Postpartum maternal mood, feeding practices, and infant temperament in Barbados

Neurodevelopmental effects of childhood malnutrition: A neuroimaging perspective

Approximately one in five children worldwide suffers from childhood malnutrition and its complications, including increased susceptibility to inflammation and infectious diseases. Due to improved early interventions, most of these children now survive early malnutrition, even in low-resource settings (LRS). However, many continue to exhibit neurodevelopmental deficits, including low IQ, poor school performance, and behavioral problems over their lifetimes. Most studies have relied on neuropsychological tests, school performance, and mental health and behavioral measures. Few studies, in contrast, have assessed brain structure and function, and to date, these have mainly relied on low-cost techniques, including electroencephalography (EEG) and evoked potentials (ERP). The use of more advanced methods of neuroimaging, including magnetic resonance imaging (MRI) and functional near-infrared spectroscopy (fNIRS), has been limited by cost factors and lack of availability of these technologies in developing countries, where malnutrition is nearly ubiquitous. This report summarizes the current state of knowledge and evidence gaps regarding childhood malnutrition and the study of its impact on neurodevelopment. It may help to inform the development of new strategies to improve the identification, classification, and treatment of neurodevelopmental disabilities in underserved populations at the highest risk for childhood malnutrition.

Prenatal depression and young low-income mothers' perception of their children from pregnancy through early childhood

This study investigates the role of prenatal depression on young mothers' perception of difficulty in child behavior and parent-child interaction from pregnancy through the first two years of child development. 248 low-income, African American women aged between 13 and 21 years reported on their perceptions of child behavior, parent-child interaction, and on depressive symptoms at the third trimester of pregnancy and at 4-, 12- and 24-months postpartum. During pregnancy, a high percentage (47%) of the young mothers scored above the clinical level of prenatal depressive symptoms. These mothers anticipated and perceived significantly more child difficulty and parent-child interaction difficulty than did non-depressed mothers during pregnancy and over the first two years of the child's development. Moreover, prenatal depression uniquely predicted negative maternal perception throughout the early years of child development even after adjusting for postpartum depression history. The enduring association between prenatal depression and a mother's perception of her child is discussed with respect to the importance of pregnancy in mothers' developing mental schema about their children and the emerging parent-child relationship.

Temperament and the mother-infant dyad: associations with breastfeeding and formula feeding with a bottle

Breastfeeding supports the formation of an emotional bond between mothers and their children. The feeding method is associated with both the child's temperament and the mother's perception of herself and the child. Therefore, the present study focuses on the feeding method, mothers' reaction during feeding, and infants' temperament traits. Ninety-eight mothers with children aged 3 to 5 months participated in the study. Children were assessed with the Children Development Scale (A. Matczak et al., 2007) to measure their temperament. Mothers completed the Mother and Baby Scale (D. Wolke & I. St James-Roberts, 1987, as cited in T.B. Brazelton & K. Nugent, 1995), which measures mothers' evaluation of their children's behaviors during feeding and their overall experiences with their children's care. The results show that breastfed newborns, as compared to bottle-fed newborns, demonstrate higher vigor, which includes activity and the intensity of reaction. Bottle-fed children demonstrate higher regularity than do breastfed children. Mothers who bottle-feed their children perceive themselves to be less confident in the feeding domain than do mothers who breastfeed. Our results indicate that children's temperament might be an important factor in the decision regarding the feeding method. The study supports the idea of promoting knowledge of children's behaviors during feeding among mothers even before their children are born, such as during antenatal classes.

Parental Involvement, Child Temperament, and Parents' Work Hours: Differential Relations for Mothers and Fathers

This study examined how child temperament was related to parents' time spent accessible to and interacting with their 2-year-olds. Bivariate analyses indicated that both fathers and mothers spent more time with temperamentally challenging children than easier children on workdays, but fathers spent less time with challenging children than easier children on non-workdays. After accounting for work hours, some associations between temperament and fathers' workday involvement dropped to non-significance. For fathers, work hours also moderated the relation between irregular temperament and workday play. For mothers, work hours moderated the relation between both difficult and irregular temperament and workday interaction. Mothers also spent more time with girls (but not boys) who were temperamentally irregular. Results speak to the influence of child temperament on parenting behavior, and the differential construction of parenting roles as a function of child characteristics and patterns of work.

Early childhood malnutrition predicts depressive symptoms at ages 11-17

BACKGROUND

We examined the prevalence of depressive symptoms in Barbadian youth with histories of infantile malnutrition and in a healthy comparison group and the extent to which the effect of malnutrition was mediated/moderated by maternal depression.

METHODS

Depressive symptoms were assessed using a 20-item scale administered to youths (11-17 years of age) who had experienced an episode of protein-energy malnutrition (marasmus or kwashiorkor) during the first year of life and in a comparison group of healthy youths without a history of malnutrition. Their mothers completed the same questionnaire on the same test on three occasions when their children were 5-17 years of age at 2-5-year intervals.

RESULTS

The prevalence of depressive symptoms was elevated among previously malnourished youth relative to healthy comparison children (p < .001). When youth depression scores were subjected to a longitudinal multiple regression analysis, adjusting for the effect of maternal depressive symptoms, significant effects due to the history of early childhood malnutrition remained and were not discernibly attenuated from an unadjusted analysis. We also found significant independent effects of maternal depressive symptoms on youth depressive symptoms.

CONCLUSION

Early childhood malnutrition contributed independently to depressive symptoms in youths who experienced a significant episode of malnutrition in the first year of life. This relationship was not mediated or moderated by the effects of maternal depression. Whether the later vulnerability to depression is a direct effect of the episode of malnutrition and related conditions early in life or whether it is mediated by the more proximal neurobehavioral effects of the malnutrition remains to be determined.

A systematic review of the effects of postnatal maternal anxiety on children

Several decades of research have focused on the impact of exposure to postnatal depression on children, while anxiety has been largely overlooked. Estimates of the prevalence of postnatal maternal anxiety (PMA) range from 3% to 43%, suggesting PMA may be an important risk factor for adverse outcomes in children. This review summarizes what is known about the effects of PMA exposure on children and makes recommendations for future research. A systematic search of Ovid MEDLINE and PsychINFO through 2008 identified 18 studies that evaluated child outcomes associated with PMA exposure. Identified studies covered three domains: somatic, developmental, and psychological outcomes. The strongest evidence for an adverse effect of PMA exposure is in somatic and psychological outcomes; the evidence for an effect of PMA on child development is inconclusive. Methodological differences among the studies make comparisons difficult and there are a number of common limitations that challenge the validity of these studies.

Fragmented maternal sleep is more strongly correlated with depressive symptoms than infant temperament at three months postpartum

To determine the contribution of infant temperament to the relationship between maternal sleep disturbance and depressive symptoms. Utilizing a repeated measures design, 112 couples recruited from childbirth education classes were assessed in third trimester and postpartum. Instruments included Center for Epidemiologic Studies Depression Scale, General Sleep Disturbance Scale, wrist actigraphy, and an investigator-developed tool to assess infant temperament completed by mothers and fathers. Regardless of infant temperament, mothers who slept < 4 h between midnight and 6 am and mothers who napped < 60 min during the day were at increased risk for depression at three months postpartum. Infant temperament was associated with maternal sleep but was not a significant predictor of depressive symptoms after controlling for other contextual factors. Postpartum clinical visits should include questions about maternal sleep so interventions can be directed toward sufficient sleep to minimize risk of postpartum depression.

Factors affecting exclusive breastfeeding of healthy babies aged zero to four months: a community-based study of Turkish women

AIM

The purpose of this study was to determine the factors that affect exclusive breastfeeding of healthy babies aged 0-4 months.

BACKGROUND

Both the World Health Organization (WHO) and UNICEF recommend feeding babies of 0-6 months exclusively with breast milk and starting complementary foods after the sixth month. In Turkey, however, a vast majority of babies 1-5 months of age (89.4%) are given complementary foods.

METHODS

This cross-sectional study was conducted in central Ankara province, with a sampling of 514 individuals who were selected using the convenience sampling method.

RESULTS

Of the 514 mothers who participated in my research, 260 (50.6%) were found to be feeding their babies exclusively with breast milk; 77 (15.0%), with breast milk + water; 87 (16.9%), with breast milk + baby formula; 70 (13.6%), with breast milk + baby formula + other foods; and 20 (3.9%), baby formula + other foods. Based on multivariate logistic regression analysis results, the mother's employment [odds ratio (OR) = 0.488; 95% confidence interval (CI) = 0.288-0.827) considerably reduced the incidence of complementary foods, while frequent crying of the baby (OR = 1.687; 95% CI = 1.125-2.530) significantly increased the use of supplementary foods in infant nutrition.

CONCLUSION

This study concluded that frequent crying of the baby increases the likelihood of giving the baby complementary foods. Midwives and nurses can encourage exclusive breastfeeding behaviour by providing individual education and counselling to women whose babies cry frequently.

RELEVANCE TO CLINICAL PRACTICE

Exclusive breastfeeding of babies aged 0-6 months is crucial for the development and growth of the baby and instrumental in reducing infant morbidities and mortalities. One factor that increases the likelihood of provision of complementary foods is frequent crying of the baby. Midwives and nurses can encourage exclusive breastfeeding behaviour by providing individual education and counselling to women whose babies cry frequently.

Postpartum feeding attitudes, maternal depression, and breastfeeding in Barbados

Maternal feeding attitudes, maternal moods and infant feeding practices during the first 6 months postpartum were assessed in 226 healthy, well-nourished Barbadian mother-infant dyads. Factor analysis of the feeding attitudes questionnaire resulted in six independent factors. The belief that breastfeeding was better than bottle-feeding was associated with higher family income, more information seeking behavior and older maternal age at the time of her first pregnancy. Women who believed that breastfeeding was better at 7 weeks postpartum were also more likely to breastfeed at concurrent and later ages, up to 6 months postpartum. This belief was also associated with less maternal depression at 7 weeks and 6 months. The association between feeding attitudes and actual feeding practices was significant even after correcting for maternal moods and other background variables. Conversely, after controlling for feeding attitudes, maternal mood at 7 weeks was still significantly associated with infant feeding practices at 6 months. Thus, feeding attitudes and maternal moods were closely linked, but each contributed independently and uniquely to different aspects of breastfeeding, especially at 6 months. These findings suggest that early intervention addressing maternal feeding attitudes, may improve the extent of breastfeeding and the health of children in this setting.