Parental compliance with home cardiorespiratory monitoring.

AIMS: To evaluate parental compliance with home cardiorespiratory monitoring of premature infants with apnoea, siblings of infants who died of sudden infant death syndrome (SIDS), and infants with an apparent life threatening event (ALTE), during the first month of use. METHODS: A retrospective review of the first month's recordings was conducted on 39 premature infants with apnoea, 13 siblings of SIDS, and 16 infants with ALTE. All infants were singletons. Recommendations during the study period (1992-1994) were for daily use for 23 hours per day. Measurements were average daily hours of use and consistency of use (daily or variable). Gestational age, maternal age, and socioeconomic status as measured by receipt of public assistance were also recorded. RESULTS: Siblings of SIDS were monitored for fewer hours than were premature or ALTE infants. Only 54% of sibings of SIDS were monitored daily, compared to 87% of premature infants and 93% of ALTEs. Within each diagnostic category socioeconomic status did not affect average hours of monitoring. Consistency of use was more evident in those with private insurance, although the trend did not reach significance. CONCLUSIONS: Parents of infants with apnoea of prematurity or ALTE are highly compliant with cardiorespiratory monitoring recommendations in the first month of monitor usage. Siblings of SIDS are monitored for fewer hours and are less likely to be monitored on a daily basis.

Maternal behavior toward premature twins: implications for development.

Assisted reproductive techniques and fertility enhancing therapies have increased multiple births and, therefore, the risk of prematurity and its developmental consequences. Parent intervention is an effective source of compensation for the cognitive effects of prematurity. We hypothesized that relative to parents of preterm singletons, parents of preterm twins are less able to provide such enhancing care, resulting in a developmental disadvantage for preterm twins. Maternal-infant interactions of premature singletons (n = 22; birth weight = 1668 +/- 350 g, gestational age = 32.3 +/- 2.1 weeks) and premature twins (n = 8; birth weight = 1618 +/- 249 g; gestational age = 32.0 +/- 2.6 weeks) with comparable demographic and medical status were observed at home at 1 and 8 months corrected age using a 30 min checklist of developmentally facilitative behavior. Mental (MDI) and psychomotor (PDI) indices of the Bayley Scales of Infant Development and Caldwell Home Observations for Measurement of the Environment (HOME) inventories were administered (18 months corrected age). Compared with mothers of premature singletons, mothers of premature twins exhibited fewer initiatives (P < 0.001) and responses (P < 0.01) and were less responsive to positive signals (P < 0.01) and crying (P < 0.01). Unprompted by the infant, twin mothers lifted or held (P < 0.05), touched (P < 0.01), patted (P < 0.05) or talked (P < 0.01) less. Singleton MDIs surpassed twins (119.4 +/- 7.7 vs 103.6 +/- 7.7; P < 0.01). Maternal verbal behavior and the acceptance of child factor (HOME), both favoring singletons, correlated with MDI (R-square = 0.46, P < 0.0002). Mothers of premature twins exhibited fewer initiatives and responses toward offspring than did mothers of premature singletons. Maternal behavior was predictive of cognitive development.

Factitious disorder by proxy: awareness among mental health practitioners.

Factitious disorder by proxy (FDP) is a form of abuse in which a caregiver surreptitiously simulates or induces illnesses in a person for whom he or she cares. Typically, a mother is the perpetrator and at least one of her children is victimized. FDP has a high morbidity and mortality rate, and a knowledgeable health team increases the primary physician's confidence in making this difficult diagnosis. The purpose of this study was to determine the levels of awareness of FDP among mental health practitioners and their sources of information. Anonymous questionnaires were sent to 687 primary care physicians and mental health practitioners. Psychiatrists (89%) and psychologists (69%) were more aware of the disorder than were social workers (42%). Years in practice were not associated with awareness of FDP. Psychiatrists were more likely than psychologists or social workers to have had exposure through an actual case or through their professional journals. These findings were statistically significant. Awareness of FDP varies significantly among mental health professionals and may reflect the availability of information during training and in journals. Since social workers and psychologists often have earlier and broader opportunities than psychiatrists to interface with families, enhancements in training and the professional literature in these disciplines are needed if FDP is to be consistently considered and identified.

Maternal grief after sudden infant death syndrome.

Six months after the death of their infants of Sudden Infant Death Syndrome (SIDS), the subjective impression of mothers anonymously rating their initial and present grief was that there had been a reduction in all symptoms (p < .001). However, an increase in the relative ranking of some cognitive symptoms over somatic ones, the association of certain lifestyles and situational variables with higher levels of grief, and the implication for future symptoms of family decisions made during bereavement underscore the importance of continuing active support for these families. In relative ranking, guilt rose from 10th to 5th most prominent symptom, particularly among the 34% of mothers whose infants manifested clinical symptoms (p < .05). Single mothers had higher grief scores both initially (p < .05) and at 6 months (p < .002), were almost three times more likely to become pregnant within 6 months of the death but only one-third as likely to attend a support group, and were also more likely to move after the death (44% vs 25%). Mothers whose infants had been discovered by another caregiver reached out more to a crisis intervention service of a support program available to SIDS families (p < .05). Mothers without surviving children had grief levels comparable with those with children but were less likely to rate their pediatrician's support as satisfactory, increasing the probability that they would change physicians with subsequent children, thereby losing continuity of care and support.

NJ SIDS Resource Center: program for bereaved families.

The New Jersey Sudden Infant Death Syndrome Resource Center counsels approximately 120 bereaved families each year, conducts l medical and community education programs, and manages the sudden infant death syndrome database for New Jersey.

Psychological interventions in Gilles de la Tourette's syndrome.

Even with the advent of successful pharmacotherapy of TS, emotional sequelae of chronicity, the public and intrusive nature of the disorder, and the potential side effects of the medications challenge the family's and the patient's capacity to successfully adjust to the disorder. Psychological intervention provides the physician with a comprehensive assessment of related problems that can affect family dynamics and social and academic adjustment, thus enhancing the ability to treat the patient successfully. Behavioral intervention may improve the patient's capacity to alter or inhibit a tic, which can lead to a reduction in medication dosage. Supportive psychotherapy in various forms can enhance adjustment, family relations, and self-esteem.