‫به نام خدا‬
‫برقراری رابطه عاطفی‬
‫دکتر فریبا همتی‬
Living and working
conditions
Work Environment
Unemployment
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Sanitation
Education
Health Care
Services
Agriculture and
Food Production
Age, sex and
constitutional
Factors
Housing
Parenting and
Attachment
The bonding process of mother and
father to infant
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.
Attachment: Baby
Mother
Bonding : Mother
Baby
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.
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.
Why a secure attachment bond is
important?
Good enough
mothering
Phases of attachment

Introductory bonding


Acquaintance phase


first week
mutual regulation


initial contact
2-6 wks
reciprocity

6 wks and beyond
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.
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
Events affecting attachment

Prior to pregnancy


During pregnancy


confirming, accepting, quickening.fetal identity
Intrapartum


beliefs, planning
preparation, emotional state
Postpartum

birth, seeing baby, touching, giving care
Factors enhancing attachment
Planned pregnancy
baby close to “ideal”
right gender
prepared childbirth
easy labor
no complications
good feeder
staff compliance, support
compliments
support systems
Factors hindering attachment






Unwanted pregnancy
difficult pregnancy or labor
stress during pregnancy
anesthesia
sick or deformed infant
C-section






Busy L&D,rigid policies or
routines
no rooming in
separation from infant
maternal complications
no support systems
negative comments
Challenges in babies that can
affect secure attachment






Babies with compromised nervous systems
Babies who experienced problems in delivery
Babies with health problems at birth or at a very early
age
Premature babies who spent time in intensive care
Babies who were separated from their primary
caretakers at birth
Babies who have experienced a series of caretakers
Challenges in parents that can
affect secure attachment






Depression, anxiety, or other emotional problems
Drug or alcohol problems
High levels of stress (from financial problems, lack of
support, overwork, etc.)
An abusive, neglected, or chaotic childhood history
Living in an unsafe environment
Mainly negative memories of your own childhood
experiences
Quality of the attachment bond
Securely Attachment
Insecurely Attachment
Securely attachment bond

provides the baby with an optimal foundation
for life: eagerness to learn, healthy selfawareness, trust, and consideration for others.
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





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.
Cooper, Hoffman, Marvin &Powell , 2000
Disorders Of Attachment
FTT
Separation anxiety disorder
Depression
Antisocial behaviors
Learning Disorders
Border line IQ
Personality disorders: Border line P.D
Avoidant P.D
KMC & ATTACHMENT
ILL CHILD & PARENTS
ILL BABY
HOSPITALIZATION
,
Babies Needs
,
Parents Needs
Medical service problems
Why We Must To
Know?
Medical Illness Can Affect
•
Infants and children developmental course
•
The nature of the child-parents relation ship
•
Parents’ relationship with another one
•
Parents’ receptiveness to medical care system
•
Responsiveness of the medical care system
Parental Reaction to Hospitalization
•
•
•
Denial and disbelief
Fear and frustration , anxiety
Depression , guilt
•
Beginning to accept the fact and help of the staff
to learn about illness
•
Danger ! / overprotective & over controlling
parents
•
Long-term psychosocial developmental problems
for children
Represent a foreign environment
•
•
•
•
Large hospitals with rotating staff
Interns , Residents , …
Frequent questions
Technological sophistication
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.
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.
THANKS