Two siblings with recurrent cardiorespiratory arrest: Munchausen syndrome by proxy or child abuse?

The terms "Munchausen syndrome by proxy" or "Polle syndrome" have been used to describe children who are victims of parentally induced or fabricated illness. This report gives case histories of two siblings (a 7-month-old girl and a 4-year-old boy) with recurrent episodes of cardiorespiratory arrest that were induced by a mother who skillfully resuscitated the children and who demonstrated model parental behavior. Polygraphic monitoring with hidden camera was used to determine that the episodes of cardiorespiratory arrest were parentally induced in the infant. The 4-year-old sibling had previously undergone multiple diagnostic and surgical procedures. After the diagnosis was made in the infant, and the mother was no longer permitted to be alone with the children, neither child had further episodes. A psychologic profile of the mother is presented, and special features of these two and other cases in the literature are reviewed. These cases represent a form of child abuse. A parentally induced illness should be considered in the differential diagnosis of unusual illnesses with bizarre features, even when the parent's behavior appears exemplary.     

The nature of the mother's absence and the infant's response to brief separations.

During a brief play period away from the mother, the responses of 40 10-mo-old infants were observed as a function of 2 factors: first, whether the mother or the infant initiated the separation and, second, whether the mother was visible during the separation. When the mother was visible in another room the infant was content to stay and play longer than when she was out of sight. Whether the infant left the mother or was left by her had no effects. In all conditions, distress away from the mother was rare. Results show that separation distress is not inevitable and suggest that manipulations of separation situations may elucidate the interplay between exploratory and attachment responses. (20 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Nongenetic induction of acquired levels of aggression.

Proposes the empirical hypothesis, supported by a review of primarily primate laboratory research, that there is some direct mechanism for the nongenetic transmission of acquired levels of aggression from mother to offspring. When aggression levels of the mother are experimentally altered, the aggression levels experienced during maternal dependency over a wide range of conditions are positively related to subsequent aggression levels of offspring. This behavior cannot be attributed to simple genetic mechanisms of inheritance of aggressiveness and is in conflict with many learning–conditioning explanations. This mechanism, rather than leading to the production of a fearful and nonaggressive individual when that individual is subjected to high levels of maternal abuse, results in the production of an individual with aggression levels related to those experienced during the period of maternal dependency. It would be advantageous to possess a mechanism whereby an infant would automatically copy or internalize behavioral characteristics or modifications shown by the mother. (4 p ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Intimate partner violence moderates the association between mother–infant adrenocortical activity across an emotional challenge.

This study examined the relationship between mother and infant adrenocortical levels and reactivity to an emotion eliciting task. The impact of intimate partner violence (IPV) on these relationships was assessed as a moderator. The sample (n = 702 mother–infant dyads) was racially diverse and from predominantly low-income, rural communities. During a home visit, the dyad’s saliva was sampled before, 20 min, and 40 min after standardized tasks designed to elicit the infant’s emotional arousal and later assayed for cortisol. Mothers completed self-report measures of their partner’s violence, and parenting behaviors were assessed via structured interview and mother–child interactions. In response to the task, infants had positive, and mothers had negative, cortisol slopes. Contrary to expectations, there were no IPV-related differences in mean pretask cortisol levels or reactivity in the mothers or infants. Mother–infant dyads from households characterized by either (1) violence or (2) restrictive and punitive parenting behaviors exhibited correlated cortisol reactivity measured in response to the infant challenge task. The findings suggest that social contextual features of the early caregiving environment may influence individual differences in the coordination between maternal and infant adrenocortical reactivity. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Infant–mother attachment and children's friendship quality: Maternal mental-state talk as an intervening mechanism.

Utilizing data from the Eunice Kennedy Shriver National Institute of Child Health and Human Development's Study of Early Child Care and Youth Development, we investigated mothers' talk about mental states during play with their 24-month-old children as a mechanism though which infant–mother attachment was associated with children's later friendship quality. A series of repeated measures analyses of covariance indicated that a secure versus avoidant or disorganized infant–mother attachment was associated with more maternal talk about cognitions (but not emotions or desires) at 24 months. Latent growth curve models tested within a structural equation modeling framework revealed indirect effects of infant–mother attachment on observed and mother-reported positive friendship interaction at 54 months and decreases in mother-reported negative friendship interaction from 54 months to 1st grade via maternal cognitive talk at 24 months. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Reconciliation and healing for mothers through skin-to-skin contact provided in an American tertiary level intensive care nursery

Feasibility and safety of skin-to-skin contact through the Kangaroo method of care in a modern American tertiary intensive care was studied, as well as effects of this innovative care on mother's emotional reactions. Eight mother infant dyads participated in skin-to-skin contact a minimum of 4 hours each day for six days per week during a period of three consecutive weeks. The cognitive adaptation framework was used to identify themes in maternal responses. During the first week, mothers were preoccupied with childbirth events in attempts to understand their sense of loss and victimization. During the second week, maternal emotions intensified and manifested in fears for the baby's well-being and a need to discuss negative and positive emotional reactions to having a premature and sick baby. All mothers requested respite time from skin-to-skin contact, so they could deal with their emotional crises. By the third week, mothers had an increased sense of meaning, mastery, and self-esteem about what had happened to themselves and their infants. Themes of reconciliation and healing occurred when mothers placed their infant skin-to-skin in the Kangaroo position over the three consecutive weeks that this type of nursing care was experienced.     

A case of vertical transmission of hepatitis A virus infection

We present a case of hepatitis A infection in a 2.5-month-old male who became icteric after 18 d of birth. The diagnosis of hepatitis A was made by compatible clinical symptoms, laboratory results and liver biopsy showing evidence of hepatitis, and confirmed by detection of anti-HAV IgM antibodies. Because the mother had an acute icteric hepatitis A 1 week before delivery, and the viraemic phase of hepatitis A infection is very short, approximately 7 d, we suggest that the infant was infected by his mother, before birth.     

The nature of love.

Infant monkeys were reared with the aid of a laboratory constructed mother-substitute. "We produced a perfectly proportioned streamlined body stripped of unnecessary bulges and appendices. Redundancy in the surrogate mother's system was avoided by reducing the number of breasts from two to one and placing this unibreast in an upper-thoracic, sagittal position, thus maximizing the natural and known perceptual-motor capabilities of the infant operator. The surrogate was made from a block of wood, covered with sponge rubber, and sheathed in tan cotton terry cloth. A light bulb behind her radiated heat. The result was a mother, soft, warm, and tender, a mother with infinite patience, a mother available twenty-four hours a day, a mother that never scolded her infant and never struck or bit her baby in anger." The data obtained "make it obvious that contact comfort is a variable of overwhelming importance in the development of affectional responses, whereas lactation is a variable of negligible importance." It is suggested that the primary function of nursing "is that of insuring frequent and intimate body contact of infant with mother." (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Infant-mother recognition in a social rodent (octodon degus).

Octodon degus (degu), a biparental species with precocious offspring is a potential model for the study of social attachment and related affective disorders such as depression. This study investigates the nature of the social bond between young degus and their mothers with a special emphasis on infant-mother recognition. We tested young degus in a potentiation paradigm to determine if social contact, particularly with the mother, can modulate an infant's vocal response to isolation. One week later, animals were presented with a choice between their mother and an unfamiliar female or a sample of familiar and unfamiliar nesting materials. Subsequently, the ability of whole litters to discriminate between their mother and unfamiliar females was tested. We observed that infant degus alter their isolation response after brief social contact. Degu infants readily distinguish between familiar and unfamiliar nesting materials but fail to differentiate between their mother and unfamiliar females in an identical setting. Nevertheless, entire litters show a preference for their mothers when tested similarly in a group, demonstrating a perhaps socially facilitated ability to recognize the biological mother at an early age. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Maternal identification from skeletal remains of an infant kept by the alleged mother for 16 years with DNA typing

This is a case study concerning maternal identification by DNA typing at various loci. An infant skeleton was found in the alleged mother's apartment after it was kept for 16 years. We obtained the skeletal remains as well as saliva stains from the alleged mother. DNA typing was conducted for three loci in the HLA class II region (HLA-DQA1, -DPB1, and DRB1), five loci with the AmpliType PM kit (LDLR, GYPA, HBGG, D7S8, and GC), five STR loci (LPL, vWA, F13B, TH01, and TPOX) and D-loop region in mtDNA for maternal identification. Sex determination was accomplished using fluorescent DNA capillary electrophoresis typing. Approximately 5 ng of human DNA was recovered from 1 g of femur bone retrieved from the infant skeletal remains. The probability of two unrelated Japanese sharing the same genotypes was estimated as 7.2 x 10(-11). The combined probability of exclusion that an individual is not the mother was also calculated at 0.998. We therefore conclude that the skeleton is from a female infant, and that there is no inconsistency in the claim that the infant was a daughter of the alleged mother.     

Roles of living arrangements and grandmother social support in adolescent mothering and infant attachment.

Examined the roles of social support from adolescents' mothers and living arrangements in 197 adolescent mother–infant pairs. Major observational measures were teaching interactions, Home Observation for Measurement of the Environment (HOME) scores, and infant attachment security. Adolescents living with neither mothers nor partners had better teaching interactions but lower HOME scores compared with those living with mothers. High mother support was associated with more secure infant attachment only for those adolescents living with partners. When mother support was low, adolescents living alone had more secure infants than adolescents living with partners. Although parenting scores were related to differences in demographics and personal resources (intelligence and social skills), these did not appear to be responsible for the major findings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Natural forms of shed tumor gangliosides

Data on activity states were collected from 29 group-housed capuchin monkey (Cebus apella) infants for 3 h each week from birth to 11 weeks of age. The amounts of time spent in sleeping/drowsy, alert-quiet, and alert-active states were measured in these subjects. Videotaped observations of these infants were recorded 3 times/week in the home cage over the first year of life and were scored for a number of social and exploratory behaviors. The extent to which early infant activity state scores predicted later behavior in the home cage was examined. Infant state measures correlated significantly with home cage behavior during months 2-6 in that infants that had been more active in early infancy spent more time alone, with other animals, and in exploration and play and less time with mothers than did quieter infants. Early state measures were less successful in predicting home cage scores beyond 8 months of age, whereas differences in behavior attributable to housing variables became more salient in the latter part of the first year. There was also a negative correlation between mother and infant activity in months 2 and 3, in that more sedentary mothers tended to have more active infants.     

Infant response to the still-face situation at 3 and 6 months.

Observed 37 mother–infant dyads in the laboratory when infants were 3 and 6 mo old to investigate developmental changes in infant responses to the mother's still face (SF). Infants reduced their smiling and increased their gazing away from mother during the SF at both 3 and 6 mo. Compared with 3-mo-olds, 6-mo-olds were more likely to use directed hand activities while gazing away from mother. Results suggest that developmental changes in gaze and motor activity are incorporated into the infant's response to a stressful situation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predictors and correlates of continuing involvement with the baby's father among adolescent mothers.

Predictors and correlates of a stable ongoing relationship with the baby's father among adolescent mothers were examined. A longitudinal study was conducted of 105 adolescent mothers and their infants over an 18- to 24-month period. Fathers were more likely to stay involved with the adolescent mother if the couple had an intimate and supportive relationship 6 weeks after delivery. They were less likely to stay involved if the young mother experienced a large number of stressful life events during pregnancy and in the first 6 weeks after delivery. Among adolescent mothers who remained in a stable relationship with the baby's biological father, higher scores were obtained on the Home Observation for Measurement of the Environment (B. M. Caldwell & R. H. Bradley, 1984), the young mothers were more likely to report continuous custody of their infants, and the infants' physicians were less likely to report infant injuries, accidents, or investigations of child abuse or neglect. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Fetal risks due to warfarin therapy during pregnancy

Two mothers with heart valve prosthesis were treated with warfarin during pregnancy. In the first case a caesarean section was done one week after replacement of warfarin with heparin. The baby died of cerebral and pulmonary hemorrhage. The second mother had a male infant by caesarean section. The baby showed warfarin-induced embryopathy with nasal hypoplasia and stippled epiphyses (chondrodysplasia punctata). Nasal hypoplasia with or without stippled epiphyses has now been reported in 11 infants born to mothers treated with warfarin during the first trimester, and a causal association is probable. In view of the risks to both mother and fetus in women with prosthetic cardiac valves it is recommended that therapeutic abortion be advised as the first alternative.     

A note on deep-seated social values and countertransference in mother-infant dyadic psychotherapy.

Presents an example of countertransference in mother–infant dyadic psychotherapy based in the value expressed as "A mother takes care of her child." Once this social value is brought to conscious awareness, the interfering nature of this countertransference is recognized. The therapist is freed to work with the mother toward her underlying treatment goal, which is to "be a good mother." If she is not emotionally capable of being the child's primary caretaker, the objective of enhanced attachment can be abandoned and "being a good mother" can be translated into "allowing the child to have a competent caretaker." The treatment objective can become the mother's emotional separation from her infant. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Assessment of attachment in differentially reared infant monkeys (Macaca radiata): Response to separation and a novel environment.

Observed infants from 2 environments, either low foraging demand or variable foraging demand for their mothers, to assess the developmental consequences of rearing environments for 12 infant bonnet macaques under 2 test conditions after the completion of the differential rearing treatment. One of the test conditions involved introduction of the rearing cohorts to a novel room; this was done in 2 series of 4 1-hr sessions: a series before and a series after completion of the 2nd test condition. The 2nd test condition involved a 20.5-hr removal of each mother from the rearing cohort; this was repeated once a week for 3 wks. Results of the novel room tests effectively differentiated rearing treatments in this study and suggested group differences in attachment security. In contrast, the maternal separations failed to differentiate treatments. (PsycINFO Database Record (c) 2010 APA, all rights reserved)