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Nurs*252 Scholarly Paper

Nurs*252 Scholarly Paper


The Psychosocial Effects of a Cleft Lip on an Infant and
How Physical Malformations Affect Parent-Infant Bonding
Professor: Wendy Chow
Humber College ITAL
Due: March 16 2015
By: Courtney Braithwaite (823-144-563)

Nurs*252 Scholarly Paper

As a trained medical professional we view each patient as a unique individual. We learn to


develop care plans for our patients based upon their individual needs using the nursing process.
The first step towards creating a care plan is to determine the priority for your patient from the
priority data you have access too. The priority data from my case study entailed a three month
old baby boy who presents with bruises to his back and abdomen prior to undergoing surgery for
a cleft lip repair. At 8 hours post op the child is alert and fussy with normal reflexes. His mother
is sitting in the room quietly, does not ask any questions and is texting on her cellular phone.
As a nursing student I was concerned to see the infant has bruising and knew this concern
must be addressed. This made me suspect that the infant may be a victim of physical abuse. In
addition, the fact that the child has just returned from surgery and his mother is in the room not
asking questions nor paying attention to him or providing him with affection is suspicious. This
made me wonder if the mother may be neglectful of her child since he is fussing and she is not
consoling him as would be expected from a new mom after their baby has undergone surgery.
i. Chosen psychosocial priority:
I chose to focus on the psychosocial aspect as my priority of care. I felt that the nursing
diagnosis of being at risk for impaired parenting was more crucial than the pathophysiological
priority of preventing infection. Maslows Hierarchy of Needs states that physiological needs are
required before safety or love and belonging, but what is important to point out is the fact that if
a parent is unable to cope or has the inability to form an effective bond with their infant, than
their physiological and psychosocial needs may not be met. I felt that the fact that the mother is
at risk for impaired parenting will affect the infants physiological status i.e. they will have
increased fussiness, be more difficult and cause mom to feel more overwhelmed.
Having an infant born with a cleft has been found to adversely affect the parent-infant

Nurs*252 Scholarly Paper

bonding and attachment process (Coy et al 2000). It is important for this baby to receive extra
care and attention due to the medical challenges and feeding problems experienced. However
that being said, this mom seems distant and unattached. It has been found that cleft babies may
be exposed to less optimal parent-child environment, involving negative parental responses and
emotions because of the childs appearance and increased caregiver demands (Maris et al 1999).
I feel this is a reason to intervene and get involved in improving the bonding process.
Given that the infant has undergone surgery, the healthcare team would be focusing on and
monitoring for signs of infection, and pain, rather than monitoring for impaired parenting,
ineffective coping or failure to bond. Ineffective parenting may appear in the form of being
distant, aloof, unaffectionate and an inability to comfort the infant due to moms fear of bonding
with her new baby. This could be due to the fact that the child was born with a cleft lip. The
mother may be disappointed or feel guilty and that could impact her ability to form a loving
relationship with her child. Clunn (1991) writes about adaptive and maladaptive caregiver
characteristics or actions based on the developmental stage and age of an infant. At 0-3 months, a
homeostatic stage requires a childs caregiver to be invested, dedicated, protective, comforting
and engaging. However, the infants mom shows signs of maladaptive caregiving such as being
unavailable and potentially abusive. During the Attachment phase, 2-7 months, the caregiver
should be loving and wooing the baby while providing a pleasurable environment, but this
mother is emotionally distant, aloof and ambivalent, all of which are signs of maladaptive
caregiving.
ii. Clinical Manifestation:
I chose to focus on the increased risk for abuse and neglect because this is a clinical
manifestation or complication that is associated with having a baby that has a craniofacial

Nurs*252 Scholarly Paper

abnormality (Knutson, 1995). I believe that the infant in the case study was abused because the
child presents with black and blue bruises to his back and abdomen prior to surgery. Mom is
ignoring her child, not asking questions nor comforting her baby. A study by Lynch and Roberts
from 2007 discusses the concept of bonding failure. They define bonding failure as the
inability or failure to form normal parent-child love. This study stated that an infant is at an
increased risk for abuse when bonding failure occurs. Having a child born with deformity could
have led to rejection and therefore affected the mom from bonding with her baby.
Stanford School of Medicine states that bruising is one of the most common signs of physical
abuse especially to a childs back and trunk, similar to the baby in our case study. At three
months of age, a child is unlikely to cause self-bruising since they barely can roll over. In
addition, physical abuse accounts for 18% of abuse cases, second to neglect (Kellogg, 2007), and
approximately 44.4% of all childhood abuse and neglect occurs in individuals under the age of
one (Child Welfare, 2012).
A study by Kellogg et al. (2007) found that child abuse has significant long-term medical and
mental health morbidity. They determined that victims of physical abuse in childhood are more
likely to develop behavioural and functional problems including anxiety and depression, as well
as relationship deficits later in life. In this case, the baby boy may be experiencing discomfort
postoperatively leading to his fussiness which could lead to a prolonged recovery time and
further abuse from the mother who is having difficulty coping with her new sons care.
iii. Nursing Interventions:
My first nursing intervention would be to get The Childrens Aid Society involved. As a
healthcare professional, it is mandatory that we report even the suspicion of abuse in order to
protect the child and it is better to err on the side of caution than ignore the suspected signs of

Nurs*252 Scholarly Paper

abuse. The infant is our patient and his health and safety is our priority.
My second intervention would be to suggest to mom that she become involved in a support
group with mothers that have babies born with cleft lips. Perhaps speaking to other moms and
learning how they coped, fed their babies and cared for their child post-operatively would be a
helpful way to provide the mom with some reassurance.
My third intervention would be to have a social worker or psychologist meet with mom with
respect to developing coping strategies and determining what the relevant issues she is facing in
bonding with her child. The mom needs to find ways to remain calm, help her son recuperate and
deal with his fussiness. I would need to learn what events are triggers and want to reassure mom
that we are here to help her and her baby because we do not want to separate them.
The fourth nursing intervention would be to have mom enroll in some mother-infant group
activities such as mother-baby yoga or going to child-parent centres like the Early Year Centre.
This could benefit the mom in developing relaxation techniques but also help to improve the
bond between the two of them because they would be doing activities together and dedicating
time to unwinding together. Reynolds et al. (2009) found a 31% reduction rate in maltreatment
when parents attended Child-Parent Centres with their infants. Lastly, I would want to get mom
involved in a public health program such as Healthy Babies Healthy Childrens In Home Visiting
Program. In such a program, a volunteer visits the mom and baby and provides a respite break
so that mom can do things she needs to get done without experiencing undue stress related to her
child. Nelson et al. (2001) found that in home visits was found to decrease the outcome of abuse
and neglect and improve family outcomes. This short reprieve may make all the difference in
better allowing mom to cope with difficult times by knowing that she has support, and set time
for herself, making caring for her baby easier.

Nurs*252 Scholarly Paper

References:
Clunn, P. (1991) Child Psychiatric Nursing. Missouri: Mosby-Year Book Inc.
Child Abuse (2012). Standford School of Medicine. Retrieved from:
http://childabuse.stanford.edu/screening/bruising.html on March 13 2015.
Coy, K.; Speltz, M. L. and Jones, K. (2002). Facial appearance and attachment in infants
With Orofacial Clefts: A Replication. Cleft Palate-Craniofacial Journal, 39 (1), 66-72.
De Sousa, A., Davare, S. and Ghanshani. J. (2009). Psychological issues in cleft lip and
Cleft palate. J Indian Assoc. Pediatr Surg. 14(2), 55-58.
Dogra, N. and Leighton, S. (2010). Nursing in Child and Adolescent Mental Health.
New York: McGraw Hill
Hodgkinson, P.D.; Brown, S.; Duncan, D.; Grant, C.;McNaughton, A.; Thomas, P. and
Mattick, C.R. (2005). Fetal and Maternal Medicine Review, 16 (1), 1-27.
Kellog, N.D. (2007). Evaluation of Suspected Child Physical Abuse. Pediatrics, 11 (6),
1232-1241.
Knutson, J.F. (1995) Physical Abuse in Infants With Physical Deformity. American
Psychological Association. Annual Review of Psychology, 46. 401-431.
Lynch, M.A., Roberts, J. (1977). Predicting Child Abuse: Signs of Bonding Failure in the
Maternity Hospital. British Medical Journal, 1. 624-626.
Maris, C. L.; Endriga, M. C.; Speltz, L.; Jones, K. and Deklyen, M. (2000). Are Infants
With Orofacial Clefts at Risk for Insecure Mother-Child Attachments? Cleft Palate
Craniofacial Journal, 37 (3)257-265.
Nelson, Geoffrey; Laurendeau, Marie-Claire; Chamberland, Claire.(2001). A Review of
Programs to Promote Family Wellness and Prevent the Maltreatment of Children. Canadian
Journal of Behavioural Science, 33(1) 1-13.
Reynolds, A.J, Mathieson, L.C, and Topitzes, J.W. (1999) Do Early Childhood Interventions
Prevent Child Maltreatment? Child Maltreatment, 14 (2) 182-206.
Standford School of Medicine. (2012). Child Abuse. Retrieved from:
http://childabuse.stanford.edu/screening/bruising.html on March 13 2015.
Videbeck, S.L. (2008). Psychiatric Mental Health Nursing, 4th ed. Philadelphia:Wolters Kluwer
Health.

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