Infants at risk for child abuse

Child abuse is most likely to occur when socially isolated parents react impulsively to aversive stimuli emitted by their children. Certain child signals and characteristics are aversive to adults. Infant cries are aversive to all parents, but children who are unusually irritable or whose cries are especially grating may become aversive to their parents even when they are not crying. Studies show that the cries of premature infants and the cries of babies incorrectly labelled premature are more aversive to parents, and that abusive mothers and the mothers of premature infants find cries more aversive than other mothers do. The incidence of abuse would be reduced by the availability of supportive social networks and the elimination of distorted parental expectations.     

In Hope’s Shadow: Assisted Reproductive Technology and Neonatal Intensive Care

While assisted reproductive technologies (ART) have helped countless men and women become parents there are births that cast a long shadow. This article looks at ART from the little described vantage point of the Neonatal Intensive Care Unit (NICU), where newborn babies struggling to live meet their parents for the first time. Babies conceived through ART where more than one embryo is transferred are more likely to be multiples and multiple births are more frequently premature necessitating a NICU stay that can be long and arduous both for the infant and for the parents, often compounded with uncertain developmental outcomes. The technological salvation promised by ART is contrasted with the life and death realities of the NICU, including the despair, guilt and shame that NICU parents can feel. The complexities of how to counsel these hopeful prospective parents are discussed. Voice is given to the traumatic experience of these parents both in the NICU and then home.     

EFFECTS OF KANGAROO MOTHER CARE ON MATERNAL MOOD AND INTERACTION PATTERNS BETWEEN PARENTS AND THEIR PRETERM,LOW BIRTH WEIGHT INFANTS: A SYSTEMATIC REVIEW

The birth of a premature infant can have adverse effects on the mood of mothers and on the interaction patterns between parents and their preterm babies. The aim of the present systematic review was to examine whether the Kangaroo Mother Care (KMC) intervention can attenuate these adverse psychological effects of a premature birth by ameliorating negative maternal mood and/or promoting more positive interactions between preterm infants and their parents. The results showed that although findings of studies were inconclusive, there is some evidence to suggest that KMC can make a positive difference on these areas. Specifically, it was found that KMC can improve negative maternal mood (e.g., anxiety or depression) and promote more positive parent–child interactions. Limitations and directions for future research are discussed.     

Perceptions of infant boys' behavior and mental health: Relation to infant attachment

Two studies were conducted to determine the impact of infants' attachment classifications and behaviors on naive adults' impressions of their behavior and mental health. In Study 1, three groups of 44 adults viewed a videotape of episode 8 of the Strange Situation for either an avoidant, a resistant, or a secure male infant. After viewing the videotape, they made judgments about aspects of the infant's mental health. Adults viewed the resistant baby as less socially competent and more negative in affect than the other two babies and the secure baby as the least independent of the three babies. Parents rated babies as more intelligent than did nonparents. In Study 2, 15 parents were matched on race and gender with 15 nonparents. All adults viewed a videotape of the reunions of two secure, two avoidant, and two resistant male infants. Avoidant babies were viewed as more socially competent and independent than secure babies and the C2 baby was viewed as the least intelligent, least independent, least socially competent, and most affectively negative of the infants. Results are interpreted as underscoring the need to educate parents and paraprofessionals about the importance of infant distress and physical contact with parents.     

Should Extremely Premature Babies Get Ventilators During the COVID-19 Crisis?

Abstract

In a crisis, societal needs take precedence over a patient’s best interests. Triage guidelines, however, differ on whether limited resources should focus on maximizing lives or life-years. Choosing between these two approaches has implications for neonatology. Neonatal units have ventilators, some adaptable for adults. This raises the question of whether, in crisis conditions, guidelines for treating extremely premature babies should be altered to free-up ventilators. Some adults who need ventilators will have a survival rate higher than some extremely premature babies. But surviving babies will likely live longer, maximizing life-years. Empiric evidence demonstrates that these babies can derive significant survival benefits from ventilation when compared to adults. When “triaging” or choosing between patients, justice demands fair guidelines. Premature babies do not deserve special consideration; they deserve equal consideration. Solidarity is crucial but must consider needs specific to patient populations and avoid biases against people with disabilities and extremely premature babies.     

Responsiveness to babies: Life-situation specific sex differences in adulthood

Responsivity to babies was observed in 96 mature adults representative of three junctures of parenthood: parents of infants, parents of 8-to-9-year-olds, and parents of adolescents. Among the measures used were reactions to an unfamiliar infant in a waiting room, interest in pictures of babies versus other objects, and sex-role concept and attitudinal questionnaires. Stage of family life cycle affected women's responsivity, but not men's. New mothers displayed a heightened generalized interest in babies which is optimally timed and functional in terms of sex-differentiated role requirements. A possible confounding between cohort effects and stage in the family life cycle was examined and rejected. Traditionally sex-typed behaviors were reinterpreted as life-situation specific rather than general traits.This study was supported by grants from NIMH (1 R03 MH28264-01) and from Boys Town Center for the Study of Youth Development, Stanford University. The authors thank Barbara Aschenbrenner for her invaluable assistance in all phases of the research.     

Use of the Brazelton neonatal assessment scale to educate parents of high-risk infants

This article describes how the Brazelton Neonatal Assessment Scale might be used to assist parents in recognizing their infant's cues and capabilities. Infants to whom the scale as administered were high-risk babies requiring care in an intensivecare unit. The scale can be a useful component of an educational program for parents of newborns.     

Do early parental postnatal depression,attachment style and perceived social support affect neurodevelopmental outcomes of premature infants?

BackgroundThe birth of a premature infant is both a stressful event for both parents and associated with an increased rate of postnatal depression (PND). Additionally some mothers may have delayed feelings of attachment to their babies because of the medical procedures or possible medical complications. Social support is known as an important factor for well-being in the postnatal period. However there is scarce data about these factors for fathers. We aimed to identify the impact of parental PND, attachment style and social support on premature infant development considering the prematurity degree and risk groups.MethodsThis prospective study was conducted by including 96 infants who were born preterm. Mothers and fathers were given Edinburgh Postnatal Depression Scale (EPDS), Adult Attachment Style Scale (AASS), and Multidimensional Scale of Perceived Social Support (MSPSS) to fill out when their infants’ corrected age was 3 months. The developmental evaluation was conducted with Bayley III at the corrected 6 months and 18 months of age.ResultsPostnatal depression scores were more in mothers than fathers, the rates of secure attachment and social support were similar between mothers and fathers. Factors associated with the neurodevelopmental outcomes including prematurity degree and risk groups, EPDS, AASS and MSPSS scores were analyzed for both parents. In multivariate analysis, fathers’ depression scores were inversely associated with cognitive development (p = 0.030, R² = 0.080, B=-0.283) and mothers’ anxious/ambivalent attachment style was inversely associated with language development (p = 0.011, R² = 0.108, B=-0.329) at the age of corrected 6 months old.ConclusionsOur findings underscore that the efforts to improve developmental outcomes of premature infants should include parental well-being taking into account new fathers’ depressive symptomatology and maternal anxious/ambivalent attachment.     

The early resumption of employment by mothers: Implications for parent-infant interaction

Home observations of mother-father-infant interaction and mother-infant interaction were contrasted in middle-class families in which the mother was employed or a full-time caregiver. First-born infants and their parents were observed at 3 months. The results indicate that when mother, father, and infant were together parents in the single wage-earner families provided more tactile stimulation to their babies; fathers in single wage-earner families tended to interact more with their infants than did mothers, while in dual wage-earner families mothers tended to interact more than fathers; and fathers in single wage-earner families exceeded fathers in dual wage-earner families in interactions with their infants. By contrast, mothers in the two groups showed very little difference in their interactions with their babies. No significant differences were found for maternal behavior in the three-person observation, and a single behavior differentiated between the groups in the mother-baby observation, with homemaker mothers more often making visual contact with their babies. The implications of these findings are discussed, both with respect to further research, and with regards to the development of children of employed mothers.     

Birth Parents Who Relinquished Babies for Adoption Revisited

The fact that adoption records may be opened by court decree to enable adoptees to have access to identifying information about their birth parents makes it incumbent upon those concerned with adoption practices to study the impact of this on adoptees, adoptive parents, birth parents, and professional practice. This paper reports on research addressed to the attitudes and feelings of birth parents years after they relinquished babies for adoption.     

The breathing bear with preterm infants: Effects on sleep,respiration, and affect

This study investigated the sleep/wake states, respiration, and affective behaviors of premature infants who were provided à “breathing” bear in the isolette from 33 to 35 weeks conceptional age (CA). The Breathing Bear is à source of rhythmic stimulation that is optional for the infants. Its “breathing” reflects the breathing rate of the individual infant. At 33 weeks CA, 27 premature infants were provided à Breathing Bear (BrBr) and 26 were given à Non-Breathing Bear (N-BrBr). At 35 weeks, interfeed observations for an average of 1.7 hours were made of the babies' states and state-specific behaviors, along with respiration recordings. By 35 weeks, the BrBr babies showed less wakefulness, more quiet sleep, fewer startles in quiet sleep, and less crying than the N-BrBr babies. In addition, they were more likely to smile and N-BrBr babies were more likely to grimace in active sleep. These findings replicate and extend previous reports of effects of the Breathing Bear on neurobehavioral organization. They also suggest that less negative affect is expressed by the BrBr babies; and they point to the importance of future study of preterm infants' affective expressions, both in sleep and in waking.     

The risk of low risk: First time motherhood,prematurity and dyadic well-being

Premature birth has a well-documented impact on infants, mothers and their dyadic interactions. First time motherhood in the context of low risk premature birth—relatively unexplored in the literature—is a specific experience that sits at the nexus of premature infancy, motherhood and the processes that underpin dyadic connection. This qualitative study analyzed semistructured interviews with first time mothers of low risk premature babies. Findings were generated in response to research questions concerning mothers’ meaning-making, bonding and identity. Findings demonstrated that maternal meaning-making emerged from a dyadic framework. When mothers or their infants were considered outside of a dyadic context, surplus suffering inadvertently occurred. Findings have important implications for infant mental health practice in medical settings, for postnatal support in the aftermath of premature birth, and for understanding the meaning of risk.     

Abandoned babies -- abandoned issue

Abandoned babies generate enormous interest but very little academic or systematic study. The psychological state of their mothers and consideration of their fathers is not studied and access to these groups are restricted or unavailable. This pilot study grapples with the concepts of abandonment, looks at patterns over time via notifiable criminal record data and explores systematic factors by way of newspaper report analysis. The discourse around abandonment is emotive. More boys are abandoned than girls. Newborn abandonments differ from older babies in that parents are rarely identified and society judges them with sympathy. Finders are emotionally moved, but rarely included in ongoing policy. Some pointers for future policy are drawn.     

The impact of premature childbirth on parental bonding

The development of an affectionate parent-infant bond is essential for a newborn infant's survival and development. However, from evolutionary theory it can be derived that parental bonding is not an automatic process, but dependent on infants' cues to reproductive potential and parents' access to resources. The purpose of the present study was to examine the process of bonding in a sample of Dutch mothers (n = 200) and fathers (n = 193) of full-term (n = 69), moderately premature (n = 68), and very premature infants (n = 63). During the first month postpartum parents completed the Pictorial Representation of Attachment Measure (PRAM) and Postpartum Bonding Questionnaire (PBQ). Longitudinal analyses revealed that mothers' PRAM scores decreased after moderately preterm delivery, whereas decreases in PRAM scores occurred in both parents after very preterm delivery. As lower PRAM scores represent stronger feelings of parent-infant connectedness, our findings suggest a higher degree of bonding after premature childbirth. Results of the PBQ analysis were in line with PRAM outcomes, as parents of preterm infants reported less bonding problems compared to parents of full-terms. These findings support the hypothesis that in affluent countries with adequate resources, bonding in parents of preterm infants on average may be higher than in parents of full-term infants.     

Mothers' responses to the cries of normal and premature infants as a function of the birth status of their own child

Mothers of premature and full-term infants viewed and heard videotapes of premature and full-term infants. The onset of crying by both infants elicited physiological arousal (evident in blood pressure, skin conductance, and heart rate increases) in the adults. The mothers of premature infants responded with especially marked arousal to the infants' cries. These mothers also reported that they were more attentive and alert while the infant was crying. The subjects responded similarly to the cries of full-term and premature infants. Mothers who described their own baby as easy exhibited a lower increase in diastolic blood pressure and heart rate, and reported being more alert, attentive, and willing to interact with the stimulus babies than those whose own baby appeared “difficult.”     

Preimplantation Genetic Diagnosis: Understanding What Parents Plan to Tell Their Children About Their Conception

Over 10,000 babies have been born by PGD and PGS worldwide (Simpson, Prenatal Diagnosis 30(7): 682–695 2010). The experience of parents who have undergone this procedure and their children’s well-being are documented, but no research to date has explored whether parents intend to tell their children how they were conceived and whether this raises special issues for them. PGD practitioners recommend research in this area as parents of children born by PGD increasingly ask questions pertaining to disclosure. We conducted 30 in-depth interviews with couples who have had a baby conceived by PGD. We explored what couples plan to tell their children about how they were conceived, when they plan to do this, and issues they anticipate may arise. The couples had a family history of a monogenic disorder or chromosome rearrangement. Six themes emerged which highlight key issues: (1) To tell or not to tell? (2) Primary reason for undergoing PGD, (3) The ideal time to tell, (4) Situations which may warrant earlier disclosure, (5) Words which parents might choose, and (6) Issues which parents anticipate may arise. We conclude that parents are likely to inform their children about PGD because there is an affected sibling or relative about whom they ask questions, and/or their children are carriers of a condition their parents feel obliged to tell them about. Parents felt they would benefit from access to a genetic counsellor at the time of disclosure and are optimistic about the future of reproductive technology for their children.     

Read your baby: A follow-up intervention program for parents with NICU infants

An intervention model designed to provide education and support to parents of sick or preterm infants throughout their first year of life is described. The intervention focused on helping parents communicate more skillfully with their infant and encouraging parents to maximize their infant's participation in the family system. Seventeen medium-risk infants received intervention; another seventeen served as controls. Independent evaluations of all families at 12 months adjusted age revealed that intervention babies were significantly advanced on Bayley Scales of Infant Development and Mastery Motivation tasks and that their mothers viewed them as easier to care for and less irritable.     

Kangaroo mother care and mother‐premature infant dyadic interaction

The aim of this study was to investigate the psychological impact of Kangaroo Mother Care (KMC) on mother‐infant bonding in cases of premature delivery. Examined variables were mother‐infant relationships, maternal anxiety levels, and infant interactive signals. The KMC method requires that babies be undressed and held upright between their mother's breasts for a minimum of 1 hr a day, from birth until they are discharged from hospital. The present study examined 40 premature infants and their mothers, with 21 dyads experiencing KMC and 19 receiving traditional care (TC). Maternal emotional stress was assessed with the Parent Stress Index‐Short Form questionnaire (Abidin, 1990), and mother‐newborn interactive style was assessed with the Nursing Child Assessment Feeding Scale (Barnard, 1975). Results revealed a better mother‐infant interactive style, a significant decrease in maternal emotional stress, and better infant ability to make requests and respond to parental interactive style in the KMC group.     

Illness perception ratings of high-risk newborns by mothers and clinicians: Relationship to illness severity and maternal stress

Objective: Patients' views of illness are often thought to differ from those of medical staff, although this is rarely assessed. This study examined the correspondence between mothers' and clinicians' perceptions of the same high-risk newborns, as well as with an objective measure of illness severity. We also investigated how mothers' perceptions were related to reported stress. Methods: Mothers of 99 high-risk infants admitted to either a neonatal intensive care or neonatal high dependency unit, which offers specialized but not intensive care, completed illness perception ratings of their baby's condition as well as perceived stress 3 to 5 days following admission. At the same time, a standardized measure of neonatal illness severity was calculated and the baby's primary neonatologist completed illness perceptions ratings. Results: Unlike clinician ratings, mothers' illness perceptions were not significantly correlated with illness severity. Mothers generally rated babies in both units as sicker and having a more serious illness than did neonatologists. Whereas clinicians, compared with mothers, rated babies in intensive care as having an illness that would affect their life more and last for a longer time. Mothers rated medical treatment to be significantly more helpful than did clinicians, particularly for babies admitted to the high dependency unit. Mothers' stress was significantly associated with illness perceptions but unrelated to illness severity. Conclusions: Significant differences exist in the perceptions of illness severity, helpfulness of treatment, and the long-term effects of the baby's illness between parents and clinicians and this may lead to misunderstandings and misinterpretations in communication. (PsycINFO Database Record (c) 2012 APA, all rights reserved).