The implications of face masks for babies and families during the COVID-19 pandemic: A discussion paper

Communication challenges caused by wearing masks and strategies used by pediatric nurses during the COVID-19 pandemic: A qualitative study

PURPOSE

The COVID-19 pandemic and the use of facemasks have caused many communication challenges for pediatric nurses. The purpose of this study was to investigate these challenges and the strategies that nurses use to overcome them during the nursing care of sick children.

DESIGN AND METHODS

This was a qualitative study using conventional content analysis. The nurses were selected by purpose-based sampling and interviewed semi-structurally between April and June 2023 at the Children's Educational Therapy Center in Tabriz, Iran. The sample size was determined by the data saturation principle. The report of this research followed the COREQ guidelines.

RESULTS

Twelve nurses were interviewed. The analysis revealed four main categories: "Disturbances in communication", "Disturbances in trust", "Disturbances in providing care", and "Nurses' strategies to mitigate the challenges of mask usage. To solve the challenges caused by the mask, nurses used solutions such as removing the mask and mitigating the adverse effects of mask usage they used. The central theme of the study was "Humanistic care requires trust-based communication".

CONCLUSIONS

This study highlights the communication challenges faced by pediatric nurses due to mask-wearing during the COVID-19 pandemic. Despite these challenges, nurses have developed innovative strategies to improve communication and build trust with their young patients. Further research is needed to evaluate the effectiveness and feasibility of these strategies.

PRACTICAL IMPLICATIONS

These strategies can be useful for other nurses who work with children in similar conditions. Further research is needed to evaluate the effectiveness and feasibility of these strategies in different settings and populations.

Associations between maternal postpartum depression and infant temperament in treatment-seeking mothers prior to and during the COVID-19 pandemic

It remains unclear how the COVID-19 pandemic has affected the mother-infant relationship and associations between maternal postpartum depression (PPD) and offspring temperament. This study examined the impact of the pandemic on these links and how maternal ratings of the mother-infant relationship mediated associations between PPD and infant temperament in a sample of treatment-seeking mothers in Ontario, Canada before and during the COVID-19 pandemic. Mothers with infants <12 months of age and Edinburgh Postnatal Depression Scale scores ≥10 enrolled in two separate randomized controlled trials of 1-day cognitive behavioral therapy-based workshops for PPD conducted before COVID-19 (n = 392) and during the pandemic (n = 403). Mothers reported on depressive symptomatology, infant temperament, and the mother-infant relationship. Maternal PPD was associated with more infant negative affectivity and mother-infant relationship difficulties. While associations between PPD and infant-focused anxiety were stronger during COVID-19, the pandemic did not otherwise affect associations between PPD and infant temperament. Mediation analyses suggested that aspects of the mother-infant relationship mediated associations between PPD and infant negative affectivity. Findings highlight the importance of detecting PPD and intervening to potentially improve outcomes for mothers and their children.

The Mediating Role of Fear of COVID-19 in the Association between COVID-19-Related Work Stressors and Subjective Well-being: Path Analysis by Cross-sectional Evidence in the Child Care Sector across Three Samples

OBJECTIVE

COVID-19 has changed work conditions and instilled fear. However, research overlooked the contributing factors to fear of COVID-19 and its impact on well-being. We addressed this research gap and focused on the essential workforce of child care.

METHODS

Three samples of early childhood professionals (ECPs) ( NT1 = 423, NT2 = 142, NT3 = 584) were gathered in Germany between June 2020 and May 2021. We tested via path analysis whether (1) fear of COVID-19 relates to well-being, (2) COVID-19-related work stressors relate to fear of COVID-19, and (3) fear of COVID-19 mediates the relationship of work stressors and well-being.

RESULTS

Findings of N T1 and N T3 lent support, while results of N T2 differed.

CONCLUSIONS

This study underlines the importance of adapting the work conditions during pandemics to reduce the fear of infection and thus preserve ECPs' well-being.

Infants' responses to masked and unmasked smiling faces: A longitudinal investigation of social interaction during Covid-19

During the COVID-19 pandemic, face masks became an effective hygienic measure to reduce infection rates. Given the relevance of facial expressions for social interactions, the question arises how face masks affect early social interactions. The current longitudinal study investigated how covering parts of the face might impact infants' responses to others' emotional expressions. Infants who were born during the pandemic were examined at three measurement points at the age of 6, 10 and 14 months. After displaying a neutral facial expression an experimenter smiled at infants while either wearing a mask (mask condition) or not wearing a mask (no mask condition). Infants' change in affect (i.e., negative, neutral, positive) from the neutral to the test phase (i.e., smiling experimenter) was evaluated. Results showed that at 6 and at 10 months infants' behavior did not differ between conditions, whereas at 14 months infants were more likely to show a change from neutral/negative affect to positive affect in the no mask condition than in the mask condition. Moreover, at 14 months infants were less likely to respond positively to the experimenter's smile (across conditions) than at 6 and at 10 months. These findings broaden our understanding of potential effects of mask wearing on the development of face processing and affective communication. Overall, they indicate a developmental trend according to which infants' processing and response to others' positive emotions becomes more selective and differentiated with increasing age.

Parental Perspectives on Impact of Parental Presence Restrictions in the Neonatal Intensive Care Unit During the COVID-19 pandemic: A Cross-Sectional Study

PURPOSE

To describe parental experiences in the neonatal intensive care unit (NICU) during the COVID-19 restrictions. We explore what parents found most challenging, the impact these restrictions had on them and their infant, and how they coped.

METHODS

A cross-sectional online survey was completed by parents of infants who required care in a Canadian NICU during the early period of the COVID-19 pandemic. Data from 3 questions were coded using thematic analysis.

RESULTS

Participants ( n = 161) were primarily mothers (93%), with an average length of stay of 32.1 days. Three themes were identified from responses: (1) emotional and physical closeness of the parents to their infant; (2) physical and psychosocial well-being of the infant and parent; and (3) how parents coped, and strategies for moving forward. Parents reported that parental restriction policies adversely impacted their perceived physical and emotional closeness with their infant and their infant's physical and psychosocial well-being. Parents reported that being able to be present with their infant, having their partner able to be present with them, and effective communication helped them cope.

CONCLUSION

Despite the need for some restrictive policies to control the spread of the virus, the benefits and risks to the overall well-being of the parents and infants must be weighed.

Community diversity and the other-race effect in infancy

The other-race effect (ORE) is characterized by processing advantages for faces of one's own race over faces of another race and is observed at ~9 months of age. Environmental exposure to other races has an impact on the development of the ORE. In the current study, we examined the effects of community racial diversity on the ORE in 9- to 12-month-olds from across the United States. We hypothesized that community racial diversity would influence the amount of experience that infants have with individuals of other races and be an important factor in predicting the ORE across broad regions of the United States. We predicted that infants from more diverse communities would demonstrate successful processing of own- and other-race faces, while infants from less diverse communities would demonstrate successful processing of own-race but not other-race faces. This would indicate that the ORE is exhibited more strongly in infants from less diverse communities than in infants from more diverse communities. Participants completed familiarization and visual paired comparison (VPC) trials with own- and other-race faces in an online study. Our results showed that although the ORE was present, the effect was driven by community members who were the racial majority. Recognition biases were not observed in community racial or ethnic minority participants, potentially due to increased exposure to racial out-group members, which mitigated the development of the ORE in this subset of participants. This study has far-reaching implications in the study of infant face perception, child development, and social justice, as the ORE develops at a young age, and may lead to a complex pattern of racial biases contributing to systemic barriers in society.

Revisiting the rationale of mandatory masking

In this perspective, we review the evidence for the efficacy of face masks to reduce the transmission of respiratory viruses, specifically severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and consider the value of mandating universal mask wearing against the widespread negative impacts that have been associated with such measures. Before the SARS-CoV-2 pandemic, it was considered that there was little to no benefit in healthy people wearing masks as prophylaxis against becoming infected or as unwitting vectors of viral transmission. This accepted policy was hastily reversed early on in the pandemic, when districts and countries throughout the world imposed stringent masking mandates. Now, more than three years since the start of the pandemic, the amassed studies that have investigated the use of masks to reduce transmission of SARS-CoV-2 (or other pathogens) have led to conclusions that are largely inconsistent and contradictory. There is no statistically significant or unambiguous scientific evidence to justify mandatory masking for general, healthy populations with the intention of lessening the viral spread. Even if mask wearing could potentially reduce the transmission of SARS-CoV-2 in individual cases, this needs to be balanced against the physical, psychological and social harms associated with forced mask wearing, not to mention the negative impact of innumerable disposed masks entering our fragile environment. Given the lack of unequivocal scientific proof that masks have any effect on reducing transmission, together with the evident harms to people and the environment through the use of masks, it is our opinion that the mandatory use of face masks in the general population is unjustifiable and must be abandoned in future pandemic countermeasures policies.

Deficiencies in the Intentions, Attitudes, and Knowledge of Future Healthcare Professionals Regarding Breastfeeding

The aim of this study was to determine the level of knowledge, positive intentions, and attitudes regarding breastfeeding among university students. A validated questionnaire collected data from 236 students of the Faculty of Dental Medicine and Health Osijek about breastfeeding intentions, attitudes, and knowledge. Descriptive methods were used to present the students' results in terms of their intentions, attitudes, and knowledge. For each question included in the questionnaire, the maximum possible and maximum achieved numbers of points were calculated, as well as the percentage of points achieved in relation to the maximum possible number. Correlations between the results on individual scales of the questionnaire and the total results of the questionnaire are shown by Spearman's correlation coefficient. Questionnaire answers that were least in line with professional recommendations were selected and analyzed. We found that the areas that should be given special attention in the education of students are: the intention of breastfeeding for more than a year; the use of breaks for breastfeeding in the workplace; attitudes and knowledge about the quality of breast milk in relation to substitutes; attitudes about breastfeeding in public places and breastfeeding for more than two years; and the feeling of maternity and breastfeeding (compared to bottle feeding). The relationship between the results was considered in terms of intentions, attitudes, and knowledge in relation to the overall results of the questionnaire, and the authors' thoughts on the reasons behind the poorer results achieved for certain questions were presented.

Does wearing facial masks increase perceived facial attractiveness? An eye-tracking experiment

As wearing a mask has become a routine of daily life since COVID-19, there is a growing need for psycho-physiological research to examine whether and how mask-fishing effects can occur and operate. Building upon a notion that people are likely to utilize information available from the facial areas uncovered by a mask to form the first impression about others, we posit a curvilinear relationship between the amount of the facial areas covered by a mask and the perception of others' attractiveness such that the attractiveness perception increases initially and then decreases as more facial areas are covered by a mask. To better examine this covering effect, we conduct an experiment using an eye-tracker and also administer a follow-up survey on the facial attractiveness of target persons. Our results showed that the facial attractiveness of target persons increased as the areas covered by a mask increased as in the moderate covering condition where the target persons wore only a facial mask, demonstrating that the mask-fishing was indeed possible thanks to the covering effect of a mask on the facial attractiveness. The experimental results, however, revealed that the mask-fishing effect disappeared as the areas covered increased further as in the excessive covering condition where the target persons' face and forehead were covered with a mask and a bucket hat. More importantly, the eye-tracking data analysis demonstrated that both the number of gaze fixation and revisits per unit area were significantly lower in the moderate covering than in the excessive covering condition, suggesting that participants in the moderate covering were able to form the impression about the target persons using cues available from the eyes and forehead areas such as hairstyle and eye color whereas those in the excessive covering were provided only a limited set of cues concentrated in the eyes area. As a result, the covering effect no longer existed under the excessive covering. Furthermore, our results showed that participants in the moderate covering were more likely than those in the excessive condition to exhibit the higher level of curiosity and perception of beautifulness but perceived the lower level of coldness when evaluating the target persons. The current research offers theoretical contributions and practical implications made from the eye-tracking experiment and discusses possible avenues for further research.

Effects of face masks on language comprehension in bilingual children

Due to the COVID-19 pandemic, many children receive language input through face coverings. The impact of face coverings for children's abilities to understand language remains unclear. Past research with monolingual children suggests that hearing words through surgical masks does not disrupt word recognition, but hearing words through transparent face shields proves more challenging. In this study, we investigated effects of different face coverings (surgical masks and transparent face shields) on language comprehension in bilingual children. Three-year-old English-Mandarin bilingual children (N = 28) heard familiar words in both English and Mandarin spoken through transparent face shields, surgical masks, and without masks. When tested in English, children recognized words presented without a mask and through a surgical mask, but did not recognize words presented with transparent face shields, replicating past findings with monolingual children. In contrast, when tested in Mandarin, children recognized words presented without a mask, through a surgical mask, and through a transparent face shield. Results are discussed in terms of specific properties of English and Mandarin that may elicit different effects for transparent face shields. Overall, the present findings suggest that face coverings, and in particular, surgical masks do not disrupt spoken word recognition in young bilingual children.

Perinatal women's experiences of childbirth and parenting during the COVID-19 pandemic: A qualitative descriptive study

In this study, we described perinatal women's experiences of childbirth and parenting during the COVID-19 pandemic, guided by the qualitative descriptive methodology. We interviewed 14 women who gave birth during the pandemic. Data were analyzed using inductive qualitative content analysis. Our results showed that perinatal women experienced fear of COVID-19 infection, depression, and difficulties related to childbirth and parenting. They believed that online services and sharing information through social networking were helpful. They were looking forward to participating in outdoor activities to promote children's development and suggested enforcing untact (no contact) services for perinatal women in the post-COVID-19 era.

Mother-infant emotional availability through the COVID-19 pandemic: Examining continuity, stability, and bidirectional associations

The COVID-19 pandemic may impact the development of infants' social communication patterns with their caregivers. The current study examined continuity, stability, and bidirectional associations in maternal and infant dyadic Emotional Availability (EA) before and during the COVID-19 pandemic. Participants were 110 Israeli mother-infant dyads (51% girls) that were assessed prior to (Mage = 3.5 months) and during (Mage = 12.4 months) the pandemic. At both time points, mother-infant interactions were observed during play (nonstressful context) and tasks designed to elicit infant frustration (stressful context). Maternal and child EA were coded offline. Maternal EA demonstrated no significant mean-level changes from before to during the COVID-19 pandemic, whereas infant responsiveness and involvement increased over time. Stability and bidirectional associations in EA differed by context and were evident only in the stressful context. Mothers' perceived levels of social support further moderated these associations. Specifically, infants' pre-pandemic responsiveness and involvement predicted maternal EA during the pandemic only when mothers reported low levels of social support. Our findings suggest that maternal and child EA were not adversely impacted by the COVID-19 pandemic. However, patterns of EA demonstrated moderate-to-no stability over time, suggesting considerable individual differences in trajectories of EA.

The effect of masks on the visual preference for faces in the first year of life

To prevent the spread of COVID-19, face masks were mandatory in many public spaces around the world. Since faces are the gateway to early social cognition, this raised major concerns about the effect face masks may have on infants' attention to faces as well as on their language and social development. The goal of the present study was to assess how face masks modulate infants' attention to faces over the course of the first year of life. We measured 3, 6, 9, and 12-month-olds' looking behavior using a paired visual preference paradigm under two experimental conditions. First, we tested infants' preference for upright masked or unmasked faces of the same female individual. We found that regardless of age, infants looked equally long at the masked and unmasked faces. Second, we compared infants' attention to an upright masked versus an inverted masked face. Three- and 6-month-olds looked equally long to the masked faces when they were upright or inverted. However, 9- and 12-month-old infants showed a novelty preference for the inverted masked face. Our findings suggest that more experience with faces, including masked faces, leads to efficient adaptations of infants' visual system for processing impoverished social stimuli, such as partially occluded faces.

Impact of the COVID-19 Pandemic Regulations on the Health Status and Medical Care of Children with Trisomy 21

BACKGROUND

While children are considered at low risk for COVID-19, little is known about the impact of SARS-CoV-2 on paediatric risk patients like children with Trisomy 21 (T21). As these children often need regular therapy and various medical appointments, this study aimed to investigate the possible impact of the COVID-19 pandemic on children with T21.

PATIENTS AND METHODS

Parents of children with T21 in the age of 0-12 years in Saxony-Anhalt were interviewed via phone in June 2021 regarding the health status and medical care of their children during the past 15 months of pandemic.

RESULTS

37 children with mean age of 6.1 years (min 0; max 12) were included in the study. The majority did not have any additional congenital anomalies. Surveyed parents hardly reported adverse changes of health status during the pandemic, but rather improvements, such as decreased number of respiratory infections and more time spend with their children. Outpatient appointments and therapy were cancelled or postponed at the onset of the pandemic, but parents reported low impact on their child's health and development. The main concern seemed to be lack of childcare during school and day-care closures and uncertainty concerning possible health impacts of an infection on their children.

CONCLUSION

There was low impact of the COVID-19 pandemic on health and medical care of children with T21 in our study population. Further research is needed to help weigh the child's individual risk of infection against the need for medical treatment and therapy when dealing with paediatric risk patients.

Face processing in the infant brain after pandemic lockdown

The role of visual experience in the development of face processing has long been debated. We present a new angle on this question through a serendipitous study that cannot easily be repeated. Infants viewed short blocks of faces during fMRI in a repetition suppression task. The same identity was presented multiple times in half of the blocks (repeat condition) and different identities were presented once each in the other half (novel condition). In adults, the fusiform face area (FFA) tends to show greater neural activity for novel versus repeat blocks in such designs, suggesting that it can distinguish same versus different face identities. As part of an ongoing study, we collected data before the COVID-19 pandemic and after an initial local lockdown was lifted. The resulting sample of 12 infants (9-24 months) divided equally into pre- and post-lockdown groups with matching ages and data quantity/quality. The groups had strikingly different FFA responses: pre-lockdown infants showed repetition suppression (novel > repeat), whereas post-lockdown infants showed the opposite (repeat > novel), often referred to as repetition enhancement. These findings provide speculative evidence that altered visual experience during the lockdown, or other correlated environmental changes, may have affected face processing in the infant brain.

Toddler-teacher interaction and teachers' sensitivity as predictors of toddler's development during COVID-19: Stability or change over time

This study examined the stability and change patterns among toddlers' interactions with their teachers, teachers' sensitivity, and toddlers' development during the COVID-19 pandemic and the three plausible paths were tested to identify which of the study variables affected the development of toddlers in subsequent periods over time. The subjects of this study were 63 toddlers and 6 head teachers who attended a subsidized child care center, located in Kyunggi province, Korea. In order to carry out the research objectives, a non-experimental survey research design was undertaken, and the qualitative data was obtained via on-site observations by trained researchers. With regard to continuity and change patterns among the study variables toddlers who had been actively involved in initiating their verbal interactions with teachers showed more verbal interactions with their teachers even after 4 months passed. Also, it was found that the early (T1) social disposition of toddlers and the behavioral interaction that toddlers had initiated with teachers revealed a significant effect, supporting each of the three models, which are simultaneous, cumulative, and complex paths. The main results of this research support the contention that the interaction patterns vary by contexts of subject, time, and history, indicating that it would be useful to understand new competencies required for teachers within the context of the multi-faceted ramifications of the pandemic on toddler development.

Communicating and reading emotion with masked faces in the Covid era: A short review of the literature

Face masks have proven to be key to slowing down the SARS-Cov2 virus spread in the COVID-19 pandemic context. However, wearing face masks is not devoid of "side-effects", at both the physical and psychosocial levels. In particular, masks hinder emotion reading from facial expressions as they hide a significant part of the face. This disturbs both holistic and featural processing of facial expressions and, therefore, impairs emotion recognition, and influences many aspects of human social behavior. Communication in general is disrupted by face masks, as they modify the wearer's voice and prevent the audience from using lip reading or other non-verbal cues for speech comprehension. Individuals suffering from psychiatric conditions with impairment of communication, are at higher risk of distress because masks increase their difficulties to read emotions from faces. The identification and acknowledgement of these "side-effects" on communication are necessary because they warrant further work on adaptive solutions that will help foster the use of face masks by the greatest number.

Assessing the impact of the COVID-19 pandemic on parental satisfaction in two European neonatal intensive care units

BACKGROUND

Neonatal units across the world have altered their policies to prevent the spread of infection during the COVID-19 pandemic. Our aim was to report parental experience in two European neonatal units during the pandemic.

METHODS

Parents of infants admitted to each neonatal unit were asked to complete a questionnaire regarding their experience during the COVID-19 pandemic. At King's College Hospital, UK (KCH), data were collected prospectively between June 2020 and August 2020 (first wave). At the Hospital Clínic Barcelona (HCM), data were collected retrospectively from parents whose infants were admitted between September 2020 and February 2021 (second and third wave).

RESULTS

A total of 74 questionnaires were completed (38 from KCH and 36 from HCM). The parents reported that they were fully involved or involved in the care of their infants in 34 (89.4%) responses in KCH and 33 (91.6%) responses in HCM. Quality time spent with infants during the pandemic was more negatively affected at KCH compared with HCM (n=24 (63.2%) vs n=12 (33.3%)). Parents felt either satisfied or very satisfied with the updates from the clinical care team in 30 (79.0%) responses at KCH and 30 (83.4%) responses in HCM. The parents felt that the restrictions negatively affected breast feeding in six (15.8%) responses at KCH and two (5.6%) responses in HCM. Travelling to the hospital was reported overall to be sometimes difficult (39.2%); this did not differ between the two units (14 (36.8%) respondents at KCH and 15 (41.6%) from HCM). Furthermore, the self-reported amount of time spent giving kangaroo care also did not differ between the two countries.

CONCLUSION

Restrictive policies implemented due to the COVID-19 pandemic had a negative impact on the perception of quality of time spent by parents with their newborns admitted to neonatal units.

How experience shapes infants' communicative behaviour: Comparing gaze following in infants with and without pandemic experience

The COVID-19 pandemic has been influencing people's social life substantially. Everybody, including infants and children needed to adapt to changes in social interactions (e.g., social distancing) and to seeing other people wearing facial masks. In this study, we investigated whether these pandemic-related changes influenced 12- to 15-months-old infants' reactions to observed gaze shifts (i.e., their gaze following). In two eye-tracking tasks, we measured infants' gaze-following behavior during the pandemic (with-COVID-19-experience sample) and compared it to data of infants tested before the pandemic (no-COVID-19-experience sample). Overall, the results indicated no significant differences between the two samples. However, in one sub-task infants in the with-COVID-19-experience sample looked longer at the eyes of a model compared to the no-COVID-19-experience sample. Within the with-COVID-19-experience sample, the amount of mask exposure and the number of contacts without mask were not related to infants' gaze-following behavior. We speculate that even though infants encounter fewer different people during the pandemic and are increasingly exposed to people wearing facial masks, they still also see non-covered faces. These contacts might be sufficient to provide infants with the social input they need to develop social and emotional competencies such as gaze following.

Impact of Using Facemasks on Literacy Learning: The Perception of Early Childhood Education Teachers

In this work, quantitative research is carried out on the importance that educators give to literacy work in early childhood education classrooms and the impact that the COVID-19 pandemic and the use of facemasks have had on it. To this end, a survey designed for this purpose has been used, which has been passed on to a set of 112 Spanish early childhood educators. The teachers surveyed occupy different positions in the classroom (tutors, support technicians, specialists in bilingualism, therapeutic pedagogy and speech and hearing), and, in addition, they themselves learned to read from different methods of literacy learning (synthetic or analytical). The results found in this study indicate that educators express intermediate evaluations of the importance of literacy work in the classroom, higher if it is done through digital resources, and higher for the synthetic method than for the analytical method. In addition, the impact of the use of masks on literacy learning was rated as very negative. On the other hand, gaps have been identified in the above perceptions by the position occupied in the classroom and by the method used to learn to read. Finally, some actions are suggested to homogenize the perceptions of the different professionals, and some lines of research are proposed.

Learning to Recognize Unfamiliar Voices: An Online Study With 12- and 24-Month-Olds

Young infants are attuned to the indexical properties of speech: they can recognize highly familiar voices and distinguish them from unfamiliar voices. Less is known about how and when infants start to recognize unfamiliar voices, and to map them to faces. This skill is particularly challenging when portions of the speaker’s face are occluded, as is the case with masking. Here, we examined voice−face recognition abilities in infants 12 and 24 months of age. Using the online Lookit platform, children saw and heard four different speakers produce words with sonorous phonemes (high talker information), and words with phonemes that are less sonorous (low talker information). Infants aged 24 months, but not 12 months, were able to learn to link the voices to partially occluded faces of unfamiliar speakers, and only when the words were produced with high talker information. These results reveal that 24-month-old infants can encode and retrieve indexical properties of an unfamiliar speaker’s voice, and they can access this information even when visual access to the speaker’s mouth is blocked.

Parents' experiences regarding neonatal care during the COVID-19 pandemic: country-specific findings of a multinational survey

OBJECTIVES

The COVID-19 pandemic has disrupted healthcare systems, challenging neonatal care provision globally. Curtailed visitation policies are known to negatively affect the medical and emotional care of sick, preterm and low birth weight infants, compromising the achievement of the 2030 Development Agenda. Focusing on infant and family-centred developmental care (IFCDC), we explored parents' experiences of the disruptions affecting newborns in need of special or intensive care during the first year of the pandemic.

DESIGN

Cross-sectional study using an electronic, web-based questionnaire.

SETTING

Multicountry online-survey.

METHODS

Data were collected between August and November 2020 using a pretested online, multilingual questionnaire. The target group consisted of parents of preterm, sick or low birth weight infants born during the first year of the COVID-19 pandemic and who received special/intensive care. The analysis followed a descriptive quantitative approach.

RESULTS

In total, 1148 participants from 12 countries (Australia, Brazil, Canada, China, France, Italy, Mexico, New Zealand, Poland, Sweden, Turkey and Ukraine) were eligible for analysis. We identified significant country-specific differences, showing that the application of IFCDC is less prone to disruptions in some countries than in others. For example, parental presence was affected: 27% of the total respondents indicated that no one was allowed to be present with the infant receiving special/intensive care. In Australia, Canada, France, New Zealand and Sweden, both the mother and the father (in more than 90% of cases) were allowed access to the newborn, whereas participants indicated that no one was allowed to be present in China (52%), Poland (39%), Turkey (49%) and Ukraine (32%).

CONCLUSIONS

The application of IFCDC during the COVID-19 pandemic differs between countries. There is an urgent need to reconsider separation policies and to strengthen the IFCDC approach worldwide to ensure that the 2030 Development Agenda is achieved.

Infant looking preferences towards dynamic faces: A systematic review

Although the pattern of visual attention towards the region of the eyes is now well-established for infants at an early stage of development, less is known about the extent to which the mouth attracts an infant's attention. Even less is known about the extent to which these specific looking behaviours towards different regions of the talking face (i.e., the eyes or the mouth) may impact on or account for aspects of language development. The aim of the present systematic review is to synthesize and analyse (i) which factors might determine different looking patterns in infants during audio-visual tasks using dynamic faces and (ii) how these patterns have been studied in relation to aspects of the baby's development. Four bibliographic databases were explored, and the records were selected following specified inclusion criteria. The search led to the identification of 19 papers (October 2021). Some studies have tried to clarify the role played by audio-visual support in speech perception and early production based on directly related factors such as the age or language background of the participants, while others have tested the child's competence in terms of linguistic or social skills. Several hypotheses have been advanced to explain the selective attention phenomenon. The results of the selected studies have led to different lines of interpretation. Some suggestions for future research are outlined.

"Responsible" or "Strange?" Differences in Face Mask Attitudes and Use Between Chinese and Non-East Asian Canadians During COVID-19's First Wave

Early in the COVID-19 pandemic, journalists and scholars noted differences between Asians and North Americans in their support for public mask use. These differences were primarily assumed to be due d to variations in ethnocultural norms and practices. To better ascertain people's motives for wearing masks and potential cultural differences in these rationales, this comparative, mixed-methods research examines Chinese and non-East Asian Canadians' mask use attitudes utilizing online group interviews (Study 1) and a nation-wide survey (Study 2) Study 1, conducted in the early stages of the pandemic, captured an ambivalent, yet evolving attitude toward public mask use among the non-East Asian Canadians, which differed from their Chinese counterparts who more uniformly perceived mask use favorably. Study 2, conducted 2 months later, suggests that both groups primarily wore masks for disease protection- and prevention-related reasons. However, age and education appeared to influence the mask wearing frequency of the non-East Asian Canadians, for whom public mask use was less prevalent and normative. The attitudinal differences in public mask use call for targeted strategies to support mask wearing for different ethnocultural groups, which may be achieved partially through enhancing interethnic understanding on the diversified use of and opinions about masks. The findings suggest that favorable social norms, along with evidence-based information campaigns involving personal appeals may encourage greater mask use by the non-East Asian population.

The impact of the COVID-19 pandemic on infant and toddler development

BACKGROUND

The COVID-19 pandemic has created new cultural norms with pervasive societal implications. Families have experienced a heightened amount of physical, psychological, emotional, and financial stress. Infants and children living with stress have the potential for delayed developmental milestones, difficulty with emotional regulation, and social or behavioral issues.

PURPOSE

This study aims to determine if the pandemic has affected developmental outcomes in infants and toddlers.

METHODOLOGY

Prepandemic and postpandemic developmental (ASQ-3) scores were obtained from charts of 1,024 patients (6, 12, 18, 24, and 36 months) from two pediatric practices.

RESULTS

There were no significant differences in prepandemic and postpandemic ASQ-3 scores for the overall sample. Age-group analysis showed statistically significant differences in domain scores. Postpandemic problem-solving scores decreased among 6-month-olds while increasing among 24-month-olds. Categorization by score interpretation categories showed a slight decrease in postpandemic scores in the communication domain among 6- and 12-month-olds.

CONCLUSIONS

The pandemic has the potential to affect childhood development. However, the results of this study are reassuring, showing only slight differences in developmental scores prepandemic versus postpandemic. More studies are needed to establish causation and possible trends in future developmental trajectories.

IMPLICATIONS

An increased focus on communication screening and promotion of language and communication skills in young children postpandemic is needed. Education about the importance of parent-child engagement, nurturing relationships, opportunities for free-play and exploration, and caregiver support and stress reduction will continue to be of paramount importance.

The Impact of the Implementation of Preventive Measures Due to COVID-19 on Work Design and Early Childhood Professionals' Well-Being-A Qualitative Study

The reopening of child-care programs during COVID-19 demanded comprehensive preventive measures. Research to date has overlooked this reopening process as well as early childhood professionals’ (ECPs) implementation efforts and resulting changes in their work practices and well-being. As a result, this study sought insights into (1) the practical implementation of measures, (2) perceptions and evaluations of measures, (3) changes in work characteristics, and (4) its impact on well-being. Qualitative interviews were conducted with German child-care managers (N = 27) between June and August 2020. The semi-structured interviews were audio-recorded, transcribed, and content-analyzed using MAXQDA. ECPs, through a combination of high effort and engagement, ensured the feasibility of most preventive measures. This included practices which were perceived to be unreasonable or ones which were stricter than practices required for the public. This exacerbated the critical work characteristics (e.g., high workload, overtime, and multitasking) from pre-pandemic scenarios and led to new work demands (e.g., changes in work content and social interactions). ECPs maintained intensive work demands and consequently suffered from broad strain outcomes (e.g., worry, exhaustion, anger, fear of infection, and reduced psychological sense of community). This study highlights the adverse psychosocial work environment of ECPs despite the necessity of ensuring health and safety at work.

Nursing care recommendation for pediatric COVID-19 patients in the hospital setting: A brief scoping review

BACKGROUND

The hospitalization of children during the COVID-19 pandemic has affected their physical and mental health. Pediatric nurses have faced challenges in providing high-quality nursing care for children and their families. However, the pediatric nursing care recommendations for COVID-19 patients in the hospital setting remain unclear. The current scoping review provides recommendations for nursing interventions for pediatric COVID-19 patients in the hospital setting.

METHODS AND FINDINGS

The selected articles containing management and nursing recommendations for COVID-19 that have occurred in pediatric patients ages 0-19 years old. A search strategy was developed and implemented in seven databases. We included peer-reviewed articles that reported observational or interventional studies, as well as policy papers, guides or guidelines, letters and editorials, and web articles. A total of 134 articles and other documents relevant to this review were included. We categorized the results based on The Nursing Intervention Classification (NIC) taxonomy which consists of six domains (e.g., Physiological: Basic); eleven classes (e.g., Nutrition Support); and eighteen intervention themes (e.g., Positioning, Family Presence Facilitation, Family Support, and Discharge Planning).

CONCLUSION

Apart from the intervention of physical problems, there is a need to promote patient- and family-centered care, play therapy, and discharge planning to help children and families cope with their new situation.

Early impact of the COVID-19 pandemic on promotion of infant activity, strength and communication: A qualitative exploration

INTRODUCTION

Fostering physical activity, muscle strengthening and communication skills in diverse environments are vital to ensuring healthy infant development; however, promotion of these skills may be impacted by the COVID-19 pandemic. Therefore, the purpose of this study was to explore healthcare workers, parents and childcare providers' perceptions of the pandemic's influence on how they engage with infants to promote physical activity, muscle strength and communication.

METHODS

37 subjects (12 = parents; 12 = childcare providers, 13 = healthcare workers) participated in a semi-structured interview. Data were analyzed via an inductive content analysis.

RESULTS

The majority of caregivers identified concerns related to: limitations in social interactions (especially masks impacting communication), lack of access to peer modeling, fewer opportunities for physical exploration, and a need for creative activities in diverse environments (e.g., home/childcare) for infant development during and after the pandemic.

CONCLUSIONS

Caregivers are concerned about the role COVID-19 is having on infant development. Additional resources on how to promote infant physical activity, muscle strength and communication despite challenges associated with the COVID-19 pandemic are needed.

How South African Families Protected Themselves during the COVID-19 Pandemic: A Qualitative Study

The World Health Organization (WHO) reported a cluster of cases of ‘viral pneumonia’—‘Coronavirus Disease 2019’ (COVID-19)—in Wuhan City, the People’s Republic of China on 31 December 2019. To curb the spread of the virus, various containment measures were introduced. However, no study has explored how families protected themselves during the pandemic. Therefore, this study explored how families protected themselves during the COVID-19 pandemic using a qualitative exploratory design. Thirty-one adult participants, representing families in the Western Cape province of South Africa, were virtually interviewed. The sampling approach was both convenient and snowball. The data were analysed using thematic analysis. The results show that families followed and adapted to the mainstream protection measures as implemented by the South African government but in addition believed that adherence to non-pharmaceutical interventions would protect them from contracting the virus. Therefore, the government and other stakeholders should support families in making it easier to protect themselves during the current and future pandemic(s).

Beyond the beauty of occlusion: medical masks increase facial attractiveness more than other face coverings

The sanitary-mask effect (Miyazaki and Kawahara in Jpn Psychol Res 58(3):261–272, 2016) is the finding that medical face masks prompt an image of disease and thus result in lower ratings of facial attractiveness of the wearer. However, during the COVID-19 pandemic, medical masks have been found to increase attractiveness (Patel et al. in Plast Reconstruct Surg Glob Open 8(8), 2020) although this could have been a general effect of occlusion. To further explore this issue, female participants were presented with a series of male faces of low or high attractiveness that were occluded with a medical mask, cloth mask, book or not occluded and asked to rate them on attractiveness. The results show that faces were considered as most attractive when covered by medical masks and significantly more attractive when occluded with cloth masks than when not occluded. Contrary to expectation, base attractiveness did not interact with the type of occlusion, suggesting that this is not simply due to occlusion of negative features. The present findings are contrary to the sanitary-mask effect and explanations in terms of social desirability, and the association of medical masks with caregiving professions is explored.

Deep Learning Models for Multiple Face Mask Detection under a Complex Big Data Environment

The Covid-19 (coronavirus) pandemic creates a worldwide health crisis. According to the WHO, the effective protection system is wearing a face mask in public places. Many studies proved that carrying a face mask is also one of the precautions to decrease the possibility of viral transmission. Strict monitoring of face mask being worn by people is now enforced in many countries. Manual observation and monitoring is quite tedious. Hence, automated systems have been researched using well-kwown face mask detection methods. However, this research paper, deals with some deep learning models which can be effectively used to detect multiple face masks in a crowded environment when the amount of incoming data from sensors is huge or in otherwise stated to a Big data problem. Hence, standalone face detection models are not quite suited. Deep learning models are required in such Big data scenario which forms the essence of this study.

The Implications of COVID-19 on Family-Centered Care in the NICU

During the recent COVID-19 pandemic, neonatal intensive care units (NICUs) issued strict visiting policies that limited parent visitation and impacted how family-centered care was practiced. This article describes how these visiting policies impacted parents and neonates. Implications for clinical practice and future research will also be discussed.

The effect of coronavirus disease 2019 on newborns

PURPOSE OF REVIEW

To evaluate the available literature regarding effects of coronavirus disease 2019 (COVID-19) on newborns, ranging from effects related to in utero and perinatal exposure to maternal severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, to pandemic-related stress and socioeconomic changes.

RECENT FINDINGS

Several large studies and national registries have shown that the risk of vertical transmission from SARS-CoV-2-infected mothers to newborns is rare and does not appear to be related to postnatal care policies such as mother-newborn separation and breastfeeding. Newborns exposed to SARS-CoV-2 in utero are at higher risk for preterm delivery for reasons still under investigation. When newborns do acquire SARS-CoV-2 infection, their disease course is usually mild. Long-term follow-up data are lacking, but preliminary reports indicate that, similarly to prior natural disasters, being born during the pandemic may be associated with developmental risk.

SUMMARY

Although risk of vertical or perinatal transmission is low across a range of postnatal care practices, early indicators suggest developmental risk to the generation born during the pandemic. Long-term follow-up data are critically needed to determine the developmental impact of in utero and early life exposure to SARS-CoV-2 and the COVID-19 pandemic.

Understanding the Impact of Face Masks on the Processing of Facial Identity, Emotion, Age, and Gender

The COVID-19 pandemic has introduced new challenges for governments and individuals. Unprecedented efforts at reducing virus transmission launched a novel arena for human face recognition in which faces are partially occluded with masks. Previous studies have shown that masks decrease accuracy of face identity and emotion recognition. The current study focuses on the impact of masks on the speed of processing of these and other important social dimensions. Here we provide a systematic assessment of the impact of COVID-19 masks on facial identity, emotion, gender, and age. Four experiments (N = 116) were conducted in which participants categorized faces on a predefined dimension (e.g., emotion). Both speed and accuracy were measured. The results revealed that masks hindered the perception of virtually all tested facial dimensions (i.e., emotion, gender, age, and identity), interfering with normal speed and accuracy of categorization. We also found that the unwarranted effects of masks were not due to holistic processes, because the Face Inversion Effect (FIE) was generally not larger with unmasked compared with masked faces. Moreover, we found that the impact of masks is not automatic and that under some contexts observers can control at least part of their detrimental effects.

[Impact of wearing face masks in public to prevent infectious diseases on the psychosocial development in children and adolescents: a systematic review]

Hintergrund

Zur Prävention tröpfchenübertragener Infektionskrankheiten wird das Tragen einer Maske im öffentlichen Raum unter bestimmten Bedingungen empfohlen.

Ziel der Arbeit

Ziel war, über eine sensitive Literatursuche möglichst alle deutsch- und englischsprachigen Forschungsergebnisse aus begutachteten Fachzeitschriftenartikeln zu den Auswirkungen des Masketragens zur Prävention von Infektionen auf die psychosoziale Entwicklung von Kindern und Jugendlichen zusammenzutragen.

Methoden

Es wurde ein systematischer Review unter Berücksichtigung verschiedener Studiendesigns durchgeführt (Suchzeitraum bis einschließlich 12.07.2021). Das Verzerrungsrisiko der Studien wurde mit einem Risk-of-Bias-Verfahren ermittelt. Es fand eine deskriptiv-narrative Ergebnissynthese statt.

Ergebnisse

Es wurden 13 Studien eingeschlossen, wobei das Gesamtverzerrungsrisiko in allen Primärstudien als hoch eingeschätzt wurde. Es gibt Hinweise aus Befragungsstudien, dass die Fähigkeit zum Lesen der Mimik von Kindern/Jugendlichen und/oder ihren Betreuer:innen im (Vor‑)Schulsetting durch das Masketragen als beeinträchtigt erlebt wird, die durch mehrere Experimentalstudien bestätigt wurden. 2 Studien berichteten über psychische Symptome wie Ängste oder Stresserleben sowie Konzentrations- und Lernschwierigkeiten durch das Masketragen während der COVID-19-Pandemie. Eine Studie während der SARS-Pandemie 2002/2003 untersuchte mündliche Prüfungsleistungen in Englisch als Fremdsprache und zeigte keinen Unterschied zwischen den Bedingungen „Maske“ versus „keine Maske“.

Diskussion

Zu den Auswirkungen des Masketragens auf verschiedene Entwicklungsbereiche von Kindern und Jugendlichen lassen sich basierend auf der unzureichenden Studienlage nur wenige Erkenntnisse ableiten. Es fehlen Forschungsdaten zu den Folgen für die Endpunkte psychische Entwicklung, Sprachentwicklung, sozioemotionale Entwicklung, soziales Verhalten, Schulerfolg und Teilhabe. Weitere qualitative Studien und epidemiologische Studien sind unbedingt nötig.

Zusatzmaterial online

Zusätzliche Informationen sind in der Online-Version dieses Artikels (10.1007/s00103-021-03443-5) enthalten.

Neonatal care during the COVID-19 pandemic - a global survey of parents' experiences regarding infant and family-centred developmental care

BACKGROUND

The COVID-19 pandemic restrictions affect provision and quality of neonatal care. This global study explores parents' experiences regarding the impact of the restrictions on key characteristics of infant and family-centred developmental care (IFCDC) during the first year of the pandemic.

METHODS

For this cross-sectional study, a pre-tested online survey with 52 questions and translated into 23 languages was used to collect data between August and November 2020. Parents of sick or preterm infants born during the pandemic and receiving special/intensive care were eligible for participation. Data analysis included descriptive statistics and statistical testing based on different levels of restrictive measures.

FINDINGS

In total, 2103 participants from 56 countries provided interpretable data. Fifty-two percent of respondents were not allowed to have another person present during birth. Percentages increased with the extent of restrictions in the respondents' country of residence (p = 0·002). Twenty-one percent of total respondents indicated that no-one was allowed to be present with the infant receiving special/intensive care. The frequency (p < 0·001) and duration (p = 0·001) of permitted presence largely depended on the extent of restrictions. The more restrictive the policy measures were, the more the respondents worried about the pandemic situation during pregnancy and after birth.

INTERPRETATION

COVID-19 related restrictions severely challenged evidence-based cornerstones of IFCDC, such as separating parents/ legal guardians and their newborns. Our findings must therefore be considered by public health experts and policy makers alike to reduce unnecessary suffering, calling for a zero separation policy.

FUNDING

EFCNI received an earmarked donation by Novartis Pharma AG in support of this study.

Breastfeeding in the context of the COVID-19 pandemic: A discussion paper

Breastfeeding offers one of the most fundamental global health benefits for babies. Breastmilk is lifesaving, providing not only nutrition but immunologic benefits and as such is strongly supported by the World Health Organization and leading healthcare associations worldwide. When the COVID-19 pandemic started in 2020, the impact of the restrictions to prevent the spread of the disease created challenges and questions about provision of safe, quality care, including breastfeeding practices, in a new 'normal' environment. Mothers were temporarily separated from their babies where infection was present or suspected, parents were prevented from being present on neonatal units and vital breastfeeding support was prevented. This discussion paper provides an overview of essential areas of knowledge related to practice for neonatal nurses and midwives who care for breastfeeding mothers and babies, in the context of the COVID-19 pandemic and the latest global guidance. Three areas will be discussed; the protective benefits of breastfeeding, keeping breastfeeding mothers and babies together and supporting mothers to breastfeed their babies. Finally, care recommendations are presented to serve as a summary of key points for application to practice for neonatal nurses and midwives.

Presentation of a participatory approach to develop preventive measures to reduce COVID-19 transmission in child care

Background

It can be suspected that work in child care facilities is associated with an elevated exposure risk towards SARS-CoV-2 infections. It is still unclear under which conditions employees in those facilities can safely pursue their work. Preventive workplace-related measures to reduce transmission dynamics in this work environment need to be developed. These measures need to build on a solid scientific foundation and be ready for practical use at the same time. Therefore, the aim of the study is to present a participatory approach to identify, minimize, and eliminate workplace-specific COVID-19 transmission within child care. The approach presented combines quantitative as well as qualitative elements and includes a screening of critical workplace conditions and the development of preventive measures to foster a safe workplace design.

Methods

First, 428 employees of different child care facilities in a large German city reported their subjective risk of infection, fear of infection, and support received by the employer. Second, the participants commented in detail about high risk conditions during work. Third, employees provided suggestions for preventive measures. We conducted a qualitative analysis of free text answers to evaluate which aspects are perceived as critical from an employee perspective.

Results

Participants provided valuable and practicable ideas on how to design and improve preventive measures to reduce COVID-19 transmission in child care dealing with structural conditions, the interaction with the parents, the implementation of preventive measures and recommendations for policy makers.

Conclusions

These new insights help to organize pandemic risk management in order to align theoretical based measures with the practical realization. We encourage researchers to adapt the approach presented to other work areas in order to foster participation of employees in work design to reduce COVID-19 transmission.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12995-021-00316-0.

Maintaining Momentum in Infant Mental Health Research During COVID-19: Adapting Observational Assessments

Understanding the potential effects of the COVID-19 pandemic on the developing parent-infant relationship is a priority, especially for medically-fragile infants and their caregivers who face distinct challenges and stressors. Observational assessments can provide important insights into parent-child behaviors and relational risk; however, stay-at-home directives and physical distancing measures associated with COVID-19 have significantly limited opportunities for in-person observational parent-infant assessment. To maintain momentum in our research program during the pandemic, we rapidly pivoted to remote, technology-assisted parent-infant observational assessments. In this commentary, we offer a series of strategies and recommendations to assist researchers in adapting observational parent-infant paradigms. We also discuss the benefits, challenges, and limitations of distance-delivered assessments, and offer considerations for clinical service provision and future research during and post the COVID-19 pandemic. .