Maternal deprivation syndrome - Paediatric Association of Nigeria

Maternal deprivation syndrome By Dr. B Arinde Resident, Pediatric Department University of Ilorin Teaching Hospital

Outline • Introduction • Epidemiology • Causes/risk factors • Features of MDS • Treatment • Complications • Prevention • Prognosis • Conclusion

Introduction • Compared to other mammals, the human infant depends on the adult for its survival for a prolonged period • The knowledge of the basic needs of the newborn, and the application thereof by paediatricians, has resulted in a remarkable reduction of neonatal morbidity and mortality. • Less readily apparent among the fundamental needs of the infant are requirements for gentle physical contact, sounds of pleasant and varying tones of the human voice, antigravity play, visual stimuli from the human environment and the more subtle interpersonal communications- in sum, all of those activities ordinarily supplied by a loving mother.

Introduction • The term Maternal deprivation dates back to the early work of psychoanalyst John Bowlby, on the effects of separating infants and young children from their mother

Core theory- Bowlby theory • He believed the attachment between a caregiver and infant had to happen at least in the first 3 years of the infant’s life. • He called this the CRITICAL PERIOD for attachment.

Maternal deprivation theory • Based on Bowlby’s ideas: • Attachment is important for survival • Prototypes for later relationships

• Predicts developmental difficulty if the attachment relationship goes wrong: • General developmental problems • Specific issues with social development

Core theory- Bowlby theory • MATERNAL DEPRIVATION is the failure of a child to form an attachment in the first 5 years of life, leading to negative psychological effects especially in adulthood • When a child never experiences the opportunity to form any sort of bond it causes PRIVATION

Difference between separation and deprivation SEPARATION • A physical disruption of the bond between the parental unit and the child • A suitable replacement of the parental unit (e.g. a surrogate) should not cause any adverse events

DEPRIVATION • Loss of the emotional care that is provided by the parental unit • Note the use of the term “parental unit”: can be father or mother • A parent may be physically present and yet provide no emotional support

Maternal Deprivation Syndrome (MDS) • A failure to thrive seen in infants and young children and exhibited as a constellation of signs, symptoms, behaviors, usually associated with maternal loss, absence or neglect, and is characterised by lack of responsiveness to the environment and often depression.

Maternal deprivation syndrome • Approximately two-third are caused by dysfunctional caregiver interaction, poverty, child abuse and parental ignorance about child care. • Although mother and other primary caregiver may appear concerned, the interplay of physical contact normally seen between mother and

child is absent or distorted

Local study • Exploratory spatial analysis done in 2003 by O. Uthman • Data collected from Nigeria Demographic and health survey • 6029 children aged 0-59 months • Maternal socioeconomic deprivation index included -mothers with no education -residence in rural area -unemployed mothers -mothers living below poverty level Conclusion; children living in north-east and north-west Nigeria had higher rate of maternal deprivation

Maternal deprivation syndrome • Deprivation can occur when -A child lives in an institutionalized setting where he has no major substitute mother and insufficient interaction with a mother figure -He lives with his mother or a permanent substitute mother, where he receives insufficient care and with whom he has insufficient interaction -The child is unable to interact with a mother figure despite the fact that one is present and ready to give sufficient care- this inability being due to repeated break in ties with mother figures

Causal /Risk factors • Young parental age • Unplanned/unwanted pregnancy • Maternal death • Absence of father

Causal /Risk factors • Wrong child gender! • Low birth weight • Congenital abnormality • Children not breastfed • Chronically ill babies • Children with CP or other neurocognitive problems

Causal /risk factors • Low levels of education • Lower economic status/ Affluence • Children from household with high birth order and/or under-5 children greater than 4 • Maternal illness (may be a postpartum complication or debilitating

chronic illness) • Absence of support network (family, close friends, or other support)

Phases of response to separation/deprivation • Protest; crying and acute distress at loss of mother and by efforts to replace her through limited efforts at child’s disposal

• Despair; increasing helplessness, withdrawal and decreasing efforts to regain mother • Detachment; here, the child ‘settles down’ and accepts care from whatever substitute figure available.

Symptoms and signs • Subtle to blatant abnormality in

interaction between mother and child • Weight loss