MATERNAL DEPRIVATION

1. MATERNALDEPRIVATION BY IGBODIPE V.I 29-06-09

2. OUTLINE INTRODUCTION DEFINITION HISTORY CAUSES/TYPES OF MATERNAL DEPRIVATION. MATERNAL DEPRIVATION SYNDROME CONCLUSION.

3. INTRODUCTION The term maternal deprivation dates back to the early work of psychoanalyst John Bowlby on the effects of separating infants and young children from their mother (or mother-substitute). Maternal deprivation is when a child is denied of normal maternal care. The effect is marked if the child is deprived in the first two years of life. It is a form of extrinsic handicap

4. WHAT IS MATERNAL DEPRIVATION Maternal deprivation is when a child is denied of normal maternal care. The effect is marked if the child is deprived in the first two years of life. It is a form of extrinsic handicap As it is commonly used, the term maternal deprivation is ambiguous as it is unclear whether the deprivation is that of the biological mother, of an adoptive or foster mother, a consistent caregiving adult of any gender or relationship to the child, of an emotional relationship. Mary Ainsworth in 1962 indicates: "Although in the early months of life it is the mother who almost invariably interacts most with the child... the role of other figures, especially the father, is acknowledged to be significant hence, Paternal deprivation. The term 'parental deprivation ' would have been more accurate if the child has been... deprived of interaction with a father-figure as well as a mother-figure. [It may be better to] discourage the use of [the term 'deprivation'] and encourage the substitution of the terms 'insufficiency', 'discontinuity', and 'distortion' instead."[14] Ainsworth implies, neither the word "maternal" nor the word "deprivation" seems to be a literally correct definition of the phenomenon under consideration. As it is commonly used, the term maternal deprivation is ambiguous as it is unclear whether the deprivation is that of the biological mother, of an adoptive or foster mother, a consistent caregiving adult of any gender or relationship to the child, of an emotional relationship. Mary Ainsworth in 1962 indicates: "Although in the early months of life it is the mother who almost invariably interacts most with the child... the role of other figures, especially the father, is acknowledged to be significant hence, Paternal deprivation. The term 'parental deprivation ' would have been more accurate if the child has been... deprived of interaction with a father-figure as well as a mother-figure. [It may be better to] discourage the use of [the term 'deprivation'] and encourage the substitution of the terms 'insufficiency', 'discontinuity', and 'distortion' instead."[14] Ainsworth implies, neither the word "maternal" nor the word "deprivation" seems to be a literally correct definition of the phenomenon under consideration.

5. Maternal deprivation- Inadequate mothering, whether delivered by the mother or another primary care giver, during the first six months of life, leading to a failure of attachment, OR more generally inadequate mothering during the first five years of life.

6. HISTORICAL BACKGROUND John Bowlby was commissioned by the WHO to write a report on the mental health of homeless children in Europe after World war II. The report was published in 1951 and titled Maternal Care and Mental Health Bowlby's work on delinquent and affectionless children and the effects of hospital and institutional care lead to his being commissioned to write the World Health Organisation's report on the mental health of homeless children in post-war Europe whilst he was head of the Department for Children and Parents at the Tavistock Clinic in London after World War II. The report titled Maternal Care and Mental Health led to what was later called the maternal deprivation hypothesis. The quality of parental care was considered by Bowlby to be of vital importance to the child's development and future mental health. He was commissioned by the WHO to write a report on the mental health of homeless children in the post War Europe. The report was published in 1951 and titled Maternal Care and Mental Health Bowlby's work on delinquent and affectionless children and the effects of hospital and institutional care lead to his being commissioned to write the World Health Organisation's report on the mental health of homeless children in post-war Europe whilst he was head of the Department for Children and Parents at the Tavistock Clinic in London after World War II. The report titled Maternal Care and Mental Health led to what was later called the maternal deprivation hypothesis. The quality of parental care was considered by Bowlby to be of vital importance to the child's development and future mental health. He was commissioned by the WHO to write a report on the mental health of homeless children in the post War Europe. The report was published in 1951 and titled Maternal Care and Mental Health

7. HISTORICAL BACKGROUND He submitted that �An infant and young child should experience a warm, intimate and continuous relationship with his mother (or permanent mother-figure) in which both find satisfaction and enjoyment�. MATERNAL DEPRIVATION HYPOTHESIS: �Breaking the maternal bond with the child during the early years of his life is likely to have serious effects on his intellectual, social and emotional development�. Bowlby (1969, 1988) also postulated that the fear of strangers represents an important survival mechanism, built in by nature. Babies are born with the tendency to display certain behaviours which help ensure proximity and contact with the mother or mother figure (e.g. crying, smiling, crawling, etc.) � these are species-specific behaviours. Given this relationship, emotions of guilt and anxiety (characteristics of mental illness when in excess) would develop in an organised and moderate way. Naturally extreme emotions would be moderated and become amenable to the control of the child's developing personality.Bowlby (1969, 1988) also postulated that the fear of strangers represents an important survival mechanism, built in by nature. Babies are born with the tendency to display certain behaviours which help ensure proximity and contact with the mother or mother figure (e.g. crying, smiling, crawling, etc.) � these are species-specific behaviours. Given this relationship, emotions of guilt and anxiety (characteristics of mental illness when in excess) would develop in an organised and moderate way. Naturally extreme emotions would be moderated and become amenable to the control of the child's developing personality.

8. TYPES OF MATERNAL DEPRIVATION. Mother- Child separation Multiple Mothering Distortion in Quality of Care Institutionalization

9. TYPES Mother � Child separation: occurs when a child is separated from his/her mother or mother substitute for prolonged periods of time or permanently through death, chronic illness such as insanity. B. Multiple Mothering- A child has different people providing the care that a mother or a mother substitute should provide. There is no particular person that the child can identify as his/her mother.

10. TYPES CONTD C. Distortion in the quality of care- two extremes Overprotection Child abuse Overprotection The child is extremely sheltered, not adequately disciplined and quite often too spoilt. This often occurs if the child is a precious baby, only child or a particular sex the parents have been hoping for. It doesn�t allow the child to develop properly.

11. Child abuse Also known as child maltreatment. It constitutes all forms of physical and /or emotional ill treatment, sexual abuse, neglect or negligent treatment or commercial exploitation resulting in actual or potential harm to the child�s health, survival, development or dignity in the context of a relationship of responsibility, trust and power. The Centers for Disease Control and Prevention (CDC) defines child maltreatment as any act or series of acts or commission or omission by a parent or other caregiver that results in harm, potential for harm, or threat of harm to a child.[1] Most child abuse happens in a child's home, with a smaller amount occuring in the organizations, schools or communities they interact with. There are four major categories of child abuse: neglect, physical abuse, psychological/emotional abuse, and sexual abuseThe Centers for Disease Control and Prevention (CDC) defines child maltreatment as any act or series of acts or commission or omission by a parent or other caregiver that results in harm, potential for harm, or threat of harm to a child.[1] Most child abuse happens in a child's home, with a smaller amount occuring in the organizations, schools or communities they interact with. There are four major categories of child abuse: neglect, physical abuse, psychological/emotional abuse, and sexual abuse

12. CAUSES OF CHILD ABUSE Most of d time it is not entirely intentional. Previous abuse or neglect in parents themselves. Very young or inexperienced parents. Extraordinary family stress. Alcoholism or use of other drugs. Socioeconomic class.

13. MAJOR CATEGORIES OF CHILD ABUSE Neglect Psychological / Emotional Abuse Sexual Abuse Exploitation

14. NEGLECT AND NEGLIGENT TREATMENT Neglect is failure to provide for the development of the child in all spheres: health, education, emotional development, nutrition, shelter and safe living conditions, in the context of resources reasonably available to the family and caretakers and can cause harm to the child�s health or physical, mental, spiritual, moral or social development.

15. EMOTIONAL ABUSE A pattern of behaviour that impairs a child�s emotional development or sense of self worth. Acts include restriction of movement, pattern of belittling,scape-goating, threatening, scaring, discriminating, ridiculing or other non physical forms of hostile or rejecting treatment. There may also be acts towards the child to that cause or have a high probability of causing harm to the child�s health or physical, mental, spiritual, moral or social development. These acts must be reasonably within the control of a parent or person in a position of responsibility, power or trust. There may also be acts towards the child to that cause or have a high probability of causing harm to the child�s health or physical, mental, spiritual, moral or social development. These acts must be reasonably within the control of a parent or person in a position of responsibility, power or trust.

16. SEXUAL ABUSE Child sexual abuse is the involvement of a child in sexual activity that he or she does not fully comprehend, is unable to give informed consent to, or that violates the laws and social taboos of the society. This includes : The inducement of a child to engage in any unlawful sexual activity The exploitative use of a child in prostitution or other unlawful sexual practices The exploitative use of children in pornographic performances and materials

17. EXPLIOTATION Refers to the use of the child in work and other activities for the benefit of others. This includes child labor and child prostitution. These activities are to the detriment of the child�s physical or mental health, education, spiritual, moral or social- emotional development

18. PREVENTION OF CHILD ABUSE Understand the problem. Understand the causes. Support programs that support families. Report suspected abuse and neglect Education and Media Campaign

19. D. INSTITUTIONALIZATION This occurs when a child is kept in an institution such as motherless babies home or hospital (for congenital malformations, surgery) for a prolonged period of time. Elmer kersey, the first Baptist nurse in Ogbomosho established the 1st motherless babies home- kersey�s children�s home in Nigeria

20. CARE OPTIONS FOR MOTHERLESS BABIES Institutional care Care within the extended family with supervision Foster care - kinship or non kinship Care within the extended family without supervision Adoption

21. 1. Institutional care Provides a temporary relief for the family to enable them to adjust to the loss of the mother. The fathers/family are supposed to provide financially for the babies upkeep in the home- on a monthly basis. However, quite often the child is neglected and later abandoned (some believe that the child brought bad luck- death of the mother).

22. Problems of motherless Babies home Psychosomatic ailments among babies due to maternal deprivation, these symptoms usually disappear when the child is returned to individual care or fostering High cost of maintenance for each child High infant mortality rate 67-150/1000 (National rates (85/1000). High risk of epidemics Risk of abandonment by fathers Acute shortage of trained staff High risk of mental retardation

23. 2. Care within the Extended Family With supervision- this programme was developed by Mrs Solanke. It involves trained nurses paying home visits to families taking care of motherless babies, providing health education, nutritional counseling and free medical care at the community level. Such babies do better and grow well in terms of physical, mental and emotional development.

24. 3. Foster Homecare Maybe kinship or non kinship In Nigeria kinship is common e.g. taking the child of a blood relation and bringing him up. This type of child enjoys the same privileges as the other children in the family. Non kinship fostering- the child is placed in the care of an adult who is not in anyway related to the child. This is not popular in Nigeria and the reservoir for foster parents is very low. Many expariates are willing to take up children for fostering but the children may face discrimination later in life.This is not popular in Nigeria and the reservoir for foster parents is very low. Many expariates are willing to take up children for fostering but the children may face discrimination later in life.

25. Criteria for Foster Parents Must be Nigerian Must be Adults =21 yrs Single men must not be allowed to foster female children. Should have a reasonable level of education. Must show evidence emotional stability. Should be in good physical and mental health. The motivation for the foster care must be established. It should be noted that fostering is not necessarily a permanent arrangement. If the foster parents are fed up, they can be relinquish the responsibility. Also the social welfare department can withdraw the child if they are not happy with the care being provided. It should be noted that fostering is not necessarily a permanent arrangement. If the foster parents are fed up, they can be relinquish the responsibility. Also the social welfare department can withdraw the child if they are not happy with the care being provided.

26. Adoption To adopt means to raise a child of other biological parents as if it were your own, in accordance with formal legal procedures A child will be at least 3mths old before being given up for adoption. Interim order- the child stays with the adoptive parents for 2yrs. The adoptor is investigated. During the process the child is advertised to be adopted. Once adoption is carried out, the adoptee has the same legal rights as the children of the adoptors.

27. Obstacles to Adoption Not all states have adoption laws ( esp north) Fostering because of its traditional root is generally preferred to adoption. Adoption laws are rather restrictive Other factors discourage parents from adopting children.

28. MATERNAL DEPRIVATION SYNDROME(MDS) Also known as Non-organic Failure to thrive. It is a form of failure to thrive that is caused by neglect which can be intentional or unintentional. Failure to thrive (FTT) is defined as failure to gain adequate weight, failure of linear growth and failure to achieve some or all developmental milestones. An early reference to an infant who �ceased to thrive� can be traced to more than a century ago in the initial edition of the Disease of infancy and Childhood by L. Emmet Holt in 1897. Holt equated infantile wasting with malnutrition although he clearly recognised that disease could be associated with a variety of clinical circumstances. Statistically, a child is said to have FTT when the weight of the child is less than the 3rd percentile for age on a growth chart or least 2 Standard deviation less than the mean for children of that age or Sex.An early reference to an infant who �ceased to thrive� can be traced to more than a century ago in the initial edition of the Disease of infancy and Childhood by L. Emmet Holt in 1897. Holt equated infantile wasting with malnutrition although he clearly recognised that disease could be associated with a variety of clinical circumstances. Statistically, a child is said to have FTT when the weight of the child is less than the 3rd percentile for age on a growth chart or least 2 Standard deviation less than the mean for children of that age or Sex.

29. CAUSES OF MDS Poverty Child abuse Dysfunctional Caregiver interaction Parental ignorance about appropriate child care.

30. PREDISPOSING FACTORS Young age of parents (teenage parents) Unwanted pregnancy Lower socioeconomic status Lower levels of education Absence of the father Absence of a support network (family, close friends, or other support) Mental illness, including severe postpartum depression.

31. FEATURES OF MDS �Decreased or absent linear growth ("falling off" the growth chart) Lack of appropriate hygiene Interaction problems between mother and child Weight less than the 5th percentile, or an inadequate rate of weight gain Other feature includes inappropriate clothing, Thin extremities, A narrow face, prominent ribs, Wasted buttocks , unwashed skin, Avoidance of eye contact, expressionless face, etcOther feature includes inappropriate clothing, Thin extremities, A narrow face, prominent ribs, Wasted buttocks , unwashed skin, Avoidance of eye contact, expressionless face, etc

32. DIAGNOSIS History taking from the parent(s) Physical Examination of the child Anthropometric measurements :OFC, MUAC. Careful examination of the patient�s growth chart. Extensive lab inv. should be delayed until dietary mgt has been attempted for at least 1 week and has failed.

33. MGT OF MDS It involves a multidisciplinary team approach, which includes: Physicians Nutritionist Social Workers Behavioural Specialist Visiting Nurses

34. MGT OF MDS Helping extended family members recognize that a problem exists and recruiting their help will provide increased support for the mother and child. In special cases, the infant may be admitted to the hospital where adequate feeding, care can be given. Emphasis should be given to the psychological aspect of the care giver and the child. Infants temperaments and parental perception of the temperament influence interaction btw infants and parents. Following treatment follow up visit is very important in sustaining good health and adequate growth in these children.Infants temperaments and parental perception of the temperament influence interaction btw infants and parents. Following treatment follow up visit is very important in sustaining good health and adequate growth in these children.

35. Prevention of MDS Addressing the causes and risk factors appropriately. e.g. Parental classes and support groups for pregnant teenagers and young adults should be encouraged Early intervention programs specifically designed to bring together the necessary resources to assist children with FTT.

36. CONCLUSION Mother�s love in infancy and childhood is as important for the mental health of a child as are vitamins and proteins for physical health John Bowlby (1953)

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