ABSTRACT
Resumen Este estudio tuvo por objetivo examinar las prácticas de crianza (PRC) y su asociación con el desarrollo infantil, psicomotriz y mental, en niños con distinta condición nutricia provenientes de dos entidades federativas de México: Sonora (ES) y Estado de México (EM). Participaron 24 díadas cuidador-hijo, 12 del ES y 12 del EM. La edad de los niños (8 mujeres y 16 varones) fue de los 6 a los 19 meses (M = 10.2, DE = 3.1), quienes fueron evaluados mediante las Escalas de Desarrollo de Bayley. Los cuidadores aportaron datos sociodemográficos y de historia de salud del niño, además de responder el Cuestionario de Práctica Responsiva y Estimulación (CuPRE). Los resultados mostraron relación entre el estado de nutrición (EN) y el orden de nacimiento, así como la edad y escolaridad de los padres; entre el desarrollo infantil y las PRC, así como de éstas con la edad y el orden de nacimiento del niño. De las PRC evaluadas, solo la duración de la lactancia se asoció con el EN. De acuerdo con la procedencia de los participantes, fueron identificadas diferencias en las PRC y en las variables asociadas a éstas. Los resultados sugieren relaciones interesantes que, sin embargo, deberán ser corroboradas a partir del planteamiento de modelos a probar en futuros estudios.
Abstract The objective of this study was to examine the child-rearing practices (CRP) and its association with infant psychomotor and mental development in children with different nutritional status from two states in Mexico: Sonora (S) and State of Mexico (SM). A total of 24 pairs caregiver-child, 12 from S and 12 from SM (8 girls and 16 boys) with an age range of 6 to 19 months (M = 10.2, SD = 3.1) were evaluated using the Bayley Development Scales. Caregivers offer sociodemographic data and child's health history, in addition they answered the Questionnaire of Responsible Practice and Stimulation. The results showed a relationship between the state of nutrition (SN) and birth order, as well as the age and schooling of parents; between child development and CRPs, as well as the child's age and birth order. Of the CRPs assessed, only the breastfeeding duration was associated with SN. According to the origin of the participants, differences were identified in the CRP and in the variables associated to them. The results su ggest interesting relationships that should be confirmed on the approach of models tested in future studies.
ABSTRACT
En este trabajo, el autor, considera los aportes de Peter Fonagy y su conceptualización de la mentalización en la comprensión y tratamiento de los pacientes limítrofes. Fonagy psicoanalista de formación empírica ha desarrollado una teoría psicoanalítica en la cual integra la teoría del apego con conceptos winnicottianos y bionianos, aportando descripciones operacionalizables que han permitido el testeo empírico de estas ideas y una mejor comprensión del funcionamiento mental de pacientes con trastornos graves de la personalidad.El concepto de mentalización es central en la teoría de Fonagy. En este trabajo se lo define y se describe en forma sucinta la teoría del desarrollo mental que lleva a adquirir esta función. Este logro necesita de una relación de apego que permita al niño internalizar aspectos del cuidador necesarios para simbolizar, autoregularse y finalmente a mentalizar. El fallo frecuente de esta función, sobre todo cuando se activan relaciones de apego, es lo que caracteriza a los pacientes que llamamos limítrofes.Para concluir, se hace una breve comparación de similitudes y diferencias entre la teoría de Otto Kernberg y la de Peter Fonagy.
The author, in this paper, considers the work of Peter Fonagy and his development of the concept of mentalization in the understanding and treatment of borderline patients. Fonagy ,psychoanalyst with strong empirical background, has developed a psychoanalytic theory that integrates attachment theory with winnicottian and bionian concepts, giving them operational descriptions which has allowed empirical testing of these ideas and a better understanding of the mental functioning of patients with severe personality disorders. Mentalization is Fonagys theory main concept. This paper defines it and describes briefly the childs mental development which culminates with the acquisition of this function. This achievement needs an attachment relationship which allows internalization of caregiver aspects, necessary to symbolize, self-regulate and finally mentalize.Frequent failure of this function, especially when attachment relationships are activated, is characteristic of patients called borderline.Finally, there is a brief comparison of similarities and differences between Kernbergs and Fonagys theory.
Subject(s)
Humans , Borderline Personality Disorder , Psychoanalysis/methods , Psychotherapy/methods , Theory of Mind , Human Development , Object AttachmentABSTRACT
Introduction The study of the possible protector factors and the risk factors can favour or harm women during pregnancy, and so, the infant during the pre- and post-natal periods, has today become a necessary and a high priority objective of world health. In agreement with this proposal, carrying out follow-up programs to prevent, detect and treat consequences in infant development is one of the objectives of Early Care (EC). The follow-up is the way to verify whether the development of the child is occurring within the guidelines of normalcy, or if there is a suspicion that he may be suffering from delays. In order to do this in an appropriate way, one of the necessary conditions is to have access to the tables and instruments that include up-to-date parameters of the course of overall development in the normal population. If the detection and follow-up of risk populations is a key task in the context of early attention, so are the longitudinal studies that use the normal population as the focus of their study. Currently, in various countries in the European Union, important follow-up studies are being carried out of a multi-disciplinary nature (EARNEST Project, NUHEAL Project, and Spanish INMA Network), with the purpose of evaluating the development of the child in general and, specifically, his mental development. These studies take into account, among others, a series of parameters that contemplate the eating habits of the mother, exposure to environmental contaminants, styles of care and the physical, mental and social follow-up of the development of the children up to ages that include adolescence. One of the factors associated with mental development is psychomotricity. The psychomotor development refers to the acquisition of skills observed in the child in a continuous way throughout childhood, and it is associated, on the one hand, with the maturing of the Central Nervous System (proliferation of the dendrites, synaptogenesis and the myelinazation of the axons) from the first months of life up to the age of two. This maturation process has a pre-established order and a clear and predictable sequence: the progress is in a cephalocaudal sense and from proximal to distal. On the other hand, the psychomotor development is also associated with the learning done by the baby and the child in their interactions with themselves and their surroundings, with the affective links they establish based on the affect and stability of the care received and the perception of everything around them (people, images, sounds, movement…). These conditions are determinants in the emotional development, communicative functions, adaptive behaviours and attitude toward learning. It has been proposed that the psychomotor development precedes the mental development and forms the base on which it is established. And although it must be kept in mind that there are degrees of individual variation in normal psychomotor development, depending on the interaction between genetic and environmental factors, it can be said that full term babies who are born healthy follow a pattern of development or skills acquisition. This pattern is clear, and basic milestones have been defined that are easy to measure and that make it possible to know when a child is progressing satisfactorily. In these children, the rhythm of psychomotor development in the first two years of life is quite rapid. At six to seven months, they can sit and crawl; at eight to nine months, they stand up; and at 10 to 12 months, they walk with help. Through their movements and manipulations, they are exploring, imitating, learning and understanding. It is important to observe and rigorously follow the way the psychomotor development is occurring and being established in children because it may provide us with early indications of possible consequences in some parameters of their mental development. Another factor that is related to the mental development, in addition to the psychomotor development, is the somatic growth or development of the child. Numerous studies show how the weight, length and cephalic perimeter are predictors of disorders in development in the case of a risk, high-risk and/or clinical population with established problems and diverse associated pathologies. Therefore, these measures of growth constitute essential parameters to keep in mind for an early intervention in the deviations and disorders in development. In this study, it has been proposed the need to verify whether this relationship of prediction between somatic growth and psychomotor and mental development also occurs in populations of healthy children. The main objective of this study was to describe the evolution of the neurodevelopment in healthy children from the sixth to the 20th month of life. We now present the results of a part of the follow-up from the NUHEAL Project. Material and method The sample studied was composed of 66 (32 boys/34 girls) full-term, healthy infants, with a weight at birth appropriate for their gestational age, born at the San Cecilio Clinical University Hospital in Granada. All of their mothers were participants in the NUHEAL project, and they did not received docosahexaenoic acid and eicosapentaenoic acid supplements. To evaluate the neurodevelopment of the infants, the Bayley Scales of Infant Development (BSID) were used at six months (6.22±0.29) (n:66) and at 20 months (19.56±1.17) (n:56). The evaluation was performed by a psychologist who had been trained for this. The BSID evaluates three aspects of development: motor development, mental development and the behaviour of the child. It provides an index of mental development (MDI) and an index of psychomotor development (PDI). In addition, an evaluation of the somatic or anthropometric development was also performed by an expert paediatrician, taking into account the following variables: weight, height, cephalic and thoracic perimeter at birth, at six months of age and at 20 months. The local Ethical Committee of the University Clinical Hospital "San Cecilio" of Granada approved the study protocol. After a careful explanation of the study details, written informed consent was obtained from all participating women. Results The preliminary data obtained in this study showed that the psychomotor development of the children was greater than the mental development, at both six and 20 months of age, with the mean from the Psychomotor Development Index (PDI) being (107.95±11.70 vs 125.39±10.51) at six and 20 months, respectively, and the mean from the Mental Development Index (MDI) being (97.73±9.14 vs. 119.64±12.41) at six and 20 months of age. The results showed that the MDI at 20 months was greater in those children who had a greater PDI at six months, (F(1. 52)= 4.27; p<0.044). No statistically significant relationships were found between the anthropometric data at six months and the EBDI development indices (MDI and PDI) at 20 months of age.
Introducción El estudio de los posibles factores tanto protectores como de riesgo que puedan favorecer o dañar a la mujer durante el embarazo y, por tanto, al niño en el período prenatal y postnatal, se ha convertido hoy en una necesidad y en un objetivo prioritario de salud mundial. Uno de los objetivos de la Atención Temprana es la realización de programas de seguimiento para prevenir, detectar y tratar secuelas en el desarrollo infantil. El seguimiento es el modo de comprobar si el desarrollo se está produciendo dentro de unas pautas de normalidad. Si la detección y el seguimiento de poblaciones de riesgo son unas tareas claves en la atención temprana, no lo son menos la realización de estudios longitudinales que toman a la población normal como objeto de estudio. Actualmente, en diversos países de la Comunidad Europea se están llevando a cabo importantes estudios aleatorizados con seguimiento longitudinal (proyectos NUHEAL, EARNEST, Red de Excelencia INMA) para evaluar el desarrollo global de los niños sanos y el desarrollo mental, en particular. Dentro de los factores asociados al desarrollo mental se encuentran el desarrollo psicomotor y el desarrollo somático. Numerosos estudios muestran que el peso, la talla y el perímetro cefálico son predictores de trastornos del desarrollo cuando se trata de una población de alto riesgo o con alguna patología. El objetivo principal de este estudio es describir la evolución del neurodesarrollo en niños sanos desde el sexto al vigésimo mes de vida. En este artículo se presentan parte de los resultados del Proyecto Europeo NUHEAL. Material y método Se estudiaron 66 bebés sanos (32 niños / 34 niñas), nacidos a término, con peso al nacimiento apropiado para la edad gestacional, que fueron reclutados en el Hospital Clínico Universitario "San Cecilio" en Granada y cuyas madres eran participantes del proyecto NUHEAL pero que no recibieron suplementación de ácido docosahexaenoico y ácido eicosapentanoico. Se les realizó evaluación del neurodesarrollo a los seis (n:66) y 20 (n:56) meses de edad utilizando las Escalas Bayley de Desarrollo Infantil (EBDI). Estas escalas proporcionan un índice de desarrollo mental (IDM) y un índice de desarrollo psicomotor (IDP). Igualmente se realizó evaluación del desarrollo somático, mediante el estudio antropométrico de las siguientes variables: Peso, talla, perímetro cefálico y torácico al nacimiento, a los seis y 20 meses de edad. El protocolo del presente estudio fue aprobado por el Comité Ético local del Hospital Clínico Universitario <
ABSTRACT
La deficiencia de hierro es el trastorno hematológico más frecuente alrededor del mundo y afecta a 2,000 millones de personas aproximadamente, de los cuales 77 millones viven en América Latina y el Caribe. La deficiencia de hierro tiene un espectro que va desde la reducción y agotamiento de las reservas de hierro, hasta la reducción de las células rojas y de la concentración de hemoglobina. En consecuencia, hay deficiencias de hierro sin anemia. Los niños son uno de los grupos más vulnerables a esta deficiencia, debido al rápido período de crecimiento cerebral, en especial durante los dos primeros años de vida. El hierro es uno de los principales sustratos que soportan y permiten el desarrollo y la actividad metabólica de múltiples procesos a nivel cerebral, entre los cuales se encuentra el proceso de mielinización. Una insuficiente disponibilidad de hierro en un período de alta incorporación de éste en el tejido cerebral, que coincide con el período de mielinización del tejido nervioso, puede proveer una base fisiológica para explicar los efectos conductuales observados cuando hay deficiencias del micronutriente. De la misma manera, la deficiencia de hierro afecta la regulación y la conducción de neurotransmisores como la serotonina, la dopamina y GABA. La alteración de los receptores y transportadores de dopamina, compromete en los infantes las respuestas afectivas y el funcionamiento cognoscitivo, y los de los receptores GABA, la coordinación de patrones de movimiento y memoria. La importancia consiste que cuando ocurre un déficit de hierro cerebral en etapas tempranas, los daños ocurridos persisten en la etapa adulta, más allá de la recuperación de la anemia durante los primeros meses de vida.
The iron deficiency is the more frequent hematological dysfunction around the world and it affects approximately to 2000 million people, of which 77 millions live in Latin America and the Caribbean. The iron deficiency has a spectrum that goes from the reduction and exhaustion of the iron reservations, until the reduction of the red cells and of the hemoglobin concentration. In consequence, there are iron deficiencies without anemia. The children are one of the most vulnerable groups to this deficiency, due to the quick period of cerebral growth, especially during the first two years of life. Iron is one of the main substrates that support and allow the development and the metabolic activity of multiple processes at brain, among which is the myelination process. An insufficient iron readiness in a period of high incorporation of this in the cerebral fabric, coinciding with the myelinization period of the nervous fabric, can provide a physiologic base of explanation to the observed behavioral effects when there are deficiencies of the micronutrient. In the same way, the iron deficiency affects the regulation and the neurotransmitters conduction of serotonin, dopamine and GABA. Alteration of the receivers and dopamine transporters, imply in the infants the affective answers and the operation cognitive, and those of the receiving GABA, the coordination of movement patterns and memory. The importance consists that when it happens a deficit of cerebral iron in early stages, those damages persist in the adulthood, beyond the recovery of the anemia during the first months of life. These cerebral alterations are reflected long term in a delay of the mental and physical development of the children that they have had anemia, and its consequence of minor r school acting, with high levels of repetition of grades and desertion of the primary school in economically poor communities. However, the results of the diverse investigations carried out in this fiel.
Subject(s)
Child , Anemia , Child , Cerebrum/growth & development , Mental Processes , Psychomotor Performance , UnderachievementABSTRACT
Objetivos: Describir las pautas de interacción de dos familias con VIH/SIDA con la infección ubicada en los padres y evaluar a dos niñas de estas familias en su organización conductual alrededor de los cuarenta días de vida y el desarrollo mental y motor a los seis y doce meses de edad. Material y métodos: A través del genograma se evaluaron los sistemas familiares de dos niñas, hijas de padres infectados por VIH/SIDA; las pequeñas, a su vez, fueron evaluadas con la Escala de Conductas Neonatales de Brazelton (NBAS) entre los 39 y 44 días después del nacimiento y a través de las Escalas de Desarrollo de Nancy Bayley (BSID-II) a los seis y doce meses de edad. Resultados: En los dos casos la organización familiar corresponde a una pareja de adultos-jóvenes con VIH positivo en etapa de bebés y con hijos no enfermos; en el primer caso la madre se define como la transmisora; en el segundo el padre. Hay un debilitamiento en el subsistema de los padres. Las relaciones de parejas de los padres presentan ambivalencias. A medida que la VIH/SIDA avanza, las alianzas dividen a las familias y excluyen de la colaboración contra la enfermedad a varios miembros, lo que sobrecarga a las abuelas maternas. Las jerarquías y los límites son difusos, lo cual impide una contención estable y firme a los hijos. Las dos familias se encuentran estancadas en la etapa de estrés situacional. En el NBAS las dos lactantes obtuvieron una ejecución de buena a excelente (puntajes 7, 8 y 9) en los diferentes conglomerados; en el BSID-II, se advirtió que en ambos casos, en los primeros seis meses el desarrollo mental y motor cursó dentro de los límites normales; mientras que a los 12 meses el primer caso continuó con un desarrollo normal y en el segundo no fue posible evaluar con precisión el desarrollo, debido a una conducta de oposicionismo. Conclusiones: Ambos sistemas familiares presentan una organización con enfermo crónico y en particular con VIH-SIDA. Este estudio nos muestra que la evaluación en el desarrollo motor y mental de las dos niñas cursa conforme a lo esperado y que en la organización actual existe la estructura familiar con un proceso de parentalización (inversión de roles) y desamparo para las niñas.
Objective: To describe the family patterns of interaction of two girls born to parents infected with AIDS/HIV, and their behavioral organization around forty days, also the mental and motor development at six and twelve months. Methodology: The two family systems of the two girls with both parent infected by AIDS/HIV, were evaluated using a genogram; they were also appraised with the Brazelton Neonatal Behavioral Assesment Scale (NBAS), between days 39 and 44; and with the Bayley Scale of Infant Development (BSID-II) at six and twelve months of age. Results: In the two cases, the family organization belongs to a young adult couple with HIV positive and two healthy sons; in the first case, the mother is identified as the transmitter; in the second, the father is the spreading agent. There is a weakening effect in the parental subsystem. The couples relations are ambivalent. As the HIV/AIDS advances, the alliances divide the family, excluding several members from the collaboration effort against the illness; this overloads the maternal grandmothers. Hierarchies and limits become diffused, resulting in a lack of a firm and stable emotional contention for the children. The two families are stalled in a situational stress period. In respect to the NBAS the two infants obtained performance from good to excelent (scores 7,8,9) across the clusters; in the BSID-II both cases had a normal score in the first six months of their mental and motor development, while at twelve months of age, the first case continued with a normal development, but the second case was not precisely evaluated due to oppositional behavior. Conclusions: Both family systems are identified with an organization affected by the HIV presence, their structure is promoting a parentalization (role reversal) process and neglect for the children; though the motor and mental development of the two girls were found according to the expected norm for their age.