Open Door Review

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F)*$:27$*)_!a>q!@B660(($_!O>q!G!/<0Y2M_!=>![+,--^!"#0!10&$2(%$7!7)*6B<(2($)*?!2!:$%6(!6(01!$*()!$*:2*(!90*(2!QZ$(C0%<2*&>!O0Y0*$%_!+P[+^?--dE+d>! /<0Y2M_!=>q!Q7#0<)(()_!@>q!F)*$:27$*)_!a>q!G!@B660(($_!O>![+,-+^!8)*6B<(2!10&$y(%$72!0*!<2!1%$90%2!!!!!!$*:2*7$2?! B*2!)1)%(B*$&2&!12%2!<2!&0(077$W*!&0!$*&$72&)%06!&0!%$06D)!0*!0!@)*(0Y$&0)>!=%7#$Y)6!&0!/0&$2(%X2!&0!R%BDB24_!bP[+^?+.EP,>! F)*$:27$*)_!a>q!/<0Y2M_!=>q!@B60(($_!O>q!G!Q$![+,-]^!50(%2$9$0*()!6)6(0*$&)>!R*!$*&$72&)%!&0!%$06D)!0*!0!O0(077$W*!0!$*(0%Y0*7$W*!0*!0!'c10%$0*7$2!0*!&)6! 70*(%)6!&0!62!!@)*(0Y$&0)>!=%7#$Y)6!&0!/0&$2(%X2!&0!R%BDB24_!b.[-^?P-EP\>! W;6@:!>J==";M! In this work complex psychoanalytical conceptions were taken to an operative field to promote the dialog with related disciplines in an integrative conception of the individual health. From this perspective the psychoanalytical intervention is open to the pediatric medicine interest, recognizing the pediatric consultation as a first step into Infant mental health from the first level of care. The study was carried out offering pediatricians training in a psychoanalytical perspective of early emotional development and recognizing the relevant position for the intervention of these professionals which are in the closest relationship with the infant and his/her parents. This position is reinforced because of the parents’ transferential aspects that are involved in this professional relationship that take care of the infant´s health. We also offered pediatricians training in ADBB scale (Alarm Baby Distress Scale), which proposes a systematized observation of the infant during the well- baby visit, with the purpose to detect early indicators of relational withdrawal. This is a symptom that is found in the clinic of the most important psychopathological situations of first infancy: attachment disturbances, autism, early interactive difficulties – such as the one caused by the effect of mother depression – post-traumatic syndromes, early relationship difficulties. It also appears as a consequence of organic factors such as sensorial handicaps (auditory and visual), chronic or severe pain, and in sickness. The progressive nature of its installation in the relational pattern of the baby makes its early expressions hard to detect and easily overlooked in the clinical observation without the help of a specific instrument to detect it. The instrument we propose for its detection is simple, accessible and user–friendly. It evaluates 8 items related to the relational pattern of the baby. It is validated in different countries and has a good internal coherence. In a second step of the experience we provide pediatricians trained in the scale, resources to implement interventions oriented by ADBB assessment and aimed to improve the condition of the infants in which indicators of withdrawal were detected. Early detection of withdrawal indicators was done with ADBB scale during well-baby visit to 67 babies between 2 and 14 months, who were video-taped in four pediatric visits during 2010 in two Public Health Centers. Two parallel ways were done to compare results. One pediatrician trained in ADBB since the beginning of the study assessed 30 babies and in the cases which she detected withdrawal, she did interventions oriented to promote in the parents new resources in the interaction with the baby. The others 37 babies were assisted in their regular pediatric visits in the traditional way by other nine pediatricians, who were trained in ADBB and in the implementation of interventions after the second video-taped consultation. Statistical analysis of the data showed that in the group of 37 infants, 40% presented withdrawal in the 1st. assessment, 57% in the 2nd, and in the 3rd one, which was done after the training, the percentage

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