2. برقراری رابطه عاطفی به نام خدا دکتر فریبا همتی

3. Age, sex and constitutional Factors Housing Health Care Services Water & Sanitation Unemployment Living and working conditions Work Environment Education Agriculture and Food Production

5. Parenting and Attachment The bonding process of mother and father to infant

6. Definition The secure attachment bond is the nonverbal emotional relationship between an infant and primary caregiver, defined by emotional responses to the baby's cues, as expressed through movements, gestures, and sounds.

7. Attachment: Baby Mother Bonding : Mother Baby Attachment: Baby Mother Bonding : Mother Baby

8. Why a secure attachment bond is important? The attachment bond is a key factor in the way infant's brain organizes itself and influences the child’s social, emotional, intellectual, and physical development.

9. Why a secure attachment bond is important? By understanding how you can better participate in this emotional interaction, you can ensure that your child has the best foundation for life.

10. Why a secure attachment bond is important? Good enough mothering

11. Phases of attachment Introductory bonding Introductory bonding initial contact initial contact Acquaintance phase Acquaintance phase first week first week mutual regulation mutual regulation 2-6 wks 2-6 wks reciprocity reciprocity 6 wks and beyond 6 wks and beyond

12. Signs of attachment Names baby before birth or shortly after Wants to hold, feed, room in with infant When holding infant is focused on baby, not on phone, visitors, self or TV Calls infant by name, makes eye contact Identifies distinguishing characteristics which are “just like his father”, or brother, etc.

13. Mother to infant infant to mother Touch--typical pattern look--en face voice--high pitched entrainment time (biorhythms) lymphocytes and macrophages flora odor heat eye to eye cry entrainment oxytocin odor prolactin

14. Typical mother behavior patterns with infant Crooning voice high pitched talk finger tip touching examines extremities palmar enfolding of trunk holds baby close to body en face position

15. Events affecting attachment Prior to pregnancy Prior to pregnancy beliefs, planning beliefs, planning During pregnancy During pregnancy confirming, accepting, quickening.fetal identity confirming, accepting, quickening.fetal identity Intrapartum Intrapartum preparation, emotional state preparation, emotional state Postpartum Postpartum birth, seeing baby, touching, giving care birth, seeing baby, touching, giving care

16. Factors enhancing attachment Planned pregnancy Planned pregnancy baby close to “ideal” baby close to “ideal” right gender right gender prepared childbirth prepared childbirth easy labor easy labor no complications no complications good feeder good feeder staff compliance, support staff compliance, support compliments compliments support systems support systems

17. Factors hindering attachment Unwanted pregnancy Unwanted pregnancy difficult pregnancy or labor difficult pregnancy or labor stress during pregnancy stress during pregnancy anesthesia anesthesia sick or deformed infant sick or deformed infant C-section C-section Busy L&D,rigid policies or routines Busy L&D,rigid policies or routines no rooming in no rooming in separation from infant separation from infant maternal complications maternal complications no support systems no support systems negative comments negative comments

18. Challenges in babies that can affect secure attachment Babies with compromised nervous systems Babies with compromised nervous systems Babies who experienced problems in delivery Babies who experienced problems in delivery Babies with health problems at birth or at a very early age Babies with health problems at birth or at a very early age Premature babies who spent time in intensive care Premature babies who spent time in intensive care Babies who were separated from their primary caretakers at birth Babies who were separated from their primary caretakers at birth Babies who have experienced a series of caretakers Babies who have experienced a series of caretakers

19. Challenges in parents that can affect secure attachment Depression, anxiety, or other emotional problems Depression, anxiety, or other emotional problems Drug or alcohol problems Drug or alcohol problems High levels of stress (from financial problems, lack of support, overwork, etc.) High levels of stress (from financial problems, lack of support, overwork, etc.) An abusive, neglected, or chaotic childhood history An abusive, neglected, or chaotic childhood history Living in an unsafe environment Living in an unsafe environment Mainly negative memories of your own childhood experiences Mainly negative memories of your own childhood experiences

20. Quality of the attachment bond Securely Attachment Insecurely Attachment Insecurely Attachment

21. Securely attachment bond provides the baby with an optimal foundation for life: eagerness to learn, healthy self- awareness, trust, and consideration for others. provides the baby with an optimal foundation for life: eagerness to learn, healthy self- awareness, trust, and consideration for others.

22. Father to infant behavior Finger pokes kitchy kitchy koo playful holds baby out but facing his face roughhouse as baby gets older, more with male children

23. Insecurely Attachment one that fails to meet the infant’s need for safety and understanding, can lead to confusion about his or her own identity and difficulties in learning and relating to others in later life.

24. Cooper, Hoffman, Marvin &Powell, 2000

25. Disorders Of Attachment FTT FTT Separation anxiety disorder Separation anxiety disorderDepression Antisocial behaviors Learning Disorders Border line IQ Personality disorders: Border line P.D Personality disorders: Border line P.D Avoidant P.D Avoidant P.D

26. KMC & ATTACHMENT

27. ILL CHILD & PARENTS

28. ILL BABY HOSPITALIZATION

29. Babies, Needs Babies, Needs Parents, Needs Medical service problems Medical service problems

30. Why We Must To Know?

31. Medical Illness Can Affect Infants and children developmental course Infants and children developmental course The nature of the child-parents relation ship The nature of the child-parents relation ship Parents ’ relationship with another one Parents ’ relationship with another one Parents ’ receptiveness to medical care system Parents ’ receptiveness to medical care system Responsiveness of the medical care system Responsiveness of the medical care system

32. Parental Reaction to Hospitalization Denial and disbelief Denial and disbelief Fear and frustration, anxiety Fear and frustration, anxiety Depression, guilt Depression, guilt

33. Beginning to accept the fact and help of the staff to learn about illness Beginning to accept the fact and help of the staff to learn about illness Danger ! / overprotective & over controlling parents Danger ! / overprotective & over controlling parents Long-term psychosocial developmental problems for children Long-term psychosocial developmental problems for children

34. Represent a foreign environment Large hospitals with rotating staff Large hospitals with rotating staff Interns, Residents, … Interns, Residents, … Frequent questions Frequent questions Technological sophistication Technological sophistication

35. Medical Terminology Medical Terminology Medical hierarchy, the important of orders Medical hierarchy, the important of orders Parents ’ competing activities outside the hospital : ( Needs of the children demands of their own work) Parents ’ competing activities outside the hospital : ( Needs of the children demands of their own work)

36. The Process Of Intervention For The Parents Of Medically Ill Children 1.Forming an alliance and assessing the parents’ reaction to the ill child, the nature of the illness and the hospitalization 2.Clarifying information and helping the parents process their reactions.

37. 3.Helping the parents understand their child’s reaction to illness and hospitalization within a developmental framework 4.Assisting the parents in defining their roles on the medical unit 5.Maintaining and ongoing therapeutic relation ship with the parents 6.Facilitating communication between the staff and the parents.

38. THANKS