Infant Observation Research Articles

Blood culture time to positivity in febrile infants with bacteremia.

Blood cultures are often obtained as part of the evaluation of infants with fever and these infants are typically observed until their cultures are determined to have no growth. However, the time to positivity of blood culture results in this population is not known. To determine the time to positivity of blood culture results in febrile infants admitted to a general inpatient unit. Multicenter, retrospective, cross-sectional evaluation of blood culture time to positivity. Data were collected by community and academic hospital systems associated with the Pediatric Research in Inpatient Settings Network. The study included febrile infants 90 days of age or younger with bacteremia and without surgical histories outside of an intensive care unit. Blood culture growing pathogenic bacteria. Time to positivity and proportion of positive blood culture results that become positive more than 24 hours after placement in the analyzer. A total of 392 pathogenic blood cultures were included from 17 hospital systems across the United States. The mean (SD) time to positivity was 15.41 (8.30) hours. By 24 hours, 91% (95% CI, 88-93) had turned positive. By 36 and 48 hours, 96% (95% CI, 95-98) and 99% (95% CI, 97-100) had become positive, respectively. Most pathogens in febrile, bacteremic infants 90 days of age or younger hospitalized on a general inpatient unit will be identified within 24 hours of collection. These data suggest that inpatient observation of febrile infants for more than 24 hours may be unnecessary in most infants.

Medical and Surgical Management of Congenital Laryngomalacia: A Retrospective Case‐Control Study

Objectives: Compare the growth of infants with moderate to severe laryngomalacia who underwent supraglottoplasty to the growth of those treated with medical therapy alone. Methods: Retrospective case-control chart review of patients treated between 2008 and 2013 in a tertiary care pediatric otolaryngology practice. 51 infants newly diagnosed with moderate to severe congenital laryngomalacia were included. A total of 17 infants underwent supraglottoplasty and 34 matched controls had medical management, which included acid suppression therapy, speech and swallowing therapy, and/or high-calorie formula. The primary outcome measure was weight percentile recorded at the second clinic visit and at the last available follow-up. The secondary outcomes were the need for tracheostomy or gastrostromy, development or persistence of failure to thrive, surgical complications, and new onset developmental delay. The management strategy was considered a success if none of the secondary outcomes occurred. Results: There was no difference in the mean weight percentile between the surgical and nonsurgical groups at the time of last follow-up ( P = .89). Twenty-nine (85%) patients in the medical management group and 12 (71%) in the surgical group were managed successfully. There were no statistically significant differences in the success rate between groups ( P = .27). Conclusions: Medical management and close observation of infants with moderate to severe congenital laryngomalacia may be a viable alternative to supraglottoplasty.

Infant observation – a source of knowledge about personality development

Infant observation – a source of knowledge about personality development

The uncomfortable subject: observing the Indian girl child

This paper uses material from an infant observation to explore the place of women in Indian social hierarchy. This theme was introduced in a previous paper, which outlined the experience of setting up an infant observation seminar in Delhi, India. The infant observation seminars, part of a psychotherapy training programme at Ambedkar University, Delhi, provided a setting in which the observer was able to make close, sometimes uncomfortably close, contact with her infantile self and her own unresolved conflicts. The most powerful of these conflicts was aroused by the issue of gender and the form it takes in Indian society; outside yet internal, simultaneously reverberating through the inner world, individual relationships and shared ordinary daily interactions.

The relevance of infant observation for early intervention: containment in theory and practice

This paper explores the links between the practice of Infant Observation as a mode of study of early development, and a means of training future clinicians and others, and its potential use in research and early intervention, particularly in respect of risk. Material from an infant observation undertaken as part of a clinical training is quoted before moving on to two illustrations of babies at risk – one of developing autism, and the other, a baby in foster care, observed as part of a research project into what happens to babies taken into care. Both illustrations are observation-based interventions, rather than pure observations, and are seen as providing good evidence for development of the practice to support healthier development in vulnerable infants and to enrich the understanding of social workers and others who take significant decisions about the lives of young children.

Can you read the writing on the wall: what needs to happen for a researcher to see what she is observing?

This article describes and evaluates the use of infant observation to study children's transitions to infant school in Switzerland. Vignettes from observations are cited in order to illustrate the nature of the observations, and excerpts from the students' notes are examined to analyse the interpretations she made. We discuss these two sets of findings to show some of the pitfalls of using infant observation when the researcher has not been trained in it, and there is no weekly seminar to support the emergence of insight into the experience of the children observed.

From Infant Observation To Parent-Infant Treatment: The Anni Bergman Parent-Infant Training Program

A collection of recent papers from The Anni Bergman Parent-Infant Training Program has been assembled for this edition of the Journal of Infant, Child, and Adolescent Psychotherapy. We were asked b...

Moments of Loneliness: A Shared Experience of Learning from Impasse in Couple Therapy

In this paper, the author describes how she works with two theoretical ideas not commonly referred to by couple therapists: Klein's views on loneliness and Bion and O'Shaughnessy's concept of the absent object. She also weaves in Winnicott's theory of how the baby develops the capacity to be alone. Theoretically, her ideas are embedded in the British Object Relations School as well as her experiences as a couple and family therapist, a teacher of the Tavistock model of infant and young child observation, and day-to-day practice as a psychoanalyst. The author illustrates how she works within the transference-countertransference matrix to detect and name disturbing moments of loneliness. Clinical vignettes show how couples are assisted in uncovering the unconscious phantasies that push them into mutually hostile states of mind and which, in an instant, destroy feelings of goodness within and between them. While the author focuses on her work with couples, the approach is applicable in many clinical situations.

Sequential observation of infant regulated and dysregulated behavior following soothing and stimulating maternal behavior during feeding

To describe maternal behaviors occurring before infant regulated or dysregulated behavior at three times in early infancy and examine behavioral patterns over time with their prematurely born infants. Video recordings of 37 dyads were coded on infant regulated and dysregulated behaviors following maternal soothing and stimulating behaviors. At each time, infants showed more regulation after maternal soothing than after maternal stimulating. Further study is merited. Knowing infant regulation and dysregulation following categories of maternal behavior could help mothers anticipate infant regulatory or dysregulatory behavior in response to their own behavior and identify supportive caregiving strategies.

Who observes whom? Infant observation observed: an experience of setting up an infant observation skills training in India

This paper describes the travails of setting up an infant observation seminar as part of a psychotherapy training course in Delhi, India. It focuses on the attempts of potential observers to find suitable infants and explores the difficulties faced when setting up these observations, by placing them in a cultural context. The paper also discusses the meaning of Nazar, (the Evil Eye) and the place of women in society in India. The paper brings attention to the suspicion with which infant observation is viewed and explores why this is and how to make it less so, in order that observation can become more acceptable and useful in the Indian sociocultural context.

Infant observation as part of a training programme for psychoanalysts in Sweden: candidates' expectations and experiences

This paper describes a study involving 46 candidates undertaking infant observation as part of a training programme for psychoanalysts in the Swedish Psychoanalytic Association, over a 10-year period. The study builds on the candidates' statements about their expectations and experiences before and after having undertaken an infant observation. The results show that a six-month observation, compared with traditions of one-year observations in other psychoanalytic trainings, is of significant importance in enhancing their understanding of psychoanalytic theory as well as of clinical work with an emphasis on the setting and observing the transference and counter-transference. The paper also discusses the role of infant observation in forming the professional identity of a psychoanalyst.

The role of infant observation in developing the capacity of workers with refugee and asylum-seeking families in France

The paper describes an outreach project, set up as a collaborative endeavour between a centre for asylum seekers in a town to the east of Paris and a child guidance clinic; the project's aim was to understand and address the emotional needs of asylum-seeker children, in which close observation played a central role. It presents the rationale for developing a project that supported the workers' confidence in their capacity to think about and respond to the needs of the children in their care, and goes on to present a detailed analysis of the particular emotional needs of the children and their families. The paper also describes the weekly playgroups that the workers set up for traumatised children and adolescents in which the presence of an observer helped them to remain emotionally receptive in their work with highly traumatised families. Observational vignettes illustrate some of the insight gained about the children's behaviour and difficulties. Monthly work discussions of observations supported the workers' capacities to work with the children, and helped them to shape a new way of working using observation and a psychoanalytic frame; two workers evaluated the work and the ways in which both team and children were helped.

What Can We Learn through Careful Observation of Infants and Toddlers in Nature?

The authors describe a yearlong investigation, initiated by an intern teacher at Boulder Journey School, a school for young children in Boulder, Colorado. The teacher-researcher, noting that most of the current research on children and nature focuses on children ages 3 and older, carefully observed and reflected on the interactions of the infants in her class in nature. Her initial guiding questions about infants and nature were: What do infants do outside? Do they behave differently outside than inside? Do they interact differently inside versus outside with the same materials? Can we see differences between their interests and interactions with natural versus manmade materials? This observational research, conducted during the school year 2011–12, led to several other school-wide outdoor investigations, including a project in collaboration with Nature Explore, which are described in the article.

What Can We Learn through Careful Observation of Infants and Toddlers in Nature?

What Can We Learn through Careful Observation of Infants and Toddlers in Nature?

Shaping and misshaping (French: ‘Formation et deformation’) during clinical training: some reflections on the impact of infant observation on the clinical paradigm

The author reflects on clinical training in psychoanalysis and psychodynamic psychotherapy and on the impact of including infant observation as first developed by Esther Bick, in such trainings. The exploration of training (formation) implies both the shaping and the risk of some misshaping of the clinician. The question of balance between learning from the personal experience of observation, having an analysis, practical experience and didactic learning is also considered. In some parts of the world, the author suggests that students are not able to observe babies and small children in their family setting which also influences their perspective since institutional observation and placements are inevitably very different.

Prevention of Infant’S Otic Barotrauma – Observing the Infant Prior to Air Travel and Identifying Infants Less Likely At Risk

Otic barotrauma is a potential risk for travelers using commercial aircraft. A significant proportion of passengers are infants. No literature exists regarding pre-flight assessment for prevention of barotrauma in infants due to air travel. Infants are preverbal in their development and cannot communicate their distress with words, though will show age-typical distress and pain responses. Pain and concomitant trauma, where possible, are ideally prevented. This paper suggests that it may be possible for parents to detect prior to flight whether their infant is likely to suffer pain from Eustachian tube malfunction with in-flight cabin pressure changes. This may be achieved by co-incidental observation of infants and their subsequent distress with small rapid air pressure change, such as in rapid elevator ascent/descent, which elicits ear popping in the parents. This may help predict a healthy infant's response to change in air pressure during air travel. A case example is given. Barotrauma in the context of the infant's neuropsychology is described and relevant literature to the topic is reviewed.

The early development of a thinking mind: a one-year infant observation

The author uses the one-year infant observation to illustrate the development of his mind and imagination, and tracks early signs of the development of the capacity to think. This is related to many good experiences with his mother, the primary carer and father, which he internalises over time, in identification with them. Bion's Theory of Thinking and Klein's work on the epistemophilic instinct both link with the capacity to tolerate being a separate person and to make use of internalised experiences and objects when carers are not present. The baby boy's mental development over one year is impressive; this is linked to his mother's capacity to think about him which is linked with an evident experience of feeling understood as well as cared-for.

James Astor in conversation with Warren Colman

In this interview with Warren Colman, James Astor speaks about his development as a Jungian analyst from his own experience of personal analysis in the 1960s to his recent retirement from clinical practice. The discussion covers his long association with Michael Fordham, the child analytic training at the SAP, the infant observation seminars with Fordham and Gianna Henry through which Fordham was able to make new discoveries about infant development, his experience of supervision with Donald Meltzer and the development of his own thinking through a series of papers on the analytic process, supervision and the relation between language and truth. The interview concludes with reflections about the legacy of Michael Fordham and the future of analytic work.

‘The Parental Couple’: Françoise Dolto and Jacques Lacan: Contributions to the Mirror Stage

This paper aims to sketch a comparison of the different and sometimes complementary approaches of Lacan and Dolto to the theory of becoming a subject – through bringing to light Dolto's clinical contributions to the Mirror Stage – and the development of her own theory on the Unconscious Image of the Body. This paper makes extensive use of the correspondence between Dolto and Lacan published in 2005, as well as of the references they made to each other in their written work. Both have a Freudian theoretical background, but Dolto's theories are built upwards from the observation of infant and child development as well as from their treatment, whilst Lacan's stems from adult psychoanalysis, the re-reading of Freud's cases and structural anthropology and linguistics. Through this paper I hope to bring to the Anglo-Saxon attention the fascinating seminal interaction of this famous French ‘parental couple’.

Ontogeny and control of the heart rate power spectrum in the last third of gestation in fetal sheep

Power spectral analysis of fetal heart rate variability has been proposed to provide a non-invasive estimate of autonomic balance. However, there are few systematic data before birth. We therefore examined developmental changes in the frequency power spectrum at very low (0-0.04 Hz), low (0.04-0.15 Hz) and high frequencies (0.15-0.4 Hz), as well as the ratio of low- to high-frequency power (LF/HF), in chronically catheterized, healthy fetal sheep at 0.6 (n = 8), 0.7 (n = 7) and 0.8 gestational age (ga; n = 11). In a second study, 0.8 ga fetuses received either atropine (4.8 mg bolus, then 4.8 mg h(-1) for 30 min, n = 6) or 6-hydroxydopamine (20 mg ml(-1) at 2.5 ml h(-1) for 3 h; n = 9). Data were analysed by sleep state, defined by low-voltage-high-frequency (LV) or high-voltage-low-frequency (HV) EEG. Total spectral power increased with gestational age (P < 0.05), while LF/HF decreased from 0.6 to 0.7 ga. At 0.8 ga, heart rate and LF/HF were significantly higher during HV than LV sleep (P < 0.05). Consistent with this, although total spectral power was not significantly greater during HV sleep, there was a significant interaction between sleep state and frequency band (P = 0.02). Both atropine (P = 0.05) and 6-hydroxydopamine (P < 0.05) were associated with an overall reduction in spectral power but no significant effect on the LF/HF ratio. This study does not support substantial, consistent differences between the frequencies of sympathetic and parasympathetic activity in late-gestation fetal sheep.