To investigate how a high risk for infant neurological impairment affects the quality of infant verbal interactions, and in particular properties of infant-directed speech, spontaneous interactions between 14 mothers and their 4.5-month-old infants at high risk for neurological disorders (7 female) were recorded and acoustically compared with those of 14 dyads with typically developing infants (8 female). Mothers of at-risk infants had proportionally less voicing, and the proportion of voicing decreased with increasing severity of the infants’ long-term outcome. Follow-up analysis based on manual annotation of phonation style revealed breathy phonation as more common toward infants with more severe long-term outcomes (N=7; 44.7% of speech) than controls (N=14; 22.0%; p=0.005) or at-risk infants with typical or mildly abnormal long-term outcomes (N=7; 16.5%; p=0.002). The results indicate that maternal phonation style during early dyadic interactions is affected by the infant’s neurological condition.