T.
Berry Brazelton, M.D.Department of Pediatrics, Harvard Medical School, and Boston Lying-in Hospital, Boston, Massachusetts
ADDRESS: 51 Brattle Street, Cambridge 38, Massachusetts.
(Submitted July 16, 1962; accepted for publication May 20, 1963.)
This paper was supported in part by a grant from the N.I.H. Study on “Prenatal Factors in the Origin of Cerebral Palsy and Mental Retardation” No. BP2372, Boston Lying-in hospital, Boston,
Massachusetts.
PEDIATRICS, November 1963
THE
EARLY
MOTHER-INFANT
ADJUSTMENT
931
T
HE EFFECTIVE ROLE of the pediatricianin preventing psychiatric illness was
stressed in a recent paper by Eisenbergl in
tilis journal. Early recognition of
disturb-ance in the environment may enable us to
combine our physiologic understanding of
the child with supportive manipulation of
his earliest environmental influences. Since
the young mother with her first baby may
be most vulnerable and malleable to such
efforts, it seems important to understand
the psychologic mechanisms inherent in the
development of a normal, healthy
mother-infant relationship.
Surprisingly little documentation has
i)een available concerning the mechanisms
at work in the young mother’s adjustment.
Byers’2 plea for a more scientific
interdis-ciplinary approach is well founded, and the
following statements about the new
moth-er’s psychologic processes may be drawn
largely from the kind of literature Dr.
Byers decries. However, an awareness by
the pediatrician of the depth of maternal
adjustment may greatly increase his value
at a time when his support may be most
necessary.
The contribution of the infant in
deter-mining the nature of the mother-infant
re-lationship is based on the author’s own
observations and perhaps open to Dr. Byers’
criticism. But again, through suggesting
unanswered questions we hope to focus
attention on neonatal behavior as it
per-tains to future development. This may be as
important to pediatricians as are
physiologi-cal studies revealing physical homeostatic
mechanisms.
THE YOUNG MOTHER
The young mother’s reaction to becoming
a mother is probably founded in her own
infancy and childhood. Her adjustment may
be largely governed by the mothering she
has received as a child, and her own
capa-bilities to mother are probably limited by
these experiences. There may be a residual
memory or patterning of feelings she
ex-penenced as an infant. But as she becomes
a little girl, and plays with dolls or smaller
siblings, she entrenches her mothering
ca-pacities. They may be colored by her later
experiences, and her abilities as a future
mother are certainly affected by all of her
life experiences. Since her eventual
per-sonal adjustment may be thought of as a
circular pie with an ever increasing
diam-eter, early experiences seem to be more
important as determinants for pie-shaped
pieces of future ability to function as a
mother. The healthier her personal
adjust-ment, the freer she is to become a mother.
According to Helene Deutsch,3 in her
classic volume, Psychology of Women,
“Motherhood is not only a biologic process
but it is a unique psychologic experience,
in which a woman is given the opportunity
of experiencing a real sense of immortality
and of the victory of life over death.” The
first pregnancy in particular is also a
chal-lenge to the woman’s own adjustment as
an individual in equilibrium with
herself-her anxieties and her defenses. This
equilib-rium has been shaken by marriage-often
for the better-but in pregnancy she faces
for 9 months an unknown future for which
932 MOTHER-INFANT ADJUSTMENT
she must take the primary role for the
en-tire family unit. Her past experience with
such a role has been as the passive recipient
in her and her mother’s relationship. No
matter how good this relationship may have
been as preparation, it is no wonder that
each woman enters her first pregnancy with
mixed emotions.
All the wishes, phantasies, and fears
about herself as a mother, and about
poten-tial offspring are activated during
preg-nancy. A woman tends to withdraw into
herself, and to spend a large part of the
time invested in this 4
Preg-nancy may be a period of great physical
lassitude during which a young woman’s
psychic energy is at work preparing her
for her coming role. This day-dreaming is
an important factor. Mobilization of her
psychologic resources in dreaming helps to
accustom psychic energy to the
approach-ing new phase in which a woman must give
up her girlhood and initial adjustment to
marriage for the even more selfless one of
motherhood.
Associated with the idea of herself as a
mother are fears of inadequacy, of
destruc-tion through pregnancy or delivery, and of
inability in one way or another to play this
totally feminine role. As the end of
preg-nancy approaches, her wishes and fears are
concentrated on the fetus. Thus the fetus
has a personality and an independent
real-ity for the mother long before it is separate
from her. Given an opportunity, a young
prospective mother can construct a credible
image of the baby she wants. She may,
however, be too superstitious to do this,
afraid that she won’t fulfill her wishes. She
visualizes the fetus as the perfect infant of
preferred sex, filling a role based on her
past experience so that any real baby is
likely to be an initial disappointment. These
dream babies are usually suggested by
“baby magazine” photographs and the fat,
smiling, responsive 6-month-old baby in the
neighbor’s carriage. Hence the bluish,
mot-tied, moulded neonate, covered with vernix
and amniotic fluid comes as a shock to a
young, new mother.
In addition, there is a haunting fear that
the baby may be defective or damaged.
Since every woman feels some inadequacy,
she tends to fear or resent a parasitic fetus
who threatens her own adjustment. She
may wish to be rid of it, or see it destroyed
to protect herself. Any defect or damage
she relates to her own imagined inadequacy
and earlier wishes for his destruction so
that such a baby is, from the outset,
in-volved in her feelings of guilt and
responsi-bility for his defect. This fundamental guilt
mechanism of human females must be
ac-counted for in helping a mother adjust to a
defective infant. This accounts for the
diffi-culty for the pediatrician in his attempts to
convince her that there is a rational basis
for the defect. The mother returns
irration-ally and emotionally to her own feared
re-sponsibility in producing the defect, so that
it is all the more important that the reality
be emphasized and the guilt alleviated at
the first opportunity and each subsequent
visit. Otherwise her guilty feelings interfere
with her functioning normally with the
baby. The over-protectiveness which could
result requires an understanding
pediatri-cian to demonstrate tile mechanics of her
natural guilt, and to accept it with her as a
debilitating but inevitable aspect of any
handicap in her child. Then, he will be in
a position to be of real help to the mother
in avoiding her over-protective tendencies
toward the child.
The delivery process is a tremendous
hurdle for most women. Given her fears of
self-destruction, of losing part of herself
with the fetus, of destruction of the baby,
each woman prepares herself for this
ex-perience differently. Many women feel they
must remain conscious and in control to
prevent subsequent guilt for what happens
while they are sedated and “out of control.”
Others find great relief in turning over
re-sponsibility to the obstetrician as a figure
of authority. The depth of these feelings of
reliance in the obstetrician indicates the
extent to which they can accept relief from
their fears about the birth process. On the
according to her hopes, a woman must
project her innermost anger and guilt onto
her obstetrician. After successful delivery,
most women experience a relief amounting
to euphoria which supports them for several
days.
The pediatrician steps into the supportive
role just vacated by the obstetrician with
little awareness of the extent of dependency
already developed. At first, the mother may
resent the intrusion of a new physician,
feeling the loss of her ties to the old one.
Her need at this point for a dependent
relationship is just as great; and the mother
who finds the transfer the most difficult
usually becomes the most co-operative with
the pediatrician who has been able to
un-derstand her feelings.
In the course of phylogenetic evolution,
the relationship between mother and
off-spring has assumed increasingly complex
aspects.5 Prolongation of dependency of the
young results in different kinds of
physio-logic needs in both mother and infant.
These physiologic demands in both meet
with complex instinctive reactions satisfied
by mothering and being mothered.
Gratifi-cation of somatic sensations furthers the
wish for repetition, and a cycle is set up
which has an innate dynamic force to
per-petuate itself. Mother and offspring each
receives increasing pleasure as the cycle
repeats itself. Thus, physiologic needs and
their gratification become the solid basis for
unification. Perhaps the most valuable role
a pediatrician plays in these early days may
be in supporting these gratifications. He
can point out the infant’s positive
charac-teristics to the mother and show her paths
to follow in her interaction with the infant.
His participation with her in protecting the
infant and in getting him started well sets
the stage for a strong physician-mother
relationship.
The desire to feed the baby-by breast
or by bottle-may be a sign of this early
mother-infant unity. Every young girl who
faces motherhood sees her role as that of
protecting and fostering the maturation of
her young. The act of feeding is typical of
this responsibility. In the decision about
whether or not to nurse her baby from her
own breasts is incorporated her image of
herself (1) as an adequate female-adequate
to the final step in the utilization of her
feminine equipment, and (2) as an adequate
mother who can give up enough of herself
to meet the unknown demands of the new
baby. Many women deny that they have
faced such an adjustment, and transfer the
feeding responsibility to a reliable external
source, such as a formula. This is made easy
for them in our culture where formula
feeding is accepted and reliable. In this
decision are
her
own needs, fears, anddefences which are important in adjusting
to the new role. Hence, to disturb a mother
by enforcing breast-feeding might upset her
optimal capacity to mother the infant.
Other women feel adequate or wish to
prove themselves adequate in this area,
since it represents another real hurdle to
becoming a mother. Occasionally, with
women whose great wish is to breast feed,
an unsuccessful experience signifies failure
in the first step of their adjustment to
moth-ering. The despair or distress that overtakes
them can be appreciated in this light.
Since the pediatrician rarely has an
op-portunity to know well the mother’s needs
and wishes, he must work by intuition and
watchful waiting. Perhaps his best role is in
(1) giving her a free choice as to the kind
of feeding she will attempt, (2) supporting
her in her strongest efforts, (3) guiding her
to learn all she can about proper feeding
and feeding climate, but
(
4) assuring herthat he is present to see that the baby does
not suffer physically from her attempts
when they are less than successful, and (5)
encouraging her to success in another way
of feeding if she is unsuccessful, without
leaving the fear that she may have injured
the infant by her lack of success.
Since neither the mother’s dreams nor
her expectations of herself as a mother are
likely to be fulfilled, the immediate neonatal
period is fraught with constant adjustment
for her. Often she feels she has not
934
been noted with real defects, any minor
difficulty with the baby-psychological,
psy-chophysiological-even the normal
drowsi-ness of the newborn is blamed upon
her-self. These guilty feelings may obstruct her
early adjustment. A pediatrician can
ac-count for the normality of the infant’s
de-pression and confidently predict the
awak-ening of the infant.
Instead of the euphoria experienced by
some after delivery, disappointment and
other negative feelings may overwhelm a
new mother for a variable period.
Emo-tional depression joins forces with
physio-logical depletion to produce the commonly
recognized “blue period” in the first week
or weeks. If her psychological constitution
is already delicate, this slump may trigger
a postpartum psychosis. The pediatrician
may recognize the symptoms of this normal
slump as evidence of her reorganization,
physical and psychological, and can
reas-sure her accordingly. He can protect the
mother from too much pressure to perform
in her new role and see to it that she has
support from the environment until she has
regained her own equilibrium. She may
turn to him for such constant support that
these early demands may seem excessive
for him as a busy physician. Yet many
women whose demands are greatest in the
first weeks and whose needs the
pediatri-cian has met later become the most
re-warding and independent mothers.
As the mother mobilizes her psychic
en-ergy to recover from depression, while her
baby is achieving his own physiologic
homeostasis, her instinctive forces and her
maternal feelings join to make the eventual
positive relationship with the child. This
process is well outlined by Deutsch, and
an analysis of the patterns of mothering in
our culture is made by Brody. There is no
aspect of pediatrics which is as rewarding
as being a witness to and a physician
par-ticipant in the formation of a strong,
healthy mother-infant relationship.
THE INFANT’S CONTRIBUTION
The contribution of the infant as an
in-dividual who influences the outcome of this
relationship nlust not be underestimated.
The strength of each infant in influencing
the environment to adjust to him in a
par-ticular way is apparent immediately to his
mother. Although her reaction to him is
often on an unconscious level, a mother is
immediately aware of strong innate
differ-ences between newborn infants, and is
in-fluenced by them in her mothering.
The immediate neonatal period presents
a unique opportunity to evaluate the mother
and child as individuals in the midst of
their major adjustments-physiological and
psychophysiological.
Since the adjustment to the birth process
and to extrauterine existence is the first
major test of the infant’s homeostatic
capac-ities, this period may lend invaluable clues
as to the potentialities of the individual
in-fant. Homeostatic mechanisms reflect not
only the capacity of the infant to respond
to the physical stresses of extrauterine
sur-viva!, but help in understanding the extent
of stress undergone in the birth process,
and its effect on the particular infant.
Clem-ent Smith6 summarizes physiological
nor-mals in his book on the Physiology of thc
Newborn and suggests significant
varia-tions which may have retrospective and
predictive significance. Study of the
psy-chophysiological mechanisms utilized to
achieve homeostasis in this period may
re-fleet the neonate’s individual capacities to
respond to stress, and to adjust to his
par-ticular environment. Phyllis Greenacres
sug-gests that there is an anxiety prototype for
the baby created in the birth process which
may later act as a pattern for the anxiety
created by other stress situations. If the
organization of this pattern could be
fol-lowed, it might be of predictive value in an
estimate of future personality potential.
There are many difficulties in evaluating
individual traits or characteristics of
psy-chological importance during the first week.
More dramatic physiological changes easily
mask these subfler reactions. The problem
of placing any predictive value on these
adaptive reactions becomes that of finding
satisfactory methods for (1) evaluating each
ad-justment, (2) quantifying them against each
other within the individual, and against the
total population, (3) relating any one system
to the total potentialities of the individual
organism, and
(
4) the pattern of interactionof these systems. Repeated day-to-day
at-tempts to observe and evaluate each
new-born in this period of adjustment may
over-come some of these difficulties.
Thus, immediately after delivery, there
is a short period
(
1-3 hours) of relativealertness and responsiveness in infants who
have had a “normal” delivery. This period
may be a response to the sudden onrush of
new extrauterine stimuli and/or to the
stimulation of labor and delivery. Complex
behavioral responses can be demonstrated
in this interval and seem to point to an
alerted central nervous system, such as (1)
fixing and following a visual object for
several minutes, (2) quieting and attending
to a mild auditory stimulus, (3)
hand-to-mouth organization which can be
repeat-edly demonstrated.
A relative state of CNS disorganization
follows, and may be evidence of
physiologi-cal and psychophysiological exhaustion
at-tendant upon birth and reorganization for
extrauterine existence. For one or more
days, the infant appears to be more difficult
to rouse. He may lie quietly for relatively
long periods in a flexed position, eyes closed,
respirations slow, regular, and deep.
Re-spiratoly irregularities from time to time
reflect internal or external stimuli received,
but there is less startling of a generalized
nature than is seen later. Spontaneous
ac-tivity or responsiveness may be confined to
brief respiratory changes, or to isolated
movements of small body segments-facial
grimaces, twitches of fingers, toes, etc. This
state resembles the deep, regular sleep
described by Wolff.9 Skin color is mottled
and reflects reduced cardiovascular activity.
Moderate stimuli may penetrate this sleep
state but with some latency and a
dimin-ished response. Strange stimuli or tactile
and temperature changes disturb the baby
more quickly, and responses spread to all
parts of the body. Modulation or
suppres-sion of cyclic general movement is now
lacking; the movements themselves are
jerk-ier, restricted in scope, have the snapback
seen in immature babies. This sleep state
is intermingled with wide awake crying
states, and there may be rapid transition
from one extreme state to the other.
Our observations indicate that this period
is particularly affected by natal and
pre-natal variables-such as the relative
matur-ity of the central nervous system, its
in-tactness before and during delivery, the
effects on variably immature equipment of
medication and anesthesia given the mother
prior to and during delivery, the kind and
duration of delivery, trauma, anoxia, etc.
This period of disorganization seems to be
prolonged and intensified by adverse effects
of these variables on the neonate’s
equip-ment.
The final period of reorganization leads
to the neonate’s most effective functioning,
and by the end of the first week most
new-born infants are contributing to their
en-vironment an alertness and responsiveness
to stimuli that is of major importance to a
young mother. The period of reorganization
of neonatal forces, and of the use of innate
homeostatic mechanisms may be a
particu-larly fruitful period for study of individual
differences in psychophysiological
equip-ment. Observing the interaction between
mother and infant during this week of
re-adjustment offers a unique opportunity to
evaluate the future mother-child
relation-ship, and its ability to withstand stress.
CASE REPORTS
Two cases may serve to demonstrate the effects
of such variables on the interaction between the new mother and her infant.
Case 1
Judy was born to a gravida I mother after 1734
hours of labor. In this period, medication to the
mother consisted of 30 mg alphaprodine (Nisentil)
hydrochloride given at 934, 6, and 4 hours prior to
delivery; and secobarbital 200 mg (Seconal), 1234
mg chlorpromazine (Thorazine), and 0.6 mg
sco-polamine. The second stage was 234 hours long
and ended in a normal pelvic delivery. The cord
was wound around Judy’s neck at delivery. and
her face and head were suffused, presumably due
circula-936
tion. The mother was completely unconscious
dur-ing the last half hour and roused only briefly after
the delivery, but did not open her eyes. The
in-fant grimaced and breathed immediately, cried 2
minutes later.
She was a mature well-formed infant weighing
7 lb 8 oz (3,345 gm). Neurological and pediatric
findings were entirely normal. Although she was
alert, and responded to internal and external slim-till with startles, and with slow fluid movements, her
level of spontaneous activity was low from the
first observation. Much more striking was the
re-sponsiveness observed in facial movements-
espe-cially in her wide-open eyes. Her eyes remained
open and alert after delivery. She fixed on a red
ring with both eyes and followed it in all
direc-lions in the delivery room. She seemed sensitive to
other sensory stimuli also but did not appear as
attentive as she seemed to visual stimuli.
J udy’s acrocyanosis and the suffusion of her
face and head decreased in the next 24 hours. Her
muscle tone was good all through the first week.
However her spontaneous muscular activity
re-mained at a markedly low level, and there was
little jitteriness or startling observed. The facial
grimacing and wide-open eyes observed at birth
began to take a central position as she emerged
as a baby whose face was extraordinarily
expres-sive. Her large, dark eyes were almost constantly
open, even when she was crying, and on one
occasion a loud prolonged cry abruptly ceased as
she focussed on the dangling red ring. She actively
rejected the finger cot, pushing it out of her mouth
with her tongue. But she accepted lactose and the breast without any difficulty. Thus there was a ieal definiteness of response from the first. She never
became really upset but always gave the
impres-sion of having extra resources to deal with her
tension. She was quite outstanding in being able
to maintain an alert state for long periods and was
unique in being able to combine alertness to
sen-sory stimuli with motor activity. Muscular activity
remained low in comparison to the relatively highly active eyes, mouth and face.
The general impression of the baby at the end
of the first week was that she was outstanding for
the maturity and stability of her states of alertness,
for the high investment in visual and auditory
re-sponses, and her low motor activity in other areas.
Her mother was a rather quiet but anxious
per-son who had waited for several years for a baby.
She had expressed little of her anxiety or wishes
about the forthcoming baby, but when she saw
Judy, she breathed a sigh of relief that she was
normal and that she was a girl. She was delighted with Judy’s inactivity and interpreted it as
evi-dence of how “good” she was. Her wide-open and
alert responsiveness to visual and auditory stimuli
were “like her father’s.” She handled her very
gently, moved her little but spoke to her softly and spent a lot of lime looking at her while she held her to the breast. With this gentle, appropriate
re-sponsiveness from her mother, Judy became
in-creasingly responsive to her mother, and breast
feeding went along very smoothly. Judy went to the
breast easily for brief periods at first, sucked well by the fourth day, although she was fairly poor at
continuous sucking in the first three days. Mother
did not recognize this as depression or
disorganiza-lion in the baby, but felt she was “quiet” and
would eat “when she was ready.” Even when Judy
cried and could not be comforted easily, her
mother’s attempts during a nursing period
con-sisted of gentle rocking and talking to her, and the
presentation of mild sensory stimuli-such as look-lug over at her or crooning to her in a low voice. She waited for a long period to present her breast
again when Judy became upset in the middle of a
feeding, and showed little anxiety about Judy’s
dis-organized periods.
The positive effect of such early recognition of
the baby’s potentials by the mother established a
solid relationship between them which became
in-creasingly pleasurable for each of them. The
de-pressing effects of delivery on the baby, and of
the premedicating drugs, were attributed by the
mother to positive attributes in the infant, and
were an asset to this early adjustment period.
Case 2
In contrast to this smooth interaction in Case 1,
the second case (summarized from a previously
described case)’#{176}presents a more disturbing effect
on the mother produced by the infant.
Bill was the first child of professional parents
who wanted a boy “so he could become a doctor.”
The mother was determined to feed her baby at
the breast because all of the women in her family
had nursed their babies. At her urgent request,
she had no medication during labor, despite 12
hours of second stage labor. Her ol)stetrician
finally administered spinal anesthesia, hut no other
anesthetic, dislodged the baby’s head which was
“stuck on a rim of cervix” and delivered the baby immediately.
Bill cried at once, had good color, and showed
no signs of distress in the delivery room. He
weighed 834 lb (3,856 gm), had a large moulded
head, and a big frame. Neurological and physical
findings were negative. He seemed moderately
re-sponsive at this time to auditory, visual, tactile,
and kinesthetic stimuli, but showed no obvious
preference.
Through the first week of life Bill constantly and
characteristically demonstrated two extremes of
consciousness. Although he showed marked
state consisted of extreme floppiness of
muscula-ture, with little or no spontaneous movement
ex-cept a periodic brief, jerky startle of one or an-other parts of his body. He was difficult to rouse from this sleepiness, and single stimuli seemed to cause little reaction except respiratory rate change
or mild startles, but no change in alertness. Even when he was held in this state, he adjusted his body position and muscle tone only briefly, then resumed his flaccid, original condition. Talking to
him, undressing him, stroking his cheeks or mouth
had only transient effects, and his refractoriness
and capacity to maintain this unresponsive state was striking. After many disturbing stimuli were
presented, he would rouse suddenly to a second,
awake state of screaming hyperactivity. He was
hypersensitive to stimuli in this state, stopped
briefly’ to attend, then began crying even harder.
Continuous thrusting, thrashing activity of his
extremities was interspersed with startles and Moro reflexes which seemed to add to his general upset
condition. This state lasted for 15 to 20 minutes on
most occasions. His continuous activity interfered
with any organized behavior such as
hand-to-mouth, visual fixation or following, or sucking con-tinuously on the breast or bottle. Major efforts to restrain him with swaddling were necessary to facilitate any effective nursing. Often, however, as he quieted from the effects of this restraint, he
lapsed quickly into his sleep state.
The tense young mother became increasingly
unable to cope with Bill, and each nursing became
a nightmare. She became depressed and less
effec-tive in handling him, jerkily attempted to rouse him
with inappropriate stimuli. Finally, with constant
attendance from nurses and physicians, she was aI)le to institute successful nursing, and Bill seemed to
learn about this specific situation. However, she never played with him or enjoyed him at his
feed-ings, but seemed relieved when she could send him back to the nursery.
Although these extreme states were unusual and
seemed to indicate restricted adaptive capacities in
this neonate, no real evidence of CNS dysfunction was found. Perhaps with a more relaxed, accepting
mother he might have more quickly become less
restricted, and he might have learned nuances in
state changes, as he did learn to nurse. But his hypersensitivity and hyperactivity in his awake
state were reinforced by his mother’s tension and inability to present him with appropriate stimula-tion. This distressed interaction in the first week can easily be seen as a prototype for a future dis-turbance in this mother-infant relationship, and for
future difficulties in the child’s emotional
develop-ment.
SUMMARY
The ability of the physician to evaluate
and predict the individual innate capacities
of an infant for interaction with his
en-vironment can be blended with an
under-standing of the mother to effect a positive
start in the mother-infant relationship. The
psychological adjustments required of a
new mother and the psychophysiological
homeostatic mechanisms of the baby’s first
week offer the pediatrician opportunities
for important observation and effective
as-sistance. Two cases serve to demonstrate
divergent reactions between mothers and
their new babies, as they adjust to each
other. The recognition of the role each of
the participants plays in this first
adjust-ment becomes important to the pediatrician
in his efforts to strengthen a positive
mother-infant relationship.
REFERENCES
1. Eisenberg, L. : Possibilities for preventive psy-chiatry. PEDIATRICS, 30:815, 1962.
2. Byers, R. K. : The pediatrician and the psychi-atrist. PEDIATRICS, 30:679, 1962.
3. Deutsch, H. : The Psychology of Women, Vol. 2: Motherhood. New York, Grune &
Strat-ton, 1945.
4. Blitzer, J. M., and Murray, J. M. : On the Trans-formation of Early Narcissism during
Preg-nancy’. Presented December, 1961, to the American Psychoanalytic Society, New York. 5. Brody, S.: Patterns of Mothering. New York,
mt.
Univ. Press, 1956.6. Smith, C. A.: Physiology of the Newborn.
Springfield, Thomas, 1953.
7. Escalona, S. K. : The study of individual
differ-ences and the problem of state. J. Child Psych. 1:11, 1962.
8. Greenacre, P.: Trauma, Growth and Personal-ity. New York, Norton, 1952.
9. Wolff, P.: Observations on newborn infants.
Psychosom. Med., 21: 110, 1959.
