes that can emerge from racism. This confirms findings from earlier research of African American families, with associations between positive parent-child relationships in middle childhood and adolescents having skills to make decisions, pay attention, avoid distractions, set priorities, and control emotions.

In this study, the researchers make the case that, given how typical the experience of the negative effects of racial discrimination is in African American families, it is important to understand these strength-based, cultural parenting assets. Family support services need to understand and build around these assets when delivering preventative interventions for African-American families.

Middle Childhood

Middle childhood is an important stage in child development. This is when children develop a greater sense of self and the capacity to regulate their emotions. Their social world expands during this time as they learn how to engage in wider social settings. Such social competence is associated with numerous positive developmental outcomes in adolescence. Talking to your children about racism is another topic we’ve covered.

In the abovementioned study, African-American mothers were asked how satisfied they were with their children and how happy they were with their relationship with their children. The mothers were also asked questions like, “How often do you know what your child does after school?” “When you discipline your child, how often does the type of discipline you use depend on your mood?” and “How often do you give reasons to your child for your decisions?”

Middle childhood is an important stage in child development. This is when children develop a greater sense of self and the capacity to regulate their emotions.

When the mothers reported experiences of discrimination, they were more likely to report depression and anxiety on their part, as well as strained relationships with their children.

These in turn were associated with a greater likelihood of lower-quality parenting, as assessed by the mother. Both maternal depression/anxiety and lower parenting quality are linked to a greater likelihood of children developing poor self-control and emotion regulation skills.

Results & Conclusions

The study produced one surprising result. African American children who experienced the negative effects of racial discrimination during middle childhood showed a higher likelihood of developing stronger self-regulation and emotional control in early adolescence, which in turn was associated with less depression and greater social competence. This was the same for boys and girls. In some children, exposure to adversity during early childhood may help them self-soothe and regulate emotion, protecting them from adverse impacts on mental health.

However, this unexpected finding does not counteract the overall negative correlations between a family’s experience of racial discrimination and symptoms of depression in children. These links were found both in this and in earlier work by the same researchers.

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In adolescent pregnancies, we need to pay more attention to the increasingly negative effects of shocks such as COVID-19, displacement, and natural disasters.

The COVID-19 pandemic has reignited concerns about the effects of crises on the development of children globally. Within this realm of concern is an area that continues to be overlooked: the particular vulnerability of adolescent mothers and mothers to be, and by proxy, their children. Countries with high rates of adolescent childbearing also tend to struggle with reaching education goals and reducing poverty. It’s not that adolescent motherhood is rare; in many parts of the world, marriage and childbearing under age 18 is very common. An estimated 12 million girls aged 15 to 19, and nearly 777,000 girls younger than 15, give birth each year – and most of their pregnancies are unintended. But the particular risks for this subdemographic often go overlooked because governments and the development community prefer to think about preventing adolescent pregnancies than supporting adolescent mothers. Our research addresses this gap, noting that, around the world, shocks like a global pandemic make adolescent mothers and their offspring exponentially more vulnerable.

Adolescent mothers are already among some of the most vulnerable, even in the best of times and regardless of cultural perceptions (in some contexts, adolescent pregnancies are stigmatized; in others they are celebrated). Most teenage pregnancies occur in low- and middle-income countries and are often concentrated among the parts of society of the lowest incomes. Pregnancy at an early age often means mothers leave school and transition to domestic roles, resulting in lower levels of education, fewer economic resources, and less bargaining power in the home; these outcomes coincide with restricted access to sexual and reproductive health services. Adolescent childbearing is also associated with higher risks to maternal health. In fact, pregnancy and birth complications are the leading causes of death among 15- to 19-year-old girls worldwide.

“Adolescent mothers are already among some of the most vulnerable, even in the best of times and regardless of cultural perceptions (in some contexts, adolescent pregnancies are stigmatized; in others they are celebrated).”

However, not all of the risk is contextual. At least some of it lies “below the skin.” We argue in a forthcoming article that part of the risk adolescent mothers and their offspring face stems from neurobiological processes specific to adolescent development, for instance, heightened sensitivity to reward and stress. This becomes particularly salient when exploring how these processes interconnect with stressful life events. In short, adolescents’ heightened sensitivity to stressful events leads to higher levels of physiological stress, which has been demonstrated to affect adolescent development as well as pregnancy outcomes (e.g., preterm labor and low birthweight) and child development. Stress is transmitted to children prenatally through neuroendocrine pathways and postnatally through caregiving. In fact, recent studies link stress related to COVID-19 to pregnancy outcomes and early caregiving. Ultimately, we argue that the physiological stress response is a key factor in why adolescent moms and their offspring, on average, have worse developmental outcomes later in life, a fact that is supported by abundant evidence.

Given the scale and urgency of the COVID-19 pandemic, we are asking questions about the impact of the pandemic on early child development broadly, and adolescent motherhood more specifically. We already know that large shocks, such as financial crises, pandemics, natural disasters, and armed conflict, are accompanied by massive social and institutional disruptions and cause substantial stress in individuals, families, and communities; we also know that these often lead to widespread displacement and insecurities in housing and livelihood. Higher rates of adolescent pregnancies have been observed in contexts of displacement, often due to inadequate availability of sexual and reproductive health and family planning services for adolescent girls. By mid-2020, more than 15 million people were newly displaced internally due to conflict or disaster. Their situations are made even more precarious by the fact that, in response to the pandemic, in many places, non-essential services and programs closed their doors or refocused to respond to the pandemic. Moreover, stigma associated with COVID-19 has drastically reduced clinic visits for prenatal care.

Pregnant adolescents and adolescent mothers are even more at risk when sexual and reproductive health services become scarcer. In contexts of displacement, high rates of gender-based violence and poverty-driven transactional sex contribute to the increase in adolescent pregnancies. With lockdowns, there is the added risk of increased domestic violence and abuse in the home. For instance, both Kenya and Paraguay have reported increasing adolescent pregnancy rates during COVID-19 lockdowns. High rates of and increases in adolescent pregnancies during such stressful times should sound alarm bells.

“High rates of and increases in adolescent pregnancies during such stressful times should sound alarm bells.”

There is little evidence on how to best support adolescent mothers and mothers-to-be effectively, but some innovative interventions are pioneering the way. Countries such as Zimbabwe have started to change laws around school attendance for pregnant adolescent girls, allowing them to continue their education and ensuring that pregnant and mothering girls stay in school. A program in Ethiopia, “Meseret Hiwott,” used community women as mentors to facilitate group discussions for married adolescent mothers, focusing on increasing voluntary counselling and testing for HIV, as well as sexual and reproductive health awareness, family planning, motherhood, gender and power dynamics, and financial literacy. And a recent experimental evaluation of a home visiting program for low-income adolescent moms in São Paulo, Brazil, demonstrated positive effects on caregiving and maternal well-being. Such programs are promising, but more rigorous research is needed to better understand their impact and how to take them to scale successfully.

Unfortunately, most efforts in this area have focused on preventing adolescent pregnancies. Many of these initiatives have largely failed to produce substantial change, and can contribute to stigmatization and drive underage marriage practices underground, increasing the risks to adolescent mothers and their offspring. They also fail to acknowledge that adolescent motherhood will not be going away in many parts of the world anytime soon. We need more investigation and inquiry into the most effective ways to support adolescent mothers and their children – particularly in contexts of acute stress. The effects of the current pandemic are likely to be felt for a while to come and new crises are inevitable. Understanding how crises affect adolescent girls and how to effectively support their development, education, and reproductive health, with or without children, will likely yield long-term returns, not just to them and their families, but to society at large and generations to come.

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Many want schools to challenge prejudice against new family forms and want parents to provide more information about donors, half-siblings, and surrogates, according to a new book, We Are Family.

People concerned about children growing up in new forms of families (e.g., LBGTQ families, families created by donor eggs) have worried unnecessarily. In the face of dire warnings about such families, studies consistently show that their children turn out just as well as – and sometimes better than – kids from traditional families with two heterosexual parents. Findings have been remarkably similar, whether studies have focused on families with lesbian mothers, gay fathers, transgender parents, or single mothers by choice. Findings on families created by donations of eggs, sperm, or embryos, as well as by surrogacy, reflect the same pattern.

In studies of all these new forms of family, we, along with other research teams, have found that the quality of family relationships matters for children’s welfare far more than the number, gender, gender identity, sexual orientation, or biological relatedness of the parents.

It has taken nearly 50 years of studies, many following children across decades, to establish the empirical evidence. And there has been plenty of heartache along the way, starting with lesbian mothers who lost custody of their children back in the 1970s. In the half century since then, public and expert fears about new forms of family have underpinned various legal barriers to parenthood, discriminatory practices, and widespread stigmatization.

“My brother and I knew people in our school that had gay and lesbian parents and that did get bullied quite a lot, and that scared us from telling people.”

More new forms of family coming

However, even though research on children’s outcomes is clear, the story does not end there, for two reasons. First, the diversity of new family forms seems likely only to expand as science advances and people seek new paths to parenthood. Artificial wombs, eggs, and sperm are just over the horizon. At the University of Cambridge Centre for Family Research, we are already examining children’s outcomes in co-parenting families in which couples are not romantically involved, children are parented by single fathers by choice, and transgender people give birth after they have transitioned.

These developments pose fresh challenges to what has long been seen as the norm for children to flourish. Let’s hope people avoid repeating over-hasty judgments. We should await the evidence and be calmed by encouraging outcomes from other new forms of family.

Children are asking for change

Second, and perhaps more important, there is much more to say about children in these new forms of family, beyond simply logging their long-term outcomes. What is it like for them to grow up in such families? We should listen to their voices, and hear their thoughts and feelings. To that end, our team has conducted many studies gathering children’s stories.

Through our work, we have found that schools, parents, and the wider society still have much to learn about supporting children in non-traditional families through their experiences, which can be upsetting. The distress is not related to the type of family children have, but because of stigmatization, inadequate communication, and lack of understanding, mainly from those on the periphery of home.

So, for example, many children with LGBTQ parents have been stigmatized in school, by society, and sometimes by wider family. When we interviewed children of lesbian mothers born in the mid-1960s when they were young adults, almost half reported being teased or bullied as teenagers.

Stigmatization burdens children

“I wasn’t allowed to go to my friend’s house anymore,” said Anna. “Her mum and dad forbade me from going anywhere near, and that hurt me because she had been my best friend for a long, long time. I lost that friend. And then, of course, there was a chain reaction. Everybody found out. They said, ‘Don’t go near her, she’ll turn out like her mum.’”

John was bullied when schoolmates found out about his lesbian mom. “School was one big nightmare really, because I got picked on so much,” he explained. “I had cigarettes stubbed out on the back of my neck, and high-heeled shoes thrown at me, and a bit of hair cut off, and my head chucked down the loo, and that sort of thing.”

Children have felt the need to clam up about their families because of widespread prejudice. Stacey explained: “My brother and I knew some people in our school that had gay and lesbian parents and that did get bullied quite a lot, and that scared us from telling people. So, we never told anyone. It was hard keeping secrets.”

“Schools, parents, and wider society still have a lot to learn about supporting children through their experiences.”

Effective school challenges to prejudice

Schools must create a positive, supportive environment for such children. It pays off. Carol, 14, highlighted helpful action by her school: “Basically, they spread the word how it’s not very good to say, ‘Oh this is so gay’ or ‘that’s so gay,’ even though it’s used as a different meaning. They tell them that’s wrong and why you shouldn’t say that.” Mike, 17, recalled how a new English teacher, who was gay, made a difference: “He has one of the Stonewall ‘Some People Are Gay, Get Over It’ posters in his classroom. Just seeing the poster in his room is really cool.” As part of our research project, the UK campaign for equality of LGBTQ people, Stonewall, published 10 recommendations from children on how schools can support them and their same-sex parents.

Children of transgender parents have been bullied and teased in similar ways, and inclusive attitudes by schools can help them. Wendy explained: “I put my hand up and said, ‘I don’t have a dad because my dad’s transgender,’ and I got an award for it ‘cos it was actually really brave of me to say.”

Tell children what’s happening

Parents also should consider being more open about what is happening in their families. “It would have helped if he had explained things a bit better,” said Henry, 18, reflecting on when his father transitioned to being a woman. “It wasn’t so much him wearing dresses, but more him being a bit manic and doing strange things.” Chris, 18, advised other children in a similar situation: “Try to get them to communicate with you as much as possible because it’s worse if things are happening and you don’t know why.”

Children tend to accept, in a matter of fact way, their father’s or mother’s change of gender if it happened while they were little or a long time ago. “Chloe’s always been Chloe,” said Susanna, 14, who was a toddler when her father transitioned. “I don’t remember when it actually happened, so it’s basically been for as long as I remember.”

Experiencing transition can worry them

 But some children find it difficult when they experience a parent’s transition. They can have fears of loss, which typically pass, but which can be very real during gender transition. Jade, who was six when her father transitioned, was upset about losing her dad: “When she transitioned, I felt like there was a hole in my heart because I missed my dad and every time somebody talked about their dad, I got really upset.” But she grew more accepting. At age nine, Jade reflected: “When she transitioned, it made her a lot happier ‘cos, when she was a boy, she was really unhappy. Ever since she’s transitioned, she’s come home from work, hugged us, and been really happy. It’s changed a lot since she transitioned.”

Another upset can be rejection of parents by their wider family, so children lose contact with some relatives. Theresa, whose father transitioned when she was six, explained: “People on my mum’s side of the family really struggle with it. Her parents and brothers, and basically everyone over there, cut us off. It made me sad and kind of angry because it’s really no reason to be horrible.”

“When children found out later, as teenagers or adults, they felt more negatively about how they were conceived and their relationship with their parents.”

Children should not have to explain their families

Children may also feel responsible for explaining to the outside world issues such as gender transition. “My problem,” explained Susanna, “has been having to explain to other people constantly because no one really understands.” Josh reported: “Sometimes, random people ask me questions and I have to explain to them. That gets tiring for me.”

Our research has highlighted issues for children born through assisted reproductive technologies, such as egg, sperm, and embryo donation, or surrogacy. Some children as young as two or three years might ask of a single mother by choice: “Do I have a daddy? Where is he?” Some – but by no means all – especially as they get into their teens, are eager to fill a gap in knowledge about themselves by finding out more about their donor, surrogate, and any half-siblings born to the same donor or surrogate.

“It’s important to me now . . . I’m always thinking about what she looks like,” explained Sarah, 14, who was born through egg donation. Alex, 14, conceived by sperm donation, said: “I would like to know who he is . . . quite a lot . . . Recently a lot more than I used to.”

Tell children early about their origins

We have found that it is generally better to start talking to children early about how they were conceived and born. Children who find out later, as teenagers or adults, tend to feel more negatively about how they were conceived and in their relationships with their parents than children who have had the conversation about their beginnings early. Many parents hold off telling their children, fearing that the children will love them less. However, these fears are unfounded because children who are told early tend to be very accepting, often not particularly interested, and unshocked by learning more as they grow older.

The risks of not disclosing this information to children have grown with the advent of ancestry sites offering DNA tests, which can suddenly lead unsuspecting children to discover half-siblings and relatives of whom they had no inkling. Children may find their identities destabilized, and learning about their beginnings in this way can undermine their trust in their parents.

The story of new forms of family is largely good news, of children flourishing, much as we might expect them to do in traditional families, and sometimes doing even better. The composition of their family does not upset them. It is other factors, such as people’s reactions to their family or the lack of information about their origins, that cause them distress. The solutions lie in better understanding, greater societal acceptance of diverse families, swift challenges to prejudice, and openness within families about where their much-wanted children came from.

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