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This article presents the construction of a chain of care of perinatal psychiatric situations within the University Service of Child and Adolescent Psychiatry, which evolved within the framework of the departmentalization of this service. This chain of care includes the psychiatry of the liaison, the outpatient clinics as well as and day hospital care and extends from the prenatal period to the child's five years, with a focus on the relationship between child and caregivers, as well as an individual perspective on the child. Herein, we present and describe the different units and their functioning emphasizing the synergies and collaborations put in place that ensure the best possible continuity for patients and their families by promoting as much as possible the therapeutic alliance in this chain of care.Cet article présente la mise en place d’une filière de soins pour la prise en charge des situations de psychiatrie périnatale au sein du Service universitaire de psychiatrie de l’enfant et de l’adolescent, qui prend place dans le cadre de la départementalisation de ce service. Cette filière de soins comprend des prises en charge de liaison, en ambulatoire et en hôpital de jour, et s’étend de la période prénatale aux 5 ans de l’enfant, en se focalisant sur les aspects relationnels parents-bébé mais également sur l’enfant en tant qu’individu. Les différents lieux de prise en charge sont présentés et chacun de leur mode de fonctionnement est décrit. Cet article insiste sur l’importance capitale d’une articulation et d’une collaboration étroite entre les différents lieux de prise en charge afin d’assurer la meilleure continuité possible des soins pour les patients et leur famille en favorisant au maximum l’alliance thérapeutique.

The labio-maxillofacial cleft (LMFC) penalizes the child from birth by its aesthetic, functional, psychological and social repercussions. The prognosis is conditioned by a multidisciplinary care that starts from the antenatal period to continue until the end of growth. The treatment is long and complex. This explains the multiplicity of techniques and the variability of schedules according to the teams. The purpose of this article is to describe the protocol of management of the LMFC within the multi-disciplinary team in Lausanne and to emphasize the novelties in both surgical and organizational plan.La fente labio-maxillo-palatine (FLMP) pénalise l’enfant dès sa naissance par ses retentissements esthétiques, fonctionnels, psychologiques et sociaux. Le pronostic est conditionné par une prise en charge multidisciplinaire qui commence dès la période anténatale pour se poursuivre jusqu’à la fin de la croissance. Le traitement est long et complexe. Ceci explique la multiplicité des techniques et la variabilité des calendriers selon les équipes. Le but de cet article est de décrire le protocole de prise en charge des FLMP au sein de l’équipe pluridisciplinaire lausannoise et en mettant l’accent sur les nouveautés tant sur le plan chirurgical qu’organisationnel.

This study examines the attachment quality and how this changed over time among infants who had cleft lip and palate (CLP), by conducting a prospective longitudinal study addressing the effects of this type of perinatal event on the parent-infant relationship and the emotional development of the infants. At 12 months of age, the Strange Situation Paradigm (SSP; M. Ainsworth, M.C. Blehar, E. Waters, & T. Wall, 1978) was administered to a sample of 38 CLP infants (born between 2003 and 2010) and 17 healthy controls. At 4 years of age, the Attachment Story Completion Task (ASCT; I. Bretherton, D. Ridgeway, & J. Cassidy, 1990) was administered to 32 individuals from the CLP sample and 14 from the control group. As reported in the literature, CLP infants display secure attachment behaviors as frequently as do control infants (55%). However, a more detailed analysis of the attachment scales revealed that CLP infants show more avoidance and less proximity seeking. In addition, a closer examination of the subcategories of attachment styles revealed that most CLP infants (71%) displayed distal attachment strategies such as the B1/B2 or A1/A2 subcategories. At 4 years old, CLP infants clearly displayed more deactivation and less security than did the control sample. Moreover, when detailing the evolution of attachment individually, almost 60% of the CLP children showing distal strategies at 12 months became deactivated or disorganized when they reached 4 years. Indeed, subtle differences in attachment behaviors at 12 months old-which can be considered marginally secure at that age-may reveal attachment vulnerabilities, which seem to be more apparent over the course of development.

This study examines the attachment quality and how this changed over time among infants who had cleft lip and palate (CLP), by conducting a prospective longitudinal study addressing the effects of this type of perinatal event on the parent-infant relationship and the emotional development of the infants. At 12 months of age, the Strange Situation Paradigm (SSP; M. Ainsworth, M.C. Blehar, E. Waters,T. Wall, 1978) was administered to a sample of 38 CLP infants (born between 2003 and 2010) and 17 healthy controls. At 4 years of age, the Attachment Story Completion Task (ASCT; I. Bretherton, D. Ridgeway,J. Cassidy, 1990) was administered to 32 individuals from the CLP sample and 14 from the control group. As reported in the literature, CLP infants display secure attachment behaviors as frequently as do control infants (55%). However, a more detailed analysis of the attachment scales revealed that CLP infants show more avoidance and less proximity seeking. In addition, a closer examination of the subcategories of attachment styles revealed that most CLP infants (71%) displayed distal attachment strategies such as the B1/B2 or A1/A2 subcategories. At 4 years old, CLP infants clearly displayed more deactivation and less security than did the control sample. Moreover, when detailing the evolution of attachment individually, almost 60% of the CLP children showing distal strategies at 12 months became deactivated or disorganized when they reached 4 years. Indeed, subtle differences in attachment behaviors at 12 months old-which can be considered marginally secure at that age-may reveal attachment vulnerabilities, which seem to be more apparent over the course of development.

Cet article a pour objectif de decrire l’experience d’un groupe d’accueil pour les freres et sœurs d’enfants hospitalises en neonatologie. Cet evenement represente un facteur de stress et suscite d’importantes angoisses chez les parents. Sensibles et permeables au vecu parental, les freres et sœurs peuvent eprouver une difficulte a se representer ce qui se deroule autour d’eux. Leur offrir un lieu de parole avec leurs parents se revele important et permet de preparer la rencontre avec le nouveau-ne hospitalise. Il s’agit d’un espace permettant de nouvelles representations du bebe, pour la fratrie et pour les parents.

A partir d’une analyse clinique du discours de parents d’enfants nes avec une fente labio-palatine et en nous aidant des theories psychodynamiques actuelles, nous nous sommes interroges sur la place de la honte et de la culpabilite au sein du traumatisme que represente un tel diagnostic et sur le travail psychique que ces deux affects imposent et permettent. Nous mettons en avant l’importante expression de ces emotions, meme si difficile, afin qu’un travail d’elaboration du traumatisme puisse se mettre en route.

A partir des resultats d’une recherche clinique avec des parents d’enfants nes prematurement, cet article presente une reflexion sur le role du corps medical dans les differentes etapes d’elaboration du traumatisme parental. Le “ traumatisme parental ” est ici defini comme etant specifique aux parents dont l’enfant est menace de mort ou d’handicap grave, et par opposition, d’une part, au “ traumatisme psychique classique ”, et d’autre part, au “ traumatisme psychique ”.

Objective The main objective of this study was to assess mother-child patterns of interaction in relation to later quality of attachment in a group of children with an orofacial cleft compared with children without cleft. Design Families were contacted when the child was 2 months old for a direct assessment of mother-child interaction and then at 12 months for a direct assessment of the child's attachment. Data concerning socioeconomical information and posttraumatic stress symptoms in mothers were collected at the first appointment. Participants Forty families of children with a cleft and 45 families of children without cleft were included in the study. Families were recruited at birth in the University Hospital of Lausanne. Results Results showed that children with a cleft were more difficult and less cooperative during interaction at 2 months of age with their mother compared with children without a cleft. No significant differences were found in mothers or in dyadic interactive styles. Concerning the child's attachment at 12 months old, no differences were found in attachment security. However, secure children with a cleft were significantly more avoidant with their mother during the reunion episodes than secure children without cleft. Conclusion Despite the facial disfigurement and the stress engendered by treatment during the first months of the infant's life, children with cleft and their mothers are doing as well as families without cleft with regard to the mothers' mental health, mother-child relationships, and later quality of attachment. A potential contribution for this absence of difference may be the pluridisciplinary support that families of children with cleft benefit from in Lausanne.

ObjectiveThe announcement, prenatally or at birth, of a cleft lip and/or palate represents a challenge for the parents. The purpose of this study is to identify parental working internal models of the child (parental representations of the child and relationship in the context of attachment theory) and posttraumatic stress disorder symptoms in mothers of infants born with a cleft.MethodThe study compares mothers with a child born with a cleft (n = 22) and mothers with a healthy infant (n = 36).ResultsThe study shows that mothers of infants with a cleft more often experience insecure parental working internal models of the child and more posttraumatic stress symptoms than mothers of the control group. It is interesting that the severity or complexity of the cleft is not related to parental representations and posttraumatic stress disorder symptoms. The maternal emotional involvement, as expressed in maternal attachment representations, is higher in mothers of children with a cleft who had especially high posttraumatic stress disorder symptoms, as compared with mothers of children with a cleft having fewer posttraumatic stress disorder symptoms.DiscussionMothers of children with a cleft may benefit from supportive therapy regarding parent-child attachment, even when they express low posttraumatic stress disorder symptoms.