Infant-mother interaction as a predictor of child's chronic health problems

Review: Improving access to mental health interventions for children from birth to five years: A Scoping Review

BACKGROUND

In spite of infants and children aged 0-5 years experiencing mental health difficulties being estimated to be in the range of 6%-18% globally, the mental health care needs for this age group are often overlooked in the design of specialist mental health services. Although there is increasing recognition of the importance of infant mental health services and treatments for younger children, access remains a barrier. Mental health services specifically designed for children 0-5 years are vital; however, little is known about how these services ensure access for infants at risk of mental health difficulties and their families. This scoping review seeks to address this knowledge gap.

METHODS

A scoping review methodology framework was used to search for relevant articles published between January 2000 and July 2021, identified using five databases: MEDLINE, CINAHL, PsycINFO, SocIndex and Web of Science. The selection of studies was based on empirical research about access to infant mental health services and models of care. A total of 28 relevant articles met the eligibility criteria for inclusion in this review.

RESULTS

Findings can be summarised under five broad themes: (1) accessibility for at-risk populations (2) the importance of early detection of infants in need of mental health services and interventions; (3) the promotion of culturally responsive services and interventions; (4) ensuring the sustainability of IMH services and programs and (5) the integration of innovative interventions to improve existing practice models.

CONCLUSIONS

The findings from this scoping review highlight barriers to access and provision of infant mental health services. Future infant mental health service design, informed by research, is needed to improve access for infants and young children with mental health difficulties and their families.

Longitudinal assessment of maternal depression and early childhood asthma and wheeze: Effect modification by child sex

BACKGROUND

Studies report associations between maternal mental health and adverse respiratory outcomes in children; however, the impact of timing and duration of maternal distress remains understudied. We sought to longitudinally examine associations between maternal depression and childhood asthma and wheeze, and explore sex differences.

METHODS

Maternal depression (n = 601) was assessed using the Edinburgh Depression Scale questionnaire, dichotomized at a clinically relevant cutoff (>12) (a) during pregnancy, (b) postpartum, and (c) postpartum and subsequent time points postnatally (recurrent depression). Report of wheeze in the past 12 months (current wheeze) and asthma were obtained using the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire at 48 and 72 months. Associations were analyzed using a modified Poisson regression adjusted for covariates, and in interaction models.

RESULTS

Both postpartum and recurrent depression were associated with higher risk of current wheeze (relative risk [RR]: 1.87, 95% confidence interval [CI]: 1.21, 2.90; RR: 2.41, 95% CI: 1.53, 3.79) and asthma at 48 months (RR: 2.42, 95% CI: 1.01, 5.84; RR: 2.45, 95% CI: 1.02, 5.84). In interaction analyses, associations were stronger in females. Recurrent depression was associated with a higher risk of current wheeze at 48 months in females (RR: 4.34, 95% CI: 2.02, 9.32) when compared to males (RR: 1.89, 95% CI: 1.05, 3.39).

CONCLUSIONS

Postpartum and recurrent depression were associated with a higher risk of wheeze and asthma in children. Understanding the temporal- and sex-specific effects of maternal depression may better inform prevention strategies.

Impact of the COVID-19 pandemic on expectant and new parents' experience of pregnancy, childbirth, breast feeding, parental responsiveness and sensitivity, and bonding and attunement in high-income countries: a systematic review of the evidence

OBJECTIVES

To review the evidence on how pregnancy, birth experience, breast feeding, parental responsiveness and sensitivity, and bonding and attunement were impacted by COVID-19.

METHODS

We searched eight literature databases and websites of relevant UK-based organisations. The review focused on evidence during pregnancy and the early years (0-5 years). Studies of any study design published in English from 1 March 2020 to 15 March 2021 and conducted in high-income countries were included. Screening and data extraction were undertaken in duplicate. Evidence was synthesised using a narrative approach. Study quality of included studies was assessed using the Mixed Methods Appraisal Tool.

RESULTS

The search yielded 9776 publications, of which 26 met our inclusion criteria. Significant knowledge gaps on how COVID-19 affected pregnancy and breast feeding limited healthcare providers' ability to provide consistent evidence-based information and care at the start of the pandemic. There was an enduring sense of loss about loved ones being restricted from taking part in key moments. Parents were concerned about the limitations of virtual healthcare provision. Some parents reported more opportunities for responsive breast feeding and improved parent-infant bonding due to reduced social and work pressures. Women from minoritised ethnic groups were less likely to continue breast feeding and attributed this to a lack of face-to-face support.

CONCLUSIONS

The evidence suggests that new and expectant families have been both negatively and positively impacted by the COVID-19 pandemic and the resulting restrictions. The impacts on parents' opportunities to bond with their young children and to be attuned to their needs were felt unequally. It is important that emergency response policies consider the mother and the partner as a family unit when making changes to the delivery of maternal and child health and care services, so as to mitigate the impact on the family and existing health inequalities.

PROSPERO REGISTRATION NUMBER

CRD42021236769.

Understanding links between maternal perinatal posttraumatic stress symptoms and infant socioemotional and physical health

Maternal posttraumatic stress symptoms (PTSS) are associated with adverse consequences for older children, but very few studies have examined links between perinatal maternal PTSS and infant outcomes. Trauma exposure and psychopathology, including PTSS, is often heightened for women during pregnancy through 1 year postpartum. Therefore, the perinatal period may be a critical time for understanding the risk maternal PTSS and other mental health factors pose to the socioemotional and physical health of infants. The present study explored the relation between maternal PTSS and infant socioemotional and physical health problems in a sample of racially and ethnically diverse mother-infant dyads (N = 295) assessed prenatally and at 12 months postpartum. This study also examined whether there are: (1) moderating effects of maternal depressive symptoms and parenting stress on these associations and (2) indirect effects of PTSS on infant outcomes through observed maternal sensitivity. Results indicated that postpartum depressive symptoms and parenting stress, rather than PTSS, were associated with greater infant socioemotional health problems. However, prenatal PTSS were associated with greater infant physical health problems when mothers also reported clinically significant levels of postpartum depressive symptoms. Maternal sensitivity was not associated with maternal PTSS, depressive symptoms, or parenting stress, nor was it related to infant socioemotional and physical health; thus, maternal sensitivity was not tested as an intermediary mechanism linking maternal mental health with infant outcomes. Implications for promoting maternal mental health in the perinatal period to bolster socioemotional and physical health of infants are discussed.

Postpartum Depressive Symptoms as a Mediator Between Intimate Partner Violence During Pregnancy and Maternal-Infant Bonding in Japan

Studies show that experiencing intimate partner violence (IPV) during pregnancy is related to poor maternal-infant bonding. However, the mechanisms underlying this relationship are unclear. This article aims to examine whether maternal postpartum depressive (PPD) symptoms mediate the association between pregnancy IPV and maternal-infant bonding, and whether the relationship differs by maternal-infant bonding subscales-lack of affection, anger/rejection. A survey was conducted among women who participated in a postpartum health check-up program in Aichi prefecture, Japan (N = 6,590) in 2012. We examined whether experiences of emotional and physical IPV were related to maternal-infant bonding and whether PPD symptoms mediated this relationship. Path analysis showed that emotional and physical IPV were associated with PPD symptoms, and PPD symptoms predicted poor bonding. The total effect of emotional IPV on poor bonding was significant, showing a marginally significant direct effect and statistically significant indirect effect. The total effect of physical IPV on poor bonding was not statistically significant. Emotional IPV was significantly associated with both lack of affection and anger/rejection bonding subscales, which were similarly mediated by PPD symptoms. Findings revealed a modest indirect association between IPV, emotional IPV in particular, and poor maternal-infant bonding, which was mediated by PPD symptoms. While prevention of IPV is the ultimate goal, the treatment of PPD symptoms among women who experience IPV during pregnancy may improve maternal-infant bonding and mitigate cross-generational effects of IPV. Identifying opportunities for detection of IPV and PPD symptoms, as well as prevention and early intervention, may improve maternal-infant bonding.

The impact of postpartum depressive symptoms on self-reported infant health and analgesic consumption at the age of 12 months: A prospective cohort study

The infants of mothers with elevated depressive symptoms (EDS) postpartum appear to be at increased risk of somatic health problems during their first 12 months of life in low- and lower-middle-income countries. However, in higher-income countries, knowledge of this association is scarce. We sought to examine whether maternal reports of infant health problems, adherence to vaccination schedules and analgesic supply to the infant during the first 12 months of life differ between mothers with and without postpartum EDS. Altogether, 969 women who were enrolled in the Kuopio Birth Cohort study (www.kubico.fi) during 2012-2017 were included in this investigation. Depressive symptoms were measured with the Edinburgh Postnatal Depression Scale during pregnancy (1st and/or 3rd trimester) and at eight weeks postpartum. Infant health data were collected as a part of a 12-month online follow-up questionnaire for mothers and were based on self-reports of either maternal observations or physician-determined diagnoses. Postpartum EDS were associated with a 2- to 5-fold increased likelihood of abnormal crying and paroxysmal wheezing (based on parental observations), as well as gastroesophageal reflux and food allergy (based on physician-determined diagnoses). Mothers with postpartum EDS also supplied their infants with analgesic medication for longer periods. Adherence to vaccination schedules was similar between the examined groups. In conclusion, infants of mothers with postpartum EDS may be more likely to experience health problems or to be perceived by their mother as having health problems, and thus receive more medications.

Father-infant interactions and infant regional brain volumes: A cross-sectional MRI study

Fathers play a crucial role in their children’s socio-emotional and cognitive development. A plausible intermediate phenotype underlying this association is father’s impact on infant brain. However, research on the association between paternal caregiving and child brain biology is scarce, particularly during infancy. Thus, we used magnetic resonance imaging (MRI) to investigate the relationship between observed father–infant interactions, specifically paternal sensitivity, and regional brain volumes in a community sample of 3-to-6-month-old infants (N = 28). We controlled for maternal sensitivity and examined the moderating role of infant communication on this relationship. T2-weighted MR images were acquired from infants during natural sleep. Higher levels of paternal sensitivity were associated with smaller cerebellar volumes in infants with high communication levels. In contrast, paternal sensitivity was not associated with subcortical grey matter volumes in the whole sample, and this was similar in infants with both high and low communication levels. This preliminary study provides the first evidence for an association between father-child interactions and variation in infant brain anatomy.

Trial of healthy relationship initiatives for the very early years (THRIVE), evaluating Enhanced Triple P for Baby and Mellow Bumps additional social and care needs during pregnancy and their infants who are at higher risk of maltreatment: study protocol for a randomised controlled trial

Background

Growing evidence suggests that experiences in the early years play a major role in children’s development in terms of health, wellbeing and educational attainment. The Trial of healthy relationship initiatives for the very early years (THRIVE) aims to evaluate two antenatal group interventions, Enhanced Triple P for Baby and Mellow Bumps, designed for those with additional health or social care needs in pregnancy. As both interventions aim to improve maternal mental health and parenting skills, we hypothesise that in the longer term, participation may lead to an improvement in children’s life trajectories.

Methods

THRIVE is a three-arm, longitudinal, randomised controlled trial aiming to recruit 500 pregnant women with additional health or social care needs. Participants will be referred by health and social care professionals, predominately midwives. Consenting participants will be block randomised to one of the three arms: Enhanced Triple P for Baby plus care as usual, Mellow Bumps plus care as usual or care as usual. Groups will commence when participants are between 20 and 34 weeks pregnant.

Discussion

The population we aim to recruit are traditionally referred to as “hard to reach”, therefore we will monitor referrals received from maternity and social care pathways and will be open to innovation to boost referral rates. We will set geographically acceptable group locations for participants, to limit challenges we foresee for group participation and retention. We anticipate the results of the trial will help inform policy and practice in supporting women with additional health and social care needs during antenatal and early postnatal periods. This is currently a high priority for the Scottish and UK Governments.

Trial registration

International Standard Randomised Controlled Trials Number (ISRCTN) Registry, ISRCTN:21656568. Registered on 28 February 2014 (registered retrospectively (by 3 months)).

Electronic supplementary material

The online version of this article (10.1186/s13063-019-3571-5) contains supplementary material, which is available to authorized users.

[Body dysmorphic disorder : Diagnostics and treatment in cosmetic dermatology]

People with a body dysmorphic disorder (BDD) suffer from excessive preoccupation and anxiety about an imagined or to others a negligible defect in their appearance. They cannot bear to look at themselves, feel ugly, are convinced that their nose, their physique and their skin are disfiguring. The more concerned they become about their appearance, the more their attention is drawn to the ostensible blemishes and reinforces the impression of their own unattractiveness. Those affected do not consider themselves to be ill, but are convinced that it is a real physical defect which forces them again and again to stand in front of the mirror. Such patients may consult a dermatologist, some even a plastic surgeon, in order to get closer to their ideal of beauty, which perforce remains unattainable for patients because of a distorted perception of their body.

Maternal Distress and Infant Social Withdrawal (ADBB) Following Infant Cardiac Surgery for Congenital Heart Disease

Background:

Mothers and infants are exposed to multiple stresses when cardiac surgery is required for the infant. This study reviewed infant responsiveness using a standardized objective observational measure of social withdrawal and explored its association with measures of maternal distress.

Methods:

Mother–infant pairs involving infants surviving early cardiac surgery were assessed when the infant was aged two months. Infant social withdrawal was measured using the Alarm Distress Baby Scale. Maternal distress was assessed using self-report measures for maternal depression (Edinburgh Postnatal Depression Scale), anxiety (Spielberger State-Trait Anxiety Scale), and parenting stress (Parenting Stress Index–Short Form). Potential associations between infant social withdrawal and maternal distress were evaluated.

Results:

High levels of maternal distress and infant social withdrawal were identified relative to community norms with a positive association. Such an association was not found between infant social withdrawal and the cardiac abnormality and surgery performed.

Conclusion:

The vulnerability of infants requiring cardiac surgery may be better understood when factors beyond their medical condition are considered. The findings suggested an association between maternal distress and infant social withdrawal, which may be consistent with mothers’ distress placing infants subjected to cardiac surgery at substantially increased risk of social withdrawal. However, it is unclear to what extent infant withdrawal may trigger maternal distress and what the interactive effects are. Further research is warranted. Trialing a mother–infant support program may be helpful in alleviating distress and improving the well-being and outcomes for these families.

Maternal depressive symptoms linked to reduced fecal Immunoglobulin A concentrations in infants

Secretory Immunoglobulin A (sIgA) plays a critical role to infant gut mucosal immunity. Delayed IgA production is associated with greater risk of allergic disease. Murine models of stressful events during pregnancy and infancy show alterations in gut immunity and microbial composition in offspring, but little is known about the stress-microbiome-immunity pathways in humans. We investigated differences in infant fecal sIgA concentrations according to the presence of maternal depressive symptoms during and after pregnancy. A subsample of 403 term infants from the Canadian Healthy Infant Longitudinal Development (CHILD) cohort were studied. Their mothers completed the Center of Epidemiologic Studies Depression Scale when enrolled prenatally and again postpartum. Quantified by Immundiagnostik sIgA ELISA kit, sIgA from infant stool was compared across maternal depressive symptom categories using Mann-Whitney U-tests and logistic regression models that controlled for various covariates. Twelve percent of women reported clinically significant depressive symptoms only prenatally, 8.7% had only postpartum symptoms and 9.2% had symptoms both pre and postnatally. Infants born to mothers with pre and postnatal symptoms had significantly lower median sIgA concentrations than those in the reference group (4.4 mg/g feces vs. 6.3 mg/g feces; p = 0.033). The odds for sIgA concentrations in the lowest quartile was threefold higher (95% CI: 1.25-7.55) when mothers had pre and postnatal symptoms, after controlling for breastfeeding status, infant age, antibiotics exposure and other covariates. Postnatal symptoms were not associated with fecal sIgA, independently of breastfeeding status. Infants born to mothers with depressive symptoms appear to have lower fecal sIgA concentrations, predisposing them to higher risk for allergic disease.

Care Through the Newborn's Eyes

Separation of mothers and infants after birth is standard practice for many hospitals, yet not evidence-based. Nonseparation clearly has numerous benefits. However, newborns lack a voice to make choices to direct their course of care. The evidence supports nonseparation strategies for mothers and infants that promote attachment, physiologic regulation, nutrition, sleep, communication, and management of stress/pain. Moreover, the evidence is compelling that nonseparation is essential. The time has come to act on the evidence and begin seeing the care we provide through the newborn's eyes.

Cesarean Birth Regret and Dissatisfaction: A Qualitative Approach

BACKGROUND

The most consistently noted difference between unplanned cesarean and vaginal births is patient dissatisfaction or regret. This has been explored in multiple quantitative studies. However, the causes of this dissatisfaction remain elusive as a result of the limitations of survey instruments that restrict possible choices.

METHODS

Using open-ended, semi-structured interviews (n = 14), the purpose of this study was to identify potentially alterable factors that contribute to cesarean section regret when the surgery is performed during labor. In interviews that took place between 2 and 6 weeks postpartum, patients who had undergone an unscheduled cesarean birth during labor and had volunteered for the study were asked to share the story of their birth. Each participant was prompted to describe her understanding of the indication for her cesarean, and reflect on what felt positive and negative about her experience. Using consensus coding, three investigators independently evaluated the transcribed interviews, identifying recurring themes that were then discussed until consensus on the major themes was achieved.

RESULTS

Four key themes emerged from patients' unplanned cesarean narratives: poor communication, fear of the operating room, distrust of the medical team, and loss of control. Lack of or incomplete trust in care providers was a new factor not previously recognized as a cause of distress or dissatisfaction in the literature to date.

CONCLUSION

The four factors identified in this study are all potentially ameliorable, suggesting that changes in physician behavior may reduce patient dissatisfaction with unplanned cesarean birth.

Impact of maternal prenatal and parental postnatal stress on 1-year-old child development: results from the OTIS antidepressants in pregnancy study

Perinatal psychological stress has been associated with unfavorable maternal and neonatal outcomes. We aimed to assess the impact of perinatal stress on infant development at 1 year of age. We recruited pregnant women calling North American Teratogen Information Services or attending outpatient clinics at CHU Sainte Justine (Montreal) between 2008 and 2010 and their spouses. To be part of our study, women had to be (1) >18 years of age, (2) <15 weeks of gestational age at recruitment, (3) living within 250-km radius of Montreal, and (4) taking antidepressants or non-teratogenic drugs. Stress was assessed using the telephone-administered four-item perceived stress scale during pregnancy in mothers and at 2 months postpartum in both parents. Child development at 1 year of age was evaluated with the Bayley III scales. Socio-demographic and potential confounders were collected through telephone interviews. Multivariable linear regression models were built to assess the association between perinatal parental stress and child development. Overall, 71 couples and their infants were included. When adjusted for potential confounders, maternal prenatal stress was positively associated with motor development (adjusted β = 1.85, CI 95 % (0.01, 3.70)). Postpartum maternal and paternal stresses were negatively associated with motor and socio-emotional development, respectively (adjusted β = -1.54, CI 95 % (-3.07, -0.01) and adjusted β = -1.67, CI 95 % (-3.25, -0.10), respectively). Maternal and paternal postnatal stress seems to be harmful for the motor and socio-emotional development in 1-year-old children. No association was demonstrated between parental stress and cognitive, language, and adaptive behavioral development. However, prenatal maternal stress appears to improve motor skills.

A Norwegian prospective study of preterm mother-infant interactions at 6 and 18 months and the impact of maternal mental health problems, pregnancy and birth complications

OBJECTIVE

Pregnancy, birth and health complications, maternal mental health problems following preterm birth and their possible impact on early mother-infant interaction at 6 and 18 months corrected age (CA) were explored. Predictors of mother-infant interaction at 18 months CA were identified.

DESIGN AND METHODS

This prospective longitudinal and observational study included 33 preterm mother-infant (<33 gestational age (GA)) interactions at 6 and 18 months CA from a socioeconomic low-risk, middle-class sample. The Parent-Child Early Relational Assessment (PCERA) scale was used to assess the mother-infant interaction.

RESULTS

'Bleeding in pregnancy' predicted lower quality in preterm mother-infant interaction in 6 PCERA scales, while high 'maternal trait anxiety' predicted higher interactional quality in 2 PCERA scales and 'family size' predicted lower interactional quality in 1 PCERA scale at 18 months CA. Mothers with symptoms of post-traumatic stress reactions, general psychological distress and anxiety at 2 weeks postpartum (PP) showed significantly better outcome than mothers without symptoms in 6 PCERA subscales at 6 months CA and 2 PCERA subscales at 18 months CA.

CONCLUSIONS

Our study detected a correspondence between early pregnancy complications and lower quality of preterm mother-infant interaction, and an association between high levels of maternal mental health problems and better quality in preterm mother-infant interaction.

Postpartum depression, a direct and mediating risk factor for preschool wheeze in girls

BACKGROUND

Postpartum depression affects over 1 in 10 child-bearing women. A growing body of evidence links maternal distress during the key developmental stages of infants with poor health outcomes, including wheeze and asthma.

OBJECTIVE

We sought to investigate whether postpartum depression had an independent association with the development of wheeze in preschool-aged children. A second a priori objective was to ascertain whether postpartum depression functioned as a mediating factor for associations between wheeze, and prenatal distress and nutrition.

METHODS

Data from the Community Perinatal Care Trial on maternal postpartum depression (Edinburgh Postnatal Depression Scale), the dependent variable, wheeze at age 3, and possible confounding factors were obtained for 791 women and their children in Calgary, Canada. Adjusted gender-specific logistic regression analyses were performed to test the association between postpartum depression and child wheeze, which was independent of maternal distress and vitamin use during pregnancy, pre/postnatal smoking, preterm birth, exclusive breastfeeding duration, daycare attendance, and maternal education. The potential mediating effects of postpartum depression were investigated in a path analysis.

RESULTS

Wheeze at age 3 was almost 5 times more likely in girls of mothers who experienced postpartum depression. Results from a path analysis suggested that postpartum depression has a direct effect on wheeze (beta-coefficient=0.135, P < 0.05), and also mediates the effects of prenatal distress and vitamin use on wheeze in preschool girls. In boys, only prenatal smoking was a statistically significant predictor of wheeze, mainly through the effects of postnatal smoking.

CONCLUSIONS & CLINICAL RELEVANCE

Postpartum depression may be a risk factor for preschool wheeze among girls in a low risk population, directly and indirectly through prenatal distress and vitamin use. Interventions which target postpartum depression and promote a healthy pregnancy may also reduce the risk of wheeze in children.

Socioeconomic Adversity, Negativity in the Parent Child-Relationship, and Physiological Reactivity: An Examination of Pathways and Interactive Processes Affecting Young Children's Physical Health

OBJECTIVE

We tested the hypothesis that socioeconomic status (SES) would predict children's physical health problems at the end of kindergarten among children whose parent reported greater parent-child relationship (PCR) negativity and/or who exhibited greater parasympathetic (RSA) reactivity. We also tested whether RSA and PCR negativity mediated the SES-health association.

METHODS

Data were collected from 338 children (mean [SD] age, 5.32 [.32] years) and their primary caregivers (87% biological mothers) during the fall and subsequent spring of kindergarten. In the fall, parents reported income and education level (SES) and PCR negativity, and RSA reactivity was assessed via a standardized challenge protocol for young children. In the fall and then spring, parents reported children's chronic medical conditions and physical health impairments. Multivariate regression was conducted within a structural equation-modeling framework to test hypotheses.

RESULTS

Significant interactions were found between SES and PCR negativity (b = -0.074, p = .035) and between SES and RSA reactivity (b = 0.169, p = .019) as predicts children's spring health impairment, adjusting for health in the preceding fall. Lower SES was associated with greater health impairment among children whose parents reported more PCR negativity (b = -0.110, p = .024) and children who showed greater RSA reactivity (b = -0.106, p = .011). Socioeconomic status was unrelated to physical health at low PCR negativity or RSA reactivity. Mediation models were not supported.

CONCLUSION

Parent-child relationship quality and individual differences in stress reactivity may modulate the influence of SES on physical health in childhood.

Paternal and Maternal Transition to Parenthood: The Risk of Postpartum Depression and Parenting Stress

Transition to parenthood represents an important life event increasing vulnerability to psychological disorders. Postpartum depression and parenting distress are the most common psychological disturbances and a growing scientific evidence suggests that both mothers and fathers are involved in this developmental crisis. This paper aims to explore maternal and paternal experience of transition to parenthood in terms of parenting distress and risk of postpartum depression. Seventy-five couples of first-time parents were invited to compile the Edinburgh Postnatal Depression Scale and the Parenting Stress Index-Short Form in the first month of children life. Study sample reported very high levels of parenting distress and a risk of postpartum depression in 20.8% of mothers and 5.7% of fathers. No significant correlation between parenting distress and the risk of postpartum depression emerged, both in mothers than in fathers group while maternal distress levels are related to paternal one. The first month after partum represents a critical phase of parents life and it could be considered a developmental crisis characterized by anxiety, stress and mood alterations that could have important repercussions on the child psycho-physical development.

Perinatal stress and food allergy: a preliminary study on maternal reports

Maternal stress in fetal and early life has been associated with the development of respiratory allergies, but no studies exist about food allergy. Stressful events and the quality of caregiving provided, as they affect the emotional and physiologic regulation of the infant, could alter the hypothalamic-pituitary-adrenal and immune system, facilitating an increased allergic response. This study aimed to investigate the influence of perinatal stress, as perceived by mothers, on developing food allergy in childhood. A survey on pregnancy and the first three months after giving birth was submitted to 59 Italian mothers of at least one child suffering from severe food allergy and one completely healthy child, for a total of 118 children examined. The presence of stressful events and the quality of perinatal period for each child were assessed retrospectively. The food allergic children's data were compared to siblings' data through inferential statistics. The results showed a significantly higher number of stressful events occurred during patients' perinatal period, compared to siblings, in particular bereavements in pregnancy and parenting difficulties in postpartum. Mothers reported harder pregnancies and more stressful, harder, and, in general, worse postpartum when referring to their food-allergic children, in comparison with their siblings (p < .05). Psychological aspects are demonstrated to be involved in the development of allergic diseases. This study constitutes the first step to examine the role of early stress and perinatal psychosocial factors in the pathogenesis of food allergy; further studies are necessary to understand individual psychological impact and its relations with genetic and biological factors.

Infant cardiac surgery: mothers tell their story: a therapeutic experience

BACKGROUND

Serious congenital heart disease frequently requires major congenital heart surgery. It causes much distress for parents, which may not always be recognized and treated appropriately.

PATIENTS AND METHODS

As part of a larger study, 26 mothers of two-month-old infants subjected to recent cardiac surgery were interviewed in depth. Each mother was invited to describe her own and what she perceived were her infant's experiences and to comment on the interview process. A systematic content analysis of the interviews was performed using qualitative research methodology.

RESULTS

Almost all participants described acute stress symptoms relating to the diagnosis and the infant's surgery. In addition, most mothers reported that the interview helped them to think about and integrate what had happened to them and their infant, suggesting a probable therapeutic value to the interview.

CONCLUSIONS

A suitably qualified and experienced mental health professional, assisting the mother to tell her story about the diagnosis and her infant's cardiac surgery, may provide a valuable, brief, and very cost-effective therapeutic intervention for these mothers and infants. It has the potential to alleviate maternal distress, with associated gains for the developing mother-infant relationship, reducing infant morbidity, and enhancing the quality of life for both infant and mother.

The maternal adversity, vulnerability and neurodevelopment project: theory and methodology

OBJECTIVE

To describe the theory and methodology of the multi-wave, prospective Maternal Adversity, Vulnerability and Neurodevelopment (MAVAN) study. The goal of MAVAN is to examine the pre- and postnatal influences, and their interaction, in determining individual differences in mental health.

METHOD

MAVAN is a community-based, birth cohort study of pregnant Canadian mothers and their offspring. Dyads are assessed longitudinally, with multiple assessments of both mother and child in home and laboratory across the child's development. Study measures, including assessments of cognitive and emotional function, are described. The study uses a candidate gene approach to examine gene-environment interdependence in specific developmental outcomes. Finally, the study includes measures of both brain-based phenotypes and metabolism to explore comorbidities associated with child obesity. One of the unique features of the MAVAN protocol is the extensive measures of the mother-child interaction. The relation between these measures will be discussed.

RESULTS

Evidence from the MAVAN project shows interesting results about maternal care, families, and child outcomes. In our review, preliminary analyses showing the correlations between measures of maternal care are reported. As predicted, early evidence suggests that maternal care measures are positively correlated, over time.

CONCLUSIONS

This review provides evidence for the feasibility and value of laboratory-based measures embedded within a longitudinal birth cohort study. Though retention of the samples has been a challenge of MAVAN, they are within a comparable range to other studies of this nature. Indeed, the trade-off of somewhat greater participant burden has allowed for a rich database. The results yielded from the MAVAN project will not only describe typical development but also possible targets for intervention. Understanding certain endophenotypes will shed light on the pathogenesis of various mental and physical disorders, as well as their interrelation.

Impact of the environment on asthma control

Asthma is a complex condition that requires individualized interventions. The purpose of this article is to describe the relationship between the physical and social environments with asthma symptoms, present evidence that supports environmental interventions in asthma control and the implications for asthma management. There is evidence that indoor and outdoor allergens relate to asthma morbidity. Knowledge about which environmental exposures present risk is essential because many of these exposures can be modified, reduced, or eliminated. The community health nurse should provide care relative to the client's indoor and outdoor environment and existing allergens.

A new framework for childhood health promotion: the role of policies and programs in building capacity and foundations of early childhood health

Although the connection between early life experiences and later health is becoming increasingly clear, what is needed, now, is a new organizing framework for childhood health promotion, grounded in the latest science. We review the evidence base to identify the steps in the overall pathway to ensuring better health for all children. A key factor in optimizing health in early childhood is building capacities of parents and communities. Although often overlooked, capacities are integral to building the foundations of lifelong health in early childhood. We outline a framework for policymakers and practitioners to guide future decision-making and investments in early childhood health promotion.

The Mother and Baby Interaction Scale: a valid broadband instrument for efficient screening of postpartum interaction? A preliminary validation in a Norwegian community sample

BACKGROUND AND AIMS

The mother-infant relationship may represent a risk or a protective factor for child development. Hence, an early focus on the relationship may be a worthwhile preventive measure. A simple 10-item instrument, the Mother and Baby Interaction Scale, could be a convenient screening instrument for early bonding failure. In this pilot study, preliminary indications of the internal consistency, stability, principal components validity of the Mother and Baby Interaction Scale were investigated.

METHODS

Seventy-six postpartum women participated. The Mother and Baby Interaction Scale and Postpartum Bonding Questionnaire were completed together with the Edinburgh Postnatal Depression Scale. The internal reliability of the Mother and Baby Interaction Scale, and its correlations with the Postpartum Bonding Questionnaire and Edinburgh Postnatal Depression Scale, was examined. Principal component analysis of the Mother and Baby Interaction Scale was conducted, and the emerging subscales were compared with the Postpartum Bonding Questionnaire.

RESULTS

The principal component analysis yielded four subscales: Bonding problems, Worries about caretaking, Regulation and routine and Sensitivity and separation. We found acceptable internal consistency of the Mother and Baby Interaction Scale. The total score of the Mother and Baby Interaction Scale correlated better (r=0.72) with the Postpartum Bonding Questionnaire than the four subscales. The correlation between the total scores of the Edinburgh Postnatal Depression Scale and the Mother And Baby Interaction Scale was r=0.49.

CONCLUSIONS

The total score of the Mother and Baby Interaction Scale is a promising measure for early screening of the quality of the mother-infant relationship and is suitable for general practitioners, midwives and other health workers dealing with postpartum women and their children.

Prevalence of child and adolescent psychiatric disorders in Santiago, Chile: a community epidemiological study

PURPOSE

To determine the prevalence of DSM-IV psychiatric disorders in a representative sample of children and adolescents living in Santiago, Chile, as part of a national sample.

METHOD

Subjects aged 4-18 were selected using a stratified multistage design. First, ten municipalities/comunas of Santiago were selected; then the blocks, homes, and child or adolescent to be interviewed were chosen. Psychology graduate students administered the Spanish-language, computer-assisted version of DISC-IV that estimated DSM-IV 12-month prevalence.

RESULTS

A total of 792 children and adolescents were evaluated, with a participation rate of 76.7%. The most stringent impairment DSM-IV DISC algorithm for psychiatric disorders revealed a prevalence of 25.4% (20.7% for boys and 30.3% for girls). The majority of the diagnoses corresponded to anxiety and affective disorders. Prevalence was higher in children aged 4-11 (31.9%) than in adolescents aged 12-18 (18.2%). This difference was mainly accounted for by disruptive disorders in the younger age group. Anxiety disorders had the highest prevalence, although impairment was low. In contrast, most children and adolescents with affective disorders were impaired.

CONCLUSIONS

In Santiago, the prevalence of psychiatric disorders in children and adolescents was high. This study helps raise awareness of child and adolescent mental health issues in Spanish-speaking Latin America and serves as a basis for improving mental health services.

An overview of prevention of multiple risk behaviour in adolescence and young adulthood

The observed clustering, and shared underlying determinants, of risk behaviours in young people has led to the proposition that interventions should take a broader approach to risk behaviour prevention. In this review we synthesized the evidence on 'what works' to prevent multiple risk behaviour (focusing on tobacco, alcohol and illicit drug use and sexual risk behaviour) for policy-makers, practitioners and academics. We aimed to identify promising intervention programmes and to give a narrative overview of the wider influences on risk behaviour, in order to help inform future intervention strategies and policies. The most promising programme approaches for reducing multiple risk behaviour simultaneously address multiple domains of risk and protective factors predictive of risk behaviour. These programmes seek to increase resilience and promote positive parental/family influences and/or healthy school environments supportive of positive social and emotional development. However, wider influences on risk behaviour, such as culture, media and social climate also need to be addressed through broader social policy change. Furthermore, the importance of positive experiences during transition periods of the child-youth-adult phase of the life course should be appropriately addressed within intervention programmes and broader policy change, to reduce marginalization, social exclusion and the vulnerability of young people during transition periods.

Symptoms of depression during pregnancy are associated with increased systolic blood pressure responses towards infant distress

A mother's response towards her infant's distress is important for the mother-infant relationship and infant development. There is evidence that maternal responses are impaired in depressed mothers. Further understanding of how depression disrupts maternal responses is important to direct treatment strategies. There is evidence that maternal responses develop during pregnancy. Further understanding of the relationship between depression and maternal responses during pregnancy is therefore important. We have previously found that depression during pregnancy is associated with reduced attentional engagement with infant distress but is unclear whether this is an insensitive or avoidance response. In the current study, we investigated the impact of anhedonic symptoms of depression on pregnant women's autonomic response towards infant distress. We found that women experiencing anhedonic depressive symptoms during pregnancy had significantly larger systolic blood pressure responses towards infant distress (β, 1.6 mmHg, 95 % CI 0.5 to 2.6, p = 0.004) than non-depressed pregnant women. These results suggest that anhedonic symptoms during pregnancy may be associated with increased sympathetic sensitivity. This suggests that depression is not, at a sympathetic level at least, associated with insensitivity to infant distress and rather depression may be associated with an abnormally sensitive response.

The association between observed non-verbal maternal responses at 12 months and later infant development at 18 months and IQ at 4 years: a longitudinal study

BACKGROUND

An infant's early environment has an important influence on their development. For example, the sensitivity and warmth of a mother's responses towards her infant is associated with the infant's later socio-emotional development. However, it is less clear whether maternal responses are associated with the infant's later cognitive development.

METHOD

We used data from a large UK cohort study to investigate the association between non-verbal maternal responses and later infant development and IQ. Maternal responses were rated at 12 months during an observed mother-infant interaction. Infant development was assessed using the Griffiths scales at 18 months and IQ at 4 years was assessed using the Wechsler Preschool and Primary Scale of Intelligence (WPPSI). Data on the infant's developmental level at 6 months (prior to the maternal response ratings) was also available. The complete case sample comprised 732 mother-infant pairs.

RESULTS

There was evidence for an association between positive maternal responses and infant development at 18 months. After adjusting for infant developmental level at 6 months and other confounders, we found a difference of 0.25 standard deviations (coef 2.0, 95% CI (0.8-3.2), p=0.002) on the Griffiths scales between infant's whose mothers showed positive compared to neutral non-verbal responses at 12 months. However, an association between positive maternal responses and IQ at 4 years diminished following adjustment for maternal educational attainment.

CONCLUSION

The results provide evidence that positive maternal responses are associated with improved development in infants at 18 months. However, the association between maternal response and IQ at 4 years may be explained by higher educational attainment in mothers who show positive responses. Future studies are needed to explore the influence of maternal responses on different aspects of infant development as well as the role of maternal factors such as education.

Exploring modifiable risk factors for wheezing in African American premature infants

OBJECTIVE

To examine the degree to which obesity during infancy, consistent exposure to secondhand smoke, and parenting (positive attention, maternal involvement, and negative control) were related to early development of wheezing in a cohort of African American premature infants at 2, 6, 12, 18, and 24 months corrected age.

DESIGN

Secondary analysis of a subset of variables from a larger nursing support intervention study.

SETTING

Two regional perinatal centers in the southeastern United States.

PARTICIPANTS

One hundred and sixty-eight African American premature infants (70 boys, 98 girls) who weighed less than 1,750 g or required mechanical ventilation and their mothers.

METHODS

The presence of wheezing was obtained from maternal report at 2, 6, 12, 18, and 24 months. Infants were considered to have medically significant wheezing if they were using bronchodilators or pulmonary anti-inflammatory medications.

RESULTS

The percentage of infants who had medically significant wheezing increased from 12% at 2 months to 24% at 24 months corrected age. Infants who received more positive attention from their mothers had a slightly higher increase in the probability of developing wheezing over time. Infants of mothers who received public assistance had an increased probability of wheezing. Consistent exposure to secondhand smoke, obesity during infancy, maternal negative control, and maternal involvement were not related to the development of wheezing.

CONCLUSION

These findings suggest that the likelihood of developing wheezing in African American premature infants is associated with receiving more positive attention from their mothers and having mothers who receive public assistance. Because modifiable risk factors were not highly related to wheezing, intervention efforts need to focus on early identification and treatment of wheezing and asthma-related symptoms.

Predictors of wheezing in prematurely born children

OBJECTIVE

To examine the degree to which neonatal illness severity, postneonatal health problems, child characteristics, parenting quality as measured by the HOME Inventory, and maternal characteristics are related to the development of wheezing in prematurely born children over the first 27 months after term.

DESIGN

Longitudinal predictive study.

SETTING

Infants were recruited from two neonatal intensive care units, one in southeast and one in Midwest.

PARTICIPANTS

One hundred thirteen preterm infants who weighed less than 1,500 g or required mechanical ventilation and their mothers.

MAIN OUTCOME MEASURES

The presence of wheezing was obtained from maternal report at 2, 6, 9, 13, 18, 22, and 27 months. Wheezing was considered to be medically significant if the child was using bronchodilators or pulmonary antiinflammatory medications.

RESULTS

Sixty-eight percent of the children had wheezing at least one or more ages; 47% of the children were also taking bronchodilators or pulmonary antiinflammatory medications and thus had medically significant wheezing.

CONCLUSION

Postneonatal health problems and the social environment appear to be more important in developing wheezing in prematurely born children than neonatal medical complications.

Children with high and intermediate imperforate anus: remembering and talking about medical treatment carried out early in life

Treatment of children with high and intermediate imperforate anus entails several different surgical procedures during the first 3-12 months of life, which are accompanied by a strict follow-up treatment regimen. It has not been studied whether the children remember this treatment carried out early in life. Research has shown that small children may demonstrate so-called non-verbal memories of salient events occurring in early childhood. The purpose was to examine whether children with imperforate anus showed distressing memories of previous medical treatment and whether parent-child dialog about medical treatment is related to the child's psychosocial functioning later in life. Parents of 25 children (9 boys, 16 girls) with high and intermediate imperforate anus participated in the study. The mean age among the children was 10.5 years (range 8.0-13.6). A comparison group of 30 children (5 boys and 25 girls) with juvenile chronic arthritis also participated in the study. The mean age was 10.6 years (range 7.8-13.6). All parents answered the Child Behavior Checklist (CBCL/4-18) and a study-specific questionnaire. Children in both groups were reported to show distressing memories of early treatment. Children who had been talked to showed good psychosocial function and were in a better mood and less angry than those who had not been talked to. Parent-child discussions about the child's experiences of medical treatment did not seem to be harmful or in any other way detrimental to the child, instead such discussions seemed to facilitate the child's psychosocial functioning.

Continued exposure to maternal distress in early life is associated with an increased risk of childhood asthma

RATIONALE

Evidence is emerging that exposure to maternal distress in early life plays a causal role in the development of childhood asthma.

OBJECTIVES

Because much of the data are from high-risk cohorts, we undertook a birth cohort study in a complete population of children to test this association.

METHODS

Using Manitoba, Canada's, health care and prescription databases, this longitudinal study assessed the association between maternal distress during the first year of life and onward, and asthma at age 7 in a 1995 birth cohort of 13,907 children.

MEASUREMENTS AND MAIN RESULTS

Maternal distress was defined on the basis of health care or prescription medication use for depression or anxiety. Asthma status was derived from health care and prescription records for asthma, using a definition validated by comparison to pediatric allergist diagnosis. Multiple logistic regression was used to determine the likelihood of asthma (odds ratio [OR], 95% confidence interval [95% CI]). Independent of well-known asthma risk factors, our population-based study of a non-high-risk cohort demonstrated an increased risk of childhood asthma (OR, 1.25; 95% CI, 1.01-1.55) among children exposed to continued maternal distress from birth until age 7. Exposure to maternal depression and anxiety limited to the first year of life did not have a demonstrable association with subsequent asthma. Of interest, we observed that the risk of asthma associated with continued maternal distress was increased in children living in high- versus low-income households (OR, 1.44; 95% CI, 1.12-1.85).

CONCLUSIONS

Maternal distress in early life plays a role in the development of childhood asthma, especially if it continues beyond the postpartum period.

Screening for risk factors of relational withdrawal behaviour in infants aged 14-18 months

OBJECTIVES

The objectives of this study were (1) to evaluate the prevalence of relational withdrawal behaviour in infants aged 14-18 months attending a public health centre in Paris, (2) to check some identified risk factors for relational withdrawal behaviour in this population.

METHODS

A cross-sectional study was conducted in infants aged 14-18 months attending a child health screening centre during the year 2005.

RESULTS

A total of 640 children were included in the study. Thirteen percent of the 640 infants (n=83, 95% CI [10.4%; 15.6%]) had an ADBB score at 5 and over 5 on the ADBB. There was a clear relationship between withdrawal behavior and having psychological difficulties as reported by parents, and between withdrawal and developmental delay. Withdrawal was also significantly associated with being a boy, with living in risk conditions (e.g. child being in joint custody, or with living in a foster family), with being adopted, or with being a twin. More withdrawn infants were taken care of at home.

CONCLUSION

Sustained relational withdrawal behaviour was linked with developmental disorders and psychopathology and not with SES, ethnical origin or rank of birth. The scale could be used in screening early psychopathology in infants aged 2-24 months of age.

Detecting infants in need: Are complicated measures really necessary?

The object of this paper was to study how the Baby Alarm Distress Scale (ADBB), developed as a simple screening tool for front line professionals working with infants, correlates with the more detailed assessment method of the Global Rating Scale (GRS) for Mother-Infant Interaction at two and four months. A sample of 127 eight- to eleven-week-old infants was videotaped in free interaction with their mothers, and infant interaction behavior was rated with both methods by independent researchers. Compared to the GRS infant scales the sensitivity of the ADBB, using the recommended cutoff point of 5 or more, was 0.77 and specificity 0.80. In further analyses it was found that deviant ratings of two items of the ADBB, the quality of eye contact between the infant and the caregiver and assessment of the sense of relationship between the infant and the caregiver, were the items most strongly associated with poor interaction skills of the infant on the GRS. Mothers of infants found deviant in the ADBB performed more poorly in the interaction with their infants when compared to mothers of infants found healthy in the ADBB. For the purpose of detecting deviations in infant interaction skills as signs of possible problems in early parent-infant interaction the ADBB seems to be a sufficiently sensitive and specific instrument. However, the results of this study still need to be tested with larger samples and against other observation methods.

Socioeconomic risk, parenting during the preschool years and child health age 6 years

BACKGROUND

Parent child relationships and parenting processes are emerging as potential life course determinants of health. Parenting is socially patterned and could be one of the factors responsible for the negative effects of social inequalities on health, both in childhood and adulthood. This study tests the hypothesis that some of the effect of socioeconomic risk on health in mid childhood is transmitted via early parenting.

METHODS

Prospective cohort study in 10 USA communities involving 1041 mother/child pairs, selected at birth at random with conditional sampling.

EXPOSURES

income, maternal education, maternal age, lone parenthood, ethnic status and objective assessments of mother child interaction in the first 4 years of life covering warmth, negativity and positive control.

OUTCOMES

mother's report of child's health in general at 6 years. Modelling: multiple regression analyses with statistical testing of mediational processes.

RESULTS

All five indicators of socioeconomic status (SES) were correlated with all three measures of parenting, such that low SES was associated with poor parenting. Among the measures of parenting maternal warmth was independently predictive of future health, and among the socioeconomic variables maternal education, partner presence and 'other ethnic group' proved predictive. Measures of parenting significantly mediated the impact of measures of SES on child health.

CONCLUSIONS

Parenting mediates some, but not all of the detectable effects of socioeconomic risk on health in childhood. As part of a package of measures that address other determinants, interventions to support parenting are likely to make a useful contribution to reducing childhood inequalities in health.

Mother's early perception of her infant's difficult temperament, parenting stress and early mother-infant interaction

The current study investigated factors contributing to mother's early perception of her infant's difficult temperament. One hundred and twenty-four mother-infant dyads participated in the study. Mother's perception of the infant's temperament was assessed with the Infant Characteristics Questionnaire (ICQ). The influence of mother-infant interaction, mother's mental health and parenting stress were investigated. Mother-infant interaction was videotaped during a face-to-face interaction and analysed using the Global Rating Scale. Mother's mental health was assessed through a structured interview (Structured Clinical Interview for DSM-IV, SCID) and parenting stress was examined by a questionnaire (Parenting Stress Index). First, the difficulty scale of the ICQ was used as a continuous variable and factors contributing to mother's perception of her infant's temperament as more or less difficult were examined. Secondly, infants were categorized into difficult and non-difficult, and factors increasing the infant's risk of being perceived as difficult were examined. The model including mother's mental health and parental distress accounted for 24% of the variance in perceived infant difficulty, with parental distress in particular being an influential contributor. When infants categorized as difficult were examined, mother's intrusiveness and infant's poor interactive behaviour in early mother-infant interaction as well as parental distress significantly increased the infant's risk of being perceived as difficult.

10-year research update review: the epidemiology of child and adolescent psychiatric disorders: II. Developmental epidemiology

OBJECTIVE

To describe the growth of developmental epidemiology in the past decade and to illustrate it with examples of recent studies.

METHOD

A review of publications on developmental epidemiology in the past 10 years and a discussion of some key examples.

RESULTS

The authors describe how the interaction between developmental psychopathology and psychiatric epidemiology has produced developmental epidemiology, the study of patterns of distribution of psychiatric disorders in time as well as in space. They give two examples of the kinds of questions that developmental epidemiology can help to answer: (1) Is the prevalence of autism increasing? Does the use of vaccines explain the increase? (2) Is there an epidemic of child and adolescent depression? Finally, they describe two areas of science that are beginning to inform developmental epidemiology: molecular genetics and the use of biological measures of stress.

CONCLUSIONS

While child and adolescent psychiatric epidemiology continues, as described in the first of these reviews, to address questions of prevalence and burden, it has also expanded into new areas of research in the past decade. In the next decade, longitudinal epidemiological data sets with their rich descriptive data on psychopathology and environmental risk over time and the potential to add biological measures will provide valuable resources for research into gene-environment correlations and interactions.

Helping children with asthma by repairing maternal-infant bonding problems

Studies about the psychology of childhood asthma have revealed that parenting difficulties are related to the development of asthma in some children. Disruptions in maternal-infant bonding are highly correlated with pediatric asthma and are presented as a cause for these parenting problems. Bonding problems are known to be caused most often by physical separation at birth or by some recent trauma in the mother's life. By using hypnosis to remove the pain of the separation or trauma in the mother, and by creating a new birth history in her imagination, some children's asthmatic symptoms have been shown to remit or greatly improve. The hypnotic method for this treatment is described.

Measuring stress responses in postpartum mothers: perspectives from studies in human and animal populations

Reduced hypothalamic-pituitary-adrenal (HPA) responses to stress during the last week of pregnancy and lactation have been consistently observed in rat studies. Several contributing factors have been proposed for this phenomenon in lactation, including the suckling stimulus from the pups, hormones (oxytocin and prolactin) and opioids, a decrease in the ability of noradrenaline to potentiate hypothalamic responses and changes in pituitary responsiveness to ACTH secretagogues (AVP and CRF). In contrast to this vast literature using the rat model, only few studies have addressed this issue in the human population. The consensus is that women engaging in breastfeeding activities exhibit reduced anxiety, although the reductions in neuroendocrine and autonomic responses to stressors are variable, in part because of the different nature of the stressors used. Further work is required to investigate how additional factors, such as maternal parity or emotional salience of the stressor can affect stress responsiveness in postpartum women. Here, we review first the findings regarding stress responsiveness during lactation in both rat and human studies, and then discuss potential research avenues and methodological issues that could be the lead to future research protocols in human subjects. Knowing the reciprocal relationship in the mother-infant dyad, it is clear that investigation of the mechanisms regulating stress responses and mental health in postpartum mothers can only be beneficial to the development of the infant.