Infant Neglect Research Articles

Clinical training of undergraduate communication pathology students in the neonatal assessment and neonate-caregiver interaction in South Africa

Developing an undergraduate clinical training module in Early Communication Intervention (ECI) that provides sufficient opportunity for students' learning experiences, and that allows contextually relevant and ethically accountable services to clients, as well as the dissemination of the latest scientific findings to both students and clients, poses a significant challenge. The article describes the development of a clinical training block and the development of an appropriate instrument for the assessment of neonatal communication skills that was used in this student practical. A qualitative research approach, employing a series of formative assessments, was used to refine the instrument. The results indicated changes in the content and use of the neonatal assessment instrument regarding the approach to infant and caregiver risk assessment; caregiver beliefs about neonatal capabilities; newborn state observation; caregiver training; language, cultural and age barriers; collaboration with nurses; kangaroo mother care; involvement of caregivers during the assessment; and adolescent mothers. The results confirmed the need for the ongoing refinement of an instrument to ensure quality training of students in the difficult field of neonatal assessments and neonate-caregiver interaction. The results also highlighted to the importance of initiating ECI services before birth in communities at risk for infant neglect and abuse, and the close relationship between ECI service delivery and student training.

Parental failure in captive cotton-top tamarins (Saguinus Oedipus).

Several New World monkey species experience high rates of infant mortality in captivity, and parental failure in the form of infant neglect and abuse is often regarded as one of the leading causes of this problem. We explored a large archival database to assess environmental, familial, and biological variables identified as significant for parental success in previous studies of captive tamarins, through several generations and across several dozen pedigrees. Using a stepwise multiple regression analysis we developed a model including the fewest variables able to identify statistically significant predictors of infant outcome. We found that seven independent variables could predict infant outcome in the colony. The most important appeared to be the presence of helpers with whom parents could share infant carrying. Mother's experience and litter size were two other variables that contributed to a significant extent to explaining parental failure. Moreover, the model showed that there is a measurable contribution to infant outcome due to the health status of both parents. Finally, we found a distinct role for mothers and fathers, and that parental failure follows different patterns for abuse and rejection.

Risk Factors for Infant Abuse and Neglect in Group-Living Rhesus Monkeys

This study investigated maternal abuse and neglect of offspring in a large population of rhesus monkeys over a period of 29 years. Abuse and neglect did not occur together and were associated with different risk factors. Infant abuse was concentrated in 8 of 57 families and among closely related females. Abuse was also repeated with successive offspring. In contrast, infant neglect was not affected by genealogical factors, was not repeated with successive offspring, and was displayed mostly by primiparous mothers. These results suggest that abuse and neglect may be different phenomena and that infant abuse in group-living monkeys could represent a good animal model for investigating the mechanisms underlying the intergenerational transmission of child maltreatment.

THE IMPACT OF PRENATAL DRUG EXPOSURE ON THE NEONATE

Several social or recreational drugs singly or together have demonstrated effects on the fetus and neonate, with those effects extending into adulthood. The use of recreational drugs during pregnancy remains a major health problem, with adverse effects including higher rates of fetal distress and demise, lower Apgar scores, growth retardation, and adverse neurodevelopmental outcome. Ethanol has the most profound effects, with physical stigmata of the drug seen in one third of exposed infants. In children without the affected physical appearance, profound neurodevelopmental sequelae have been demonstrated. Other drugs, such as cocaine, heroin, amphetamines, and nicotine, have been associated with impaired fetal growth and acute withdrawal during the neonatal period. Subsequently, these infants and children have an increased risk for altered neurodevelopment and long-term health status. Long-term follow-up and assessment are essential. The risk of neonatal withdrawal or abstinence syndrome is greatest with narcotic drugs but has been found to occur in neonates following exposure to cocaine, nicotine, and amphetamines. Early treatment with tincture of opium, paregoric, or phenobarbital is crucial. Assessment of the overall health status of the infant should include growth parameters, signs and symptoms of infection (especially hepatitis, syphilis, and immunodeficiency viruses), and neurobehavioral function. Such assessments should not be limited to the newborn period, as neurodevelopmental sequelae may not be manifest until later in infancy and childhood. In addition, evaluation of the social milieu is warranted because of the increased risk for neglect and abuse of drug-exposed infants and children. Early intervention, maternal drug rehabilitation treatment, and parenting classes are frequently prescribed, but their efficacy is variable. Further investigations should study the potential benefits of these recommendations.

The epidemiology of urban pediatric neurological trauma: evaluation of, and implications for, injury prevention programs.

To describe the incidence and causes of pediatric head, spinal cord, and peripheral nerve injuries in an urban setting and to assess the implications of these data for injury prevention programs. Pediatric deaths and hospital admissions secondary to neurological trauma included in the Northern Manhattan Injury Surveillance System from 1983 to 1992 were linked to census counts to compute incidence rates. Rates before the implementation of a nonspecific injury prevention program were compared with rates after the implementation, and rates for the target population were compared to rates for the control population. Rates were analyzed on the basis of the cause of injury as well as the age, gender, and neighborhood income level of the injured. The incidence of neurological injuries resulting in hospitalization or death was 155 incidents per 100,000 population per year; the mortality rate was 6 people per 100,000 population per year. Neurological injuries represented 18% of all pediatric injuries and accounted for 23% of all traumatic deaths. Spinal cord and peripheral nerve injuries were relatively rare (5%) compared to head injuries (95%). Minor head injuries, including isolated cranial fractures, minor concussions (<1 h loss of consciousness), and unspecified minor head injuries, accounted for the majority of neurological injuries (76%), whereas severe head injuries, including severe concussion (>1 h loss of consciousness), cerebral laceration/contusion, intracerebral hemorrhage, and unspecified major injuries, were less common (18% of all neurological injuries). Boys were more often affected than girls at every age, and this preference increased with age. Children younger than 1 year showed the highest incidence of both major and minor injuries. One- to 4-year olds showed the lowest rates, with steady increases thereafter. Traffic accidents and falls were the leading causes (38 and 34%, respectively), and assaults were the next leading causes (12%). Among children admitted to surveillance system hospitals, falls were most common in children younger than 4 years, pedestrian motor vehicle accidents were most common in late childhood, and assaults were most common in early adolescence. fatality rates were 5 to 7% for all age groups except 5- to 12-year-olds, for whom the case:fatality rate was 1.9%. Residence in a low-income neighborhood was associated with an increased risk of injury (rate ratio, 1.71; confidence interval, 95%, 1.54, 1.89). The average hospitalization cost per injury was $8502. Medicaid (54%) and other government sources (5%) covered the majority of expenses, including indirect reimbursement of usually uncollected self-pay billing (19%). Although injury incidence rates fell in both the control and intervention cohorts during implementation of a nonspecific injury prevention program, targeted age and population groups demonstrated greater relative reductions in injuries than nontargeted ones, suggesting a positive effect. Deaths and hospital admissions secondary to pediatric neurological trauma represent a significant public health problem, with the majority of the direct cost being born by government agencies. Future efforts to prevent neurological trauma in children who live in inner cities should focus on families with low incomes and provide novel education programs regarding infant abuse, infant neglect, and infant injury avoidance. Age-appropriate school-based programs should also be developed to address traffic safety and conflict resolution.

Infant abuse and neglect in monkeys--a discussion of definitions, epidemiology, etiology, and implications for child maltreatment: Reply to Cicchetti (1998) and Mason (1998).

Infant abuse and neglect in monkeys--a discussion of definitions, epidemiology, etiology, and implications for child maltreatment: Reply to Cicchetti (1998) and Mason (1998).

New views on education for maternity care providers

M onumental changes are currently occurring in the organization and provision of health care to Americans, creating both the need and the opportunity for changes in the education of health care providers. This is especially true for providers of maternity care because the criticisms of current US health care tend to focus on our comparatively high infant mortality rates, our problems with unintended pregnancy with resultant infant neglect and child abuse, and the maleorientation of our health care research in the past. This article argues for dramatic changes in the way we train caregivers for mothers and babies following on proposed broad changes in maternity care itself.

On the function of swaddling as traditional infant-care practiced by Native South Americans

Placing the infant in a device which restrained his/her movement was a traditional custom of infant caretaking in a number of parts of the world, and is still observed in some of them. An example of such practices, swaddling, was investigated with Native Americans, the Aymara, in Bolivia, and caretaking behaviors in 24 swaddling and 18 non-swaddling families were compared. Results did not support the notion that swaddling was a form of infant neglect on the part of caretakers. Swaddling caretakers actually exhibited as strong interest in the infant as non-swaddling caretakers, and spent more money on his/her clothes. The mother spent less time for infant care in the swaddling family. However, other members of the family took more time to take care of the infant than those in the non-swaddling family. It is argued that swaddling effectively encourages non-mother family members to participate in infant caretaking, in addition to serving a potentially beneficial function to protect infants from unsafe and unsanitary home environments.

Difference and Danger: The Cultural Dynamics of Childhood Stigma, Rejection, and Rescue

This paper presents a brief overview of some cultural, ecologic, and demographic influences on the treatment and maltreatment of infants and children with congenital anomalies. Based on research on the selective neglect of infants leading to death in parts of the developing world, it is suggested that such practices be viewed as "ethno-eugenic" survivalist strategies altogether distinct from malicious child abuse and neglect in the modern, industrialized world. Caution with respect to heroic (and not so heroic) medical interventions and "child saving" in the contexts of both developing and modern societies is stressed.

Cotton-top tamarins (Saguinus (o.) oedipus) in a semi-naturalistic captive colony.

To test the prediction that the breeding success of captive cotton-top tamarins (Saguinus (o.) oedipus) could be improved by maintaining them in groups whose size and age-sex composition resembled those of wild groups, data were collated from 6.5 years of records from a breeding colony that otherwise had housing and husbandry procedures similar to those of other successful colonies. Group size and composition in the colony closely resembled those of wild groups, and infant survival was the highest yet reported for the species, with 69% of the 124 infants born reared by their parents to adulthood, and a mean surviving litter size of 1.5 infants. Abortion, stillbirth, and parental neglect of infants were rare. Parity had several effects on reproduction: mean litter size decreased, but percentage infant survival increased; interbirth intervals decreased in length; and seasonality in reproduction was more pronounced for the first four litters born to breeding females than for their subsequent litters, with a birth peak in the spring. Although a spacious and complex physical environment, retention of offspring in their natal families until experience of several sets of infant siblings had been obtained, and non-invasive husbandry and research techniques may all have contributed to the colony's success, it seems possible that the improvement over other colonies is due to the resemblance of group composition to those of wild tamarins.

Severely Handicapped Infants with Life-Threatening Conditions: Federal Intrusions Into the Decision Not To Treat

In recent years the federal government has attempted to intervene in certain family-medical decisions to withhold treatment from seriously handicapped newborns with life-threatening conditions. Invoking section 504 of the Rehabilitation Act of 1973, which prohibits discrimination against "otherwise qualified handicapped" individuals, the Reagan Administration promulgated regulations allowing federal government investigations of such decisions. Recently, the U.S. Supreme Court upheld lower court decisions invalidating these "Baby Doe" regulations. The federal government's fall-back position is reflected in the Child Abuse Prevention and Treatment Amendments of 1984, requiring states accepting funds under the Child Abuse Prevention and Treatment Act to establish and maintain procedures to assure that cases of medical neglect of handicapped infants are investigated by the states. Although the primary oversight of parental decision-making has been returned to the states where it has traditionally belonged, the federal government's definition of medical neglect of handicapped infants with life-threatening conditions is an ethically inadequate response to the complex needs of the handicapped child, the family, the medical profession, and society as a whole. After examining the relevance of Kantian, utilitarian, and Rawlsian ethical positions, the author contends that an effective governmental policy, capable of enforcement and acceptance by the public, must utilize the strengths of each philosophy and reflect the pragmatism of American society.

Is child abuse a human instinct?

The modern concept of instinct maintains that certain physical signs or events trigger the release of appropriate behavioural responses. According to Konrad Lorenz and other ethological theorists, the features and proportions of the infant body and face convey a sense of cuteness which releases a protective human instinct. Members of the Lorenz-Tinbergen school may also regard violent crime or war as manifestations of aggressive drives. A survey of medical and sociological literature shows that the rate of abuse and neglect of infants and children is higher than violent crimes against adults, which reveals a contradiction in basic premises.

The plight of female infants in India.

For most human populations the infant mortality for males is about 20-30% higher than for females. But in several States of India male infants experience a better survival than females. Many social, religious, and economic factors appear to operate against females throughout India. In the agriculturally prosperous States of Haryana and Punjab the neglect of female infants appears most severe; it is estimated that more than 10 000 die of neglect every year. Additional reasons could well be deeply rooted in the turbulent history of north-western India, which has borne the brunt of savage invasions through Afghanistan for several centuries. These areas have not seen peace for the last 1000 years.