Maternal deprivation syndrome - Paediatric Association of Nigeria

Maternal deprivation
By Dr. B Arinde
Resident, Pediatric Department
University of Ilorin Teaching Hospital
• Introduction
• Epidemiology
• Causes/risk factors
• Features of MDS
• Treatment
• Complications
• Prevention
• Prognosis
• Conclusion
• Compared to other mammals, the human infant depends on the adult
for its survival for a prolonged period
• The knowledge of the basic needs of the newborn, and the
application thereof by paediatricians, has resulted in a remarkable
reduction of neonatal morbidity and mortality.
• Less readily apparent among the fundamental needs of the infant are
requirements for gentle physical contact, sounds of pleasant and
varying tones of the human voice, antigravity play, visual stimuli from
the human environment and the more subtle interpersonal
communications- in sum, all of those activities ordinarily supplied by
a loving mother.
• The term Maternal deprivation dates back to the early work of
psychoanalyst John Bowlby, on the effects of separating infants and
young children from their mother
Core theory- Bowlby theory
• He believed the attachment
between a caregiver and infant
had to happen at least in the
first 3 years of the infant’s life.
• He called this the CRITICAL
PERIOD for attachment.
Maternal deprivation theory
• Based on Bowlby’s ideas:
• Attachment is important for
• Prototypes for later relationships
• Predicts developmental difficulty
if the attachment relationship
goes wrong:
• General developmental problems
• Specific issues with social
Core theory- Bowlby theory
failure of a child to form an
attachment in the first 5 years of
life, leading to negative
psychological effects especially
in adulthood
• When a child never experiences
the opportunity to form any sort
of bond it causes PRIVATION
Difference between separation and deprivation
• A physical disruption of the bond
between the parental unit and
the child
• A suitable replacement of the
parental unit (e.g. a surrogate)
should not cause any adverse
• Loss of the emotional care that
is provided by the parental unit
• Note the use of the term
“parental unit”: can be father or
• A parent may be physically
present and yet provide no
emotional support
Maternal Deprivation Syndrome (MDS)
• A failure to thrive seen in infants
and young children and
exhibited as a constellation of
signs, symptoms, behaviors,
usually associated with maternal
loss, absence or neglect, and is
characterised by lack of
responsiveness to the
environment and often
Maternal deprivation syndrome
• Approximately two-third are caused by dysfunctional caregiver
interaction, poverty, child abuse and parental ignorance about child
• Although mother and other primary caregiver may appear concerned,
the interplay of physical contact normally seen between mother and
child is absent or distorted
Local study
• Exploratory spatial analysis done in 2003
by O. Uthman
• Data collected from Nigeria Demographic
and health survey
• 6029 children aged 0-59 months
• Maternal socioeconomic deprivation index
-mothers with no education
-residence in rural area
-unemployed mothers
-mothers living below poverty level
Conclusion; children living in north-east and
north-west Nigeria had higher rate of
maternal deprivation
Maternal deprivation syndrome
• Deprivation can occur when
-A child lives in an institutionalized setting where he has no major
substitute mother and insufficient interaction with a mother figure
-He lives with his mother or a permanent substitute mother, where he
receives insufficient care and with whom he has insufficient interaction
-The child is unable to interact with a mother figure despite the fact
that one is present and ready to give sufficient care- this inability being
due to repeated break in ties with mother figures
Causal /Risk factors
• Young parental age
• Unplanned/unwanted pregnancy
• Maternal death
• Absence of father
Causal /Risk factors
• Wrong child gender!
• Low birth weight
• Congenital abnormality
• Children not breastfed
• Chronically ill babies
• Children with CP or other neurocognitive problems
Causal /risk factors
• Low levels of education
• Lower economic status/ Affluence
• Children from household with high birth order and/or under-5 children
greater than 4
• Maternal illness (may be a postpartum complication or debilitating
chronic illness)
• Absence of support network (family, close friends, or other support)
Phases of response to separation/deprivation
• Protest; crying and acute distress at loss of
mother and by efforts to replace her through
limited efforts at child’s disposal
• Despair; increasing helplessness, withdrawal
and decreasing efforts to regain mother
• Detachment; here, the child ‘settles down’
and accepts care from whatever substitute
figure available.
Symptoms and signs
• Subtle to blatant abnormality in
interaction between mother and
• Weight loss <5th percentile or an
inadequate rate of weight gain
• Decreased or absent linear growth
‘falling off’ growth chart
Symptoms and signs of MDS
• Poor hygiene
• Inappropriate clothing
• Unusual or overly restricted diet
• General lack of care
Emotional effects of MDS
• A certain amount of maturity and conscious cerebral functioning is
necessary in order to produce this syndrome. Thus it is not seen in
• young premature infants,
• the newborn for the first 2 weeks and;
• the severely retarded child
• Abandonment
• Developmental delay
• Severe malnutrition
• Mental retardation
• Abuse
• Neurocognitive disorders
• Depression
• Delinquency
• Sociopathic behavior
• Treatment of failure to thrive is a major undertaking which requires
the input of a multidisciplinary team including physicians,
nutritionists, social workers, behavioral specialists, and visiting
• Many programs are available for young parents, single parents, and
parents having other problems. Referrals should be made as early as
possible to appropriate programs.
• Helping extended family members recognize that a problem exists
and recruiting their help will provide increased support for the
mother and infant.
Effectiveness of treatment
Depends on
• Age of child
• Clinical symptoms
• Severity of problem
• Type and duration of deprivation
• Adequacy of therapeutic measures available
• Attempt should be made to prevent separation by maintaining the
• Prevent the results of unavoidable separation by well planned foster
• Humanizing institutions of care
• Family planning!
• With early adequate attention and care, full recovery is
• However, neglect severe enough to cause failure to thrive
can kill the child if it continues without intervention
• MDS is not only limited to physical maternal loss, it also include the
loss of emotional support and feeling of wellbeing that is usually
projected from mother to child.
• The syndrome is not far from us and we must actively look beneath
the surface to identify it and institute timely intervention.
Thank you…….
• Kurt G: Maternal deprivation: J. AAP: 18;626, 1956
• Ainsworth M D: The Effects of maternal deprivation; a review of
findings and controversy in the context of research strategy: WHO
PHP 14
• New York Times: Maternal Deprivation Syndrome
• Wikipedia: Maternal Deprivation syndrome

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