The adaptation of parents to the birth of an infant with a congenital malformation: a hypothetical model.

To determine the course of parental reactions to the birth of a child with a congenital malformation and the process of parental attachment, the parents of 20 children with a wide range of malformations including mongolism, congenital heart disease, and cleft palate were interviewed. Structured interviews took place 7 days to 60 months after birth. Despite the wide variation of malformations, analysis of the interviews demonstrated five stages of parental reactions--shock, denial, sadness and anger, adaptation, and reorganization--in dealing with a congenitally malformed child during the course of his development and care. Observations of these patients suggest that early crisis counseling in the first months of life may be particularly crucial in parental attachment and adjustment.