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Orientador: Olga Maria Piazentin Rolim Rodrigues / Resumo: Compreender os processos envolvidos desde o início do desenvolvimento da linguagem tem sido o desafio de múltiplas áreas do conhecimento devido a sua complexidade e a gama de variáveis que podem estar correlacionadas. Para alguns estudiosos, as interações iniciais que o ser humano é exposto, desempenha papel fundamental no desenvolvimento de habilidades linguísticas. Culturalmente, a mãe está no cenário das primeiras relações com maior frequência e, por isso, acaba viabilizando mais oportunidades de interação com o bebê. Considerando assim, o presente estudo propôs-se a descrever e relacionar aspectos da interação mãe-bebê no desenvolvimento da linguagem expressiva e receptiva de bebês de três meses. Participaram deste estudo trinta mães e seus bebês com três meses que frequentam um serviço de acompanhamento do desenvolvimento infantil no primeiro ano de vida, em uma universidade pública do interior do estado de São Paulo. Para a avaliação da interação mãe-bebê, a díade foi filmada em situação estruturada em um episódio de três minutos. Para a avaliação das habilidades comunicativas foi utilizada a Escala de Desenvolvimento Bayley-III, contemplando apenas as áreas de Linguagem Expressiva e Linguagem Receptiva. As filmagens foram analisadas através da cotação de comportamentos interativos maternos e do bebê por segundo, utilizando o protocolo Interadíade. Os resultados demonstraram que, tanto as mães quanto os bebês, apresentaram maior frequência de comportamentos positivos na... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Understanding the processes involved since the beginning of language development has been the challenge of multiple areas of knowledge due to their complexity and range of variables that may be correlated. For some studies, the initial interactions that the human being is exposed plays a fundamental role in the development of language skills. Culturally, the mother is in the scene of the first relationships with more frequency and for this reason it ends up making viable more opportunities of interaction with the baby. Considering this, the present study aimed to describe and relate aspects of the mother-baby interaction in the development of expressive and receptive language of three-month-old babies. Thirty mothers and their three-month-old infants attending a child development follow-up service in the first year of life at a university in the interior of the state of São Paulo participated in this study. For the evaluation of the mother-baby interaction, the dyad was filmed in a structured situation in a three-minute episode. For the evaluation of communicative abilities, the Development Scale Bayley-III was used, considering only the areas of Expressive Language and Receptive Language. Filming was analyzed through the quotation of interactive maternal and baby behaviors per second. The results showed that both mothers and infants had a higher frequency of positive behaviors in the dyad. Babies had more mother-to-be-behaving behaviors with neutral or positive sounds, and m... (Complete abstract click electronic access below) / Mestre

Há décadas discute-se a importância da qualidade da interação mãe-bebê para um desenvolvimento saudável. Estudos têm demonstrado que prejuízos na interação mãe-filhote podem resultar em danos hormonais e comportamentais, além de desregulação emocional em diversos mamíferos. Estes dados sugerem adaptação evolutiva de mecanismos neurofisiológicos que mantém altos os níveis de comportamentos pró-sociais. Estudos com humanos evidenciaram que desde o nascimento, bebês apresentam habilidades que permitem a comunicação inicial por meio do olhar, voz, expressão facial, gestos e toque. O objetivo da Tese de Doutorado foi aprofundar conhecimento sobre a interação inicial por meio do estudo dos comportamentos da mãe e do recém-nascido imediatamente após o parto, em situação naturalística, e investigar a influência de procedimentos hospitalares, condições emocionais e sociais maternas, e das características físicas do bebê, além de averiguar as concentrações hormonais de cortisol e DHEA-s. Este estudo foi realizado em parceria com o Hospital Universitário da Universidade de São Paulo para a gravação de vídeos dos primeiros minutos de vida de 120 recém-nascidos e suas mães. A codificação do comportamento dos bebês considerou: choro, atividade motora, acalmar-se e permanecer de olhos abertos e, para a mãe, olhar para o bebê, falar com ele, tocá-lo de forma afetuosa e sorrir. A frequência dos comportamentos foi transformada em variáveis ordinais com base nos valores dos quartis. Regressões ordinais foram usadas com o intuito de prever a influência das variáveis de interesse na frequência dos comportamentos da díade. Adicionalmente, análises de variância foram usadas para investigar as concentrações hormonais de cortisol e DHEA-s em função das condições emocionais maternas e da frequência dos comportamentos. Os resultados apontaram contribuição importante dos procedimentos hospitalares em promover a interação inicial. Bebês nascidos de parto normal tiveram maior chance de apresentar atividade motora em comparação aos de parto fórceps e ao contrário do esperado os bebês que foram colocados em contato pele a pele com a mãe apresentaram menor chance de chorar em comparação aos que receberam este contato físico. A influência das condições emocionais maternas sobre os comportamentos justificou maior atenção e investimento no bem-estar das gestantes: piores condições emocionais foram preditores de maior frequência de choro do recém-nascido e mulheres que relataram conflito com o pai do bebê apresentaram menor chance de olhar e falar com o bebê. Os resultados apontaram diferenças relativas ao sexo, logo ao nascer: bebês do sexo masculino tiveram mais chance de chorar em relação aos de sexo feminino. As mães, por sua vez, mostraram mais chance de acariciar e falar com os bebês do sexo masculino. Maior concentração de cortisol foi observada em bebês filhos de mães em piores condições emocionais, sugerindo influência hormonal durante a gestação. Estes resultados evidenciaram o papel ativo dos indivíduos desde os primeiros momentos de vida e lançaram luz sobre as complexas interações que influenciam sua trajetória de desenvolvimento desde o nascimento, e possivelmente antes. Assistência à mãe, desde a gestação, salientou-se como ferramenta essencial para a saúde física e psicológica do indivíduo / The quality of early interaction plays a crucial role in child development. Findings from animal and human studies demonstrate hormonal, behavioral and emotional impairment as a result of an impoverished interaction. These results suggest an evolutionary adaptation of mechanisms to maintain high levels of prosocial behaviors. Babies communicate from birth, through gaze, voice, facial expression, gestures, and touch. The aim of the Ph.D. thesis was to improve knowledge of initial interaction through the study of the mother and infant behavior immediately after birth in a naturalistic situation and to investigate the influence of hospital procedures, emotional and social conditions from the mother, infant characteristics as well as average hormonal concentrations of cortisol and DHEA-s. This study was conducted in association with the University of São Paulo Hospital in order to record videos from the first minutes of life of 120 newborns with their mothers. Behaviors were coded every ten seconds focused on: a) infant: motor activity, cry, soothing and open eyes; b) mother: affectionate touch, smile, talking and looking at the baby. The frequency of each behavior was converted into quartiles. Multiple ordinal regressions were performed to predict independent variables and analyses of variances were performed to investigate mean differences of hormonal concentrations. The results pointed out an important contribution of the hospital procedures in promoting early interaction. In general, babies born by normal birth were more likely to show physical activity compared to those born by instrumental delivery, contrary to our initial hypothesis, infants that were not placed skin-to-skin on mothers chest were less likely to cry compared to those who had this skin contact. Worse maternal emotional state predicted increased frequencies of infants\' cry, highlighting the need to promote well-being during pregnancy. Women who reported conflict with the childs fathers showed less chance to look and talk to the baby in the delivery room. The analyses yielded differences at birth related to sex: male infants showed a greater chance of crying than females. Mothers, in turn, showed a greater chance of caressing and talking to male babies. Infants whose mothers were in worse emotional condition showed higher concentrations of cortisol, suggesting an influence from mothers hormones on the fetus during pregnancy. These results showed the active role of individuals from the first moment of their lives, shedding light on the complex interactions that influence their developmental trajectory since their birth. Thus, assistance to the mother during her pregnancy has been emphasized as an essential tool for her physical and psychological health

A construção do Sistema Único de Saúde trouxe sem dúvida uma melhora do acesso com a ampliação da oferta dos serviços, contudo, ainda há grandes desafios para se alcançar um modelo de assistência eficaz, resolutivo e universal. Necessário se faz promover mudanças na formação profissional de modo a aproximá-la dos princípios do SUS, como a integralidade da assistência, e do conceito ampliado de saúde, entre outros, com o desenvolvimento de competências que dêem conta da complexidade do trabalho em saúde para atenção integral e humanizada à população brasileira. A formação para área da saúde deve ter como objetivos a transformação das práticas profissionais, estruturadas a partir da problematização do processo de trabalho e sua capacidade de construir o cuidado para as várias dimensões e necessidades em saúde. Assim, esta investigação tem como objetivo analisar uma experiência de aprendizagem do estágio da Observação da Relação Mãe-Bebê-Família (ORMBF) como ferramenta para a constituição de sujeitos competentes para a produção de cuidados, na perspectiva da integralidade da assistência à saúde. O estágio acontece em uma parceria da Faculdade de Ciências e Letras com o Centro de Saúde Escola da Faculdade de Medicina de Ribeirão Preto, ambas da Universidade de São Paulo, para estudantes do 4º e 5º anos da Faculdade de Psicologia. O material empírico se constituiu dos registros de observações de 5 famílias efetuadas durante o ano de 2003, sendo utilizada a análise temática. Na análise do material foi possível a articulação dos núcleos de sentido: preparo para o encontro e postura do observador, a disponibilidade da família para o observador, se deparando com uma realidade diferente – o impacto com o cotidiano das famílias, a comunicação como elemento fundamental para a interação e a construção da interação e do vínculo. Estes núcleos de sentido apontaram para um grande tema: o aprendizado para a interação, na perspectiva da clínica ampliada para atenção integral à saúde. Todos estes elementos da ORMF que compõem a aprendizado para interação, na realidade, identificam o observador participante privilegiado para compreender a complexidade do processo saúde e doença, com responsabilização e vínculo com a família que se propôs conhecer, campo de competência para atenção integral à saúde. Revelam aprendizado pela experiência e, também, novos conteúdos a serem pensados por pensadores implicados com a mudança dos modelos de atenção à saúde e de ensino. / The construction of the Single Health System (SHS) has undoubtedly led to a better access, offering a wider range of services. However, great challenges remain ahead if we want to reach an efficient, problem-solving and universal care model. Professional formation needs to get closer to the principles of the SHS, such as care integrity, and to a broader health concept, among others, developing competencies that are able to handle the complexity of health work, with a view to delivering integral and humanized care to the Brazilian population. Hence, health formation has to aim for the transformation of professional practices, structured on the basis of the problematization of the work process and its capacity to construct care for different health dimensions and needs. Thus, this research aims to analyze a learning experience during a training period in Observation on the Mother-Infant-Family Relation (OMIFR) as a tool for developing competent subjects for care delivery, from the perspective of integral health care. This training period is part of a partnership between the University of São Paulo School of Sciences and Languages and the Ribeirão Preto Medical School Teaching Health Center and directed at 4th and 5th-year students from the School of Psychology. 5 families were observed in 2003. The records of these observations were used as empirical material and were subject to thematic analysis. This analysis revealed the following clusters of meanings: preparation for the meeting and observer’s attitude, family’s availability for the observer, facing a different reality – the confrontation with the family’s daily reality, communication as a basic element for interaction and the construction of interaction and bonding. These clusters pointed towards one large theme: learning for interaction, from the perspective of an expanded clinical practice to provide integral health care. All of these OMIFR elements that constitute learning for interaction actually identify the participant observer, who is in a privileged position to understand the complexity of the sickness and health process, being answerable to and bonding with the family (s)he aimed to get to know, which is a competence area for integral health care. They disclose learning through experience, as well as new contents that should be taken into consideration by thinkers who are committed to changing health care and teaching models.

No primeiro ano de vida, os cuidados com a criança são de importância vital devido ao fenômeno do crescimento/desenvolvimento e sua dependência. Neste contexto, um fator imprescindível dentre suas necessidades básicas é a nutrição. Oferecer à criança alimentos que não o leite materno antes do sexto mês de vida é, em geral, desnecessário e pode deixar a criança mais susceptível a diarréias, infecções respiratórias e desnutrição. Entretanto, a introdução tardia de alimentos não lácteos no esquema alimentar infantil leva ao aparecimento de retardo de crescimento e deficiências nutricionais. O Ministério da Saúde, bem como a OMS, preconizam o aleitamento materno exclusivo até seis meses de idade e a oferta do leite materno até os dois anos. O objetivo deste estudo constituiu analisar o cuidado materno na alimentação das crianças menores que um ano, considerando o perfil da alimentação ofertada pelas mães e a compreensão que estas fazem destes cuidados às crianças. Trata-se de um estudo descritivo e exploratório, baseado em dados quantitativos e qualitativos. É parte de um projeto multicêntrico intitulado Deficiência de ferro em crianças entre 3 a 12 meses: compreensão de determinantes biológicos, sociais, e suas implicações para o incentivo ao aleitamento materno exclusivo. Foi realizado no ambulatório da Unidade Distrital de Saúde Dr. Marco Antônio Sahão, na cidade de Ribeirão Preto-SP e constituído por 122 mães. Os dados foram coletados através de um instrumento adaptado e entrevista após assinatura do Termo de Consentimento Livre e Esclarecido. Os dados quantitativos foram analisados no programa SPSS (versão 11.5), realizando-se uma distribuição simples de freqüência. O conteúdo das entrevistas foi categorizado com base na técnica de análise de conteúdo, modalidade temática. Observou-se que 5,7% recebiam AME, 10,6% estavam em AMP e 47,5% em AM. As demais 44 estavam desmamadas ou nunca mamaram. Das 70 crianças menores de 6 meses, 82,8 % faziam uso de água / chá, 61,4% continha frutas em sua dieta, 32,8 % consumiam legumes, 7,2 % verduras e um pequeno percentual caldo de carne e carne. Quando analisamos as crianças maiores de 6 meses, idade em que se recomenda a introdução da alimentação complementar, identificamos o consumo reduzido de verduras ( 55,8%), de carnes (65,4% ) e feijão (32,7%). Quanto à análise qualitativa, sobre a primeira categoria temática, identificamos os seguintes núcleos de sentido: a criança como centro de atenção; prover a criança de suas necessidades; alimentação como espaço de presença materna. Na segunda categoria temática, o significado os alimentos, depreendemos dois núcleos de sentido: o bom alimento é o que sustenta a criança; o bom alimento é o que tem vitaminas. Na terceira categoria temática, o significado da alimentação, identificou-se quatro núcleos de sentido: faz a criança ficar saudável e se desenvolver; a criança precisa comer muito e de tudo; é uma parte do processo da vida que ela aprende a comer; adaptando a criança à comida da família e a família à comida da criança. Tanto as mulheres como os profissionais de saúde carecem de melhor instrumentalização quanto a alimentação complementar e os guias alimentares que, embora representem um importante instrumento na educação nutricional, requerem adequações que considerem não só as crianças em aleitamento materno mas também as especificidades que ocorrem na alimentação infantil. Importante considerar a mulher como agente do cuidado na alimentação infantil e provê-la de suporte necessário a condução de práticas alimentares que atendam as recomendações para uma alimentação complementar adequada e oportuna. / In the first year of life, the care with child is vital importance due to the phenomenon of growth / development and its dependence. In this context, a vital factor among their basic needs is the nutrition. Offer the child food than breast milk before the sixth month of life is generally unnecessary and can leave the child more susceptible to diarrhea, respiratory infections and malnutrition. However, the late introduction of foods no milk in infant feeding scheme leads to the emergence of growth retardation, and nutritional deficiencies. The Ministry of Health and the OMS recommend exclusive breastfeeding up to 6 months of age and supply of milk up to two years old. The purpose of this study was examining the care of maternal nutrition in children less than one year old, considering the profile of the food offered by mothers and understanding that they do care for these children. This is a descriptive and exploratory study, based on quantitative and qualitative data. It is part of a multicentric project entitled \"Iron deficiency in children between 3 to 12 months: understanding determinants of biological, social and their implications for the encouragement of exclusive breastfeeding\". It was done in the Ambulatory Unit of the District Health Dr. Marco Antonio Sahão in the city of Ribeirão Preto-SP and formed by 122 mothers. The data were collected through an interview and adapted after the signature of the Free and Informed Consent Term. The figures quantitative were analyzed in SPSS (version 11.5), holding up a simple distribution of frequency. The content of the interviews was categorized based on technical analysis of content, thematic way. It was observed that 5.7% received AME, 10.6% were in AMP and 47.5% in AM. The other 44 were weaned or never breastfeeding. Of the 70 children under 6 months, 82.8% were using water / tea, 61.4% contained fruit in their diet, 32,8% consumed vegetables, 7.2% vegetables and a small percentage of meat and meat broth . When we analyses children older than 6 months, age at which recommends the introduction of supplementary feeding, identified the reduced consumption of vegetables (55.8%), meat (65.4%) and beans (32.7%). As for the qualitative analysis on the first thematic category, we identified the following clusters of meaning: the child as the centre of attention, provide the child of their needs; nutrition as an area of maternal presence. In the second thematic category, meaning the food, deduct two clusters of meaning: the good food is what sustains the child, the good food is what has vitamins. In the third thematic category, the meaning of food, there were identified four clusters of meaning: does the child stay healthy and develop, the child needs to eat well and everything, is a part of the process of life she learns to eat; adapting the child to the familys food and the familys food of the child. Both women and health care professionals need further instrumentation on complementary feeding and food guides that while representing an important tool in nutritional education, require adjustments they consider not only children in breastfeeding but also the specific features that occur in food child. Its important to consider the woman as the agent of care in infant feeding and it provides the support needs to the conduct of feeding practices that meet the recommendations for a timely and appropriate complementary feeding.

Submitted by Jailda Nascimento (jmnascimento@pucsp.br) on 2016-10-05T17:00:06Z No. of bitstreams: 1 Alcimeri Kühl Amaral Veiga Prata.pdf: 867401 bytes, checksum: 7b5fab47f49cf5693e3e10091dc7dd84 (MD5) / Made available in DSpace on 2016-10-05T17:00:06Z (GMT). No. of bitstreams: 1 Alcimeri Kühl Amaral Veiga Prata.pdf: 867401 bytes, checksum: 7b5fab47f49cf5693e3e10091dc7dd84 (MD5) Previous issue date: 2016-07-08 / Conselho Nacional de Desenvolvimento Científico e Tecnologia / he aim of this study was to analyze four cases of women who became mothers for the first time and were answered through an empathetic psychoanalytic listening, directed to the issue of maternal helplessness. The theoretical framework focused on the contributions of Freud, Klein, Bion and Winnicott, among other psychoanalysts who specifically work with motherhood. One of the most relevant results was the construction of a listening model psychoanalytically oriented towards motherhood vicissitudes / O objetivo desse estudo foi analisar quatro casos de mulheres que se tornaram mães pela primeira vez e que foram atendidas através de uma escuta psicanalítica empática, direcionada para a questão do desamparo materno. O referencial teórico privilegiou as contribuições de Freud, Klein, Bion e Winnicott, além de alguns psicanalistas que trabalham especificamente com a maternidade. Um dos resultados relevantes foi a construção de um modelo de escuta psicanaliticamente orientado para as vicissitudes da maternidade

Mutual regulation of attention was investigated in a group of prenatally cocaine-exposed and non-exposed mother-infant dyads during a 5-minute videotaped free play session. Mutual regulation was measured using a state-based coding scheme designed to categorize dyadic interactions into three mutually exclusive and exhaustive states: maternal bid, mutual engagement, and non-involved. Results revealed no significant differences between cocaine-exposed and non-exposed dyads in overall amount of mutual engagement displayed. Cocaine-exposed dyads exhibited significantly longer mutual engagement episodes. Mothers in the two groups did not differ in the number or quality of bids for mutual engagement, and infants in both groups were equally responsive to maternal bids. No ecological variables were found to predict mutual engagement.

Early sensitive caregiver (typically mother)-infant interactions form an important foundation for infant development. When sensitive, mothers behave with the apparent goal to keep their infants happy and engaged. Mutual enjoyment is thought to motivate proximity and continued interactions. The main focus in the literature has been on the influence of stable/pathological maternal negative emotions on parenting, with parenting often assessed on one occasion, in an unnatural setting, or with a researcher present. The primary objective of this research was to explore what accounts for the variability in typical mothers’ sensitivity with their 15- to 28-week-old infants across interactions. Specific goals were to develop a novel methodology to increase the ecological validity and acceptability of assessments by having mothers themselves videotape their infant interactions in their homes, to explore the effect of mothers’ emotion states and fatigue on their ensuing sensitivity, and to evaluate if infant engagement determined whether mothers felt better (i.e., were reinforced) the more sensitively they behaved. A feasibility study was conducted with 9 mother-infant dyads, and a main study with an additional 40 dyads. Mothers completed a brief emotion and fatigue rating scale (Profile of Mood States – 15; Cranford et al., 2006) before and after each interaction, twice daily, over five to seven days. Interviews with feasibility study mothers indicated that most found the procedure acceptable, though not representative of their typical interactions. Little data were missing or uncodeable. Methodological changes are proposed to enhance the representativeness of observed interactions and to further minimize data loss. Contrary to predictions, pre-interaction emotion and fatigue states did not individually or jointly account for the significant within-subject variability in sensitivity across interactions. Mothers felt better after interacting and, the more sensitively they behaved, the more engaged their infants were, and the more positive mothers felt thereafter. However, infant engagement did not account for the relationship between sensitivity and how mothers then felt. Results suggest mothers can behave sensitively irrespective of how they feel; then, upon behaving sensitively, feel better regardless of their infants’ engagement. Interacting effects of maternal stress, cognitions, specific emotion behaviour relations, and methodology remain to be further investigated.

The purpose of this project was to interview mothers of newborns who participated in early intervention services focusing on the implementation of a tool developed at the Family, Infant and Preschool Program (FIPP) in North Carolina. The intent was to examine the experience of mothers and home visitors employing the tool, which was designed to enhance the mother/infant relationship. However, a stronger focus on the relationship between mother and home visitor emerged throughout the interviews. Among some participants the relationship among practitioner and parent appeared to create a safe space to share, practice strategies and grow. Although characteristics of FIPP practices associated with the tool remained consistent among home visitors, the way in which services were implemented were unique to each home visitor and parent. Mothers participating in the project were identified as coping with numerous life stressors associated with poverty at the time of the interviews.

Book sharing is a key literacy activity in the early years that predicts children's subsequent literacy and language abilities, and a wealth of evidence illustrates socioeconomic status (SES) differences in early childhood abilities. However, whilst research has examined book sharing frequency in depth, far less is known about how the quality of verbal and non-verbal interactions varies by the SES of the parent. This thesis addresses this question by considering the quality of book sharing interactions between mothers and their infants or children across three studies. In the first, longitudinal study, mother-infant dyads (N = 44) were filmed book sharing at 12 and 18 months (N = 34), and infant development was measured. A novel coding scheme identified a wide range of verbal and non-verbal book sharing behaviours. High SES dyads produced more positive behaviours at 12 and 18 months and these predicted infants' linguistic and cognitive abilities at 18 months. Differences in infants were observed only at 18 months, with low SES infants disengaging more frequently. To examine the link between book sharing, SES and emotional functioning in older children, the second study considered mother-child book sharing behaviours in a preschool aged sample (N = 46). There were SES differences in verbal, but not non-verbal book sharing behaviours. A small number of maternal book sharing behaviours were associated with children's social and emotional abilities, suggesting children's behaviour influenced the book sharing interaction. In the final study, a book sharing intervention was designed and delivered predominantly to low SES mothers (N = 24) to explore whether mothers' book sharing behaviours could be enhanced, and increases were found in all targeted behaviours. In conclusion, book sharing behaviours that have been found to provide a more enriched interaction were seen more in high SES dyads, and predicted infants' abilities. Encouraging low SES mothers to use these enhanced interactions was successful, indicating that higher quality book sharing can be increased via a short intervention.