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PubMed1987

Impact of the diagnosis of AIDS on hospital care of an infant.

Detailed analysis of caretaker response to the first infant newly diagnosed with AIDS at a university hospital was done by review of nursing notes for three periods: before diagnosis of AIDS, after diagnosis, and after psychiatric consultation. Five consultation questions were posed, and the findings on investigation of these questions are discussed. It was found that the percentage of time that PRN medication was given dropped after diagnosis of AIDS but rose above the initial level after the consultation. The number of times per shift the nurse touched the baby (TLCs) was not found to be associated with use of PRN medication; rather it was explained by which nurse was caring for the child. This study focuses on variations in nursing care of one infant to illustrate how variation in caretaker response can amplify the range of perturbations of the infant's behavioral response. It is speculated that caretakers of patients with AIDS may normally have feelings considered unacceptable in medical settings, including fear, blaming the patient, or a wish to avoid the patient. Such feelings are more difficult to tolerate in the care of children or infants and are superimposed upon the familiar stains associated with the care of chronically ill or dying pediatric patients.

Acquired Immunodeficiency Syndrome↗
PubMed1988

A descriptive analysis of infant social referencing.

The study was designed to provide a descriptive analysis of the frequency and patterning of social referencing in a seminaturalistic setting. 32 infants, half of them 12 and half 18 months old, were observed exploring a caged rabbit with their mothers present. Referencing was operationalized as looks directed toward the mother following a look to the rabbit, accompanied by quizzical facial or vocal expressions. As a function of initial reaction to the rabbit, the infants were classified as wary or bold. Wary infants were more likely to reference their mothers when the rabbit was first presented; however, as the exploration period progressed, bold and wary infants referenced equally often. Referencing occurred less often than affective sharing; it increased in frequency when the mother was instructed to actively offer information and the infant no longer needed to solicit information by looking at her. Mothers directed both affective and instrumental information to their infants, providing affective information through facial expressions and tone of voice, and emphasizing instrumental information in the semantic content of their vocalizations.

Adult↗
PubMed1983

On learning to speak.

Every language, spoken or signed, deploys a large lexicon, made possible by permutation and combination of a small set of linguistic elements. In speech, rapid interleaving of the gestures that form these elements (consonants and vowels) leads to a complex acoustic signal in which the boundaries between elements are lost. However, for the child learning to speak, the initial task is not to recover these elements, but simply to imitate the sound pattern that it hears. Studies of "lipreading" in adults and infants suggest that imitation is mediated by an amodal representation, closely related to the dynamics of articulation, and that a left-hemisphere perceptuo-motor mechanism specialized to make use of this representation develops during the first six months of life. By drawing on this specialized mechanism, the infant learns the recurrent patterns of acoustic structure and articulatory gesture from which linguistic segments must be presumed to emerge.

Dominance, Cerebral↗
PubMed1997

[APN: evaluation behavioral scale of acute pain in newborn infants].

AIM: This study was designed to validate a behavioral acute pain rating scale for term and preterm neonates (APN). METHODS: From January through June 1996, neonates requiring a heel lance or a venous puncture for blood sampling at the intensive care unit and the nursery of Poissy Hospital were recruited into the study. After a pilot study, a pain rating scale was developed. The scale score pain ranged from 0 to 10 and it evaluated three items: facial expression, limb movements, and vocal expression with ratings per item ranging from 0 to 4, 0 to 3 and 0 to 3, respectively. Two observers evaluated independently each infant during a painful procedure (puncture for a blood sample) and during a dummy procedure (rubbing the thigh softly). RESULTS: Forty-two neonates born between 25 and 41 weeks gestational age were included in the study. Medians (quartiles) of gestational age, birth weight, and corrected postmenstrual age at time of investigation were 34 (29-39) weeks, 1,850 (1,055-3,093) g, and 35.5 (31-39) weeks, respectively. Ten infants were intubated. The scale showed to be sensitive because all possible scores were obtained; during painful procedures scores ranged from 1 to 10, with 95% of scores > or = 3 while during dummy procedures they ranged from 0 to 5, with 88% of scores < or = 2. The medians (95% confidence interval) of scores were for painful procedures 5 (5 to 7) and for dummy procedures 1 (0 to 1). This indicates a good specificity of the scale. High intercorrelation of items (internal consistency) was confirmed by a Cronbach's coefficient alpha of 0.88. Inter-rater agreement was high since the Krippendorff R test was 91.2. CONCLUSION: This behavioral acute pain rating scale for newborns demonstrated a good specificity and sensitivity, internal consistency and inter-rater reliability. This scale could be used to test the analgesic effects of different therapies during painful procedures.

Acute Disease↗
PubMedDate not supplied

Determinants of weaning age in rural Bangladesh.

Weaning at an appropriate age with appropriate foods is vital for the growth and health of infants. Weaning beliefs and practices were studied in two representative rural villages in Bangladesh by interviews with 180 mothers with infants between 4 and 12 months of age. Maternal parity and family size were not found to be related to weaning age. Family income and maternal education were consistently related to appropriate weaning. Bivariate controlled analysis showed that a mismatch between mothers' responses and actual weaning behavior toward infants 4-6 months old could be attributed to family poverty.

Age Factors↗
PubMed1997

Pregnant and parenting adolescents and their younger sisters: the influence of relationship qualities for younger sister outcomes.

On the basis of social modeling theory and a sibling interaction hypothesis, it was hypothesized that specific relationship qualities between a pregnant or parenting teen and her younger sister would be associated with permissive younger sister outcomes, such as permissive childbearing attitudes and permissive sexual behavior. Results indicated that negative relationship qualities, such as rivalry, competition, and conflict, were more closely related to younger sisters engaging in problem delinquent-like behavior and sexual behavior than were positive relationship qualities, such as warmth and closeness. Additionally, a shared friendship network with the older sister was found to be associated with extensive younger sister problem behavior and sexual behavior. Three potential explanatory processes are discussed.

Adolescent↗
PubMed1989

Metabolic correlates of learning disability.

To summarize, the neuropsychologic findings in MSUD and MMA children in both groups demonstrated deficits in cognitive/language areas, but interesting individual differences existed. For example, a marked contrast in abilities existed between NT and GV, even taking into account the age difference between these children with MSUD. While NT's general intellectual functioning was within the low-average range, GV was severely impaired. In more specific areas of cognitive functioning, NT had an uneven performance profile with areas of strengths and weaknesses, while GV evidenced a flat profile with significant impairment in all areas. NT demonstrated mild delay in visual-spatial processing, articulation development, motor-speech abilities, and selective attention and concentration; however, his language and psychosocial development were within the broad range of normality. In contrast, GV exhibited severe dysfunction in speech, language, and perceptual/conceptual development. The three children with MMA also exhibited a range of disabilities in cognitive functioning. TJ and SH contrasted in the degree of developmental delay across language and cognitive domains. Both were distractible and exhibited very short attention spans but there was a measurable difference in the extent of their speech, language, visual-spatial development. CH was markedly delayed in all areas of cognitive development, which is consistent with global retardation. The severity of her disease and its probable impact on brain development were undoubtedly related to her intellectual impairment. These datasets illustrate the challenges we face, because within each group we see a range of impairment. Nevertheless, we are optimistic that our efforts to relate metabolic, anatomic and neuropsychologic findings for such children will lead to a better understanding of these disorders. We are hopeful that this will result in new advances in diagnosis and intervention, which will ultimately improve the prognosis for cognitive development. In summary, a multidisciplinary center has been established at UCSD to study the neurologic basis of disorders of language, learning and behavior in infants and children. The center draws together a group of researchers from many fields including neurology, biochemistry, pediatrics, cognitive and developmental neuropsychology, psycholinguistics, neurophysiology and communicative disorders. Because of the diverse interests and expertise of our group, it is hoped to forge a synthesis of the behavioral and neurosciences to study populations of children with a variety of neurologic, metabolic, and language/learning disorders. Disorders currently under study include Lesch-Nyhan disease, oculocutaneous tyrosinemia, propionic acidemia, carnitine palmityl transferase deficiency, Schwachman-Diamond syndrome, histidinemia, Hartnup disease, citrullinemia, galactosemia, maple syrup urine disease, and methylmalonic acidemia.(ABSTRACT TRUNCATED AT 400 WORDS)

Child↗
PubMed2006

Father-infant interaction patterns as precursors of children's later externalizing behavior problems: a longitudinal study over 11 years.

AIM: This study examined the extent to which fathers' and infants' interaction behavior were related to children's externalizing behavior problems at age 8 and 11 years. METHODS: In a prospective longitudinal study of children at risk for later psychopathology, 72 fathers and their 3-month-old children were videotaped and evaluated during a standardized playing and nursing situation. Externalizing behavior problems at age 8 and 11 years were assessed using Achenbach's Child Behavior Checklist. RESULTS: In the high externalizing group, fathers were found to be less responsive and less sensitive (the latter only with respect to girls) during early interaction than fathers of the low externalizing group, while children were more positive with their fathers. Furthermore, low scores on the interaction pattern of "sensitive fathering/negative infant" and high scores on the "nonresponsive fathering or active infant" pattern were associated with more externalizing problems. CONCLUSION: These findings suggest that father and infant interaction behaviors during early infancy may predict later problem behaviors at school age, although the mechanisms underlying this relationship have yet to be identified.

Adult↗
PubMed1983

Cardiac orienting and vowel discrimination in newborns: crucial stimulus parameters.

To delineate the acoustic parameters crucial for eliciting a cardiac deceleratory response in newborns, 2 experiments investigated stimulus dimensions implicated as important by previous research. In experiment 1, the temporal pattern and spectral complexity of moderately intense auditory stimuli influenced the cardiac responses of 24 alert newborns. Temporal pattern determined response direction: pulsed stimuli elicited cardiac deceleration, whereas continuous stimuli elicited acceleration. Stimulus complexity influenced response magnitude: the most complex stimulus, a synthetically produced vowel, produced both the largest deceleration for pulsed stimuli and the largest acceleration for continuous ones. Experiment 2 (N = 16) extended the temporal pattern effect to other vowel stimuli in a no-delay discrimination paradigm. These findings indicate that the cardiac deceleratory response to auditory stimuli is a predictable component of the newborn infant's behavior. Furthermore, they suggest that stimulus parameters that influence cardiac deceleration may also play a critical role in stimulus discrimination.

Attention↗
PubMedDate not supplied

Steps to successfully breastfeed the premature infant.

The birth of a premature infant causes emotional upheaval for parents. They often wonder what they can do to help their infant during the critical newborn period. Providing breast milk is one of the most important physiologic benefits a mother can give her premature infant. The advantages of breast milk are numerous. It is the responsibility of those who care for premature infants and their families to provide parents with the support they need to supply the best possible nutrition for their infant. Breastfeeding a premature infant can challenge both the mother and her health care team, however. Infants should be assessed individually for readiness to proceed through the steps leading to successftil breastfeeding. From establishing a milk supply to putting the baby to the breast, parents rely on the nurse for information, instruction, and encouragement. This article identifies obstacles to breastfeeding the premature infant and offers a step-by-step approach for promoting successful breastfeeding in the NICU.

Age Factors↗
PubMed2004

Generalization of deferred imitation during the first year of life.

Infants first generalize across contexts and cues at 3 months of age in operant tasks but not until 12 months of age in imitation tasks. Three experiments using an imitation task examined whether infants younger than 12 months of age might generalize imitation if conditions were more like those in operant studies. Infants sat on a distinctive mat in a room in their home (the context) while an adult modeled actions on a hand puppet (the cue). When they were tested 24 h later, 6-month-olds generalized imitation when either the mat or the room (but not both) differed, whereas 9-month-olds generalized when both the mat and the room differed. In addition, 9-month-olds who imitated immediately also generalized to a novel test cue, whereas 6-month-olds did not. These results parallel results from operant studies and reveal that the similarity between the conditions of encoding and retrieval-not the type of task-determines whether infants generalize. The findings offer further evidence that memory development during infancy is a continuous function.

Child Development↗
PubMed2005

Plexiform fibrohistiocytic tumor: three unusual cases occurring in infancy.

BACKGROUND: Plexiform fibrohistiocytic tumor is a soft-tissue tumor of intermediate malignancy occurring in children and young adults but is only rarely found in infants. The tumor usually involves the upper limbs and is slow growing and painless. Recurrence rate is high. Lymph node and systemic metastases can occur, but have never been reported in infants. Clinical behavior in infancy is not known. Histologically, the tumor is characterized by nodules of histiocyte-like and multinucleated cells and fascicles of spindle cells arranged in a plexiform pattern. Mitosis, atypia, and nuclear pleomorphism are common but not pronounced. METHODS AND RESULTS: We report three cases in infants, one of which is congenital, having an unusual topography and a broad histological spectrum. CONCLUSION: In infants, wide excision with large safety margins should be performed as the behaviour of this tumor remains uncertain. Leclerc S, Hamel-Teillac D, Oger P, Brousse N, Fraitag S. Plexiform fibrohistiocytic tumor: three unusual cases occurring in infancy.

Biomarkers, Tumor↗
PubMed2005

Is maternal obesity a cause of poor lactation performance.

Several investigators have reported a relationship between maternal obesity and low rates of initiation and duration of breast-feeding. Recent research findings suggest that poor infant feeding behavior and reduced hormonal responses in the early postpartum period result in delayed lactogenesis and early cessation of breast-feeding among overweight/obese women.

Adult↗
PubMed1982

Learning display rules: the socialization of emotion expression in infancy.

This study presents data on changes from 3 to 6 months in the type and frequency of infant facial expression. 60 mother-infant dyads were videotaped during play and reunion following a brief separation. Mothers' and infants' facial expressions were coded using the Max muscular components method. The mothers' verbal responses to infant expressiveness were also analyzed. Infants at both ages display a wide range of expressions and a high rate of change. Mothers respond contingently to 25% of infant changes; patterns of contingent responding varied slightly as a function of infant age and sex. Mothers show more contingent responding to older sons' smiles (vs. daughters' smiles) and follow sons' (vs. daughters') expressions with imitative expressions of their own. The only expressive difference between boys and girls at this age is that girls show more frequent interest expressions. Age-related changes included an attenuation of negative affect and a slower lability of expression change for older infants. The mothers' part in these age-related changes is revealed in the following results; Maternal expressions are limited to positive emotions, especially toward younger infants; mothers show less nonverbal and verbal acknowledgment of older infant expression change and do not acknowledge certain infant negative expressions. Finally, we report mother-infant dyadic similarities in expressiveness, including particular expression types and preferential use of the brow or mouth region in expressiveness. These results indicate that socialization of affect expression is occurring during early infancy and that the infants' expressiveness is becoming appropriate according to cultural, gender, and familial demands well before the first birthday.

Affect↗
PubMed1997

Presurgical and postsurgical mental and psychomotor development of infants with sagittal synostosis.

OBJECTIVE: The current study compared the mental and psychomotor development of infants with nonsyndromic sagittal synostosis (SS) with a demographically matched comparison group without congenital defects. Within the SS group, we tested the hypothesis that age of cranial release would be inversely correlated with mental development. DESIGN: The design was prospective and longitudinal. Participants were assessed at 4, 12, and 24 months of age. SETTING: The study was conducted in a craniofacial clinic at an urban children's hospital. PARTICIPANTS: Participants were 19 infants with SS (consecutive craniofacial program referrals) and 19 demographically matched comparison infants recruited from the community. One infant with SS did not attend the 24-month assessment. MAIN OUTCOME MEASURES: Mental and Psychomotor Indices from the Bayley Scales of Infant Development were the primary outcome measures. Subdomains of development were created using Kohen-Raz scoring procedures. All measures were determined a priori. RESULTS: Repeated-measures MANOVAs revealed no statistically significant differences in the developmental trajectories of the two groups. None of the SS group infants received Mental Development Index (MDI) scores in the mentally retarded or borderline range of intellectual functioning (i.e., below 78). An inverse correlation (r = -.30) was found between the age at surgery and Bayley growth curve coefficients; however, this association was not statistically significant (p = .10, one-tailed). CONCLUSIONS: Results are consistent with previous studies of the mental and psychomotor development of infants with nonsyndromic craniosynostoses in relation to normative test data. The relation between surgery age and developmental outcome merits further study in a larger sample with a greater range of surgery ages.

Age Factors↗
PubMed1979

The development of preschool children of heroin-addicted mothers: a controlled study.

Disturbances of growth and behavior in infants and toddlers of women addicted to heroin during pregnancy have been reported in uncontrolled studies. In this study, 3- to 6-year-old children of heroin-addicted mothers were compared to three other groups matched for age, race, sex, birth weight, and socioeconomic status. Heroin-exposed children weighed less and were shorter than those in the comparison groups; 14% had a head circumference below the third percentile. Heroin-exposed children were rated by parents as less well adjusted than control children and they differed significantly in perceptual measures and on subtests of the Illinois Test of Psycholinguistic Abilities and McCarthy Scales of Children's Abilities relating to the process of organization. These findings suggest that chronic intrauterine exposure to heroin may affect growth and behavior as well as perceptual and learning processes in preschool children.

Child↗
PubMed1997

Developmental care does not alter sleep and development of premature infants.

OBJECTIVE: The Neonatal Individualized Developmental Care Program (NIDCAP) for very low birth weight (VLBW) preterm infants has been suggested by Als et al to improve several medical outcome variables such as time on ventilator, time to nipple feed, the duration of hospital stay, better behavioral performance on Assessment of Preterm Infants' Behavior (APIB), and improved neurodevelopmental outcomes. We have tested the hypothesis of whether the infants who had received NIDCAP would show advanced sleep-wake pattern, behavioral, and neurodevelopmental outcome. METHODS: Thirty-five VLBW infants were randomly assigned to receive NIDCAP or routine infant care. The goals for NIDCAP intervention were to enhance comfort and stability and to reduce stress and agitation for the preterm infants by: a) altering the environment by decreasing excess light and noise in the neonatal intensive care unit (NICU) and by using covers over the incubators and cribs; b) use of positioning aids such as boundary supports, nests, and buntings to promote a balance of flexion and extension postures; c) modification of direct hands-on caregiving to maximize preparation of infants for, tolerance of, and facilitation of recovery from interventions; d) promotion of self-regulatory behaviors such as holding on, grasping, and sucking; e) attention to the readiness for and the ability to take oral feedings; and f) involving parents in the care of their infants as much as possible. The infants' sleep was recorded at 36 weeks postconceptional age (PCA) and at 3 months corrected age (CA) using the Motility Monitoring System (MMS), an automated, nonintrusive procedure for determining sleep state from movement and respiration patterns. Behavioral and developmental outcome was assessed by the Neurobehavioral Assessment of the Preterm Infant (NAPI) at 36 weeks PCA, the APIB at 42 weeks PCA, and by the Bayley Scales of Infant Development (BSID) at 4, 12, and 24 months CA. RESULTS: Sleep developmental measures at 3 months CA showed a clear developmental change compared with 36 weeks PCA. These include: increased amount of quiet sleep, reduced active sleep and indeterminate sleep, decreased arousal, and transitions during sleep. Longest sleep period at night showed a clear developmental effect (increased) when comparing nighttime sleep pattern of infants at 3 months with those at 36 weeks of age. Day-night rhythm of sleep-wake increased significantly from 36 weeks PCA to 3 months CA. However, neither of these sleep developmental changes showed any significant effects of NIDCAP intervention. Although all APIB measures showed better organized behavior in NIDCAP patients, neither NAPI nor Bayley showed any developmental advantages for the intervention group. The neurodevelopmental outcome measured by the Bayley at 4, 12, and 24 months CA showed 64% of the NIDCAP intervention group at the lowest possible score compared with 33% of the control group. These findings could not be explained by the occurrence of intraventricular hemorrhage or the socioeconomic status of the parents, which showed no significant group effect. CONCLUSION: The results of this study, including measures of sleep maturation and neurodevelopmental outcome up to 2 years of age did not demonstrate that the NIDCAP intervention results in increased maturity or development. Buehler et al (Pediatrics. 1995;96:923-932) have reported that premature infants (N = 12; mean gestational age 32 weeks, mean birth weight 1700 g) who received developmental care compared with a similar group of infants who received routine care showed better organized behavioral performance on an APIB assessment at 42 weeks PCA. None of the medical outcome measures were significantly different in this study. Although our APIB results are in agreement, the results of the NAPI, the Bayley and sleep measures do not show an increase in neurodevelopmental maturation. In the earlier report by Als et al (Journal of the American Medical Associatio

Adult↗