Family reactions to the birth of a child with a congenital abnormality

Child mental health consultation with families of medically compromised infants

Prematurity and birth defects present parents with a crisis for which they have usually had little preparation and no prior education. Both types of early medical complications may represent a state of suspended animation for most parents. Even large premature infants with good prognoses induce anxiety and symbolize potential death and disability, and children with birth defects may portend years of medical procedures and long-term disability. The fear of serious neurologic impairment or mental retardation presents parents with a long period of ambiguity and chronic anxiety. During this period, they must be helpless observers rather than active participants. Recent research has indicated that the active involvement of parents in the care of their premature infants can be helpful in alleviating the guilt and anxiety related to loss and impairment. Similarly, early physical contact between parents and their severely malformed infant is equally critical. Even if the ultimate complexities of early attachment have yet to be delineated fully, this is a worthwhile practice and useful approach in the nursery. Child mental health professionals have important roles to fulfill in helping staff members deal with increased parental participation and directly managing family members with intense distress related to their infants' fragility. The role of the mental health professional in such consultation may cover five related tasks: 1. Understanding the nature of the biologic issues facing the child and integrating that understanding with an evaluation of the child's neurobehavioral profile. 2. Understanding the family's relationship with the child and their overall level of functioning during an acutely stressful time. 3. Developing an appreciation of the place of the child in his or her family and how the parents understand the nature of the medical problems. 4. Forming a collaborative relationship with the pediatricians and other subspecialists who care for the child so that behavioral and psychological interventions are integrated with the child's biomedical care. 5. Fostering a brief, or sometimes long-term, therapeutic relationship with the family or facilitating the family's finding such a relationship with another clinician. There will never be enough child and adolescent psychiatrists and psychologists to treat all families of medically compromised infants. Knowledge of normative responses has advanced to the point at which basic skills can be used by and transmitted to others who can provide basic services. There is much to be learned about the short- and long-term sequelae of such stressful situations on individuals and family systems with preexisting psychopathology. For such families, child mental health professionals are uniquely suited to play a further role in research and treatment.

Weighing the risks and the benefits: a call for the empirical assessment of perceived teratogenic risk

Pregnant women are often faced with complex decisions about whether to undergo medical treatment or continue working in an occupational setting that is permeated with hazardous chemicals. The task for these women is to weigh the benefits of these activities against the potential risks that they may have on the developing embryo. Scientific uncertainty with respect to the teratogenicity of drugs and chemicals in humans leaves health care professionals and their pregnant patients with little predictive information. Cognitive research has shown that it is difficult for people to make complex decisions, particularly when the risks are uncertain. Although the problems inherent in counseling pregnant women regarding teratogenic risk are not new, little time has been devoted to the empiric assessment of how people perceive teratogenic risk and how teratogenic risk information can be best communicated. This article explores the variables that have been found, through psychometric research, to influence people's perception of risk and how cognitive models derived from these studies may be applicable to teratogen information counseling. Understanding the variables that shape the perception of teratogenic risk can help health care professionals improve how they communicate these risks to their patients. Improved teratogenic risk communication will result in better management of pregnancies and reduction of costly litigation that ensues when risks are not properly communicated and understood.

Grief reactions of parental couples: congenital handicap and cot death

This study addresses the grief reaction of parental couples to congenital handicap and cot death. It was thought that the two groups would be similar in their response patterns and follow the sequential stages that are described in the literature on grief and bereavement, but that they would differ in the intensity and duration of their grief. Results indicate that, in the short term, parents who have experienced a sudden infant death have higher levels of unresolved grief and that, overall, mothers experienced greater anxiety and depression than did fathers.

Maternal withdrawal from handicapped toddlers

Videotaped observations of the free-play interaction of mothers and (a) 12 physically handicapped, (b) 14 premature and (c) nine healthy 2-year-olds were evaluated. Mothers of handicapped toddlers were significantly more likely to ignore their children at 24 months than were mothers in other groups. Further, although children's Bayley scores had not differed when seen previously at 1 year, children of mothers who ignored at 2 years had lower concurrent 2-year IQ scores and experienced an average 30-point drop between the two evaluations. These results support clinical reports of maternal withdrawal from handicapped young children and suggest that the mother-child dyad in such cases may be at continuing risk throughout the early years.

How parent attitudes and emotional reactions affect their handicapped child's self-concept

The parents of 24 physically handicapped children were grouped according to their responses to a Primary Mood Factors grid and comparisons were made with their children's responses to a self-concept scale. It was found that parents who were close together in their primary mood reactions had handicapped children who were more positive in self-esteem than those dyads who were divided in their primary mood reaction.

Adult perception of infant appearance: a review

Recent research is reviewed which deals with adult perception of variations in specific features of infant appearance. While there is relative consensus as to the general features which compose the "babyishness" ideal type, there is less work examining the representative variation of these specific features as a function of gestational age or infant population. An important distinction is made between behavioral expressivity and morphological appearance. Research on infant behavioral assessment and social expressiveness is assessed with regard to how well different studies account for the distinct influence of behavioral expressivity and morphological appearance. Several ways of accounting for the functional significance of infant appearance are presented and speculation is given as to the effect of infant appearance on the developing adult-infant relationship.

The birth of a child with Down's syndrome. A medico-social study of thirty-one children and their families

In a study of 31 children with Down's syndrome and their families in the Glasgow area, medico-social help was found to be adequate in dealing with the major physical problems (especially congenital heart disease) of the child, and in providing genetic advice to those families in whom recurrence was a major anxiety.

Help was deficient in catering for the emotional and social needs of many of the families of these children.

It is suggested that these findings reflect the narrow medical concept of Down's syndrome as an isolated pathological entity, and that a major shift of emphasis of medical attention from the child on to the family unit is required to effect changes in the standards of care of such children and their families.