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Jalal MS, Mehdi SZ, Akber JU, Gowa MA, Lifschitz C. Infantile Colic: A Survey of Physicians in Pakistan. Pediatr Gastroenterol Hepatol Nutr 2024; 27:186-195. [PMID: 38818275 PMCID: PMC11134182 DOI: 10.5223/pghn.2024.27.3.186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 09/12/2023] [Accepted: 02/04/2024] [Indexed: 06/01/2024] Open
Abstract
Purpose Infantile colic diagnostic criteria were established by Rome IV. A universally accepted management remains to be established. We aimed to evaluate diagnostic criteria, management strategies, and perceived regional prevalence of infantile colic in Pakistan, as well as its effect on physicians and parents. Methods A questionnaire was distributed amongst 1,256 physicians. Results We received 800 replies. Wessel and Rome IV criteria were used by most physicians for diagnosis; however, the response "any infant who cries a lot" was selected by older physicians (48% of those over 60 years), physicians in rural areas (32%), physicians practicing in private clinics (27%), and general physicians (30%). Estimated prevalence of infantile colic ranges from 21-40%. Reassurance was the most widely recommended management strategy followed by herbal teas (51%), switching to a different formula (49%), probiotics (28%) and antibiotics (26%), discontinuation of breastfeeding (14%), elimination of dairy products from the breastfeeding mothers' diet (6%), and the administration of colic drops (1%). Most physicians considered the negative impact of colic on their personal lives and the parents as mild-to-moderate. Notably, 38% of percent of physicians routinely screened for maternal depression, and 45% of physicians were aware of the association between infantile colic and shaken baby syndrome. Conclusion Most physicians in Pakistan diagnose and manage infantile colic according to the established guidelines. However, the guidelines pertaining to treatment planning are not followed. Educational efforts directed toward general physicians and doctors practicing in rural areas and clinics must be implemented to avoid unnecessary testing and treatment burden.
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Affiliation(s)
- Muhammad Saif Jalal
- Department of Pediatrics, Fatima Hospital, Baqai Medical University, Karachi, Pakistan
| | - Syed Zafar Mehdi
- Department of Pediatrics, Fatima Hospital, Baqai Medical University, Karachi, Pakistan
| | - Jalal Uddin Akber
- Department of Pediatrics, Fatima Hospital, Baqai Medical University, Karachi, Pakistan
| | | | - Carlos Lifschitz
- Section of Pediatric Gastroenterology, Hepatology and Transplantation, Hospital Italiano, Buenos Aires, Argentina
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Alzahrani TH, Anteet AM. Mothers' Awareness Towards Infantile Colic in Saudi Arabia. Cureus 2023; 15:e50364. [PMID: 38213344 PMCID: PMC10782146 DOI: 10.7759/cureus.50364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2023] [Indexed: 01/13/2024] Open
Abstract
Background Infantile colic is defined as severe pain in the abdominal region of a baby primarily due to gastrointestinal implications and is believed to self-resolve with time. Recently established Rome IV criteria of diagnosis state that infantile colic should be diagnosed if there are symptoms like excessive crying, irritability and fussiness. Hence, this study aimed to assess the level of maternal awareness towards infantile colic in Saudi Arabia and to explore the relationship between the level of awareness and different socio-demographic factors like age, gender, nationality, etc. Methodology A cross-sectional study was carried out in Saudi Arabia from February to May 2021. An online self-administered questionnaire via Google Forms was used as the primary data collection tool. The generated link was randomly shared on electronic social media platforms including Facebook, WhatsApp, Telegram, and Twitter. Results A total of 425 participants were finally enrolled in the study. One-third of the participants (n=141, 33.2%) were aged more than 40 years and 399 were married (93.9%). Out of a total of 20 points, the mean score of maternal awareness was found to be 13.6±2.5. One-third of the participants (n=143, 33.6%) thought that rocking or carrying the baby would soothe the colic symptoms. Further, 175 participants (41.2%) used pain-relieving drugs and 7.8% sang lullabies. A total of 346 (81.4%) usually got frustrated/exhausted due to excessive crying sessions of the baby. Additionally, those who had received guidelines, educational programs or awareness sessions about the management of colic symptoms in babies had a significant awareness level (P-value = 0.032), while those who had not received education had poorer awareness. Conclusion Nearly one-third of the participants had good knowledge about infantile colic. More than one-third of the participants had previously received educational programs or awareness sessions about the management of colic symptoms in babies. More than half of the participants stated that postnatal maternal depression can occur as a result of infantile colic thereby psychological conflicts occur regarding the maternal role and inconsistent interaction styles with babies. Age, nationality, and marital status did not have a significant effect on the awareness level of the participants.
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Affiliation(s)
| | - Abeer M Anteet
- Pediatric Gastroenterology, King Khalid University Hospital, Riyadh, SAU
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3
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Chouraqui JP, Brancato S, Delmas B, Hanh T. Effectiveness of a starch thickened infant formula with reduced lactose content, probiotics and prebiotics on quality of life and clinical outcome in infants with regurgitation and/or colic. Front Nutr 2023; 10:1164722. [PMID: 37305080 PMCID: PMC10249472 DOI: 10.3389/fnut.2023.1164722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 05/09/2023] [Indexed: 06/13/2023] Open
Abstract
Background Regurgitation and colic are quite common in young infants, leading to a reduced quality of life (QoL) and to parental distress. Their management is challenging and aims to effectively reassure and relieve symptoms. This study aimed to assess the effectiveness over 30 days of a starch thickened formula with a reduced lactose content, Limosilactobacillus reuteri (Lactobacillus reuteri) DSM 17938 and FOS/GOS. Methods A real-world prospective multicenter experimental study was conducted in a before-after design within subject. Full term infants 0-5 months with regurgitation or colic or both symptoms and without intercurrent illness were included after parental informed consent and received the studied formula. The primary endpoint was the improvement in QoL using the QUALIN infant's questionnaire. Secondary endpoints were the symptoms outcome and the formula tolerance. Results Of the 101 infants included (age: 6.2 ± 4.3 weeks), 33 had regurgitation, 34 colic and 34 had both. At D30, the QoL score was improved in 75% of infants in per protocol analysis (n = 68; +8.2 ± 13.7; p < 0.001), more in those with colic or both symptoms. Meanwhile, in intention to treat analysis (all p < 0.001), the daily number of regurgitations decreased by 61% and the weekly number of days with colic by 63% while the daily cumulative duration of crying decreased by 82 ± 106 mn. These improvements were observed within the first week by 89 and 76% of parents, respectively. Conclusion The study formula associated with reassurance is shown to be quickly effective in the management of infant's regurgitation or/and colic in routine clinical practice. Clinical trial registration https://clinicaltrials.gov/, identifier NCT04462640.
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Affiliation(s)
- Jean-Pierre Chouraqui
- Pediatric Gastroenterology and Nutrition, University Hospital Grenoble-Alpes, La Tronche, France
| | - Sandra Brancato
- Association Française de Pédiatrie Ambulatoire (AFPA), Brignon, France
| | - Berenice Delmas
- Département Médical Nutrition Infantile, Nestlé France, Issy-les-Moulineaux, France
| | - Thierry Hanh
- Département Médical Nutrition Infantile, Nestlé France, Issy-les-Moulineaux, France
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Montazeri R, Hasanpour S, Mirghafourvand M, Gharehbaghi MM, Tehrani MMG, Rezaei SM. The effect of behavioral therapy based counseling with anxious mothers on their infants' colic: a randomized controlled clinical trial. BMC Pediatr 2022; 22:645. [PMID: 36348313 PMCID: PMC9641922 DOI: 10.1186/s12887-022-03683-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 10/19/2022] [Indexed: 11/10/2022] Open
Abstract
Background Given the possible effect of maternal anxiety on the severity of colic pain in infants, this study aimed to investigate the effects of behavioral therapy counseling on infantile colic (primary outcome), maternal anxiety, and mother-infant attachment (secondary outcomes) in anxious mothers with colicky infants. Method This randomized controlled clinical trial was conducted on 46 anxious mothers of 2–6-weeks-old exclusively breastfed colicky infants who had a score of 112 and above according to the Postpartum Specific Anxiety Scale (PSAS), reffered to the pediatric clinics of Al-Zahra, Taleghani and Children Hospitals of Tabriz, Iran. The participants were randomly assigned to the intervention (n = 23) and control (n = 23) groups using randomized block design. Mothers in the intervention group attended 8 systematic desensitization counseling sessions (2–3 sessions per week). Those in the control group received routine care. The researcher completed the Postpartum Specific Anxiety Scale (PSAS), Mother-Infant Attachment Questionnaire (MIAQ), and Infant Colic Scale (ICS) by interviewing the participants before and two weeks after the intervention. Results There was no significant difference between the intervention and control groups in the socio-demographic profile of participants. After the intervention, the mean postpartum anxiety score of women in the intervention group was significantly lower than that of those in the control group (Mean Difference (MD) = 22.5, 95% Confidence Interval (CI) = 2.3 to 42.7; p = 0.029). The mean infant colic score of the infants of mothers in the intervention group was insignificantly lower than that of those in the control group (MD = -2.9, 95% CI = -8.3 to 2.4; p = 0.271). In addition, no significant difference was observed between the two groups in terms of their mean mother-infant attachment scores (MD = -0.04, 95% CI = -3.1 to 0.3; p = 0.976). Conclusion Behavioral therapy counseling effectively reduced postpartum anxiety in women with colicky infants; however, this reduction did not lead to a significant decrease in the infants’ colic pain. Therefore, health care providers are recommended to use this counseling method in combination with other effective counseling approaches to promote mental health of these mothers. Trial Registration IRCT Registration Number: IRCT20111219008459N14, registered on 08/10/2020. https://irct.ir/user/trial/45949/view
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Oral lactase for infantile colic: a randomized double-blind placebo-controlled trial. BMC Pediatr 2022; 22:468. [PMID: 35922776 PMCID: PMC9347088 DOI: 10.1186/s12887-022-03531-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 07/28/2022] [Indexed: 11/15/2022] Open
Abstract
Background Infantile colic is a common problem during the first three months of life. This randomized, double-blind, placebo-controlled trial conducted in an urban hospital in Delhi, India evaluated the efficacy and safety of oral lactase in management of infantile colic. Methods One hundred sixty-two clinically healthy infants aged < 5 months age [mean (SD) = 63.5 (30.5) days] fulfilling the Rome-IV diagnostic criteria for infantile colic were enrolled. Eligible children were randomly allocated to receive 5 drops of lactase (600 FCC units/mL) (n = 80) or placebo (n = 82) mixed with breast milk or formula feed four times a day for a duration of 4 weeks. Primary outcomes were duration of crying or fussing (min/d), and number of days with colic lasting > 3 h/d; secondary outcomes were parental satisfaction and adverse events. Results At the end of four weeks, mean (SD) crying or fussing time (min/d) was significantly shorter in infants receiving lactase in comparison to placebo [89.9 (115.2) vs.178.5 (153.2); P = 0.001]. The mean (SD) number of days with colic was also significantly less in the lactase group as compared to placebo group at the end of the treatment [12.1 (7.8) vs 17.6 (8.4); P < 0.001]. By the end of 4th week, parental satisfaction in terms of infant’s mood, activity, alertness, comfort and oral intake was better in intervention group. The adverse event profile was comparable between two groups. Conclusions Oral lactase treatment in infantile colic results in symptomatic relief in terms of shortening of duration of crying or fussing, and better parental satisfaction. Trial registration Clinical trial registry of India (CTRI/2017/12/010930) registered on 20/12/2017.
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Astó E, Huedo P, Altadill T, Aguiló García M, Sticco M, Perez M, Espadaler-Mazo J. Probiotic Properties of Bifidobacterium longum KABP042 and Pediococcus pentosaceus KABP041 Show Potential to Counteract Functional Gastrointestinal Disorders in an Observational Pilot Trial in Infants. Front Microbiol 2022; 12:741391. [PMID: 35095783 PMCID: PMC8790238 DOI: 10.3389/fmicb.2021.741391] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 12/23/2021] [Indexed: 12/22/2022] Open
Abstract
Functional gastrointestinal disorders (FGIDs) are a common concern during the first year of life. Recognized as gut-brain axis disorders by Rome IV criteria, FGIDs etiology is linked to altered gut-brain interaction, intestinal physiology, and microbiota. In this regard, probiotics have emerged as a promising therapy for infant FGIDs. In this study, we have investigated the probiotic potential of the strains Bifidobacterium longum KABP042 and Pediococcus pentosaceus KABP041-isolated from healthy children's feces-in the treatment of FGIDs. To this scope, genome sequences of both strains were obtained and subjected to in silico analyses. No virulence factors were detected for any strain and only the non-transferable erm(49) gene, which confers resistance to erythromycin and clindamycin, was identified in the genome of B. longum KABP042. Safety of both strains was confirmed by acute oral toxicity in rats. In vitro characterization revealed that the strains tolerate gastric and bile challenges and display a great adhesion capacity to human intestinal cells. The two strains mediate adhesion by different mechanisms and, when combined, synergically induce the expression of Caco-2 tight junction proteins. Moreover, growth inhibition experiments demonstrated the ability of the two strains alone and in combination to antagonize diverse Gram-negative and Gram-positive bacterial pathogens during sessile and planktonic growth. Pathogens' inhibition was mostly mediated by the production of organic acids, but neutralization experiments strongly suggested the presence of additional antimicrobial compounds in probiotic culture supernatants such as the bacteriocin Lantibiotic B, whose gene was detected in the genome of B. longum KABP042. Finally, an exploratory, observational, pilot study involving 36 infants diagnosed with at least one FGID (infant colic and/or functional constipation) showed the probiotic formula was well tolerated and FGID severity was significantly reduced after 14 days of treatment with the 2 strains. Overall, this work provides evidence of the probiotic and synergic properties of strains B. longum KABP042 and P. pentosaceus KABP041, and of their potential to treat pediatric FGIDs. Clinical Trial Registration: [www.ClinicalTrials.gov], [identifier NCT04944628].
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Affiliation(s)
- Erola Astó
- R&D Department, AB-Biotics S.A. (Part of Kaneka Corporation), Barcelona, Spain
- Basic Sciences Department, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Pol Huedo
- R&D Department, AB-Biotics S.A. (Part of Kaneka Corporation), Barcelona, Spain
| | - Tatiana Altadill
- R&D Department, AB-Biotics S.A. (Part of Kaneka Corporation), Barcelona, Spain
- Basic Sciences Department, Universitat Internacional de Catalunya, Barcelona, Spain
| | | | - Maura Sticco
- Pediatric Primary Care Local Health Authority, ASL Caserta, Caserta, Italy
| | - Marta Perez
- R&D Department, AB-Biotics S.A. (Part of Kaneka Corporation), Barcelona, Spain
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Gonçalves-Ferri WA, Pereira-Cellini FM, Coca K, Aragon DC, Nader P, Lyra JC, do Vale MS, Marba S, Araujo K, Dias LA, de Lima Mota Ferreira DM, Nieto G, Anchieta LM, de Cássia Silveira R, de Moura MDR, Tuma Calil VML, Moraes VCC, de Almeida JHCL, Magalhães M, Sonini TCB, Javorsky JB, Ribeiro ÉLA, Ferreira R, de Almeida LDC, Garbers R, da Silva Faria GM, Roosch A, de Mesquita ARA, de Oliveira Pinto RM. The impact of coronavirus outbreak on breastfeeding guidelines among Brazilian hospitals and maternity services: a cross-sectional study. Int Breastfeed J 2021; 16:30. [PMID: 33789708 PMCID: PMC8010275 DOI: 10.1186/s13006-021-00377-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 03/16/2021] [Indexed: 12/23/2022] Open
Abstract
Background The World Health Organization recognizes exclusive breastfeeding a safe source of nutrition available for children in most humanitarian emergencies, as in the current pandemic caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Despite the Brazilian national guideline protecting breastfeeding practices, there are many concerns about protecting infants from their infected mothers. This study aimed to analyze how the Brazilian hospitals and maternity services promote and support mothers suspected or diagnosed with coronavirus disease (COVID-19). Methods This is a descriptive cross-sectional and multicenter study which collected data from 24 Brazilian hospitals and maternity services between March and July 2020. Representatives of the institutions completed a questionnaire based on acts to promote and support breastfeeding, the Baby-Friendly Hospital Initiative, and Brazil’s federal law recommendations. Results The results showed that in delivery rooms, 98.5% of the services prohibited immediate and uninterrupted skin-to-skin contact between mothers and their infants and did not support mothers to initiate breastfeeding in the first hour. On the postnatal ward, 98.5% of the services allowed breastfeeding while implementing respiratory hygiene practices to prevent transmission of COVID-19. Companions for mothers were forbidden in 83.3% of the hospitals. Hospital discharge was mostly between 24 and 28 h (79.1%); discharge guidelines were not individualized. Additionally, a lack of support was noticed from the home environment’s health community network (83.3%). Hospital and home breast pumping were allowed (87.5%), but breast milk donation was not accepted (95.8%). There was a lack of guidance regarding the use of infant comforting strategies. Guidelines specific for vulnerable populations were not covered in the material evaluated. Conclusions In Brazil, hospitals have not followed recommendations to protect, promote, and support breastfeeding during the COVID-19 outbreak. The disagreement between international guidelines has been a major issue. The absence of recommendations on breastfeeding support during the pandemic led to difficulties in developing standards among hospitals in different regions of Brazil and other countries worldwide. The scientific community needs to discuss how to improve maternal and infant care services to protect breastfeeding in the current pandemic.
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Affiliation(s)
| | | | - Kelly Coca
- Department of Pediatrics, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Davi Casale Aragon
- Department of Pediatrics, Ribeirão Preto Medical School- University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Paulo Nader
- Department of Pediatrics, Curso de Medicina da ULBRA, Universidade Luterana do Brasil, Porto Alegre, RS, Brazil
| | - João Cesar Lyra
- Department of Pediatrics, Neonatology Discipline, Faculdade de Medicina do Campus de Botucatu, UNESP, Botucatu, SP, Brazil
| | | | - Sérgio Marba
- Department of Pediatrics, Universidade Estadual de Campinas- UNICAMP, Campinas, SP, Brazil
| | - Katiaci Araujo
- Department of Pediatrics, Hospital Aliança, Salvador, BA, Brazil
| | - Laura Afonso Dias
- Department of Pediatrics, Maternidade Lilia Neves, CEPLIN - Instituto de pediatria e neonatologia ltda, Campus dos Goitazes, RJ, Brazil
| | | | - Gislayne Nieto
- Department of Pediatrics, Hospital e Maternidade Santa Brígida, Curitiba, PR, Brazil
| | - Lêni Marcia Anchieta
- Department of Pediatrics, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Rita de Cássia Silveira
- Department of Pediatrics, Universidade Federal do Rio Grande do Sul, Porto Alegre, RGS, Brazil
| | | | | | | | - João Henrique Carvalho Leme de Almeida
- Department of Pediatrics, Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira - Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
| | - Maurício Magalhães
- Department of Pediatrics, Hospital Central da Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil
| | | | | | - Érica Lobato Acaui Ribeiro
- Department of Pediatrics, Hospital da Clínicas da Faculdade de Medicina de Marília -Unidade Materno Infantil, Marília, SP, Brazil
| | - Rodrigo Ferreira
- Department of Pediatrics, Universidade Do Estado Do Amazonas, Platô do Piquiá, Boca do Acre, AM, Brazil
| | | | - Rosângela Garbers
- Department of Pediatrics, Maternidade Nossa Senhora de Fátima, Curitiba, PR, Brazil
| | | | - Anelise Roosch
- Department of Pediatrics, Ribeirão Preto Medical School- University of São Paulo, Ribeirão Preto, SP, Brazil
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Singh BSK, Danckaerts M, Van den Bergh BRH. Helping Families of Infants With Persistent Crying and Sleep Problems in a Day-Clinic. Front Psychiatry 2021; 12:591389. [PMID: 33716810 PMCID: PMC7952858 DOI: 10.3389/fpsyt.2021.591389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 01/28/2021] [Indexed: 11/13/2022] Open
Abstract
Excessive crying and sleep problems affect up to 30% of infants and often coexist. Although usually benign and self-limiting, persistent crying, and sleep problems exceeding 6 months of age need attention as they may impair the mental health of the infant and its family. The source and the impact of these persistent regulatory problems is often not restricted to the infant, but extends to the parents and the parent-infant relationship. Clinical practice needs interdisciplinary and multi-method interventions focusing beyond regulatory problems of the infant but also on parental self-regulation and parent's co-regulatory responses toward the infant. Treating clinicians may encounter limitations of home-visits, outpatient, and pediatric residential settings when working with families in distress. We describe an infant mental health day-clinic treatment, drawing attention to this viable future direction. It offers a therapeutic climate based on forming a triangle of co-regulation between clinician, parent and infant to first help the parent and the infant settle down. This stress reduction restores parent-infant connectedness and parental learning and reflecting capacity. Clinicians then use established therapeutic modalities to support parental self- and co-regulatory skills which is important for the development of self-regulation in the infant. Experience with this treatment program suggests that a day-clinic setting facilitates interdisciplinary and integrative multi-method intervention, infant and parental stress reduction and integration of parental self- and co-regulatory skills in daily family life, improving overall outcomes. This perspective warrants further investigation.
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Affiliation(s)
- Binu S K Singh
- University of Leuven, University Psychiatric Center, Leuven, Belgium
| | - Marina Danckaerts
- University of Leuven, University Psychiatric Center, Leuven, Belgium.,Faculty of Medicine, University of Leuven, Leuven, Belgium
| | - Bea R H Van den Bergh
- Department for Welfare, Public Health and Family, Flemish Government, Brussels, Belgium.,Health Psychology Research Group, University of Leuven, Leuven, Belgium
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