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Reactive attachment disorder

Reactive attachment disorder is a rare but serious condition in which an infant or young child doesn't establish healthy attachments with parents or caregivers. Reactive attachment disorder may develop if the child's basic needs for comfort, affection and nurturing aren't met and loving, caring, stable attachments with others are not established.

With treatment, children with reactive attachment disorder may develop more stable and healthy relationships with caregivers and others. Treatments for reactive attachment disorder include positive child and caregiver interactions, a stable, nurturing environment, psychological counseling, and parent or caregiver education.

Symptoms Causes Risk factors Complications Prevention

Reactive attachment disorder can start in infancy. There's little research on signs and symptoms of reactive attachment disorder beyond early childhood, and it remains uncertain whether it occurs in children older than 5 years.

Signs and symptoms may include:

  • Withdrawal, fear, sadness or irritability that is not readily explained
  • Sad and listless appearance
  • Not seeking comfort or showing no response when comfort is given
  • Failure to smile
  • Watching others closely but not engaging in social interaction
  • Failing to ask for support or assistance
  • Failure to reach out when picked up
  • No interest in playing peekaboo or other interactive games

Reactive attachment disorder is rare. Signs and symptoms can occur in children who don't have reactive attachment disorder or who have another disorder such as autism spectrum disorder. It's important to have your child evaluated by a psychiatrist who can tell whether such behaviors indicate a more serious problem.

When to see a doctor

If you think your child may have reactive attachment disorder, you may start by visiting your primary care provider or pediatrician. However, you may be referred to a doctor who specializes in the diagnosis and treatment of reactive attachment disorder or a pediatrician specializing in behavior and development for a complete evaluation.

Consider getting an evaluation if your baby or child shows any of the signs and symptoms above.

To feel safe and develop trust, infants and young children need a stable, caring environment. Their basic emotional and physical needs must be consistently met. For instance, when a baby cries, his or her need for a meal or a diaper change must be met with a shared emotional exchange that may include eye contact, smiling and caressing.

A child whose needs are ignored or met with a lack of emotional response from caregivers does not come to expect care or comfort or form a stable attachment to caregivers.

Most children are naturally resilient, and even those who've been neglected, lived in orphanages or had multiple caregivers can develop healthy relationships. It's not clear why some babies and children develop reactive attachment disorder and others don't.

Various theories about reactive attachment disorder and its causes exist, and more research is needed to develop a better understanding and improve diagnosis and treatment options.

The risk of developing reactive attachment disorder from serious social and emotional neglect or the lack of opportunity to develop stable attachments may increase in children who:

  • Live in a children's home or other institution
  • Frequently change foster homes or caregivers
  • Have inexperienced parents
  • Have prolonged separation from parents or other caregivers due to hospitalization
  • Have a mother with postpartum depression
  • Are part of an unusually large family, such that parental time is scarce or available unequally or rarely

However, most children who are severely neglected don't develop reactive attachment disorder.

Without treatment, reactive attachment disorder can continue for several years and may have lifelong consequences. However, more research is needed to determine if problems in older children and adults are related to experiences of reactive attachment disorder in infancy and early childhood.

While it's not known with certainty if reactive attachment disorder can be prevented, there may be ways to reduce the risk of its development.

  • Educate yourself about attachment issues if your child has a background that includes institutions or foster care. Ask your pediatrician about resources, check reputable Internet sites, or consider checking with an adoption agency to identify educational materials and other resources.
  • Take classes or volunteer with children if you lack experience or skill with babies or children. This will help you learn how to interact in a nurturing manner.
  • Be actively engaged with your child by lots of playing, talking to him or her, making eye contact, and smiling.
  • Learn to interpret your baby's cues, such as different types of cries, so that you can meet his or her needs quickly and effectively.
  • Provide warm, nurturing interaction with your child, such as during feeding, bathing or changing diapers.
  • Offer both verbal and nonverbal responses to the child's feelings through touch, facial expressions and tone of voice.
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