Mörelius E, Nelson N, Gustafsson P A
Department of Molecular and Clinical Medicine/Division of Paediatrics, Linköping University Hospital, Linköping, Sweden.
Child Care Health Dev. 2007 Mar;33(2):128-36. doi: 10.1111/j.1365-2214.2006.00637.x.
The aim of the present study was to investigate the adrenocortical response to diaper change in mother-infant dyads with psychosocial risk factors.
Twenty-two mother-infant pairs with well-defined psychosocial problems were included. The mother-infant pairs were treated for 6 weeks in a daycare programme to improve attachment. Salivary cortisol was measured before and after a diaper change during the first and last weeks of enrollment in the programme. Mothers' sensitivity towards their infants' signals was measured using a scale from 1 (highly insensitive) to 9 (highly sensitive) according to Ainsworth.
Median salivary cortisol increased in 15 out of 22 infants after the first diaper change. The increase was most pronounced in the group of infants below 3 months of age (n = 15) where median salivary cortisol increased 170% after the first diaper change (P < 0.05) and decreased 19% after the last diaper change (not significant). Out of these 15 infants, 11 showed an increase in salivary cortisol in response to the first diaper change while four out of 15 did so in response to the last diaper change (P < 0.05). The salivary cortisol response did not change over time in infants aged 3 months or above. A mother's sensitivity to her child increased significantly (P < 0.001) from the first to the last week. In mothers, median salivary cortisol decreased 38% after the first diaper change (P < 0.05) and 57% after the last diaper change (P = 0.001).
A diaper change is normally not perceived as stressful. The stress response caused by a diaper change may illustrate an insufficiency in the mother-infant relationship before treatment. Professional support improved the mothers' sensitivity and stabilized the stress response to diaper change in the youngest infants.
本研究旨在调查具有心理社会风险因素的母婴二元组中肾上腺皮质对换尿布的反应。
纳入22对存在明确心理社会问题的母婴。这些母婴对在一个日托项目中接受了6周的治疗，以改善依恋关系。在项目入学的第一周和最后一周，测量换尿布前后的唾液皮质醇水平。根据安斯沃思量表，使用从1（高度不敏感）到9（高度敏感）的量表来测量母亲对婴儿信号的敏感性。
22名婴儿中有15名在第一次换尿布后唾液皮质醇中位数增加。这种增加在3个月以下的婴儿组中最为明显（n = 15），其中第一次换尿布后唾液皮质醇中位数增加了170%（P < 0.05），最后一次换尿布后下降了19%（无统计学意义）。在这15名婴儿中，11名在第一次换尿布时唾液皮质醇增加，而15名中有4名在最后一次换尿布时出现这种情况（P < 0.05）。3个月及以上婴儿的唾液皮质醇反应随时间没有变化。从第一周到最后一周，母亲对孩子的敏感性显著增加（P < 0.001）。在母亲中，第一次换尿布后唾液皮质醇中位数下降了38%（P < 0.05），最后一次换尿布后下降了57%（P = 0.001）。
换尿布通常不被认为是有压力的。换尿布引起的应激反应可能说明治疗前母婴关系存在不足。专业支持提高了母亲的敏感性，并稳定了最年幼婴儿对换尿布的应激反应。
