Early Literacy Research Library (ELRL) - Article

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

Leung, C.Y.Y., Suskind, D.L. (2020) What Parents Know Matters: Parental Knowledge at Birth Predicts Caregiving Behaviors at 9 Months. The Journal of Pediatrics, 221, 72–80.,

Access: Institutional Access

Publication year


study description


core topic(s)

Early Relational Health , Pediatric Primary Care

Population Characteristics

Poverty/Low-Income , Pregnancy/Postpartum

Exposures, Outcomes, Other

Anticipatory Guidance , Child Behaviors and Skills , Language and Literacy Development , Parent Behaviors and Skills , Parent Knowledge, Attitudes, and Beliefs


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.


Anticipatory Guidance (AG) during WCV.

outcomes evaluated

Parental knowledge and parenting behaviors.


Well-child visits at 10 pediatric clinics predominantly serving families with public assistance in Chicago, Illinois, between June 2016 and February 2018.


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).

sample size

n=173 (participants)


Measure of Basic demographics: primary language, education level, number of children in the home.


Measure of Comprehension-Knowledge (lexical, listening, verbal): two subtests of the Woodcock Johnson IV Tests of oral language, picture vocabulary, oral comprehension.


Measure of Knowledge/Expectations: Scale of Parent/Provider Expectations and Knowledge (SPEAK)


Measure of Caregiving Behaviors: Nursing Child Assessment Satellite Training (NCAST) Teaching Scale.


Measure of Anticipatory Guidance Received: parental report of topics discussed from Recommendations for Preventative Pediatric Health Care by Bright Futures.


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: β = 0.06; B = 0.07; SE = 0.04; 95% CI, 0.007-0.165; early childhood: β = 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.


This study was correlational in design. Future experimental studies are necessary to examine the impact of changing parental knowledge on promoting positive caregiving behaviors among socioeconomically disadvantaged families. Education level was examined as a continuous variable in this study. Further studies might compare parents with different education levels instead. The present findings should be interpreted with caution as they might not be generalized to parents from all SES backgrounds.