Orientadores: María Yolanda Makuch, Mary Angela Parpinelli / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-24T12:11:47Z (GMT). No. of bitstreams: 1 Fleury_Camila_D.pdf: 2613695 bytes, checksum: 572ad631d8acc3d622c9e4a14344493e (MD5) Previous issue date: 2014 / Resumo: Objetivo: Estudar o desenvolvimento da relação mãe-bebê de mulheres diagnosticadas com gravidez de alto risco, cujos bebês foram internados em unidade de cuidados intermediários neonatais (UCIN) e as perspectivas e ações dos profissionais de saúde, que cuidam destes bebês, sobre o desenvolvimento dessa relação. Método: Como marco conceitual utilizou-se os conceitos psicanaliticos de preocupação materna primária e holding desenvolvidos por Winnicott. Foi realizado um estudo clínico-qualitativo com amostragem proposital, onde o número de participantes foi determinado pelo critério de saturação de informação. A amostra foi composta de dois grupos de participantes. Um grupo foi formado por mulheres puérperas diagnosticadas com síndrome hipertensiva ou diabetes gestacional, cujos bebês necessitaram internação na UCIN. O outro grupo foi formado por profissionais de saúde que cuidaram destes recém-nascidos na UCIN. Foram realizadas entrevistas semi-dirigidas utilizando-se roteiro temático. Todas as entrevistas foram gravadas e transcritas na íntegra. Os dados foram analisados por meio da técnica de análise de conteúdo temática. As categorias de análise foram organizadas de acordo com os conceitos do referencial teórico e temas emergentes. Resultados: Participaram do estudo 20 mulheres e 20 profissionais de saúde da UCIN - médicos assistentes, médicos residentes do terceiro ano, enfermeiras assistentes e técnicos de enfermagem. Todas as mulheres mostraram sinais do desenvolvimento da preocupação materna primária. As mães se referiram a uma aproximação crescente com seu bebê já nos relatos sobre a gestação. Apesar do receio inicial elas expressaram desejo de assumir os cuidados prestados ao filho, desenvolvendo habilidades para compreendê-lo, atendendo suas necessidades de forma sensível e amorosa. As mães sentiram restrições de contato com o bebê e expressaram a necessidade de maior liberdade para atender às suas necessidades. O contato mais próximo com o bebê foi descrito pelas mães e profissionais como importante para que as mulheres se sentissem desempenhando o papel materno. A atitude de holding às mães foi realizada de modo diferente entre médicos e profissionais de enfermagem. Os médicos auxiliavam as mães fornecendo informações clínicas, com atitude cuidadosa, mantendo-se à disposição para elucidar dúvidas. A equipe de enfermagem incentivava o contato mãe-bebê, apresentando e favorecendo diferentes formas de aproximação e cuidados. De acordo com as mães, o cuidado e carinho dos profissionais de saúde com as próprias mães e com os bebês incentivou sua aproximação com o bebê e contribuiu para deixá-las mais tranquilas e seguras para cuidar dele. Conclusão: Mulheres diagnosticadas com gravidez de alto risco, cujos bebês necessitaram internação em UCIN logo após o nascimento, embora tenham sentido limitações para o relacionamento com o filho, conseguiram desenvolver a preocupação materna primária e um bom relacionamento inicial com ele. O ambiente de holding proporcionado pelos profissionais de saúde foi importante para auxiliar estas mães a desenvolverem sua relação com o bebê no ambiente de internação / Abstract: Objective: Study the development of the mother-child relationship of the women diagnosed with high risk pregnancy whose newborn were hospitalized in an intermediate neonatal intensive care unit (NICU), and the perspectives and actions of the healthcare professionals, who take care of these babies, regarding this relationship development. Methods: Winnicott theoretical concepts regarding the primary maternal preoccupation and holding were used as a conceptual framework. A clinical-qualitative study was performed with purposeful sampling, whose number of participants was determined following the information saturation criteria. The sample was composed of two participants groups. One group was formed by postpartum women diagnosed with postpartum hypertension syndrome or gestational diabetes, whose newborns needed to be hospitalized in NICU. The other group was formed by health professionals who took care of these babies in the NICU. Semi-structured interviews were performed using a thematic guide. All interviews were recorded and verbatim transcribed. The data were analyzed through the thematic content analysis technique. The analysis categories were organized according to the theoretical concepts and emerging themes. Results: A total of 20 women and 20 health professionals of NICU participated in the study (physicians, medical residents, nurses and nursing technicians). All the women showed primary maternal preoccupation development signs. The mothers referred to a growing closeness with your baby in their pregnancy reports. Despite initial fears the mothers expressed a desire to take over the care provided to their child, developing skills to understand them, meeting their needs in a sensitive and loving way. Mothers felt restrictions of contact with the baby and expressed the need for a greater freedom to meet your needs. The closest contact with the baby was described by mothers and professionals as important for women to feel playing the maternal role. The holding attitude with the mothers was conducted differently among doctors and nurses. Doctors assisted mothers providing clinical information, with careful attitude, making them available to clarify doubts. The nurses encouraged the mother-infant contact, presenting and promoting different ways to approach and care. According to the mothers, the care and affection of health professionals with their own and the babies, encouraged their approach with the baby, making them more more calm and safe to care about him. Conclusion: Women diagnosed with high-risk pregnancy, whose babies required hospitalization in NICU after birth, although they felt limitations to relate with his child, developed the primary maternal preoccupation and a good initial relationship with her baby. The holding environment provided by the health professionals was important to help these mothers to develop their relationship with the baby in the hospitalization environment / Doutorado / Saúde Materna e Perinatal / Doutora em Ciências da Saúde

One of the research areas in mother-child health has focused on examining which are the signs inmothers' psychological functioning that would lead to a further disturbed development in an infant.The perspective of this paper has deviated from this research area. Natural observation of an infantduring his/her first year of life suggests that early mother-child affective bonding grows and strengthens progressively, even mother's behavior is not totally adequate. This article al so suggests that mother and child feed back each other in this early bonding. / Una de las líneas de investigación en salud materno-infantil se ha interesado en investigar cuáles son los indicadores del funcionamiento psicológico de las madres que llevarían a un desarrollo posterior perturbado del infante. La perspectiva del presente trabajo se distancia de esta línea de investigación. La observación natural de un infante durante el primer año de su vida, nos permite sugerir que el vínculo temprano entre una madre y su bebé se va gestando y consolidando progresivamente,más allá que el funcionamiento de la madre no sea del todo adecuado. Se sugiere además que en este vínculo afectivo temprano, la madre y el bebé se retroalimentan mutuamente.

Attachment theory states that emotion regulation is one of the central features of attachment system. The current study adopted an attachment perspective to investigate how mother-child attachment at 36 months and teacher-child relationships at 54 months influence children’s emotion regulation in 3rd grade, and whether teacher-child relationships moderate the associations between mother-child attachment and children’s emotion regulation. Longitudinal data from the first three phases of the National Institute of Child Health and Human development Early Child Care Research Network of Study of Early Child Care and Youth Development (NICHD SECCYD) were used in the study. The results showed that the association of teacher-child conflict and child’s negative engagement with peers was statistically significant. Additionally, teacher-child relationships significantly moderated the impacts of mother-child attachment on children’s emotion regulation. Specifically, the relationship between teacher-child conflict and negative engagement with peers for children with secure attachment and for those with disorganized attachment were in opposite directions. The relationship between teacher-child closeness and negative engagement with peers was significant for children with disorganized attachment, but not for children with secure attachment. And, the results showed that the levels of conflict in teacher-child relationships for children with ambivalent and with disorganized attachment were statistically different from those for children with secure attachment. The present study fills in the research gap with regard to the effects of teacher-child relationships on children’s emotion regulation. It also suggests that children’s experiences of positive teacher-child relationships may compensate for the negative impacts of insecure early mother-child attachment patterns on emotion regulation development.

The research problem of the thesis undertakes psychological aspects of carrying an infant on a mother's body using a sling or carrier. The research question states: What are the motives of mothers to carry their infant in carrying aid, according to opinions of mothers who carry their babies? The theoretical part discusses psychological findings about an early mother-child relationship in terms of contact and emerging bonds (attachment) from a prenatal period, through perinatal period, and up to one year of an infant's age. More attention has been paid to biological, behavioural, anthropological, and especially psychological assumptions for carrying an infant by its mother. A qualitative research method has been chosen for the emphirical part of the thesis. The data has been obtained by means of semi-structured interview conducted with nineteen respondents that have had experiences with carrying an infant. The respondents have been selected by an improbability selection method. The recorded interviews have been transcribed verbatim and analysed using a grounded theory. Among the most common motives for carrying a child include pleasurable feelings and experiences of mothers; especially feelings of naturalness, tranquillity, security, and freedom. Furthermore, the mothers appreciate the practicality...

This dissertation presents three studies that examined the effects of diverse cultural backgrounds on maternal socialization strategies and how these were related to the development of their pre-school aged children. Specifically, the investigations focused on mother-child discourses about past events when children were three and four years of age. The present work systematically applied the ecocultural approach by investigating relatively homogenous samples, which were selected based on population parameters and sociodemographic characteristics. These sociocultural contexts represented three different cultural models: (1) the model of psychological autonomy (urban middle-class families from Western societies), (2) the model of relational adaptation (rural farming families from no-Western societies), and (3) the model of autonomy-relatedness (urban middle-class families from non-Western societies). We could demonstrate that the three cultural models manifest in mother-child reminiscing: both, how mothers and children reminisced -the structure- and what they talked about -the content. Mothers of the psychological autonomous contexts structured conversations with many elaborations and evaluations in order to actively involve the child to participate. On the content level, conversations were child-centered, with many child references and talk about personal judgments and opinions. Consequently, children were more expressive and self-centered in these contexts. Thus, conversations mirror the socialization strategy and social roles associated with the cultural model of psychological autonomy: The mother treats the child as a quasi-equal interlocutor and reinforces the child to express her- or himself. Mothers of relational adapted contexts structured conversations rather rigidly by using many repetitions, and few elaborations and evaluations. On the content level, they focused more on social contexts than on the child compared to the autonomous contexts. Accordingly, children contributed less information to conversations and showed a greater focus on social contexts. Thus, conversations mirror the socialization strategy and social roles associated with the cultural model of relational adaptation: The mother is the expert and the child the adaptive apprentice. There was greater heterogeneity for conversational structure and content of mothers and children from autonomous-related contexts. However, overall they mirrored the hybrid orientation in their cultural emphases. The different reminiscing styles and thematic foci were thus meaningful within the different sociocultural environments and fostered children’s cultural development of becoming a competent societal member. Furthermore, we could also demonstrate variations within the elaborative style of mothers all valuing autonomy. Thus, when looking at more specific categories, differences also existed among cultural contexts with the same cultural model. Children’s internalization of the respective cultural orientation was also mirrored in another, adult independent task we conducted: children’s self-drawings. Children of autonomous contexts drew themselves bigger -pronounced and space-demanding- whereas children of the relational contexts drew themselves smaller -mirroring greater self-effacement. Drawings of children from the autonomous-related contexts were intermediate in size. Correlation patterns among maternal and child variables varied across the different cultural contexts. Thus, the studies support the notion that psychological processes have to be considered and interpreted in relation to the sociocultural context in which they unfold. This refers to level-oriented (mean differences) as well as functional (correlation based) analyses: Becoming a competent member of a specific cultural context requires very different skills within universal domains, such as mother-child discourse. Additionally, in this process the effect of socialization strategies on the adults’ part may vary across different sociocultural contexts. Results are also discussed in light of practical implications for culture sensitive intervention programs.

Indiana University-Purdue University Indianapolis (IUPUI) / The literature is varied as to whether there is a positive correlation or if there is no relation between maternal anxiety and a child's behavior at the dentist's office. The purpose of this study was to determine if there is a correlation between maternal anxiety and a child's behavior in the dental chair at the first dental visit. The hypothesis for this research study was that there would be a positive correlation found between maternal anxiety and a child's behavior in the dental chair. A total of 59 essentially healthy children between the ages of 1.2 and 9. 7 years of age with no previous dental treatment were selected for this study. Informed consent was obtained with approval from the Institutional Review Board. All children received an initial dental examination, dental prophylaxis, a fluoride treatment, and radiographs when indicated clinically. The children were videotaped during the dental appointment with consent obtained from the parents. The child's cooperativeness during the dental treatment was measured using the four-point Frankl scale and was evaluated by two separate investigators. The mother's anxiety was measured using a modification of Corah's Dental Anxiety Scale. Fifty-six of these children presented to the dental clinic with their mothers, while the other three presented with their fathers. There were 31 females and 28 males. The correlation between the 1natemal anxiety score and the child's behavior score was estimated using a Spearman rank correlation coefficient, adjusted for the child's age. In addition, Spearman correlation coefficient shows a 95-percent confidence interval. In this study, there was an attempt to determine if the relationship that exists between a mother and child allows the fears of the mother to be expressed through the behavior of the child. However, this research showed that there is no significant correlation between the dental anxiety level of the mother or father and the behavior of the child at the first dental visit. Ultimately, there was no difference in the results between those that presented with their fathers versus those with their mothers; however, there was not a large enough sample to make this conclusive.

The study integrated attachment theory and developmental systems theory to examine the mediating and moderating role of teacher-child relationships in characterizing early mother-child attachment influences on behavior problems in preschool. The study used the data from National Institute of Child Health and Human Development's (NICHD) Early child Care Research Network Study of Early Child Care and Youth Development (SECCEY). The results indicated that early mother-child attachment did not predict teacher-child closeness after controlling for the demographic variables and prior internalizing problems. Mother-child attachment had a statistically significant effect on teacher-child conflict; specifically, those with insecure-controlling/insecure-other attachments had higher levels of conflict than those with secure attachments. Early mother-child attachment did not have a statistically significant effect on later behavior problems after controlling for demographic variables and prior behavior problems. Teacher-child closeness did not have a statistically significant effect on either internalizing or externalizing problems after controlling for the demographic variables, early mother-child attachment behavior and prior behavior problems. Teacher-child conflict had a statistically significant effect on later behavior problems (both internalizing and externalizing problems) after controlling for the demographic variables, early mother-child attachment behavior and prior behavior problems. However, moderation analyses did not indicate that early mother-child attachment and teacher-child relationship quality interact together to significantly affect the later behavior problems. Mediation analyses also did not indicate that the relationship between early mother-child attachment and later behavior problem was mediated by teacher-child relationships either. However, an indirect effect was found such that those with insecure-controlling/insecure-other attachments had higher levels of conflict (than those with secure attachments) and such conflict was associated with higher levels of externalizing problems.

Homeless women and families are among the most disenfranchised groups in society. Further, because of their homelessness and associated problems, many homeless women become separated from their children. The purpose of this study was to determine the effects on predictors of entering a shelter with or without children (shelter status) and whether or not one is separated from one or more children (child separation status) on various special need predictors. A second objective was to determine the relationship between shelter status and child separation and to understand the unique experiences of homeless women who are separated from their children. These objectives were achieved via thematic analysis, quantitative methods and qualitative methods. Results suggest that shelter status significantly related to mental illness, drug abuse and domestic violence, but child separation status only significantly relates to drug abuse. The qualitative findings examined the origins of homelessness, child separation and the women's desires to be reunited with their children. Suggestions for further research and program changes are included.

Maternal depression has a negative impact on child development and the parent-child relationship (NICHD Early Child Care Research Network, 1999). The purpose of this study was to determine the treatment effectiveness of Parent Child Interaction Therapy (PCIT) with mothers identified with high levels of depressive symptoms in comparison with mothers with low levels of depressive symptoms and their children with behavior problems. The treatment effectiveness of PCIT was measured by pre- to post-treatment changes in the quality of parent-child relationship and reductions in child behavior problems, maternal depression, and parental stress. Subjects were 23 mothers identified with low levels of depressive symptoms and 26 mothers identified with high levels of depressive symptoms and their children. Findings showed there were improvements at post-treatment for both groups in child behavior problems, the quality of the parent-child relationship, maternal depressive symptoms, and parent stress levels. Mothers in the high depressive symptoms group reported achieving greater treatment gains when compared to the mothers in the low symptom group.

Past research has focused extensively on the influence of temperament and mother-child interactions for the development of psychopathology. However, there is a paucity of research that has examined the role of natural variations in temperament and mother-child interactions on socioemotional outcome in samples of low-risk typically developing children. Furthermore, most research has investigated temperament and mother-child interactions in separate studies. Accordingly, the present work addressed three issues: 1) the short-term and long-term continuity of temperament and joint attention in typically developing children; 2) the predictive value of temperament and joint attention for socioemotional outcome in typically developing children; and 3) joint attention behaviours in a clinical sample of children. Temperament was assessed through maternal report on the Infant Behavior Questionnaire (IBQ) beginning when children were between 18 and 3 7 months of age while joint attention was assessed through direct observation. All the IBQ subscales showed 9-month continuity and 4 of the 6 IBQ subscales showed moderate to high stability. Although there was 9-month continuity for all the joint attention measures, only 4 out of the 7 joint attention behaviors showed low to moderate levels of stability. There was little 4-year continuity or stability of temperament. Cross-sectional relations were found between temperament and socioemotional outcome at both 18 and 37 months of age as well as 69 and 88 months of age. Established joint attention, measured when children were between 18 and 37 months of age, significantly predicted internalizing behaviours in typically developing children between the ages of 69 and 88 months. Significant differences in joint attention were also found in a clinical sample of children with internalizing disorders between the ages of 5 and 8 years. The present results suggest that some ofthe same temperament and joint attention behaviours that are associated with atypical development are also associated with typical variations in socioemotional development. / Thesis / Doctor of Philosophy (PhD)