Work/non-workday differences in mother,child, and mother–child morning cortisol in a sample of working mothers and their children

Background

Mothers have been shown to have higher morning cortisol on days they go to work compared to non-workdays; however, it is unknown how maternal workday associates with child morning cortisol or the attunement of mother–child morning cortisol.

Aims

This study examined the presence and stability of morning cortisol levels and slopes (i.e., cortisol awakening response or CAR) in a sample of 2–4 year old children in out-of-home child care with working mothers. In addition, we examined the differential contributions of maternal workday on mother–child attunement in morning cortisol.

Method

Mother and child morning cortisol was sampled twice a day (awakening and 30 min later) across four consecutive days (2 non-workdays; 2 workdays) among 47 working mothers and their young children. Mothers also reported on compliance with sampling procedures and provided demographic information.

Results

While children exhibited stability in cortisol levels, children's CARs were variable, with children's non-work CARs not predictive of work CARs. Similarly, a significant morning rise in cortisol was only found on workdays, not non-workdays. Overall, mothers had higher cortisol levels and steeper CARs than their children. Further, maternal workday moderated the attunement of mother–child morning cortisol, such that mothers and children had concordant cortisol levels on non-workdays, but discordant cortisol levels on workdays.

Conclusions

Morning cortisol may be more variable in pre-school aged children than adults but may be similarly responsive to the social environment. Further, workday mornings may be a time of reduced mother–child cortisol attunement.     

Early relations between language development and the quality of mother–child interaction in very-low-birth-weight children

Background

It is not clearly understood how the quality of early mother–child interaction influences language development in very-low-birth-weight children (VLBW).

Aims

We aim to analyze associations between early language and the quality of mother–child interaction, and, the predictive value of the features of early mother–child interaction on language development at 24 months of corrected age in VLBW children.

Study design

A longitudinal prospective follow-up study design was used.

Methods

The participants were 28 VLBW children and 34 full-term controls. Language development was measured using different methods at 6, 12 and at 24 months of age. The quality of mother–child interaction was assessed using PC-ERA method at 6 and at 12 months of age.

Results

Associations between the features of early interaction and language development were different in the groups of VLBW and full-term children. There were no significant correlations between the features of mother–child interaction and language skills when measured at the same age in the VLBW group. Significant longitudinal correlations were detected in the VLBW group especially if the quality of early interactions was measured at six months and language skills at 2 years of age. However, when the predictive value of the features of early interactions for later poor language performance was analyzed separately, the features of early interaction predicted language skills in the VLBW group only weakly.

Conclusions

The biological factors may influence on the language development more in the VLBW children than in the full-term children. The results also underline the role of maternal and dyadic factors in early interactions.     

Mother–infant circadian rhythm: Development of individual patterns and dyadic synchrony

BackgroundMutual circadian rhythm is an early and essential component in the development of maternal–infant physiological synchrony.AimsThe aim of this to examine the longitudinal pattern of maternal–infant circadian rhythm and rhythm synchrony as measured by rhythm parameters.Study designIn-home dyadic actigraphy monitoring at infant age 4, 8, and 12 weeks.SubjectsForty-three healthy mother–infant pairs.Outcome measuresCircadian parameters derived from cosinor and non-parametric analysis including mesor, magnitude, acrophase, L5 and M10 midpoints (midpoint of lowest 5 and highest 10 h of activity), amplitude, interdaily stability (IS), and intradaily variability (IV).ResultsMothers experienced early disruption of circadian rhythm, with re-establishment of rhythm over time. Significant time effects were noted in increasing maternal magnitude, amplitude, and IS and decreasing IV (p < .001). Infants demonstrated a developmental trajectory of circadian pattern with significant time effects for increasing mesor, magnitude, amplitude, L5, IS, and IV (p < .001). By 12 weeks, infant phase advancement was evidenced by mean acrophase and M10 midpoint occurring 60 and 43 min (respectively) earlier than at 4 weeks. While maternal acrophase remained consistent over time, infants became increasingly phase advanced relative to mother and mean infant acrophase at 12 weeks occurred 60 min before mother. Mother–infant synchrony was evidenced in increasing correspondence of acrophase at 12 weeks (r = 0.704), L5 (r = 0.453) and M10 (r = 0.479) midpoints.ConclusionsDevelopment of mother–infant synchrony reflects shared elements of circadian rhythm.     

“Just let me go”; When suicidal ideation and goals of care collide in adolescent cancer at the end of life

Cancer in adolescents and young adults is associated with an increased risk for suicidal ideation (SI). There are no reported pediatric oncology cases describing management of SI during end of life. We present the case of a 14-year-old male with relapsed, high-risk, B-cell acute lymphoblastic leukemia who received a haploidentical stem cell transplant and was suicidal at various points in his treatment. We discuss how to manage acute suicidality in this patient population, the importance of giving a voice to the adolescent patient, the impact of discordant goals of care, and potential preventive strategies for similar cases.     

Influence of socio-economic status on play development in toddlers – a mother child dyadic interaction based study

PurposeThe present study aimed to analyze the influence of SES on play skills in toddlers during a mother–child dyadic interaction.MethodologyThe study followed a cross sectional study design and included forty toddlers between the ages of 2–3 yrs, with their mothers. Participants were divided based on their SES into two groups as Group 1[Middle Socio-Economic State (MSES)] and Group 2 [Lower Socio- Economic Status (LSES)] with an equal number of participants in each group (20). Dyadic interaction between the mother and the toddler was recorded for 25 minutes for both the groups. The first and the last 5 minutes were excluded from the analysis and the middle 15 minutes were coded using the Play observation Scheme.Results and conclusionThe present study findings indicate a strong social class effect on the play skills demonstrated by toddlers. The findings of the present study indicated that the occurrences of interactive play such as Associative and Cooperative play were higher in toddlers of the MSES group compared to the LSES group. Another interesting finding is the significant difference in the occurrence of Simple and Complex pretend play between the two groups, with the MSES group outperforming their peers in the LSES group. An insight into the play skills of toddlers from low-income household would be helpful in creating awareness about the importance of play for holistic child development. It could also aid in the development of play assessment and intervention for toddlers from these socio-economic strata.     

Do developmental milestones at 4, 8, 12 and 24 months predict IQ at 5–6 years old? Results of the EDEN mother–child cohort

Rationale

The present study aims: (i) to determine how well developmental milestones at 4, 8, 12 and 24 months may predict IQ at 5–6 years old, (ii) to identify cognitive domains during the first two years that best predict later IQ and (iii) to determine whether children with IQ in the normal range at 5–6 years old may differ from disabled (IQ < 70) and gifted children (IQ > 130) with regard to their early cognitive development.

Is elective caesarian section really essential for prevention of mother to child transmission of HIV in the era of antiretroviral therapy and abstinence of breast feeding?

AIM: To determine whether vaginal delivery along with antiretroviral therapy and avoidance of breast feeding is safe in preventing mother to child transmission (MTCT) of HIV. SETTING: Pediatric & Perinatal HIV clinic, B.J. Wadia Hospital for children, Mumbai. STUDY DESIGN: Retrospective analysis. METHODS AND MATERIALS: 222 HIV-infected pregnant women were treated with zidovudine from 14 weeks of gestation onwards. 174 women underwent an elective caesarian section whereas 48 women delivered spontaneously vaginally. All infants were treated with zidovudine for 6 weeks and breast feeding was withheld. The HIV status of infants was determined at 18 months by ELISA test. RESULTS: Of the 174 infants delivered through LSCS delivery, two were HIV infected whereas 172 (98.9%) were HIV uninfected. Of the 48 infants delivered vaginally, 47 (97.9%) were HIV negative and one child was HIV infected. Thus, elective caesarean section was not statistically better as compared to vaginal delivery (p = 0.8696) suggesting that vaginal delivery was as effective as caesarean section for prevention of MTCT of HIV when added with antiretroviral therapy and no breast feeding. CONCLUSION: Vaginal delivery along with antiretroviral therapy in mother and baby and avoidance of breast feeding is equivalent to that of an elective LSCS delivery for prevention of mother-to-child transmission of HIV. Surgical intervention may thus not be required in these women.     

Parents and oncology team members are getting together after the death of a child. Report from Children's hospital Tübingen

The death of a child after an oncologic disease gives rise to feelings of mourning, loss and anger in family members and often also in oncology team members. All people involved need to find ways of coping with these emotions and thought. Therefore, the oncology team of the Children's Hospital Tuebingen has, for many years, offered communicative sessions to relatives of a deceased child. Based on years of experience, the author's aim is to demonstrate why a communicative session of parents and members of the oncology team after the death of a child may be experienced as supportive and valuable, even necessary for both sides. Guidelines are given on when and how to conduct these sessions. In three case presentations the pertinent elements of these communicative sessions are demonstrated with emphasis on the resulting implications for our daily clinical practice.     

MTHFR 677 TT genotype in a mother and her child with Down syndrome, atrioventricular canal and exstrophy of the bladder: implications of a mutual genetic risk factor?

Apart from Husmann and Vandersteen [in: Gearhart JP, Matthews R (eds) The Epispadias-Exstrophy Complex. Kluwer, New York, pp 199–206, 1999], we report only the second case of Down syndrome (DS) associated with exstrophy of the bladder (EB). Besides the appearance of DS, the newborn exhibited a complete atrioventricular canal (CAVC) and classical EB, including diastases of the symphysis, an epispadic penis and an open bladder plate. Despite current recommendations, the mother had not supplemented her intake of folic acid during the periconceptional period. In a comparable case, Al-Gazali et al. (Am J Med Genet 103:128–132, 2001) found the homozygous 677T allele of the methylenetetrahydrofolate (MTHFR) gene 677C→T polymorphism in a mother and her child with DS and cervical meningomyelocele. They found that the mother, who also had not supplemented her folic acid intake, had a secondarily altered folate status with an increased homocysteine level, suggesting that the homozygous TT mutation in the MTHFR gene in both mother and her child had contributed to the presentation of DS and a neural tube defect. The combined clinical findings of the present case and the observations of Al-Gazali et al. led us to investigate the 677C→T polymorphism in our mother–child pair. Likewise we found that mother and child were homozygous for the mutant 677T allele. Our findings support the suggestion of Al-Gazali et al. that the MTHFR 677TT could be a mutual genetic risk factor for the co-occurrence of trisomy 21 and midline defects, the risk of which may be reduced by periconceptional folic acid supplementation.     

Psychometric Evaluation of the Dutch Version of the Assessment of Preschool Children's Participation (APCP): Construct Validity and Test–Retest Reliability

ABSTRACT

The aim of this study is to examine construct validity, internal consistency, and test–retest reliability of the Dutch translation of the Assessment of Preschool Children's Participation (APCP) a participation measure for children aged 2 to 5 years and 11 months with and without physical disabilities. Parents of 126 preschool children participated. Sixty-seven of the children had no physical disabilities (mean age three years two months, SD 1.2) and 59 children had physical disabilities (mean age two years nine months, SD 1.8). Validity was tested using three hypotheses regarding having a physical disability, gender and age differences. Most, but not all hypotheses were confirmed. Children with a physical disability participated in fewer activities and with lower intensity than children without physical disabilities (p < .001). Boys and girls participated in an equally wide variety of activities and with similar intensity except for skill development. Four- to five-year-old children in general participated in more activities than two- to three-year-old children and had a higher intensity score (p < .001). For activity types, age differences were found for skill development (p < .001) and social activities (p < .001). Internal consistency was sufficient for four out of 10 activity types. Intra Class Correlations for test–retest reliability ranged from 63 to .91. Our findings indicate that the Dutch APCP shows sufficient psychometric properties for some but not all aspects of the measure.     

The ‘not knowing’ state of mind: intolerance of uncertainty in mother–infant bonding and ‘the position’ of the observer

The author defines the primitive anxieties experienced by a mother during the infant’s earliest stage of life as the ‘not knowing’ state of mind. She discusses the place of this state of mind in relation to mother–infant bonding and considers there to be parallels in the internal work the student-observer must do in order to find her internal ‘position’ and role, as observer. The observer, like the mother, is new to this relationship and must get to know the baby, mother and other family members. The observer has to tolerate not knowing until she goes through the painful experience of feeling what is communicated unconscious in parallel with what she observes in order to find the ‘position’ from which she can take in what she sees. The highly emotional new experience of observing a new baby brings with it, for the observer, if only for an hour a week, and in writing notes and discussing in the observation seminar, an encounter with the primitive anxieties which abound in the earliest days and weeks after the arrival of a new baby and, later, when there are premature or abrupt changes in circumstance.