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Meeting the Needs of Court Involved Infants
and Toddlers
Meeting the Needs of Court Involved Infants
and ToddlersJoAnne Solchany PhD, ARNP, RN,
BC
Copyright 2007
Frederick IIPhysicians
FreudSpitz
Anna FreudCaffeyBowlby
Mahler, Stern, Emde, Zero to Three
13th Century1900’s1900’s1945
40’s-50’s1940’s1950’s
>1955
History of Children’s Well BeingHistory of Children’s Well Being
Report FindingsReport Findings
Over 100 babies in total 6 cases reported on:
23 total fractures (r = 3-5 each) Radius, ulna, femur, tibia, fibula,
humerus 17/23 fractures followed subdural
hematomas 27 lesions 4 contusions
Child CharacteristicsChild Characteristics
Impacting black and white infants Impacting male and female infants Age range: 2 weeks-8 months All initially breast fed No history of injury Mothers all primary caregivers Initially normal development
SymptomsSymptoms
Chronic subdural hematoma Multiple long bone fractures Ear infections Weight loss Black and bluish spots on face Rigidity Weakness
Subdural HematomaSubdural Hematoma
Anaclitic DepressionAnaclitic Depression
Primary loss of a love object Apprehension, sadness, weepiness Lack of contact Rejection of environment Withdrawal Loss of appetite, refusal to eat, loss
of weight
Anaclitic DepressionAnaclitic Depression Retardation of development Retardation of reaction to
stimuli Slowness of movement,
dejection, stupor Insomnia The expression best
described as the expression you see in the depressed adult
Interaction & Exploration
InputInput
Experiences Caregiving Relationship Caregiving Quality Nutrition Environment Play Protection from Danger and Risks
Brain Development & Cognitive PerformanceBrain Development & Cognitive Performance Prenatal Environment is Important Childhood Environment is Crucial However, the most critical period
for brain growth and development is that early post-natal environment.
Increases in head circumference was associated with greater cognitive ability
Maximizing children’s growth throughout infancy and childhood is critical for optimal cognitive functioning in adulthood
Gale, et al., 2004
Impact of Neglect & DeprivationImpact of Neglect & Deprivation Sensory deprivation Smaller head circumference PTSD symptoms Insecure attachment Poor peer relationships Under-activation of some systems Over-activation of other systems
Impact of Neglect: 3 Year OldsImpact of Neglect: 3 Year Olds
Bruce Perry, 2005
Where You Might See ItWhere You Might See It
Addicted Caregivers Depressed Caregivers Caregivers in Grief Divorcing Parents Compromised Families Overworked Caregivers Domestic Violence Medically or Mentally Ill Caregivers Caregivers who are not invested in the baby
Brain StructureBrain Structure
Increasing
Complexity
Brain Stem
Dienchepalon
Limbic
Neocortex
Increasing Maturity
BrainstemBrainstem
Most basic and primitive part of the brain
Provides basic life functions Maintains body temperature,
blood pressure, heart rate and breathing regulation
Overall physical competency
DienchephalonDienchephalon
Appetite & satietyMotor regulationArousal—ability to wake,
pay attention, deal with stimulation, and ability to regulate arousal states
Sleep
LimbicLimbic
Emotional reaction—range of emotions, ways of expressing emotion
Sexual behavior—understanding, connecting sexuality and relationships
Attachment—feeling connected, safe and secure with someone else in the world
NeocortexNeocortex
Abstract thought—how to think about possibilities, options, other’s points of view
Concrete thought—black and white thinking
Language Affiliation—relationships,
connections, social skills
Impact of Stress on Young ChildImpact of Stress on Young Child
Chronic Stressors Acute Stressors Resiliency of Child Perception of the Child Nature of their Ability to Process Developmental Stage and/or
Abilities Structure, Quality, and
Availability of a Support System Examples: moving to a new
caregiver, addition of a family member, loss of a family member, abuse, neglect, birth of a sibling
Trilogy of Early ChildhoodTrilogy of Early Childhood
Sleep
EliminationEating
How and Where We See the ImpactHow and Where We See the Impact
Biorhythms Nature of Relating or
Connecting Nature of the Ability to
Self-Regulate or to be Regulated by Another
Evidence of Stress-Related Behaviors—aggression, regression, self abuse, teeth grinding, startle, etc.
Desirable Sleep PatternsDesirable Sleep Patterns
Developing longer night time sleep patterns
Stabilizing to a predictable schedule
Increasing ability to regulate and self sooth
Growth FalteringGrowth Faltering
Samuel's Growth Percentiles
01020304050607080
Monthsof Age
Baby AGrowthPercentiles
Ricky's Growth Percentiles
-10
-5
0
5
10
15
20
25
30
3/7/
2003
4/7/
2003
5/7/
2003
6/7/
2003
7/7/
2003
8/7/
2003
9/7/
2003
10/7
/200
3
11/7
/200
3
12/7
/200
3
1/7/
2004
2/7/
2004
3/7/
2004
4/7/
2004
5/7/
2004
6/7/
2004
7/7/
2004
8/7/
2004
9/7/
2004
Grow th Percentiles
Ricky’s Growth PercentilesRicky’s Growth Percentiles
Physical Issues to ConsiderPhysical Issues to Consider
Overall health Growth Patterns
Height, Weight, Head Circumference
Frequency of infections, colds, etc.
Immunizations up to date
Hearing and vision Communicable diseases Dental health
Developmental Issues to ConsiderDevelopmental Issues to Consider
Developmental Evaluations Speech Fine Motor Gross Motor Cognitive Emotional Social
The course of
development… The course of
development… …can be altered in early childhood by effective interventions that change the balance between risk and protection, thereby shifting the odds in favor of more adaptive outcomes.
Neurons to Neighborhoods, 2000
Emotional Issues to ConsiderEmotional Issues to Consider
Uninterested in playing or learning Odd, whiney, or cat-like cry No cry or empty cry Aggression Animation Sense of sadness Range of expression Attention/ability to focus
Relationship Issues to ConsiderRelationship Issues to Consider
Child vs. Parent/Caregiver Clinginess vs. avoidance Eye Contact Looking to an adult when
hurt, sick, or injured Unsoothable Demonstrating fear Over compliance Degree of self reliance
Other Issues to ConsiderOther Issues to Consider
Sensory deprivation Lack of language
development Developmental delays
across the board Little or no fear of
strangers Affectionate behaviors
with strangers Exaggerated fear of
others Aggressive behaviors Self injurious behaviors
Our lives no longer Our lives no longer belong to us alone; belong to us alone; they belong to all they belong to all those who need us so those who need us so desperately.desperately.
Elie Wiesel, Elie Wiesel, NightNight
Attachment Focussed Care for Babies and Young Children
Attachment Focussed Care for Babies and Young Children
Dr. JoAnne Solchany RN, ARNP, PhD, BC
Family & Child Nursing
Center for Infant Mental Health & Development
School of Nursing
University of Washington
Seattle, Washington
