Well-baby Clinics Research Articles

Knowledge, Attitude and Utilization of Family Planning Methods among Postpartum Women in A Selected Tertiary Care Facility in India

Background & aim: Utilization of family planning services among married women in India, especially postpartum family planning, is poor, with only around one fifth of currently married women using a spacing method. Womenâ��s awareness about PPFP methods in India is also limited. This study aimed to assess the knowledge, attitude and utilization of family planning methods among postpartum women in India. Methods: A cross-sectional survey of 284 postpartum mothers was conducted in a well-baby clinic of a tertiary care facility using convenience sampling. Respondents were interviewed using self-developed, pretested and validated tools. Data was analyzed with STATA software version 31.1 using descriptive statistical methods. Results: Almost two third of the mothers did not receive family planning counseling in the antenatal period (66.1) and over half did not receive it in the immediate postpartum period (53.5). The majority (66.6) did not use any contraceptive method. The mean knowledge score was 7.82i�±3.90 out of a total score of 16 points, and the mean attitude score was 33.53i�±3.90 out of a total score of 50 points. Knowledge of postpartum mothers related to the family planning methods was significantly associated with their educational status, number of antenatal visits, and use of contraceptives, while the use of contraceptive methods was significantly associated with resumed sexual activity.  Conclusion: Lower scores on knowledge about PPFP compared to attitudes to PPFP emphasize the need for innovative approaches to make postpartum women aware about healthy reproductive practices including adoption of FP methods of their choice.

Prevalence of Vitamin B12 Deficiency among Exclusively Breast Fed Term Infants in South India.

Vitamin B12 is not synthesized in the body and its only dietary sources are non-vegetarian. The breast milk of mothers in resource poor countries who are on predominantly vegetarian diets is deficient in vitamin B12. Hence exclusive breast feeding (EBF) may result in B12 deficiency in the infant, which can affect the neurodevelopmental outcome. Our aim was to study the serum vitamin B12 levels among EBF infants and identify the risk factors for B12 deficiency. This cross-sectional study was done among EBF, term, otherwise healthy infants, 1-6 month of age in the well-baby clinic .The sociodemographic data of mother and the infants' anthropometric measurements were noted and blood samples were sent for complete blood count and serum vitamin B12 levels. The data were analysed using SPSS software version 16. We enrolled 149 EBF infants, aged 1-6 months and the mean age was 3.1 (±1.03) months. The mean serum vitamin B12 level was 199.91 (±112.523) pg/ml. Low serum vitamin B12 levels (<200 pg/ml) was seen in 95 (63.7%) infants. On multivariate analysis, there were no other significant risk factors for B12 deficiency in the infants. The prevalence of vitamin B12 deficiency among EBF infants is 63.7%. Because of its importance in neurological development during infancy, there is an urgent need to address this issue while promoting exclusive breast feeding.

Maternal Factors Influencing Exclusive Breastfeeding Practices in the First Six Months of Infant Life in the Sudair and Al Zulfi Areas of Saudi Arabia

This study aims to determine the prevalence of and maternal factors that are associated with exclusive breastfeeding (EBF) in Sudair and Al Zulfi, Riyadh, Saudi Arabia. A cross-sectional study was undertaken by means of recruiting 522, mother-infant pairs with infants aged six months. These participants were attending the Well-Baby Clinics in Sudair and Al Zulfi from January 1st to April 30th, 2016, using a pilot-tested Arabic questionnaire. The EBF prevalence was determined via the “recall since birth” technique and regression analysis. EBF prevalence among mothers of infants (6 months) was 17.1%. Mothers’ insights of insufficient milk were the most recurrently reported reason (42.5%) for not practising exclusive breastfeeding. Saudi mothers (adjusted odds ratio: 10.06; 95% confidence interval: 8.46, 12.53), mothers aged 28–38 years (36.03; 1.96, 62.21), mothers who attended breastfeeding health education (90.52; 5.49, 134.8), multiparous mothers (67.25; 5.83, 122.8), and mothers with housekeeping availability (19.59; 1.36, 281.47) were more likely to practice exclusive breastfeeding in comparison to their counterparts. EBF rates in both areas are far below the WHO recommended level. The mother’s nationality, age, parity, breastfeeding health education, and housekeeping availability were essential determinants to the practice EBF. Thus, aggressive multisectoral governmental interventions should be made to promote as well as support breastfeeding.

Health Personnel's Perceived Usefulness of Internet-Based Interventions for Parents of Children Younger Than 5 Years: Cross-Sectional Web-Based Survey Study.

BackgroundApproximately 10%-15% of children struggle with different socioemotional and psychological difficulties in infancy and early childhood. Thus, health service providers should have access to mental health interventions that can reach more parents than traditional face-to-face interventions. However, despite increasing evidence on the efficacy of internet-based mental health interventions, the pace in transferring such interventions to health care has been slow. One of the major suggested barriers to this may be the health personnel’s attitudes to perceived usefulness of internet-based interventions.ObjectiveThe purpose of this study was to examine health professionals’ perceived usefulness of internet-based mental health interventions and to identify the key areas that they consider new internet-based services to be useful.MethodsBetween May and September 2018, 2884 leaders and practitioners of infant and child health services were recruited to a cross-sectional web-based survey through the following channels: (1) existing email addresses from the Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, course database, (2) an official mailing list to infant and child health services, (3) social media, or (4) other recruitment channels. Respondents filled in background information and were asked to rate the usefulness of internet-based interventions for 12 different infant and child mental health problem areas based on the broad categories from the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood (DC:0-5). Perceived usefulness was assessed with 1 global item: “How often do you think internet-based self-help programs can be useful for following infant and child mental health problems in your line of work?” The answers were scored on a 4-point scale ranging from 0 (never) to 3 (often).ResultsThe participants reported that they sometimes or often perceived internet-based interventions as useful for different infant and child mental health problems (scale of 0-3, all means>1.61). Usefulness of internet-based interventions was rated acceptable for sleep problems (mean 2.22), anxiety (mean 2.09), and social withdrawal and shyness (mean 2.07), whereas internet-based interventions were rated as less useful for psychiatric problems such as obsessive behaviors (mean 1.89), developmental disorders (mean 1.91), or trauma (mean 1.61). Further, there were a few but small differences in perceived usefulness between service leaders and practitioners (all effect sizes<0.32, all P<.02) and small-to-moderate differences among daycare centers, well-baby clinics, municipal child welfare services, and child and adolescent mental health clinics (all effect sizes<0.69, all P<.006).ConclusionsInternet-based interventions for different infant and child mental health problems within services such as daycare centers, well-baby clinics, municipal child welfare services, and child and adolescent mental health clinics are sometimes or often perceived as useful. These encouraging findings can support the continued exploration of internet-based mental health interventions as a way to improve parental support.

Development and validation of Egyptian developmental screening chart for children from birth up to 30 months.

BackgroundDetecting developmental delay in children is an ongoing world commitment, especially for those below three years. To accurately assess the development of children; a culturally appropriate screening tool must be used. Egypt lacks such tool and multiple studies have shown that western tools are not suitable in other cultures.ObjectivesTo develop and validate an easy, rapid, culturally appropriate and applicable screening chart for early detection of developmental delay among Egyptian children from birth up to 30 months and develop a Z-score chart for motor and mental development follow up based on our Egyptian screening chart.MethodsA cross sectional randomized study was carried out on 1503 Egyptian children of both genders aged from birth up to 30 months assumed to have normal development according to the inclusion and exclusion criteria. They were selected from vaccination centers and well-baby clinics. Developmental milestones from Baroda development screening test (BDST) were applied on them after items were translated and adapted to Egyptian culture. Egyptian children developmental milestones scores were analyzed and carefully prepared in tables and charts. A 97% pass level of developmental achievements represents the threshold below which children are considered delayed. A Z-score chart for motor and mental development follow up was designed by calculating each age group achievement. The developed Egyptian developmental screening chart (EDSC) was validated against Ages and Stages Questionnaires (ASQ-3) as a reference standard in another different sample of 337 children in different age groups.ResultsThe developed EDSC is represented in a chart format with two curves 50% and 97% pass level. Children considered delayed when the score below 97% pass level. Results revealed a statistically significant difference between EDSC and BDST at 50% and 97% pass levels. A Z-score chart for motor and mental development follow up was designed by calculating each age group achievement. EDSC sensitivity and specificity were calculated 84.38 (95% CI [67.21%–94.72%]) and 98.36 (95% CI [96.22%–99.47%]) respectively with an overall test accuracy 97.03 (95% CI [94.61%–98.57%]) (p ≤ .001). Agreement between EDSC and ASQ-3 was high (kappa score was 0.827) with negative and positive agreement 98.36 and 84.38, respectively.ConclusionsExtensive revision of the BDST was needed in order to create and validate a more culturally appropriate Egyptian screening chart. This is the first study to create and validate an Egyptian-specific screening tool, to be rapid and easy to use in Egypt for early detection of developmental delay and enabling early intervention practices. A Z-score curve is reliable for follow up motor and mental development by calculating each age group achievement.

Outcome of vision screening by community health workers at immunization outlets in Nigeria to support access to early visual evaluation in children aged 0–2 years

PURPOSE:Routine eye examination in early life is not the practice in most resource-limited countries. Delay in the presentation for eye problems is typical. Community health officers are often consulted by caregivers for all health problems during routine immunization and well-baby clinics in primary healthcare for children aged 0–2 years. This study evaluated the value and limitation of interview, Bruckner red reflex test, and instrument vision screener by noneye care middle-level staff of rural and urban well-baby immunization clinics, in early detection and referral for childhood eye disorders.MATERIALS AND METHODS:This was a cross-sectional study. Middle-level community health workers (CHWs) working at well-baby/immunization clinics were trained to perform vision screening using interview of caregivers, red reflex eye examination with ophthalmoscope, and instrument vision screener (Welch Allyn SPOT™ Vision Screener) without mydriatic drugs during routine immunization of children aged 0–2 years. IRB approval was obtained.RESULTS:Over a 6-month period in 2017, the CHWs screened 5609 children. Overall, 628 (11.2%) patients were referred to the tertiary child eye care unit. Referred cases included cataract, glaucoma, congenital nasolacrimal duct obstruction, ophthalmia neonatorum, retinoblastoma, and significant refractive errors. Referral from the interview of mothers was enhanced if specific questions to elicit visual function were asked. Bruckner red reflex test was more effective than instrument vision screener in the detection of cataract and life-threatening diseases such as retinoblastoma. Instrument vision screener was preferred by parents and better at detecting amblyopic risk factors.CONCLUSION:Preschool vision screening during routine immunization by primary healthcare workers in resource-limited settings was effective. Whenever instrument vision screener does not give any recommendation during screening, consider vision- or life-threatening pathology and refer.

Innovative postnatal risk assessment in preventive child health Care: A study protocol.

To introduce the rationale and design of a postnatal risk assessment study, which will be embedded in Preventive Child Health Care. This study will evaluate: (a) the predictive value of an innovative postnatal risk assessment, meant to assess the risk of growth and developmental problems in young children; and (b) its effectiveness in combination with tailored care pathways. This study concerns a historically controlled study design and is designed as part of the Healthy Pregnancy 4 All-2 program. We hypothesize that child growth and developmental problems will be reduced in the intervention cohort due to the postnatal risk assessment and corresponding care pathways. The study was approved in August 2016. Children and their parents, visiting well-baby clinics during regular visits, will participate in the intervention (N=2,650). Additional data of a historical control group (N=2,650) in the same neighbourhoods will be collected. The intervention, consisting of the risk assessment and its corresponding care pathways, will be executed in the period between birth and 2months of (corrected) age. The predictive value of the risk assessment and its effectiveness in combination with its corresponding care pathways will be assessed by Preventive Child Health Care nurses and physicians in four Preventive Child Health Care organisations in three municipalities with adverse perinatal outcomes. A total risk score above a predefined threshold, which is based on a weighted risk score, determines structured multidisciplinary consultation. The successful implementation of this innovative postnatal risk assessment including corresponding care pathways has potential for further integration of risk assessment and a family-centred approach in the work process of Preventive Child Health Care nurses and physicians. This study introduces a systematic approach in postnatal health care which may improve growth and developmental outcomes of children and even future generations.

Pattern and treatment of adverse event following immunization (AEFI) in infants attending well-baby clinics in secondary health facilities in Benin City, Nigeria

Pattern and treatment of adverse event following immunization (AEFI) in infants attending well-baby clinics in secondary health facilities in Benin City, Nigeria

The Prevalence and Risk Factors of Iron Deficiency Anemia in Thai Infants by Complete Blood Count at 9-Month-Old

Background: Infants are the most at risk from iron deficiency (ID) and iron deficiency anemia (IDA), but the prevalence of the latter in this group is unclear. Estimation as to the prevalence of IDA using Hb of less than 11 g/dL may have been exaggerated due to thalassemia and hemoglobinopathies. On the other hand, iron studies are costly and not routinely available in low resource settings. In the present research, the authors estimated the prevalence of IDA in 9-month-old infants at the authors’ well-baby clinic by improving the post-iron-treatment criteria of Hb and defined the risk factors of IDA in infants. Objective: To estimate the prevalence of IDA in 9-month-old infants at the well-baby clinic and to define the risk factors of IDA. Materials and Methods: A retrospective cohort study of 391 children who had complete blood count (CBC) screening at 9-month-old at the well-baby clinic. Anemia was defined according to the WHO criteria (hemoglobin of 11 g/dL or less for children aged six months to five years). IDA was defined as an increase of at least Hb 1 g/dL after receiving iron treatment for one to two months. Mean levels of hematological parameters were compared between groups using independent samples t-test. The characteristics with potential risk factors for IDA were compared with iron non-responder and normal group. Multivariable adjusted odd ratios and 95% confidence intervals (CIs) of IDA were calculated using multinomial logistic regression with control for risk factors. Results: One hundred fourteen children (29.1%) were anemic. There was no difference between anemic and non-anemic children in baseline characteristics. Seventy children in the anemic group were diagnosed with IDA. The prevalence of IDA in the present study was 17.9%. The IDA group showed significant improvement in Hb, Hct, MCV, MCH after receiving iron treatment, but there were no significant changes in the iron non-responder group. The risk factor for IDA was exclusive breastfeeding for at least six months (odds ratio 3.14, 95% CI 1.67 to 5.90, p&lt;0.001). Conclusion: The prevalence of IDA and anemia in the present study was 17.9% and 29.1%, respectively. The risk factor for IDA was exclusive breastfeeding for at least six months. Keywords: Anemia, Iron deficiency anemia, Prevalence of anemia in infants, Complete blood count screening, Thai infants

Assessment of Awareness and Knowledge About Rickets in Primary Health Care Centers in Saudi Arabia Based on Health Belief Model and Social Cognitive Theory

BACKGROUND: Rickets is considered a significant health issue affecting children especially infants and toddlers. Despite the development affordable and accessible of a health care system in Saudi Arabia, Saudi children had a high prevalence of rickets. This study aims to assess knowledge and awareness of mothers about rickets after short interventional program based on the health belief model and social cognitive theory.&#x0D; &#x0D; METHODS: A Quasi-experimental design pre-posttest type was carried out by using self-administered questionnaire. A sample size of 180 mothers who attended the well-baby clinic in primary health care centers in Riyadh and Medina Region were consented and then enrolled in the study. The questionnaire focused on 7 domains; demographic information and the other 6 domains based on health believe model and social cognitive theory.&#x0D; &#x0D; RESULTS: The mean scores of knowledge, self-efficacy, and health belief model constructs (susceptibility, severity, benefits) significantly increased. The mean score and the percentages of knowledge and health belief model constructs show changes between pretest and post test result with statistical significant (27.9% in knowledge and self-efficacy, 34.9% in perceived susceptibility, 54.5% in perceived severity, 25.9% in perceived benefits, 11.7% in perceived barriers and 5.4% in cues to action) all were with a p-value of less than 0.05. &#x0D; &#x0D; CONCLUSION: Educational intervention based on social cognitive theory and health belief model were effective in improving knowledge, awareness and practice related to preventive behaviors of rickets.

Prevalence and Management of Perceived Adverse Events Following Immunization in Infants attending Well Baby Clinics in Benin City, Nigeria

Background: Immunization is an important public health intervention for vaccine-preventable diseases (VPDs). However, adverse events may follow immunization of infants. This study determined the prevalence and management of Adverse Events following Immunization (AEFI) reported by caregivers of infants in Well-Baby Clinics in Benin City, Nigeria.Methods: The study was carried out in 2015 among 400 caregivers of infants attending Well- Baby Clinics in Benin City, Nigeria. A descriptive cross-sectional study design was utilized. Respondents were selected using a systematic sampling technique. An adapted structured interviewer-administered questionnaire was used to collect data. Data analysis was done using IBM SPSS version 20.0.Results: Less than half, 169 (42.3%) of the caregivers stated that their children had AEFI. Three-quarters 126 (74.6%) and 68 (40.2%) of the AEFI occurred following vaccination with Bacillus Calmette-Guerin and pentavalent vaccine. Fever and swelling of the injection sites occurred in 142 (84.0%) and 65 (38.5%) of the children, respectively. Almost all 167 (98.8%) of the respondents reported an AEFI. Few of those who reported an AEFI, 13 (7.8%) had their children hospitalized.Conclusion: A significant proportion of children vaccinated experienced side effects perceived to be AEFI that presented mainly as fever and swollen injection sites which were mainly reported at the immunization clinic. Few of the reported cases of AEFI were hospitalized. Healthcare workers should continue to educate and reassure caregivers of infants of the symptoms and signs that may occur following vaccination and how they can be managed.&#x0D; Keywords: Adverse Events Following Immunization; Infants; Management; Prevalence; Nigeria.

Parenting support to prevent overweight during regular well-child visits in 0-3 year old children (BBOFT+ program), a cluster randomized trial on the effectiveness on child BMI and health behaviors and parenting.

BackgroundPrevention of overweight during early childhood seems promising.ObjectiveTo evaluate the effectiveness of the parenting-based BBOFT+ overweight prevention program on child BMI, child health behavior and parenting behavior among 0–36 month old children. BBOFT+ is an acronym for the key healthy lifestyle behaviors that are targeted in the BBOFT+ intervention: breastfeeding (B), daily breakfast (B), daily going outdoors (O), limiting sweet beverages (in Dutch, F) and minimal TV or computer time (T), complemented with healthy sleep behavior and improvement of parenting skills (+).MethodsA cluster randomized controlled trial in newborn children visiting well-baby clinics, comparing the BBOFT+ intervention (N = 901) with care as usual (CAU) (N = 1094). In both groups, parents received regular well-child visits (±11 visits in the first 3 years). In the intervention group, care was supplemented with the BBOFT+ program, which focuses on improving parenting skills from birth onwards to increase healthy behavior. Questionnaires were filled in at child's age 2–4 weeks, 6, 14 and 36 months. In multivariate analyses we corrected for child’s birthweight, age, ethnic background, mother’s educational level and BMI.ResultsNo differences were found in weight status at 36 months between intervention and control group children. At 6 months, BBOFT+ parents reported their child drinking less sweet beverages than control parents (48% vs 54%;p = .027), and going outdoors daily with their child less often (57% vs 62%;p = .03). At 14 months, more BBOFT+ parents than control parents reported to have breastfed for six months or longer (32% vs 29%;p = .022). At 36 months, more BBOFT+ parents than control parents reported their child going outside daily (78% vs 72%;p = .011) and having less TV/computer time on week- (38% vs 46%;p = .001) and weekend days (48% vs 56%;p = .002). Also, BBOFT+ parents reported having more parental control than control parents (3.92 vs 3.89;p = .02). No significant differences were found for daily breakfast, sleep duration and parenting practices in adjusted analyses.ConclusionThe BBOFT+ overweight prevention program showed small improvements in parent-reported child health behaviors, compared to care as usual; no effect was observed on child BMI. The identified modifiable elements are potentially relevant for interventions that aim to prevent overweight.

Low prevalence of infantile functional gastrointestinal disorders (FGIDs) in a multi-ethnic Asian population

Functional gastrointestinal disorders (FGIDs) are common in children. The prevalence of FGIDs varies across the world but is unknown in Malaysia. We aimed to investigate the prevalence of FGIDs in healthy Malaysian infants. This was a cross-sectional study involving healthy infants younger than 12 months of age who attended a well-baby clinic. A universal sampling method was adopted. Children with congenital disorders potentially affecting gastrointestinal functions, chronic debilitating diseases and hypothyroidism were excluded. Rome IV criteria were used to define FGIDs. Of the total 534 infants recruited (54% males), 92% were born at term; 85% had normal birth weight [range 2.5-4.0kg], and the mean (±S.D.) age at interview was 6.8 (±3.4) months. Thirty-six percent were breastfed, 29% were formula-fed, and 35% had mixed feeding. Prevalence of infant regurgitation and rumination syndrome was 10.5% and 1.7%, respectively. Prevalence of infant colic was 1.9% (3/160) (infant<5 months old) while infant dyschezia, functional constipation and diarrhoea were 1.3%, 1.1% and 0.3%, respectively. No subjects fulfilled diagnostic criteria for cyclic vomiting syndrome. Breastfed infants were less likely to regurgitate, after adjustment for age, gender, ethnicity, birth weight and gestation (adjusted OR 0.25 [95% CI 0.12-0.54]; p<0.001). No significant differences among other factors (gender, Malays vs. non-Malays, premature vs. term, and birthweight) were noted for other FGIDs. With the exception of the lower prevalence of infant colic and functional constipation, the prevalence rates of other FGIDs observed in the present study were similar to those published in the literature. Breastfeeding protects against infant regurgitation.

Newborn cord care practices amongst mothers in Makurdi, Benue State Nigeria

Background: Omphalitis is a neonatal infection resulting from unhygienic care of the umbilical cord.In 2014, the World Health Organization issued a new recommendation; the application Of daily Chlorhexidine gel to the umbilical stump. The aim of this study was to determine cord care practices common amongst mothers in Makurdi Local Government area of Benue State in North Central Nigeria.&#x0D; Methodology: The study was a cross-sectional study carried out at the well-baby Immunization Clinic of the Benue State University Teaching hospital (BSUTH) and the Immunization Clinic at the Epidemiology unit of the Benue State Ministry of Health both in Makurdi Local Government area of Benue State from April to July 2018.Subjects were mothers presenting with their babies at these clinics during the study period. Information was collected using a structured intervieweradministered questionnaire.&#x0D; Results: Three hundred and ninetyeight mother-infant pairs participated in this study. Of the infants the males were 205 (51.5%) while the females were 193 (48.5%); they were aged 1-16 days with mean age of 4.29±2.37 days. Two hundred and seventy-two (68.3%) mothers had their babies’ cords cleaned with methylated spirit alone while 11 (2.8%) cleaned with methylated spirit and another substance. The commonest substance applied to cord after cleaning was Vaseline 58(14.6%).&#x0D; Conclusion: The use of methylated spirit for cord care is high among mothers in Makurdi, the uptake of Chlorhexidine as recommended by WHO is significantly very low and this calls for more concerted efforts in educating mothers about the use of Chlorhexidine for cord care.&#x0D; Key words: Chlorhexidine, Cord care, Mothers, Newborn, Practices,

Newborn Behavioral Observation, maternal stress, depressive symptoms and the mother-infant relationship: results from the Northern Babies Longitudinal Study (NorBaby)

BackgroundFamilies can experience the postpartum period as overwhelming and many report a special need for support. The Newborn Behavioral Observation (NBO) aims to promote a positive parent-infant relationship by sensitising parents to the infant’s signals. This article evaluates the NBO as a universal preventive intervention within the regular well-baby clinic service on measures of maternal depressive symptoms, parental stress, the mother-infant relationship and satisfaction/benefit of the postpartum follow-up.MethodsThis investigation is part of a larger longitudinal study comprising 220 women and 130 of their partners recruited between 2015 and 2017. The study had a non-randomised cluster-controlled design with 6 measurement points. This article is based on a sample of 196 women using data from T1 (gestational weeks 13–39), T4 (5–15 weeks postpartum) and T5 (3–9 months postpartum). Participants were allocated to a group receiving the NBO (n = 82) and a care as usual comparison group (n = 114). We measured maternal depressive symptoms and parental stress using the Edinburgh Postnatal Depression Scale (EPDS) and the Parenting Stress Index (PSI). The mother-infant relationship was assessed with the Parental Reflective Functioning Questionnaire (PRFQ), the Maternal Postnatal Attachment Scale (MPAS) and the Maternal Confidence Questionnaire (MCQ). Participants also answered questions about satisfaction/benefit of the postpartum follow-up.ResultsA Mann-Whitney U test indicated that participants in the NBO-group learned significantly more than the comparison group from the follow-up about the baby’s signals in relation to sleep/sleep patterns, social interaction and crying/fuzziness. Multivariate analyses of covariance (MANCOVA) and repeated measures ANCOVA found no significant differences between the groups for the mother-infant relationship domain and few differences in depressive symptoms and parental stress. The repeated measures ANCOVA found that participants in the NBO-group scored slightly higher on parental stress, although the difference was small.ConclusionsThe results indicate that the NBO-group learned more than the comparison group about reading their child’s signals in important everyday situations. However, the benefits of the NBO were limited for depressive symptoms, parental stress and self-reported mother-infant relationship. The study sample was generally well-functioning, and the results indicate that the benefits of the NBO may be limited within a well-functioning sample.Trial registrationClinicalTrials, NCT02538497, Registered 2 September 2015.

Antecedents of fathers' perception of child behavior at child age 12 months.

This study investigates whether fathers' adverse childhood experiences (ACE) and attachment style reported during pregnancy predict fathers' perception of child behavior assessed 12 months postpartum, expressed by the Parenting Stress Index (PSI), Child Domain. Prospective fathers (N=835) were recruited to "The Little in Norway (LiN) study" (Moe & Smith) at nine well-baby clinics in Norway, with data collection composed of five time points during pregnancy and two time points postpartum (6 and 12 months). The main analyses included linear regression, path-analysis modeling, and intraclass correlation based on mixed effects modeling. First, linear regression analyses showed that neither fathers' ACE nor attachment style significantly predicted perceived child behavior postpartum directly. Furthermore, path analyses showed that ACE and less secure attachment style (especially avoidant attachment) measured early in pregnancy strongly predicted negatively perceived child behavior, mediated by fathers' mental health symptoms during pregnancy and partner disharmony postpartum. Second, intraclass correlation analyses showed that fathers' perceived child behavior showed substantial stability between 6 and 12 months postpartum. Family interventions beginning in pregnancy may be most beneficial given that fathers' early experiences and perceptions of attachment in pregnancy were associated with later partner disharmony and stress.

Prevalence of Functional Gastrointestinal Disorders in European Infants and Toddlers

To assess the prevalence of functional gastrointestinal disorders (FGIDs) in young children in a cross-sectional, multicenter study in Belgium, Italy, and The Netherlands. Children were enrolled if they were age 0-48months, attending a general pediatrician (Belgium, Italy) or a well-baby clinic (The Netherlands) for routine follow-up. Separate questionnaires were developed for infants age 0-12months and for toddlers age 13-48months. Questionnaires evaluated the clinical history, symptoms, sociodemographic information on the family, and exposure to stressful life events. FGIDs were defined according to Rome IV criteria. In total 2751 children were included: 1698 infants age 0-12months and 1053 children age 13-48months. The prevalence of any FGID in infants age 0-12months and 13-48months was 24.7% and 11.3%, respectively. The most common disorders were infant regurgitation (13.8%) in infants and functional constipation (9.6%) in toddlers. Multivariable regression analyses demonstrated that younger age (P=.030) and formula feeding (P=.045) were associated with the prevalence of any FGID among infants. Country (Italy) (P=.033) and parents subjected to domestic violence (P=.035) were associated with the prevalence of any FGID in toddlers age 13-48months. FGIDs are common in a community sample of Western European infants and toddlers. Regurgitation is most prevalent in infants and functional constipation is most common in toddlers. Younger age, formula feeding, and domestic violence to parents are associated with the prevalence of FGIDs.

Are the World Health Organization growth standards universal? The Israeli children validity study

The World Health Organization (WHO) 2006 growth standards were adopted in most countries, Israel included. We aimed to study the assumption that growth in early years is similar across populations by studying the validity of the WHO growth standards in a large population-based study of Israeli infants. Computerized data on infants born in 2011–2015 who were followed in the well-baby clinics for the first 2 years of their lives were retrieved from the Ministry of Health. Data included sociodemographics, delivery information, and visit-specific measurements of weight, recumbent length, and head circumference. Sex- and age-specific z-scores, percentiles, and outliers of anthropometric measurements were calculated and compared with the Standards. These analyses were repeated for “ideally grown” infants. Israeli infants were consistently shorter, with z-scores ranging from −0.07 SD (standard deviation) to −0.5 SD. Also, Israeli infants weighed less than predicted by the standards in the first 9 months. The proportion over 2 SD in weight-for-length increased with age from 2.2–2.9% in the first 6 months of life to 3.4–5.1% in the second year of life, which is well above the expected value of 2.3%. Israeli infants were shorter and more likely to be obese than predicted by the Standards. Having differences in length even more prominent among “ideally grown” children suggest that the WHO standards might not be optimal for monitoring the growth of Israeli infants.

Effects of 20-year infancy-onset dietary counselling on cardiometabolic risk factors in the Special Turku Coronary Risk Factor Intervention Project (STRIP): 6-year post-intervention follow-up

Primordial and primary prevention is the cornerstone for cardiometabolic health. In the randomised, controlled Special Turku Coronary Risk Factor Intervention Project (STRIP; n=1116), a 20-year dietary counselling intervention was given to children biannually from infancy, and cardiometabolic health benefits had been observed among the participants in the intervention group. Here, we report on the key results of the first follow-up done 6 years after the end of the intervention, at age 26 years. The randomised controlled STRIP study recruited children at age 5 months from well-baby clinics in Turku, Finland, and randomly assigned them to either an intervention or control group; group allocation was unmasked. The intervention introduced participants to a heart-healthy diet, characterised by low proportional intake of saturated fat and cholesterol, by dietary counselling and nutrition education sessions to parents and children from the age of 7 months to 20 years. Children in the control group received only the basic health education given at Finnish well-baby clinics and school health care. We assessed diet, lifestyle, and cardiometabolic risk factor data, including blood pressure, anthropometry, serum biochemistry (lipids, apolipoproteins, glucose, and insulin), and homoeostatic model assessment of insulin resistance (HOMA-IR) in the participants at age 26 years. 1116 children were included in the original STRIP study, of whom 551 provided data at the age 26 years follow-up, and data for 507 participants were analysed (243 in the intervention group and 264 in the control group). At follow-up, those who had been in the intervention group had slightly lower mean intake of saturated fat as a proportion of total energy intake than the control group (13·0% [SD 3·3] vs 13·7% [3·6], p=0·049). A higher proportion of participants in the intervention group achieved the targeted monounsaturated and polyunsaturated fat to saturated fat ratio of more than 2:1 than the control group (78 [39%] of 200 vs 70 [30%] of 235; risk ratio [RR] 1·16 [95% CI 1·01-1·33]; p=0·035). A higher proportion of intervention group participants met the ideal total cholesterol concentration of less than 5·17 mmol/L (194 [81%] of 240 vs 187 [72%] of 261; RR 1·45 [1·05-2·01], p=0·024) and optimal LDL cholesterol concentration of less than 3·0 mmol/L (166 [69%] of 240 vs 158 [61%] of 251; RR 1·30 [1·03-1·66], p=0·031). Those who received the intervention had lower glucose (5·00 mmol/L [SD 0·43] vs 5·07 mmol/L [0·46], p=0·040) and HOMA-IR (median 1·44 [IQR 1·09-1·91] vs 1·62 [1·22-2·09], p=0·037) than the participants in the control group. Previously observed intervention effects during the 20-year counselling were largely maintained into adulthood 6 years after the withdrawal of the intervention. Dietary counselling introduced in infancy thus provided a sustained benefit to diet quality and cardiometabolic risk factor levels. Academy of Finland, Juho Vainio Foundation, Finnish Foundation for Cardiovascular Research, Finnish Ministry of Education and Culture, Finnish Cultural Foundation, Sigrid Jusélius Foundation, Special Governmental grants for Health Sciences Research (Turku University Hospital), Yrjö Jahnsson Foundation, Finnish Medical Foundation, and Turku University Foundation.

Associations between human milk oligosaccharides and growth in infancy and early childhood

Breastfeeding modulates infant growth and protects against the development of obesity. However, whether or not maternal variation in human milk components, such as human milk oligosaccharides (HMOs), is associated with programming of child growth remains unknown. Our objective was to determine the association between maternal HMO composition and child growth during the first 5 y of life. In addition, the association between maternal prepregnancy BMI and HMO composition was assessed. Human milk samples from 802 mothers were obtained from a prospective population-based birth cohort study, Steps to healthy development of Children (STEPS), conducted in Turku, Finland. HMO composition in these milk samples was analyzed by HPLC. Child growth data from 3 mo to 5 y were collected from municipal well-baby clinics and linked to maternal HMO composition data to test for associations. Maternal HMO composition 3 mo after delivery was associated with height and weight during the first 5 y of life in children of secretor mothers. Specifically, HMO diversity and the concentration of lacto-N-neo-tetraose (LNnT) were inversely associated and that of 2'-fucosyllactose (2'FL) was directly associated with child height and weight z scores in a model adjusted for maternal prepregnancy BMI, mode of delivery, birthweight z score, sex, and time. Maternal prepregnancy BMI was associated with HMO composition. The association between maternal HMO composition and childhood growth may imply a causal relation, which warrants additional testing in preclinical and clinical studies, especially since 2'FL and LNnT are among the HMOs now being added to infant formula. Furthermore, altered HMO composition may mediate the impact of maternal prepregnancy BMI on childhood obesity, which warrants further investigation to establish the cause-and-effect relation.