It appears that some cases of psychological distress in women following childbirth may be inaccurately conceptualised as depression. Clinically significant fatigue and moderate distress are distinguishable from depression, and warrant specifically tailored assessment strategies and treatments. Following the birth of a baby, the partner of a mother has a strong influence on her emotional health and should be included in any assessment and intervention.
Australia has a system of residential parentcraft services which offer brief admissions to mothers experiencing difficulties with infant care and postnatal mood disturbance. Most of these are state-funded public access services. In 1996 a comparable but differentiated service was opened in the private sector. Masada Private Hospital Mother Baby Unit accommodates five mother-infant pairs who are admitted to a five-night structured residential program. Care is provided by a multidisciplinary team comprising a paediatrician, general practitioner, clinical psychologist and specialist nurses. Complex maternal mood disorders as measured on standardised psychometric instruments include depression, anxiety and severe occupational fatigue. Their babies are unsettled, cry for prolonged periods, wake frequently at night and do not sleep well during the day. Many have feeding difficulties. The treatment program comprises both individualised training in infant care and settling strategies and psycho-educational groups offered in a supportive non-judgemental setting. One month post-discharge maternal mood is significantly improved and infant behaviour more manageable compared with functioning on admission.
Recurrent abdominal pain is one of the most common presentations to pediatricians; yet an organic etiology can be found in only 10% of cases. Because infection with Helicobacter pylori in adults and children results in gastritis, a causative role for the organism has been postulated. To investigate this theory, we conducted a prospective case-control study in children with recurrent abdominal pain using serum H. pylori IgG antibodies measured by an enzyme immunoabsorbent assay. Age, sex, ethnicity, and socioeconomic status were adjusted in the statistical model. Five subjects (5.1%) and 14 controls (14.3%) had raised serum IgG antibodies to H. pylori (adjusted OR, 0.21; 95% confidence interval, 0.05, 0.85). The negative association between H. pylori and recurrent abdominal pain indicates that this organism is unlikely to have an important etiologic role in this disorder.
While infant behaviour is influenced by maternal care, infant crying and dysregulated sleep can reciprocally affect maternal mood. The temperament and behaviour of two 4 -12-months-old infant cohorts admitted with their mothers to a residential parenting program were examined using behaviour charts and the Short Infant Temperament Questionnaire (SITQ). One group was re-assessed one and six months later. Infant temperament was significantly more difficult than population norms and most had dysregulated sleep. One month after treatment, total infant crying and fussing, frequency of night-time waking, and sleep and feeding dysregulation were significantly (p 5 .001) reduced, with change sustained at six months. Easy-Difficult scores (SITQ) were stable and significantly worse than population norms. The contribution of a ''difficult'' infant temperament to maternal mood disorder warrants further investigation.
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