Infant’s Regulatory Problems, Perinatal Mental Health and the Quality of the Parent-Infant Relationship

The prevailing emphasis on the importance of early intervention in improving both parental functioning and fostering secure attachment relationships in young children support the clinical need to detect very early risks for parents and babies. Attachment theory is the buzzword in parenting guides and professional publications, and risk to the child’s attachment development is widely used as the threshold for early intervention. Given the severe impact of inaccurately diagnosed attachment disturbances on the child’s wellbeing, the valid assessment of the quality of the early parent-infant relationship is crucial. This is particularly relevant during the ongoing pandemic which specifically burdens young families. 
Based on the assessment of peripartal mental health based on self-report questionnaires such as EPDS, STAI, IES-R, ECR and PBQ this pilot study at the Baby Clinic in Hamburg, Germany – an outpatient early intervention service – evaluates parental postpartum depression, anxiety and traumatic experiences at birth, parental mentalizing capacities and their experience of bonding to their baby. The infant’s affective regulation capacities as well as its regulatory problems are evaluated. The impact of parental mental health and the infant’s capacity of state and affect regulation on the quality of the parent-infant relationship is evaluated based on a psychoanalytic understanding of the parent-infant relationship, its crucial importance for the infant’s emerging self, assessed by using the Parent-Infant Relational Assessment Tool (PIRAT) Global Scales (Broughton, Hommel, the Parent-Infant Project, 2016; Hommel, 2018), conceptualized at the Anna Freud Centre in London, the PIRAT was developed and validated by the first author.
The data supports the relevance of a psychodynamic assessment of relational disturbance in the first year in combination with standard self-report questionnaires to screen for parental mental health in order to securing both parental functioning and fostering secure attachment relationships in young children by an early intervention.

Specifics of Posttraumatic Feeding Disorders in Early Childhood and their Relevance for Treatment

This retrospective study examined an inpatient clinical sample of children with severe Feeding Disorders in order to evaluate the differences between Posttraumatic Feeding Disorders (PTFD) and non-posttraumatic Feeding Disorders (non-PTFD) regarding the perceived levels of stress in mothers and children and the quality of the parent-child relationship. 
Children’s Feeding Disorders were classified according to the criteria by Chatoor (2002, 2005). The groups with PTFD and non-PTFD were compared by child and maternal variables as well as cumulative scores of perceived stress levels before and after treatment. Children (0 – 6 years) and their mothers were treated for 1-19 weeks at a Child and Adolescent Psychiatry and Psychosomatics inpatient parent-child unit. Children and mothers of both groups showed high levels of perceived distress. Children of the PTFD-group showed more severe somatic symptoms, more indicators of psychosocial stress and significantly higher cumulative stress scores. Interestingly, mothers of both groups showed high psycho-social stress levels. And both groups showed severely disturbed interactional patterns qualifying for a classification of a disturbed parent-child relationship by DC:0-3 R (2005), often associated with forced feeding. Both, the PTFD- and the non-PTFD-group experienced a significant reduction of symptoms in the children, of distress in children and mothers, and an improved quality of mother-child-interactions after treatment. However, the PTFD group clearly required longer treatment. This study demonstrated very severe levels of distress and somatic symptoms experienced by children with PTFD requiring the longest treatment. Furthermore, the results supported the clinical impression of severely disturbed qualities of parent-child relationship in both groups. The findings support a relational focus in treating feeding disorders of early childhood, a concern about aversive consequences of eating and the observation of feeding and play in order to assess specific interactional patterns between young children and their parents that inform treatment. 

Belastungen junger Familien nach der Pandemie . Eine Evaluationsstudie

Angesichts der Folgen der Pandemie sind wir daran interessiert, die individuellen wie familiären Belastungen von Eltern mit Babys und Kleinkindern besser zu verstehen, um für diese Familien passende Angebote zur Unterstützung anbieten zu können. Wir freuen uns über kollegialen Austausch und Evaluations- und ForschungsKooperation!

Weitere Projekte zur Interventions- und OutcomeForschung sind in Planung. Bei Interesse wenden Sie sich gerne an: Dr. Susanne Hommel susanne.hommel (at) elternhaus . net