Maternal deprivation syndrome

By Dr. B ArindeResident, Pediatric Department

University of Ilorin Teaching Hospital

Outline

• Introduction • Epidemiology• Causes/risk factors• Features of MDS• Treatment • Complications • Prevention • Prognosis• Conclusion

Introduction • Compared to other mammals, the human infant depends on the adult

for its survival for a prolonged period• The knowledge of the basic needs of the newborn, and the

application thereof by paediatricians, has resulted in a remarkable reduction of neonatal morbidity and mortality.• Less readily apparent among the fundamental needs of the infant are

requirements for gentle physical contact, sounds of pleasant and varying tones of the human voice, antigravity play, visual stimuli from the human environment and the more subtle interpersonal communications- in sum, all of those activities ordinarily supplied by a loving mother.

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

Core theory- Bowlby theory

• He believed the attachment between a caregiver and infant had to happen at least in the first 3 years of the infant’s life.• He called this the CRITICAL

PERIOD for attachment.

Maternal deprivation theory• Based on Bowlby’s ideas:• Attachment is important for

survival • Prototypes for later relationships

• Predicts developmental difficulty if the attachment relationship goes wrong: • General developmental problems• Specific issues with social

development

Core theory- Bowlby theory

• MATERNAL DEPRIVATION is the failure of a child to form an attachment in the first 5 years of life, leading to negative psychological effects especially in adulthood • When a child never experiences

the opportunity to form any sort of bond it causes PRIVATION

Difference between separation and deprivation

SEPARATION• A physical disruption of the bond

between the parental unit and the child• A suitable replacement of the

parental unit (e.g. a surrogate) should not cause any adverse events

DEPRIVATION• Loss of the emotional care that

is provided by the parental unit• Note the use of the term

“parental unit”: can be father or mother• A parent may be physically

present and yet provide no emotional support

Maternal Deprivation Syndrome (MDS)• A failure to thrive seen in infants

and young children and exhibited as a constellation of signs, symptoms, behaviors, usually associated with maternal loss, absence or neglect, and is characterised by lack of responsiveness to the environment and often depression.

Maternal deprivation syndrome • Approximately two-third are caused by dysfunctional caregiver

interaction, poverty, child abuse and parental ignorance about child

care.

• Although mother and other primary caregiver may appear concerned,

the interplay of physical contact normally seen between mother and

child is absent or distorted

Local study

• Exploratory spatial analysis done in 2003 by O. Uthman• Data collected from Nigeria Demographic and

health survey• 6029 children aged 0-59 months• Maternal socioeconomic deprivation index

included -mothers with no education-residence in rural area-unemployed mothers-mothers living below poverty levelConclusion; children living in north-east and north-west Nigeria had higher rate of maternal deprivation

Maternal deprivation syndrome

• Deprivation can occur when-A child lives in an institutionalized setting where he has no major substitute mother and insufficient interaction with a mother figure-He lives with his mother or a permanent substitute mother, where he receives insufficient care and with whom he has insufficient interaction-The child is unable to interact with a mother figure despite the fact that one is present and ready to give sufficient care- this inability being due to repeated break in ties with mother figures

Causal /Risk factors

• Young parental age• Unplanned/unwanted pregnancy• Maternal death• Absence of father

Causal /Risk factors

• Wrong child gender!• Low birth weight• Congenital abnormality• Children not breastfed• Chronically ill babies• Children with CP or other neurocognitive problems

Causal /risk factors• Low levels of education

• Lower economic status/ Affluence

• Children from household with high birth order and/or under-5 children

greater than 4

• Maternal illness (may be a postpartum complication or debilitating

chronic illness)

• Absence of support network (family, close friends, or other support)

Phases of response to separation/deprivation• Protest; crying and acute distress at loss of

mother and by efforts to replace her through

limited efforts at child’s disposal

• Despair; increasing helplessness, withdrawal

and decreasing efforts to regain mother

• Detachment; here, the child ‘settles down’ and

accepts care from whatever substitute figure

available.

Symptoms and signs

• Subtle to blatant abnormality in

interaction between mother and

child

• Weight loss <5th percentile or an

inadequate rate of weight gain

• Decreased or absent linear growth

‘falling off’ growth chart

Symptoms and signs of MDS

• Poor hygiene

• Inappropriate clothing

• Unusual or overly restricted diet

• General lack of care

Emotional effects of MDS

• A certain amount of maturity and conscious cerebral functioning is

necessary in order to produce this syndrome. Thus it is not seen in

• young premature infants,

• the newborn for the first 2 weeks and;

• the severely retarded child

Complications

• Abandonment

• Developmental delay

• Severe malnutrition

• Mental retardation

Complications

• Abuse

• Neurocognitive disorders

• Depression

• Delinquency

• Sociopathic behavior

Treatment • Treatment of failure to thrive is a major undertaking which requires

the input of a multidisciplinary team including physicians, nutritionists, social workers, behavioral specialists, and visiting nurses.• Many programs are available for young parents, single parents, and

parents having other problems. Referrals should be made as early as possible to appropriate programs.• Helping extended family members recognize that a problem exists

and recruiting their help will provide increased support for the mother and infant.

Effectiveness of treatment Depends on • Age of child• Clinical symptoms• Severity of problem• Type and duration of deprivation• Adequacy of therapeutic measures available

Prevention

• Attempt should be made to prevent separation by maintaining the home• Prevent the results of unavoidable separation by well planned foster

home• Humanizing institutions of care• Family planning!

Prognosis

•With early adequate attention and care, full recovery is expected.

• However, neglect severe enough to cause failure to thrive can kill the child if it continues without intervention

Conclusion

• MDS is not only limited to physical maternal loss, it also include the

loss of emotional support and feeling of wellbeing that is usually

projected from mother to child.

• The syndrome is not far from us and we must actively look beneath

the surface to identify it and institute timely intervention.

Thank you…….

References

• Kurt G: Maternal deprivation: J. AAP: 18;626, 1956• Ainsworth M D: The Effects of maternal deprivation; a review of

findings and controversy in the context of research strategy: WHO PHP 14• New York Times: Maternal Deprivation Syndrome• Wikipedia: Maternal Deprivation syndrome