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Objective The aim of this study was to assess early language acquisitions in treated individuals with spinal muscular atrophy (SMA) type 1 and in infants identified by newborn screening (NBS). Methods Parents of SMA individuals aged between 8 and 36 months were asked to fill in the MacArthur-Bates Communicative Development Inventory (MB-CDI) that assesses comprehension, gesture and expressive skills. A follow-up assessment was performed in 21 of the 36. Results The MB-CDI was completed by parents of 24 type 1 and 12 infants identified by NBS. Comprehension skills were preserved in 81% of the type 1 SMA and in 87% infants identified by NBS. Gesture abilities were <5th centile in 55% of the type 1 SMA and in none of those identified by NBS. Lexical expressions were <5th centile in more than 80% type 1 SMA and in 50% of infants identified by NBS. At follow-up, despite an increase in lexical expression skills, the scores remained below the fifth centile in 43% type 1 SMA and in 86% of infants identified by NBS. Conclusions These results suggest that language and communication development may follow a similar pattern to that observed in motor function with the possibility to develop skills (eg, ability to say clear words) that are not usually present in untreated infants but with a level of performance that does not reach that of their typically developing peers.

Individual differences in social looking are commonly believed to reflect one single heritable dimension tightly linked to autism. Yet, recent data suggest that in human infants, looking to eyes (rather than mouth) and preference for faces (versus non-social objects) reflect distinct genetic influences, and neither appear to have a clear-cut relation to autism.

Introduction: Complementary feeding represents a crucial phase in an infant's developmental journey. Inadequate implementation, marked by an imbalance in both quantity and quality, can lead to varying degrees of nutritional disorders, whether from excess or deficiency. Study Objectives and Methods: Conducted from December 2023 to February 2024, this research aims to assess the weaning age and the age of initiating dietary diversification among Moroccan infants. Additionally, it seeks to scrutinize specific nutritional practices and behaviors within the Moroccan infant population. Our methodology involved an extensive bibliographic search using databases such as PubMed, Science Direct, Scopus, and Google Scholar, focusing on research conducted in Morocco from 2005 to 2020. Variables examined include the prevalence of breastfeeding at six months, the age of weaning, the commencement of dietary diversification at six months, and the prevalence of advice from healthcare professionals, particularly nursing experts, provided to Moroccan mothers. Results and Discussion: Complementary feeding practices in Morocco navigate the intersection of maternal nutritional beliefs and a plethora of infant feeding concepts, resulting in a complex landscape. The crucial role of medical and nursing personnel in conveying appropriate information and advice to Moroccan mothers is highlighted. Conclusion: Complementary feeding is a pivotal milestone in infant nutrition, necessitating adjustments and updates in Moroccan practices. The active involvement of medical and nursing personnel is essential to ensure optimal weight development and prevent infant nutritional disorders. Impact and Contribution of Patient or Public: Emphasizing the importance of the results in positively influencing infant feeding practices in Morocco, with a focus on the crucial role played by medical and nursing personnel in promoting infant health.

Negatively biased cognitive response to infant stimuli during pregnancy is associated with increased postpartum depression (PPD) risk. This proof-of-concept study aimed to investigate the feasibility and effects of a two-week affective cognitive training intervention on cognitive responses to emotional infant stimuli for pregnant participants at risk of PPD. Forty-three participants were included: 23 ​at high risk and 22 ​at low risk of PPD. Cognitive response to emotional infant stimuli was assessed at baseline, immediately after the intervention and at a two-week follow-up for the intervention group (n ​= ​16) and twice over two weeks for the comparison group. The intervention was feasible, as 80% completed all sessions and gave positive feedback. The intervention group showed increased sensitivity to happy infant faces (p-values < 0.02, d ​> ​0.1), more infant-directed facial expressions (p ​< ​0.001, d ​= ​0.6), greater attention toward infant stimuli (p ​= ​0.04, d ​= ​0.2), and reduced negative reactivity to infant distress (p ​= ​0.01, d ​= ​2.6). The increased sensitivity to happy infant faces correlated with fewer depressive symptoms six months after birth (r = −0.59, p = 0.03). Interpretation of the results is limited by the lack of a high-risk control group and small sample size. Randomised controlled trials are now warranted to investigate whether the effects of prenatal affective cognitive training on affective cognitive response to infant stimuli confer reduced risk of PPD.

According to the neo-functional developmental theory, newborns and infants exhibit complex psycho-bodily functioning. The Basic Experiences of the Self (BEsS) refer to how they fulfil their essential life needs by organising their psycho-bodily functions in a typical configuration. As part of our research study, we developed a prototype psychometric tool called the BEsS Assessment Form (BAF) to assess the BEsS in infants aged zero to three years. We collected video recordings of their spontaneous behaviour and used the BAF to evaluate function polarity. In the BAF, thirty pairs of words represent functions in their dyadic polarity. To estimate the level of function polarity, we used the Osgood semantic differential scale, which ranges from seven to one. The study’s results confirm that functions can be assessed by grading along the opposite polarity spectrum. Moreover, in accordance with the theory, the functions can be grouped into four domains: the emotional, postural motor, physiological, and cognitive-symbolic planes. Our findings suggest that the characteristics of BEsS are significantly influenced by the activation of the physiological and postural motor functions, which are related to the early regulation of the autonomic nervous system and can be used to evaluate infant arousal.

Introduction: Much of our understanding of infant psychological development relies on an in-person, laboratory-based assessment. This limits research generalizability, scalability, and equity in access. One solution is the development of new, remotely deployed assessment tools that do not require real-time experimenter supervision. Methods: The current nationwide (Sweden) infant twin study assessed participants remotely via their caregiver's tablets (N = 104, ages 3 to 17 months). To anchor our findings in previous research, we used a gaze-following task where experimental and age effects are well established. Results: Closely mimicking results from conventional eye tracking, we found that a full head movement elicited more gaze following than isolated eye movements. Furthermore, predictably, we found that older infants followed gaze more frequently than younger infants. Finally, while we found no indication of genetic contributions to gaze-following accuracy, the latency to disengage from the gaze cue and orient toward a target was significantly more similar in monozygotic twins than in dizygotic twins, an indicative of heritability. Discussion: Together, these results highlight the potential of remote assessment of infants' psychological development, which can improve generalizability, inclusion, and scalability in developmental research.

The use of the term Social Attention (SA) in the cognitive neuroscience and developmental psychopathology literature has increased exponentially in recent years, in part motivated by the aim to understand the early development of autism spectrum disorder (ASD). Unfortunately, theoretical discussions around the term have lagged behind its various uses. Here, we evaluate SA through a review of key candidate SA phenotypes emerging early in life, from newborn gaze cueing and preference for face-like configurations to later emerging skills such as joint attention. We argue that most of the considered SA phenotypes are unlikely to represent unique socio-attentional processes but have to be understood in the broader context of bottom-up and emerging top-down (domain-general) attention. Some types of SA behaviors (e.g., initiation of joint attention) are linked to the early development of ASD, but this may reflect differences in social motivation rather than attention per se. Several SA candidates are not linked to ASD early in life, including the ones that may represent uniquely socio-attentional processes (e.g., orienting to faces, predicting others’ manual action goals). Although SA may be a useful super-ordinate category under which one can organize certain research questions, the widespread use of the term without proper definition is problematic. Characterizing gaze patterns and visual attention in infants at elevated likelihood for ASD in social contexts may facilitate early detection, but conceptual clarity regarding the underlying processes at play are needed to sharpen research questions and identify potential targets for early intervention., The work leading to these results was supported by Riksbankens Jubileumsfond (Grant No. P18-0743:1 [to ET]), Knut and Alice Wallenberg Foundation (to TFY), and Innovative Medicines Initiative 2 Joint Undertaking (Grant No. 777394 [to TFY]). This Joint Undertaking receives support from the European Union’s Horizon 2020 research and innovation program and EFPIA and AUTISM SPEAKS, Autistica, SFARI.

BACKGROUND: Care of young children with neurodevelopmental disorders (NDD) is a major component of paediatric outpatient practice. However, cross-country practice reviews to date have been limited, and available data demonstrate missed opportunities for early identification, particularly in vulnerable population subgroups. METHODS: Multicountry review of national paediatric body guidance related to developmental surveillance, early identification and early childhood intervention together with review of outpatient paediatrician practices for developmental assessment of children aged 0-5 years with/at risk of NDDs. Review included five countries with comparable nationalised universal child healthcare systems (ie, Australia, Canada, New Zealand, Sweden and the UK). Data were collected using a combination of published and grey literature review, supplemented by additional local sources with descriptive review of relevant data points. RESULTS: Countries had broadly similar systems for early identification of young children with NDDs alongside universal child health surveillance. However, variation existed in national paediatric guidance, paediatric developmental training and practice, including variable roles of paediatricians in developmental surveillance at primary care level. Data on coverage of developmental surveillance, content and quality of paediatric development assessment practices were notably lacking. CONCLUSION: Paediatricians play an important role in ensuring equitable access to early identification and intervention for young children with/at risk of NDDs. However, strengthening paediatric outpatient care of children with NDD requires clearer guidance across contexts; training that is responsive to shifting roles within interdisciplinary models of developmental assessment and improved data to enhance equity and quality of developmental assessment for children with/at risk of NDDs.

We aim to investigate early developmental trajectories of the autonomic nervous system (ANS) as indexed by the pupillary light reflex (PLR) in infants with (i.e. preterm birth, feeding difficulties, or siblings of children with autism spectrum disorder) and without (controls) increased likelihood for atypical ANS development. We used eye-tracking to capture the PLR in 216 infants in a longitudinal follow-up study spanning 5 to 24 months of age, and linear mixed models to investigate effects of age and group on three PLR parameters: baseline pupil diameter, latency to constriction and relative constriction amplitude. An increase with age was found in baseline pupil diameter (F(3,273.21) = 13.15, p < 0.001, eta(2)(p) = 0.13), latency to constriction (F(3,326.41) =3.84, p = 0.010,eta(2)(p) = 0.03) and relative constriction amplitude(F(3,282.53) =3.70, p = 0.012,eta(2)(p)= 0.04). Group differences were found for baseline pupil diameter (F(3,235.91) = 9.40, p < 0.001,eta(2)(p) = 0.11), with larger diameter in preterms and siblings than in controls, and for latency to constriction (F(3,237.10) = 3.48, p = 0.017, eta(2)(p) = 0.04), with preterms having a longer latency than controls. The results align with previous evidence, with development over time that could be explained by ANS maturation. To better understand the cause of the group differences, further research in a larger sample is necessary, combining pupillometry with other measures to further validate its value.

Human milk contains all of the essential nutrients required by the infant within a complex matrix that enhances the bioavailability of many of those nutrients. In addition, human milk is a source of bioactive components, living cells and microbes that facilitate the transition to life outside the womb. Our ability to fully appreciate the importance of this matrix relies on the recognition of short- and long-term health benefits and, as highlighted in previous sections of this supplement, its ecology (i.e., interactions among the lactating parent and breastfed infant as well as within the context of the human milk matrix itself). Designing and interpreting studies to address this complexity depends on the availability of new tools and technologies that account for such complexity. Past efforts have often compared human milk to infant formula, which has provided some insight into the bioactivity of human milk, as a whole, or of individual milk components supplemented with formula. However, this experimental approach cannot capture the contributions of the individual components to the human milk ecology, the interaction between these components within the human milk matrix, or the significance of the matrix itself to enhance human milk bioactivity on outcomes of interest. This paper presents approaches to explore human milk as a biological system and the functional implications of that system and its components. Specifically, we discuss study design and data collection considerations and how emerging analytical technologies, bioinformatics, and systems biology approaches could be applied to advance our understanding of this critical aspect of human biology.

BackgroundMaternal obesity has been associated with a higher risk of pregnancy-related complications in mothers and offspring; however, effective interventions have not yet been developed. We tested two interventions, calorie restriction and pravastatin administration, during pregnancy in a rhesus macaque model with the hypothesis that these interventions would normalize metabolic dysregulation in pregnant mothers leading to an improvement in infant metabolic and cognitive/social development.MethodsA total of 19 obese mothers were assigned to either one of the two intervention groups (n = 5 for calorie restriction; n = 7 for pravastatin) or an obese control group (n = 7) with no intervention, and maternal gestational samples and postnatal infant samples were compared with lean control mothers (n = 6) using metabolomics methods.ResultsGestational calorie restriction normalized one-carbon metabolism dysregulation in obese mothers, but altered energy metabolism in her offspring. Although administration of pravastatin during pregnancy tended to normalize blood cholesterol in the mothers, it potentially impacted the gut microbiome and kidney function of their offspring. In the offspring, both calorie restriction and pravastatin administration during pregnancy tended to normalize the activity of AMPK in the brain at 6 months, and while results of the Visual Paired-Comparison test, which measures infant recognition memory, was not significantly impacted by either of the interventions, gestational pravastatin administration, but not calorie restriction, tended to normalize anxiety assessed by the Human Intruder test.ConclusionsAlthough the two interventions tested in a non-human primate model led to some improvements in metabolism and/or infant brain development, negative impacts were also found in both mothers and infants. Our study emphasizes the importance of assessing gestational interventions for maternal obesity on both maternal and offspring long-term outcomes.

Background: Phthalates are endocrine disrupters used in a variety of consumer products. Human studies suggest an association between phthalate exposure and cognitive development but adverse effects of the recently introduced phthalate substitutes have only been sparsely studied.Objectives: To investigate associations between prenatal and concurrent exposure to phthalates and IQ in 7-year-old children from the Odense Child Cohort.Methods: Pregnant women from the Odense Child Cohort had phthalate metabolites measured in urine samples during 3rd trimester in 2010 to 2012. In addition, phthalates were also measured in urine samples from their offspring at age 7 years. IQ was assessed at age 7 years using four subtests from Wechsler Intelligence Scale for Children. The total study population consisted of 585 mother-child pairs with available prenatal urinary phthalate metabolites concentrations and IQ data at age 7 years. A subset of those (N = 274) had urinary phthalate metabolites measured in child urine at age 7 years. Phthalate concentrations were grouped into tertiles and associations with IQ were investigated using multiple linear regression adjusting for sex, maternal education and maternal/child BMI.Results: Urinary phthalate metabolite concentrations both in pregnant women and children were generally lower compared to previous cohorts. Children with high prenatal urinary concentrations of MEP and metabolites of DEHP (EDEHPm)(3rd tertile) had-3.1 (95% CI:-5.5,-0.6) (MEP) and -3.0 (-5.5,-0.6) (EDEHPm) IQ points at age 7 years compared to children with low concentrations (1st tertile). High concurrent urinary phthalate concentrations of MCPP, EDnHxPm, EDiDPm and EDiNPm in the 3rd tertile was associated with-3.7 (-7.2,-0.2),-4.4 (-7.9,-0.9),-3.7 (-7.2,-0.2) and -5.6 (-9.1,-2.2) IQ points, respectively, compared to those with the lowest concentrations (1st tertile).Conclusion: We found significant inverse associations between some prenatal and concurrent urinary p

Substantial empirical evidence exists regarding the benefits of infant-directed speech (IDS), also known as “motherese,” for developing infants and children. Recent studies indicate that IDS facilitates the development of joint attention and emotional recognition in infants and young children. And, recent studies in robotic technologies have suggested robotic paradigms as a possible efficacious tool for facilitating and enhancing social interaction skills in very young children. There is currently scant evidence about the potential benefits of utilizing robots containing a similar speech register to IDS. The current study utilized eye-tracking paradigms to measure and examine infants and toddlers’ social gaze preferences for human agents performing “motherese” versus robot agents performing in a similar speech register to IDS, thus designated “robotese.” The results indicated that infants and toddlers display similar gaze allocation patterns towards “robotese” and “motherese” stimuli, were able to identify and allocate attention towards both agents as social interaction partners, and were capable of following triadic engagement processes present within a display of human-robot interaction. Implications of gaze allocation and preference in both typical and atypical populations of young children are discussed.

Early life represents a period of profound immunological development and heightened susceptibility to infectious disease. The developmental trajectory over this period is influenced by a number of factors, including gestational age, mode of delivery, mode of feeding, microbiome development, and environmental exposures. There are also several maternal factors that have been shown to have a negative effect on both immune development and clinical outcomes, including maternal infection and inflammation. Studies have associated maternal HIV infections with an increase in infectious morbidity and mortality and decreased growth measures among their HIV-exposed uninfected (HEU) offspring. Among HEU infants, socioeconomic factors, maternal nutrition, maternal viral load, and maternal inflammation have also all been associated with impaired infant immune status and clinical outcomes. However, the mechanisms underlying these observations have not been elucidated and, apart from measures of disease severity, few studies thus far have undertaken in-depth assessments of maternal health status or immune function during gestation and how these influence developmental outcomes in their infants. The lack of a mechanistic understanding of how these gestational influences affect infant outcomes inhibits the ability to design and implement effective interventions. This review describes the current state of research into these mechanisms and highlights areas for future study include; how HIV infection causes the inflammatory trajectory to deviate from normal gestation, the mechanism(s) by which in utero exposure to maternal inflammation influences infant immune development and clinical outcomes, the role of socioeconomic factors as an inducer of maternal stress and inflammation, and maternal nutrition during gestation., SCOPUS: sh.j, info:eu-repo/semantics/published

OBJECTIVE: In 2010, the Dutch practice regarding initiation of active treatment in extremely preterm infants was lowered from 25 completed weeks' to 24 completed weeks' gestation. The nationwide Extremely Preterm Infants - Dutch Analysis on Follow-up Study was set up to provide up-to-date data on neurodevelopmental outcome at 2 years' corrected age (CA) after this guideline change. Design: National cohort study. PATIENTS: All live born infants between 24 0/7 weeks' and 26 6/7 weeks' gestational age who were 2 years' CA in 2018-2020. MAIN OUTCOME MEASURE: Impairment at 2 years' CA, based on cognitive score (Bayley-III-NL), neurological examination and neurosensory function.RESULTS: 651 of 991 live born infants (66%) survived to 2 years' CA, with data available for 554 (85%). Overall, 62% had no impairment, 29% mild impairment and 9% moderate-to-severe impairment (further defined as neurodevelopmental impairment, NDI). The percentage of survivors with NDI was comparable for infants born at 24 weeks', 25 weeks' and 26 weeks' gestation. After multivariable analysis, severe brain injury and low maternal education were associated with higher odds on NDI. NDI-free survival was 48%, 67% and 75% in neonatal intensive care unit (NICU)-admitted infants at 24, 25 and 26 weeks' gestation, respectively.CONCLUSIONS: Lowering the threshold has not been accompanied by a large increase in moderate-to-severely impaired infants. Among live-born and NICU-admitted infants, an increase in NDI-free survival was observed from 24 weeks' to 26 weeks' gestation. This description of a national cohort with high follow-up rates gives an accurate description of the range of outcomes that may occur after extremely preterm birth.

BackgroundEarly puberty increases risk of adverse health conditions throughout the life course. US girls are experiencing earlier puberty without clear reasons. Studies suggest early life factors, such as infant growth, may influence pubertal timing. We assessed the associations between infant growth and onset of breast development (thelarche), pubic hair development (pubarche), and menarche in girls.MethodsA prospective cohort of girls born at a Kaiser Permanente Northern California medical facility in 2005-11 was used. Weight-for-age z-scores were calculated at birth and 24 months. Difference in z-scores greater than 0.67 represent rapid "catch-up" growth, less than -0.67 represent delayed "catch-down" growth, and between -0.67 and 0.67 represent "normal" growth. Pubertal onset was measured using clinician-assessed sexual maturity ratings (SMRs) and defined as the age at transition from SMR 1 to SMR 2 + for both thelarche and pubarche. SMR data was collected through June 2020. Menarche was analyzed as a secondary outcome. Weibull and modified Poisson regression models were used. Models were adjusted for potential confounders.ResultsThere were 15,196 girls included in the study. Approximately 30.2% experienced catch-up growth, 25.8% experienced catch-down growth, and 44% had normal growth. Girls with catch-up growth had increased risk of earlier thelarche (hazard ratio = 1.26, 95% confidence interval (CI): 1.18, 1.35), pubarche (1.38, 95% CI: 1.28, 1.48), and menarche (< 12y, relative risk = 1.52, 95% CI: 1.36, 1.69) compared to those with normal growth, after adjusting for covariates. These associations were partially mediated by childhood body mass index. Catch-down growth was associated with later pubertal onset.ConclusionsGirls who experience infant catch-up growth have higher risk of earlier pubertal development compared to girls with normal growth and the associations are partially explained by childhood obesity. This information may help clinicians t

Maternal gestational obesity is associated with elevated risks for neurodevelopmental disorder, including autism spectrum disorder. However, the mechanisms by which maternal adiposity influences fetal developmental programming remain to be elucidated. We aimed to understand the impact of maternal obesity on the metabolism of both pregnant mothers and their offspring, as well as on metabolic, brain, and behavioral development of offspring by utilizing metabolomics, protein, and behavioral assays in a non-human primate model. We found that maternal obesity was associated with elevated inflammation and significant alterations in metabolites of energy metabolism and one-carbon metabolism in maternal plasma and urine, as well as in the placenta. Infants that were born to obese mothers were significantly larger at birth compared to those that were born to lean mothers. Additionally, they exhibited significantly reduced novelty preference and significant alterations in their emotional response to stress situations. These changes coincided with differences in the phosphorylation of enzymes in the brain mTOR signaling pathway between infants that were born to obese and lean mothers and correlated with the concentration of maternal plasma betaine during pregnancy. In summary, gestational obesity significantly impacted the infant systemic and brain metabolome and adaptive behaviors.

Little is known about the development of higher-level areas of visual cortex during infancy, and even less is known about how the development of visually guided behavior is related to the different levels of the cortical processing hierarchy. As a first step toward filling these gaps, we used representational similarity analysis (RSA) to assess links between gaze patterns and a neural network model that captures key properties of the ventral visual processing stream. We recorded the eye movements of 4- to 12-month-old infants (N = 54) as they viewed photographs of scenes. For each infant, we calculated the similarity of the gaze patterns for each pair of photographs. We also analyzed the images using a convolutional neural network model in which the successive layers correspond approximately to the sequence of areas along the ventral stream. For each layer of the network, we calculated the similarity of the activation patterns for each pair of photographs, which was then compared with the infant gaze data. We found that the network layers corresponding to lower-level areas of visual cortex accounted for gaze patterns better in younger infants than in older infants, whereas the network layers corresponding to higher-level areas of visual cortex accounted for gaze patterns better in older infants than in younger infants. Thus, between 4 and 12 months, gaze becomes increasingly controlled by more abstract, higher-level representations. These results also demonstrate the feasibility of using RSA to link infant gaze behavior to neural network models. A video abstract of this article can be viewed at https://youtu.be/K5mF2Rw98Is.

Mental health problems are highly prevalent in childhood and adolescence and may be associated with nutritional intake. It has recently been shown that a high percentage of infants and children consume large amounts of free sugars. In this paper, we analyse the relationship between free sugar consumption at 12 and 30 months and the risk of developing psychological problems at 30 months in a community sample of 86 children evaluated longitudinally. Socio-family and anthropometric data, and the amount of free sugars consumed were collected at both ages. At 30 months, the Child Behavior Checklist 1.5-5 was administered to parents and an interview was conducted to identify psychological disorders in accordance with DC: 0-3's classification. We report a relationship between high free sugar consumption at 30 months and the concurrent presence of sleeping problems, ADHD and anxiety symptoms. However, no significant association was observed between free sugar consumption at 12 months and the subsequent development of psychological problems. Early detection of emotional and behavioural manifestations and high sugar consumption in children may help to prevent the persistence of psychological problems.

The COVID-19 pandemic has forced developmental researchers to rethink their traditional research practices. The growing need to study infant development at a distance has shifted our research paradigm to online and digital monitoring of infants and families, using electronic devices, such as smartphones. In this practical guide, we introduce the Experience Sampling Method (ESM) – a research method to collect data, in the moment, on multiple occasions over time – for examining infant development at a distance. ESM is highly suited for assessing dynamic processes of infant development and family dynamics, such as parent-infant interactions and parenting practices. It can also be used to track highly fluctuating family dynamics (e.g., infant and parental mood or behavior) and routines (e.g., activity levels and feeding practices). The aim of the current paper was to provide an overview by explaining what ESM is and for what types of research ESM is best suited. Next, we provide a brief step-by-step guide on how to start and run an ESM study, including preregistration, development of a questionnaire, using wearables and other hardware, planning and design considerations, and examples of possible analysis techniques. Finally, we discuss common pitfalls of ESM research and how to avoid them.

Background: Birth by caesarean section (CS) is associated with aberrant gut microbiome development and greater disease susceptibility later in life. We investigated whether oral administration of maternal vaginal microbiota to infants born by CS could restore their gut microbiome development in a pilot single-blinded, randomised placebo-controlled trial (Australian New Zealand Clinical Trials Registry, ACTRN12618000339257). Methods: Pregnant women scheduled for a CS underwent comprehensive antenatal pathogen screening. At birth, healthy neonates were randomised to receive a 3 ml solution of either maternal vaginal microbes (CSseeded, n = 12) or sterile water (CS-placebo, n = 13). Vaginally-born neonates were used as the reference control (VB, n = 22). Clinical assessments occurred within the first 2 h of birth, and at 1 month and 3 months of age. Infant stool samples and maternal vaginal extracts from CS women underwent shotgun metagenomic sequencing. The primary outcome was gut microbiome composition at 1 month of age. Secondary outcomes included maternal strain engraftment, functional potential of the gut microbiome, anthropometry, body composition, and adverse events. Findings: Despite the presence of viable microbial cells within transplant solutions, there were no observed differences in gut microbiome composition or functional potential between CS-seeded and CS-placebo infants at 1 month or 3 months of age. Both CS groups displayed the characteristic signature of low Bacteroides abundance, which contributed to a number of biosynthesis pathways being underrepresented when compared with VB microbiomes. Maternal vaginal strain engraftment was rare. Vaginal seeding had no observed effects on anthropometry or body composition. There were no serious adverse events associated with treatment. Interpretation: Our pilot findings question the value of vaginal seeding given that oral administration of maternal vaginal microbiota did not alter early gut microbiome developm

Perturbations to the gut microbiome are implicated in altered neurodevelopmental trajectories that may shape life span risk for emotion dysregulation and affective disorders. However, the sensitive periods during which the microbiome may influence neurodevelopment remain understudied. We investigated relationships between gut microbiome composition across infancy and temperament at 12 months of age. In 67 infants, we examined if gut microbiome composition assessed at 1-3 weeks, 2, 6, and 12 months of age was associated with temperament at age 12 months. Stool samples were sequenced using the 16S Illumina MiSeq platform. Temperament was assessed using the Infant Behavior Questionnaire-Revised (IBQ-R). Beta diversity at age 1-3 weeks was associated with surgency/extraversion at age 12 months. Bifidobacterium and Lachnospiraceae abundance at 1-3 weeks of age was positively associated with surgency/extraversion at age 12 months. Klebsiella abundance at 1-3 weeks was negatively associated with surgency/extraversion at 12 months. Concurrent composition was associated with negative affectivity at 12 months, including a positive association with Ruminococcus-1 and a negative association with Lactobacillus. Our findings support a relationship between gut microbiome composition and infant temperament. While exploratory due to the small sample size, these results point to early and late infancy as sensitive periods during which the gut microbiome may exert effects on neurodevelopment.

Relationships support social animals' health, but maintaining relationships is challenging. When transitioning to parenthood, new parents balance pair-bond maintenance with infant care. We studied pair-bond maintenance via affiliation in 22 adult titi monkey pairs (Plecturocebus cupreus) for 16 months centered around their first offspring's birth. Pair affiliation peaked during pregnancy, decreased across the postpartum period, and rose after reaching minimum affiliation 32.6 weeks postpartum. Pairs in which fathers carry infants more than average had lower affiliation at the infant's birth and return to an increase in affiliation sooner. Parents of infants who were slow to independence had higher rates of affiliation. Titi monkey infants actively prefer their fathers; mothers may avoid their infant-carrying mate, suggesting infants play an active role in parental affiliative decline. Our data supports previous findings that affiliation between partners declines following an infant's birth, but demonstrates new knowledge about the extent and duration of affiliative decline.

Background: Indonesia comes in the fifth for the greatest number of preterm births. Preterm infants may inflict various complication as the result of underdeveloped immunity, affecting their growth and development in the long run until they reach adult phase. Such complications could be prevented through adequate nutrition fulfillment. Purpose: This article aimed to elaborate the characteristics of growth and development of premature babies, long term effect on the development and the impact of immunity and gut health of preterm infants in supporting their growth and development. Methods: References cited in this article were obtained from the latest primary literature within the last 10 years. Discussion: The rate and ability of infants to perform catch-up growth depends on the birth weight and gestation age, at which the lower birth weight and lower gestational age had slower rate. Brain structures that of preterm infants differ compared to the term, and these changes give rise to various clinical outcomes, including long term emotional, behavioral changes, cognitive and executive functioning. Immature immune system in preterm infants reduces the protective ability by innate and adaptive immunity in overcoming pathogens compared to term infants, including gut microbiota prematurity which affects nutrition absorption and growth and development catch up ability. Appropriate and adequate nutrition supplementation has shown beneficial effects in promoting the growth of normal gut flora, which allow better absorption of nutrition and therefore enhancing growth rate and supporting the development of preterm infants. Conclusions: Optimal growth and development of preterm infants are supported by sufficient nutrition supplementation to support the growth of gut microbiota, facilitating the catch-up growth and development of premature infants and immune system maturity.

Research beginning with Piaget reveals a change in infants’understanding of multistep, means-end action sequences:Whereas 12-month-old infants reason that (e.g.) one opens abox to access its contents, younger infants are more likely toreason that one’s goal is simply to open the box. Here weexplore the implications of this developmental change ininfants’ action understanding for infants’ social evaluations.Using a puppet show paradigm, we examined infants’evaluations of two agents who helped another agent to achieveeither the end or the means of a means-end sequence, bothbefore and after 12 months of age. In a subsequent preferencetest, 15-month-old infants reached for an End-Helper over aMeans-Helper, whereas 8-month-old infants did the reverse.These findings link infants’ evaluation of helpers to theirrepresentations of action plans, consistent with recentcomputational models of naïve psychology.

Many mammalian species display sex differences in the frequency of play behavior, particularly in the domain of social play. Yet the animal literature largely lacks longitudinal studies on developmental patterns of play over the lifespan, which are important for understanding the timing of sex differences and the evolutionary functions of this ubiquitous behavior. I analyzed sex-specific patterning of social play, solitary play, and grooming using an 18-year dataset on a cohort of 38 wild white-faced capuchin monkeys (Cebus capucinus) followed since infancy. Rates of each behavior were measured as the proportion of point samples taken during focal follows in which the individual was engaging in social play, solitary play, or grooming. To determine sex differences in the rates of these behaviors, I ran three Poisson generalized linear mixed models with a random effect for each individual. Results for social play and solitary play showed significant fixed effects for age, such that rates of both types of play decreased with age. Results for social play showed significant fixed effects for sex and the interaction between sex and age, such that males had higher overall rates of social play than females and had a slower decline in the rate of social play with age compared to females. Solitary play did not show a significant fixed effect for sex; however, rates of solitary play decreased more quickly over time for females than for males. Females had significantly higher overall rates of grooming than males, and the interaction between sex and age was significant such that rates of grooming increased more quickly over time for females than males; in fact, the proportion of time spent grooming increased over the lifespan for females but decreased over the lifespan for males. My results suggest that males allocate more time overall toward social play than females, particularly throughout the juvenile period, but that females may compensate for lower bonding opportunities in

Introduction: Human milk is the normative standard for infant/toddler nutrition. To better understand human milk's imprinting on health, and inform complex decisions about maternal medication, substance use, and other exposures during lactation, researchers at University of California San Diego (UC San Diego) established Mommy's Milk, a Human Milk Research Biorepository (HMB). Materials and Methods: The HMB was founded in 2014 with the goal of building a constant but rotating inventory of 3,000 human milk samples available for future research. Following informed consent, women in the United States or Canada provide 50 mL up to a full pump of expressed breast milk. Participants are also interviewed about their sociodemographic characteristics, pregnancy history, dietary intake, maternal stress, anxiety and depression, breastfeeding behaviors, and signs and symptoms of potential adverse reactions in the offspring. Data on growth of the infant/toddler are captured from medical records, and neurodevelopmental assessments are conducted longitudinally. Sample collections occur at UC San Diego, community sites, or the woman's home, and are aliquoted and stored at -80°C. Results: To date, 1,362 unique women have contributed to the HMB. The majority of mothers were between the ages of 31-35, and identified as White. The range of ages of breastfed offspring was well-represented through 23 months. Conclusions: The HMB is a well-characterized, accessible research resource that can contribute to better understanding of the characteristics of human milk, and potential effects of maternal medications, substances, and other environmental agents on the health and development of the breastfed infant/toddler.

Objective: To know the different occupational therapist duties in neonatal intensive care units in the evaluation and treatment of premature infants with birth weight under 1500g. Methods: A bibliographic review was carried out using 3 databases selecting only those studies answering the study question, that is, occupational therapy’s role in neonatal units throughout the last 15 years. Results: Sixteen studies were evaluated in which an occupational therapist was included as part of the intensive care unit, emphasizing their role as the health care professional in charge of implementing the techniques and processes which allow infants to continue their growth and neurological development. Conclusions: Further studies are necessary in order to prove the need of occupational therapy practitioners in neonatal units., Objetivos: conocer las diferentes funciones del o de la terapeuta ocupacional en las Unidades de Cuidados de Neonatología en la evaluación y tratamiento de prematuros menores de 1500g. Métodos: se realizó una revisión bibliográfica utilizando 3 bases de datos donde fueron seleccionados los artículos que daban respuesta a la pregunta de estudio para conocer el trabajo de la persona profesional terapeuta ocupacional en las unidades neonatales durante los últimos 15 años. Resultados: fueron evaluados un total de dieciseis estudios en los que se incluye al terapeuta ocupacional como profesional de las unidades UCI, donde se resalta que el es el que debe llevar a cabo técnicas y procesos, que permitan continuar con su crecimiento y desarrollo neurológico. Conclusiones: se concluye que, sería conveniente llevar a cabo más estudios para demostrar la necesidad de terapia ocupacional en unidades de neonatología.

La intervención familiar supone un factor clave en la intervención de niños con cualquier tipo de discapacidad, por ello con este estudio se pretende revisar la literatura científica realizando una búsqueda bibliográfica que recoja los trabajos realizados sobre la familia en Atención Temprana. Se realizó una búsqueda sistemática en las bases de datos de Psicodoc y PsycInfo de las publicaciones académicas realizadas en los últimos diez años (2010-2019) en España, con los siguientes descriptores: “Atención Temprana” y “Familia”. Como resultado del proceso realizado se obtuvieron un total de 26 artículos. Los resultados presentados en este estudio permiten extraer diversas lecturas de interés tanto del contenido como de la productividad. Gran parte de los artículos revisados han intentado proporcionar una puesta al día de conceptos sobre la Atención Temprana, responder a preguntas sobre aspectos etiológicos, diagnósticos o terapéuticos, e incluso presentar casos clínicos con propuestas de intervenciones. Otra gran parte de los artículos analizados han sido estudios empíricos de diferentes metodologías cuyas temáticas han sido muy variadas, destacando los dedicados a los estilos de interacción entre los profesionales y las familias, las necesidades de formación y el desarrollo profesional de los trabajadores, la influencia de la discapacidad de un hijo en la familia, y la relación entre las interacciones de los progenitores con los hijos y el desarrollo adecuado infantil. En relación a la productividad, llama la atención que en la última década sólo se hallan encontrado 26 artículos de trabajo con familia contextualizados dentro de la Atención Temprana en España. A pesar de la importancia del trabajo en familia resulta escasa la literatura que se centra en investigar sus prácticas.

The rate at which an infant develops both physically and cognitively is significant during sleep, as this is the time when the entire body can dedicate its efforts to this cause. Parents of healthy infants follow the guidelines set by the American Academy of Pediatrics (AAP) relating to safe sleep, and since their introduction in 1992, the rate of Sudden Infant Death Syndrome (SIDS) has decreased by 40% (Center for Disease Control and Prevention, 2016). However, if an infant has been hospitalized since birth due to necessary invasive procedures such as open-heart surgery, these protocols cannot be initially implemented. Common complications among post cardiac surgery infants include inability to regulate temperature (requiring coverings for comfort and safety), and reflux initiating some elevation to relieve this pain. However, a review of the literature indicates that in most cases, as the infant recovers, these conventions related to sleep can be tapered off and safe sleep guidelines instituted. Staff will often teach the value of following safe sleep guidelines to new parents, even though the practices their child has followed while hospitalized differ from the guidelines. However, when these babies are discharged home, parents are reporting that their children are having a great amount of difficulty falling and staying asleep despite the fact that they are following the protocol. This project expanded upon a 2018 patient quality care improvement study being conducted in the Cardiac Step-Down Unit at Boston Children’s Hospital. The purpose of this project was to utilize a survey created to gather information that identifies major factors related to why safe sleep protocol is not being instituted earlier. Further analysis and review of the literature was conducted to project the validity of these preventative factors. At Boston Children’s Hospital, the information collected from the survey is being used to develop an educational module for staff nurses, teaching t

My research engages with the varieties of relationship between verbal and non-verbal forms of language and communication. I approach the issue through three people who live or work with non-verbal people on the autistic spectrum: Phoebe Caldwell, Fernand Deligny and Iris Johansson. Their practices bring singular perspectives to my core question: How can we (re)conceive and engage with non-verbal forms of language and communication in our verbal being? There are diverse experiences of language and a multiplicity of registers through which it is voiced. In non-verbal communication voicing mainly manifests through non-vocal registers, such as body language, rhythm, vibration, gesture and spatial relationship – and ‘sonic utterances’ beyond exchange centred on words and speech. Voicings at the ends of the spectrum of coherent ‘normal’ speech tend to be ignored as senseless babble or not recognised as voicing at all. The practices I focus on have developed methods and ‘technologies’ to open (us) to a wider scope of listening and voicing, so that we can engage with non-verbal forms of language in and as communication. Fernand Deligny (France, 1913 - 1996) was an educationalist, writer and film-maker. Between 1967 and 1991 he elaborated an experimental living space with non-verbal autistic children, outside institutional and therapeutic frameworks. Phoebe Caldwell (UK) is a therapist and writer who specialises in non-verbal communication, working with non-verbal autistic people individually in contexts of state-run care. Iris Johansson (Sweden) is a therapist and writer, who is autistic. She was non-verbal until the age of twelve and lives in both non-verbal and verbal modes of being. All three practices describe non-verbal autism both in clinical terms as a developmental condition and as a mode of being - as an alternative, ‘other’ way of living. Caldwell, Deligny and Johansson emerge as ‘go-betweens’ between verbal and non-verbal being. My research – as recording situati

INTRODUCTION: Emergency caesarean section (ECS) qualifies as a psychological trauma, which may result in postnatal post-traumatic stress disorder (PTSD). Maternal PTSD may not only have a significant negative impact on mother-infant interactions, but also on long-term infant development. The partner's mental health may also affect infant development. Evidence-based early interventions to prevent the development of postpartum PTSD in mothers are lacking. Immediately after a traumatic event, memory formation is vulnerable to interference. There is accumulating evidence that a brief behavioural intervention including a visuospatial task may result in a reduction in intrusive memories of the trauma. METHODS AND ANALYSIS: This study protocol describes a double-blind multicentre randomised controlled phase III trial testing an early brief maternal intervention including the computer game 'Tetris' on intrusive memories of the ECS trauma (≤1 week) and PTSD symptoms (6 weeks, primary outcome) of 144 women following an ECS. The intervention group will carry out a brief behavioural procedure including playing Tetris. The attention-placebo control group will complete a brief written activity log. Both simple cognitive tasks will be completed within the first 6 hours following traumatic childbirth. The intervention is delivered by midwives/nurses in the maternity unit.The primary outcome will be differences in the presence and severity of maternal PTSD symptoms between the intervention and the attention-placebo control group at 6 weeks post partum. Secondary outcomes will be physiological stress and psychological vulnerability, mother-infant interaction and infant developmental outcomes. Other outcomes will be psychological vulnerability and physiological regulation of the partner and their bonding with the infant, as well as the number of intrusive memories of the event. ETHICS AND DISSEMINATION: Ethical approval was granted by the Human Research Ethics Committee of the Canton

Down syndrome (DS) is one of the most common genetic conditions that manifests in a physical, behavioral, mental, emotional, and neurocognitive manner (Bittles, Bower, Hussain, & Glasson, 2006; Bull & the Committee on Genetics, 2011). In terms of physical health, individuals with DS are at a higher risk for congenital heart defects, hypothyroidism, gastrointestinal issues, and sleep problems (Bittles et al., 2006; Carter, McCaughey, Annaz, & Hill, 2009). Of particular importance, is the 30% to 80% prevalence rate of obstructive sleep apnea syndrome (OSAS) in DS (Dyken et al., 2003; Shott et al., 2006). OSAS as well as other sleep disturbances have been linked to neurocognitive and developmental delays among individuals with DS (Breslin et al., 2014; Edgin et al., 2015). A limitation to previous work in DS is evaluating sleep and its impact on development from a family systems perspective. The family’s interconnectedness, cohesiveness, and self-stability characteristics may play a role in sleep and development for individuals with intellectual disability. The three studies presented in this dissertation examined the multiple ways in which sleep effects all members of the family in addition to infant development in a longitudinal sample of infants with and without DS from 6-months to 24-months of age. In Study 1, we investigated work schedules among parents of 18-month-old infants with DS and typically developing (TD) along with its impact on infant sleep quality and quantity. There were no significant differences in work schedules and total number of hours worked per week between parents in both groups. However, infants with DS displayed significantly less sleep time, greater fragmentation index, poorer sleep efficiency, and more time waking up after sleep onset (WASO). We found group differences in nights per week spent co-sleeping and parents’ perceptions regarding the importance of a consistent bedtime routine. When assessing employment schedules, regardless of gr

Human milk is uniquely optimized for the needs of the developing infant. Its composition is complex and dynamic, driven primarily by maternal genetics, and to a lesser extent by diet and environment. One important component that is gaining attention is the milk fat globule (MFG). The MFG is composed of a triglyceride-rich core surrounded by a tri-layer membrane, also known as the milk fat globule membrane (MFGM) that originates from mammary gland epithelia. The MFGM is enriched with glycerophospholipids, sphingolipids, cholesterol, and proteins, some of which are glycosylated, and are known to exert numerous biological roles. Mounting evidence suggests that the structure of the MFG and bioactive components of the MFGM may benefit the infant by aiding in the structural and functional maturation of the gut through the provision of essential nutrients and/or regulating various cellular events during infant growth and immune education. Further, antimicrobial peptides and surface carbohydrate moieties surrounding the MFG might have a pivotal role in shaping gut microbial populations, which in turn may promote protection against immune and inflammatory diseases early in life. This review seeks to: (1) understand the components of the MFG, as well as maternal factors including genetic and lifestyle factors that influence its characteristics; (2) examine the potential role of this milk component on the intestinal immune system; and (3) delineate the mechanistic roles of the MFG in infant intestinal maturation and establishment of the microbiota in the alimentary canal.

Very little is known about the effect of pet experience on cognitive development in infancy. In Experiment 1, we document in a large sample (N = 1270) that 63% of families with infants under 12 months have at least one household pet. The potential effect on development is significant as the first postnatal year is a critically important time for changes in the brain and cognition. Because research has revealed how experience shapes early development, it is likely that the presence of a companion dog or cat in the home influences infants' development. In Experiment 2, we assess differences between infants who do and do not have pets (N = 171) in one aspect of cognitive development: their processing of animal faces. We examined visual exploration of images of dog, cat, monkey, and sheep faces by 4-, 6-, and 10-month-old infants. Although at the youngest ages infants with and without pets exhibited the same patterns of visual inspection of these animals faces, by 10 months infants with pets spent proportionately more time looking at the region of faces that contained the eyes than did infants without pets. Thus, exposure to pets contributes to how infants look at and learn about animal faces.

The aim of this study was to determine the prevalence of risk for disorders of neurobehavioral development of lactating children living in the southeastern region of Mexico, through the use of the test of lactating children neurobehavioral development VANEDELA. The identified children were able to receive early stimulation or rehabilitation. A total of 118 infants aged 1 to 24 months were studied, with an average of 6.4 months, with a slight risk for alteration in 34%, high risk in 7% of infants and 59% normal development. In the assessment of developmental behaviors, the highest prevalence of involvement appeared in areas of fine motor systems (27.3%) and cognitive systems, language by 25% in all stages. 12% of 4-month-old infants presented absent developmental reactions and 6% of the sample had signs of alarm, which is why they were referred for assessment in the rehabilitation laboratory. The VANEDELA test was sufficiently precise to determine the risk of alterations in neurobehavioral development, being a screening test used in apparently healthy population and to suggest comprehensive programs of early attention or strengthen existing ones, El objetivo de este estudio fue determinar la prevalencia del riesgo para alteraciones del desarrollo de lactantes de una región del sureste de México, utilizando el instrumento de valoración neuroconductual del desarrollo del lactante VANEDELA. Los niños identificados fueron aptos para recibir estimulación temprana o rehabilitación. Se estudiaron 118 lactantes con edades de 1 a 24 meses, con un promedio de 6,4 meses, con riesgo leve para alteración en un 34%, riesgo alto en un 7% de los lactantes y el 59% desarrollo normal. En la valoración de conductas del desarrollo, la mayor prevalencia de afectación se presentó en áreas de los sistemas motor fino (27,3%) y cognoscitivo, lenguaje en un 25% en todas las etapas. El 12% de lactantes de 4 meses presentó reacciones del desarrollo ausentes y un 6% de la muestra tuvo signos de alarma, razón por la que fueron remitidos para valoración en el laboratorio de rehabilitación. La prueba VANEDELA fue suficientemente precisa para determinar el riesgo de alteraciones del desarrollo neuroconductual, siendo un test tamizaje utilizado en población aparentemente sana y para sugerir programas integrales de atención temprana o fortalecer los existentes.

During more than 40 years there has been a research interest on the bond between the institutionalized children and their caregivers. Hence, there are plenty of researches focusing on the attachment and other variables related with the institutionalization, as the possibility of presenting specific difficulties on various levels. Nevertheless there are not a many articles and researches about the relationship between both variables, attachment and difficulties. Therefore this research has as objective to study the role that the attachment has on the development of difficulties on institutionalized children. For that, 16 institutionalized children among 2 and 7 years of age were evaluated with three tools: A social- demographic questionnaire, the SDQ questionnaire, and the IMAS interview. The results showed negative correlations between the attachment security and the difficulties and also between age of arriving to the institution and the presence of severe problems, general difficulties and hyperactivity. However the variable of prosocial behavior showed a positive correlation with the age of arriving. Accordingly it was concluded that the attachment is essential to minimize the occurrence of difficulties and problems on minor institutionalized children., Desde hace más de 40 años las investigaciones se han interesado en conocer el vínculo entre el cuidador y el niño en las instituciones. Así, existen multitud de estudios centrados en la conducta de apego del menor y en otros aspectos relacionados con la institucionalización de menores como la posibilidad de presentar dificultades a distintos niveles. Sin embargo, son escasos los estudios que abordan la relación entre ambas variables, apego y dificultades. Por ello el presente estudio tiene por objetivo determinar el papel que tiene el apego en el desarrollo de dificultades en menores institucionalizados. Para ello han participado 16 menores institucionalizados entre 2 y 7 años, a los que se le ha aplicado una batería de evaluación compuesta por una ficha de datos sociodemográficos, el cuestionario SDQ y la entrevista IMAS. Los resultados pusieron de manifiesto correlaciones negativas entre la seguridad de apego y las dificultades en niños institucionalizados. También se encontró correlaciones negativas entre la edad de llegada a la institución y la presencia problemas graves, dificultades generales e hiperactividad. Sin embargo en la variable conducta prosocial, se encontró una correlación positiva en relación a la edad de llegada del menor a la institución. Por lo que podemos concluir, que el apego es un vínculo esencial para minimizar la aparición de dificultades y problemas en menores institucionalizados.

Parents frequently ask when their infant born preterm will catch up with term peers in relation to neurodevelopment. It is well known that infants born preterm (especially those born at lower gestational age) tend to have lower scores on developmental tests compared to those born at term. In order that performance is not underestimated in early assessments, it is common practice to correct for prematurity up to 2 to 3 years. The American Academy of Pediatrics recommends an age correction for infants born preterm up to 3 years of age,1 as beyond this age the difference between corrected and uncorrected developmental quotient scores become insignificant. The need to correct for prematurity is, however, still controversial. On one hand, there is concern that applying the corrected age for too long may mask the early recognition of possible developmental deviance and delay access to educational support.2, 3 On the other hand, not correcting for prematurity may lead both to underestimating preterm abilities and possibly to unnecessary referrals, causing anxiety for parents.2, 3 Most studies to date have focused on general cognitive outcome and the fact that the effect of correction may differ across multiple developmental domains. There has been increasing evidence that rather than making general statements about correction or the age when corrections should not be used any longer, more attention should be paid to other factors, including gestational age or the specific developmental areas that may present different profiles even before the age of 2 years. Morsan et al.4 report for the first time on the appropriateness of the use of the corrected age for prematurity, exploring all the developmental domains of the Bayley Scales of Infant Development, Third Edition (Bayley‐III) and focusing on infants assessed at 12 months. They conclude that even at 12 months, the age correction for prematurity in low‐risk infants born preterm should be applied differently in the cognitiv

Recent studies suggest that by the second year of life, infants can attribute false beliefs to agents. However, prior studies have largely focused on infants' ability to predict a mistaken agent's physical actions on objects. The present research investigated whether 20-month-old infants could also reason about belief-based emotional displays. In Experiments 1 and 2, infants viewed an agent who shook two objects: one rattled and the other was silent. Infants expected the agent to express surprise at the silent object if she had a false belief that both objects rattled, but not if she was merely ignorant about the objects' properties. Experiment 3 replicated and extended these findings: if an agent falsely believed that two containers held toy bears (when only one did so), infants expected the agent to express surprise at the empty, but not the full, container. Together, these results provide the first evidence that infants in the second year of life understand the causal relationship between beliefs and emotional displays. These findings thus provide new evidence for false-belief understanding in infancy and suggest that infants, like older children, possess a robust understanding of belief that applies to a broad range of belief-based responses.

Background: Childhood obesity is an ongoing problem in developed countries that needs targeted prevention in the youngest age groups. Children in socioeconomically disadvantaged families are most at risk. Mobile health (mHealth) interventions offer a potential route to target these families because of its relatively low cost and high reach. The Growing healthy program was developed to provide evidence-based information on infant feeding from birth to 9 months via app or website. Understanding user engagement with these media is vital to developing successful interventions. Engagement is a complex, multifactorial concept that needs to move beyond simple metrics. Objective: The aim of our study was to describe the development of an engagement index (EI) to monitor participant interaction with the Growing healthy app. The index included a number of subindices and cut-points to categorize engagement. Methods: The Growing program was a feasibility study in which 300 mother-infant dyads were provided with an app which included 3 push notifications that was sent each week. Growing healthy participants completed surveys at 3 time points: baseline (T1) (infant age ≤3 months), infant aged 6 months (T2), and infant aged 9 months (T3). In addition, app usage data were captured from the app. The EI was adapted from the Web Analytics Demystified visitor EI. Our EI included 5 subindices: (1) click depth, (2) loyalty, (3) interaction, (4) recency, and (5) feedback. The overall EI summarized the subindices from date of registration through to 39 weeks (9 months) from the infant’s date of birth. Basic descriptive data analysis was performed on the metrics and components of the EI as well as the final EI score. Group comparisons used t tests, analysis of variance (ANOVA), Mann-Whitney, Kruskal-Wallis, and Spearman correlation tests as appropriate. Consideration of independent variables associated with the EI score were modeled using linear regression models. Results: The overall EI me

Background: Childhood obesity is an ongoing problem in developed countries that needs targeted prevention in the youngest age groups. Children in socioeconomically disadvantaged families are most at risk. Mobile health (mHealth) interventions offer a potential route to target these families because of its relatively low cost and high reach. The Growing healthy program was developed to provide evidence-based information on infant feeding from birth to 9 months via app or website. Understanding user engagement with these media is vital to developing successful interventions. Engagement is a complex, multifactorial concept that needs to move beyond simple metrics. Objective: The aim of our study was to describe the development of an engagement index (EI) to monitor participant interaction with the Growing healthy app. The index included a number of subindices and cut-points to categorize engagement. Methods: The Growing program was a feasibility study in which 300 mother-infant dyads were provided with an app which included 3 push notifications that was sent each week. Growing healthy participants completed surveys at 3 time points: baseline (T1) (infant age ≤3 months), infant aged 6 months (T2), and infant aged 9 months (T3). In addition, app usage data were captured from the app. The EI was adapted from the Web Analytics Demystified visitor EI. Our EI included 5 subindices: (1) click depth, (2) loyalty, (3) interaction, (4) recency, and (5) feedback. The overall EI summarized the subindices from date of registration through to 39 weeks (9 months) from the infant’s date of birth. Basic descriptive data analysis was performed on the metrics and components of the EI as well as the final EI score. Group comparisons used t tests, analysis of variance (ANOVA), Mann-Whitney, Kruskal-Wallis, and Spearman correlation tests as appropriate. Consideration of independent variables associated with the EI score were modeled u