Les débuts de la communication à trois. Interactions visuelles triadiques entre père, mère et bébé

Plusieurs auteurs ont montré que les échanges visuels entre des mères dépressives ou psychotiques et leur bébé présentent de multiples perturbations : dans cet article, les auteurs proposent une étude exploratoire portant sur les échanges visuels père-mère- bébé (9-18 semaines) dans deux groupes de familles, un groupe suivi pour des difficultés du post-partum et un groupe témoin. Les observations sont réalisées dans le cadre d'un jeu à trois structuré selon diverses modalités d'interaction (un parent joue avec l'enfant en présence de l'autre parent / les deux parents jouent conjointement avec le bébé). Les variables retenues concernent d'une part le niveau d'attention visuelle conjointe des partenaires, d'autre part l'évolution de cette attention visuelle au cours du jeu. Les résultats révèlent que les échanges visuels sont plus intenses dans les familles fonctionnelles, ce qui semble indiquer que l'engagement visuel triadique établi par les partenaires peut être représentatif du fonctionnement de la triade à un moment donné de son développement. D'autre part, l'analyse de l'évolution de l'engagement visuel au travers des différents contextes de jeu amène les auteurs à proposer l'hypothèse d'une « alliance triadique » établie conjointement par les trois partenaires et formant la matrice de leurs échanges dyadiques et triadiques. De façon plus générale, les auteurs supposent que l'établissement de cette alliance joue un rôle déterminant pour le développement et l'autonomisa- tion du bébé au sein de sa famille. Disorders in the visual interaction between depressive or psychotic mothers and their baby have been widely described : in this paper, the authors propose an exploratory study of father-mother-infant visual interaction (infants are 9-18 weeks old) in two groups of families, voluntary families and families in therapy for post-par turn disorders. The observations are gathered during a three-partner play, involving different kinds of triadic interaction (one parent plays with the infant, the other parent being « only present » / both parents play together with the child). The analyses have focused on the amount of visual attention shared by the partners and on the evolution of visual interaction during the game. Results show that triadic interaction is more intense in functional triads, which means that shared visual attention may be representative of the more general functioning of the family at a definite stage of its development. Furthermore, considering the sequential organization of visual interaction throughout the game led the authors to the construct of a « triadic alliance », jointly established by the three partners and providing a matrix for their dyadic and triadic interaction. On a more general level, such an alliance could play an important role for the development and the autonomy of the baby within his j her family.

Prenatal manifestation and management of a mother and child affected by spondyloperipheral dysplasia with a C-propeptide mutation in COL2A1: case report.

It is not unusual for patients with "rare" conditions, such as skeletal dysplasias, to remain undiagnosed until adulthood. In such cases, a pregnancy may unexpectedly reveal hidden problems and special needs. A 28 year old primigravida was referred to us at 17 weeks for counselling with an undiagnosed skeletal dysplasia with specific skeletal anomalies suggesting the collagen 2 disorder, spondyloperipheral dysplasia (SPD; MIM 156550).She was counselled about the probability of dominant inheritance and was offered a prenatal diagnosis by sonography. US examination at 17, 18 and 20 weeks revealed fetal macrocephaly, a narrow thorax, and shortening and bowing of long bones. The parents elected to continue the pregnancy. At birth the baby showed severe respiratory distress for four weeks which then resolved. Mutation analysis of both mother and child revealed a hitherto undescribed heterozygous nonsense mutation in the C-propeptide coding region of COL2A1 confirming the diagnosis of SPD while reinforcing the genotype-phenotype correlations between C-propeptide COL2A1 mutations and the SPD-Torrance spectrum. This case demonstrates the importance of a correct diagnosis even in adulthood, enabling individuals affected by rare conditions to be made aware about recurrence and pregnancy-associated risks, and potential complications in the newborn.

Impending status epilepticus and anxiety in a pregnant woman treated with levetiracetam.

Levetiracetam (LEV) has been considered to undergo no significant change in bioavailability during pregnancy; however, it was recently demonstrated to display modifications leading to a drop in its serum level. We describe a patient who displayed impending status epilepticus following a fall in her LEV level during the first trimester. The oral LEV dosage was increased, and phenytoin and benzodiazepines were transiently prescribed. She experienced severe anxiety and an unbearable fear over the deleterious consequences for her baby despite repeated, reassuring explanations. Her anxiety was so strong that she aborted electively shortly after leaving the hospital. This observation emphasizes the need for LEV level monitoring during pregnancy to prevent unexpected seizure relapses. The rapid increase in levetiracetam dosage in parallel with the loss of seizure control is suspected of facilitating the induction of significant psychiatric changes.

What dads should know about breastfeeding

This leaflet gives fathers and expectant fathers information on the benefits of breastfeeding for both their baby and their partner. It highlights the importance of their support in helping their partner to continue to breastfeed.

Breastfeeding - good for both of us

This poster promotes breastfeeding and highlights the fact that it has health benefits for both mother and baby. It also provides contact details of local organisations that can offer help and advice on breastfeeding.

PHA advises 'breast is best'!

The Public Health Agency is using National Breastfeeding Awareness Week (NBAW) to emphasise the message that breastfeeding is the healthiest option for both you and your baby and that by deciding to breastfeed, you will be giving your child the best possible start in life. NBAW runs from 19-25 June and highlights the fact that any period of breastfeeding, however short, will benefit your baby.Breast milk is different to formula milk as it contains antibodies that cannot be manufactured in formula. Antibodies help protect babies from infection and stimulate their immune system.Northern Ireland has the lowest breastfeeding rate in the UK, with an average of 63% of women breastfeeding their baby at birth. Janet Calvert, Regional Breastfeeding Coordinator at the PHA, said: "This is an issue that clearly needs addressed, as breastfeeding has many important health benefits for both mother and baby. These include a reduced risk of ear, chest, kidney and stomach infections and less risk of childhood diabetes and obesity."Breastfeeding can also significantly reduce the risk of hospital admission of children for gastroenteritis and chest infections. The health benefits for mothers who choose to breastfeed include a reduced risk of developing illnesses such as breast cancer, ovarian cancer and osteoporosis."There are other benefits as well as those to your health. Breastfeeding is free - you don't have to buy formula, bottles, teats, sterilising equipment etc. Breast milk is always available, with the right ingredients, at the right temperature, so it's easier to feed at night or on the go.The PHA recognises the importance of breastfeeding to health and the need to ensure that mothers get off to a good start with breastfeeding. It is vital that mothers get the right support and encouragement from their family and friends should they decide to breastfeed. Breastfeeding can be difficult at the start and mothers need reassurance while they learn."There are many local initiatives in the community to improve breastfeeding support. These include improving support in the health service and through Sure Start programmes, which work in areas of need to help ensure children get the best start in life," Janet added."Mother to mother peer support programmes are in place in many areas and are working with expectant and new mothers to help them breastfeed for longer. There are also 70 breastfeeding support groups, which provide ongoing support for breastfeeding mothers throughout Northern Ireland. "The PHA is also working to improve attitudes to breastfeeding in public through the Breastfeeding Welcome Here scheme, which began in 2005 and now has over 200 businesses and public facilities signed up to support and welcome breastfeeding families. All these initiatives, along with support from partners and family, are vital to help expectant and new mothers stay with breastfeeding."Health Minister Edwin Poots said: "There is clear evidence that breastfeeding offers health benefits for both babies and mothers. We know that breast milk gives baby the best start in life by providing all the nutrients and protection a baby needs for the first six months of life. That is why my Department is committed to promoting and supporting breastfeeding".For further information on breastfeeding visit www.breastfedbabies.org.uk

Maternal Obesity in the UK: Findings from a national project

In 2008, the Confidential Enquiry into Maternal and Child Health (CEMACH), now known as the Centre for Maternal and Child Enquiries (CMACE), commenced a 3-year UK-wide Obesity in Pregnancy project. The project was initiated in response to a number of factors. At the time, these included: i) growing evidence that obesity is associated with increased morbidity and mortality for both mother and baby, ii) evidence from the CEMACH 'Saving Mothers' Lives' report showed that women with obesity were over-represented among those who died of direct deaths compared to those who died of indirect deaths, 1 iii) unknown national and regional prevalence rates of maternal obesity, and iv) the need for a national clinical guideline for the care of women with obesity in pregnancy.

Watching your Weight in Pregnancy

Pregnant women in the Southern Health and Social Care Trust area are learning how to manage their weight as a result of a project being funded by the Public Health Agency.The 'Watching your Weight in Pregnancy' project, being delivered by the Southern Health and Social Care Trust, got underway in December 2011 to address the rising levels of obesity across the southern area. It also aims to reduce the impact that obesity can have on the health of women and their unborn children during pregnancy and birth.Two pilot programmes are currently underway in the Kilkeel area teaching both antenatal and post natal women that feeling good about yourself and your baby is important during pregnancy.The programmes provide information about managing weight during and after pregnancy and include advice on good nutrition along with opportunities to take part in appropriate physical activities. As part of the project, there have also been training sessions for midwives in the Southern HSC Trust on healthier eating and physical activity during pregnancy.Patricia McStay, Southern Trust Head of Midwifery, explained why there was a need for this project: "Every woman wants a healthy baby and we are supporting the women to improve their own health and wellbeing. We have been seeing increasing numbers of women who are overweight or obese at their first contact with the midwife. We want to support these women to manage their weight gain in pregnancy to reduce the risk of experiencing health complications such as high blood pressure, and diabetes in pregnancy."Angela McComb, Health and Social Wellbeing Improvement Manager, for the PHA, said: "The southern office of the PHA recognised the many risks associated with obesity in pregnancy, both to the mother and her baby, and allocated funding for this pilot project to test out ways in which these health risks can be reduced. "We look forward to seeing the results of the evaluation which will inform the further development of effective approaches to support pregnant women to manage their weight both locally and across Northern Ireland."

Information for parents on the work of NICORE

This leaflet describes the work of NICORE (Neonatal Intensive Care Outcomes Research and Evaluations), highlighting the importance of the data collected on each baby admitted to neonatal intensive care and how NICORE contributes to improved standards of care.

I know he's getting the best start, because he's breastfed

This poster highlights to fathers and expectant fathers the benefits of breastfeeding for their baby.

Other people can eat here, so why can't he?

This poster promotes breastfeeding and aims to encourage the general public to support breastfeeding mothers, rather than being embarrassed or offended by breastfeeding. It carries the strapline: Breastfeeding mums need your support - because every baby deserves the best.

One breath two lives

This poster highlights the fact that cigarette smoke breathed in by the mother reaches her unborn baby and directs women to the Smokers' Helpline.

Whooping Cough (Pertussis) immunisation - Poster

This poster encourages uptake of the whooping cough vaccine for pregnant women. Cases of whooping cough are on the increase - by getting the vaccine while pregnant you can protect your baby.

Whooping Cough (Pertussis) immunisation for pregnant women - Factsheet

This factsheet provides information and encourages uptake of the whooping cough vaccine for pregnant women. Cases of whooping cough are on the increase - by getting the vaccine while pregnant you can protect your baby.