To take in account firstrelationship parents-newbornduring pediatric examination.

The objective is to detect earlydifficulties in the parent(s)-newborn relationship in order topropose earlier intervention ifnecessary.

During the first interview, parents maypresente their difficulty (anxiety) of takingcare of the newborn, sometimes it is hidingbehind an opposite attitude and silence.

Flashing is lighting in thissituation and we must be inalert to find other signals.

This way necessite early interventionand more vigilance during the

assessment with NBAS.

Subsequently, we can detect thenewborn role in the relationship withcaregiver. In fact, NBAS is certainlyusefull for detecting the newbornÔs

temperament.

Oftenly the disorder of parent(s)-infant relationship is preceded by

disturbances and troubles.

Sometimes disorder could bestand out early or better,

flashing early if the disorder isnot yet establish as

developmental disabilities.

ItÕs really interesting to detect earlyflashing because we can develop amanagement protocol for infants at

risk of later developmentaldisabilities.

We should have to listen the new motherto speak about her pregnancy, full term or

not, labour, childbirth, past history(concerning an other child or pregnancy),social and family environments (husband

and mother) , describing her baby,speaking about the babyÕs firstname, how

she feed her baby.

At this time, we should have to stand outif this new mother shaw flashing about

factors of risk of postpartum mooddisorders, for example, or fragility ofnarcissism (ideal pregnancy without

Òshadow of doubtÓ).

Professionals should be able to listenthat pregnancy and parenthood arenÕtalways Òthe beautifull day of the lifeÓ,and sometimes new parents say : Ò itÕs

difficult Ò . Questions as ÒHow are youÓare possible but we should never

interprete the answer.

We must be caution in giving advices.New mother take advices from every

source, on books or TV, the people nextdoor, friends, another professional of

health, and the family.

If we give an advice too quickly before sheproposes her opinion concerning the

question, she will be lost in an ocean ofadvices. Very often, itÕs more therapeutic if

we help her to find by herself what shewants to do.

We have to protect the emotionalintegrity of the parents, and to notconsider like trivial what they feel(general fatigue, pain É ). Parents

need time to reorganize their energyand their expectation.

Of course, this point of view necessitemeeting the families more than onetime, and the need of a longitudinal

follow-up care.

One of the difficulties of the childbirth forparents is the first meeting with the real-

baby, because, before that, they know it bythe ultrasonic scan, by their imagination, and

the unconscious fantasy-baby.

As we know there are three types ofParents-baby interactions : Behavioral(body contact, visual contact and vocalcontact), Emotional (Affective), and

Imaginative (Phantasy).

We can find three ranks ofrelationships in a family :

Disturbance : breaking off for ashort moment in the

environment, including illness,usually for less than one month.

The family will stay adapted.

Trouble of the relationship inthe family : moral suffering,difficulty in the care-giving.Pattern of malajusted but notfixed relationship which is

limited in one field (sleeping,eating, ...), for less one month.

Disorder of the relationship :Patterns of mal adapted behavior

concerning the relationship and thecare-giving which is difficult to

change. Retardation of developpmentscale, malfunctionning in several

domains of behavior. Usually morethan three months.

Subsequenly, we examine the baby andtry to help and support the parents to

recognize their competences to deal withthe newborn, and to improve their way of

observations.

NBAS is an accurate time forobservation. In fact, through

examination, we can precisely point outsome characteristics of the newborn

that parents already have found.

There are three important clusters ofthe NBAS :

Motor cluster which mesures motorperformance, quality of movements

(motor maturity and motorcoordination) and postural tonus.

State control represents abilitiesrelating to state regulation. Low StateControl scores indicating difficultiesin self regulating such as irritability,

labile change of state, poorconsolability and inhability to

properly adjust to environnementalstimuli.

Orientation cluster associated withalert state control, attention andresponsivness to animate and

inanimate visual-auditory stimuli.This score might be affected bydefective behavioral subsystem

(autonomic system, motor system andthe state system).

Recent studies show that poor motorperformance, poor state regulation and

poor interaction could be at risk oflater behavioral problems in

childhood.

Irritabily in awake state, measures thenumber of time the infant fussing or

crying for three seconds on thefollowing list : Uncover, place in

supine, response decrement to tactilestimulation of the foot, undressing,

passive tone on legs and arms, pull tosit, place in prone, defensivemovements ; TNR ; Moro.

General Irritability : reflects the infantÕsresponse to the mildly and moderatly

aversive stimulus situations during theexamination. If non-aversive stimuli

induce either state 5 or 6 for threeseconds, the infant is considered

generally irritable. The baby will be moreirritable than is reflected in the score.

Attachment relationship is influanced bythe baby but determined by the mother.We remind that baby can have different

attachment relationships with eachcaregiver.

Mother sensible to her baby, iswarm, attentive at signals sent,

responsive, she answers in a shorttime at his needs, particulary in thefirst three months of the life. ItÕs a

base of security for the developmentof the infant.

The motherÕs sensibility is expressedwhen she can adapt herself to the needs of

her baby , when she feels him pleased,accept that her infant interferes in her life,

responding approperietely to her babyduring thier interaction, displaying a

good quality of Ò handling and holding Òand efficiency of actions when he is

fussing or crying.

During medical examination, amothers at risk of relationships

problems with her baby can presentthe following behavior :

being absent-minded,indifferent toher baby , no contingence, speaking

with projections, or respondingwith aggressivity and negativity.

They are feared to not understandthe baby, not giving Ògood

enoughÓ care, they often would liketo be perfect and overregulation

caregiving.

Separation anxiety appears as a childseeks assuring responce from a parent.If a parent is present and responds to

the child's needs, the system ofattachment may disappear and a new

activity is initiated.

There are three types of attachments: insecure - avoidance, secure and

ambivalent insecure.They were described from the

experimental model of the StrangeSituation.

Insecure-avoidance : child isapparently not perturbed by the

separation with his parent, seems notin need to assurance. He looksindependant. When the parent

appears again, the child ignores him.

Secure : child protests at theseparation but welcomes parent whenhe comes back, with relief. Then he

explores again.

Insecure-ambivalent : child showsimportant disturbance by the

situation. Anxious and sometimestrouble at separation, he is reliefed but

with ambivalence : he looks forphysical contact and cling the parentbut immediatly after he declines andrejects him, with angry. He doesnÕt

want to be consoled.

In Middle Class in USA, 66% Childrenwould be secure, 22% insecure-

avoidance et 12% insecure-ambivalent.

Studies seem to demonstrate thatchildren who eventually develop asecure attachment, show in the firstyear of life more pleasure in being

carried as opposed to those that showseparation anxiety.