SECTION 4. EMOTIONAL CARE OF THE AT-RISK INFANT Early Interventions for Infants of Depressed Mothers

Infants of mothers who remain depressed for 1 year after birth have a distinct profile of behavioral, physiologic, and biochemical dysregulation. Their mothers also have a distinct profile that can be used to target those in need of intervention. These interventions may include mood induction, massage therapy, interaction coaching, and natural buffers such as nondepressed fathers and caregivers. Pediatrics 1998;102:1305–1310; mothers, infants, depression, intervention, mood induction, EEG, massage therapy, cortisol, vagal tone. ABBREVIATION. EEG, electroencephalography. Infants of mothers who remain depressed for 1 year after birth show a distinct profile of behavioral, physiologic, and biochemical dysregulation. Their mothers also have a profile that can be used to identify those mothers who are likely to remain depressed and to target high-risk mother–infant dyads in need of intervention. This article of New Perspectives in Early Emotional Development reviews data on identifying mothers who remain depressed; dysregulation in infants of depressed mothers; and interventions, both brief and intensive. Recent research suggests the following: • Maternal depression can negatively affect infants as early as the neonatal period, implicating prenatal effects of maternal depression. • Infants show a profile of dysregulation in their behavior, physiology, and biochemistry that may be attributable to prenatal exposure to a maternal biochemical imbalance. • These effects are compounded by the disorganizing influence of the mother’s interaction behavior. • Depressed mothers have two predominant interaction styles, withdrawn or intrusive, that seem to have differential, negative effects on their infants because of inadequate stimulation and arousal modulation. • Nondepressed caregivers such as fathers may buffer these effects because they provide more optimal stimulation and arousal modulation. • Interventions that are mood-altering for the mothers and arousal-reducing for the infants (eg, music and massage therapy) make them more responsive to interaction coaching and improve their interactions. The interventions we have been studying may be effective because 1) they induce a better mood state in the mothers (and alter right frontal electroencephalography [EEG], a marker of depression) and lower stress hormone (norepinephrine and cortisol) levels; 2) they reduce sympathetic arousal in the infants; and 3) reduced sympathetic arousal leads to improved responsiveness, greater availability to interaction coaching, and improved interactions.