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However, longitudinal studies on influencing factors and developmental precursors for behavioral problems in VLBW children are still scarce. This study investigates whether difficult infant temperament moderates the association between VLBW and internalizing symptoms, while controlling for family contextual factors. Data from\n                    <jats:italic>N<\/jats:italic>\n                    \u2009=\u2009146 families (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u200975 VLBW and\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u200971 term birth) were derived from the longitudinal HaFEn cohort study in Hamburg, Germany. Mothers reported on infant temperament at 12 months of age, and internalizing problems at 2.0, 4.4, and 8.0 years. Parental depressive symptoms and socioeconomic status (SES) were assessed shortly after birth. The results showed no moderating effect of infant difficultness on the association between VLBW and internalizing problems. However, difficult temperament was associated with higher levels of internalizing problems in both groups. Our findings highlight the relevance of considering infant temperamental predisposition in relation to later behavioral problems in general. Future research should further examine specific factors influencing mental health outcomes in VLBW children, such as parenting or SES.\n                  <\/jats:p>","DOI":"10.1007\/s10578-025-01925-0","type":"journal-article","created":{"date-parts":[[2025,11,20]],"date-time":"2025-11-20T09:43:57Z","timestamp":1763631837000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Does Infant Temperament Moderate the Relationship between Very Low Birth Weight and Behavioral Problems Over Six years?"],"prefix":"10.1007","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0712-6162","authenticated-orcid":false,"given":"Lydia Y.","family":"Li","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Merle","family":"Grabener","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Claus","family":"Barkmann","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dana","family":"Barthel","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nadine","family":"Helle","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carola","family":"Bindt","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,11,20]]},"reference":[{"key":"1925_CR1","unstructured":"WHO. 1 in 10 babies worldwide are born early, with major impacts on health and survival (2023) 05\/02\/2024] ; Available from: https:\/\/www.who.int\/news\/item\/06-10-2023-1-in-10-babies-worldwide-are-born-early--with-major-impacts-on-health-and-survival#:~:text=An%20estimated%2013.4%20million%20babies,UNICEF)%20and%20the%20London%20School"},{"issue":"3","key":"1925_CR2","doi-asserted-by":"publisher","first-page":"230","DOI":"10.1001\/jamapediatrics.2014.3351","volume":"169","author":"PY Ancel","year":"2015","unstructured":"Ancel PY (2015) Survival and morbidity of preterm children born at 22 through 34 weeks\u2019 gestation in France in 2011: results of the EPIPAGE-2 cohort study. 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