To have and to hold: Effects of physical contact on infants and their caregivers

Infant Care: Predictors of Outdoor Walking, Infant Carrying and Infant Outdoor Sleeping

BACKGROUND

Although spending time outdoors is beneficial for development, little is known about outdoor time during infancy. The aim of this study was to assess frequencies and durations of (1a) outdoor walking and carrying in mother-infant dyads and (1b) infant outdoor sleeping in a stationary cot or pram. We furthermore aimed to identify associations of (2a) outdoor walking and carrying and (2b) infant outdoor sleeping, with infant, maternal and environmental sample characteristics.

METHODS

An online survey was distributed among mothers of 0- to 12-month-old infants. Initially, 1453 mothers were recruited, of which 1275 were included in the analyses. With respect to (1a) the outcomes of interest were: mother-infant dyads' total weekly duration of walking in minutes, frequency of walking on weekdays, as well as weekends, and the frequency of using an infant carrier during walks, as well as the daily duration of carrying in hours (indoors and outdoors together). With respect to (1b) the outcome variables were: placing the infant outdoors to sleep (yes/no), the total weekly duration of outdoor sleeping and the weekly frequency of outdoor sleeping. For aim 2, associations of the outcome variables with infant (i.e., age), maternal (i.e., working status) and environmental (i.e., house type) sample characteristics were assessed.

RESULTS

Mother-infant dyads engaged in walks for a total weekly duration of 201 min, for approximately one to three walks over weekdays (Monday through Friday), as well as one to three walks on the weekend. The infant carrier was used by 22% of mothers at least half of the time during outdoor walks, and 18% reported a daily duration of infant carrying of one hour or more. Among other associations, infant and maternal enjoyment of outdoor walking correlated positively with the duration as well as the frequency of walking during weekdays and during the weekend. Furthermore, employed mothers walked for a shorter duration and less frequently on weekdays as compared to mothers on maternity leave or mothers without a paid job. The availability of nearby recreational areas correlated positively with the weekly duration and frequency of walks. The infant carrier was used more frequently during outdoor walks if more than one child lived in the household. Infant carrying during outdoor walks was also related to infant behavior at night. Roughly a third of the mothers (29%) regularly had their infant sleep outdoors for a weekly duration of four hours and a weekly frequency of approximately one to two times. Younger infants, infants of mothers with higher education and infants living in detached houses were more likely to be placed outdoors to sleep.

DISCUSSION

We identified associations of infant, maternal and environmental characteristics with outdoor time spent during infancy. These results lay the foundation for future research on the effects of the outdoors on child development as well as on facilitators and barriers for caregivers.

COMFORTneo scale in preterm infants during live performed music therapy-Difference between close physical contact and hand touch contact

There is evidence that music therapy combined with physical contact to parents stabilizes the vital signs of hospitalized preterm infants. Yet, there is no evidence for the difference between simple contact by touching the infant in the incubator or cod, or close physical contact during music therapy sessions (MT). Behavioral effects of the various forms of attention toward the infant during therapy need to be elucidated. Our study aimed to quantify the effects of hand touch contact (HTC) and close physical contact (CPC) during live performed MT in preterm infants regardless of gestational age on behavioral state (assessed via COMFORTneo scale) and vital signs. A maximum of ten live music therapy sessions were delivered three to four times a week until hospital discharge to 50 stable infants. Pre-, during- and post-therapy heart rates, respiratory rates, oxygen saturations and COMFORTneo scores were recorded for each session. A total of 486 sessions was performed with 243 sessions using HTC and CPC each. The mean gestational age was 33 + 3 weeks, with 27 (54%) infants being male. We observed lower COMFORTneo scores, heart and respiratory rates and higher oxygen saturation during and after live performed music therapy independent of the kind of physical contact than before therapy. While pre-therapy values were better in the CPC group for all four variables, a higher mean response on COMFORTneo scale and vital signs was observed for HTC (COMFORTneo score -5.5, heart rate -12.4 beats per min., respiratory rate -8.9 breaths per min, oxygen saturation + 1.5%) compared to CPC (COMFORTneo score -4.6, heart rate -9.6 beats per min., respiratory rate -7.0 breaths per min, oxygen saturation + 1.1%). Nonetheless, post-therapy values were better for all four measures in the CPC group. Regression modeling with correction for individual responses within each patient also yielded attenuated effects of MT in the CPC group compared to HTC, likely caused by the improved pre-therapy values. Live performed music therapy benefits preterm infants' vital signs and behavioral state. During CPC with a parent, the absolute therapeutic effect is attenuated but resulting post-therapy values are nonetheless better for both the COMFORTneo scale and vital signs.

Automatic assessment of infant carrying and holding using at-home wearable recordings

Assessing infant carrying and holding (C/H), or physical infant-caregiver interaction, is important for a wide range of contexts in development research. An automated detection and quantification of infant C/H is particularly needed in long term at-home studies where development of infants' neurobehavior is measured using wearable devices. Here, we first developed a phenomenological categorization for physical infant-caregiver interactions to support five different definitions of C/H behaviors. Then, we trained and assessed deep learning-based classifiers for their automatic detection from multi-sensor wearable recordings that were originally used for mobile assessment of infants' motor development. Our results show that an automated C/H detection is feasible at few-second temporal accuracy. With the best C/H definition, the automated detector shows 96% accuracy and 0.56 kappa, which is slightly less than the video-based inter-rater agreement between trained human experts (98% accuracy, 0.77 kappa). The classifier performance varies with C/H definition reflecting the extent to which infants' movements are present in each C/H variant. A systematic benchmarking experiment shows that the widely used actigraphy-based method ignores the normally occurring C/H behaviors. Finally, we show proof-of-concept for the utility of the novel classifier in studying C/H behavior across infant development. Particularly, we show that matching the C/H detections to individuals' gross motor ability discloses novel insights to infant-parent interaction.

Music production and its role in coalition signaling during foraging contexts in a hunter-gatherer society

Music is a cultural activity universally present in all human societies. Several hypotheses have been formulated to understand the possible origins of music and the reasons for its emergence. Here, we test two hypotheses: (1) the coalition signaling hypothesis which posits that music could have emerged as a tool to signal cooperative intent and signal strength of alliances and (2) music as a strategy to deter potential predators. In addition, we further explore the link between tactile cues and the propensity of mothers to sing toward infants. For this, we investigated the singing behaviors of hunter-gatherer mothers during daily foraging trips among the Mbendjele BaYaka in the Republic of the Congo. Although singing is a significant component of their daily activities, such as when walking in the forest or collecting food sources, studies on human music production in hunter-gatherer societies are mostly conducted during their ritual ceremonies. In this study, we collected foraging and singing behavioral data of mothers by using focal follows of five BaYaka women during their foraging trips in the forest. In accordance with our predictions for the coalition signaling hypothesis, women were more likely to sing when present in large groups, especially when group members were less familiar. However, predictions of the predation deterrence hypothesis were not supported as the interaction between group size and distance from the village did not have a significant effect on the likelihood of singing. The latter may be due to limited variation in predation risk in the foraging areas, because of the intense bush meat trade, and hence, future studies should include foraging areas with higher densities of wild animals. Lastly, we found that mothers were more likely to sing when they were carrying infants compared to when infants were close, but carried by others, supporting the prediction that touch plays an important prerequisite role in musical interaction between the mother and child. Our study provides important insight into the role of music as a tool in displaying the intent between or within groups to strengthen potentially conflict-free alliances during joint foraging activities.

Opportunities to expand postpartum support for those in recovery from opioid use disorder: Results from a qualitative study

Introduction

Over the past two decades the national prevalence of opioid use disorder (OUD) during pregnancy has increased more than 600%. Managing recovery from OUD during the postpartum period can be particularly challenging. Thus, we sought to identify ways to expand perinatal OUD treatment to ultimately reduce risk of postpartum return to opioid misuse.

Methods

We conducted in-depth semi-structured interviews with pregnant or postpartum (i.e., gave birth within the past year) mothers who have OUD, as well as with professionals who work with this population. Interviews were audio-recorded, transcribed, and coded for themes using Dedoose software using an eco-social framework.

Results

Participants included 7 mothers (median age 32 years old; 100% receiving treatment for OUD) and 11 professionals (average of 12.5 years in the field; n=7 healthcare providers, n=4 child safety caseworkers). A total of 10 major themes emerged in three levels. First, at an individual level themes included mental health, personal responsibility, and individual agency. Second, at the inter-individual level themes included support from friends and family, and other sources of support. Next, at the systems/institutional level themes included culture of healthcare systems, an ill-equipped healthcare system, social determinates of health, and continuum of care. Finally, a theme identified across all three levels included keeping mother and baby together.

Conclusions

Several opportunities to enhance the support and clinical care of OUD during the perinatal period were identified. Additional work is needed to explore how these themes may be incorporated into existing programs and/or the development of new interventions.

Universality without uniformity - infants' reactions to unresponsive partners in urban Germany and rural Ecuador

Previous studies based on non-WEIRD (Western, Educated, Industrialized, Rich, and Democratic) samples provide initial evidence that the still-face effect is universal. Based on the assumption that - independent of their cultural niches - infants share some fundamental expectations of social interactions, we put forth the assumption that a universal response exists for when a social interaction is interrupted. At the same time, we hypothesized that the size of the effect depends on the typicality of the interaction that precedes the adult partners' interruption. To test these hypotheses, we conducted the Still-Face Paradigm (SFP) with infants (3- and 4.5-month-olds) from two cultural milieus, namely Münster (urban Germany) and the Kichwa ethnic group from the northern Andes region (rural Ecuador), as these contexts presumably offer different ways of construing the self that are associated with different parenting styles, namely distal and proximal parenting. Furthermore, we developed a paradigm that comes much closer to the average expected environment of Kichwa infants, the "No-Touch Paradigm" (NTP). Overall, the results support our initial hypothesis that the still-face effect is universal. Moreover, infants from both cultural milieus responded to the no-touch condition with a change in negative affect. At the same time, some of the infants' responses were accentuated in a culture-specific way: Kichwa infants had a stronger response to an interruption of proximal interaction patterns during the NTP. While our findings underline infants' universal predisposition for face-to-face interaction, they also suggest that cultural differences in internalized interactions do influence infant behavior and experience and, in turn, development.

Oxytocin but not naturally occurring variation in caregiver touch associates with infant social orienting

Caregiver touch is crucial for infants' healthy development, but its role in shaping infant cognition has been relatively understudied. In particular, despite strong premises to hypothesize its function in directing infant attention to social information, little empirical evidence exists on the topic. In this study, we investigated the associations between naturally occurring variation in caregiver touch and infant social attention in a group of 6- to 13-month-old infants (n = 71). Additionally, we measured infant salivary oxytocin as a possible mediator of the effects of touch on infant social attention. The hypothesized effects were investigated both short term, with respect to touch observed during parent-infant interactions in the lab, and long term, with respect to parent-reported patterns of everyday touching behaviors. We did not find evidence that caregiver touch predicts infant social attention or salivary oxytocin levels, short term or long term. However, we found that salivary oxytocin predicted infant preferential attention to faces relative to nonsocial objects, measured in an eye-tracking task. Our findings confirm the involvement of oxytocin in social orienting in infancy, but raise questions regarding the possible environmental factors influencing the infant oxytocin system.

Caregiver-child proximity as a dimension of early experience

Human infancy and early childhood is both a time of heightened brain plasticity and responsivity to the environment as well as a developmental period of dependency on caregivers for survival, nurturance, and stimulation. Across primate species and human evolutionary history, close contact between infants and caregivers is species-expected. As children develop, caregiver-child proximity patterns change as children become more autonomous. In addition to developmental changes, there is variation in caregiver-child proximity across cultures and families, with potential implications for child functioning. We propose that caregiver-child proximity is an important dimension for understanding early environments, given that interactions between children and their caregivers are a primary source of experience-dependent learning. We review approaches for operationalizing this construct (e.g., touch, physical distance) and highlight studies that illustrate how caregiver-child proximity can be measured. Drawing on the concepts proposed in dimensional models of adversity, we consider how caregiver-child proximity may contribute to our understanding of children's early experiences. Finally, we discuss future directions in caregiver-child proximity research with the goal of understanding the link between early experiences and child adaptive and maladaptive functioning.