Baby Home Research Articles

Fetal Alcohol Spectrum Disorders in Children Residing in Russian Orphanages: A Phenotypic Survey

Alcohol use in Russia is among the highest in the world. Over 600,000 children reside in institutional care in Russia, most of them in baby homes and orphanages. The actual prevalence of fetal alcohol spectrum disorders (FASD) among these children is unknown. Therefore, we performed a systematic survey of phenotypic features associated with prenatal alcohol exposure among institutionalized Russian children and related these findings to their growth, development, medical, and social histories. Phenotypic screening was conducted of all 234 baby home residents in the Murmansk region of Russia (mean age 21+12.6 months). Phenotypic expression scores were devised based on facial dysmorphology and other readily observable physical findings. Growth measurements from birth, time of placement in the baby home, and at present were analyzed. In addition, the charts of 64% of the children were randomly selected for retrospective review. Information collected included maternal, medical, developmental, and social histories. Thirteen percent of children had facial phenotype scores highly compatible with prenatal alcohol exposure and 45% had intermediate facial phenotype scores. These scores correlated with maternal gravidity and age. At least 40% of mothers in whom history was available ingested alcohol during pregnancy; some also used illicit drugs and tobacco. Z scores for growth measurements corresponded to phenotypic score, as did the degree of developmental delay. Children with no or mild delay had significantly lower phenotypic scores than those with moderate or severe delay (p = 0.04); more than 70% of children with high phenotypic scores were moderately or severely delayed. More than half of residents of the baby homes in Murmansk, Russia, have intermediate (45%) or high (13%) phenotypic expression scores suggesting prenatal exposure to alcohol. Despite good physical care, stable daily routine, availability of well-trained specialists, and access to medical care, these vulnerable children show significant growth and developmental delays compared with their institutionalized peers.

Community support is key for breastfeeding mothers

All midwives know how crucial their role is in helping women to initiate breastfeeding at the point of birth whenever possible. However, midwives also know that even if feeding starts well in the maternity unit, when a mother takes her baby home she will be confronted by a range of different pressures and attitudes. There seems to be a great deal of guilt, defensiveness, lack of information and support surrounding breastfeeding and it is easy to see why some mothers lose heart and succumb to formula feeding. Fortunately there are also any number of organisations committed to promoting breastfeeding and supporting mothers. We can start from the top with the the Government, the World Health Organisation and Unicef with their joint global ‘Baby Friendly Initiative, filtering down to voluntary organisations offering information online and making home visits to help struggling mothers.

‘These children have been born in an abyss’: Slum photography in a Melbourne suburb

This article is concerned with the role of photography as an agent of ‘social truth’, with a particular interest in the way that the technology was used by slum reformers in Melbourne from the 1930s into the postwar era. The article focuses its attention on the streets and people of the inner Melbourne suburb of Fitzroy and two ‘crusaders’, F.O. Barnett (founder of the Methodist Babies Home) and Father Gerard Tucker (of the Brotherhood of St. Laurence), who would use the propagandist value of the photograph to influence their social and moral interventions into the lives of Fitzroy's poor.

Family Planning

Instead of the gold-plated onion domes Josie had hoped for, the view from their room revealed only the grimy, cement backside of the Oktyabrskaya metro station, where a few merchants had set up tables selling flimsy newsprint magazines bearing pictures of naked women. She held her map of Moscow up to the window, trying to match the city in her head with the one hulking in the half-dark outside. "I think we're here," she said, stabbing at the map and looking over her shoulder to Adrianna. "I think the river is that way." "I don't want to go out," Adrianna murmured. She was suffering on the narrow bed by the wall, with her red hair splayed across her face and her arms tightly coiled around her slender frame. It should have been a festive occasion. They were here at last; it was all coming true. But Adrianna had gotten terribly sick on the airplane, and their first Russian meal—cabbage and kasha and an unidentifiable pink meat—was now gurgling and breaking down in their stomachs. Josie paced along the wide window. "Maybe some fresh air . . ." she said, but stopped herself. There was no sense in being difficult; in their eight years together, she didn't recall ever winning a dispute with Adrianna. Still, there was so much to see out there, and they only had four days. She pressed her face against the window and practiced sounding out the few simple words she recognized on the dozens of bright city signs—. Adrianna had refused to take Russian lessons with her, claiming it was too hard a language to be able to learn anything useful in only six months, but Josie had gone ahead and taken the lessons anyway. It seemed important to try. "I think I'm going to be sick," Adrianna moaned a little theatrically. "Sshhh. They'll hear you." To reduce costs, the adoption agency had arranged for them to stay these few days in an apartment with a host family, and the walls were thin. Josie could hear their hostess, Masha, humming along with the radio in the kitchen as she cleaned up after their welcome dinner. She sat down on the edge of the bed and smoothed Adrianna's hair off her face. "Do you want to go to the bathroom?" "There are cockroaches in the bathroom." "Don't be such a wuss, A. There are roaches in every city apartment." "Not in ours." [End Page 31] Josie decided not to tell her that occasionally, in the middle of the night, she'd seen a cockroach or two in their kitchen sink in Chicago. "That's because ours is a condo," was all she said. Adrianna flopped onto her other side and pressed herself against the wall, whimpering. She was being childish, but Josie let it go. She had romanticized this trip in her mind many times, had imagined them touching hands and grinning nervously: future parents. Abroad. In the homeland of the new, mysterious child who was waiting to become theirs. She curled up behind Adrianna and put her cheek in the hollow between Adrianna's shoulder blades. "Maybe just once around the block?" she murmured, tugging back the collar of A's blouse to touch the hair at the nape of her neck. "Give it up," Adrianna said, but she was smiling, almost giggling. That was something. "You'll feel better tomorrow." "God, I hope so." In the morning they would drive west, to an orphanage outside town, which the Russians called a baby home, where they would see the boy with their own eyes. "And then, just imagine—" "Don't," Adrianna stopped her. "You said you wouldn't get your hopes up like this." "I'm not." "You are. I know how you are." Adrianna stretched out her legs, effectively pushing Josie off the bed. "I'm sorry." She shifted to make room for Josie again. "I'm sorry. There's still an awful lot that could go wrong." Josie crossed the room...

Sending Baby Home Safely : Developing an Infant Car Seat Testing Program

Sending Baby Home Safely : Developing an Infant Car Seat Testing Program

Prevention of ill health in children born to HIV-positive women.

Annals of the New York Academy of SciencesVolume 918, Issue 1 p. 386-388 Prevention of Ill Health in Children Born to HIV-Positive Women MEDIATRIX BIHIIRA, MEDIATRIX BIHIIRA Morning Star Babies Home, Kampala, UgandaSearch for more papers by this authorJ. KEITH, J. KEITH Morning Star Babies Home, Kampala, UgandaSearch for more papers by this authorE. KISEKKA, E. KISEKKA Morning Star Babies Home, Kampala, UgandaSearch for more papers by this authorT. KAYONGO, T. KAYONGO Morning Star Babies Home, Kampala, UgandaSearch for more papers by this authorH. BACHOU, H. BACHOU Morning Star Babies Home, Kampala, UgandaSearch for more papers by this authorE. OKECH, E. OKECH Morning Star Babies Home, Kampala, UgandaSearch for more papers by this authorE. NAKIGUDDE, E. NAKIGUDDE Morning Star Babies Home, Kampala, UgandaSearch for more papers by this author MEDIATRIX BIHIIRA, MEDIATRIX BIHIIRA Morning Star Babies Home, Kampala, UgandaSearch for more papers by this authorJ. KEITH, J. KEITH Morning Star Babies Home, Kampala, UgandaSearch for more papers by this authorE. KISEKKA, E. KISEKKA Morning Star Babies Home, Kampala, UgandaSearch for more papers by this authorT. KAYONGO, T. KAYONGO Morning Star Babies Home, Kampala, UgandaSearch for more papers by this authorH. BACHOU, H. BACHOU Morning Star Babies Home, Kampala, UgandaSearch for more papers by this authorE. OKECH, E. OKECH Morning Star Babies Home, Kampala, UgandaSearch for more papers by this authorE. NAKIGUDDE, E. NAKIGUDDE Morning Star Babies Home, Kampala, UgandaSearch for more papers by this author First published: 25 January 2006 https://doi.org/10.1111/j.1749-6632.2000.tb05513.xRead the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Volume918, Issue1PREVENTION AND TREATMENT OF HIV INFECTION IN INFANTS AND CHILDRENNovember 2000Pages 386-388 RelatedInformation

The Gates of Paradise by Victor Depta (review)

Amajor strength of The Heart ofConfederateAppalachia is its comprehensive approach, no small accomplishment when considering that inhabitants of the twenty-county area differed widely as to loyalties, political beliefs and reactions to war and invasion. Thus, much of Inscoe's and McKinney's story of secession, suspicion, war and invasion centers around economics, the role of women, the collapse of slavery, and the negative, long-term effects of the war years on western North Carolina. Well-researched, thoroughly documented and entertainingly written, The Heart of Confederate Appalachia sets a high standard for scholars researching regional history. —Marion B. Lucas Depta, Victor. The Gates ofParadise. Martin, Tennessee: Blair Mountain Press, 2000. 257 pages. Paperback. $11.95. Novels set in Appalachia typically must stand the charge that their significance lies only within this area of the United States. They are often deigned merely "regional" in their appeal, with little significance beyond their abilities to depict characters and places in this part of the country. Rarely, as is the case of Harriette Arnow's The Dollmaker, does an Appalachian novel achieve universal appeal. In Arnow's work, the struggle of Gertie Nevéis becomes the struggle of the reader, who takes away some shred of life experience after having journeyed with this mountain woman. By contrast, novels by regionalists such as Jesse Stuart often present "quaint," "picturesque," or "endearing" stories of life in the Appalachian Mountains. Such novels devote attention to language, customs and setting, often reinforcing stereotypes long held by those on the outside: the gun-toting, tobacco-chewing, hard-living, harddrinking characters who people such stories. Consequently, the value of these novels ends where the mountains end. Victor Depta's The Gate ofParadise attempts something in between these two types of work: It bears some stereotypical features of the Appalachian "regional novel," yet it aims at lasting significance unlimited by region. Depta, born in the coal mining region of West Virginia, is a Professor of English at the University of Tennessee at Martin and is the founder of Blair Mountain Press. He has long been a contributor to the literary world, having published five collections of poetry and one 71 other novel. With such a literary background, Depta should know and understand the inner workings of a quality piece of fiction. His latest effort, The Gate ofParadise, weaves a story loosely around an Appalachian family who mirror the frustrations of life in the southern coal counties during the 1950s: the back-breaking work in dust-filled mines, the enigmatic role of religion in daily life, the lure of the outside world and the desperate attempts of the people to give meaning to their existence. The novel focuses on an intriguing cast of characters: a six year-old boy, Keith, whose wife-beating father, deserts him, then seeks to reunite his family; Keith's mother, Ruby, who seems constantly in search of new sex partners; a grandmother, Leah, who begins as a mountain preacher only to end as a back-slider, mindlessly searching for some principle to hold onto; and a great-grandmother, Deborah, who seems, at times, the only stability the youngster can cling to. Threaded through this complex weave of culture and character is Franklin, an epileptic and the bastard son of Daddy Frank, Keith's long-dead great-grandfather. Years before, we are told, Daddy Frank brought the baby home for his wife to rear after the mother abandoned him. Predictably, Deborah despises the child, now adult, but allows Franklin to remain in the home after Daddy Frank's death. Franklin becomes the novel's most interesting character. Questions abound as to whether Franklin is really Daddy Frank's offspring, whether he is mentally retarded, and whether he will be able to survive attempts by Wade, another family member, to send him to the state insane asylum after Deborah's death. Franklin becomes, ultimately, the friend of Keith who quickly sees the good in him. Ruby, a mountain woman with loose ways, is another of Depta's clever creations. Although a poor example for her son, she comes off a sympathetic soul who only wants a man who'll treat her decently, be a father to her child and...

Case Study: Baby Aaron and the Elders

Baby Aaron was brought to the children's hospital emergency department at three months of age. His parents, members of the Amish community, told the ER doctor that the baby seemed to be having trouble breathing and was not growing well. After examining the baby, the physician was suspicious of congestive heart failure. An echocardiogram demonstrated significant congenital heart disease. A pediatric cardiologist was consulted. She informed the parents of the diagnosis and emphasized the excellent prognosis with open heart surgery. The proposed operation would provide complete correction of the defect with a single procedure. The cardiologist did not anticipate that subsequent medical treatment would be necessary and estimated that the mortality risk from surgery was approximately 1 percent. The parents stated that they had brought Baby Aaron to the children's hospital to find out what was wrong with him, but that they were not interested in any medical treatment. The cardiologist told the parents that Baby Aaron was certain to die without surgery, probably within the next several months, but the baby's parents repeatedly expressed a desire to take the baby home to die, and again refused surgery. A social worker met with the parents next. In addition to the baby's mother and father, the maternal grandfather was present and quite involved in the discussion. During the meeting, the family stated that their decision was based on religious grounds. They explained that the Church Elders had recently rejected bypass surgery that doctors had recommended for an adult church member suffering from heart disease. The Elders had concluded that this adult patient should not have the operation because it represented an invasive and burdensome intervention that was beyond the will of God. Baby Aaron's parents felt that such a decision applied to their son's case as well. In addition to thinking that their religious views opposed surgery, the family was concerned that they would be shunned by their community if they chose surgery. Yet the social worker felt that the parents fully understood the decision and its consequences. The cardiologist felt strongly that surgery was in the child's best interest. She offered to travel the two hours by car to meet with the Elders, describe the heart problem and proposed surgery, and discuss the case further. The cardiologist reasoned that by learning more about the Amish community, she might better persuade the parents that surgery ought to be done. Baby Aaron's family quite adamantly rejected this idea. The cardiologist then called a family physician with a practice in the community. The family physician told the cardiologist that he suspected economic concerns were at the root of the family's decision. Should the cardiologist let the parents take Baby Aaron home? Does the parents' rejection of heart surgery constitute child neglect, requiring that the cardiologist report this case to county authorities? commentary by Ellen Wright Clayton The cardiologist should allow Baby Aaron to be taken home and should hesitate to contact county officials. How can I say this? Reporting laws require that clinicians report all parental omissions that are reasonably likely to result in serious harm to the child. Surgery will save Baby Aaron's life. If a report is made, the state will investigate the case and will probably seek a court order for surgery. When faced with a dying child, trial courts almost always order treatment, even in the face of religious objections. If pressed, courts cite the Supreme Court's language in Prince v. Massachusetts that parents may be free to make martyrs of themselves, but they are not free to make martyrs of their children. So what the cardiologist should do seems clear--report the case in compliance with the law, and the surgery will occur. But let us ask why Baby Aaron's parents might be reluctant to proceed with this curative surgery for an otherwise lethal defect. …

Constructing a home birth environment through assuming control

Objective: the purpose of this qualitative study was to describe the experience of couples who have had a home birth. Design, setting and participants: a phenomenological approach was used to provide an understanding of the human experience of home birth in Western Australia. The research design consisted of a field study, in which 10 parent couples were interviewed and three videos of home births observed. Of the ten couples, four couples spoke of their first baby's home birth and the remaining six couples had three or four children who had been born at home. Findings: the couples' experiences of home birth were gained through identifying significant statements from transcripts and field notes, and clustering these into the following four themes: ‘constructing the environment’; ‘assuming control’; ‘birthing’; and ‘resolving expectations’. The themes of ‘constructing the environment’ and ‘assuming control’ are described in detail in this paper. ‘Constructing the environment’ describes how couples adapted the physical environment, and established support to create a positive birth environment. ‘Assuming control’ discusses exerting control and taking responsibility for the birth. The remaining themes of ‘birthing’ and ‘resolving expectations’ are described in a subsequent paper (Morison et al, in press). Key conclusions: The research furnishes an insight into the couples' experience of home birth. The lived experience of birthing at home involved a process where a couple actively created an environment that enabled them to assume control and responsibility for the birth. Implications for practice: the findings are important for midwives in any setting, as they reveal the extent to which some parents value the right to assume control and responsibility for the birth of their baby. Although the physical environment of a home birth cannot be replicated in every setting, issues specific to the birth environment are relevant to all midwives.

Primary Care of the Preterm Infant

This useful, well-written, and nicely designed softcover book should have wide acceptance among nurses, nurse practitioners, and allied health professionals, as well as by doctors who work in intensive care neonatal units. It actually deals with discharge and after care of premature infants. In the preface the authors, all associated with the University of Pennsylvania School of Medicine, state, "This book provides a practical approach to well-child care, diagnosis and treatment strategies of illness specific to preterm infants, communication and support strategies for parents, and the methods used for screening and referral for development delays." They have succeeded in their endeavors. The text begins with two of its most valuable sections, "Predischarge and Postdischarge Planning" and "Taking the Baby Home: Counseling the Family." Later are sections dealing with "Family and Social Issues" and "Parenting a Disabled Child." Most of the 344-page book concerns medical care issues such as growth and

Creating a home for babies in hospital

Margaret Sparshott discusses the categories of environmental disturbance for babies in hospital and ways in which these can be mitigated

Babies with spina bifida treated without surgery: parents' views on home versus hospital care.

From 1971 to 1981, 98 babies born with meningomyelocoele at the North Staffordshire Hospital Centre's district maternity hospital, were thought not suitable for surgery. Sixty three survived for more than one week. Over the period the hospital's policy changed: initially all such babies were kept in hospital, but later parents were given the choice of taking their baby home for palliative and terminal care. In an attempt to determine parents' views on the care of their baby the parents of 44 of the babies who survived to one week were traced in 1985-6, five to 14 years later; 80 of them were asked how they felt about the lives and deaths of their babies. Eighteen babies had been taken home, and they had lived longer than the 26 who had been cared for in hospital. Parents whose baby had remained in hospital were sadder than those who had taken their baby home when they looked back at their experiences, and they also considered that their baby's life had been of poor quality. Most of those who had taken their baby home had a more positive view of their child's life. The figures suggest that the bereavement process after a baby's death is longer than has been thought, but despite residual sadness just over half of the parents interviewed thought that something positive had come out of their experience.

Home oxygen therapy in the newborn. Costs and parental acceptance.

To assess the cost of and parental response to home oxygen therapy in the newborn, a telephone survey was conducted of 34 families of infants discharged from our intensive care nursery along with supplemental oxygen therapy. Mean birth weight was 1988 g and gestational age was 33 weeks. The mean length of time oxygen was required at home was 74 days. Savings were estimated for each infant and were found to average $33,370. The typical problems encountered by these families are described. Despite the inconveniences involved, 94% of these families stated they would again take a baby home while oxygen dependent if necessary.

An Epidemiologic Study of Very Low and Very Very Low Birth Weight Infants

VVLBW infants constitute only 1 per cent of the total births, but account for 60 per cent of the NMR and 40 per cent of the IMR. While improved technology and refinements in care continue to improve survival for VVLBW infants, questions regarding the lower limits of viability must be considered. The medical community can rightly take credit for improvement in outcome of infants with weight and gestations so small that, just a decade ago, they were considered nonviable; however, an excruciatingly slow pace of decline in the prematurity rate is an agonizing fact. Can anything be done to prevent prematurity and avoid its devastating consequences on the family and society? The recent French experience suggests the answer could be "yes." A similar experience also has been reported in the United States. Although VLBW NMR is a major fraction of total IMR, nearly one quarter of first-year deaths occur in infants who are over 2500 gm at birth. That the postneonatal death of normal birth weight infants is only next in magnitude to the neonatal death of VLBW infants further points to the need for developing preventive child health programs encompassing periods before and during the pregnancy, through the immediate peripartum period, and well into infancy and childhood. Neither a woman's pregnancy experience nor the concerns of the health community end with her taking a baby home.

Spatial Distribution of the Day Care Centers in Tohoku District, Japan

In order to gain an accurate profile of social welfare activities in the Tohoku District (the northeastern part of Honshu Island, Japan, encompassing Aomori, Akita, Iwate, Yamagata, Miyagi, and Fukushima Prefectures), the author investigated the spatial distribution of day care centers (hoikusho) by townships or shi-cho-son, in the district. The analysis, conducted in 1983, was based on the following data: fixed number (i. e., the number of children accepted by a center) and capacity rate (i. e., number of children per 100 in the centers/total population of children aged four and under in the municipality) of day care centers.In general, the fixed number of children in city day care centers exceeds that of smaller towns and villages but the average capacity rate is actually less (Table 3). The municipalities with the highest capacity rates were primarily located in underpopulated areas such as remote villages along the Ou Mountain Range (which runs north to south in the center of Tohoku) and places near the Kitakami Mountains fronting the Pacific Ocean. The number of municipalities with high capacity rates (30% and over) in each prefecture were as follows: Aomori, 56; Akita, 35; Iwate, 27; Fukushima, 19; Yamagata, 18; and Miyagi, 4.Both the fixed number and the capacity rates of day care centers in the three northern prefectures of Aomori, Akita, and Iwate are comparatively higher than those of the three southern prefectures of Yamagata, Miyagi, and Fukushima (Table 4).Areal differentials exist in each municipality due to four factors: (1) variation in the fixed number; (2) variation in total population of children aged four and under; (3) the number of “both parents employed” households (with children under six years of age); and the size of a municipality's social welfare budget. The values of these four mutually related factors are in direct proportion; e. g., an increase in the population of children aged four and under results in a proportional rise in the fixed number of children accepted by a day care center.Aomori Prefecture shows the highest correlation coefficient between fixed number and the other three factors. That prefecture's correlation coefficient ranges from 0.76 to 0.92 while that of Fukushima, the lowest ranking prefecture, ranges from 0.40 to 0.62 (Figs. 3, 4, 5).The presence of a kindergarten has a negative impact on day care center enrollment. Once a kindergarten is established in a small town or village, it is likely that day care center enrollment will decline somewhat. So far, in all prefectures, kindergartens have been concentrated in cities, with more than 70% of the available children enrolled in such a facility.Among the six prefectures, the number of children in day care centers exceeds that of kindergartens in Aomori, Iwate, and Akita but the opposite is true in Yamagata, Miyagi, and Fukushima.Recently there has been a remarkable proliferation of unauthorized “baby homes” (nonregulated nurseries that accept infants and small children without hours or restrictions) and nurseries controled by enterprises in the central cities of the district, especially in Fukushima Prefecture (Fig. 10).The ratio of the combined number of children placed in day care centers, kindergartens, and unauthorized baby homes to the total population of children aged six and under is one to three. Since this ratio differs little from prefecture to prefecture (Fig. 2), the total capacity of the institution in each prefecture is approximately the same.

The Premature Baby Book: A Parent's Guide to Coping and Caring in the First Years

<i>The Premature</i>Baby Book by Helen Harrison with Ann Kositsky is an outstanding addition to the lay literature about preterm birth. Parents faced with the sudden problem of a tiny baby who often requires neonatal intensive care need a source both of information for immediate help in understanding the complex medical problems faced by their newborns and of long-term guidance in what to expect after taking their baby home. This book is also an excellent source of services and organizations that can be of help to the new parent of a preterm newborn. The book can be viewed as having three sections. The first, chapters 1 through 4, deals with the immediate crisis of the birth. Parents often go through periods of anger and then guilt. In the second chapter, "Why Me?" the authors review the myriad reasons for preterm birth and emphasize that the parents cannot blame themselves. In

The Prenatal Visit

A visit to the pediatrician's office by the expectant couple makes good sense; yet, it appears to be the exception rather than the rule. In a recent survey, 73% of 118 practicing pediatricians reported that they conduct prenatal visits, but only 22% of their expectant couples had actually been seen before their infant's birth. This percentage is even lower in other settings. On their first contact with the pediatrician, expectant parents should be encouraged to make an appointment for an office visit. This visit, which usually takes place during the eighth or ninth month of pregnancy, represents an opportunity for the pediatrician to gather data, give information, initiate a continuing relationship, and enhance the parents' competency in decision making. The session helps the parents select a pediatrician with whom they are comfortable and enables them to feel that they are meeting their responsibility to provide skilled care for their infant. In the beginning of the prenatal visit, the pediatrician should convey a personal interest in the prospective parents by asking questions that provide an opportunity for him or her to become acquainted with the parents and their expectations: "How long have you lived in the community?" "What kind of work do you do?" "What are your interests and hobbies?" "How have you been feeling?" "How do you expect to deliver?" How do you plan to feed your baby?" "Have you obtained an infant car seat to take the baby home in?" "Is it a boy or girl?" Prenatal discussions with the pediatrician may augment the expectant couple's confidence in their feelings about breast-feeding, circumcision, and rooming-in.

Early discharge of low birthweight infants.

A study was conducted to see if the discharge weight of preterm infants born at less than or equal to 2000 g could safely be reduced. A study group (21 infants) was discharged 'early' at a mean weight of 2010 g (1890-2190) provided there were no medical problems, weight gain was adequate, temperature control in room air was stable, all feedings were by breast, and the mother was ready to have the baby home. A control group (17 infants) was discharged at a mean weight of 2261 g (2200-2400). The duration of time in hospital for the 'early' group was shortened by 11.6 days. At expected date of delivery the weight of infants in each group was similar (3095 +/- 403 compared with 3146 +/- 453 g); length, head circumference, and haemoglobin concentration in each group were similar too. There was no morbidity or mortality in either group. Early discharge did not affect mothering confidence. This study shows that low birthweight infants can be discharged early (at 2000 +/- 100 g) provided appropriate criteria are met, home conditions are adequate, and follow-up is available.

DEATH AT HOME

Paediatricians responsible for neonatal care have been increasingly involved in, and aware of, the importance of parent infant interactions. These interactions are of major importance when concerned with the dying newborn. Over the past few years parental involvement in decision making related to life and death of newborn babies is becoming increasingly accepted ... more and more parents are opting to take their baby home to die. As changing patterns of birthing increasingly involve fathers and children, so death is once again becoming a family affair.

Counselling about Down's syndrome: the parents' viewpoint.

The parents of 50 children with Down's syndrome were interviewed to find what sort of information they were given at the time of diagnosis and what arrangements were made for the child's future. Particular emphasis was placed upon the method and timing of giving the parents the diagnosis, the utilization of community resources to help the family and what information they would have liked to have been given in retrospect. The ages of the children ranged between three months and eight years at the time of the survey. Seventy-two per cent of parents were given the diagnosis during the first week, with an increasing proportion being dissatisfied with the timing the longer the delay in telling what was wrong with the child. The mother has been told first in 48% of cases, and both parents have been told together in only 20% of cases. Fifty-four per cent of parents were encouraged to take the baby home, 22% were encouraged to place the baby in an institution, while in 28% of cases the decision was left to them. Forty-six per cent of patients felt that an overly-pessimistic outlook had been given by the doctor. Eighty-four per cent had medical follow-up, community follow-up, or literature supplied, whereas 16% had no such arrangements made. The parents' own suggestions for better management were sought. The two most outstanding were to be placed in early contact with community facilities and to be given a chance to meet other parents of children with Down's syndrome.