argument is often, if not acrimonious, at least heated. It gives an impression of the fluidity of opinion on many fundamental ideas under discussion and of the urgency with which cardiac cyanosis in the newborn is regarded. When Dr. William Muscott says that the earliest he has operated for pulmonary stenosis is on an infant 3 days old, and Sir Russell Brock agrees that the earlier in the first month that operation is undertaken the better, and when Dr. Varco asks Dr. Senning 'so far as I know they have never yet catheterized any child intrauterine in Sweden, but they have done it through the delivery canal sometimes-would you tell us the indications of the Scandinavian group for catheterization in the immediate newborn period?', one is indeed being kept up with the times. But that was two years ago and already some of the questions then debated have since been answered. This beautifully printed and well-illustrated stiff paperbacked volume is, and will for a few years yet remain, an invaluable companion to a full-scale textbook on congenital heart disease.

Growth at Adolescence.

We review recent research on the presentation, nosology and epidemiology of behavioral and emotional psychiatric disorders in preschool children (children ages 2 through 5 years old), focusing on the five most common groups of childhood psychiatric disorders: attention deficit hyperactivity disorders, oppositional defiant and conduct disorders, anxiety disorders, and depressive disorders. We review the various approaches to classifying behavioral and emotional dysregulation in preschoolers and determining the boundaries between normative variation and clinically significant presentations. While highlighting the limitations of the current DSM-IV diagnostic criteria for identifying preschool psychopathology and reviewing alternative diagnostic approaches, we also present evidence supporting the reliability and validity of developmentally appropriate criteria for diagnosing psychiatric disorders in children as young as two years old. Despite the relative lack of research on preschool psychopathology compared with studies of the epidemiology of psychiatric disorders in older children, the current evidence now shows quite convincingly that the rates of the common child psychiatric disorders and the patterns of comorbidity among them in preschoolers are similar to those seen in later childhood. We review the implications of these conclusions for research on the etiology, nosology, and development of early onset of psychiatric disorders, and for targeted treatment, early intervention and prevention with young children.

Common emotional and behavioral disorders in preschool children: presentation, nosology, and epidemiology.

Synchrony, a construct used across multiple fields to denote the temporal relationship between events, is applied to the study of parent-infant interactions and suggested as a model for intersubjectivity. Three types of timed relationships between the parent and child's affective behavior are assessed: concurrent, sequential, and organized in an ongoing patterned format, and the development of each is charted across the first year. Viewed as a formative experience for the maturation of the social brain, synchrony impacts the development of self-regulation, symbol use, and empathy across childhood and adolescence. Different patterns of synchrony with mother, father, and the family and across cultures describe relationship-specific modes of coordination. The capacity to engage in temporally-matched interactions is based on physiological mechanisms, in particular oscillator systems, such as the biological clock and cardiac pacemaker, and attachment-related hormones, such as oxytocin. Specific patterns of synchrony are described in a range of child-, parent- and context-related risk conditions, pointing to its ecological relevance and usefulness for the study of developmental psychopathology. A perspective that underscores the organization of discrete relational behaviors into emergent patterns and considers time a central parameter of emotion and communication systems may be useful to the study of interpersonal intimacy and its potential for personal transformation across the lifespan.

Parent-infant synchrony and the construction of shared timing; physiological precursors, developmental outcomes, and risk conditions.

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A Secure Base Clinical Applications Of Attachment Theory

Cosponsoring associations The European Society of Endocrinology and the Pediatric Endocrine Society. This guideline was funded by the Endocrine Society. Objective To formulate clinical practice guidelines for the assessment, treatment, and prevention of pediatric obesity. Participants The participants include an Endocrine Society-appointed Task Force of 6 experts, a methodologist, and a medical writer. Evidence This evidence-based guideline was developed using the Grading of Recommendations, Assessment, Development, and Evaluation approach to describe the strength of recommendations and the quality of evidence. The Task Force commissioned 2 systematic reviews and used the best available evidence from other published systematic reviews and individual studies. Consensus process One group meeting, several conference calls, and e-mail communications enabled consensus. Endocrine Society committees and members and co-sponsoring organizations reviewed and commented on preliminary drafts of this guideline. Conclusion Pediatric obesity remains an ongoing serious international health concern affecting ∼17% of US children and adolescents, threatening their adult health and longevity. Pediatric obesity has its basis in genetic susceptibilities influenced by a permissive environment starting in utero and extending through childhood and adolescence. Endocrine etiologies for obesity are rare and usually are accompanied by attenuated growth patterns. Pediatric comorbidities are common and long-term health complications often result; screening for comorbidities of obesity should be applied in a hierarchal, logical manner for early identification before more serious complications result. Genetic screening for rare syndromes is indicated only in the presence of specific historical or physical features. The psychological toll of pediatric obesity on the individual and family necessitates screening for mental health issues and counseling as indicated. The prevention of pediatric obesity by promoting healthful diet, activity, and environment should be a primary goal, as achieving effective, long-lasting results with lifestyle modification once obesity occurs is difficult. Although some behavioral and pharmacotherapy studies report modest success, additional research into accessible and effective methods for preventing and treating pediatric obesity is needed. The use of weight loss medications during childhood and adolescence should be restricted to clinical trials. Increasing evidence demonstrates the effectiveness of bariatric surgery in the most seriously affected mature teenagers who have failed lifestyle modification, but the use of surgery requires experienced teams with resources for long-term follow-up. Adolescents undergoing lifestyle therapy, medication regimens, or bariatric surgery for obesity will need cohesive planning to help them effectively transition to adult care, with continued necessary monitoring, support, and intervention. Transition programs for obesity are an uncharted area requiring further research for efficacy. Despite a significant increase in research on pediatric obesity since the initial publication of these guidelines 8 years ago, further study is needed of the genetic and biological factors that increase the risk of weight gain and influence the response to therapeutic interventions. Also needed are more studies to better understand the genetic and biological factors that cause an obese individual to manifest one comorbidity vs another or to be free of comorbidities. Furthermore, continued investigation into the most effective methods of preventing and treating obesity and into methods for changing environmental and economic factors that will lead to worldwide cultural changes in diet and activity should be priorities. Particular attention to determining ways to effect systemic changes in food environments and total daily mobility, as well as methods for sustaining healthy body mass index changes, is of importance.

Pediatric Obesity-Assessment, Treatment, and Prevention: An Endocrine Society Clinical Practice Guideline.

The social withdrawal behaviour concept is presented, along with its historical background and its links to infant depression. Sustained social withdrawal behaviour in infancy is observed either with attachment disorders, in autism, sensory impairment, intense and chronic pain, or in interaction disorders and as effects of maternal depression on the infant. The alarm distress baby scale (ADBB) is a 8 item-assessment scale. It has been built to help screening early withdrawal behaviour, making use for example of the routine physical examination in a Well Baby clinic. Current clinical and research application and validations of the scale are presented.

/pdf/social-withdrawal-behaviour-in-infant-clinical-and-research-1eyrepgdcg.pdf

[Social withdrawal behaviour in infant: clinical and research interest].

Purpose of reviewQuality of attachment relationships is believed to be an important early indicator of infant mental health as it is considered a vital component of social and emotional development in the early years. As a result, there has been a growing call for the development of early interventi

Preventive parent-young child interaction interventions to promote optimal attachment.

Risques développementaux chez le nourrisson de la naissance à 18 mois

La qualite des interactions precoces et la sensibilite du parent aux signaux de son enfant sont des facteurs fondamentaux pour la securite de l’attachement chez l’enfant. Cette recherche visait a etudier la sensibilite maternelle et l’attachement de l’enfant dans un echantillon a haut risque psychosocial, constitue de 46 dyades mere-bebe. Les dyades ont ete evaluees lorsque les bebes avaient entre douze et dix-sept mois. L’attachement des enfants a ete evalue a travers le paradigme de la Situation Etrange (Ainsworth, et al., 1978), alors que la sensibilite maternelle a ete examinee a travers l’analyse video de trois situations d’interaction mere-enfant, en utilisant les echelles de Sensibilite Maternelle d’Ainsworth, et al., (1974). Les resultats mettent en evidence l’impact de la sensibilite maternelle dans l’etablissement d’un attachement secure ou insecure chez l’enfant. Toutefois, en ce qui concerne la desorganisation de l’attachement, d’autres facteurs que la sensibilite maternelle semblent etre en jeu car, dans la presente etude, ces deux facteurs n’apparaissent pas directement associes.

Sensibilité maternelle et sécurité de l'attachement de l'enfant au sein d'une population à haut risque psychosocial

The French system for protection of infants and toddlers relies on the collaboration of several different partners for preventing, screening, assessing, intervening in, and treating cases of infant abuse and neglect. This article first provides a brief historic overview and some data about the protection of infants in France, with data focused on the Parisian area. We then describe the tasks and interconnections of these different agencies and administrations, and offer some reflections on the actual functioning of the system. Finally, some suggestions for changes are provided. Discussion should begin on a theoretical level regarding whether we should continue with institutionalization of infants for long periods of time, as is still the case in Paris. Discussion also should take place regarding which is the higher priority when infants and children are in situations of danger, abuse, and/or neglect of infants: (a) the hope of reestablishing parental rights or (b) the need of the infant for a secure and stable attachment relationship. The process of evaluating parental caregiving skills would benefit from more clinical observation as well as structured methods of assessment.

Antoine Guedeney

Papers

[Social withdrawal behaviour in infant: clinical and research interest].

Preventive parent-young child interaction interventions to promote optimal attachment.

Risques développementaux chez le nourrisson de la naissance à 18 mois

Sensibilité maternelle et sécurité de l'attachement de l'enfant au sein d'une population à haut risque psychosocial

The infant protection system in France: How does it work?