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[Implementation and evaluation of a program of prevention against abuse in at risk infants]
S Dubois1, N Job-Spira, M Lamour
1l'Unité de recherche INSERM U292, Hôpital de Bicêtre.
Insights
This study evaluated new prevention methods for at-risk infants. While interventions improved mother-infant interactions, they did not significantly impact growth or development, highlighting research challenges.
Area of Science:
- Public Health
- Pediatrics
- Child Psychiatry
- Developmental Psychology
Background:
- Infants with medico-psychosocial risk factors require effective prevention strategies for abuse.
- Early mother-infant interactions are crucial for healthy child development.
- Existing surveillance methods may not adequately address high-risk infants.
Purpose of the Study:
- To evaluate original modes of prevention for infants identified with medico-psychosocial high risk factors.
- To assess the impact of specific prevention interventions on mother-infant interactions and child development.
- To analyze the efficacy of a randomized controlled trial (RCT) in this population.
Main Methods:
- A randomized controlled trial (RCT) involving infants selected by risk indicators on health certificates.
- Comparison of a treated group receiving specific prevention interventions versus a control group receiving classic surveillance.
- Longitudinal study of mother-infant interactions at 3 months, 1, 2, and 3 years, alongside somatic and psychomotor assessments.
Main Results:
- The intervention group received significantly more actions (mean 7.5) than the control group (mean 1).
- No significant differences were found between groups in height, weight growth, psychomotor development, or somatic status at 1 year.
- A better quality of mother-infant interactions was observed in the intervention group compared to the control group.
Conclusions:
- Specific prevention interventions showed a positive effect on mother-infant interaction quality but did not yield significant improvements in growth or psychomotor development.
- Challenges in research, including loss to follow-up and group contamination, impacted the study's ability to demonstrate efficacy.
- Further research is needed to refine prevention strategies and evaluation methods for high-risk infants.
Abstract:
Teams of pediatricians and psychiatrists led a joint action-research in public health institutions for infants which intended to evaluate original modes of prevention of abuse concerning infants with medico-psychosocial high risk factors. The framework of this study was a randomized controlled trial on the modes of prevention. The sample, consisting of children selected according to risk indicators appearing on their health certificate of the 8th day, was divided into two groups: the treated group who benefited from specific prevention interventions and a control group who benefited from classic surveillance. The research was longitudinal and was centered on the study of mother-infant interactions at 3 months, 1 year, 2 years and 3 years of age. The dynamics of early interactions was studied very precisely on the occasion of each examination. The first results concern the 161 children (72 in the "intervention" group, 89 in the control group) who were evaluated at 1 year of age. Although a real change in practice could be observed (the treated group profited by a mean number of 7.5 actions, while the control group on the average profited by only 1 action), the efficacy of those actions could not be demonstrated. No significant differences were observed between both groups with respect to height and weight growth and psychomotor development, their somatic status and the quality of early interactions, except with respect to a better quality of interactions in the action mode for the treated group. The difficulties inherent in such a type or research are analysed (children lost to follow-up, contamination of the control group by actions intended only to the treated group, difficulty in disposing of reliable criteria of estimation).
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