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By S Emans, M Laufer, D Goldstein

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Stress during pregnancy affects general intellectual and language functioning in human toddlers. Pediatric Research, 56(3), 400–410. Lou, H. , et al. (1994). Prenatal stressors of human life affect fetal brain development. Developmental Medicine and Child Neurology, 36, 826–832. , Piazza, P. , & Le Moal, M. (1995). Adoption reverses the long-term impairment in glucocorticoid feedback induced by prenatal stress. Journal of Neuroscience, 15(1 Pt 1), 110–116. Macy, R. , Martin, S. , Kupper, L. , & Guo, S.

2005). The effects of acute relaxation on indices of anxiety during pregnancy. J Psychosom Obstet Gynaecol, 26(4), 271–276. , & Chrousos, G. P. (2002). Hypothalamic-pituitary-adrenal axis, neuroendocrine factors and stress. J Psychosom Res, 53(4), 865–871. Van den Bergh, B. , & Marcoen, A. (2004). High antenatal maternal anxiety is related to ADHD symptoms, externalizing problems, and anxiety in 8- and 9-year-olds. Child Dev, 75(4), 1085–1097. Van den Bergh, B. , Mulder, E. , & Glover, V. (2005).

But in severe, intractable cases, further assessment is necessary. The most intensive assessment can be made by conjoint (mother and baby) in-patient admission. This allows 24-hour observation by a multidisciplinary team, each member contributing to the overall picture. The psychiatrist monitors the mother’s mental state, the social worker assesses family and network support, a psychologist can perform specialized assessments, and pediatric nurses assess the baby; but the crucial observations on maternal behavior are made by psychiatric nurses, who keep a shift-by-shift record of salient incidents, reporting the mother’s statements about the baby, her competence and skill, affectionate behavior and her response to crisis.

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