Parent-child bonding and attachment during pregnancy and early childhood following congenital heart disease diagnosis

Abstract

Diagnosis and treatment of congenital heart disease (CHD) can present challenges to the developing parent-child relationship due to periods of infant hospitalisation and intensive medical care, parentinfant separations, child neurodevelopmental delay and feeding problems, and significant parent and child distress and trauma. Yet, the ways in which CHD may affect the parent-child relationship are not well-understood. We systematically reviewed the evidence on parental bonding, parent-child interaction, and child attachment following CHD diagnosis, according to a pre-registered protocol (CRD42019135687). Six electronic databases were searched for English-language studies comparing a cardiac sample (i.e., expectant parents or parents and their child aged 0-5 years with CHD) with a healthy comparison group on relational outcomes. Of 22 unique studies, most used parent-report measures (73%) and yielded mixed results for parental bonding and parent-child interaction quality.Observational results also varied, although most studies (4 of 6) found difficulties in parent-child interaction on one or more affective or behavioural domains (e.g., lower maternal sensitivity, lower infant responsiveness). Research on parental-fetal bonding, father-child relationships, and child attachment behaviour was lacking. Stronger evidence is needed to determine the nature, prevalence, and predictors of relational disruptions following CHD diagnosis, and to inform targeted screening, prevention, and early intervention programs for at-risk dyads.

Psychological Outcomes and Interventions for Individuals With Congenital Heart Disease: A Scientific Statement From the American Heart Association

“…95 Attachment-based psychotherapies often take a child-led approach and focus on supporting and strengthening the parent-child attachment relationship. 96,97 Psychodynamically oriented therapies focus on patterns in an individual's thoughts, feelings, self-concept, relationship and life experiences using a developmental perspective to understand how early experiences may influence present psychological difficulties. 98 We draw on strong empirical support for psychotherapy in the general population and among individuals with heart disease and on our collective clinical experiences to suggest that psychotherapy is likely beneficial within the congenital heart disease setting.…”

Biological and structural phenotypes associated with neurodevelopmental outcomes in congenital heart disease

“…For example, parent post-traumatic stress, referring to specific psychological and physiological symptoms (e.g., flashbacks, avoidance, hyperarousal) following exposure to a traumatic event (e.g., witnessing their child go into cardiac arrest), is associated with lower psychosocial functioning ( 160 ) and quality of life ( 155 ) for children and adolescents with CHD. While the mechanisms underlying these associations are not fully understood, family environment and parent-child interactions likely play an important role ( 148 , 162 ). There is also evidence that high and persistent maternal psychological stress and anxiety during pregnancy can alter fetal brain development in both healthy fetuses and fetuses with CHD ( 147 ).…”

A Psychosocial Care Model for Families Affected by Congenital Heart Disease*

“…Parents frequently experience mental health problems (e.g., anxiety, depression, traumatic stress) due to traumatic medical events and the demands of parenting a child with critical illness (1, 2). Family relationships and parenting style are also often affected (3, 4). Difficulties with parental mental health and family functioning influence child outcomes.…”