Unterschiede in der Qualität des Körper- und Blickkontakts bei Säuglingen mit und ohne Regulationsstörung
Abstract
Fragestellung: Wie eine Vielzahl von Studien belegen, ist Körperkontakt entscheidend für Gesundheit, Regulation und Entwicklung des Säuglings sowie die Eltern-Kind-Interaktion. Daher wäre gerade für Säuglinge mit Regulationsstörungen (wie exzessivem Schreien, Schlaf- und Fütterproblemen) ein qualitativ hochwertiger Körperkontakt wünschenswert. Vorausgegangene Beobachtungen im Rahmen der Elternberatung deuteten darauf hin, dass gerade diese Säuglinge eher einen schlechten Körper- und Blickkontakt aufweisen. Dies war der Ausgangspunkt der vorliegenden Studie, in der Säuglinge mit und ohne Regulationsstörung bezüglich ihres Körper- und Blickkontakts miteinander verglichen wurden. Methodik: Die Qualität des Körper- und die Dauer des Blickkontakts wurden anhand von Videoaufzeichnungen der Mutter-Kind-Interaktion mittels Rating ausgewertet. Zusätzlich wurde die tägliche Dauer von Schreien, Schlafen, Füttern, Unruhe und ruhiger Beschäftigung mit Hilfe eines Tagebuchs erfasst. Ergebnisse: Säuglinge mit einer Regulationsstörung zeigten einen schlechteren Körperkontakt (p < .01) und weniger Blickkontakt (p < .01). In nahezu allen Tagebuchvariablen zeigten sich signifikante Gruppenunterschiede. Schlussfolgerungen: Offensichtlich können Körper- und Blickkontakt, grundlegende kommunikative Fähigkeiten, bei Säuglingen mit Regulationsstörungen blockiert sein. Dies kann sich ungünstig auf die Regulationsproblematik auswirken. Therapeutische Maßnahmen mit betroffenen Kindern und ihren Eltern sollten daher auch auf eine Verbesserung der Fähigkeit zu Körper- und Blickkontakt abzielen.
Objective: Numerous studies have emphasized the importance of body contact for health, regulation, and development of infants as well as for parent-child interaction. Especially for infants with regulatory disorders (such as excessive crying, sleeping, and feeding problems), high-quality physical contact would be desirable. Observations in the context of parental counseling suggest that precisely these infants have a poor quality of body and eye contact. The present study compares infants with and without regulatory disorders with respect to their body and eye contact. Methods: Quality of body contact and amount of eye contact were examined by means of video ratings of the mother-child interaction. In addition, we measured the daily amount of crying, sleeping, feeding, being fussy, and quiet play in an infant behavior diary. Results: Infants with regulatory disorders scored worse in body contact (p < .01) and gaze contact (p < .001). There were also significant differences in most of the diary variables. Conclusions: Body and eye contact – basic communication skills – may be disturbed in infants with regulatory disorders, which could have an adverse effect on the regulation problems. Therapeutic interventions with affected children and their parents should aim at improving the ability of body and eye contact.
References
Bayley, N. (1969). Manual for the Bayley Scales of Infant Development. San Antonio, TX: The Psychological Corporation. Bayley, N. Manual for the Bayley Scales of Infant Development1969Brazelton, T. B., & Nugent, J. K. (1995). Neonatal Behavioral Assessment Scale, 3rd ed. (Clinics in Developmental Medicine, Vol. 137). London: MacKeith. Nugent, J. K. Neonatal Behavioral Assessment Scale, 3rd ed1995Clinics in Developmental Medicine, Vol. 137Christensson, K., Cabrera, T., Christensson, E., Uvnas-Moberg, K., & Winberg, J. (1995). Separation distress call in the human neonate in the absence of maternal body contact. Acta Paediatrica, 84, 468–473. Winberg, J. Separation distress call in the human neonate in the absence of maternal body contactActa Paediatrica199584468473Chwo, M. J., Anderson, G. C., Good, M., Dowling, D. A., Shiau, S. H., & Chu, D. M. (2002). A randomized controlled trial of early kangaroo care for preterm infants: effects on temperature, weight, behavior, and acuity. Journal of Nursing Research, 10, 129–142. Chu, D. M. A randomized controlled trial of early kangaroo care for preterm infants: effects on temperature, weight, behavior, and acuityJournal of Nursing Research200210129142Conde-Agudelo, A., Belizan, J. M., & Diaz-Rossello, J. (2011). Kangaroo mother care to reduce morbidity and mortality in low birthweight infants. Cochrane Database of Systematic Reviews, (3), CD002771. doi 10.1002/14651858.CD002771.pub2 Diaz-Rossello, J. Kangaroo mother care to reduce morbidity and mortality in low birthweight infantsCochrane Database of Systematic Reviews2011(3)CD002771Deutsche Gesellschaft für Kinder- und Jugendpsychiatrie und Psychotherapie. (2007). Leitlinien zur Diagnostik und Therapie von psychischen Störungen im Säuglings-, Kindes- und Jugendalter (3. Aufl., S. 357–378). Köln: Deutscher Ärzte Verlag.Leitlinien zur Diagnostik und Therapie von psychischen Störungen im Säuglings-, Kindes- und Jugendalter2007 Erlandsson, K., Dsilna, A., Fagerberg, I., & Christensson, K. (2007). Skin-to-skin care with the father after cesarean birth and its effect on newborn crying and prefeeding behavior. Birth, 34, 105–114. Christensson, K. Skin-to-skin care with the father after cesarean birth and its effect on newborn crying and prefeeding behaviorBirth200734105114Esser, G., Dinter-Jörg, M., Herrle, J., Yantorno-Villalba, P., Rose, F., Laucht, M., & Schmidt, M. H. (1996). Bedeutung der Blickvermeidung im Säuglingsalter für den Entwicklungsstand des Kindes mit zwei und viereinhalb Jahren. Zeitschrift für Entwicklungspsychologie und Pädagogische Psychologie, 28, 3–19. Schmidt, M. H. Bedeutung der Blickvermeidung im Säuglingsalter für den Entwicklungsstand des Kindes mit zwei und viereinhalb JahrenZeitschrift für Entwicklungspsychologie und Pädagogische Psychologie199628319Feldman, R., & Eidelman, A. I. (2003). Skin-to-skin contact (kangaroo care) accelerates autonomic and neurobehavioural maturation in preterm infants. Developmental Medicine and Child Neurology, 45, 274–281. Eidelman, A. I. Skin-to-skin contact (kangaroo care) accelerates autonomic and neurobehavioural maturation in preterm infantsDevelopmental Medicine and Child Neurology200345274281Feldman, R., Eidelman, A. I., Sirota, L., & Weller, A. (2002). Comparison of skin-to-skin (kangaroo) and traditional care: Parenting outcomes and preterm infant development. Pediatrics, 110, 16–26. doi 10.1542/peds.110.1.16 Weller, A. Comparison of skin-to-skin (kangaroo) and traditional care: Parenting outcomes and preterm infant developmentPediatrics20021101626Feldman, R., Weller, A., Sirota, L., & Eidelman, A. I. (2002). Skin-to-skin contact (kangaroo care) promotes self-regulation in premature infants: Sleep-wake cyclicity, arousal modulation, and sustained exploration. Developmental Psychology, 38, 194–207. Eidelman, A. I. Skin-to-skin contact (kangaroo care) promotes self-regulation in premature infants: Sleep-wake cyclicity, arousal modulation, and sustained explorationDevelopmental Psychology200238194207Feldman, R., Weller, A., Sirota, L., & Eidelman, A. I. (2003). Testing a family intervention hypothesis: the contribution of mother-infant skin-to-skin contact (kangaroo care) to family interaction, proximity, and touch. Journal of Family Psychology, 17, 94–107. Eidelman, A. I. Testing a family intervention hypothesis: the contribution of mother-infant skin-to-skin contact (kangaroo care) to family interaction, proximity, and touchJournal of Family Psychology20031794107Ferber, S. G., & Makhoul, I. R. (2004). The Effect of skin-to-skin contact (kangaroo care) shortly after birth on the neurobehavioral responses of the term newborn: A randomized, controlled trial. Pediatrics, 113, 858–865. doi 10.1542/peds.113.4.858 Makhoul, I. R. The Effect of skin-to-skin contact (kangaroo care) shortly after birth on the neurobehavioral responses of the term newborn: A randomized, controlled trialPediatrics2004113858865Gerhold, M., Laucht, M., Texdorf, C., Schmidt, M. H., & Esser, G. (2002). Early mother-infant interaction as a precursor to childhood social withdrawal. Child Psychiatry and Human Development, 32, 277–293. Esser, G. Early mother-infant interaction as a precursor to childhood social withdrawalChild Psychiatry and Human Development200232277293Gray, L., Watt, L., & Blass, E. M. (2000). Skin-to-skin contact is analgesic in healthy newborns. Pediatrics, 105, e14–e14. doi 10.1542/peds.105.1.e14 Blass, E. M. Skin-to-skin contact is analgesic in healthy newbornsPediatrics2000105e14e14Griffiths, R. (1970). The abilities of young children: A comprehensive system of mental measurement for the first eight years of life. London: Child Development Research Center. Griffiths, R. The abilities of young children: A comprehensive system of mental measurement for the first eight years of life1970Hemmi, M. H., Wolke, D., & Schneider, S. (2011). Associations between problems with crying, sleeping and/or feeding in infancy and long-term behavioural outcomes in childhood: A meta-analysis. Archives of Disease in Childhood, 96, 622–629. doi 10.1136/adc.2010.191312 Schneider, S. Associations between problems with crying, sleeping and/or feeding in infancy and long-term behavioural outcomes in childhood: A meta-analysisArchives of Disease in Childhood201196622629Holt-Lunstad, J., Birmingham, W. A., & Light, K. C. (2008). Influence of a «warm touch» support enhancement intervention among married couples on ambulatory blood pressure, oxytocin, alpha amylase, and cortisol. Psychosomatic Medicine, 70, 976–985. doi 10.1097/PSY.0b013e318187aef7 Light, K. C. Influence of a «warm touch» support enhancement intervention among married couples on ambulatory blood pressure, oxytocin, alpha amylase, and cortisolPsychosomatic Medicine200870976985Jansen, F., & Streit, U. (2014). Fähig zum Körperkontakt. Heidelberg: Springer Medizin Verlag. Streit, U. Fähig zum Körperkontakt2014Keller, H., & Zach, U. (1993). Developmental consequences of early eye contact behaviour. Acta Paedopsychiatrica, 56, 31–36. Zach, U. Developmental consequences of early eye contact behaviourActa Paedopsychiatrica1993563136Lawn, J. E., Mwansa-Kambafwile, J., Horta, B. L., Barros, F. C., & Cousens, S. (2010). «Kangaroo mother care» to prevent neonatal deaths due to preterm birth complications. International Journal of Epidemiology, 39(Suppl 1), i144–154. doi 10.1093/ije/dyq031 Cousens, S. «Kangaroo mother care» to prevent neonatal deaths due to preterm birth complicationsInternational Journal of Epidemiology201039i144154Ludington-Hoe, S. M., Johnson, M. W., Morgan, K., Lewis, T., Gutman, J., Wilson, P. D., & Scher, M. S. (2006). Neurophysiologic assessment of neonatal sleep organization: Preliminary results of a randomized, controlled trial of skin contact with preterm infants. Pediatrics, 117, e909–923. doi 10.1542/peds.2004-1422 Scher, M. S. Neurophysiologic assessment of neonatal sleep organization: Preliminary results of a randomized, controlled trial of skin contact with preterm infantsPediatrics2006117e909923Moore, E. R., Anderson, G. C., Bergman, N., & Dowswell, T. (2012). Early skin-to-skin contact for mothers and their healthy newborn infants. Cochrane Database of Systematic Reviews, 5, CD003519. doi 10.1002/14651858.CD003519.pub3 Dowswell, T. Early skin-to-skin contact for mothers and their healthy newborn infantsCochrane Database of Systematic Reviews20125CD003519Morhenn, V., Beavin, L. E., & Zak, P. J. (2012). Massage increases oxytocin and reduces adrenocorticotropin hormone in humans. Alternative Therapies in Health and Medicine, 18, 11–18. Zak, P. J. Massage increases oxytocin and reduces adrenocorticotropin hormone in humansAlternative Therapies in Health and Medicine2012181118Ohgi, S., Fukuda, M., Moriuchi, H., Kusumoto, T., Akiyama, T., Nugent, J. K. ... Saitoh, H. (2002). Comparison of kangaroo care and standard care: Behavioral organization, development, and temperament in healthy, low-birth-weight infants through 1 year. Journal of Perinatology, 22, 374–379. doi 10.1038/sj.jp.7210749 Saitoh, H. Comparison of kangaroo care and standard care: Behavioral organization, development, and temperament in healthy, low-birth-weight infants through 1 yearJournal of Perinatology200222374379Okan, F., Ozdil, A., Bulbul, A., Yapici, Z., & Nuhoglu, A. (2010). Analgesic effects of skin-to-skin contact and breastfeeding in procedural pain in healthy term neonates. Annals of Tropical Paediatrics: International Child Health, 30, 119–128. Nuhoglu, A. Analgesic effects of skin-to-skin contact and breastfeeding in procedural pain in healthy term neonatesAnnals of Tropical Paediatrics: International Child Health201030119128Rao, M. R., Brenner, R. A., Schisterman, E. F., Vik, T., & Mills, J. L. (2004). Long-term cognitive development in children with prolonged crying. Archives of Disease in Childhood, 89, 989–992. doi 10.1136/adc.2003.039198 Mills, J. L. Long-term cognitive development in children with prolonged cryingArchives of Disease in Childhood200489989992Saeidi, R., Asnaashari, Z., Amirnejad, M., Esmaeili, H., & Robatsangi, M. G. (2011). Use of «kangaroo care» to alleviate the intensity of vaccination pain in newborns. Iran Journal of Pediatrics, 21, 99–102. Robatsangi, M. G. Use of «kangaroo care» to alleviate the intensity of vaccination pain in newbornsIran Journal of Pediatrics20112199102Schneider, C., Charpak, N., Ruiz-Pelaez, J. G., & Tessier, R. (2012). Cerebral motor function in very premature-at-birth adolescents: A brain stimulation exploration of kangaroo mother care effects. Acta Paediatrica, 101, 1045–1053. doi 10.1111/j.1651-2227.2012.02770.x Tessier, R. Cerebral motor function in very premature-at-birth adolescents: A brain stimulation exploration of kangaroo mother care effectsActa Paediatrica201210110451053Seltzer, L. J., Ziegler, T. E., & Pollak, S. D. (2010). Social vocalizations can release oxytocin in humans. Proceedings of the Royal Society B, 277, 2661–2666. doi 10.1098/rspb.2010.0567 Pollak, S. D. Social vocalizations can release oxytocin in humansProceedings of the Royal Society B201027726612666Streit, U., Nantke, S., & Jansen, F. (2007). Videostandardsituationen im Säuglingsalter. Unveröffentlichtes Auswertungssystem Jansen, F. Videostandardsituationen im Säuglingsalter2007Streit, U., Nantke, S., Jansen, F., Wolf, K., Gallasch, M., & Kohlmann, T. (2014). Einfluss einer Verbesserung des Körperkontakts auf Regulationsstörungen im Säuglingsalter. Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie, 42, 301–313. Kohlmann, T. Einfluss einer Verbesserung des Körperkontakts auf Regulationsstörungen im SäuglingsalterZeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie201442301313Tessier, R., Cristo, M. B., Velez, S., Giron, M., Nadeau, L., Figueroa de Calume, Z., ... Charpak, N. (2003). Kangaroo Mother Care: A method for protecting high-risk low-birth-weight and premature infants against developmental delay. Infant Behavior and Development, 26, 384–397. doi 10.1016/S0163-6383(03)00037-7 Charpak, N. Kangaroo Mother Care: A method for protecting high-risk low-birth-weight and premature infants against developmental delayInfant Behavior and Development200326384397Uvnas-Moberg, K. (2013). The hormone of closeness: The role of oxytocin in relationships. London: Pinter & Martin. Uvnas-Moberg, K. The hormone of closeness: The role of oxytocin in relationships2013von Kries, R., Kalies, H., & Papousek, M. (2006). Excessive crying beyond 3 months may herald other features of multiple regulatory problems. Archives of Pediatrics & Adolescent Medicine, 160, 508–511. doi 10.1001/archpedi.160.5.508 Papousek, M. Excessive crying beyond 3 months may herald other features of multiple regulatory problemsArchives of Pediatrics & Adolescent Medicine2006160508511Wolke, D. (2009). Regulationsstörungen. In S.Schneider & J.Markgraf (Eds.), Lehrbuch der Verhaltenstherapie (Vol. 3, pp. 295–312). Heidelberg: Springer-Verlag. Markgraf, J. RegulationsstörungenLehrbuch der Verhaltenstherapie2009Vol. 3295312Wolke, D., Rizzo, P., & Woods, S. (2002). Persistent infant crying and hyperactivity problems in middle childhood. Pediatrics, 109, 1054–1060. doi 10.1542/peds.109.6.1054 Woods, S. Persistent infant crying and hyperactivity problems in middle childhoodPediatrics200210910541060Wolke, D., Schmid, G., Schreier, A., & Meyer, R. (2009). Crying and feeding problems in infancy and cognitive outcome in preschool children born at risk: A prospective population study. Journal of Developmental and Behavioral Pediatrics, 30, 226–238. doi 10.1097/DBP.0b013e3181a85973 Meyer, R. Crying and feeding problems in infancy and cognitive outcome in preschool children born at risk: A prospective population studyJournal of Developmental and Behavioral Pediatrics200930226238Wurmser, H., Laubereau, B., Hermann, M., Papousek, M., & von Kries, R. (2001). Excessive infant crying: Often not confined to the first 3 months of age. Early and Human Development, 64, 1–6. von Kries, R. Excessive infant crying: Often not confined to the first 3 months of ageEarly and Human Development20016416