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To conduct a systematic review of the published peer-reviewed articles on the biochemical assessment of nutritional status of South African infants, children and adolescents in 1997–2022.
Design:
Online databases (Pubmed, CINAHL, EbscoHost and SAePublications) were used to identify thirty-nine papers.
Setting:
South Africa, 1997–2022.
Participants:
Infants, children and adolescents.
Results:
Vitamin A deficiency prevalence was 35–67 % before 2001 and mostly below 16 % after 2008. Anaemia ranged from 5·4 to 75·0 %, with 36–54 % of infants below 1 year being anaemic. Among 0- to 6-year-olds, iron deficiency (ID) was 7·2–39·4 % in rural and 16–41·9 % in urban areas. Zn deficiency remained high, especially among 0- to 6-year-olds, at 39–48 %. Iodine insufficiency (UIC < 100 µg/l) was between 0 and 28·8 %, with excessive levels in two areas. Vitamin D deficiency was 5 % for 11- to 17-year-olds in one urban study but 33–87 % in under 10-week-old infants. The 2005 national survey reported sufficient folate status among 0- to 6-year-olds, and vitamin B12 deficiency was 0–21 %. Low-grade inflammation was between 5 % and 42 % depending on the biomarker and cut-offs.
Conclusions:
Vitamin A status may have improved meaningfully during the last 25 years in South Africa to below 16 %, and iodine and folate deficiency appears to be low particularly among 0- to 6-year-olds. However, confirmation is needed by a national survey. Anaemia, Fe and Zn deficiencies still pose severe problems, especially among 0- to 6-year-olds. Sufficient data on vitamin D and B12 status are lacking.
This study aimed to explore relationships between parental stress, coping, and outcomes for parents of infants with CHD, via observational approach reflecting domains of the Parental Stress and Resilience in CHD (PSRCHD) model.
Methods:
Fifty-five parents of 45 infants with CHD completed questionnaires with measures of parental stress, Problem-Focused Coping (PFC), Emotion-Focused Coping (EFC), Avoidant Coping (AC), mental health (symptoms of anxiety and symptoms of depression), post-traumatic growth (PTG) and quality of life (QoL). Demographic and infant clinical data were obtained.
Results:
Parental stress showed significant small to medium positive correlations with MH and PTG, but no significant correlations with QoL. EFC and AC showed significant small to medium positive correlations with MH, and medium negative correlations with parental QoL. EFC and PFC had significant small to medium correlations with PTG. PFC and AC had significant small to medium correlations with infant QoL. Hierarchical multiple regression analyses indicated that parental symptoms of anxiety, PTG, parental QoL, infant QoL were significantly predicted by models comprising of parental stress, coping styles, and clinical controls (adjusted R2 = 13.0–47.9%, p range < 0.001–.048), with results for parental symptoms of depression falling marginally above significance (adjusted R2 = 12.3%, p = .056).
Conclusions:
Parental stress, coping styles, and length of hospital stay are related to psychological outcomes in parents of infants with CHD. Future research may use the PSRCHD framework to assess mechanisms underlying CHD parents’ stress and coping experiences and investigate longitudinal relationships between parental factors and parent and child outcomes.
In the current pre-registered study, we examined the associations between shared book reading, daily screen time, and vocabulary size in 1,442 12- and 24-month-old Norwegian infants. Our results demonstrate a positive association between shared reading and vocabulary in both age groups, and a negative association between screen time and vocabulary in 24-month-olds. Exploratory analyses revealed that the positive relationship between shared reading and expressive vocabulary in 12-month-olds was stronger in lower SES groups, suggesting that shared reading may act as a compensatory mechanism attenuating potentially impoverished learning environment and parent-infant interactions in low-SES families.
Vitamin D deficiency in infants is widely prevalent. Most paediatric professional associations recommend routine vitamin D prophylaxis for infants. However, the optimal dose and duration of supplementation are still debated. We aimed to compare the efficacy and safety of different vitamin D supplementation regimens in term and late preterm neonates. For this systematic review and network meta-analysis, we searched MEDLINE, the Cochrane Central Register of Controlled Trials and Embase. Randomised and quasi-randomised clinical trials that evaluated any enteral vitamin D supplementation regimen initiated within 6 weeks of life were included. Two researchers independently extracted data on study characteristics and outcomes and assessed quality of included studies. A network meta-analysis with a Bayesian random-effects model was used for data synthesis. Certainty of evidence (CoE) was assessed using GRADE. Primary outcomes were mean serum vitamin D concentrations and the proportion of infants with vitamin D insufficiency (VDI). We included twenty-nine trials that evaluated fourteen different regimens of vitamin D supplementation. While all dosage regimens of ≥400 IU/d increased the mean 25(OH)D levels compared with no treatment, supplementation of ≤250 IU/d and 1400 IU/week did not. The CoE varied from very low to high. Low CoE indicated that 1600 IU/d, compared with lower dosages, reduced the proportion of infants with VDI. However, our results indicated that any dosage of ≥800 IU/d increased the risk of hypervitaminosis D and hypercalcaemia. Data on major clinical outcomes were sparse. Vitamin D supplementation of 400–600 IU/d may be the most effective and safest in infants.
This study evaluated the effectiveness of Baby Friendly Spaces (BFS), a psychosocial support program for Rohingya refugee mothers of malnourished young children in Bangladesh. Because BFS was already being implemented, we examined the benefit of enhancing implementation supports.
Methods
In matched pairs, 10 sites were randomized to provide BFS treatment as usual (BFS-TAU) or to receive enhanced implementation support (BFS-IE). 600 mothers were enrolled and reported on maternal distress, functional impairment, subjective well-being and coping at baseline and 8-week follow-up. Data were analyzed using multilevel linear regression models to account for clustering; sensitivity analyses adjusted for the small number of clusters.
Results
Significant within-group improvements in BFSIE were observed for distres (−.48, p = .014), functional impairment (−.30, p = .002) and subjective well-being (.92, p = .011); improvements in BFS-TAU were smaller and not statistically significant. Between-group comparisons favored BFS-IE for distress (β = −.30, p = .058) and well-being (β = .58, p = .038). Sensitivity adjustments produced p-values above .05 for all between-group comparisons.
Discussion
Feasible adjustments to implementation can improve program delivery to increase impact on maternal distress and well-being. Although results should be interpreted with caution, study design limitations are common in pragmatic, field-based research.
We examined the neurophysiological underpinnings of lexical-tone and vowel-quality perception in learners of a non-tonal language. We tested 25 6- and 25 9-month-old German-learning infants, as well as 24 German adults and expected developmental differences for the two linguistic properties, as they are both carried by vowels, but have a different status in German. In adults, both lexical-tone and vowel-quality contrasts elicited mismatch negativities, with a stronger response to the vowel-quality contrast. Six-month-olds showed positive mismatch responses for lexical-tone and vowel-quality contrasts, with an emerging negative mismatch response for vowel-quality only. The negative mismatch responses became more pronounced for the vowel-quality contrast at 9 months, while the lexical-tone contrast elicited mainly positive mismatch responses. Our data reveal differential developmental changes in the processing of vowel properties that differ in their lexical relevance in the ambient language.
Undernutrition in early life remains a significant public health challenge affecting millions of infants and young children globally. Children who are wasted, stunted or underweight are at increased risk of morbidity and mortality. Undernutrition at critical periods also impacts on aspects of neurodevelopment, with longer-term consequences to educational performance and mental health outcomes. Despite consistent evidence highlighting an increased risk of neonatal and infant mortality among boys, a common assumption held across many disciplines is that girls are more vulnerable with respect to early-life exposures. In relation to undernutrition, however, recent evidence indicates the reverse, and in contexts of food insecurity, boys are at increased risk of undernutrition in early life compared to girls, with sex-specific risks for neurodevelopmental deficits. These effects appear independent of social factors that may favour boys, such as gender disparities in infant feeding practices and health-seeking behaviours. The observed vulnerability among boys may therefore be underpinned by biological processes such as differential energy requirements during periods of rapid growth. As boys have greater needs for growth and maintenance, then, in times of nutritional hardship, these needs may not be met resulting in risk of undernutrition and subsequent health consequences. In view of this emerging evidence, a greater understanding of the mechanisms behind this vulnerability among boys is needed and policy considerations to protect boys should be considered. This review will explore sex differences in risk of undernutrition and consider these in the context of existing programmes and policies.
Young children today are exposed to masks on a regular basis. However, there is limited empirical evidence on how masks may affect word learning. The study explored the effect of masks on infants’ abilities to fast-map and generalize new words. Seventy-two Chinese infants (43 males, Mage = 18.26 months) were taught two novel word-object pairs by a speaker with or without a mask. They then heard the words and had to visually identify the correct objects and also generalize words to a different speaker and objects from the same category. Eye-tracking results indicate that infants looked longer at the target regardless of whether a speaker wore a mask. They also looked longer at the speaker’s eyes than at the mouth only when words were taught through a mask. Thus, fast-mapping and generalization occur in both masked and not masked conditions as infants can flexibly access different visual cues during word-learning.
To assess the effect of daily egg consumption for six months on linear growth (primary outcome), weight-for-age, weight-for-length, mid-upper arm circumference-for-age, head circumference-for-age Z-scores, gross motor milestones development, anaemia and iron status (secondary outcomes) in a low socioeconomic community.
Participants:
Infants aged 6 to 9 months living in the peri-urban Jouberton area, in the Matlosana Municipality, South Africa.
Design:
A randomised controlled trial with a parallel design was implemented. Eligible infants were randomly allocated to the intervention (n 250) receiving one egg/day and the control group (n 250) receiving no intervention. The participants were visited weekly to monitor morbidity and gross motor development, with information on adherence collected for the intervention group. Trained assessors took anthropometric measurements, and a blood sample was collected to assess anaemia and iron status. There was blinding of the anthropometric assessors to the groups during measurements and the statistician during the analysis.
Results:
Baseline prevalence of stunting, underweight, wasting, overweight and anaemia was 23·8 %, 9·8 %, 1·2 %, 13·8 % and 29·2 %, respectively, and did not differ between groups. Overall, 230 and 216 participants in the intervention and control groups completed the study, respectively. There was no intervention effect on length-for-age, weight-for-age, weight-for-length Z-scores, gross motor milestone development, anaemia and iron status.
Conclusions:
Daily egg intake did not affect linear growth, underweight, wasting, motor milestones development, anaemia and iron status. Other interventions are necessary to understand the effect of animal-source food intake on children’s growth and development. This trial was registered at https://clinicaltrials.gov/ (NCT05168085).
Efficacy studies show early nutrition interventions improving infant nutrition status, but understanding caregiver acceptability is required for implementation of such interventions. This systematic review examines caregivers’ perceptions of nutrition interventions in young children.
Design:
We searched the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, CINAHL and PsychINFO from date of online journal inception through December 2020. Interventions included oral (powder/liquid/tablet) and/or intravenous supplementation, food fortification and nutrition counselling. Inclusion criteria included primary research, data presented on caregiver perception and studies published in English. Quality assessment was performed using the Critical Appraisal Skills Programme tool. Studies underwent narrative synthesis using inductive thematic analysis.
Setting:
No restriction.
Participants:
Caregivers of children under 24 months of age.
Results:
Of 11 798 records identified, thirty-seven publications were included. Interventions included oral supplementation, food fortification and nutrition counselling. Caregivers included mothers (83 %), fathers, grandparents and aunts. Perceptions were gathered through individual interviews, focus group discussions, questionnaires, surveys and ratings. Totally, 89 % of studies noted high acceptability (n 33 most notably increased appetite (n 17). In total, 57 % of studies (n 21) cited low acceptability, commonly from side effects (n 13) such as gastrointestinal issues, appetite loss and stained teeth.
Conclusions:
Positive perceptions and enthusiasm for interventions were frequently reported. Key to implementation was the increased appetite noted by caregivers. A substantial proportion of studies reported negative perceptions, mainly due to side effects. In future interventions, mitigation and education around common side effects are crucial for acceptability. Understanding both positive and negative caregiver perceptions is important for informing future nutrition interventions and strengthening sustainability and implementation.
While adult studies show that consonants are more important than vowels in lexical processing tasks, the developmental trajectory of this consonant bias varies cross-linguistically. This study tested whether British English-learning 11-month-old infants’ recognition of familiar word forms is more reliant on consonants than vowels, as found by Poltrock and Nazzi (2015) in French. After establishing that infants prefer listening to a list of familiar words over pseudowords (Experiment 1), Experiment 2 examined preference for consonant versus vowel mispronunciations of these words. Infants listened to both alterations equally. In Experiment 3, using a simplified version of the task with one familiar word only (‘mummy’), infants’ preference for its correct pronunciation over a consonant or a vowel change confirmed an equal sensitivity to both alterations. British English-learning infants’ word form recognition appears to be equally impacted by consonant and vowel information, providing further evidence that initial lexical processes vary cross-linguistically.
There has been much debate on the origins of prosocial behavior: do humans come into the world ready to help others, or is this something that must be learned? In this chapter, we approach this question by examining evidence on the ontogenetic and phylogenetic roots of prosocial behavior. First, we examine work with young children, focusing on the earliest developing prosocial behaviors of helping, comforting, and sharing. We then complement this developmental evidence with studies on chimpanzees and bonobos to gain insight into which elements of prosocial behavior might be evolutionarily inherited. Taken together, this evidence suggests that humans have a biological predisposition for prosocial behavior that we share with our ape cousins and that human-specific socialization practices build on this foundation throughout the course of development.
Early forms of empathy and sharing appear before the first birthday. In the second year, toddlers cooperate and help or comfort others, as they begin to recognize other people’s needs. The different types of early prosocial behavior are not necessarily correlated with each other or with measures of infants’ temperament. Individual differences and gender differences in prosocial behavior begin to emerge in early childhood, when prosocial behavior becomes associated with children’s developing skills and their social understanding.
Specialist Perinatal Mental Health Services (SPMHS) are a new development in Ireland. This service evaluation examined the impact of the introduction of a SPMHS multidisciplinary team (MDT) on prescribing practices and treatment pathways in an Irish maternity hospital.
Methods:
Clinical charts were reviewed to collect data on all referrals, diagnoses, pharmacological and non-pharmacological interventions delivered in a SPMHS over a 3-week period in 2019. The findings were compared to the same 3-week period in 2020 following the expansion of the SPMHS MDT.
Results:
In 2019 (n = 32) and 2020 (n = 47), most (75 and 79%, respectively) assessments were antenatal. The proportion of patients prescribed psychotropic medication within the SPMHS was not significantly different from 2019 (31%) to 2020 (23%), though more patients were already prescribed psychotropic medications at the time of referral (22% in 2019 v. 36% in 2020). There was an increase in MDT interventions in 2020 with more input from psychology, clinical nurse specialist (CNS), and social work intervention. Adherence to prescribing standards improved from 2019 to 2020.
Conclusion:
Prescribing patterns remained unchanged between 2019 and 2020. Improvement was observed in adherence to prescribing standards and there was increased provision of MDT interventions in 2020. Broader diagnostic categories were also used in 2020, possibly suggesting that the service is now providing more individualized care.
The development of Specialist Perinatal Mental Health Services in Ireland in recent years (2018–2021) is described. The paper highlights the role of unexpected opportunity in advancing this much needed service for women, infants and their families. It also emphasises the need for funding combined with an implementation mechanism to ensure that the service emerging is true to the Model of Care designed and is available in a uniform manner to women nationally.
Growth failure in infants born with CHD is a persistent problem, even in those provided with adequate nutrition.
Objective:
To summarise the published data describing the change in urinary metabolites during metabolic maturation in infants with CHD and identify pathways amenable to therapeutic intervention
Design:
Scoping review.
Eligibility criteria:
Studies using qualitative or quantitative methods to describe urinary metabolites pre- and post-cardiac surgery and the relationship with growth in infants with CHD.
Sources of evidence:
NICE Healthcare Databases website was used as a tool for multiple searches.
Results:
347 records were identified, of which 37 were duplicates. Following the removal of duplicate records, 310 record abstracts and titles were screened for inclusion. The full texts of eight articles were reviewed for eligibility, of which only two related to infants with CHD. The studies included in the scoping review described urinary metabolites in 42 infants. A content analysis identified two overarching themes of metabolic variation predictive of neurodevelopmental abnormalities associated with anaerobic metabolism and metabolic signature associated with the impact on gut microbiota, inflammation, energy, and lipid digestion.
Conclusion:
The results of this scoping review suggest that there are considerable gaps in our knowledge relating to metabolic maturation of infants with CHD, especially with respect to growth. Surgery is a key early life feature for CHD infants and has an impact on the developing biochemical phenotype with implications for metabolic pathways involved in immunomodulation, energy, gut microbial, and lipid metabolism. These early life fingerprints may predict those individuals at risk for neurodevelopmental abnormalities.
Human milk oligosaccharides (HMOs) are a class of structurally diverse and complex unconjugated glycans present in breast milk, which act as selective substrates for several genera of select microbes and inhibit the colonisation of pathogenic bacteria. Yet, not all infants are breastfed, instead being fed with formula milks which may or may not contain HMOs. Currently, formula milks only possess two HMOs: 2′-fucosyllactose (2’FL) and lacto-N-neotetraose (LNnT), which have been suggested to be similarly effective as human breast milk in supporting age-related growth. However, the in vivo evidence regarding their ability to beneficially reduce respiratory infections along with altering the composition of an infant’s microbiota is limited at best. Thus, this review will explore the concept of HMOs and their metabolic fate, and summarise previous in vitro and in vivo clinical data regarding HMOs, with specific regard to 2’FL and LNnT.
Up to one in four young children have been estimated to be exposed to parental mental illness. Although the majority of affected parents will not harm their children, is is now well established that parental mental illness places children at an increased risk of all types of injury. Both maternal and paternal mental illness are implicated. Children of parents with mental illness are at the greatest excess risk of being injured in their first year of life, and this applies particularly to violence related harm. Within the first year, the risk is highest during the first three months after birth. A number of parental and family background factors have been identified in the UK triannual serious case reviews of abuse related harm to children and in other publications that can increase or decrease the risk. These findings have significant implications for clinical practice. In order to mitigate the risks to young children, an early assessment of a parent with a mental illlness, close collaboration between mental health, social care and other involved professionals, and a comprehensive care package which aims to improve parental mental health health, reduce other risk factors and exploit parental strengths and protective social factors, are essential. Mental health professionals have an important role to play in achieving improved outcomes for children at risk and their families.
A large body of research has contributed to a complex picture in which bilingualism is generally associated with better performance on some cognitive tasks, particularly those that are based on executive functioning, but poorer performance on measures of verbal proficiency. However, not all studies find these effects, particularly the positive effects on cognitive function. What is now clear is that the potential impact of bilingualism on children’s cognition must be explained through multifaceted examinations of relevant factors and clarification of the specific language context from which the results emerged on an individual basis. We review the evidence for cognitive performance of children in multilingual environments and evaluate those results in terms of the type of cognitive ability being assessed and the type of environment children are experiencing. We also review how early the effects of multilingualism are detected, how long these effects last, and how childhood multilingualism can lead to brain plasticity. We conclude with a brief discussion of how multilingualism impacts other areas of cognitive functioning, such as theory of mind, creativity, and problem solving.
Infants become increasingly exposed to sweet-tasting foods in their first year of life. However, it is still unclear whether repeated exposure to sweet taste is linked to infants’ sweetness liking during this period. Making use of data from the OPALINE cohort, this study aimed to examine the link between sweetness exposure and sweetness liking during two important periods in early infant feeding: at the start of complementary feeding (3–6 months) and the transition to the family table (10–12 months). Infants’ sweetness exposure was assessed using 7-d food records which were completed by mothers every month (n 312), reporting daily consumption rates of formula/breast milk or complementary food and the type of formula milk and/or complementary foods for each feeding occasion. Infants’ sweetness liking was studied in the laboratory at 3, 6 and 12 months of age by assessing their response to a lactose–water solution and the amount drunk of this solution compared with plain water. Linear regressions and structural equation model assessed associations between exposure to and liking for sweetness at 6 and 12 months. Neither at 6 (n 182) nor at 12 months (n 197) was sweetness exposure associated with sweetness liking. While sweetness liking at 3 months was unrelated to liking at 6 months, the latter predicted sweetness liking at 12 months. These findings demonstrate no association between sweetness exposure at 3 to 12 months and liking at 6 and 12 months despite a sharp increase in sweetness exposure in that period. However, sweetness liking at 6 and 12 months was positively associated.