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Abstract: Cleft lips and palates (CLP) are the most common human facial malformations. Depending on the ethnic and/or geographical origin of the studied populations, they can affect up to 1/500 newborns. The treatment of these patients is multidisciplinary because these malformations have not only aesthetic consequences but also functional consequences as the phonation, hearing, deglutition, mastication and ventilation are altered. These consequences can also be psychological since the building of the body image, the way others perceive it, is likely to be seriously altered. Patients presenting with CLP don’t usually seem to present with any serious psychological or psychiatric pathology. Yet a close review of the related literature shows that disorders are actually described: behavioural troubles, anxiety, depression and esthetical dissatisfaction with one''s face in children as well as in adults. The difficulty in interpreting these disorders lies in the various factors that are likely to impact this condition (family setting, importance and type of the cleft, surgery protocol, growth, social environment…). A careful consideration of concerned families show the importance of the psychological context and the risks of a disharmonious structuring of the parents–child relationships on the child''s development. The identification of the difficulties faced by these families, depending on the child''s age, can be easily identified. They can be identified more particularly at birth when the family first sees the child. [Copyright &y& Elsevier]

Abstract: By way of this round table''s introduction about “transmission and genetics” and before the conference of professor J.-M. Mandel, we propose some thoughts round fundamentals questions of innate and acquired, risks of predetermination, dangers of some predictions. A clinical illustration supports our questioning about stakes of prenatal diagnosis, hazards of genetics’ diagnosis and effects of a predictive diagnosis. In fact, our experience as consultation-liaison child psychiatrist in paediatrics allows us to observe the different viewpoints applied to children: those of science, of genetics, those of neonatology, of paediatrics, of psychoanalysis. If tendency has long been to pit the science''s child against the psychoanalysis one, it appears to us that this opposition is becoming obsolete; clinical medicine itself imposes such a correction. The matter is no more to pit but to make up. Besides, it is probably no accident that psychoanalysis is more than ever topical. The more science progresses, the more the question of singularity is obvious. Neurosciences and genetics seek universal mechanisms that finally produce something singular, making still relevant what is peculiar to psychoanalysis. But the confusion is frequent between history and destiny of the child, between anamnesis and destiny, between prevention and prediction, between knowledge and certitude. We insist on the trap of causalities and determinisms (genetic, epidemiological, paediatric, sociologic and even child psychiatric determinisms) specifying that “future is not written”. Always, there is a radical hiatus between a state of the brain and the subject, which is going to deduct (brain plasticity and unconscious), a distance between IRM and the subject, between the disease and the subject who suffers, between genotype and phenotype… And it is in this distance that it''s possible to offer a space of freedom, to leave opened the question of the subject, including in the extreme situations. In this debate about the transmission and the predictive diagnosis, the child psychiatrist''s has a place. We discuss this place, specifying why the child psychiatrist''s is a practitioner of the unexpected, an artisan of the meeting. [Copyright &y& Elsevier]

Abstract: The aim of this work is to compare pregnancy for primiparous and secondiparous women, an unusual approach since most of the scientific literature focuses on primiparous women only. Our main results are: (i) sibling rivalry is strongly revived for secondiparous women, and (ii) although they manage to distanciate themselves from oedipean conflict, it is somehow reactivated, but with respect to the first child, with whom they create the second one. [ABSTRACT FROM AUTHOR]

Abstract: Duchenne muscular dystrophy (DMD) is a progressive and lethal disease involving a progressive loss of muscular strength, inherited by X-linked recessive transmission. A review of the literature does not reveal any typical psychological profile or personality type in DMD patients. The affected child is rarely told the diagnosis, although this failure has major consequences for his future ability to live with the disease throughout its progression. The progressive loss of mobility culminating in an inability to walk, the loss of the use of the upper limbs, and the multiple surgical interventions are all major hardships for the child. For the patient''s sisters, who are presumptive DMD carriers, it is important to consider a specialized genetics consultation if they are considering a pregnancy with a prenatal diagnosis and an interruption of pregnancy if the infant is a carrier. Finally, and despite the serious prognosis, it is important to help the child and his family to maintain hope, not by denying the illness, but by a progressive adaptation to the reality. [Copyright &y& Elsevier]

Abstract: Carrier of a serious cardiopulmonary malformation, prenatal diagnosed, Murielle is hospitalised during many months in paediatrics ward. She benefits from attentive observation by the unit''s child psychiatrist, psychic support and care for the child as much as for her parents and caregivers. Indeed, the numerous somatic complications that punctuate her early development put the baby Murielle in danger of psychic fragility which could evolve to psychotic disorganization. So, psychiatrist''s role at children hospital consists in restoring psychic cohesion and connection where chaos often predominates. [Copyright &y& Elsevier]