Parenting an infant with a birth defect. The regulation of self-esteem

T. Berry Brazelton, MD: a lifetime of contributions from a giant in our field

TOPIC

Dr. T. Berry Brazelton's contributions span over 60 years and have shaped the interdisciplinary field of infant-parent work.

PURPOSE

It is easy to lose sight of the foundational contributions to understandings and perspectives that currently seem universal or inherent. Brazelton's work began in the 1950s when prevailing belief suggested newborns could not see or hear, much less contribute to interactional processes, speak through their behavior, and be equal partners in the development of the parent-child relationship.

CONCLUSIONS

Brazelton's immense contributions are intrinsic to infant, child, and family work, particularly infant mental health, and continue to shape the nature of this interdisciplinary field.

Mothers' adaptation to antenatal diagnosis of surgically correctable anomalies

OBJECTIVE

To assess the applicability of Drotar model when the diagnosis of congenital malformation is made antenatally.

METHODS

In a 3-year period (2000-2003) fifty mothers, counselled for fetal malformations amenable to surgical correction at birth, were interviewed. Statistical associations were sought between each stage of the adaptation process and type of anomaly, gestational age at diagnosis, maternal age, educational background and previous miscarriage. Emotional experience at each stage was studied as dichotomous variables.

RESULTS

Fetuses were affected by the following anomalies: abdominal wall defects (11), intestinal atresia (14) and diaphragmatic hernia (25). All mothers experienced stage one, two and three. No association was found between anger, type of anomaly, maternal age, educational background, and age at diagnosis. On the contrary, such association was statistically significant for previous miscarriage. Thirty-nine mothers reached the adaptation stage while none of them experienced that of reorganization.

CONCLUSION

Despite significant differences, the adaptation process proposed by Drotar to describe parents reactions is applicable in prenatal age.

An interdisciplinary group for parents of children with hemangiomas

Parents are shocked by the unexpected appearance and growth of hemangiomas, the most common benign tumors of childhood, yet parents' psychosocial needs are largely ignored. A psychoeducational/self-help pilot group for parents is described in this article. The Mental Health Inventory and a 44-item questionnaire were used to gather pertinent biopsychosocial data. Parents were more distressed and had less of a sense of well-being than the general population. Medical complications were significantly associated with the couple's distress (P < 0.05). Parental perception of hemangiomal surface area or site was not correlated with parental distress. Therapists clinically assessed parental distress, presented coping strategies for parents and families, and discussed medical information about hemangiomas and normal childhood development.

Autistic disorder and post-traumatic stress disorder

The present case study examined an adolescent boy who initially was evaluated at our clinic and was found to meet DSM-III-R criteria for autistic disorder. After placement in a residential school using Daily Life Therapy for autistic disorder, the subject reported being physically abused by a staff member. Additional psychiatric evaluation revealed post-traumatic stress disorder (PTSD) including symbolic anxiety and repetition of the trauma. The diagnosis of PTSD should be considered in children with autistic disorder and other severe developmental disorders who have experienced physical and sexual abuse. Furthermore, parents, professionals, educators, and child care workers struggle with emotional reactions to children with severe developmental disorders and may have difficulty accepting the reality of the child rather than the fantasy of the "wished-for child." The disappointment of this fantasy and the equating of the child's weaknesses as one's own may lead to personal devaluation and increase the risk of abusive behavior.