Perinatal Risk Factors for
Tiffany Field, Ph.D.
Although clinical cases of sadness or depression in young children have appeared in the literature for several decades (Abraham, 1911; Anthony, 1977; Freud, 1917), there is continuing debate among researchers and clinicians in the United States as to the existence of the syndrome of childhood depression (Kashani et al., 1981; Schulterbrandt and Raskin, 1977). Members of the European psychiatric community, in contrast, refer to the existence of depression as early as the infancy stage. Melanie Klein, for example, theorized (1935) that a "depressive position" occurs in the infant as young as six months of age as a result of a diminution in the splitting process. Anna Freud and Burlingham (1944) have described the grief reaction of infants and young children removed from their homes and families to nurseries in outlying regions of England during the German bombing of London during World War II. Although the majority of the nurseries were generally pleasant and the caregivers well trained, large numbers of these infants developed marasmus, several of the children did not survive, and several of the survivors experienced severe emotional dysfunction even into early adulthood (Maas, 1963). Spitz's
(1946) syndrome of "anaclitic depression" appeared substantially similar to Freud and Burlingham's grief reaction. Spitz described the institutionalized French infants who were separated from their mothers as sad, weepy, and apathetic with immobile faces having a distant expression. Those infants who were separated after six months of age also refused to eat or to interact with other adults or children, and several demonstrated severe psychomotor retardation. Similarly, the studies by Robertson and Robertson as summarized by Bowlby (1973) of institutionalized and hospitalized infants and children separated from their mothers suggested a syndrome of depression similar to that described by Spitz. All these reports showed the depression as occurring in the context of stressful early separation from the parent. Direct observation of infants suggests that factors other than separation from the parent can predispose infants to depression. Among those I would like to consider are the perinatal risk factors of being born with medical complications or being born to a depressed mother.
Infants with the most common perinatal complication, that of prematurity and Respiratory Distress Syndrome (RDS), have been noted to show social/emotional problems and expressive language deficits as they reach school age (Field and Dempsey, 1983). Although psychiatric evaluations were not made____________________