P0070 - Cuddle-Calm Intervention to Strengthen Emotional Connection

Background: Healthy parent-child emotional connection (EC) enhances child development, reduces parenting stress, and is teachable. This study explored the feasibility and efficacy of a brief primary-care intervention to strengthen EC.

Method: Together with the Nurture Science Program at Columbia, we created brief illustrated booklets titled “CUDDLE” and “CALM,” which are acronyms linked to simple rhyming couplets teaching parents how to strengthen EC and reduce emotional upset. Subjects comprised a convenience sample of mainly low-income parents of 2- to 6- year-olds seen in primary care. A research assistant read the pamphlets aloud to parents while they waited to see the doctor, subjectively judged the parents’ responses, and gave the booklets to the parents. Follow-up surveys 2 weeks after the visit included open-ended questions about the intervention, closed-ended questions about the child’s tantrums and parents’ responses to them, and a validated measure of parenting depression, anxiety, and stress (the DASS-21).

Results: Among 40 caregivers enrolled, 9 (23%) reacted with enthusiasm in the exam room, 31 (78%) showed a neutral to somewhat positive reaction, and 1 had a negative response. Follow-up interviews were completed with 20 parents (50% of those enrolled; unreachable parents did not differ in demographics or initial response). Most (15/20) reported looking at the booklets 4 or more times since the visit. Verbatim responses were generally positive and often specific, e.g. “I'm surprised it worked so well. Jeremy started coming to me every night and asking to talk and read the booklet and even sharing what happened to his friends and how it made him feel.” Parents rated the booklets “very useful” (14/20, or 70%), “somewhat useful” (5/20, 25%), or “not useful” (1/20). The children had on average 1.7 ± 0.9 tantrums per day. Parents who rated the booklets “very useful” (compared to those who rated them “somewhat” or “not” useful) reported significantly lower scores on a composite measure of negative parent responses to tantrums that included behaviors (e.g. yelling or threatening to spank) and emotions (e.g. “I feel mad at my child” or “tantrums take a lot out of me”), with mean score 7.2 v 10.0, p<.05. Scores on the DASS-21 were not different.

Conclusion: This pilot study suggests that brief advice about emotional connection in the form of instructive, accessible, and memorable booklets is well-accepted, and may mitigate the burden of temper tantrums in preschool children and their parents.