Sources and correlates of sodium consumption in the first 2 years of life

High sodium intake during infancy and early childhood can change salt preference and blood pressure trajectories across life, representing a modifiable cardiovascular risk factor. Describing young children's sodium intake is important for informing effective targets for sodium reduction.

Environmental and genetic determinants of vitamin D insufficiency in 12-month-old infants

We aimed to investigate the relationship between genetic and environmental exposure and vitamin D status at age one, stratified by ethnicity. This study included 563 12-month-old infants in the HealthNuts population-based study. DNA from participants' blood samples was genotyped using Sequenom MassARRAY MALDI-TOF system on 28 single nucleotide polymorphisms (SNPs) in six genes. Using logistic regression, we examined associations between environmental exposure and SNPs in vitamin D pathway and filaggrin genes and vitamin D insufficiency (VDI). VDI, defined as serum 25-hydroxyvitamin D3(25(OH)D3) level ≤50 nmol/L, was measured using liquid chromatography-tandem mass spectrometry (LC-MS/MS). Infants were stratified by ethnicity determined by parent's country of birth. Infants formula fed at 12 months were associated with reduced odds of VDI compared to infants with no current formula use at 12 months. This association differed by ethnicity (P;bsubesub;= 0.01). The odds ratio (OR) of VDI was 0.29 for Caucasian infants (95% CI, 0.18-0.47) and 0.04 for Asian infants (95% CI, 0.006-0.23). Maternal vitamin D supplementation during pregnancy and/or breastfeeding were associated with increased odds of infants being VDI (OR, 2.39; 95% CI, 1.11-5.18 and OR, 2.5; 95% CI, 1.20-5.24 respectively). Presence of a minor allele for any GC SNP (rs17467825, rs1155563, rs2282679, rs3755967, rs4588, rs7041) was associated with increased odds of VDI. Caucasian infants homozygous (AA) for rs4588 had an OR of 2.49 of being associated with VDI (95% CI, 1.19-5.18). In a country without routine infant vitamin D supplementation or food chain fortification, formula use is strongly associated with a reduced risk of VDI regardless of ethnicity. There was borderline significance for an association between filaggrin mutations and VDI. However, polymorphisms in vitamin D pathway related genes were associated with increased likelihood of being VDI in infancy. © 2014 Elsevier B.V. All rights reserved.

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.

The role of the music therapist in promoting parent infant attachment

Abstract
This paper provides a brief overview of recent literature relating to infant musicality and its basis for effective parent-infant work in music therapy. Two strong trends are revealed: the international breadth of the developing work by music therapists within family-centred contexts of practice, especially work with infants and their parents in the early years; and the use oftheoretical principles of communicative musicality (Malloch &Trevarthen, 2008] combined with knowledge of early musical skills. This focus on musical perception and musical development (Briggs, 1991; Trehub, 2003] provides a rationale as to why musical interaction supported by a qualified music therapist can offer a potential pathway for improved attachment between the parent and infant when therapeutic support is indicated.

Which infants with eczema are at risk of food allergy? Results from a population-based cohort

BACKGROUND: The relationship between early onset eczema and food allergy among infants has never been examined in a population-based sample using the gold standard for diagnosis, oral food challenge. OBJECTIVE: We characterised the risk of challenge-proven food allergy among infants with eczema in the general population. METHODS: One-year-old infants (n = 4453 meeting criteria for this analysis) were assessed for history of eczema, received a nurse-administered eczema examination and underwent skin prick testing to peanut, egg and sesame. Those with a detectable wheal to one of the test foods underwent an oral food challenge irrespective of wheal size. The risk of food allergy, stratified by eczema severity and age of onset, was estimated using multivariate logistic regression with population sampling weights. RESULTS: One in five infants with eczema were allergic to peanut, egg white or sesame, compared to one in twenty-five infants without eczema (OR 6.2, 95% CI 4.9, 7.9, P < 0.001). The prevalence of peanut allergy was low in the absence of eczema (0.7% 95% CI 0.4, 1.1). Infants with eczema were 11.0 times more likely to develop peanut allergy (95% CI 6.6, 18.6) and 5.8 times more likely to develop egg allergy (95% CI 4.6, 7.4) by 12 months than infants without eczema. 50.8% of infants (95% CI 42.8, 58.9) with early eczema onset (<3 months) who required doctor-prescribed topical corticosteroid treatment developed challenge-proven food allergy. CONCLUSION AND CLINICAL RELEVANCE: Eczema, across the clinical severity spectrum in infancy, is a strong risk factor for IgE-mediated food allergy. Infants with eczema were six times more likely to have egg allergy and 11 times more likely to have peanut allergy by 12 months than infants without eczema. Our data suggest that a heightened awareness of food allergy risk among healthcare practitioners treating infants with eczema, especially if early onset and severe, is warranted.

Autism spectrum disorder, essential fatty acids and infant feeding

 Dr Brown’s research identified the importance of breastfeeding duration and essential fatty acids in children. Her research found that children who were breastfed for a longer duration in infancy were significantly less likely to have a diagnosis of autism or show signs of a fatty acid deficiency.

Accounting for uncertainty in volumes of seabed change measured with repeat multibeam sonar surveys

Seafloors of unconsolidated sediment are highly dynamic features; eroding or accumulating under the action of tides, waves and currents. Assessing which areas of the seafloor experienced change and measuring the corresponding volumes involved provide insights into these important active sedimentation processes. Computing the difference between Digital Elevation Models (DEMs) obtained from repeat Multibeam Echosounders (MBES) surveys has become a common technique to identify these areas, but the uncertainty in these datasets considerably affects the estimation of the volumes displaced. The two main techniques used to take into account uncertainty in volume estimations are the limitation of calculations to areas experiencing a change in depth beyond a chosen threshold, and the computation of volumetric confidence intervals. However, these techniques are still in their infancy and, as a result, are often crude, seldom used or poorly understood. In this article, we explored a number of possible methodological advances to address this issue, including: (1) using the uncertainty information provided by the MBES data processing algorithm CUBE, (2) adapting fluvial geomorphology techniques for volume calculations using spatially variable thresholds and (3) volumetric histograms. The nearshore seabed off Warrnambool harbour - located in the highly energetic southwest Victorian coast, Australia - was used as a test site. Four consecutive MBES surveys were carried out over a four-months period. The difference between consecutive DEMs revealed an area near the beach experiencing large sediment transfers - mostly erosion - and an area of reef experiencing increasing deposition from the advance of a nearby sediment sheet. The volumes of sediment displaced in these two areas were calculated using the techniques described above, both traditionally and using the suggested improvements. We compared the results and discussed the applicability of the new methodological improvements. We found that the spatially variable uncertainty derived from the CUBE algorithm provided the best results (i.e. smaller confidence intervals), but that similar results can be obtained using as a fixed uncertainty value derived from a reference area under a number of operational conditions.

A qualitative study of the infant feeding beliefs and behaviours of mothers with low educational attainment

BACKGROUND: Infancy is an important period for the promotion of healthy eating, diet and weight. However little is known about how best to engage caregivers of infants in healthy eating programs. This is particularly true for caregivers, infants and children from socioeconomically disadvantaged backgrounds who experience greater rates of overweight and obesity yet are more challenging to reach in health programs. Behaviour change interventions targeting parent-infant feeding interactions are more likely to be effective if assumptions about what needs to change for the target behaviours to occur are identified. As such we explored the precursors of key obesity promoting infant feeding practices in mothers with low educational attainment.

METHODS: One-on-one semi-structured telephone interviews were developed around the Capability Opportunity Motivation Behaviour (COM-B) framework and applied to parental feeding practices associated with infant excess or healthy weight gain. The target behaviours and their competing alternatives were (a) initiating breastfeeding/formula feeding, (b) prolonging breastfeeding/replacing breast milk with formula, (c) best practice formula preparation/sub-optimal formula preparation, (d) delaying the introduction of solid foods until around six months of age/introducing solids earlier than four months of age, and (e) introducing healthy first foods/introducing unhealthy first foods, and (f) feeding to appetite/use of non-nutritive (i.e., feeding for reasons other than hunger) feeding. The participants' education level was used as the indicator of socioeconomic disadvantage. Two researchers independently undertook thematic analysis.

RESULTS: Participants were 29 mothers of infants aged 2-11 months. The COM-B elements of Social and Environmental Opportunity, Psychological Capability, and Reflective Motivation were the key elements identified as determinants of a mother's likelihood to adopt the healthy target behaviours although the relative importance of each of the COM-B factors varied with each of the target feeding behaviours.

CONCLUSIONS: Interventions targeting healthy infant feeding practices should be tailored to the unique factors that may influence mothers' various feeding practices, taking into account motivational and social influences.

Does positive mental health in adolescence longitudinally predict healthy transitions in young adulthood?

The present study examined the longer-term implications of adolescent positive mental health for successful young adult transitions. Positive mental health in adolescence was defined by indicators roughly corresponding to Seligman’s positive psychology PERMA framework (positive emotional experiences, engagement, relationships, purpose, and accomplishment), with the addition of health. Data were drawn from one of Australia’s longest running studies of social and emotional development (Australian Temperament Project, est. 1983, N = 2443), which has followed a large representative community sample from infancy to 27–28 years of age. In the analyzed sample of n = 999, positive mental health at 15–16 years was associated with indicators of career progression (educational attainment and perceived competence) and taking on citizenship responsibilities (volunteering and civic activities) over a decade later at 27–28 years. Mental health problems in adolescence were more relevant to establishing romantic partnerships in young adulthood: adolescent antisocial behaviors predicted higher likelihood of being in a relationship, while depressive symptoms predicted lower quality partnerships. The results suggest that successful transitions into young adult roles and responsibilities may be facilitated by targeted mental health promotion interventions designed to both foster positive mental health and address mental health difficulties in adolescence.

Considering Aboriginal palliative care models: the challenges for mainstream services

This review discusses palliative care and end-of-life models of care for Aboriginal people in the Australian state New South Wales, and considers Aboriginal palliative care needs by reflecting on recent literature and lessons derived from Aboriginal consultation. Aboriginal people in Australia account for a very small proportion of the population, have poorer health outcomes and their culture demonstrates a clear resistance to accessing mainstream health services which are viewed as powerful, isolating and not relevant to their culture, way of life, family and belief systems. Aboriginal people regard their land as spiritual and their culture dictates that an Aboriginal person needs to know their origins, emphasising the value placed on kin and also demonstrating a strong desire to remain within their own country. Currently Aboriginal people tend to not access palliative care services in mainstream facilities; and there is very little data on Aboriginal admissions to palliative care centres. Over the last two decades only two models of palliative care focusing on and developed in Aboriginal communities have been implemented. The seminal contribution to Aboriginal Palliative Care was in the form of a resource kit developed to support palliative care providers to examine their practice for cultural appropriateness for Aboriginal and Torres Strait Islanders. The "living model" coming from this project is adaptive and flexible, enabling implementation in different Aboriginal country as a participative process with community input. The Australian government"s National Indigenous Palliative Care Needs Study similarly indicated that Australian empirical research on Aboriginal palliative care service provision is in its infancy, and comprehensive data on the rates of Aboriginal access to palliative care services did not exist. What literature does exist is drawn together in an argument for the development and need for culturally specific Aboriginal palliative care models, which are culturally appropriate, locally accessible and delivered in collaboration and partnership with Aboriginal controlled health services. This is essential because Aboriginal people are a minority cultural group who are disconnected from mainstream health service delivery, and have a sense of cultural isolation when accessing mainstream services. It is preferable that palliative care is delivered in a collaboration between Aboriginal Controlled Health Service and mainstream palliative care services to ensure a dignified end of life for the Aboriginal person. These collaborations and partnerships are fundamental to ensure that a critical mass of Aboriginal clinicians are trained and experienced in end of life care and palliation. Developing palliative care programs within Aboriginal communities and training Aboriginal Health Workers, promoted and developed in partnership with the Aboriginal community, are important strategies to enhance palliative care service provision. Further partnerships should be championed in this collaborative process, acknowledging a need for palliative care models that fit with Aboriginal peoples" community values, beliefs, cultural/ spiritual rituals, heritage and place.

The fine art of conversation: the pragmatic skills of school-aged children with hearing loss

This chapter synthesizes the findings of a number of recent studies conducted by the authors. The focus will be on spoken interactions between school-aged students who are deaf and hard of hearing, and their hearing peers. Many of the participants in these studies have worn hearing aids and/or cochlear implants since infancy and have been educated in inclusive settings. The context of these studies includes face-to-face interactions during a question/answer game, in free conversation, and during an expository task. This chapter will examine the verbal and nonverbal conversational skills 'of these students within these different contexts. Using a range of quantitative and qualitative analyses, the development of pragmatic skills in students with hearing loss will be documented, and possible implications for language support and the development of social skills will be discussed.

Choosing foods for infants: a qualitative study of the factors that influence mothers

BACKGROUND: Examining the experiences of parents making food choices for infants is important because ultimately this influences what infants eat. Infancy is a critical period when food preferences and eating behaviour begin to develop, shaping dietary patterns, growth and health outcomes. There is limited evidence regarding what or why foods are chosen for infants. OBJECTIVE: To describe the experiences of mothers making food choices for their infant children. METHODS: Semi-structured interviews with 32 Australian mothers of infants aged four to 15 months from a range of socioeconomic backgrounds. An inductive thematic analysis through a process of constant comparison was conducted on transcribed interviews. RESULTS: Mothers described many ideas and circumstances which influenced food choices they made for infants. Themes were developed which encapsulate how the wider environment and individual circumstances combine to result in the food choices made for infants. Beliefs, values, norms and knowledge were a central influence on choices. Cost, quality and availabilities of various foods were also key factors. Related to this, and combined with inherent factors such as perishability and infant acceptability, fresh fruits and vegetables were often singled out as an easy or difficult choice. Influences of time, parents' capacities, social connections and different information sources were clearly apparent. Finally infants' own preferences and how parents helped infants with learning to eat were also key influences on food choices. CONCLUSIONS: Choosing foods for infants is a complex social practice. An ecological framework depicting the multiple influences on what people eat and sociological theory on food choice regarding the role of 'social structure' and 'human agency' are both applicable to the process of choosing foods for infants. Equity issues may be key regarding the degree to which mothers can choose particular foods for infants (e.g. choosing foods which promote health).

Infant adiposity at birth and early postnatal weight gain predict increased aortic intima-media thickness at 6 weeks of age: a population-derived cohort study

Infant body composition and postnatal weight gain have been implicated in the development of adult obesity and cardiovascular disease, but there are limited prospective data regarding the association between infant adiposity, postnatal growth and early cardiovascular parameters. Increased aortic intima-media thickness (aortic IMT) is an intermediate phenotype of early atherosclerosis. The aim of the present study was to investigate the relationship between weight and adiposity at birth, postnatal growth and aortic IMT. The Barwon Infant Study (n=1074 mother-infant pairs) is a population-derived birth cohort. Infant weight and other anthropometry were measured at birth and 6 weeks of age. Aortic IMT was measured by trans-abdominal ultrasound at 6 weeks of age (n=835). After adjustment for aortic size and other factors, markers of adiposity including increased birth weight (β=19.9 μm/kg, 95%CI 11.1, 28.6; P<0.001) and birth skinfold thickness (β=6.9 μm/mm, 95%CI 3.3, 10.5; P<0.001) were associated with aortic IMT at 6 weeks. The association between birth skinfold thickness and aortic IMT was independent of birth weight. In addition, greater postnatal weight gain was associated with increased aortic IMT, independent of birth weight and age at time of scan (β=11.3 μm/kg increase, 95%CI 2.2, 20.3; P=0.01). Increased infant weight and adiposity at birth, as well as increased early weight gain, were positively associated with aortic IMT. Excessive accumulation of adiposity during gestation and early infancy may have adverse effects on cardiovascular risk.

A multidisciplinary perspective on motor impairment as an early behavioural marker in children with autism spectrum disorder

Objectives: There is no medical test for autism spectrum disorder (ASD), a heterogeneous condition currently defined in the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) by dysfunction in social, communication, and behavioural dimensions. There is agreement in the literature that the motor profile of ASD may hold the key to improving clinical and diagnostic definition, with DSM-5 now referring to motor deficits, including “odd gait” (p. 55), as part of the ASD clinical description. This review describes the history of motor impairment in ASD, types of motor problems, and age-related motor findings and highlights evidence gaps and future research. Method: A narrative review is provided of the research literature describing motor impairment in ASD and its ability to differentiate between ASD versus non-ASD cohorts. Results: Findings show differences in motor development in children with ASD from infancy onwards, including difficulties across motor coordination, arm movements, gait, and postural stability. Motor disturbance may appear in young children with ASD prior to social and language difficulties becoming clinically apparent. However, challenges remain in defining and measuring the early motor profile that is specific to ASD. Despite well-established motor impairments in ASD, there is a lack of evidence regarding which motor-based interventions will be effective in this group. Conclusions: Motor impairment holds promise as an early diagnostic sign, a behavioural marker, and a means by which to improve identification and possibly phenotypic delineation in ASD. Further research is required to determine whether motor abnormalities can sensitively differentiate ASD from other developmental conditions and to establish evidenced-based interventions to reduce the associated impairment.

The Cutopia Paradox: anthropomorphism as entertainment

An infant chimpanzee, dressed in riotous checks, bowtie and braces, cradled in human arms while it regards a camera, is perhaps further from us than a tiger lurking in the deepest jungle. Anthropomorphic sentiment negates empathy, blinding us to the real animal behind the “character.” The engaging creature we imagine we’d like to hold and protect is the product, most likely, of violent separation and trauma, stolen in order to bring us this enjoyment. We read the comical face, celebrating what appear to be traces of commonality; but the eyes of the small creature are windows to a realm we cannot comprehend. By following the life of a single chimpanzee, Cobby, the oldest chimp in captivity in the USA, this paper will explore our attraction to cuteness via the lens of chimpanzees in entertainment, regarding it as an intersection of emotion and metaphor that is potentially devastating to animals. We will argue that anthropomorphic sentiment and construction misdirects empathy away from the plight of real animals, and that every animal has the right to be acknowledged as a unique individual, rather than a generic entity. Animals that have been born in captivity and, to a lesser extent, those that have been extracted from the wild in infancy, can be seen as trapped between worlds. There exists, therefore, a hybrid population of animals that lives amongst us, amnesiacs dependent upon human compassion, or conversely, prey to its absence.