Early Mother-Child Interaction and Later Quality of Attachment in Infants with an Orofacial Cleft Compared to Infants without Cleft

Abstract

Objective : The main objective of this study was to assess mother-child patterns of interaction in relation to later quality of attachment in a group of children with an orofacial cleft compared with children without cleft. Design : Families were contacted when the child was 2 months old for a direct assessment of mother-child interaction and then at 12 months for a direct assessment of the child's attachment. Data concerning socioeconomical information and posttraumatic stress symptoms in mothers were collected at the first appointment. Participants : Forty families of children with a cleft and 45 families of children without cleft were included in the study. Families were recruited at birth in the University Hospital of Lausanne. Results : Results showed that children with a cleft were more difficult and less cooperative during interaction at 2 months of age with their mother compared with children without a cleft. No significant differences were found in mothers or in dyadic interactive styles. Concerning the child's attachment at 12 months old, no differences were found in attachment security. However, secure children with a cleft were significantly more avoidant with their mother during the reunion episodes than secure children without cleft. Conclusion : Despite the facial disfigurement and the stress engendered by treatment during the first months of the infant's life, children with cleft and their mothers are doing as well as families without cleft with regard to the mothers' mental health, mother-child relationships, and later quality of attachment. A potential contribution for this absence of difference may be the pluridisciplinary support that families of children with cleft benefit from in Lausanne.

Maternal Representations and Parenting Style in Children Born With and Without an Orofacial Cleft

“…This result may be either related to the fact that parental representations were not related to parenting style, which is obviously not the case as results of this study found correlations between the two (Authoritarian style was related to Negative Affective Experience with the child, and Authoritative style was related to Global Codes) and that a large literature already linked the two (eg, Bornstein 2001), or to the small sample size resulting in a lack of power, preventing the identification of small differences across groups in representations. Anyway, the fact that mothers of children with a cleft were more Authoritarian is supported by indirect previous evidence reporting that mothers of children with a cleft were in general less sensitive during interaction with their child (Nelson et al, 2012; Habersaat et al, 2013b). Therefore, it is possible that this general lower sensitivity toward the child leads to a more controlling or punitive parenting style.…”

“…The objective of the present study was to assess maternal representations of their infants at age 2 months (before the reconstructive surgery), 12 months (after surgery), and 5 years when school starts in children born with and without an orofacial cleft. According to previous studies (Field and Vega-Lahr, 1984; Dolger-Hafner et al, 1997; Skrivan-Flocard and Habersaat, 2009; Despars et al, 2011; Bolomey et al, 2013; Habersaat et al, 2013b), we expected that mothers of children with a CL±P would show more negative emotions, be less sensitive, and perceive their child as being more difficult before the surgeries, compared with mothers of children without a cleft. After surgeries, differences between groups in terms of maternal representations were no longer expected.…”

“…Parental representations about the child (ie, the way parents perceive their child in terms of temperament, character, behaviors, etc) may therefore have an influence on maternal behaviors toward the child and on his or her subsequent development (Borghini et al, 2006; Stadelmann et al, 2007). In the case of CL±P, mother-infant interplay was shown to be less adequate (Nelson et al, 2012; Habersaat et al, 2013b) than in nonaffected children, but without negative consequences on the quality of attachment (Speltz et al, 1997; Habersaat et al, 2013b).…”

What Is the Burden of Care of Nasoalveolar Molding?

“…Sitzman et al (2016) performed a systematic review of unilateral cleft lip aesthetic outcomes and subsequent revision surgeries as a surrogate for burden of care. Other studies have assessed specific psychological factors following the birth of a child with a craniofacial difference such as the motherchild interaction and the stability of the parental relationship (St John et al, 2003;Despars et al, 2011;Habersaat et al, 2013). Burden of care, however, must not be mistaken with the epidemiological concept of "burden of disease."…”

“…Sitzman et al (2016) performed a systematic review of unilateral cleft lip aesthetic outcomes and subsequent revision surgeries as a surrogate for burden of care. Other studies have assessed specific psychological factors following the birth of a child with a craniofacial difference such as the mother–child interaction and the stability of the parental relationship (St John et al, 2003; Despars et al, 2011; Habersaat et al, 2013). Burden of care, however, must not be mistaken with the epidemiological concept of “burden of disease.” This has been previously estimated by global prevalence and incidence, in addition to attributable fraction (the amount of a disease that can be attributed to a specific risk factor), years lost of life, years lived with disability, and disability-adjusted life years (Steenland and Armstrong, 2006; Global Burden of Disease Study 2016 Collaborators, 2017).…”