Infant Behavior Research Articles

Neurons for infant social behaviors in the mouse zona incerta.

Understanding the neural basis of infant social behaviors is crucial for elucidating the mechanisms of early social and emotional development. In this work, we report a specific population of somatostatin-expressing neurons in the zona incerta (ZISST) of preweaning mice that responds dynamically to social interactions, particularly those with their mother. Bidirectional neural activity manipulations in pups revealed that widespread connectivity of preweaning ZISST neurons to sensory, emotional, and cognitive brain centers mediates two key adaptive functions associated with maternal presence: the reduction of behavior distress and the facilitation of learning. These findings reveal a population of neurons in the infant mouse brain that coordinate the positive effects of the relationship with the mother on an infant's behavior and physiology.

Soothing and Distress Behaviors of Infants, Parents, and Clinicians During Childhood Vaccinations

ObjectivesThe purpose of this study is to describe the behaviours of infants who were born preterm, their parent, and clinicians during two-, six-, twelve- and eighteen-month vaccinations. MethodsVaccination sessions were video recorded for 3-5 minutes. The proportion of five-second intervals in which distress and soothing behaviour occurred for infants, parents, and clinicians was coded using the Measure of Adult and Infant Soothing and Distress. Coding consisted of three phases: baseline/anticipatory (60 seconds prior to first needle), procedure (first needle to removal of final needle), recovery (up to 180 seconds after removal of final needle). Results64 infants were included. Distress behaviour for infants during baseline ranged from 13% (twelve-month) to 29% (two-month). There was limited anticipatory soothing behaviour from parents (10% (twelve-month) to 50% (two-month)) and clinicians (6% (twelve-month) to 17% (two-month)). Distress behaviour in infants during procedure ranged from 43% (eighteen-month) to 96% (two-month). There was limited soothing behaviour during procedure from parents (10% (twelve-month) to 81% (twelve-month)) and clinicians (13% (twelve-month) to 71% (two-month)). Few infants received additional pain reducing interventions of skin-to-skin contact, 24% oral sucrose, and topical anesthetic. DiscussionDespite infant distress, there was limited anticipatory behaviour from parents and clinicians. Two-month infants displayed the most distress across all timepoints yet received the least amount of treatment and proximal parent and clinician behaviour. Additional implementation efforts are required to increase awareness and practice uptake among parents and clinicians to ensure infants receive equitable and effective pain management.

Artificial intelligence detects awareness of functional relation with the environment in 3 month old babies

A recent experiment probed how purposeful action emerges in early life by manipulating infants’ functional connection to an object in the environment (i.e., tethering an infant’s foot to a colorful mobile). Vicon motion capture data from multiple infant joints were used here to create Histograms of Joint Displacements (HJDs) to generate pose-based descriptors for 3D infant spatial trajectories. Using HJDs as inputs, machine and deep learning systems were tasked with classifying the experimental state from which snippets of movement data were sampled. The architectures tested included k-Nearest Neighbour (kNN), Linear Discriminant Analysis (LDA), Fully connected network (FCNet), 1D-Convolutional Neural Network (1D-Conv), 1D-Capsule Network (1D-CapsNet), 2D-Conv and 2D-CapsNet. Sliding window scenarios were used for temporal analysis to search for topological changes in infant movement related to functional context. kNN and LDA achieved higher classification accuracy with single joint features, while deep learning approaches, particularly 2D-CapsNet, achieved higher accuracy on full-body features. For each AI architecture tested, measures of foot activity displayed the most distinct and coherent pattern alterations across different experimental stages (reflected in the highest classification accuracy rate), indicating that interaction with the world impacts the infant behaviour most at the site of organism~world connection.

Prenatal Social Determinants of Health: Narrative review of maternal environments and neonatal brain development.

The Social Determinants of Health, a set of social factors including socioeconomic status, community context, and neighborhood safety among others, are well-known predictors of mental and physical health across the lifespan. Recent research has begun to establish the importance of these social factors at the earliest points of brain development, including during the prenatal period. Prenatal socioeconomic status, perceived stress, and neighborhood safety have all been reported to impact neonatal brain structure and function, with exploratory work suggesting subsequent effects on infant and child behavior. Secondary effects of the Social Determinants of Health, such as maternal sleep and psychopathology during pregnancy, have also been established as important predictors of infant brain development. This research not only establishes prenatal Social Determinants of Health as important predictors of future outcomes but may be effectively applied even before birth. Future research replicating and extending the effects in this nascent literature has great potential to produce more specific and mechanistic understanding of the social factors that shape early neurobehavioral development. IMPACT: This review synthesizes the research to date examining the effects of the Social Determinants of Health during the prenatal period and neonatal brain outcomes. Structural, functional, and diffusion-based imaging methodologies are included along with the limited literature assessing subsequent infant behavior. The degree to which results converge between studies is discussed, in combination with the methodological and sampling considerations that may contribute to divergence in study results. Several future directions are identified, including new theoretical approaches to assessing the impact of the Social Determinants of Health during the perinatal period.

The potential and translational application of infant genetic research.

In the current genomic revolution, the infancy life stage is the most neglected. Although clinical genetics recognizes the value of early identification in infancy of rare genetic causes of disorders and delay, common genetic variation is almost completely ignored in research on infant behavioral and neurodevelopmental traits. In this Perspective, we argue for a much-needed surge in research on common genetic variation influencing infant neurodevelopment and behavior, findings that would be relevant for all children. We now see convincing evidence from different research designs to suggest that developmental milestones, skills and behaviors of infants are heritable and thus are suitable candidates for gene-discovery research. We highlight the resources available to the field, including genotyped infant cohorts, and we outline, with recommendations, special considerations needed for infant data. Therefore, infant genetic research has the potential to impact basic science and to affect educational policy, public health and clinical practice.

What we don't know about what babies know: Reconsidering psychophysics, exploration, and infant behavior.

Researchers must infer "what babies know" based on what babies do. Thus, to maximize information from doing, researchers should use tasks and tools that capture the richness of infants' behaviors. We clarify Gibson's views about the richness of infants' behavior and their exploration in the service of guiding action - what Gibson called "learning about affordances."

Visual stimulus structure, visual system neural activity, and visual behavior in young human infants.

In visual perception and information processing, a cascade of associations is hypothesized to flow from the structure of the visual stimulus to neural activity along the retinogeniculostriate visual system to behavior and action. Do visual perception and information processing adhere to this cascade near the beginning of life? To date, this three-stage hypothetical cascade has not been comprehensively tested in infants. In two related experiments, we attempted to expose this cascade in 6-month-old infants. Specifically, we presented infants with two levels of visual stimulus intensity, we measured electrical activity at the infant cortex, and we assessed infants' preferential looking behavior. Chromatic saturation provided a convenient stimulus dimension to test the cascade because greater saturation is known to excite increased activity in the primate visual system and is generally hypothesized to stimulate visual preference. Experiment 1 revealed that infants prefer (look longer) at the more saturated of two colors otherwise matched in hue and brightness. Experiment 2 showed increased aggregate neural cortical excitation in infants (and adults) to the more saturated of the same pair of colors. Thus, experiments 1 and 2 taken together confirm a cascade: Visual stimulation of relatively greater intensity evokes relatively greater levels of bioelectrical cortical activity which in turn is associated with relatively greater visual attention. As this cascade obtains near the beginning of life, it helps to account for early visual preferences and visual information processing.

Trajectories of brain and behaviour development in the womb, at birth and through infancy.

Birth is often seen as the starting point for studying effects of the environment on human development, with much research focused on the capacities of young infants. However, recent imaging advances have revealed that the complex behaviours of the fetus and the uterine environment exert influence. Birth is now viewed as a punctuate event along a developmental pathway of increasing autonomy of the child from their mother. Here we highlight (1) increasing physiological autonomy and perceptual sensitivity in the fetus, (2) physiological and neurochemical processes associated with birth that influence future behaviour, (3) the recalibration of motor and sensory systems in the newborn to adapt to the world outside the womb and (4) the effect of the prenatal environment on later infant behaviours and brain function. Taken together, these lines of evidence move us beyond nature-nurture issues to a developmental human lifespan view beginning within the womb.

Reach and impact of a nationwide media campaign in Ethiopia for promoting safe breastfeeding practices in the context of the COVID-19 pandemic

BackgroundIn response to the COVID-19 challenge and the consequent concerns and misconceptions about potential mother-to-child virus transmission, the United Nations Children’s Fund (UNICEF), in collaboration with the Ethiopian Ministry of Health, launched a 3-month nationwide media campaign to promote appropriate and safe breastfeeding practices using national and regional television and radio channels, as well as social media. This study assesses the reach and impact of a media campaign in Ethiopia on improving mothers’, partners’/caregivers’, and the public’s awareness of and practices related to appropriate and safe breastfeeding.MethodsA two-round mobile survey was conducted using random digit dialing (RDD) and an interactive voice response (IVR) system. In order to assess the impact of the media campaign, the study compared outcomes related to awareness, perceptions, and safe breastfeeding practices using post-intervention comparison data across levels of exposure (exposed vs. unexposed to the campaign). A propensity score matching (PSM) analysis was performed using a two sample test of proportions to estimate the impact of the media campaign.ResultsAmong the 3170 mobile subscribers who completed the survey questions, half (50%) reported that they had seen or heard media advertisements about appropriate breastfeeding, the importance of continuing breastfeeding during the COVID-19 pandemic, and how to safely breastfeed a baby when a mother is suspected or confirmed with COVID-19. The PSM analysis showed that exposure to the media campaign was significantly associated with awareness and perceptions of the importance of continuing appropriate breastfeeding during the pandemic among the general public (proportion difference, 0.16; 95% CI, 0.12–0.19; p < 0.0001) and mothers with children under 2 years old or their partners (proportion difference, 0.06; 95% CI, 0.01–0.12, p = 0.01).ConclusionsThe nationwide media campaign promoting safe breastfeeding practices in the context of COVID-19 reached half of the target breastfeeding mothers and the general public and had a significant impact on awareness and perceptions about the importance of continuing appropriate and safe breastfeeding practices. Future media campaigns should ensure that the intensity and frequency of media spots are appropriate to achieve adequate exposure, message recall, and influence infant and young child feeding behaviors.

Maternal Perceptions and Responsiveness to Cry in Armed Conflict Zones: Links to Child Behavior Problems

Crying is a typical infant behavior that activates parental caregiving behaviors, acting as “human alarms” important for the infant’s survival. When living under war-related threat, the auditory system may be sensitized given its importance for survival, potentially impacting maternal cry processing. Children living in armed-conflict zones are at increased risk for behavior problems, which may relate to both direct exposure and indirect effects through their parents’ perceptions and behaviors. This hypothesis was examined in a sample of mothers and their first-born children (aged 10–45 months) living in the Gaza vicinity area in Israel, chronically exposed to missile alarms (high-exposure; n = 45), and a comparison group (low-exposure; n = 86). Group differences in child behavior problems and maternal perceptions of and responsiveness to cry were investigated. A moderated indirect-effect of maternal cry perceptions on child behavior problems via maternal responsiveness to cry was examined. In the high-exposure group, children had more externalizing problems and mothers rated cries as more aversive. Maternal cry perception was indirectly related to child behavior problems via responsiveness to cry only in the high-exposure group: higher perceptions of cry as aversive or the child as distressed were related to faster responding to crying, and faster cry responsiveness was linked with fewer behavior problems. Results suggest that in armed-conflict zones with auditory warning signals, the parental caring system may be easily activated by cries due to the strong association between alarms and threat. Furthermore, children may need their mothers to react faster when feeling distressed, possibly because of the surrounding threat.

Validation and determining an optimal cut-off score of the Infant Behavior Checklist for autism spectrum disorder.

Given the escalating prevalence of autism spectrum disorder (ASD), the persistent paucity of child psychiatrists in Japan, and the need to prepare for unforeseen situations, such as the COVID-19 pandemic, it is essential to establish a reliable screening tool. This study aims to validate the Infant Behavior Checklist (IBC) developed by Japanese experts and determine its appropriate cut-off score. A total of 354 clinic-referred children, along with their caregivers, participated in this research. Clinical records, including diagnoses established through the sub-structured diagnostic interviews, and the IBC assessments, were subjected to rigorous statistical analysis. Among the 24 items, six failed to reach significance to differentiate ASD from non-ASD cases. The Cronbach's alpha coefficient for the IBC was calculated at 0.77. The IBC total score for ASD cases was significantly higher than that of non-ASD cases. With the chosen cut-off score, the IBC demonstrated an area under the ROC curve of 0.803, along with sensitivity, specificity, positive predictive value, and negative predictive value of 8.03, 0.79, 0.69, 0.34, and 0.94, respectively. The IBC exhibits satisfactory internal consistency and content and discriminant validity. The high sensitivity and other associated indices for the optimal cut-off score of the IBC affirm its validity as a screening instrument for ASD. Nevertheless, further investigations are warranted to ascertain the clinical utility of the IBC.

The newborn individualised developmental care and assessment program: A model of care for infants and families in hospital settings.

The Newborn Individualised Developmental Care and Assessment Program (NIDCAP) is an intervention and education programme that uses developmental observation for multidisciplinary healthcare professionals (HCP) caring for high-risk infants and families. Infants prosper with the ongoing co-regulation process of infant and family that is influenced by the physical and social environment. The Template for Intervention Description and Replication (TIDieR) Guidelines were applied to the NIDCAP intervention. The estimation of the individual infant's current goals is described from direct observation of behaviour in the context of ongoing care delivery. The infant's behaviour guides all caregivers to articulate current strengths and functioning for the development of individualised plans of care and support. The NIDCAP Nursery Program supports the full integration of NIDCAP into the healthcare system. NIDCAP is a system-based, process-oriented, attuned and responsive intervention for individualised developmental care for infants and families. Evidence shows NIDCAP significantly improves medical outcomes, with less time on the ventilator, improved weight gain, decreased length of stay, improved developmental outcomes and enhanced infant and family relationships. Evidence suggests that NIDCAP as an intervention improves parental competence, decreases stress for HCP teams and improves HCP satisfaction. NIDCAP improves outcomes for infants and families requiring hospital care.

Infant Care: Predictors of Outdoor Walking, Infant Carrying and Infant Outdoor Sleeping.

Although spending time outdoors is beneficial for development, little is known about outdoor time during infancy. The aim of this study was to assess frequencies and durations of (1a) outdoor walking and carrying in mother-infant dyads and (1b) infant outdoor sleeping in a stationary cot or pram. We furthermore aimed to identify associations of (2a) outdoor walking and carrying and (2b) infant outdoor sleeping, with infant, maternal and environmental sample characteristics. An online survey was distributed among mothers of 0- to 12-month-old infants. Initially, 1453 mothers were recruited, of which 1275 were included in the analyses. With respect to (1a) the outcomes of interest were: mother-infant dyads' total weekly duration of walking in minutes, frequency of walking on weekdays, as well as weekends, and the frequency of using an infant carrier during walks, as well as the daily duration of carrying in hours (indoors and outdoors together). With respect to (1b) the outcome variables were: placing the infant outdoors to sleep (yes/no), the total weekly duration of outdoor sleeping and the weekly frequency of outdoor sleeping. For aim 2, associations of the outcome variables with infant (i.e., age), maternal (i.e., working status) and environmental (i.e., house type) sample characteristics were assessed. Mother-infant dyads engaged in walks for a total weekly duration of 201 min, for approximately one to three walks over weekdays (Monday through Friday), as well as one to three walks on the weekend. The infant carrier was used by 22% of mothers at least half of the time during outdoor walks, and 18% reported a daily duration of infant carrying of one hour or more. Among other associations, infant and maternal enjoyment of outdoor walking correlated positively with the duration as well as the frequency of walking during weekdays and during the weekend. Furthermore, employed mothers walked for a shorter duration and less frequently on weekdays as compared to mothers on maternity leave or mothers without a paid job. The availability of nearby recreational areas correlated positively with the weekly duration and frequency of walks. The infant carrier was used more frequently during outdoor walks if more than one child lived in the household. Infant carrying during outdoor walks was also related to infant behavior at night. Roughly a third of the mothers (29%) regularly had their infant sleep outdoors for a weekly duration of four hours and a weekly frequency of approximately one to two times. Younger infants, infants of mothers with higher education and infants living in detached houses were more likely to be placed outdoors to sleep. We identified associations of infant, maternal and environmental characteristics with outdoor time spent during infancy. These results lay the foundation for future research on the effects of the outdoors on child development as well as on facilitators and barriers for caregivers.

A case-control study of the risk factors for fistula-in-ano in infants and toddlers

BackgroundLimited data are available regarding the risk factors for fistula-in-ano (FIA) in infants and toddlers, potentially affecting their daily lives.ObjectivesThe purpose of this study was to identify potential risk factors for FIA in infants and toddlers, in order to implement early preventive interventions, avoid disease progression, and develop therapeutic strategies.Design and settingsA retrospective case-control study was conducted, comparing 41 infants and toddlers diagnosed with FIA with 41 healthy controls, between August 2020 and December 2021.Independent variables(a) maternal characteristics during pregnancy and delivery, (b) perinatal characteristics, dietary behaviors, and defecation-related behaviors in infants and toddlers, (c) family dietary behaviors.ResultsMothers of infants and toddlers with FIA had given birth more times in the past, while the infants and toddlers themselves had less mealtime, a higher rate of exclusive breastfeeding, frequent loose stools, and a larger proportion of used wipes, experiencing perianal skin anomalies. The logistic regression analysis revealed that there are four significant risk factors associated with the development of FIA in infants and toddlers, including the number of previous deliveries by the mother (OR 6.327), defecation frequency score (OR 5.351), stool consistency score (OR 5.017), and cleaning with wipes after defecation (OR 8.089).ConclusionBased on our data, it appeared that FIA in infants and toddlers could be attributed to several factors. These included an increased number of previous deliveries by mothers, frequent loose stools, and repeated wipe use. To prevent the occurrence and worsening of the disease, it is important to improve the frequency and consistency of stooling and provide proper care. Further research is required to verify these findings in other clinical settings.

Social and Communication Development in Infants with Isolated Agenesis of the Corpus Callosum

ObjectiveTo evaluate the development of social behavior, communication, emotion regulation, and repetitive behaviors in infants with congenital malformation of the corpus callosum, specifically those with isolated Agenesis of the Corpus Callosum (ACC) in comparison to typically developing infants. Study DesignThis case-control longitudinal observation study examined parent report of social behavior, social-communication, emotion regulation, and repetitive behavior development in community ascertained infants (n = 156) and infants with isolated ACC (n = 57) between 12 and 24 months of age. ResultsInfants with isolated ACC produced fewer words at 12- (p = 0.003) 18- (p < 0.001), and 24-months of age (p = 0.003), and fewer gestures at 12- (p < 0.001), 18- (p < 0.001), and 24-months of age (p < 0.001). In addition, the ACC group demonstrated delays in reciprocal social behavior at 18-months (p = 0.01) and social competence at 12- (p < 0.001) and 18-months (p = 0.01). No concerns were noted in emotion regulation or restricted and repetitive behavior and social behavior appears to normalize at 24 months. ConclusionsExisting data suggests heterogeneity in developmental outcomes among individuals with isolated ACC. The current findings fill a gap in knowledge about development in the second year of life. Surveillance of social and communication ability in infants with ACC may be warranted. The role of the corpus callosum in facilitating rapid interhemispheric information processing impacts skills beyond the motor system. More work is needed to identify intervention targets for infants and toddlers with ACC.

Early Play Behaviors of Infants at Elevated Likelihood for Autism Spectrum Disorder.

Although research has examined early identification of autism spectrum disorder (ASD), few studies have found behavioral markers during midinfancy associated with later ASD diagnosis. To examine infants' play behaviors and atypical positions at age 6 mo and later outcome classification among infants at elevated likelihood (EL) and typical likelihood (TL) for ASD. Atypical positions refer to movement patterns indicative of motor delays or deviations, including atypical extension and flexion, poor weight shift and rotation, hypertonicity or hypotonicity, and the presence of primitive reflex patterns. Observational cohort longitudinal design using blinded video analysis. Fifty-eight infants (41 EL infants and 17 TL infants) 6 mo of age. Infants later diagnosed with ASD needed more support to engage in play at age 6 mo compared with infants who did not receive an ASD diagnosis (U = 130, z = -2.29, p < .05, r = .31). Atypical positions at 6 mo of age were not associated with a later diagnosis of ASD. Play behaviors may be early indicators of developmental differences for infants later diagnosed with ASD. The results of this pilot study suggest the need to observe the quality of interaction with a caregiver and objects during early play, which may serve as potential early indicators of ASD. Plain-Language Summary: Few studies have found behavioral markers during midinfancy that are associated with a later diagnosis of autism spectrum disorder (ASD). The results of this study showed that infants who were later diagnosed with ASD were found to have differences in play behaviors compared to infants who were not later diagnosed with ASD. Thus, early play behaviors may be an early indicator of developmental differences for infants who are later diagnosed with ASD.

Gaze Orienting in the Social World: An Exploration of the Role Played by Caregiving Vocal and Tactile Behaviors in Infants with Visual Impairment and in Sighted Controls.

Infant attention is a cognitive function that underlines sensory-motor integration processes at the interface between the baby and the surrounding physical and socio-relational environment, mainly with the caregivers. The investigation of the role of non-visual inputs (i.e., vocal and tactile) provided by the caregivers in shaping infants' attention in the context of visual impairment is relevant from both a theoretical and clinical point of view. This study investigated the social attention (i.e., gaze orientation) skills in a group of visually impaired (VI) and age-matched sighted controls (SCs) between 9 and 12 months of age. Moreover, the role of VI severity and maternal vocalizations and touch in shaping the social attention were investigated. Overall, 45 infants and their mothers participated in a video-recorded 4 min interaction procedure, including a play and a still-face episode. The infants' gaze orientation (i.e., mother-directed, object-directed, or unfocused) and the types of maternal vocalizations and touch (i.e., socio-cognitive, affective) were micro-analytically coded. Maternal vocalizations and touch were found to influence gaze orientation differently in VI infants compared SCs. Moreover, the group comparisons during the play episode showed that controls were predominantly oriented to the mothers, while VI infants were less socially oriented. Visual impairment severity did not emerge as linked with social attention. These findings contribute to our understanding of socio-cognitive developmental trajectories in VI infants and highlight the need for tailored interventions to promote optimal outcomes for VI populations.

Development of a protocol for using geo-trackers to identify zoonotic enteric pathogen transmission pathways in a pilot study in Kenya

Abstract Humans and animals can be exposed to fecally-transmitted pathogens in both private and public domain environments. Animals may also acquire pathogen infections from these two environments and transmit them to humans through different pathways. Evidence on how often and where interactions occur between the two environments could improve the effectiveness of public health programs for preventing zoonotic disease transmission and response to disease outbreaks. This study aimed to develop a protocol for using geo-trackers to measure the spatial-temporal movement and interaction between animals and children in households and public areas in low- and middle-income categories of urban neighbourhoods in Kenya. It also aimed to identify opportunities and challenges for the scale-up of these methods’ for surveillance of other zoonotic diseases of public health significance. One commercial geo-tracker device with the best technological performance and usability that met pre-defined criteria for the study context was identified. Community engagement meetings were then conducted to gather input on a proposed study protocol. Afterwards, infants and animals were geo-tracked in 10 households in urban informal settlements of Kibera and Jericho, Nairobi over two consecutive weeks with iterative improvements to protocols. The effectiveness of the geo-tracking exercise was evaluated through in-depth interviews with Community Health Volunteers (CHVs) and infant caregivers. Animal and infant behaviour and battery reliability of the geo-trackers were also monitored; and observed opportunities and challenges in implementing the protocol during the exercise were documented. Community members were receptive and accepted the use of geo-trackers on animals and children. In pilot testing, there was no change of behaviour from 10 infants tracked. Discomfort was observed for up to 30 min after the placement for some of the seven animals tracked, but the animals quickly adjusted. The battery for all geo-tracker devices lasted for the 24-h geo-tracking period. Some caregivers and CHVs were concerned whether the geo-trackers could record personal information. It was shown that geo-tracker devices can be successfully deployed to study animal-child interactions and movement in different categories of urban neighbourhoods. Recommendations have been made on the lessons learnt from the study to help scientists who would use geo-trackers for future community-based human and animal research. One Health impact statement Assessing human and animal risks of acquiring enteric infections from environmental contamination, or contributing to pathogen contamination of the environment requires understanding spatial-temporal patterns of human and animal movement between private households and the community. Movement of domestic animals is relevant for understanding household-community spatial patterns of pathogen transmission because animal ownership and contact with humans is common, and free-roaming animals carrying enteric pathogens can spread diverse faecal pathogens between environments. The community-based participatory research approach of this study evaluated implementation feasibility from the lens of technical usability and reliability of geo-tracking devices, as well as social acceptability and ethics related to using such devices for the community-based study of human and animal subjects in urban settings. Evidence and recommendations from this study will be useful to anyone interested in understanding human-animal-environment interactions and their contributions to infectious disease transmission.

Relaxation Therapy and Human Milk Feeding Outcomes

Human milk feeding is a key public health goal to optimize infant and maternal/parental health, but global lactation outcomes do not meet recommended duration and exclusivity. There are connections between lactation and mental health. To appraise all available evidence on whether the provision of relaxation interventions to lactating individuals improves lactation and well-being. Embase, MEDLINE, CINAHL, Allied and Complementary Medicine Database, Web of Science, and the Cochrane Library were searched on September 30, 2023, and topic experts were consulted. Two independent reviewers screened for eligibility. Inclusion criteria were full-text, peer-reviewed publications with a randomized clinical trial design. Techniques that were entirely physical (eg, massage) were excluded. A total of 7% of initially identified studies met selection criteria. Two independent reviewers extracted data and assessed risk of bias with the Cochrane Risk of Bias 2 tool. Fixed-effects meta-analysis and Grading of Recommendations, Assessment, Development, and Evaluations guidelines were used to synthesize and present evidence. Prespecified primary outcomes were human milk quantity, length and exclusivity of human milk feeding, milk macronutrients/cortisol, and infant growth and behavior. A total of 16 studies were included with 1871 participants (pooled mean [SD] age for 1656 participants, 29.6 [6.1] years). Interventions were music, guided relaxation, mindfulness, and breathing exercises/muscle relaxation. Provision of relaxation was not associated with a change in human milk protein (mean difference [MD], 0 g/100 mL; 95% CI, 0; 205 participants). Provision of relaxation was associated with an increase in human milk quantity (standardized mean difference [SMD], 0.73; 95% CI, 0.57-0.89; 464 participants), increased infant weight gain in breastfeeding infants (MD, z score change = 0.51; 95% CI, 0.30-0.72; 226 participants), and a slight reduction in stress and anxiety (SMD stress score, -0.49; 95% CI, -0.70 to -0.27; 355 participants; SMD anxiety score, -0.45; 95% CI, -0.67 to -0.22; 410 participants). Results of this systematic review and meta-analysis suggest that provision of relaxation was associated with an increase in human milk quantity and infant weight gain and a slight reduction in stress and anxiety. Relaxation interventions can be offered to lactating parents who would like to increase well-being and improve milk supply or, where directly breastfeeding, increase infant weight gain.

Maternal psychological distress and temperament traits in children from infancy to late childhood.

Maternal psychological distress during pregnancy is associated with infant temperament. Whether associations persist into late childhood, whether maternal distress is associated with temperament change from infancy to late childhood, whether associations are independent of maternal concurrent distress, and whether maternal distress has sensitive exposure periods on child temperament remain unclear. Our study includes mother-child dyads from Finnish, prospective Prediction and Prevention of Preeclampsia and Intrauterine Growth Restriction study. The mothers completed the Center for Epidemiologic Studies Depression Scale, State Anxiety Inventory and Perceived Stress Scale: biweekly up to 14 times during pregnancy; once in infancy (at child age 4-12months); and once in late childhood (at child age 7-11years). They also completed the Infant Behavior Questionnaire Revised at the infancy (n=2538) and Temperament in Middle Childhood Questionnaire at the late childhood (n=2004; 1693 children had data at both follow-ups) follow-up on child negative affectivity, extraversion and effortful control. We examined the associations of maternal distress with child temperament with linear regression, linear mixed and Bayesian relevant lifecourse exposure models. Maternal distress during pregnancy was associated with higher negative affectivity and lower effortful control in children in infancy and late childhood. Maternal distress during pregnancy was also associated with increases in negative affectivity, decreases in effortful Control, and smaller decreases in extraversion from infancy to late childhood. The associations with late childhood temperament and temperament change were independent of maternal concurrent distress. Late childhood was a sensitive period for lifetime-to-date effects of maternal distress on late childhood negative affectivity and effortful control. Distress during pregnancy and infancy had smaller contributions. Maternal psychological distress during pregnancy is associated with individual differences and change in child temperament from infancy to late childhood. However, distress during pregnancy has a smaller effect on late childhood temperament than maternal concurrent distress.