Children who experience neglect and abuse are likely to have impaired brain development and entre... more Children who experience neglect and abuse are likely to have impaired brain development and entrenched learning deficiencies. Early years interventions such as intensive education and care for these children are known to have the potential to increase their human capital. The Early Years Education Program (EYEP) is a new program offered by the Children's Protection Society (CPS) in Melbourne, Australia. EYEP is targeted at the needs of children who have been or are at risk of being abused or neglected. It has the dual focus of seeking to address the consequences of abuse and neglect on children's brain development and redressing their learning deficiencies. Our objective is to determine whether EYEP can improve school readiness by conducting a randomised controlled trial (RCT) of its impacts. The RCT is being conducted with 90 participants (45 intervention and 45 control). Eligible children must be aged under three years and assessed as having two or more risk factors as def...
... Alana, qui n'avait jamais su regarder sa mère, s'était retournée da... more ... Alana, qui n'avait jamais su regarder sa mère, s'était retournée dans l'eau pour regarder la caméra; l'eau clapotait contre son visage, ce ... Un exemple de plaisir évident éprouvé par la mère nousvient d'un ergothérapeute qui s'occupa de Jane, une petite fille d'un an souffrant du ...
Gastro-oesophageal reflux (GOR) is common in infants with persistent crying. Empirical treatment ... more Gastro-oesophageal reflux (GOR) is common in infants with persistent crying. Empirical treatment with antireflux medications is common practice, although on clinical grounds it may be difficult to determine whether GOR is abnormal. To examine the diagnostic accuracy of clinical predictors of pathological GOR in infants with persistent crying. One hundred and fifty-one infants (82 male; median age 2.5 months, range 0.5-8.2 months) with persistent crying were prospectively studied. Crying and fussing were charted for 24 h, and parents completed a validated questionnaire on reflux symptoms. All infants underwent oesophageal 24-h pH monitoring. Twenty-seven (17.9%) infants had pathological GOR with a fractional reflux time (FRT) >10%. There was no significant association between total crying duration per 24 and FRT (P = 0.84) or the number of reflux episodes (P = 0.68). Pathological GOR was more common in infants under 3 months, compared to older infants (P = 0.04). Feeding difficulties were significantly associated with pathological GOR (P = 0.02). Backarching was not increased in infants with GOR (P = 0.30). Pathological GOR was significantly associated with the frequency of regurgitation (P = 0.04), but not with vomitus volume (P = 0.62). Regurgitation more than 5 times daily was the most specific reflux symptom (specificity 70.9%), but was a poor predictor of pathological GOR (positive predictive value 22.2%). In the absence of frequent regurgitation or feeding difficulties, pathological GOR was unlikely (negative predictive value 87-90%). Investigation and treatment of GOR in infants with persistent crying should be primarily directed at infants presenting with frequent regurgitation or feeding difficulties.
To assess the effect of medical antireflux treatment, and of an infant mental health consultation... more To assess the effect of medical antireflux treatment, and of an infant mental health consultation (IMHC), on persistent crying in infants and maternal distress. Infants under 9 months of age with persistent crying, and their mothers, were enrolled in a randomized placebo-controlled trial. At enrollment, a questionnaire on demographic and clinical details was completed by mothers, and maternal distress was measured (Experience of Motherhood Questionnaire; EMQ). Oesophageal 24-h pH monitoring was performed in all infants on day 2. At week 4, the cry chart and EMQ were repeated in conjunction with a final interview. One hundred and three infants (56 under 3 months of age; 55 male) who were randomized to active medication (ranitidine plus cisapride; n = 34), placebo (n = 29) or IMHC (n = 40) completed the trial. There was a significant reduction in crying duration from baseline to week 4 (253 +/- 96.5 min vs 159 +/- 92.3 min per 24 h; P < 0.001), without differences between treatment groups (AVOVA: F = 0.75; P = 0.48). There was a modest improvement in EMQ scores from 44.9 +/- 8.6 at day 1 to 42.8 +/- 9.4 at week 4; P = 0.006. The improvement in maternal stress was similar in all treatment groups (Kruskal-Wallis chi2 = 0.354; P = 0.84), but subsequent admission to a mother-infant unit was significantly less frequent in the IMHC group (P < 0.05). Antireflux medications and IMHC were not superior to placebo in treating infants with persistent crying. Although the reduction in maternal distress was similar in all treatment groups, the individualized IMHC reduced the need for subsequent admission to a mother-infant unit.
This clinical article presents an infant mental health approach to the treatment of feeding disor... more This clinical article presents an infant mental health approach to the treatment of feeding disorders in infants and toddlers that involves the infant-parent psychotherapist directly working with the infant's representations within infant-parent psychotherapy sessions. The treatment is informed by an assessment of the infant's emotional development, subjective experience, and the dynamics of the infant-parent relationship. This model involves therapeutically using play and words with infants and draws upon concepts from D.W. Winnicott and attachment theory as well as principles from the psychodynamic treatment of posttraumatic stress disorder in infants. The model was developed from clinical work over 2 decades in a tertiary pediatric hospital with infants who presented with feeding disorders ranging from breast or bottle refusal, refusal to wean onto solids, feeding aversion, tube dependency, and failure to thrive.
This article takes a human rights perspective with a view to articulating the infant's perspectiv... more This article takes a human rights perspective with a view to articulating the infant's perspective when the infant has been subjected to abuse, neglect, or both and is reliant on the state to ensure his or her health and well-being. When a young child is removed from parental care, important and often difficult decisions have to be made about subsequent contact between child and parent. We consider a number of dilemmas which may arise for practitioners when they are assisting child welfare decision makers in relation to contact, and acknowledge the limited empirical follow-up studies of the impact of child welfare practice and legal decisions on infant outcomes. We draw on the significant and substantive evidence base about infant emotional and cognitive development and infant-parent attachment relationships as well as infant mental health to illuminate the infant's subjective experience in these practice dilemmas. We describe innovations in practice from various countries, which seek to shed light on the challenges often
ABSTRACT This is a discussion of the article Brief Interventions With Parents, Infants, and Young... more ABSTRACT This is a discussion of the article Brief Interventions With Parents, Infants, and Young Children: A Framework for Thinking by Louise Emmanuel. Questions of symptom formation, the difference between a defense and developmental phenomena, and different therapeutic techniques are explored from the perspective of The Baby as Subject (an infantparent psychotherapy approach developed at the Royal Children's Hospital in Melbourne, Australia). The relationship between feeding difficulties and the dynamics of the infantparent attachment relationship are discussed with reference to whether the infant's apparent self-sufficiency is interpersonally generated and whether bids for autonomy are a sign of healthy, age-appropriate developmental drives at play. The use of representational toys in infantparent psychotherapy to enable infants and toddlers to represent their experience or for the therapist to visually express what he or she understands the infant's experience to be and thus to work directly with the infant's representations is outlined. In addition to the linguistic content of verbal interpretations, the infant is receptive to the experience of another thinking mind and the emotional language, facial expressions, and gestures that also convey to the baby the experience of being understood or misunderstood.
IntroductionThe prevalence of postnatal depression is estimated to be 10–20%, however it is thoug... more IntroductionThe prevalence of postnatal depression is estimated to be 10–20%, however it is thought that up to 50% of cases go unrecognised in routine clinical practice. There are currently no data regarding incidence of postnatal depression in a paediatric emergency department setting, nor is there at present a systematic way to assess mothers in such an environment – current practice
To determine the prevalence of postnatal depression (PND) in mothers of young infants presenting ... more To determine the prevalence of postnatal depression (PND) in mothers of young infants presenting to the emergency department (ED). Prospective observational study of the prevalence of PND in mothers of infants aged 14 days to 6 months presenting with non-time-critical conditions to the ED of a large tertiary paediatric hospital. We assessed PND by applying a self-administered validated screening tool, the Edinburgh Postnatal Depression Scale (EPDS). Mothers of patients were approached before clinician consultation when a social worker was available on site. EPDS scores of 13 and above were considered 'positive'. Univariate analysis was used to determine associations with demographic, maternal and child factors. 236 mothers were approached; 200 consented to participate in the study. Thirty-two mothers screened positively, with a prevalence rate of 16% (95% CI 11.2% to 21.8%). A positive screen was most strongly associated with history of depression (relative risk (RR) 4.8, 95% CI 2.3 to 10.1). Other associations were with single-parent status (RR 2.5, 95% CI 1.1 to 5.4), Indigenous status (4.4, 95% CI 1.8 to 10.4) and 'crying baby' as the presenting problem (RR 2.9, 95% CI 1.4 to 6.2). Fifty-three per cent of mothers had not completed a PND screen before coming to the ED. Mothers of young infants coming to the ED regardless of infant's presenting complaint have a high prevalence of PND determined using the EPDS. Many mothers were not screened for PND before coming to the ED. Clinical staff need to be aware of the condition, incorporate appropriate questioning into the consultation, and refer mothers to support services if necessary.
Children who experience neglect and abuse are likely to have impaired brain development and entre... more Children who experience neglect and abuse are likely to have impaired brain development and entrenched learning deficiencies. Early years interventions such as intensive education and care for these children are known to have the potential to increase their human capital. The Early Years Education Program (EYEP) is a new program offered by the Children's Protection Society (CPS) in Melbourne, Australia. EYEP is targeted at the needs of children who have been or are at risk of being abused or neglected. It has the dual focus of seeking to address the consequences of abuse and neglect on children's brain development and redressing their learning deficiencies. Our objective is to determine whether EYEP can improve school readiness by conducting a randomised controlled trial (RCT) of its impacts. The RCT is being conducted with 90 participants (45 intervention and 45 control). Eligible children must be aged under three years and assessed as having two or more risk factors as def...
... Alana, qui n'avait jamais su regarder sa mère, s'était retournée da... more ... Alana, qui n'avait jamais su regarder sa mère, s'était retournée dans l'eau pour regarder la caméra; l'eau clapotait contre son visage, ce ... Un exemple de plaisir évident éprouvé par la mère nousvient d'un ergothérapeute qui s'occupa de Jane, une petite fille d'un an souffrant du ...
Gastro-oesophageal reflux (GOR) is common in infants with persistent crying. Empirical treatment ... more Gastro-oesophageal reflux (GOR) is common in infants with persistent crying. Empirical treatment with antireflux medications is common practice, although on clinical grounds it may be difficult to determine whether GOR is abnormal. To examine the diagnostic accuracy of clinical predictors of pathological GOR in infants with persistent crying. One hundred and fifty-one infants (82 male; median age 2.5 months, range 0.5-8.2 months) with persistent crying were prospectively studied. Crying and fussing were charted for 24 h, and parents completed a validated questionnaire on reflux symptoms. All infants underwent oesophageal 24-h pH monitoring. Twenty-seven (17.9%) infants had pathological GOR with a fractional reflux time (FRT) >10%. There was no significant association between total crying duration per 24 and FRT (P = 0.84) or the number of reflux episodes (P = 0.68). Pathological GOR was more common in infants under 3 months, compared to older infants (P = 0.04). Feeding difficulties were significantly associated with pathological GOR (P = 0.02). Backarching was not increased in infants with GOR (P = 0.30). Pathological GOR was significantly associated with the frequency of regurgitation (P = 0.04), but not with vomitus volume (P = 0.62). Regurgitation more than 5 times daily was the most specific reflux symptom (specificity 70.9%), but was a poor predictor of pathological GOR (positive predictive value 22.2%). In the absence of frequent regurgitation or feeding difficulties, pathological GOR was unlikely (negative predictive value 87-90%). Investigation and treatment of GOR in infants with persistent crying should be primarily directed at infants presenting with frequent regurgitation or feeding difficulties.
To assess the effect of medical antireflux treatment, and of an infant mental health consultation... more To assess the effect of medical antireflux treatment, and of an infant mental health consultation (IMHC), on persistent crying in infants and maternal distress. Infants under 9 months of age with persistent crying, and their mothers, were enrolled in a randomized placebo-controlled trial. At enrollment, a questionnaire on demographic and clinical details was completed by mothers, and maternal distress was measured (Experience of Motherhood Questionnaire; EMQ). Oesophageal 24-h pH monitoring was performed in all infants on day 2. At week 4, the cry chart and EMQ were repeated in conjunction with a final interview. One hundred and three infants (56 under 3 months of age; 55 male) who were randomized to active medication (ranitidine plus cisapride; n = 34), placebo (n = 29) or IMHC (n = 40) completed the trial. There was a significant reduction in crying duration from baseline to week 4 (253 +/- 96.5 min vs 159 +/- 92.3 min per 24 h; P < 0.001), without differences between treatment groups (AVOVA: F = 0.75; P = 0.48). There was a modest improvement in EMQ scores from 44.9 +/- 8.6 at day 1 to 42.8 +/- 9.4 at week 4; P = 0.006. The improvement in maternal stress was similar in all treatment groups (Kruskal-Wallis chi2 = 0.354; P = 0.84), but subsequent admission to a mother-infant unit was significantly less frequent in the IMHC group (P < 0.05). Antireflux medications and IMHC were not superior to placebo in treating infants with persistent crying. Although the reduction in maternal distress was similar in all treatment groups, the individualized IMHC reduced the need for subsequent admission to a mother-infant unit.
This clinical article presents an infant mental health approach to the treatment of feeding disor... more This clinical article presents an infant mental health approach to the treatment of feeding disorders in infants and toddlers that involves the infant-parent psychotherapist directly working with the infant's representations within infant-parent psychotherapy sessions. The treatment is informed by an assessment of the infant's emotional development, subjective experience, and the dynamics of the infant-parent relationship. This model involves therapeutically using play and words with infants and draws upon concepts from D.W. Winnicott and attachment theory as well as principles from the psychodynamic treatment of posttraumatic stress disorder in infants. The model was developed from clinical work over 2 decades in a tertiary pediatric hospital with infants who presented with feeding disorders ranging from breast or bottle refusal, refusal to wean onto solids, feeding aversion, tube dependency, and failure to thrive.
This article takes a human rights perspective with a view to articulating the infant's perspectiv... more This article takes a human rights perspective with a view to articulating the infant's perspective when the infant has been subjected to abuse, neglect, or both and is reliant on the state to ensure his or her health and well-being. When a young child is removed from parental care, important and often difficult decisions have to be made about subsequent contact between child and parent. We consider a number of dilemmas which may arise for practitioners when they are assisting child welfare decision makers in relation to contact, and acknowledge the limited empirical follow-up studies of the impact of child welfare practice and legal decisions on infant outcomes. We draw on the significant and substantive evidence base about infant emotional and cognitive development and infant-parent attachment relationships as well as infant mental health to illuminate the infant's subjective experience in these practice dilemmas. We describe innovations in practice from various countries, which seek to shed light on the challenges often
ABSTRACT This is a discussion of the article Brief Interventions With Parents, Infants, and Young... more ABSTRACT This is a discussion of the article Brief Interventions With Parents, Infants, and Young Children: A Framework for Thinking by Louise Emmanuel. Questions of symptom formation, the difference between a defense and developmental phenomena, and different therapeutic techniques are explored from the perspective of The Baby as Subject (an infantparent psychotherapy approach developed at the Royal Children's Hospital in Melbourne, Australia). The relationship between feeding difficulties and the dynamics of the infantparent attachment relationship are discussed with reference to whether the infant's apparent self-sufficiency is interpersonally generated and whether bids for autonomy are a sign of healthy, age-appropriate developmental drives at play. The use of representational toys in infantparent psychotherapy to enable infants and toddlers to represent their experience or for the therapist to visually express what he or she understands the infant's experience to be and thus to work directly with the infant's representations is outlined. In addition to the linguistic content of verbal interpretations, the infant is receptive to the experience of another thinking mind and the emotional language, facial expressions, and gestures that also convey to the baby the experience of being understood or misunderstood.
IntroductionThe prevalence of postnatal depression is estimated to be 10–20%, however it is thoug... more IntroductionThe prevalence of postnatal depression is estimated to be 10–20%, however it is thought that up to 50% of cases go unrecognised in routine clinical practice. There are currently no data regarding incidence of postnatal depression in a paediatric emergency department setting, nor is there at present a systematic way to assess mothers in such an environment – current practice
To determine the prevalence of postnatal depression (PND) in mothers of young infants presenting ... more To determine the prevalence of postnatal depression (PND) in mothers of young infants presenting to the emergency department (ED). Prospective observational study of the prevalence of PND in mothers of infants aged 14 days to 6 months presenting with non-time-critical conditions to the ED of a large tertiary paediatric hospital. We assessed PND by applying a self-administered validated screening tool, the Edinburgh Postnatal Depression Scale (EPDS). Mothers of patients were approached before clinician consultation when a social worker was available on site. EPDS scores of 13 and above were considered 'positive'. Univariate analysis was used to determine associations with demographic, maternal and child factors. 236 mothers were approached; 200 consented to participate in the study. Thirty-two mothers screened positively, with a prevalence rate of 16% (95% CI 11.2% to 21.8%). A positive screen was most strongly associated with history of depression (relative risk (RR) 4.8, 95% CI 2.3 to 10.1). Other associations were with single-parent status (RR 2.5, 95% CI 1.1 to 5.4), Indigenous status (4.4, 95% CI 1.8 to 10.4) and 'crying baby' as the presenting problem (RR 2.9, 95% CI 1.4 to 6.2). Fifty-three per cent of mothers had not completed a PND screen before coming to the ED. Mothers of young infants coming to the ED regardless of infant's presenting complaint have a high prevalence of PND determined using the EPDS. Many mothers were not screened for PND before coming to the ED. Clinical staff need to be aware of the condition, incorporate appropriate questioning into the consultation, and refer mothers to support services if necessary.
Uploads
Papers by Brigid Jordan