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PubMed2006

Autism and developmental delay: a comparative clinical study in very young children using IBSE scale.

OBJECTIVE: This study improves the knowledge of early autistic symptomatology and research concerning (i) the significant differences in the behaviors of children with autistic disorder (AD) and children with a developmental delay (DD), and (ii) the influence of the cognitive delay on symptomatology. METHOD: Two groups of 20 young children (7-42 months) were compared: children with AD, and those with DD. The groups were paired by chronological and developmental age. The comparison was extended to four subgroups composed according to age (younger and older children--<24 months, >24 months) and to the global development quotient (GDQ) (the more and less delayed). Each child was evaluated with the Infant Behavior Summarized Evaluation scale (IBSE). RESULTS: For the younger AD children, significant differences affected social communication and their adaptation to the environment (intolerance to frustration, resistance to change). For the older children (>24 months), this study showed the rapid progression of the number of distinctive signs between AD and DD children according to age and/or developmental level. CONCLUSIONS: Cognitive delay has an important influence on the symptomatology at the moment of initial recognition of an autistic syndrome. This study is a complement for the fuller understanding of the nature and early diagnosis of disorders specific to autism at the earliest phases of development.

Autistic Disorder↗
PubMed2006

Follow-up of twins: health, behaviour, speech, language outcomes and implications for parents.

The introduction of assisted reproduction has resulted in a growing number of multiple births. These infants and their parents experience increased, and sometimes unique, medical and psychological risks when compared to singletons. Rates of maternal morbidity, fetal and infant mortality are increased in multiple pregnancies. Twins have a death rate four times higher than singletons and this figure is six times higher for triplets. The main reason is preterm and very preterm birth in multiples, resulting in low and very low birth weight children. Perinatal mortality and morbidity are also more elevated in monozygotic (MZ) twins as compared to dizygotic (DZ) twins. In addition to an increased risk of mortality, multiples have higher rates of morbidity, specifically cerebral palsy and mental subnormality. Language and speech delays are more pronounced in multiples, as are cognitive delays, motor development, behavioural problems and difficulties in parent-child interactions. Depression among parents of multiples is reported to be higher than those of singletons. This paper aims to critically appraise the literature regarding the aforementioned topics, including a comparison between the outcomes for iatrogenic and spontaneously conceived twins and to suggest areas for further research.

Child↗
PubMed2002

Infant sucking ability, non-organic failure to thrive, maternal characteristics, and feeding practices: a prospective cohort study.

This prospective study examined the relation of neonatal sucking to later feeding, postnatal growth, maternal postpartum depression, and feeding practices. Healthy infants of at least 37 weeks gestational age were recruited. At 1 week of age, a strain-gage device was attached to the infant's cheeks during sucking to identify sucking efficiency. Two-hundred and two infants (100 males, 102 females; mean age 39.6 weeks, SD 1.1 weeks) with efficient sucking and 207 (101 males, 106 females; mean gestational age 39.4 weeks, SD 1.2 weeks) with inefficient sucking were identified. Growth was measured at 2, 6, 10, and 14 months. Mothers completed a feeding questionnaire and the Edinburgh Postnatal Depression Scale at the same testing points. While 18 infants (5%) showed a downward shift in growth, their clinical picture did not present as non-organic failure to thrive (NFTT). Inefficient neonatal sucking did not predict postnatal growth, later feeding difficulties, nor maternal feeding practices, but concurrent inefficient feeding did. Maternal depression did not affect feeding practices, infant feeding abilities, nor growth, suggesting that the importance of maternal postpartum depression in association with feeding may be less than previously assumed. The term NFTT, therefore, merits reexamination and a more focused definition.

Adult↗
PubMed2004

[Social withdrawal behaviour in infant: clinical and research interest].

The social withdrawal behaviour concept is presented, along with its historical background and its links to infant depression. Sustained social withdrawal behaviour in infancy is observed either with attachment disorders, in autism, sensory impairment, intense and chronic pain, or in interaction disorders and as effects of maternal depression on the infant. The alarm distress baby scale (ADBB) is a 8 item-assessment scale. It has been built to help screening early withdrawal behaviour, making use for example of the routine physical examination in a Well Baby clinic. Current clinical and research application and validations of the scale are presented.

Humans↗
PubMed2004

The biological significance of skin-to-skin contact and maternal odours.

UNLABELLED: Infant-mother bodily contact is believed to be the species-typical pattern of immediate postpartum child care. Mothers and newborns engage in mutually beneficial interactions. Maternal odours stimulate breastfeeding activity and are implicated in individual recognition. CONCLUSION: Skin-to-skin contact and exposure to maternal odours facilitate infants' adaptation to the early postnatal environment.

Breast Feeding↗
PubMed1999

Temperament and attachment: one construct or two?

In this chapter we described the constructs of temperament and attachment and have discussed similarities and differences between the two. We addressed the issue of whether temperament contributes to overall attachment security or to the specific type of attachment that children display. We conclude that although temperament may influence the type of secure and insecure attachment relationship children form with their parent, temperament alone will not determine if a child is classified as securely or insecurely attached. We presented evidence suggesting that certain dimensions of temperament, specifically negative emotionality, may be associated with infants' behavior during the Strange Situation, such as proneness-to-distress during separations. However, we noted that these temperament dimensions do not predict overall security of attachment. It is likely that although no single temperament characteristic, such as proneness-to-distress, in and of itself determines overall attachment security, it is possible that a constellation of temperament characteristics may be more strongly related to attachment security. The examination of constellations of temperament characteristics may be particularly useful for furthering our understanding of individual differences within attachment classifications. Such an approach may elucidate the reasons why infants are classified into one subgroup of secure, insecure-avoidant, or insecure-resistant attachment versus another subgroup. Furthermore, we suggest that the collection of findings regarding temperament and attachment not only underscores the importance of a transactional approach to early social-emotional development, but emphasizes that temperament and attachment can make unique and interactive contributions to children's social-emotional functioning. That is, the goodness-of-fit between infant and parent characteristics may best predict security of attachment. Although child characteristics clearly contribute to the development of the parent-child relationship, we believe that the effects of infant temperament on infant-caregiver attachment may well be indirect, and may be moderated by such variables as maternal personality and social support. Thus, taken together, a growing literature clearly indicates that although temperament and attachment security are interrelated, they are by no means interchangeable constructs. To return to our guiding question, "Temperament and attachment: One construct or two?" We reply, "two."

Child↗
PubMed1998

Family dynamics in families with very low birth weight and full-term infants: a pilot study.

The purpose of this pilot study was to determine differences in family health across six dimensions of functioning between families with a very low birth weight infant (VLBW) and families with a full-term infant. An epidemiologic model and Barnhill's (1979) system theory of healthy family dynamics provided the organizing framework for the study. Sixteen families with a VLBW infant and 25 families with a full-term infant were assessed for differences in family health across Barnhill's six dimensions. Independent t-tests showed no significant differences on the five dimensions of infant behavioral style. While a 2 x 3 MANOVA showed no significant differences on any of the measures by family, the Turkey HSD post hoc tests for main effect found significant differences related to the mothers' position within the family, Specifically, the position the mother maintains in the family significantly contributes to certain dimensions of family health.

Adult↗
PubMed2002

Ankyloglossia: assessment, incidence, and effect of frenuloplasty on the breastfeeding dyad.

OBJECTIVE: Ankyloglossia in breastfeeding infants can cause ineffective latch, inadequate milk transfer, and maternal nipple pain, resulting in untimely weaning. The question of whether the performance of a frenuloplasty benefits the breastfeeding dyad in such a situation remains controversial. We wished to 1) define significant ankyloglossia, 2) determine the incidence in breastfeeding infants, and 3) measure the effectiveness of the frenuloplasty procedure with respect to solving specific breastfeeding problems in mother-infant dyads who served as their own controls. METHODS: We examined 2763 breastfeeding inpatient infants and 273 outpatient infants with breastfeeding problems for possible ankyloglossia and assessed each infant with ankyloglossia, using the Hazelbaker Assessment Tool for Lingual Frenulum Function. We then observed each dyad while breastfeeding. When latch problems were seen, we asked the mother to describe the sensation and quality of the suck at the breast. When pain was described, we asked the mother to grade her pain on a scale of 1 to 10. When lingual function was impaired, we discussed the frenuloplasty procedure with the parent(s) and obtained informed consent. After the procedure, the infants were returned to their mothers for breastfeeding. Infant latch and maternal nipple pain were reassessed at this time. RESULTS: Ankyloglossia was diagnosed in 88 (3.2%) of the inpatients and in 35 (12.8%) of the outpatients. Mean Hazelbaker scores were similar for the presenting symptoms of poor latch and nipple pain. Median infant age (25th and 75th percentiles) at presentation was lower for poor latch than for nipple pain: 1.2 days (0.7, 2.0) versus 2.0 days (1.0, 12.0), respectively. All frenuloplasties were performed without incident. Latch improved in all cases, and maternal pain levels fell significantly after the procedure: 6.9 +/- 2.31 down to 1.2 +/- 1.52. CONCLUSION: Ankyloglossia is a relatively common finding in the newborn population and represents a significant proportion of breastfeeding problems. Poor infant latch and maternal nipple pain are frequently associated with this finding. Careful assessment of the lingual function, followed by frenuloplasty when indicated, seems to be a successful approach to the facilitation of breastfeeding in the presence of significant ankyloglossia.

Adult↗
PubMed2006

Feeding-facilitating techniques for the nursing infant with Robin sequence.

OBJECTIVE: To determine the effectiveness of feeding-facilitating techniques in children with Robin sequence. SETTING: Hospital de Reabilitação de Anomalias Craniofaciais, University of São Paulo, Bauru, São Paulo, Brazil. PATIENTS: Twenty-six children less than 2 months of age with Robin sequence, whose only cause of respiratory obstruction was glossoptosis. Thirteen infants were treated by being placed in the prone position (Group 1), and 13 were treated by nasopharyngeal intubation (Group 2). INTERVENTIONS: During hospitalization, the following feeding-facilitating techniques were applied daily to all children: pacifier, massage to relax and anteriorize the tongue, long and soft bottle nipple with original or enlarged hole, global symmetric position, rhythmic movement of the nipple during suction, and insertion of the nipple on the tongue. RESULTS: During the first evaluation, Group 1 patients accepted 36.15 +/- 33.05 mL milk orally within a period of 44.62 +/- 42.94 minutes, whereas Group 2 ingested 20.00 +/- 20.51 mL milk within 30.38 +/- 25.77 minutes. A significant increase (p < .01) in the volume of ingested milk was observed for the two groups at hospital discharge after a mean treatment period of 10.7 days (Group 1: 63.46 +/- 22.58 mL and Group 2: 55.00 +/- 13.07 mL). The mean duration of feeding decreased in the two groups, with a value of 21.54 +/- 7.18 minutes for Group 1 and of 20.28 +/- 8.53 minutes for Group 2. CONCLUSION: The results showed that feeding-facilitating techniques can foster oral feeding in infants with Robin sequence.

Airway Obstruction↗
PubMed2006

Theoretical interfaces in the acute paediatric context: a psychotherapeutic understanding of the application of infant-directed singing.

Psychotherapy literature provides a theoretical understanding of parent-infant attachment. This article will reflect upon the specific need to give thoughtful consideration to those infants admitted to the acute-care setting, such as neonatal and paediatric intensive care units, and the potential for this environment to affect infant development and the parent-infant relationship. Infant-directed singing, as described in this article, is an improvised form of vocal interaction that is specifically informed by an understanding of the musical parameters of pitch, rhythm, phrasing, timbre, register, dynamic, tempo and silence. This article will detail a theoretical understanding of using infant-directed singing to foster parent-infant interaction within the acute care environment. In particular, the potentially sensitive, reciprocal and engaging nature of infant-directed singing, coupled with its ability to promote and support maternal demonstrations of empathy, will be discussed with a view to the psychological and physical development of the hospitalised infant.

Child Development↗
PubMedDate not supplied

[Early signs of autism and family films: a new study by informed evaluators and those unaware of the diagnosis].

Since the initial individualization of infantile autism by Kanner, subsequent work has attempted to define the age at which disorders appear, their symptomatology and their specificity. Initially, retrospective studies based on questionnaires and interviews with parents were conducted in order to determine the age of at which the first signs appeared. Combined with interviews, clinical observations have provided incontestable aid for describing the early signs of autism. The study of home movies taken by parents before their infant's disorders were recognized has led to a new approach to the initials signs of autism. Our study is a continuation of work in our Child Psychiatry Unit under way since 1984. The aim of this work is the symptomatological and comparative analysis of home movies of 14 autistic and 10 normal infants, during the first two years of their life. Each film was scored for the 0-8, 9-17 and 18-24 month periods. Based on the use of the Infant Behavioral Summarized Evaluation (IBSE), this study confirms prior data and also shows the emergence of very early disorders, perceptible within the first few months even by blind evaluators: a docile baby, showing no overt manifestations, not seeking contact, with an absence of pre-language. Even so, the results require caution when interpreting for methodological reasons which are discussed.

Autistic Disorder↗
PubMed1975

[Behavior of the African chevrotain, Hyemoschus aquaticus Ogilby (Artiodactyla, Ruminantia). Its ecological and phylogenetic significance].

The behaviour of the African chevrotain (Hyemoschus aquaticus) was examined in 70 animals living in an enclosure. As far as possible every element of behaviour was seen in relationship to the animal's way of life in the field, and compared with the known behaviour of other Artiodactyla. It was attempted to ascertain the evolutionary stage of every behavioural element. Activity corresponds exactly to the dark period from 18.00 to 6.00. The males are by far more active than the females. An activity period during the night seems to be typical for the more primitive species. The sleeping position is reminiscent of the Suidae, the comfort behaviour of the smaller Artiodactyla. There is no mutual grooming. Hyemoschus aquaticus searches for food with its snout as do the Suidae, and can not rise on its hind legs as can most Artiodactyla. The alarm behavior is the same as in other forest-dwelling ruminants, behaviours of mainly visual importance are missing. Feces and urine are deposited anywhere. Both sexes announce their presence with these excrements, which are mixed with an excrete of the anal (male and female) and preputial glands (male). The interramal gland is occasionally used for marking twigs. Hyemoschus aquaticus does not have a single gland of the ruminant type. Fighting between females is seldom, between males more frequent, but of short duration. No demonstrations of rank order or territorial behaviour were observed. The male finds the female olfactorially. Precopulatory behaviour and copulation are similar to that of the Suidae. Early development and mother-infant behavior can be devided into 5 stages, which are described. Play behaviour of the young is very simple, there is no contact with peers. In its whole behaviour Hyemoschus aquaticus is the prototype of the solitary forest-dweller, more pig than ruminant. The Asian genus Tragulus of the same family is already more a ruminant than Hyemoschus aquaticus; the primitive Cervidae, with the genus Muntiacus, indicate the next level.

Age Factors↗
PubMed1986

Developmental intervention: a pediatric clinical review.

We have attempted to review developmental intervention for pediatricians in a way that is of clinical relevance to primary care pediatricians. In so doing, we chose not to evaluate certain topics such as therapeutic intervention for handicapped children or center-based educational programs because these have been adequately addressed elsewhere. It is clear that pediatricians have a unique and important role to play in developmental intervention for the following reasons: pediatricians have easy and routinely accepted access to infants and families in the prenatal, perinatal, and preschool periods: pediatricians possess a socially accepted role of authority; and pediatricians can integrate understanding of the child's health and developmental status within the context of the family and social environment to make clinical interpretation regarding the child's developmental status and prognosis. Pediatricians are thus in the best position to convince parents of their impact on their child's development. The following general roles have been identified for pediatricians. First, pediatricians should be aware of the child's biologic status and family environmental situation and the relative degree of risk for developmental problems. This clinical awareness, in combination with the use of appropriate screening instruments of the child's development and family environment, will allow clinical judgment regarding the frequency and type of child health supervision, the need for further diagnostic evaluation, and the need for referral to intervention programs and other resources. Second, the pediatrician should develop an approach for developmental intervention for all children, whatever their degree of biological risk. This review of medical, educational, and psychological literature demonstrate the following recurring important themes as goals for primary intervention: Improve parental understanding of normal child development and developmental expectations. Assist parent's understanding of the individual developmental characteristics and temperamental style of their child. Promote parental sensitivity to the social nature of infant behaviors. Encourage parent responsiveness to the social behaviors. Improve parental feelings of confidence and competence to affect their child's development. Pediatricians can be influential in supporting structural changes that can have beneficial effects on children's development. Support of humanization of obstetric and nursery practices, and the increased use of child health supervision to parents in groups are examples of such efforts.(ABSTRACT TRUNCATED AT 400 WORDS)

Child↗
PubMed1998

An optimality score for the neurologic examination of the term newborn.

We describe the application of a revised version of the Dubowitz neurologic examination of the newborn in 224 low-risk, term newborn infants. The method has been updated by eliminating less useful items and including new items evaluating general movements and patterns of distribution of tone. An optimality score is included to make the evaluation more quantitative and for comparison with sequential examinations with neurophysiologic and imaging findings. The score is based on the distribution of the scores for each item in the population of low-risk term infants. We defined not only the most common pattern for each item but also the variability of the findings by using 10th and 5th centiles. Because most of the items assessing tone and the Moro reflex varied with gestational age between 37 and 42 weeks, the changes were incorporated in the scoring system. The total optimality score was the sum of the optimality scores of individual items. Although the association of 4 or more deviant scores was found in less than 10% of our infants, deviant results on 1 or 2 single items could be observed in a third of this normal population, suggesting that isolated deviant signs have little diagnostic value. In contrast, an abnormal distribution of tone patterns, which we have commonly observed in infants with brain lesions, was not found in this cohort.

Arm↗
PubMed1997

Neonatal lithium toxicity as a result of maternal toxicity.

Lithium carbonate is used for the treatment of bipolar disorder. Because of its widespread use, many women of childbearing age are taking lithium carbonate, which belongs to the US FDA Category D. Administration during pregnancy can result in fetal toxicity. A 17-y-old female with pre-eclampsia and a history of manic depression gave birth to an infant at 37-w gestational age. Several hours prior to delivery, the mother had a lithium level of 2.6 mEq/L. The infant's initial lithium level after birth was 2.1 mEq/L. A subsequent lithium level on the 3rd d of the child's life was 1.4 mEq/L; the half-life in the infant was > 24 h. During the first 4 d of life, the infant was lethargic and exhibited poor suck-swallow coordination that required supplemental enteral feeding. By the 7th d of life, the infant was alert and tolerating all oral feedings. Lithium carbonate readily crosses the placental barrier and can produce teratogenic effects and toxicity. Neonates exposed in utero should be carefully monitored for symptoms of toxicity. In this case only minor toxic effects occurred.

Adolescent↗
PubMed1997

Parent stress and coping in NICU and PICU.

The purpose of this study was to identify and compare parental perceptions of their stress and coping experiences with children in pediatric intensive care units (PICU) and the neonatal intensive care units (NICU). The sample consisted of 31 NICU and 20 PICU parents. Parents in both units experienced the most stress from alteration in their parenting role and in their infants' behavior and appearance. Parents of children in PICU found assistance with parenting role more helpful than parents of children in NICU. Parents with children in the PICU perceived problems-focused coping more helpful than parents with children in the NICU; parents of children in NICU found emotion-focused coping more helpful than parents of children in PICU. Parents in both units considered problem-focused coping more helpful than appraisal- or emotion-focused coping.

Adaptation, Psychological↗
PubMed2000

Socio-demographic associations with digit and pacifier sucking at 15 months of age and possible associations with infant infection. The ALSPAC Study Team. Avon Longitudinal Study of Pregnancy and Childhood.

AIMS: To assess the prevalence of pacifier and digit sucking at 15 months of age and to investigate whether this habit adversely affects the health of 18 month old infants. STUDY DESIGN: Data collected via self-completion questionnaires from mothers forming part of the prospective, population based Avon Longitudinal Study of Pregnancy and Childhood. SUBJECTS AND METHODS: The mothers of 10006 infants gave information on their child's use of a pacifier and of digit sucking at 15 months of age and the presence of specific health symptoms at 18 months of age. Adjusted logistic regression was performed to identify any statistically significant associations between pacifier use, digit sucking or a combination of the two with possible infection. RESULTS: 36.3% of infants sucked a pacifier, 21. 3% their thumb or finger and 2.7% sucked both at 15 months. Statistically significant differences were observed among various socio-demographic variables. Mothers were more likely to give their child a pacifier if they were younger, had lower levels of education, experienced greater financial difficulties or lived in council housing (compared to owned/mortgaged). The opposite was apparent for digit suckers. After allowing for these possible confounding factors, pacifier users had a higher incidence of earache and colic compared to children with no sucking habit, however digit suckers had a lower incidence of these symptoms. Children who sucked both were significantly more likely to have reported wheezing, earache, and poor health in the past month. CONCLUSIONS: Significantly different sociodemographic characteristics were observed with pacifier suckers compared to those who sucked their thumb or finger. It is almost impossible to attribute the direction of causality between infection and a sucking habit. Further and more detailed studies are needed before any recommendations can be made based on the statistically significant associations found as they are unlikely to be of major clinical significance.

Adult↗