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26

FIGURE LEGENDS

Figure 1. The laboratory environment

Figure 2. Smartphone placement: On the side table or floor

Figure 3. Positioning the smartphone for use: Behind the baby, near the head

111.5 (6.7)

AMIS Scale overall score

28.2 (2.8)

20.1 (1.6)

Infant items

Dyadic items

20.0 (19.0–21.5)

27.0 (26.0–30.5)

63.0 (60.5–67.0)

115.0 (105.0–117.0)

20.0 (1.0)

27.3 (2.8)

62.6 (3.9)

109.9 (6.1)

0.5 (0.9)

5.7 (10.8)

0.2 (0.8)

2.7 (9.7)

806.8 (266.8)

Mean (SD)

20.0 (19.5–20.5)

27.0 (26.5–28.5)

63.0 (60.5–65.5)

111.0 (104.5–115.0)

.10 (0–0.9)

3.0 (0–6.5)

0 (0–0)

0 (0–0)

805.0 (569.0–1002.0)

Median (IQR)

Control condition

* p<0.05; ** p<0.01

2) Correlation between the smartphone use and control conditions: Spearman’s rank correlation coefficient

1) Comparison of the smartphone use and control conditions: sign test

.853**

rs2)

1.000

1.000

0.754

0.388

.588*

0.314

.573*

.572*

0.001** 0.217

0.001** 0.077

0.001** 0.463

0.001** 0.463

0.092

p1)

Abbreviations: IQR, Interquartile range; SD, Standard deviation; AMIS, Assessment of Mother-Infant Scale Japanese revised version

63.2 (4.1)

Maternal items

AMIS Subscale scores

19.5 (22.2)

Distracted feeding rate (%)

9.9 (4.3–29.5)

83.0 (37.5–198.5)

170.6 (228.5)

Distracted feeding time (s)

70.0 (20.5–198.5)

8.3 (2.6–31.2)

163.8 (232.1)

Time on smartphone (s)

845.0 (769.5–1062.5)

Median (IQR)

Proportion of time on smartphone (%) 19.5 (8.3)

904.2 (305.8)

Feeding time (s)

Mean (SD)

Smartphone use condition

Table 1. Distracted breastfeeding rates and AMIS scale scores for the smartphone and control conditions

27

10.8 (1.0)

1013.8 (302.6)

0.5 (0.5)

110.5 (7.9)

Infant’s age (weeks)

Feeding time (s)

MIBS-J

AMIS overall score

27.2 (1.6)

20.1 (2.0)

Infant items

Dyadic items

20.0 (18.0–22.3)

26.5 (26.0–28.5)

64.0 (58.3–68.0)

112.5 (102.3–117.3)

0.5 (0–1.0)

881.5 (799.5–1264.0)

10.5 (10.0–12.0)

37.0 (33.8–39.8)

Median (IQR)

20.0 (1.2)

29.1 (3.5)

63.3 (3.6)

112.4 (5.9)

0.7 (0.8)

801.1 (297.3)

15.0 (3.7)

34.9 (4.1)

Mean (SD)

20.0 (19.0–21.0)

27.0 (26.0–33.0)

63.0 (62.0–65.0)

115.0 (107.0–117.0)

1.0 (0–1.0)

840.0 (639.0–961.0)

14.0 (11.0–19.0)

33.0 (32.0–39.0)

Median (IQR)

More extensive use (n=7)

0.945

0.366

0.945

1.000

0.731

0.366

0.022*

0.234

p1)

smartphone during feeding. * p<0.05; ** p<0.01

Mann−Whitney U test. Sample was split into 1) briefer use and 2) more extensive use groups using the median time (70 seconds) spent on a

Assessment of Mother-Infant Scale Japanese revised version. 1) Comparison of briefer and more extensive smartphone use groups:

Abbreviations: IQR, Interquartile range; SD, Standard deviation; MIBS-J, Mother-to-infant Bonding Scale: Japanese version; AMIS,

63.2 (5.0)

Maternal items

AMIS subscale scores

37.0 (3.3)

Mother’s age

Mean (SD)

Briefer use (n=6)

Table 2. Comparison of AMIS scores by length of time on smartphone during breastfeeding

28

11.3 (1.5)

1006.3 (277.0)

0.7 (0.6)

111.4 (7.6)

Infant's age (weeks)

Feeding time (s)

MIBS-J

AMIS overall score

28.1 (3.0)

20.1 (1.9)

Infant items

Dyadic items

20.0 (18.0–22.0)

27.0 (26.0–30.0)

63.0 (59.0–68.0)

117.0 (10.3–117.0)

1.0 (0.0–1.0)

91.08 (803–1164.0)

11.0 (10.0–12.0)

36.0 (33.0–39.0)

Median (IQR)

20.0 (1.3)

28.3 (2.9)

63.3 (3.9)

111.7 (6.1)

0.5 (0.5)

785.0 (317.4)

15.7 (4.0)

35.2 (4.4)

Mean (SD)

19.5 (19.0–21.3)

27.0 (26.0–31.5)

63.5 (60.8–66.0)

113.5 (105.8–117.0)

0.5 (0.0–1.0)

795.0 (562.0–961.0)

15.0 (11.0–19.3)

33.5 (31.8–39.8)

Median (IQR)

Non-simultaneously responsive (n=6)

0.945

0.945

0.945

0.731

0.731

0.181

0.073

0.445

returned their gaze to the child virtually at the same time as soon as the child began bidding for their attention.

Mothers were classified as “simultaneously responsive” based on whether they never took their eyes off the child and, if they did, whether they

1) Comparison of simultaneously responsive and non-simultaneously responsive mothers: Mann-Whitney U test

Assessment of Mother-Infant Scale Japanese revised version

Abbreviations: IQR, Interquartile range; SD, Standard deviation; MIBS-J, Mother-to-infant Bonding Scale: Japanese version; AMIS,

63.1 (4.6)

Maternal items

AMIS subscale scores

36.4 (3.4)

Mother's age

Mean (SD)

Simultaneously responsive (n=7)

Table 3. Comparison of AMIS scores by maternal visual responsiveness

29

e ID

Cas

of

longe

st

insta

nce

during

operation

(For the longest

instance of

continual use)

floor

Side table or

floor

Side table or

ion

was placed

(secs

e use

phon

of

Durat

Where phone

(s)

ne

pho

on

me

Ti

(s)

screen

ome

time/h

ing

Check

Purpose

Phone use purpose/Placement during use

etc. (s)

icles,

email/art

Reading

(s)

etc.

ng,

Texti

[-]

eyes1)

Opene

s1)2)

sound

Made

nts1)2)

moveme

Body

[-]

ct1)

conta

eye

Made

g1)2)

suckin

Stoppe

1)2)

Other

Child's bid for attention during mother's smartphone use

erve

obs

Not

Table 4. Purposes of smartphone use during breastfeeding/mother’s visual response to the child’s bid for attention

us

Simultaneo

us

Simultaneo

Response1)2)

never left the child

Gaze virtually

never left the child

Gaze virtually

logged1)2)

Observation

for her attention

Mother’s visual response to bids

30

near head

Far side of child

waist/buttocks

near

Far side of child

near head

Far side of child

floor

Side table or

them

child, between

Near side of

42

28

22

17

16

70

158

205

49

33

59

32

17

22

99

205

17

16

35

42

ly[-]

Partial

[-]

[-]

Utter

soun

waist/buttocks

38

ed a

11

near

Far side of child

floor

Side table or

child's movements

or vocalizations

Did not respond to

or eye contact

child's movements

Did not respond to

making eye contact

Responded to child

never left the child

Gaze virtually

never left the child

Gaze virtually

vocalizations

child's

Responded to

never left the child

Gaze virtually

simultaneou

Non-

simultaneou

Non-

us

Simultaneo

us

Simultaneo

us

Simultaneo

us

Simultaneo

us

Simultaneo

31

used to hold her

phone, she did not

respond did not

look at the child)

and continued to

avoid the baby's

er

used

to

hold

her

hand. Responded to

movements.

eye contact or body

Did not respond to

moth

simultaneou

Non-

hand the mother

Push

sometimes did not

vocalizations,

the

Sometimes

responded to

movements.

Did not respond to

simultaneou

Non-

pushed away the

hand

Although the child

the

323

child's abdomen

122

80

away

sometimes on

122

403

ed

54

44

child, also

Near side of

near head

Far side of child

32

[-]

[-]

Non-

simultaneou

Non-

791

a distance

47

simultaneou

838

171

child, at a bit of

Far side of

249

13

ed

waist/buttocks

192

Chok

97

near

Far side of child

nursing.

child stopped

Did respond when

body movements.

Did not respond to

child was choking

even when the

vocalizations or

child's eye contact,

Did not respond to

her phone.

simultaneous" refers to lack of response to the child's bids.

*"Simultaneous" responses included both the mother not taking her eyes off the baby and looking at the baby in response to bids for attention when she did look away. "Non-

*"Responded" refers to the mother turning her gaze to the child in response to bids for her attention.

*2㸧Confirmed from tripod camera recorded images.

*1㸧Confirmed from gaze tracker camera data.

their unhappiness

and stopped using

the child voicing

phon

33

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*[-] indicates that the baby's face could not be observed in the recording when the mother was using her phone.

*ࠐ indicates the observation was confirmed.

34

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)LJXUH6PDUWSKRQHSODFHPHQW 2QWKHVLGHWDEOHRUIORRU

35

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