The purpose of this observational study is to describe distress cues and heart rate changes during feeding of infants with congenital heart disease (CHD) and compare them to a group of healthy control infants. Infants with CHD frequently have patterns of physical growth attributed to the CHD which are different from healthy infants. This study will describe the presence of potent negative distress cues and heart rate changes during feeding in infants who are less than 4 months old with significant ventral septal defects with left to right shunting. Unusually frequent potent negative cues may be contributing to the altered growth pattern in these infants. Twenty mother-infant dyads (10 with CHD, 10 controls) will be videotaped during a feeding situation. The infant will be attached to a cardiac monitor with a digital readout of heart and respiratory rate. Using two cameras, the image of the mother-infant and the heart and respiratory rates will be recorded on 3/4"""""""" videotape. This will allow the examination of heart rate changes prior to potent distress cues. The interaction during feeding will also be evaluated using the Nursing Child Assessment Feeding Scale (NCAFS). The NCAFS will allow comparison to a large cohort of healthy infants of the same age. The knowledge generated from this study will be helpful to nurses, physicians, infant mental health specialists and others dealing with infants with CHD. Infants with CHD may present behaviors during feeding which are different from healthy infants. The presence of cueing which is different from cueing found in healthy infants may be contributing to the impaired growth patterns which have previously been attributed totally only to the pathophysiology of the heart defect exclusive of infant behavior. The results of this study will provide directions for future research and they will guide caregivers in teaching parents to better read their infant's cues during feeding, resulting in more normative growth patterns. Repeated measures of analysis of variance will be used to examine heart rate changes preceding distress cues. Simple correlated and descriptive statistics will be used where appropriate.
