Dr. Jekyll Y El Senor Hide

To develop into a psychologically healthy human being, a child must have a relationship with an adult who is nurturing, protective, and fosters trust and security.19 Attachment refers to this relationship between 2 people and forms the basis for long-term relationships or bonds with other persons. Attachment is an active process—it can be secure or insecure, maladapative or productive. Attachment to a primary caregiver is essential to the development of emotional security and social conscience.

Optimal child development occurs when a spectrum of needs are consistently met over an extended period. Successful parenting is based on a healthy, respectful, and long-lasting relationship with the child. This process of parenting, especially in the psychological rather than the biologic sense, leads a child to perceive a given adult as his or her “parent.” That perception is essential for the child's development of self-esteem and self-worth.21 A child develops attachments and recognizes as parents adults who provide “… day-to-day attention to his needs for physical care, nourishment, comfort, affection, and stimulation.”Abused and neglected children (in or out of foster care) are at great risk for not forming healthy attachments to anyone. Having at least 1 adult who is devoted to and loves a child unconditionally, who is prepared to accept and value that child for a long time, is key to helping a child overcome the stress and trauma of abuse and neglect.

The psychosocial context and the quality of the relationship from which a child is removed, as well as the quality of alternative care that is being offered during the separation, must be carefully evaluated. This information should be used to decide which placement is in the child's best interest. The longer a child and parent have had to form a strong attachment with each other (ie, the older the child) the less crucial the physical proximity will be to maintain that relationship. Separation during the first year of life—especially during the first 6 months—if followed by good quality of care thereafter, may not have a deleterious effect on social or emotional functioning. Separations occurring between 6 months and about 3 years of age, especially if prompted by family discord and disruption, are more likely to result in subsequent emotional disturbances. This partly results from the typical anxiety a child this age has around strangers and the normal limitations of language abilities at this age. Children older than 3 or 4 years placed for the first time with a new family are more likely to be able to use language to help them cope with loss and adjust to change. These preschool-aged children are able to develop strong attachments and, depending on the circumstances from which they are removed, may benefit psychologically from the new setting.

The emotional consequences of multiple placements or disruptions are likely to be harmful at any age, and

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