Paternal postnatal depressive symptoms, infant sleeping and feeding behaviors, and rigid parental regulation : a correlational study

Paternal postnatal depression (PND) is now recognized as a serious and prevalent problem, associated with poorer well-being and functioning of all family members. Aspects of infant temperament, sleeping and feeding perceived by parents as problematic are associated with maternal PND, however, less is known about paternal PND. This study investigated depressive symptoms (Edinburgh postnatal depression scale (EPDS)) in 219 fathers of infants aged from 1 to 24 weeks (median 7.0 weeks). Infant predictor variables were sleeping problems, feeding problems and both mother and father reported temperament. Control variables were partner’s support, other support and life events. Rigidity of parenting beliefs regarding infant regulation was also measured as a potential moderating factor. Infant feeding difficulties were associated with paternal depressive symptoms, subsuming the variance associated with both sleep problems and temperament. This relationship was not moderated by regulation beliefs. It was concluded that infant feeding is important to fathers. Fathers of infants with feeding difficulties may not be able to fulfill their idealized construction of involved fatherhood. Role incongruence may have an etiological role in paternal PND.

Infant wrapping as an evidence-based strategy to encourage settling and the utilisation of the supine sleep position

Objective: To identify knowledge, attitudes and practices of child health nurses relating to infant wrapping as an effective settling/sleep strategy. Methods: A pre-test/post-test intervention design was used to explore knowledge, attitudes and practices relating to wrapping in a sample of child health nurses (n=182): a) pre-test survey; b) educational intervention incorporating evidence relating to infant wrapping; SIDS&KIDS endorsed infant wrapping pamphlet; Safe Sleeping recommendations. Emphasis was placed on infant wrapping as an effective settling strategy for parents to use as an alternative to prone positioning; c) post-test survey to evaluate intervention effectiveness. Results: Pretest results identified wide variation in nurses’ knowledge, attitudes and practices of infant wrapping as a settling/sleep strategy. The intervention increased awareness of wrapping guidelines and self-reported practices relating to parent advice. Significant positive changes in nurses’ awareness of wrapping guidelines (p<0.001); to wrap in supine position only (p<0.001); and parental advice to use wrapping as an alternative strategy to prone positioning to assist settling/sleep (p<0.01), were achieved post-test. Conclusions: Managing unsettled infants and promoting safe sleeping practices are issues routinely addressed by child health nurses working with parents of young infants. Queensland has a high incidence of prone sleeping. Infant wrapping is an evidence-based strategy to improve settling and promote supine sleep consistent with public health recommendations. Infant wrapping guidelines are now included in Queensland Health’s state policy and Australian SIDSandKids information relating to safe infant sleeping. In communicating complex health messages to parents, health professionals have a key role in reinforcing safe sleeping recommendations and offering safe, effective settling/sleep strategies to address the non-recommended use of prone positioning for unsettled infants.

Beliefs about infant regulation, early infant behaviors and maternal postnatal depressive symptoms

Background: Young infants may have irregular sleeping and feeding patterns. Such regulation difficulties are known correlates of maternal depressive symptoms. Parental beliefs regarding their role in regulating infant behaviours also may play a role. We investigated the association of depressive symptoms with infant feeding/sleeping behaviours, parent regulation beliefs, and the interaction of the two. Method: In 2006, 272 mothers of infants aged up to 24 weeks completed a questionnaire about infant behaviour and regulation beliefs. Participants were recruited from general medical practices and child health clinics in Brisbane, Australia. Depressive symptomology was measured using the Edinburgh Postnatal Depression Scale (EPDS). Other measures were adapted from the ALSPAC study. Results: Regression analyses were run controlling for partner support, other support, life events, and a range of demographic variables. Maternal depressive symptoms were associated with infant sleeping and feeding problems but not regulation beliefs. The most important infant predictor was sleep behaviours with feeding behaviours accounting for little additional variance. An interaction between regulation beliefs and sleep behaviours was found. Mothers with high regulation beliefs were more susceptible to postnatal depressive symptoms when infant sleep behaviours were problematic. Conclusion: Mothers of young infants who expect greater control are more susceptible to depressive symptoms when their infant presents challenging sleep behaviour.

Reproducibility of aortic intima-media thickness in infants using edge-detection software and manual caliper measurements

Background: Aortic intima-media thickness measured by transabdominal ultrasound (aIMT) is an intermediate phenotype of cardiovascular risk. We aimed to (1) investigate the reproducibility of aIMT in a population-derived cohort of infants; (2) establish the distribution of aIMT in early infancy; (3) compare measurement by edge-detection software to that by manual sonographic calipers; and (4) assess the effect of individual and environmental variables on image quality. Methods. Participants were term infants recruited to a population-derived birth cohort study. Transabdominal ultrasound was performed at six weeks of age by one of two trained operators. Thirty participants had ultrasounds performed by both operators on the same day. Data were collected on environmental (infant sleeping, presence of a sibling, use of sucrose, timing during study visit) and individual (post-conception age, weight, gender) variables. Two readers assessed image quality and measured aIMT by edge-detection software and a subset by manual sonographic calipers. Measurements were repeated by the same reader and between readers to obtain intra-observer and inter-observer reliability. Results: Aortic IMT was measured successfully using edge-detection in 814 infants, and 290 of these infants also had aIMT measured using manual sonographic calipers. The intra-reader intra-class correlation (ICC) (n = 20) was 0.90 (95% CI 0.76, 0.96), mean difference 1.5 μm (95% LOA -39, 59). The between reader ICC using edge-detection (n = 20) was 0.92 (95% CI 0.82, 0.97) mean difference 2 μm (95% LOA -45.0, 49.0) and with manual caliper measurement (n = 290) the ICC was 0.84 (95% CI 0.80, 0.87) mean difference 5 μm (95% LOA -51.8, 61.8). Edge-detection measurements were greater than those from manual sonographic calipers (mean aIMT 618 μm (50) versus mean aIMT 563 μm (49) respectively; p < 0.001, mean difference 44 μm, 95% LOA -54, 142). With the exception of infant crying (p = 0.001), no associations were observed between individual and environmental variables and image quality. Conclusion: In a population-derived cohort of term infants, aIMT measurement has a high level of intra and inter-reader reproducibility. Measurement of aIMT using edge-detection software gives higher inter-reader ICC than manual sonographic calipers. Image quality is not substantially affected by individual and environmental factors. © 2014 McCloskey et al.; licensee BioMed Central Ltd.

Hush-a-by mummy : interactions between co-sleeping and maternal sleep disturbance

Childbirth is an extraordinary, everyday experience; in 2011, 301 617 infants were born in Australia [1], resulting in countless potential occurrences of sleep disturbance and subsequent daytime sleepiness. While the relationship between sleep and sleepiness has been heavily investigated in the vulnerable sub-populations of shift workers and patients with sleep disorders, comparatively postpartum women have been overlooked. Previous research has reported slower reaction times to the Psychomotor Vigilance Task [2] and shorter sleep onset in the multiple sleep latency test [3] in new mothers compared with control women. However little is known about change in sleep and sleepiness over time or potential interactions with infant care behaviour choices, such as co-sleeping (mother and infant sharing a bed). This study aims to investigate change in new mothers sleep quantity, sleep quality and resulting daytime sleepiness over postpartum weeks 6, 12 and 18, while evaluating the impact of co-sleeping.

Comparison of measured sleeping metabolic rate and predicted basal metabolic rate during the first year of life : evidence of a bias changing with increasing metabolic rate

Objective: To compare measurements of sleeping metabolic rate (SMR) in infancy with predicted basal metabolic rate (BMR) estimated by the equations of Schofield. Methods: Some 104 serial measurements of SMR by indirect calorimetry were performed in 43 healthy infants at 1.5, 3, 6, 9 and 12 months of age. Predicted BMR was calculated using the weight only (BMR-wo) and weight and height (BMR-wh) equations of Schofield for 0-3-y-olds. Measured SMR values were compared with both predictive values by means of the Bland-Altman statistical test. Results: The mean measured SMR was 1.48 MJ/day. The mean predicted BMR values were 1.66 and 1.47 MJ/day for the weight only and weight and height equations, respectively. The Bland-Altman analysis showed that BMR-wo equation on average overestimated SMR by 0.18 MJ/day (11%) and the BMR-wh equation underestimated SMR by 0.01 MJ/day (1%). However the 95% limits of agreement were wide: -0.64 to + 0.28 MJ/day (28%) for the former equation and -0.39 to + 0.41 MJ/day (27%) for the latter equation. Moreover there was a significant correlation between the mean of the measured and predicted metabolic rate and the difference between them. Conclusions: The wide variation seen in the difference between measured and predicted metabolic rate and the bias probably with age indicates there is a need to measure actual metabolic rate for individual clinical care in this age group.

Factors potentiating the risk of sudden infant death syndrome associated with the prone position

Background. In several studies the sudden infant death syndrome (SIDS) has been significantly associated with sleeping in the prone position. It is not known how the prone position increases the risk of SIDS. Methods. We analyzed data from a case-control study (58 infants with SIDS and 120 control infants) and a prospective cohort study (22 infants with SIDS and 213 control infants) in Tasmania. Interactions were examined in matched analyses with a multiplicative model of interaction. Results. In the case-control study, SIDS was significantly associated with sleeping in the prone position, as compared with other positions (unadjusted odds ratio, 4.5; 95 percent confidence interval, 2.1 to 9.6). The strength of this association was increased among infants who slept on natural-fiber mattresses (P = 0.05), infants who were swaddled (P = 0.09), infants who slept in heated rooms (P = 0.006), and infants who had had a recent illness (P = 0.02). These variables had no significant effect on infants who did not sleep in the prone position. A history of recent illness was significantly associated with SIDS among infants who slept prone (odds ratio, 5.7; 95 percent confidence interval, 1.8 to 19) but not among infants who slept in other positions (odds ratio, 0.83). In the cohort study, the risk of SIDS was greater among infants who slept prone on natural-fiber mattresses (odds ratio, 6.6; 95 percent confidence interval, 1.3 to 33) than among infants who slept prone on other types of mattresses (odds ratio, 1.8). Conclusions. When infants sleep prone, the elevated risk of SIDS is increased by each of four factors: the use of natural-fiber mattresses, swaddling, recent illness, and the use of heating in bedrooms.

Sleeping sites, sleeping trees, and sleep-related behaviors of black crested gibbons (Nomascus concolor jingdongensis) at Mt. Wuliang, central Yunnan, China

Data on sleep-related behaviors were collected for a group of central Yunnan black crested gibbons (Nomascus concolor jingdongensis) at Mt. Wuliang, Yunnan, China from March 2005 to April 2006. Members of the group usually formed four sleeping units (adult male and juvenile, adult female with one semi-dependent black infant, adult female with one dependent yellow infant, and subadult male) spread over different sleeping trees. Individuals or units preferred specific areas to sleep; all sleeping sites were situated in primary forest, mostly (77%) between 2,200 and 2,400 m in elevation. They tended to sleep in the tallest and thickest trees with large crowns on steep slopes and near important food patches. Factors influencing sleeping site selection were (1) tree characteristics, (2) accessibility, and (3) easy escape. Few sleeping trees were used repeatedly by the same or other members of the group. The gibbons entered the sleeping trees on average 128 min before sunset and left the sleeping trees on average 33 min after sunrise. The lag between the first and last individual entering the trees was on average 17.8 min. We suggest that sleep-related behaviors are primarily adaptations to minimize the risk of being detected by predators. Sleeping trees may be chosen to make approach and attack difficult for the predator, and to provide an easy escape route in the dark. In response to cold temperatures in a higher habitat, gibbons usually sit and huddle together during the night, and in the cold season they tend to sleep on ferns and/or orchids.

Northern Ireland Infant Death Thematic Review 2015

Co-Sleeping and bed sharing are considered the social norm for approximately 90% of the world's population, with two-thirds of the world's cultures habitually practicing mother-infant co-sleeping on the same bed. Although international studies show that the practice of co-sleeping is common, it is controversial in the public health community, as many consider it a significant risk for Sudden Infant Death Syndrome (SIDS), accounting for 50% of SIDS deaths in the UK. The report offers an international review of the evidence and provides important debates and critical knowledge for both health professionals, parents and all those organisations working to support the safety of infants in their first perinatal year.

Maternal psychosocial adversity and the longitudinal development of infant sleep

Research has identified associations between indicators of social disadvantage and the presence of child sleep problems. We examined the longitudinal development of infant sleep in families experiencing high (n = 58) or low (n = 64) levels of psychosocial adversity, and the contributions of neonatal self-regulatory capacities and maternal settling strategies to this development. Assessments of infant sleep at 4-, 7-, and 12-weeks postpartum indicated no differences in sleeping difficulties between high- and low-adversity groups. However, more infant sleep difficulties were reported in the high- versus low-adversity groups at 12- and 18-month follow-ups. Neonatal self-regulatory capacities were not related to the presence or absence of adversity, or to subsequent infant sleep quality. However, there were group differences in maternal settling strategies that did predict subsequent infant sleep difficulties. The pattern of sleep disturbance observed in association with maternal psychosocial adversity at 18-months was consistent with risk for broader impairments in child functioning.

Breastfeeding and infant sleep patterns : an Australian population study

Objective : Our purpose was to determine if babies breastfed at 6 months of age were more likely to wake at night and less likely to sleep alone than formula-fed babies.

Patients and Methods : Data were drawn from the first wave of The Longitudinal Study of Australian Children, an ongoing, nationally representative study of the growth and development of Australia's children. The 4507 participants met the criteria for this study. The measures examined infant sleep problems as the outcome and breastfeeding at 6 months of age as the exposure in addition to the demographic data, maternal mental health, infant birthweight and gestational age at delivery.

Results : After adjustment for covariates, reports by mothers of infants that breastfed at 6 months of age suggested infants were 66% more likely to wake during the night and 72% more likely to report difficulty sleeping alone. However, breastfeeding had a strongly protective effect on wheezing, coughing, snoring and breathing problems, and it was not associated with restless sleep or problems getting to sleep for the infant.

Conclusions : Breastfeeding was found to be associated with increased night waking and this is consistent with other studies. There are biological reasons why this might be required to ensure breastfeeding continues to 6 months and beyond. The current low rates of sustained breastfeeding in many Western countries needs to be reconsidered in relation to parental and public health practices promoting prolonged nocturnal infant sleep patterns.

Sudden Infant Death disparities: A systematic review on health education and policy recommendations for decreasing Sudden Infant Death in the African-American community

Objective: To perform a systematic review of the literature on SIDS and SUID deaths concentrated in the African-American community, describe health education and policy recommendations and recommend a new approach that may aid in decreasing the disparity of infant mortality in the African-American community. ^ Methods: The PubMed database was systematically searched to identify relevant articles for final review and analysis. Using the CASP 2006 system to critique literature, twelve articles were found that met inclusion and exclusion criteria. ^ Results: Evidence in the literature confirmed there was a current disparity among African Americans' infant mortality rates in comparison to other US ethnic groups. The underlying reasons for these disparities included the following maternal and infant characteristics: mothers younger than eighteen, having more than one live infant, having a high school education or less, never been married, and have infants born preterm or with low birth weight. Maternal smoking, substance abuse, and breastfeeding did not have a significant impact on infant sleep environments among African Americans. ^ Conclusion: Tailored health education programs at the community level, better access to pre-pregnancy and prenatal care, and increased maternal perception of risk that is relevant to the infants sleeping environment are all possible solutions that may decrease African American infant mortality rates.^

Health service use and costs for infant behaviour problems and maternal stress

AIM: We aim to describe health service (HS) use in the first 6 months post-partum and to examine the associations between service costs, infant behaviour and maternal depressive symptoms. METHODS: Participants were 781 infants and mothers in Melbourne, Australia. Mothers reported infant feeding, sleeping and crying problems, depressive symptoms and health service use. Costs were valued in 2012 Australian dollars. RESULTS: The most common services used were maternal child health nurses, general practitioners (GP) and allied health. Infant feeding problems were associated with increased costs for services relevant to infant behaviour including maternal child health nurses (P = 0.007), GP (P = 0.008) and paediatricians (P = 0.03). Maternal depressive symptoms were associated with increased costs for services relevant to depressive symptoms including parenting centres (P = 0.04), GP (P = 0.004), psychiatrists (P = 0.02) and psychologists (P = 0.001). Mothers who completed high school had higher service costs for infant problems than those with lower education (P = 0.02). Single mothers had higher costs for services used for their depressive symptoms than partnered mothers (P < 0.001). Mothers with English as a second language had lower service costs for their depressive symptoms (P = 0.02). CONCLUSIONS: Infant feeding problems and maternal depressive symptoms are associated with higher costs for health services relevant to these conditions. Cost-effective strategies to manage these conditions are needed with accessibility being ensured for mothers who are experiencing social adversity.

Caregivers' beliefs about practice in infant child care programmes

Infant caregivers in centre-based child care were videotaped as they interacted with the children during routine and non-routine activities. During a subsequent interview, the video provided a stimulus for discussion and reflection on practices. Caregivers were also asked to write about their beliefs on good practice in caring for infants. Transcripts of the interviews and the written statements were then analysed for evidence of nave and informed beliefs about caregiving. Most caregivers held nave beliefs and only one caregiver had an informed understanding of professional practice with infants. The usefulness of the analytical framework used in this research is discussed as a means for understanding caregiving practices. It has important implications for approaches to initial professional education of early childhood teachers and for professional development programmes.