Early predictors of attachment in infants with cleft lip and/or palate.

Previous studies have found that children with cleft lip and palate (CLP) and isolated cleft palate (CP) have elevated risk for a variety of psychosocial problems, but the origins of such problems are unclear. We expected that early medical and other stressors during infancy--including feeding problems and facial disfigurement--would have adverse effects on the infant, his or her caregivers, and the family environment, leading to a higher than expected rate of insecure attachments among infants with clefts. Twelve-month attachment classifications of CLP, CP, and comparison group infants were examined. No significant group differences in attachment status were found. When 3-month infant, maternal, and social/family characteristics were examined as potential predictors of insecure attachment, predictors interacted with diagnostic status. For the cleft group, infant and maternal characteristics, but not family characteristics, significantly predicted insecure attachment. For the comparison group, maternal and family characteristics, but not factors associated with the infant, were predictive. Infants with clefts, despite their special needs and caregiving requirements, seem not to have elevated risk for insecure attachments at the end of their first year. Contrary to social-psychological formulations, the facial appearance of infants with CLP had no adverse effect on the quality of their maternal attachment.