Abstract
alnutrition
is a pervasive health concern around the world. Its impact is related to its
severity, age at which it begins, and duration. As of now, the impact of the
mother’s psychological variables on maltrunition have been hardly studied. In
particular, research showing the impact of having a mother raised by a child
instead of an adult is absent from the literature. The goal of this work was to
fill that gap. The sample consisted of 111 mother-child dyads assisting the
Argentinean centers, that support families whose children are exposed to
resource scarcity conditions and diagnosed with malnutrition. In Particular, we
aimed to assess the effect of being reared by a child on future caregiver
quality and stress responses, in a population with child malnutrition. Given
the absence of previous studies, the nature of the present work was
exploratory. We found that mothers that were raised by a child reported higher
levels of perceived stress at present and a lower quality of caregiving during
infancy. Additionally, they feel incapable of coping with their problems and
unable to control the events that affect them. These findings are discussed in
the context of Attachment Theory and social buffering.
Key words: Parenting
- Stress - Social Buffering - Child Malnutrition
Acknowledgements:
We thank the institutions who actively collaborated with this research:
Haciendo camino, Llegando a vos - CONIN and Ayres de Esperanza – CONIN.
Funding: This work was
supported by the PIP-CONICET (PIP Nº 11220150100553) and the Universidad
Abierta Interamericana, awarded to Giselle Kamenetzky.
Introduction
ccording
to data from UNICEF (WHO, 2021), at least one of every three children under
five years of age in the world suffers from either malnutrition or
overweightness, and one of every two suffers from hidden hunger, which affects
their growth and development. Around 45% of infant deaths (below five years of
age) are related to malnutrition and occur mainly in countries of low or medium
income. At the same time, in these countries, the rates of child overweight and
obesity are rising. The COVID-19 pandemic has worsened this crisis, with dire
consequences for the most vulnerable children.
The impact of malnutrition is related to its
severity, the age at which it starts, and the duration of the period of
deprivation. The earlier the signs of malnutrition manifest, the greater the
consequences it will have in both growth and development. Among the different
types of malnutrition proposed by the WHO (2021), the emaciation refers to that
produced as a function of the child’s weight and size, and that can be
classified as mild, moderate or severe. A low weight in relation to size in
babies can be caused by limitations in the ingestion of the required nutrients
for their adequate development, as well as infectious diseases such as
diarrhea, which results in weight loss. Babies with signs of chronic emaciation
are at risk of presenting arrested development, becoming a predictor of future
poverty.
Among the variables that may result in child
malnutrition, the mother’s psychological variables have been hardly taken into
account. One prevailing characteristic among this population is that children
tend to be raised not by an adult, but by other children. A large body of
literature has focused on the neglect experienced by children, but little is
known about the way it affects those children that are raised by another child.
Studies evaluating the short- and long-term consequences (i.e., in the following
generations) of being raised by another child cannot be found in the
literature, even though there is evidence of the long term consequences of
adverse early experiences. Data in preparation from our laboratory suggest that
exposure to early traumatic experiences and having felt unprotected, depressed
or anxious frequently increments the stress responses during adulthood.
Stress is a widely studied construct in the scientific
literature, given its relevance in psychological, inmunological, neurological,
endocrinological, and social aspects, among others (Lazarus & Folkman,
1984). It is defined as any real or perceived threat to the physical or
psychological integrity of the individual, resulting in psychological and/or
behavioral responses (Hostinar et al., 2014). Early life stress impacts
greatly, especially when it happens within the family context. Parents act as a
source of safety for their children, partly through social buffering (Sullivan,
2003). Nonetheless, the capacity of children to use the mother as a buffer is
dependent on the quality of care. This can also have an effect on early life
programming, defined as the process that causes adversity experienced early in
life to have an effect in the future. The link between a low quality of care
and future outcomes appears to be an impaired regulation of stress responses in
infants (Packard et. al., 2021).
Even though there is no record about the consequences
of being raised by another child, there is evidence of the risk posed by being
raised by an adolescent mother, especifically, risk of poor attachment outcomes
associated with detrimental effects in cognitive, adaptive, and behavioral
areas (Belsky & Fearon, 2002; Kumar, & Huang, 2021). The theory of
attachment has been developed by a myriad of authors, most notable John Bowlby
and Mary Ainsworth, followed by Mary Main (Ainsworth, 1982; Bowlby, 1969/1982;
Main, Kaplan, & Cassidy, 1985). The description Bowlby provided for
attachment was that of an inherent biological responses and behavioral system
that serves the purpose of providing satisfaction of certain basic needs. Main
et al. (1985) studied adult attachment representations, that is, how adults
remember what they experience early in life, and found that these
representations exert an influence in the attachment categorization of their
own children. When a mother is reflective, responsive and sensitive towards her
children, secure attachment follows, which leads to the development of trust,
confidence and resilience during those children’s later life.
A variable that has been systematically studied for its
effects attenuating the negative consequences of stress is social buffering. A
vast body of evidence shows that the hypothalamic-pituitary-adrenal axis can be
regulated by the presence of conspecifics (Gunnar & Hostinar, 2015). This
effect has been observed in several different species, such as humans and rats,
and under different situations, including everyday stress and maternal
separation (See Avellaneda & Kamenetzky, 2019, for a review). The characteristics
of the stimulus that acts as a buffer differ among the different stages of
development (Stanton and Levine, 1990). Stimuli coming from the mother seem to
be effective in reducing stress during the early ontogeny. The evidence shows
that the social buffering mechanisms are associated to the presence of the
maternal odor (Kamenetzky et. al., 2015; Packard et. al., 2021). Furthermore,
support from the family and partner are tightly related with the mothers’
emotional state, as well as the nutritional state of the infants. Paredes et
al. (2017), after carrying out a case and control study in a high-complexity
hospital in Colombia, managed to determine that inadequate social support
during the gestational period, along with socioeconomic and educational level
of the mother are predictors of low weight of newborn infants.
New evidence also indicated that parents that exhibit
unhealthy attachment towards their children are not effective buffers. Social
buffering becomes compromised when the caregiver is under stress as a
consequence of resource scarcity. This was studied with a model of resource
scarcity in rats, that models’ abusive caregiving
produced by maternal stress by providing insufficient bedding material to the
mothers to construct their nests. It was discovered that the interactions with
and caregiving of the offspring are highly affected. This manipulation results
in alterations of maternal behaviors, including rough handling of the pups and
reduced nurturing behaviors (Raineki et al., 2012). Unpublished data from our
laboratory showed that caregiving under these condition compromises the
infants’ growth, and such growth retardation was observed until adulthood
(i.e., lower weight, body length and skull width).
The objective of this research was to assess the
effects of being reared by another child on caregiver quality and stress
responses in adulthood, in mother of a population with child malnutrition. This
was an exploratory study, since there were no local data available and no
previous evidence was found in the literature about this topic. The hypothesis
was that parenting by another child, rather than an adult, would decrease the
quality of care and increase perceived stress responses during adulthood in the
mothers.
Method
Sample: The sample
consisted of 111 mother-child dyads assisting the Argentinean centers Haciendo
Camino from Chaco and Santiago del Estero (n=58), Ayres de Esperanza (n=18) and
Llegando a vos (n=35) from Buenos Aires, that assist families whose children
are exposed to resource scarcity conditions and diagnosed with malnutrition. It
was required that every child was six years old or less for their mother to
participate in the survey. The mothers’ age ranged from 16 to 46 years old,
with most of them found in the 20-34 range. To be admitted to the centers, the
dyads go through a lengthy evaluation of different variables, including
occupation and educational level of the parents, sanitary conditions of the
house, income level, growth and developmental measures, and current health
conditions.
Data Collection. A semi-directed interview developed by
the research group was used to collect the data. Some of the questions were
extracted from the following instruments:
·
Generalized Anxiety Disorder Screener
(GAD-7; Soto-Balbuena et al., 2021)
·
Validación argentina del Cuestionario MOS
de Apoyo Social Percibido (Rodríguez Espínola, & Enrique, 2007)
·
Parental Bonding Instrument (PBI; Espinoza
Marca, 2016)
·
Perceived Stress Scale (PSS, Remor, 2006)
These questions were reformulated to make the language
appropriate to the target population. The remaining questions were formulated
by the researchers in order to evaluate maternal stress and social buffering.
Procedure: The interviews took place through the Google
Meet platform during the days when the participants attended the corresponding
center. They lasted approximately 15 minutes and were completed in a single
session. The questions asked can be found in Appendix 1. Before beginning, they
were requested to sign an informed consent explaining the details of the
research, the conditions of their participation, and how the obtained data
would be handled. Due to the lack of local data regarding the variables under
study, the nature of the research was exploratory. The protocol was approved by
the Ethics Committee of the Universidad Abierta Interamericana (approval
number: 0-1071).
Data Analysis
Pearson’s Chi-Square tests, and Pearson’s linear
correlation coefficients were calculated.
Caregiver index
We constructed an index to measure the perceived
quality of the main caregiver. To this end, we used the
following questions:
·
Was he/she affectionate towards you?
·
Did he/she help you with everything you
needed?
·
Did he/she allow you to do what you
enjoyed?
·
Was he/she cold or distant towards you?
·
Did you feel loved by him/her?
·
Did he/she talk to you?
Affirmative responses to all but the fourth question,
which was counted in the opposite way, added a point to the index, which thus
ranged from zero to six. A higher index corresponds to a better quality
perceived.
Perceived stress index
Additionally, we developed an index of stress perceived
at present using the following questions:
·
Do you sometimes feel that it is hard for
you to relax?
·
Do you usually feel that you can handle the
things that are important to you? Or do you frequently feel that what happens
to you escapes your control?
·
Do you feel that your problems come all at
once and you cannot solve them?
Affirmative responses to the first and third questions
added one point to the index, and so did a response to the second one
indicating that they cannot control what happens to them. Additionally, we
categorized each mother as stressed or not stress based on the open question
“in general, how do you feel nowadays? Do you feel good in general? Or are you
stressed about something? For example, something related to your family, or
money”. Being categorized as stressed added one further point to the index. Thus,
higher indexes correspond to greater perceived stress levels.
Results
The proportion of mothers that were raised by an adult
or a child caregiver was 27.78% (n=30) of the mothers had a child caregiver
when they were children, while the rest were raised by an adult (n=78).
A Chi-Square test revealed an apparent dependency
between the type of caregiver and the stress perceived at present time (χ^2
(4,N=108)=11.07,p=.026,V=.316), with higher stress indexes found among those
raised by a child (see Fig. 1).
Figure
1
Percentage of mothers raised by an adult or another
child during their childhood
Another dependency is apparent between the caregiver
index and type (χ^2
(6,N=108)=15.06,p=.02,V=.368): higher indexes are more likely to be found if
the caregiver was an adult, which suggests that mothers who have been raised in
their childhood by an adult, report that they have had a higher quality of care
(see Fig. 2).
Figure
2
Frequencies
in the Index of Perceived Stress of mothers who have been raised by an adult or
another child
Some apparent dependencies were also found between the
type of caregiver and questions related to current stress (Do you usually feel
that you can handle the things that are important to you? Or do you frequently
feel that what happens to you escapes your control?, χ^2
(1,N=108)=5.48,p=.019,V=.222; see Fig. 3) and perceived quality of the
caregiver (Was he/she affectionate towards you?, χ^2
(1,N=108)=4.49,p=.034,V=.201; see Fig. 4).
Figure
3
Frequencies
in the Caregiver Index of mothers who have been raised by an adult or another
child
Figure
4
Frequencies
in current stress related to the type of caregiver (Do you frequently feel that
what happens to you escapes your control?)
A marginally significant dependency was also found
between the type of caregiver and the question “When you were little, did you
have enough money to buy food and clothes?” (χ^2
(1,N=108)=3.74,p=.053,V=.184; see Fig. 5).
Figure
5
Frequencies in perceived quality of care provided by
the caregiver during the mother's childhood, related to the type of caregiver
(Was he/she affectionate towards you?)
A negative correlation was found between the perceived
stress and caregiver indexes (r(111)=-.23,p=.015), implying that better quality
of care is associated with lower stress perceived at present time. This result
can be observed in Fig. 6.
Figure
6
Frequencies in responses “yes” or “no” based on the
question “When you were little, did you have enough money to buy food and
clothes?”, depending on the type of caregiver
Discussion
Mothers raised by another child, instead of an adult,
during their childhood reported higher levels of perceived stress at present
and a lower quality of caregiving during infancy. Furthermore, they expressed a
lower capacity for problem solving and feeling that they are unable to control
the events that affect them. These results are novel and constitute a valuable
contribution to the field of developmental psychology in a context of child
malnutrition, which has been barely explored so far.
Children raised by another child are exposed, on the
one hand, to maternal isolation, and on the other, to a poor quality of care,
as described by the mothers in the present study. Exposure to each of these
conditions would seem to be associated with long-term consequences. Myron
Hofer, among others, showed during the 1980s that parents have a pivotal role
in the regulation of their children’s physiology and behavior. Separation from
the mother resulted in dysregulations of many physiological functions and behaviors
in children (Hofer, 1981, 1994). Already during the 1960s, Blowlby’s Attachment
Theory drew attention to the role of parents in reducing fear in their
children. Especifically, less fear is exhibited when children are exposed to
novel or threatening situations if one of the parents is present (Bowlby,1969).
However, a poor quality of care results in increased hormone levels related to
stress, and attenuates the ability of the attachment figure to decrease their
stress responses (Packard et al., 2021). This elevation in stress levels can
disrupt brain development, which can be prevented by social buffering. When
social buffering is hindered, however, the opposite is observed:
stress-hormones levels are further increased when the caregiver is present.
Studies using animal models reveal that, among other
effects, a compromised attachment impedes the pups from using the caregiver as
a safety signal. Indeed, higher cortisol levels are found in toddlers exposed
to a novel situation if their attachment with their mother is insecure
(Nachmias et al., 1996). Furthermore, maternal quality can predict whether
stress responses will be inhibited by infants (Albers et al., 2008). We
therefore see the lasting consequences of being raised by a child instead of an
adult as seen in this study, this type of caregiver is related to higher stress
levels in adulthood, which in turn potentially hinders the capacity of the
mother to buffer their own children’s stress. This potentially increases stress
levels in those children, thus potentially prolonging the cycle to the next
generation.
Even though the results are sound and valuable, we
should consider the exploratory nature of the study. Being an unexplored area,
and with the intention of not overwhelming the mothers with prolonged
evaluations, we decided to analyze many variables with an instrument developed
by the research team. Given the results found here, we will employ reliable and
valid instruments to assess each construct in the future.
This study constitutes a starting point to assess to
what extent the events that occur in childhood can disturb the breeding and
development of subsequent generations, in a population with child malnutrition.
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