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Elbow flexion contracture development in school-age children with a brachial plexus birth injury (BPBI) is common. Reports indicate onset between 2 and 4 years; however, little is known about early childhood prevalence, development, and trajectory of these contractures. To determine the prevalence and predictors of BPBI elbow flexion contractures during early childhood. A retrospective cross-sectional study. Demographic, diagnostic, treatment, and elbow contracture data were collected for children with a BPBI <4 years between 2015 and 2019 from a prospectively collected database. Spinal root motor contributions and injury were determined using Active Movement Scale (AMS) scores at 6 weeks of age and used to predict contracture development. Of the 171 children that met inclusion criteria, 87% (n = 149) had upper plexus injuries. The mean age at the time of evaluation for an elbow contracture was 21.4 ± 12.7 months. The prevalence of elbow flexion contractures was 22% (n = 38), with mean onset at 13.4 ± 11.0 months. Mean contracture degree was −10.8 ± −6.9 degrees with 76% (n = 29) <−10 degrees. AMS shoulder abduction, flexion, and external rotation; elbow flexion; forearm supination; and wrist extension scores at a mean 2.3 ± 1.4 months were significantly lower in children who developed elbow flexion contractures (p < 0.001). Logistic regression found that low AMS elbow flexion with high elbow extension scores were a significant (p < 0.003) predictor of elbow contracture development. The prevalence of elbow flexion contractures in early childhood is greater than previously understood. These findings indicate that C5-C6 injury affecting elbow flexion with relative preservation of elbow extension is a predictor of contracture development. Further research is needed to investigate the nature and sequelae of C5-C6 injury and its effects on elbow flexion contracture development. • Early childhood prevalence of BPBI elbow contractures was 22% with a mean onset at 13.4 months of age. • The magnitude of the contractures was mild and a mean 10.8 ± -6.9 degrees. • C5/C6 injury affecting elbow flexion with preserved extension predicted contracture development. [ABSTRACT FROM AUTHOR]

To better understand caregivers' decisional processes related to offering novel and disliked foods to their infants and toddlers. As part of a parent study on young children's food acceptance that took place in Denver, CO, this secondary analysis used a basic qualitative approach to explore caregivers' decisional processes related to repeated exposure and children's food rejection. English-speaking caregivers of infants and toddlers (aged 6–24 months; n = 106) were recruited via flyers and social media and interviewed (from July, 2017 to January, 2018) during a laboratory visit focused on introducing a novel food. Factors influencing caregiver decisions to (dis)continue offering novel or disliked foods. Using a combined deductive and inductive coding approach, trained researchers coded transcripts and codes, which were reviewed and discussed by all investigators to identify themes. Three major themes (and 2 subthemes) were generated regarding caregivers' decisions about re-offering rejected foods: 1) Caregivers understand that multiple experiences with new foods are needed because children's reactions can be unpredictable and depend upon time, developmental stage, and child traits; 2) Caregivers vary in their persistence and decisions to keep offering foods depending on responsiveness to child cues (sub-theme) and adult-centered beliefs, needs, and decisions (sub-theme); 3) Child food acceptance will change with time, circumstances, and development if you keep trying. Although caregivers are aware of repeated exposure, additional implementation research focused on translating theory into effective home practices could assist caregivers to persist in offering novel or disliked foods. [ABSTRACT FROM AUTHOR]

Anhedonia, an impairment in the motivation for or experience of pleasure, is a well-established transdiagnostic harbinger and core symptom of mental illness. Given increasing recognition of early life origins of mental illness, we posit that anhedonia should, and could, be recognized earlier if appropriate tools were available. However, reliable diagnostic instruments prior to childhood do not currently exist. We developed an assessment instrument for anhedonia/reward processing in infancy, the Infant Hedonic/Anhedonic Processing Index (HAPI-Infant). Exploratory factor and psychometric analyses were conducted using data from 6- and 12-month-old infants from two cohorts (N = 188, N = 212). Then, associations were assessed between infant anhedonia and adolescent self-report of depressive symptoms. The HAPI-Infant (47-items), exhibited excellent psychometric properties. Higher anhedonia scores at 6 (r = 0.23, p <.01) and 12 months (r = 0.19, p <.05) predicted elevated adolescent depressive symptoms, and these associations were stronger than for established infant risk indicators such as negative affectivity. Subsequent analyses supported the validity of short (27-item) and very short (12-item) versions of this measure. The primary limitations of this study are that the HAPI-Infant awaits additional tests of generalizability and of its ability to predict clinical diagnosis of depression. The HAPI-Infant is a novel, psychometrically strong diagnostic tool suitable for recognizing anhedonia during the first year of life with strong predictive value for later depressive symptoms. In view of the emerging recognition of increasing prevalence of affective disorders in children and adolescents, the importance of the HAPI-Infant in diagnosing anhedonia is encouraging. Early recognition of anhedonia could target high-risk individuals for intervention and perhaps prevention of mental health disorders. • Anhedonia is a well-established transdiagnostic harbinger of mental illness. • No diagnostic tool for anhedonia assessment exists prior to childhood. • We present a valid new tool enabling assessment of anhedonia in infancy. • Infant anhedonia uniquely predicts youth self-report of depressive symptoms. • Early recognition of anhedonia may support strategies for prevention and intervention. [ABSTRACT FROM AUTHOR]

The early assessment of language and communication abilities is critical to meet the needs and challenges of inclusive societies. We developed a novel e-health approach whereby well-known assessment tools are available through online applications that allow a quick (computer, tablet, smartphone) on-screen assessment, making health monitoring and intervention in this field highly flexible and possible in a rich variety of contexts and users, including practitioners, educators, researchers, and caregivers. The app versions of the MacArthur-Bates Communicative Development Inventory Short forms (CDI) and the Communication and Symbolic Behavior Scales Developmental Profile (CSBS-DPTM) Infant-Toddler Checklist offer automatic scoring and percentile profiles for the individual infant and toddler. The easy, quick, decentralized access to health monitoring in the sensitive areas of cognitive and language development fosters the early identification of risk for language and communication impairments, early intervention and diagnosis, with individual, social and economic benefits. [ABSTRACT FROM AUTHOR]

Recognizing what is normal constitutes a key skill for medical practitioners, especially paediatricians. It is a necessary requisite to providing reassurance and avoiding unnecessary referrals, investigations and treatment. Normal variants are atypical or uncommon findings in a given population which are of no clinical or pathological significance yet fall within the spectrum of what is considered the normal range. The list of conditions discussed in this article is by no means complete or comprehensive but merely a reflection of frequently encountered issues in primary care, paediatric outpatients and the paediatric emergency department; they include infantile dyschezia, 'catch down' growth, familial macrocephaly, positional plagiocephaly, asymmetrical thigh creases, sacral dimples, physiological anisocoria, PURPLE screaming episodes, gastro-oesophageal reflux and infant gratification and also provide guidance on what not to miss. This short article provides essential guidance for those new to paediatric outpatients or those less familiar with providing advice and guidance to worried parents. [ABSTRACT FROM AUTHOR]

• A brief parenting intervention led to improvements in infant effortful control (EC) • Intervention effects on infant behavior were moderated by EC. • Early interventions that increase positive parenting may increase infant EC. • Infants with low EC may benefit from additional support to achieve similar results. Despite the important developmental outcomes associated with effortful control (EC), there is limited research demonstrating the efficacy of early interventions for improving EC and assessing the extent to which a child's level of baseline EC impacts the outcome of intervention on externalizing problems. This study aims to fill these gaps in the literature by assessing the efficacy of the Infant Behavior Program (IBP), a parenting intervention for infants with elevated levels of behavior problems, in improving infant EC and the moderating effect of baseline infant EC on intervention outcomes. Participants included 60 high-risk 12- to 15-month-old infants and their mothers. Families were randomized to receive the IBP or standard pediatric primary care. Parent-report measures of infant behavior and compliance were examined at baseline, post-intervention, and 3- and 6-month follow-up assessments. Results showed infants who received the IBP displayed significantly higher levels of EC at the post-intervention assessment compared to infants in the control group. Additionally, moderation analyses showed initial levels of EC moderated the effect of the IBP on externalizing problems and compliance, such that infants with higher levels of baseline EC displayed greater decreases in externalizing problems at post-intervention and greater increases in compliance at the 6-month follow-up. While these findings did not survive a false discovery rate correction, they offer preliminary support for the efficacy of the IBP in improving infants' EC and highlight the importance of considering EC as a factor associated with early intervention outcomes for externalizing problems. [ABSTRACT FROM AUTHOR]

Prenatal maternal anxiety is a known influence on offspring development. General anxiety and pregnancy-related anxiety (a distinct type of anxiety encompassing fears associated with pregnancy) are associated with offspring socioemotional development, with potential consequences for later emotional and behavioral problems. This study examines whether maternal pregnancy-related and general anxiety relate to infant attention to affective faces, a process which plays an integral role in early socioemotional development. Participants included 86 mothers and their 6-month-old infants (56.3 % female). Mothers completed measures of pregnancy-related and general anxiety three times through gestation. Infants' attention to affective faces was assessed with an eye-tracking task during which a series of face pairs were presented (happy, angry, or sad face paired with a neutral face). Overall attention measures included attention-holding (total looking time) and attention-orienting (latency to faces); affect-biased attention measures included proportion of total looking time to emotional faces and latency difference score. Higher maternal pregnancy-related anxiety across gestation predicted decreased infant attention-holding to affective faces [ F (1,80) = 7.232, p =.009, partial η2 = 0.083]. No differences were found in infant attention-orienting or affect-biased attention. Reliance on a correlational study design precludes the ability to make causal inferences. Maternal pregnancy-related anxiety is an important predictor of child outcomes. We provide novel evidence that pregnancy-related anxiety predicts infant attention to emotional faces, behaviors which have important implications for socioemotional development. Providers may consider pregnancy-related anxiety as a target for screening and treatment that may benefit both pregnant individual and offspring. • Maternal pregnancy-related anxiety has intergenerational effects. • Fetal exposure to maternal anxiety and depression predicts child emotion processing. • Infant attention to affective faces is linked with later socioemotional development. • Infants exposed to greater pregnancy-related anxiety look less at affective faces. • Reducing pregnancy-related anxiety may benefit offspring socioemotional development. [ABSTRACT FROM AUTHOR]

Developmental shifts in infant temperament predict distal outcomes including emerging symptoms of psychopathology in childhood. Thus, it is critical to gain insight into factors that shape these developmental shifts. Although parental depression and anxiety represent strong predictors of infant temperament in cross-sectional research, few studies have examined how these factors influence temperament trajectories across infancy. We used latent growth curve modeling to examine whether mothers' and fathers' anxiety and depression, measured in two ways – as diagnostic status and symptom severity – serve as unique predictors of developmental shifts in infant temperament from 3 to 12 months. Participants included mothers (N = 234) and a subset of fathers (N = 142). Prior to or during pregnancy, both parents were assessed for lifetime diagnoses of depression and anxiety as well as current severity levels. Mothers rated their infants' temperament at 3, 6, and 12 months of age. Mothers' depression and anxiety primarily predicted initial levels of temperament at 3 months. Controlling for mothers' symptoms, fathers' depression and anxiety largely related to temperament trajectories across infancy. Lifetime diagnoses and symptom severities were associated with distinct patterns. Infant temperament was assessed using a parent-report measure. Including an observational measure would provide a more comprehensive picture of the infants' functioning. These results indicate that mothers' and fathers' mental health are uniquely associated with infant temperament development when measured using diagnostic status and/or symptom severity. Future studies should examine whether these temperament trajectories mediate intergenerational transmission of risk for depression and anxiety. • Mothers' depression and anxiety prior to birth predicted temperament at 3 months. • In fathers, these predictors related to shifts in temperament across infancy. • Lifetime diagnoses and symptom severities predicted distinct temperament profiles. • These results have implications for mental health screening and early intervention.s [ABSTRACT FROM AUTHOR]

The mother represents one of the earliest sources of microorganisms to the child, influencing the acquisition and establishment of its microbiota in early life. However, the impact of the mother on the oral microbiota of the child from early life until adulthood remains to unveil. This narrative review aims to: i) explore the maternal influence on the oral microbiota of the child, ii) summarize the similarity between the oral microbiota of mother and child over time, iii) understand possible routes for vertical transmission, and iv) comprehend the clinical significance of this process for the child. We first describe the acquisition of the oral microbiota of the child and maternal factors related to this process. We compare the similarity between the oral microbiota of mother and child throughout time, while presenting possible routes for vertical transmission. Finally, we discuss the clinical relevance of the mother in the pathophysiological outcome of the child. Overall, maternal and non-maternal factors impact the oral microbiota of the child through several mechanisms, although the consequences in the long term are still unclear. More longitudinal research is needed to unveil the importance of early-life microbiota on the future health of the infant. [Display omitted] [ABSTRACT FROM AUTHOR]

Objective: Differences in reward processing have been associated with numerous psychiatric disorders, including autism and ADHD. Many attempts to understand reward processing characterize differences in clinical populations after disorder onset; however, divergence may begin much earlier. In fact, the typical developmental progression of reward processing in infancy and early childhood is poorly understood. We reconceptualize classic infant developmental constructs such as preferential looking into a Six-Component Developmental Model of Reward Processing: an infant- and young child-focused framework to guide research and assessment of reward processing across development.Method: The extant developmental literature including recent textbooks, systematic reviews, and meta-analyses was reviewed to build a conceptual framework. We describe experimental paradigms to assess each developmental component of reward processing longitudinally from infancy. A timeline of each component's emergence was estimated.Results: Six components of reward processing were identified - association, discrimination, preference/valuation, effort, anticipation, and response. Selected evidence suggests emergence between birth and six months. Application of this model to autism led to a reinterpretation of existing disparate results, and illuminated a path to study the developmental processes underlying a popular hypothesis of autism, the motivation hypothesis. Current evidence further suggests a sensitive period may exist for the emergence of reward processing.Conclusion: The proposed framework offers a useful reconceptualization of the extant literature. Future longitudinal work using the suggested experimental paradigms with high-risk populations could elucidate the developmental trajectory of the six components and timing of potential sensitive period(s) for each component. [ABSTRACT FROM AUTHOR]

Right ventricular mass indexed to body surface area (RVMI) decreases and left ventricular mass index (LVMI) increases rapidly and substantially during early infancy. The relationship between these sizeable mass transformations and simultaneous electrocardiographic changes have not been previously delineated. Normal term infants (#45 initially enrolled) were prospectively evaluated at 2 days and at 2-week, 2-month, and 4-month clinic visits. Ventricular masses were estimated with 2D echocardiographic methods. QRS voltages were measured in leads V 1 , V 6 , I and aVF. Mean QRS axis shifted from 135 (95%CI 124, 146) to 65 degrees (95%CI 49, 81) and correlated with both RVMI decrease and LVMI increase (R = 0.46⁎ vs. 0.25†, respectively. * p < 0.01, † p < 0.05). As RVMI decreased from mean 28.1 (95%CI 27.1, 29.1) to 23.3 g/m2 (95%CI 21.4, 25.2) so did V 1 R and V 6 S voltages. RVMI changes correlated with V 1 R, V 6 S, and V 1 R + V 6 S voltages (R = 0.29*, 0.23† and 0.35*, respectively. * p < 0.01, †p < 0.05) but not with V 1 R/S ratio. As LVMI increased from 44.6 (95%CI 42.9, 46.3) to 55.4 g/m2 (95%CI 52.3, 58.5) V 6 R and V 6 Q increased but V 1 S voltage did not. LVMI changes correlated with V 6 R, V 6 R-S, and V 6 (Q + R)-S voltages (R = 0.31*, 0.34*, and 0.38* respectively. *p < 0.01) but not with V 1 S or V 6 R/S (R = 0.01 and 0.18 respectively, p = NS). Conclusions: During early infancy the RVMI decrease correlates best with the QRS axis shift and V 1 R + V 6 S voltage, and the LVMI increase correlates best with V 6 R-S and V 6 (Q + R)-S voltages • In early infancy indexed right ventricular mass decreases while the left increases. • Right ventricular mass index changes correlate best with the QRS axis shift. • Left ventricular mass index changes correlate best with V 6 (Q + R)-S voltage. • V 1 R/S voltage ratio does not correlate with right ventricular mass index. • V 1 S voltage and V 6 R/S voltage ratio do not correlate with left ventricular mass index. [ABSTRACT FROM AUTHOR]

New mothers generally experience poor and/or disrupted sleep. A range of infant care and mental health factors may impact new mothers' sleep quality. A cross-sectional online survey was completed by a sample of 101 Australian new mothers with children under 12 months (M = 5.52 months, SD = 3.29 months) to examine the relationship between infant feeding method, infant sleeping location, and postpartum depression with maternal sleep quality. Subjective maternal sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI), and postpartum depression was measured using the Edinburgh Postpartum Depression Scale (EPDS). Overall, new mothers experienced poor subjective sleep quality, with high average PSQI scores, above the cut-off of 5 (M = 9.63, SD = 4.07). The majority of new mothers did not experience postpartum depression, with an average EPDS score below the cut-off of 11 (8.66, SD = 5.20). Mothers who breastfed their infants experienced significantly better subjective sleep quality than mothers who bottle-fed, with a medium effect size (ηp2 = 0.458). Subjective maternal sleep quality did not differ based on infant sleeping location. Poor subjective maternal sleep quality was a significant predictor of postpartum depression. While poor sleep was common in this sample of Australian new mothers, this study demonstrated that new mothers who breastfeed may experience slightly better subjective sleep quality than other feeding methods. Further research into, and better services for the education and advocation of, new mothers' sleep quality will be beneficial to both new mothers and clinicians. • New mothers typically experience poor and/or disrupted sleep. • Their sleep can be impacted by personal factors and factors relating to infant care. • Breastfeeding was associated with better maternal sleep quality. • Maternal sleep quality was associated with infant sleeping location. • Poor maternal sleep quality predicted postpartum depression. [ABSTRACT FROM AUTHOR]

The purpose of this study was to investigate if social adversity is associated with mother reported emotional dysregulation behaviors and trajectories during infancy and early childhood. A secondary data analysis from the Durham Child Health and Development study study included 206 child-mother dyads. Three models were used to explore the relationship between social adversity and mother reported emotional dysregulation during infancy (Infant Behavior Questionnaire-Revised) and early childhood (Child Behavior Checklist - Dysregulation Profile). Linear mixed effects models were adopted to investigate if social adversity was associated with mother reported emotional dysregulation longitudinally. Regression analysis was conducted to explore if social adversity was associated with maternal reported emotional dysregulation trajectory slope scores and maternal reported emotional dysregulation trajectory class. Maternal psychological distress and the child's sex assigned at birth were included as covariates in each analysis. Infants with greater social adversity scores had significantly higher maternal reported fear responses across the first year of life. Social adversity was associated with maternal reported distress to limitations trajectory, dysregulated recovery class, and dysregulated distress to limitations class. During early childhood social adversity was significantly associated with maternal reported emotional dysregulation but not trajectories which showed little variability. Our results indicate that social adversity is associated with maternal reported emotional dysregulation during infancy and early childhood. Nursing and other professionals can participate in early screening to determine risk and provide intervention. • Social adversity was related to infant and child emotional dysregulation behaviors. • Social adversity was related to infant fear, distress, and recovery subscales. • Social adversity was not related to childhood emotional dysregulation trajectories. • Childhood emotional trajectories were stable across 18–84 months. • Nurses can screen and intervene on children susceptible to emotional dysregulation. [ABSTRACT FROM AUTHOR]

Heightened maternal stress during pregnancy is associated with atypical brain development and an elevated risk for psychopathology in offspring. Supportive environments during early postnatal life may promote brain development and reverse atypical developmental trajectories induced by prenatal stress. We reviewed studies focused on the role of key early environmental factors in moderating associations between prenatal stress exposure and infant brain and neurocognitive outcomes. Specifically, we focused on the associations between parental caregiving quality, environmental enrichment, social support, and socioeconomic status with infant brain and neurocognitive outcomes. We examined the evidence that these factors may moderate the effects of prenatal stress on the developing brain. Complementing findings from translational models, human research suggests that high-quality early postnatal environments are associated with indices of infant neurodevelopment that have also been associated with prenatal stress, such as hippocampal volume and frontolimbic connectivity. Human studies also suggest that maternal sensitivity and higher socioeconomic status may attenuate the effects of prenatal stress on established neurocognitive and neuroendocrine mediators of risk for psychopathology, such as hypothalamic-pituitary-adrenal axis functioning. Biological pathways that may underlie the effects of positive early environments on the infant brain, including the epigenome, oxytocin, and inflammation, are also discussed. Future research in humans should examine resilience-promoting processes in relation to infant brain development using large sample sizes and longitudinal designs. The findings from this review could be incorporated into clinical models of risk and resilience during the perinatal period and used to design more effective early programs that reduce risk for psychopathology. [ABSTRACT FROM AUTHOR]

Due to its easy and straightforward use, regional analysis with the "standard" mask is the most common approach for quantifying plantar pressures in infancy. Such a mask, however, identifies foot regions based on typical foot proportions and pressure gradients. Alternatively, the use of a customised mask retaining infants' feet proportions has not been explored. Does a customised mask scaled on infants' feet improve processing of pressure data collected during walking development compared with a standard mask? Thirteen infants walked across an EMED xl platform. Steps were grouped applying eight foot-regions standard and customised masks. To evaluate masks' performance, peak pressure (PP) and contact area (CA) were extracted from each region, and mask. Intra-individual coefficients of variation were then calculated for each variable, and compared between masks using a Mann-Whitney U test (p < 0.05). Unsuccessful masks application was reported, expressed as percentage of data loss. For CA variation, significant differences were found in all the regions but the lateral toes in new (Z = −0.184, p = 0.8540) and confident walking (Z = −1.562, p = 0.118). For PP variation, a significant difference was found in confident walking within the lateral midfoot (Z = −2.598, p = 0.009). With the standard mask, 22–27 % of data was lost in new and confident walking respectively, compared to 1.6–0 % with the customised. As a result, the customised mask characterised the more variable steps, demonstrating higher variation compared to the standard mask. Identifying foot regions using a mask based on infants' feet proportions yielded an improved performance compared to the standard mask. With the customised mask, we retained almost all the steps and characterised the variability of the data, thereby providing an appropriate approach for infants' pressure data processing. Application of the customised mask could therefore be beneficial in future studies analysing highly variable data sets. • Masking approaches are widely adopted to analyse infants' pressure data. • The customised approach improves mask application and mitigate data loss. • Analysis of infants' pressure data requires population-specific approaches. [ABSTRACT FROM AUTHOR]

Melanotic neuroectodermal tumors of infancy (MNTI) are a rare type of benign tumor that affects the head and neck region. MNTI represents (68–80%) of the tumors in the maxillary region. This tumor is usually located in the alveolar crest, skull, mandible, and brain. Although this tumor is considered benign, it can grow rapidly, with a high risk of recurrence and interference with functions of infancy, such as feeding and breathing. It is also frequently harmful to the surrounding soft and hard tissues or adjacent sensitive vital structures. This study aimed to review the pathological, clinical presentation, and treatment of melanotic neuroectodermal tumors in infancy and the role of dentists in these cases. [ABSTRACT FROM AUTHOR]

Background Research is needed to identify pathways by which household food insecurity (FI) contributes to parental controlling feeding styles and infant food responsiveness, 2 factors that play a role in shaping obesity risk across infancy and early childhood. Objectives This longitudinal study tested the hypothesis that prenatal FI would be positively associated with higher infant food responsiveness via greater parental mental health symptomatology and controlling feeding styles (pressuring, restrictive). Methods Participants included a community sample of 170 birth parents and their infants participating in an ongoing longitudinal study. Parents self-reported household FI and mental health symptoms (depression and anxiety) during pregnancy. Postnatally, parents reported their mental health symptoms, their use of controlling feeding styles, and infant food responsiveness. Path analyses with bias-corrected 95% bootstrapped CIs tested direct and indirect associations between prenatal FI and infant food responsiveness. Results Prenatal FI was indirectly associated with higher infant food responsiveness via greater parental mental health symptomatology and pressuring to finish (b = 0.01; 95% CI: 0.001, 0.025). Prenatal FI was associated with greater parental mental health symptomatology across the peripartum period (β = 0.54; P  < 0.001), which in turn was associated with more pressuring to finish at 2 months pospartum (β = 0.29; P  = 0.01) and higher infant food responsiveness at 6 months (β = 0.17; P  = 0.04). There were no direct effects of prenatal FI on controlling feedings styles or infant food responsiveness. Conclusions Our findings point to parental mental health as a potential pathway by which FI may be associated with obesity-promoting parental feeding styles and infant appetitive behaviors. In addition to ensuring reliable access to enough quality food during pregnancy, multipronged assistance that promotes emotional well-being during the peripartum period and clinical guidance on noncontrolling feeding styles could benefit parent and infant health and well-being. [ABSTRACT FROM AUTHOR]

Eye contact with a human and with a humanoid robot elicits attention- and affect-related psychophysiological responses. However, these responses have mostly been studied in adults, leaving their developmental origin poorly understood. In this study, 114 infants (6–8 months old) viewed direct and averted gaze directions of a live human and an embodied humanoid robot while their heart rate deceleration (attention orienting), skin conductance (affective arousal), and facial muscle activity (affective valence) were measured. In addition, a non-humanoid object (a vase) was used as a control stimulus. Infants' attention orienting was stronger to averted versus direct gaze of a human and a robot, but indifferent to the averted versus direct orientation of the non-humanoid object. Moreover, infants' attention orienting was equally intensive toward a human and a robot, but less intensive toward a non-humanoid object. Affective arousal was insensitive to gaze direction and did not differ between the human, the robot, and the non-humanoid object. Facial muscle responses showed sensitivity to the gaze direction of a human and of a robot but not to the orientation of the non-humanoid object. These results suggest that infants recognize the attentional and affective/affiliative significance not only in a human's gaze but also in a robot's gaze. • We investigated infants' psychophysiological responses to eye contact. • Infants viewed direct and averted gaze of a live human and of a humanoid robot. • Heart rate deceleration, skin conductance and facial electromyography were measured. • Responses were sensitive to the gaze direction of a human and of a humanoid robot. [ABSTRACT FROM AUTHOR]

The HEALthy Brain and Child Development (HBCD) Study, a multi-site prospective longitudinal cohort study, will examine human brain, cognitive, behavioral, social, and emotional development beginning prenatally and planned through early childhood. Wearable and remote sensing technologies have advanced data collection outside of laboratory settings to enable exploring, in more detail, the associations of early experiences with brain development and social and health outcomes. In the HBCD Study, the Novel Technology/Wearable Sensors Working Group (WG-NTW) identified two primary data types to be collected: infant activity (by measuring leg movements) and sleep (by measuring heart rate and leg movements). These wearable technologies allow for remote collection in the natural environment. This paper illustrates the collection of such data via wearable technologies and describes the decision-making framework, which led to the currently deployed study design, data collection protocol, and derivatives, which will be made publicly available. Moreover, considerations regarding actual and potential challenges to adoption and use, data management, privacy, and participant burden were examined. Lastly, the present limitations in the field of wearable sensor data collection and analysis will be discussed in terms of extant validation studies, the difficulties in comparing performance across different devices, and the impact of evolving hardware/software/firmware. [ABSTRACT FROM AUTHOR]

The HEALthy Brain and Child Development (HBCD) Study, a multi-site prospective longitudinal cohort study, will examine human brain, cognitive, behavioral, social, and emotional development beginning prenatally and planned through early childhood. Given its aim to examine the impact of adversity and protective factors on children's outcomes, the recruitment and retention of families who have a wide diversity in experiences are essential. However, the unfortunate history of inequitable treatment of underrepresented families in research and the risks with which some participants will contend (e.g., substance use) makes their recruitment and retention in social science and neuroscience research particularly challenging. This article explores strategies that the HBCD Study has developed to recruit and retain participants, including marginalized, underserved, and hard-to-reach populations, capitalizing on the extant literature and the researchers' own experiences. In this paper, we address strategies to recruit and retain families within HBCD, including: 1) creating experiences that engender trust and promote relationships; 2) maintaining connections with participants over time; 3) ensuring appropriate compensation and supports; 4) considerations for study materials and procedures; and 5) community engagement. The implementation of these strategies may increase representation and inclusiveness, as well as improve the quality of the resulting data. [ABSTRACT FROM AUTHOR]

Independent locomotion provides autonomy for infants, drastically changing their relationship with their surroundings. From a dynamic systems perspective, the interaction between environment, tasks, and organismic constraints leads to the emergence of new behaviors over time. This 6-month longitudinal study aimed to verify associations between the emergence of locomotor behaviors and infants' characteristics, developmental status, parental beliefs, and practices. This observational study remotely assessed 37 full-term Brazilian infants aged 5 to 15 months, divided into two groups (G1: 5 to 11 months, n = 19; and G2: 9 to 15 months, n = 18). The motor developmental status of infants was closely associated with the emergence of behaviors (p < 0.05). Infants in G2 whose parents agreed with the statement "In typically developing infants, motor development occurs naturally and there is no need to actively stimulate it" started to walk later than those whose parents disagreed. Infants whose parents expected them to walk around 10–11 months walked earlier compared to those expected to walk after 11 months (G2, p = 0.011). Infants in G2 with a high frequency of staying in the supine position started to walk, both with and without support, later than those with a low frequency (p < 0.05). For infants in G1 with a high frequency of playing on the floor, locomotion (p = 0.041) and crawling on hands-and-knees (p = 0.007) started sooner compared to those with a low frequency. Staying in the cradle more frequently was related to a later emergence of supported walk (p = 0.046) among infants in G2. The emergence of locomotor behaviors is associated with motor developmental status, the surfaces where the infant plays, and body position. Parental beliefs and expectations influence how infants are stimulated and, consequently, the emergence of independent walking. • Infants were filmed during free play at home each 15 days over 6 months of follow-up. • The developmental status was closely related to the emergence of locomotor behaviors. • To place the infant to play on the floor at 5 months old favors locomotion onset. • Parental beliefs were related to the emergence age of the upright locomotion. • Walking onset was associated with placing the infant in supine position and cradle. [ABSTRACT FROM AUTHOR]

Identifying the type of mechanisms at the core of phonetic categorization remains a central subject of research in infant language learning. Amongst different theories, one is that infants compute distributional information of phonemes based on their surrounding sounds (i.e., word context) such that phonemes that appear in different word contexts are more likely to be discriminated and categorized separately than phonemes that appear in similar word contexts. Following the procedure of Feldman et al. (2013a), we investigated the role of contextual information in the acquisition of phonetic categories in 8-month-old infants, using a non-native vowel contrast (English /ɒ/-/ʌ/). In Experiment 1, we established lack of discrimination of the non-native contrast without prior exposure to it. In Experiment 2, we manipulated the type of exposure prior to testing: half of the infants were exposed to minimal pair carriers (words that differ by one phoneme only; e.g., lituh and litoh), and the other half of the infants were exposed to non-minimal pair carriers (words formed by different phonemes; e.g., lituh and nutoh). All infants were tested for discrimination of the contrast (tuh vs. toh) presented as alternating (e.g., tuh-toh-tuh-toh) and non-alternating trials (e.g., tuh-tuh-tuh), as in Experiment 1. Infants in both conditions looked on average longer at alternating rather than non-alternating trials, suggesting that they discriminated the /ɒ/-/ʌ/ contrast after a brief exposure to the vowels embedded into words. Crucially, discrimination occurred regardless of whether words were minimal pair carriers or non-minimal pair carriers. A cross-experiment comparison revealed that infants showed different patterns of looking times based on whether they were exposed to the contrast before testing (Experiment 2) or not (Experiment 1). Our study shows that any type of word context helps infants to re-establish discrimination of non-native contrasts once sensitivity has been lost. These findings aid to better understand how the speech input modulates learning mechanisms during the establishment of phonetic categories in the first year of postnatal life. • Eight-month-old infants discriminated a non-native vowel contrast after brief exposure to vowels embedded in word forms. • Discrimination occurred regardless of whether word forms were minimal pairs or non-minimal pairs. • Any word context seems to help infants re-establishing discrimination of non-native contrasts once sensitivity has been lost. [ABSTRACT FROM AUTHOR]

Early vocabulary development is crucial for future cognitive and academic outcomes, and parent-child booksharing has been recognized as a powerful home literacy practice to promote word learning. However, evidence about the link between booksharing and language development in diverse cultural and socioeconomic settings is currently limited, hindering the formulation of a broadly applicable framework to understand the favorable conditions for early vocabulary development. This study explores the relationship between booksharing and early receptive and expressive vocabulary in a sample of 183 mothers and their toddlers in Costa Rica, a context where reading is not a common practice and children have limited access to books. Mothers completed an interview about their booksharing practices and reported children's receptive and expressive vocabulary. Results demonstrated a positive link between maternal booksharing and children's expressive vocabulary. Child gender moderated the link between booksharing and receptive vocabulary, exhibiting a stronger association in girls than in boys. Mothers with lower education levels reported higher expressive vocabulary scores for their children than mothers with higher education levels. These findings underscore the significance of booksharing in the home literacy environment, even in cultural contexts with distinct reading practices. Moreover, they highlight the need to incorporate sociocultural factors into comprehensive accounts concerning the role of booksharing in early word learning. • The relationship between self-reported maternal booksharing behavior and vocabulary development was examined in a sample of monolingual, Spanish-speaking children in Costa Rica. • Maternal booksharing behavior predicted children's expressive vocabulary. • Child gender moderated the relationship between maternal booksharing behavior and receptive vocabulary, exhibiting a stronger association in girls than in boys. • Mothers with lower education levels reported higher expressive vocabulary scores for their children than mothers with higher education levels. [ABSTRACT FROM AUTHOR]

Current knowledge suggests that the gene region containing MUC5B and TOLLIP plays a role in airway defence and airway inflammation, and hence respiratory disease. It is also known that exposure to air pollution increases susceptibility to respiratory disease. We aimed to study whether the effect of air pollutants on the immune response and respiratory symptoms in infants may be modified by polymorphisms in MUC5B and TOLLIP genes. 359 healthy term infants from the prospective Basel-Bern Infant Lung Development (BILD) birth cohort were included in the study. The main outcome was the score of weekly assessed respiratory symptoms in the first year of life. Using the candidate gene approach, we selected 10 single nucleotide polymorphisms (SNPs) from the MUC5B and TOLLIP regions. Nitrogen dioxide (NO 2) and particulate matter ≤10 μm in aerodynamic diameter (PM 10) exposure was estimated on a weekly basis. We used generalised additive mixed models adjusted for known covariates. To validate our results in vitro , cells from a lung epithelial cell line were downregulated in TOLLIP expression and exposed to diesel particulate matter (DPM) and polyinosinic-polycytidylic acid. Significant interaction was observed between modelled air pollution (weekly NO 2 exposure) and 5 SNPs within MUC5B and TOLLIP genes regarding respiratory symptoms as outcome: E.g., infants carrying minor alleles of rs5744034, rs3793965 and rs3750920 (all TOLLIP) had an increased risk of respiratory symptoms with increasing NO 2 exposure. In vitro experiments showed that cells downregulated for TOLLIP react differently to environmental pollutant exposure with DPM and viral stimulation. Our findings suggest that the effect of air pollution on respiratory symptoms in infancy may be influenced by the genotype of specific SNPs from the MUC5B and TOLLIP regions. For validation of the findings, we provided in vitro evidence for the interaction of TOLLIP with air pollution. [Display omitted] • SNPs in the MUC5B and TOLLIP regions modify infants' susceptibility to NO2. • This may help identify infants more susceptible to air pollution effects on the lungs. • Downregulation of TOLLIP alters cell reactions to pollutants (in vitro analysis). [ABSTRACT FROM AUTHOR]

OBJECTIVES: We evaluated the prevalence of high weight status in children ages 0 to 24 months (m) using data from electronic health records (EHR) and NHANES. We also examined relationships between weight status during infancy and obesity at 24 months of age. METHODS: EHR data from 4 institutions in North and South Carolina included patients born January 1, 2013--October 10, 2017 (N = 147,290). NHANES data included study waves from 1999 to 2018 (unweighted N = 5121). We calculated weight-for-length (WFL). weight-for-age (WFA), and body mass index (BMI), excluding implausible values, and categorized weight status (<85th, 85th to <95th, or ≥95th percentile), assessing prevalence at birth, 6, 12, 18, and 24 months. Utilizing individual, longitudinal EHR data, we used separate regression models to assess obesity risk at 24 months based on anthropometries at birth, 6, 12, and 18 months, adjusting for sex, race/ethnicity, insurance, and health system. RESULTS: Prevalence of BMI ≥95th percentile in EHR data at 6, 12, 18, and 24 months were 9.7%, 15.7%, 19.6%, and 20.5%, respectively. With NHANES the prevalence was 11.6%, 15.0%, 16.0%, and 8.4%. For both, the prevalence of high weight status was higher in Hispanic children. In EHR data, high weight status at 6, 12, and 18 months was associated with obesity at 24 months, with stronger associations as BMI category increased and as age increased. CONCLUSIONS: High weight status is common in infants and young children, although lower at 24 months in NHANES than EHR data. In EHR data, high BMI at 6, 12, and 18 months was associated with increased risk of obesity at 24 months. [ABSTRACT FROM AUTHOR]

The impact of breast-feeding on certain childhood respiratory illnesses remains controversial. We sought to examine the effect of exclusive breast-feeding on the early-life upper respiratory tract (URT) and gut microbiome, the URT immune response in infancy, and the risk of common pediatric respiratory diseases. We analyzed data from a birth cohort of healthy infants with prospective ascertainment of breast-feeding patterns and common pediatric pulmonary and atopic outcomes. In a subset of infants, we also characterized the URT and gut microbiome using 16S ribosomal RNA sequencing and measured 9 URT cytokines using magnetic bead–based assays. Of the 1949 infants enrolled, 1495 (76.71%) had 4-year data. In adjusted analyses, exclusive breast-feeding (1) had an inverse dose-response on the ⍺-diversity of the early-life URT and gut microbiome, (2) was positively associated with the URT levels of IFN-α, IFN-γ, and IL-17A in infancy, and (3) had a protective dose-response on the development of a lower respiratory tract infection in infancy, 4-year current asthma, and 4-year ever allergic rhinitis (odds ratio [95% CI] for each 4 weeks of exclusive breast-feeding, 0.95 [0.91-0.99], 0.95 [0.90-0.99], and 0.95 [0.92-0.99], respectively). In exploratory analyses, we also found that the protective association of exclusive breast-feeding on 4-year current asthma was mediated through its impact on the gut microbiome (P =.03). Our results support a protective causal role of exclusive breast-feeding in the risk of developing a lower respiratory tract infection in infancy and asthma and allergic rhinitis in childhood. They also shed light on potential mechanisms of these associations, including the effect of exclusive breast-feeding on the gut microbiome. [Display omitted] [ABSTRACT FROM AUTHOR]

Early life stress has been associated with elevated risk for later psychopathology. One mechanism that may contribute to such long-term risk is alterations in amygdala development, a brain region critical to stress responsivity. Yet effects of stress on the amygdala during human infancy, a period of particularly rapid brain development, remain largely unstudied. In order to model how early stressors may affect infant amygdala development, several discrepancies across the existing literatures on early life stress among rodents and early threat versus deprivation among older human children and adults need to be reconciled. We briefly review the key findings of each of these literatures. We then consider them in light of emerging findings from studies of human infants regarding relations among maternal caregiving, infant cortisol response, and infant amygdala volume. Finally, we advance a developmental salience model of how early threat may impact the rapidly developing infant brain, a model with the potential to integrate across these divergent literatures. Future work to assess the value of this model is also proposed. [Display omitted] • Infancy is a time of particularly rapid amygdala development. • Effects of stress on the infant amygdala are almost unstudied in humans. • Rodent studies suggest early stress responses to low maternal nurturance. • Rodent studies also suggest a hyporesponsive period to aversive maternal behavior. • A developmentally sequenced model of early threat could integrate these literatures. [ABSTRACT FROM AUTHOR]

In Western societies, social contingency, or prompt and meaningful back-and-forth exchanges between infant and caregiver, is a powerful feature of the early language environment. Research suggests that infants with better attentional skills engage in more social contingency during interactions with adults and, in turn, social contingency supports infant attention. This reciprocity is theorized to build infant language skills as the adult capitalizes on and extends the infant's attention during socially contingent interactions. Using data from 104 infants and caregivers, this paper tests reciprocal relations between infant attention and social contingency at 6- and 12-months and the implications for infant vocabulary at 18-months. Infant attentional skills to social (women speaking) and nonsocial (objects dropping) events were assessed, and social contingency was examined during an 8-minute toy play interaction with a caregiver. Child receptive and expressive vocabulary was measured by caregiver-report. Both social and nonsocial attentional skills related to engagement in social contingency during caregiver-infant interaction, though only models that included social attention and social contingency predicted vocabulary. These findings provide empirical evidence for the proposed reciprocal relations between infant attention and social contingency as well as how they relate to later language. • Infant attention relates to social contingency in the first year of life. • Attention to objects at 6 months relates to contingency at 12 months. • Attention to faces has bidirectional associations with contingency. • Early attention shifting and late attention maintenance relate to contingency. • Attention to faces and social contingency predict infant vocabulary. [ABSTRACT FROM AUTHOR]

Musical interactions between babies and their primary caregivers are very frequent during the early years of life and their impact on dyadic interaction and infants' development has garnered significant attention in recent literature. However, the difficulties that natural observations entail have meant that research often carries out methodological manipulations that have a significant impact on the phenomenon studied. In order to clarify how to investigate best natural musical interactions and the information that these can provide, we have carried out a systematic review to analyze the proposed scenarios and the variables analyzed in the studies published on such interactions between main caregivers and babies under three years old. We have screened 971 articles and yielded 27. We have found a higher prevalence in the literature of studies on singing interactions, between mothers and babies under 12 months of age. We have also been able to identify two extremes in terms of methodological structuring of natural interactions. Regarding the analysis variables, a few behaviors are repeated throughout the studies, being emotions, rhythmic behaviors and characterizations of the vocal emissions common between parents and babies. Synchrony is the dyadic variable with the most weight and also one of the preferred focuses of interest in the most recent literature that has undergone a shift of focus from characterization of musical interactions to the search for the mechanisms that underlie and make them specific. • Parent-infant musical engagment is crucial during early interactions, yet it is often studied with non-ecological approaches • In the studies reviewed, the most common interaction was mothers singing to typically developing infants under 12 months of age • Infants' attention, parents' vocalizations and synchrony in the dyads were the most analyzed variables in musical interactions • Literature has shifted from describing singing characteristics to delving into the underlying mechanisms by studying synchrony [ABSTRACT FROM AUTHOR]

Background: An increasing number of infant and follow-on formulas are enriched with probiotics and/or prebiotics; however, evidence for health effects of such enrichment in early childhood remains inconclusive.Objectives: The present study aimed to assess whether the consumption of formula enriched with probiotics or prebiotics was associated with the risk of infection and allergic diseases in early childhood.Methods: Analyses involved data for 8389 formula-fed children from the Etude Longitudinale Française depuis l'Enfance (ELFE) cohort. Enrichment of the formula with probiotics or prebiotics that was consumed from the age of 2-10 mo was identified by the formula ingredient list. Lower respiratory tract infection (LRTI), upper respiratory tract infection (URTI), gastrointestinal infection, wheezing, asthma, food allergy, and itchy rash were prospectively reported by parents up to the age of 5.5 y. Adjusted logistic regression models were used to assess associations between the consumption of enriched formula and risk of infection and allergic diseases.Results: Aged 2 mo, more than half of formula-fed infants consumed the probiotic-enriched formula and only 1 in 10 consumed the prebiotic-enriched formula. Consumption of the Bifidobacterium lactis-enriched formula at 2 mo was associated with a lower risk of LRTI [OR (95% CI) = 0.84 (0.73-0.96)]. Consumption of the Bifidobacterium breve-enriched formula up to 6 mo was associated with a higher risk of LRTI [OR (95% CI) = 1.75 (1.29-2.38)] and asthma [OR (95% CI) = 1.95 (1.28-2.97)], whereas its consumption from 6 to 10 mo was associated with a lower risk of LRTI [OR (95% CI) = 0.64 (0.48-0.86)] and asthma [OR (95% CI) = 0.59 (0.40-0.88)]. Moreover, the consumption of Streptococcus thermophilus from 6 to 10 mo was associated with a higher risk of asthma [OR (95% CI) = 1.84 (1.29-2.63)]. No significant association was found for gastrointestinal infection, food allergy, and itchy rash. Overall, the consumption of prebiotic-enriched formula was not significantly associated with infection and allergy risk.Conclusions: Associations between the consumption of probiotic-enriched formula and risk of respiratory symptoms differ according to the strain considered and consumption period. Further well-designed studies are needed to confirm these results. [ABSTRACT FROM AUTHOR]

• Maternal childhood trauma resulted in maternal and infant emotional difficulties. • Sexual abuse predicted the greatest disruption to perinatal outcomes. • Biological processes, such as cortisol levels, and psychosocial processes, such as current psychopathology, were identified as potential mechanisms. • Trauma screening is recommended in the perinatal period and standardised practices for research are suggested. Maternal childhood maltreatment (MCM) is linked to poor perinatal outcomes but the evidence base lacks cohesion. We explore the impact of MCM on four perinatal outcome domains: pregnancy and obstetric; maternal mental health; infant; and the quality of the care-giving environment. Mechanisms identified in the included studies are discussed in relation to the maternal programming hypothesis and directions for future research. We completed a comprehensive literature search of eight electronic databases. Independent quality assessments were conducted and PRISMA protocols applied to data extraction. Inclusion criteria was met by N = 49 studies. MCM was consistently associated with difficulties in maternal and infant emotional regulation and with disturbances in the mother-infant relationship. Directly observed and maternal-reported difficulties in the mother-infant relationship were often mediated by mothers' current symptoms of psychopathology. Direct and mediated associations between MCM and adverse pregnancy and obstetric outcomes were suggested by a limited number of studies. Emotional and sexual abuse were the most consistent MCM subtype significantly associated with adverse perinatal outcomes. A meta-analysis was not possible due to inconsistent reporting and the generally small number of studies for most perinatal outcomes. MCM is associated with adverse perinatal outcomes for mothers' and infants. Evidence suggests these associations are mediated by disruptions to maternal emotional functioning. Future research should explore biological and psychosocial mechanisms underpinning observed associations between specific subtypes of MCM and adverse perinatal outcomes. Services have a unique opportunity to screen for MCM and detect women and infants at risk of adverse outcomes during the perinatal period. [ABSTRACT FROM AUTHOR]

Background Inflammation during pregnancy may aggravate iron deficiency (ID) by increasing serum hepcidin and reducing iron absorption. This could restrict iron transfer to the fetus, increasing risk of infant ID and its adverse effects. Objectives We aimed to assess whether iron bioavailability and/or iron transfer to the fetus is impaired in overweight/obese (OW) pregnant women with adiposity-related inflammation, compared with normal-weight (NW) pregnant women. Methods In this prospective study, we followed NW (n  = 43) and OW (n  = 40) pregnant women who were receiving iron supplements from the 14th week of gestation to term and followed their infants to age 6 mo. We administered 57Fe and 58Fe in test meals mid-second and mid-third trimester, and measured tracer kinetics throughout pregnancy and infancy. Results In total, 38 NW and 36 OW women completed the study to pregnancy week 36, whereas 30 NW and 27 OW mother–infant pairs completed the study to 6 mo postpartum. Both groups had comparable iron status, hemoglobin, and serum hepcidin throughout pregnancy. Compared with the NW, the OW pregnant women had 1) 43% lower fractional iron absorption (FIA) in the third trimester (P = 0.033) with median [IQR] FIA of 23.9% [11.4%–35.7%] and 13.5% [10.8%–19.5%], respectively; and 2) 17% lower maternal–fetal iron transfer from the first tracer (P = 0.051) with median [IQR] maternal–fetal iron transfer of 4.8% [4.2%–5.4%] and 4.0% [3.6%–4.6%], respectively. Compared with the infants born to NW women, infants born to OW women had lower body iron stores (BIS) with median [IQR] 7.7 [6.3–8.8] and 6.6 [4.6–9.2] mg/kg body weight at age 6 mo, respectively (P = 0.024). Prepregnancy BMI was a negative predictor of maternal–fetal iron transfer (β = −0.339, SE = 0.144, P = 0.025) and infant BIS (β = −0.237, SE = 0.026, P = 0.001). Conclusions Compared with NW, OW pregnant women failed to upregulate iron absorption in late pregnancy, transferred less iron to their fetus, and their infants had lower BIS. These impairments were associated with inflammation independently of serum hepcidin. This trial was registered at clinicaltrials.gov as NCT02747316. [ABSTRACT FROM AUTHOR]

Introduction: Nearly one-third of all infants with epilepsy develop drug-resistant epilepsy. Although epilepsy surgery is a well-established therapy across all age groups, there might be a reluctance to operate on infants in the first six months of life due to unique surgical and anesthesiologic difficulties.Methods: We performed a meta-analysis and systematic review to assess the outcome and complication rate of epilepsy surgery in infants operated on ≤ six months of life.Results: 158 infants underwent epilepsy surgery, most frequently a hemispherotomy rather than focal surgery. Overall seizure freedom after surgery was 65.6% [CI: 0.5785; 0.7261], with higher seizure-free rates following hemispherotomy (71%) than after focal surgery (58%). Complications occurred in 27.7% [0.1794; 0.4004] of patients. Most prevalently, a hydrocephalus developed in 20 out of 136 cases (14.71%). Anti-seizure medication (ASM) was discontinued in 21.5% [0.1431; 0.3100] and reduced in 85.9% [0.515; 0.9721] of 93 patients postoperatively. 84.6% of infants displayed cognitive impairment (development quotient (DQ) <85) preoperatively. After surgery, there was a trend toward a cognitive gain. However, cognitive gain was seen almost exclusively in seizure-free patients.Discussion: Excellent seizure control can be achieved with epilepsy surgery in the first six months of life, a large proportion of patients are able to reduce or discontinue ASM. Data regarding cognitive outcome are promising, but also show that the primary goal should be to achieve seizure freedom. Given the more difficult surgical conditions, epilepsy surgery in the first six months of life should only be performed in specialized epilepsy centers. [ABSTRACT FROM AUTHOR]

The risk factors determining short- and long-term morbidity following acute respiratory infection (ARI) due to respiratory syncytial virus (RSV) in infancy remain poorly understood. Our aim was to examine the associations of the upper respiratory tract (URT) microbiome during RSV ARI in infancy with the acute local immune response and short- and long-term clinical outcomes. We characterized the URT microbiome by 16S ribosomal RNA sequencing and assessed the acute local immune response by measuring 53 immune mediators with high-throughput immunoassays in 357 RSV-infected infants. Our short- and long-term clinical outcomes included several markers of disease severity and the number of wheezing episodes in the fourth year of life, respectively. We found several specific URT bacterial-immune mediator associations. In addition, the Shannon ⍺-diversity index of the URT microbiome was associated with a higher respiratory severity score (β =.50 [95% CI = 0.13-0.86]), greater odds of a lower ARI (odds ratio = 1.63 [95% CI = 1.10-2.43]), and higher number of wheezing episodes in the fourth year of life (β = 0.89 [95% CI = 0.37-1.40]). The Jaccard β-diversity index of the URT microbiome differed by level of care required (P =.04). Furthermore, we found an interaction between the Shannon ⍺-diversity index of the URT microbiome and the first principal component of the acute local immune response on the respiratory severity score (P =.048). The URT microbiome during RSV ARI in infancy is associated with the acute local immune response, disease severity, and number of wheezing episodes in the fourth year of life. Our results also suggest complex URT bacterial-immune interactions that can affect the severity of the RSV ARI. [ABSTRACT FROM AUTHOR]

To assess the prevalence and development of muscle tone impairments in infants at high risk of developmental disorders, and their associations with cerebral palsy (CP) and cystic periventricular leukomalacia (cPVL). Longitudinal exploration of muscle tone in 39 infants at high risk of CP (LEARN2MOVE 0–2 project) mostly due to an early lesion of the brain. Muscle tone was assessed ≥4 times between 0 and 21 months corrected age (CA) with the Touwen Infant Neurological Examination. Diagnosis of CP was determined at 21 months CA. Neonatal neuro-imaging was available. Developmental trajectories were calculated using generalized linear mixed effect models. Infants showed atypical muscle tone in three or four body parts in 93% (172/185) of the assessments. The most prevalent muscle tone pattern was hypotonia of neck and trunk with hypertonia of the limbs (28%). From 7 months CA onwards hypertonia of the arms was associated with CP. Asymmetric arm tone during infancy was associated with unilateral CP. At 18–21 months CA ankle hypertonia was associated with CP at 21 months; leg hypertonia in infancy was not associated with CP. Leg hypertonia was associated with cPVL, regardless of age. High-risk infants due to an early lesion of the brain often present with muscle tone impairment. In these infants, hypertonia and asymmetric muscle tone of the arms were from 7 months onwards associated with the diagnosis of CP at 21 months; hypertonia of the legs was not. • High-risk infants have a high prevalence of muscle tone impairments (>90%). • Axial hypotonia with limb hypertonia is most common pattern in high-risk infants. • From 7 months onwards arm hypertonia was associated with CP. • Asymmetrical muscle tone of the arms was associated with unilateral CP. • Hypertonia of the legs was associated with cPVL. [ABSTRACT FROM AUTHOR]

Background: In population-based growth surveys in sub-Saharan Africa, boys have higher rates of growth failure than girls.Objectives: Our goal was to assess for the presence, timing, and potential etiology of sex-based differences in length-for-age z score (LAZ), weight-for-age z score (WAZ), and head circumference-for-age z score (HCZ) in a birth cohort in rural Tanzania.Methods: We performed a secondary analysis of randomized controlled trial data on 1084 children followed from age <2 wk to 18 mo, assessing anthropometry (measured every 3 mo), illness (hospitalization and monthly maternal report of symptoms), and feeding [monthly maternal report of exclusive breastfeeding (EBF) and complementary solids and liquids (CSLs)]. We used linear regression to assess sex differences in LAZ, WAZ, and HCZ over time.Results: Although male and female infants had similar anthropometry measures at study entry, males exhibited poorer growth through 6 mo (e.g., 3-mo mean LAZ: males -0.94, females -0.74, P < 0.01; 3-mo mean WAZ: males -0.63, females -0.48, P < 0.05), without significant worsening from 6 to 18 mo. Males had lower HCZ only at 9 mo. In evaluating possible etiologies, mediation analysis failed to identify illness or hospitalization as mediators of poorer growth among males, although at age 3 mo, males with recently reported illness exhibited greater decline in WAZ than females with illness (ΔWAZ: males -0.24, females 0.03, heterogeneity test P = 0.01). Differences in EBF and introduction of CSL did not explain the sex-based growth outcomes.Conclusions: In longitudinal analysis, males exhibited more severe growth failure by 3 mo than girls and did not exhibit catchup growth between 6 and 18 mo. Reported symptoms of illness and early introduction of CSL did not appear to be mediators of these sex-based differences, although likely not all sickness was captured by monthly maternal report. Given the early nature of these deficits, LAZ and WAZ measures at 6 mo may be good outcomes for intervention studies targeting improvements in early childhood growth and thriving. [ABSTRACT FROM AUTHOR]

Background In utero or early-life exposure to aflatoxin, which contaminates staple crops in disadvantaged settings, may compromise pregnancy and infant outcomes, but investigations into the extent, persistence, and determinants of aflatoxin exposure at these life stages have lacked longitudinal data collection and broad geographic representation. Objectives Aflatoxin exposure and selected determinants thereof were characterized in mother–child dyads with serial plasma/serum samples in prenatal, perinatal, and early life in Malawi and Bangladesh. Methods Circulating aflatoxin B1 (AFB1)–lysine albumin adducts were measured in dyads from Bangladesh (n  = 573; maternal first and third trimester, 3 mo postpartum, cord blood, infant 24 mo) and Malawi (n  = 255; maternal second and third trimester, 6 mo postpartum, infant 6 and 18 mo) with isotope dilution mass spectrometry. We examined AFB1-lysine adduct magnitude, persistence, seasonality, and associations with infant feeding, and estimated daily AFB1 intake. Results Maternal AFB1-lysine was higher in Malawi (98% detectable; median: 0.469, IQR: 0.225–1.027 pg/µL) than in Bangladesh (59%; 0.030, nondetectable [nd]–0.077 pg/µL). Although estimated dietary exposure in Malawi was temporally stable (648 ng AFB1/day), estimated intake in Bangladesh was reduced by 94% between rainy and winter seasons (98 to 6 ng/day). AFB1-lysine was low in cord blood from Bangladesh (15% detectable; 0.045, 0.031–0.088 pg/µL among detectable) and in Malawian infants at 6 mo of age (0.072, nd–0.236 pg/µL), but reached maternal concentrations by 18 or 24 mo (Bangladesh: 0.034, nd–0.063 pg/µL; Malawi: 0.370, 0.195–0.964 pg/µL). In Malawian infants, exclusive breastfeeding at 3 mo was associated with 58% lower AFB1-lysine concentrations at 6 mo compared with other feeding modes (P  = 0.010). Conclusions Among pregnant women, aflatoxin exposure was persistently high in Malawi, while lower and seasonal in Bangladesh. Infants were partially protected from exposure in utero and with exclusive breastfeeding, but exposures reached adult levels by 18–24 mo of age. The Bangladesh and Malawi trials are registered at clinicaltrials.gov as NCT00860470 and NCT01239693. [ABSTRACT FROM AUTHOR]

• Observed sensitivity was not predicted by parental gender or caregiver role. • Observed intrusiveness during play and feed was not predicted by parental gender or caregiver role. • Secondary caregiving fathers were more intrusive than secondary caregiving mothers while cleaning their infants. • Having twins was related to more intrusive behavior during play. The goal of our study was to examine whether differences in the sensitivity and intrusiveness of fathers and mothers from gay-, lesbian-, and heterosexual-parent families (57 French couples, 47 Dutch couples, and 31 British couples) with their first-born infants were explained by gender or caregiver role, while controlling for nesting within families, infant temperament, and twinship. We assessed the sensitivity and intrusiveness of 147 primary caregivers (45 fathers, 102 mothers) and 123 secondary caregivers (68 fathers and 55 mothers). All infants were conceived using assisted reproductive techniques and averaged 4 months of age. They were videotaped at home with both parents while engaged in play, feeding, and other childcare (bathing or changing) and these videotapes were coded for sensitivity and intrusiveness. Information about relative levels of caregiving, infant temperament, and twinship was collected via parent report questionnaires. Mixed linear models showed that sensitivity while playing, cleaning, and feeding were not predicted by parental gender, relative parental involvement, and the interaction between parental gender and parental caregiver role. Models for intrusiveness while playing and feeding showed similar results. However, intrusiveness during cleaning was predicted by parental gender and the interaction between parental gender and caregiver role. Post-hoc analyses showed that secondary caregiving fathers showed more intrusive behavior during cleaning (M = 1.51, SD = 0.09) than secondary caregiving mothers (M = 1.26, SD = 0.10). Our results also showed that contextual factors, such as having singletons or twins, infant temperament, and country of residence were related to parenting behavior. In sum, our findings do not support presumptions that mothers are more capable of providing better quality care than fathers, or that, at this early stage, primary caregiving parents are better attuned to their infants than those who are less involved. [ABSTRACT FROM AUTHOR]

• Shared book reading between parents and 9-month-old children predicts 36-month vocabulary ability in an Irish cohort. • Four in 5 infants in Ireland are read to by at least 1 parent. • Irish children are most likely to be read to if their parents are educated, non-depressed, and report a rich communicative home environment. • Implications for the small yet significant effect of early shared reading are discussed. It is well-established that participation in shared book reading interactions with caregivers supports children's early language and literacy development. Most of this literature focuses on reading experiences during the preschool period. Less is known about the nature and importance of such practices during infancy. Therefore, the goal of this study was to examine literacy practices between parents and infants in a large cohort study, Growing Up in Ireland. Interview, survey, and direct measurements of children's language skills were used to examine whether parent-report of book reading practices when children were 9-months predicted child expressive vocabulary at 36-months (N = 9171). Regression analysis indicated that approximately 80% of 9-month-old Irish children are read to by parents. Characteristics of families who were more likely to report reading with children emerged: those with higher educational attainment, fewer depressive symptoms, and those who report a high-quality home language environment (e.g., reported talking more to children during everyday activities). Furthermore, children who were read to at 9-months had stronger expressive vocabulary skills at 36-months, even after accounting for socio-demographic and home literacy environment covariates measured at both 9- and 36-months. Results are discussed using a bioecological framework to describe how proximal and distal factors in the child's environment converge to impact early childhood literacy development. [ABSTRACT FROM AUTHOR]

Findings of caregiver-child biological attunement were inconsistent across studies. Results varied depending on methodological approach used to study attunement. Limitations of methodological approaches are discussed. Recommendations are provided for future studies with consideration of methodology. The objective of the current study was to systematically review the literature on caregiver-child biological attunement within distress contexts during the first three years of life. A total of 9932 unique abstracts were identified through Medline, Embase, PsycINFO, CINAHL, and Scopus databases. Thirty-six studies provided data from caregivers and their infants or toddlers within a distress paradigm, used biological indicators of distress, and assessed the relations between caregiver and child biological indicators. Findings were synthesized based on biological indicators, type of analysis, and measurement epochs pre- and post-distress. Most articles examined cortisol. Associations between caregiver and child cortisol indicators were moderate to large, though findings varied depending on the analysis used and measurement epochs examined. Many of the findings examining relations between mother and child cardiac, sAA, and EEG indicators were weak or inconsistent, likely due to the limitations of methodological approaches used to capture the complexity of the caregiver-child attunement process. Gaps in the literature and suggestions for future research are discussed. [ABSTRACT FROM AUTHOR]

Infancy is a period of rapid bone growth and mineral accretion; nonetheless, reference data remain scarce for this age group. The purpose of this report is to generate reference data for bone mass in breastfed vitamin D replete infants and investigate patterns of bone mineral accretion and sex differences. This is a secondary analysis from a double-blinded randomized controlled trial (NCT00381914). Healthy term breastfed (exclusively or mixed) infants were randomized to different doses of oral vitamin D supplementation (400-1600 IU/d) and followed prospectively from 1 to 12 mo. Plasma 25-hydroxyvitamin D (LC-MS/MS), bone mineral content (BMC; whole body (WB) and lumbar spine (LS)) and bone mineral density (BMD; LS) were measured at 1, 3, 6, 9, and 12 mo by dual-energy x-ray absorptiometry (Hologic Discovery 4500A) with no effect of supplementation on bone outcomes. For the purpose of this analysis, 63 infants with adequate plasma 25-hydroxyvitamin D ≥ 50 nmol/L at baseline, were included. Differences over time and between sexes were tested using mixed model repeated measures ANOVA. Infants (31 males, 32 females) were 39.5 ± 1.1 wk gestational age at birth and appropriate for gestational age. WB BMC, LS BMC, and LS BMD increased by 143.2%, 116.8%, and 31.1% respectively across infancy. WB BMC was higher (4.2% - 9.4%; p = 0.03) in males than in females across the study. After adjusting WB BMC for weight, length or head BMC, sex differences were not evident. LS BMC and LS BMD did not vary by sex. LS BMD growth charts for both sexes combined, were generated using LMS chartmaker. WB BMC more than doubles during the first year of life confirming the importance of skeletal growth and the need for age-specific reference data in infancy. Sex differences in BMC, if any, are mostly driven by differences in body size. [ABSTRACT FROM AUTHOR]

Children in low-income Hispanic families are at high risk of obesity and are more likely to live with grandparents than their non-Hispanic white counterparts. We aimed to determine if grandparent coresidence (prenatal through age 2 years) was associated with: 1) obesogenic feeding practices; and 2) child weight outcomes from birth to three years. We analyzed data from 267 low-income, Hispanic mother-infant pairs in the control group of an obesity prevention trial in New York City. Linear and logistic regression tested differences in obesogenic feeding practices and weight outcomes at 2 and 3 years, dependent upon grandparent coresidence. Multilevel modeling tested associations between grandparent coresidence and WFAz over time. Persistent grandparent coresidence (vs none) was associated with putting cereal in the bottle (adjusted odds ratio [aOR] 3.46; 95% confidence interval [CI] 1.43, 8.40). Persistent grandparent coresidence (vs none) was associated with higher mean WFAz (2 years: B 0.83; 95% CI 0.41, 1.25; 3 years: B 0.79; 95% CI 0.32, 1.25) and higher odds of child overweight/obesity risk (2 years: aOR 4.38; 95% CI 1.64, 11.69; 3 years: aOR 3.15; 95% CI 1.19, 8.36). In multilevel models, more occasions of grandparent coresidence were associated with higher WFAz. Grandparent coresidence may be associated with higher risk of child overweight/obesity in low-income, Hispanic families. Further research is needed to elucidate mechanisms of these associations and to inform obesity prevention strategies in the context of multigenerational families. [ABSTRACT FROM AUTHOR]

Maternal stress has been associated with early child obesity through pathways related to decreased exclusive breastfeeding and increased nonresponsive maternal-infant feeding styles. We sought to gain an in-depth understanding of how maternal stress, sadness, and isolation are perceived to affect feeding, in order to inform modifiable targets of intervention. We conducted semi-structured qualitative interviews with Hispanic mothers living in poverty with young infants between 3 and 7 months old (n = 32) from the intervention group of a randomized controlled trial of an early child obesity prevention intervention (Starting Early Program). Bilingual English-Spanish interviewers conducted the interviews, which were audio recorded, transcribed, and translated. Building on an existing theoretical framework developed by the National Scientific Council on the Developing Child, we used an iterative process of textual analysis to code the transcripts, until thematic saturation was reached. Three key themes were described: 1) maternal stress responses were varied and included positive (brief and mild), tolerable (sustained but limited long-term impacts), or toxic stress (sustained and severe); 2) buffers included support from family, infants, health care providers, social service programs, and community organizations; 3) perceived effects on infant feeding included decreased breastfeeding due to concerns about stress passing directly through breast milk and indirectly through physical closeness, and increased nonresponsive feeding styles. Maternal stress, particularly toxic stress, was perceived to negatively affect infant feeding. Mothers reported disrupting healthy feeding to avoid infant exposure to stress. Interventions to enhance buffering may help to mitigate toxic stress and promote healthy feeding interactions. Maternal stress, including toxic stress, was perceived to adversely affect breastfeeding and maternal-infant feeding interactions. Findings highlight the need for early child obesity prevention to incorporate stress reduction and mental health counseling, and to enhance buffering with increased social support. [ABSTRACT FROM AUTHOR]

Background A large proportion of infants in low- and middle-income countries are stunted. These infants are often fed complementary foods that are low-quality, primarily in terms of protein and micronutrients. Objectives We aimed to test 2 milk–cereal mixes supplemented with modest and high amounts of protein during 6–12 mo of age, compared with no supplementation, for their effect on length-for-age z score (LAZ) at 12 mo of age. Methods Eligible infants (6 mo plus ≤29 d) were randomly assigned to either of the 2 interventions (modest- and high-protein) or a no supplement group. The milk–cereal mixes provided ∼125 kcal, 30%–45% energy from fats, and 80%–100% RDA of multiple micronutrients (MMN). The modest-protein group received 2.5 g protein [protein energy ratio (PER): 8%; 0.75 g from milk source] and the high-protein group received 5.6 g protein (PER: 18%, 1.68 g from milk source). One packet was given daily for 180 d. Counseling on continued breastfeeding and optimal infant-care practices was provided to all. Results We enrolled 1548 infants (high-protein: n  = 512; modest-protein: n  = 519; and no supplement: n  = 517). Compared with the no supplement group, there was an improvement in LAZ [adjusted mean difference (MD): 0.08; 95% CI: 0.01, 0.15], weight-for-age z score (MD: 0.12; 95% CI: 0.06, 0.19), weight-for-length z score (MD: 0.11; 95% CI: 0.02, 0.19), and midupper arm circumference z score (MD: 0.10; 95% CI: 0.02, 0.18) in the high-protein group at 12 mo of age. No significant differences for these anthropometric indicators were noted between the modest-protein and no supplement groups or between the high- and modest-protein groups. Conclusions Cereal mixes with higher amounts of milk-based protein and MMN may lead to improvement in linear growth and other anthropometric indexes in infants, compared with no supplementation. This trial was registered at ctri.nic.in as CTRI/2018/04/012932. [ABSTRACT FROM AUTHOR]

Background: Variability in the 25-hydroxyvitamin D [25(OH)D] response to prenatal and postpartum vitamin D supplementation is an important consideration for establishing vitamin D deficiency prevention regimens.Objectives: We aimed to examine interindividual variation in maternal and infant 25(OH)D following maternal vitamin D supplementation.Methods: In a randomized trial of maternal vitamin D supplementation (Maternal Vitamin D for Infant Growth Trial), healthy pregnant women (n = 1300) received a prenatal cholecalciferol (vitamin D-3) dose of 0, 4200, 16,800, or 28,000 IU/wk from 17 to 24 wk of gestation followed by placebo to 6 mo postpartum. A fifth group received 28,000 IU cholecalciferol/wk both prenatally and postpartum. In a subset of participants, associations of 25(OH)D with hypothesized explanatory factors were estimated in women at delivery (n = 655) and 6 mo postpartum (n = 566), and in their infants at birth (n = 502) and 6 mo of age (n = 215). Base models included initial 25(OH)D and supplemental vitamin D dose. Multivariable models were extended to include other individual characteristics and specimen-related factors. The model coefficient of determination (R2) was used to express the percentage of total variance explained.Results: Supplemental vitamin D intake and initial 25(OH)D accounted for the majority of variance in maternal 25(OH)D at delivery and postpartum (R2 = 70% and 79%, respectively). Additional characteristics, including BMI, contributed negligibly to remaining variance (<5% increase in R2). Variance in neonatal 25(OH)D was explained mostly by maternal delivery 25(OH)D and prenatal vitamin D intake (R2 = 82%). Variance in 25(OH)D in later infancy could only partly be explained by numerous biological, sociodemographic, and laboratory-related characteristics, including feeding practices (R2 = 43%).Conclusions: Presupplementation 25(OH)D and vitamin D supplemental dose are the major determinants of the response to maternal prenatal vitamin D intake. Vitamin D dosing regimens to prevent maternal and infant vitamin D deficiency should take into consideration the mean 25(OH)D concentration of the target population. [ABSTRACT FROM AUTHOR]

• Respiratory symptoms are not more frequent or severe in CF infants compared to healthy controls. • Lung function measurements in infants with CF are not associated with subsequent respiratory symptoms throughout the first year of life. • Higher respiratory rate measurements in CF infants are not associated with more frequent or severe respiratory symptoms in the first year of life. Lung disease can develop within the first year of life in infants with cystic fibrosis (CF). However, the frequency and severity of respiratory symptoms in infancy are not known. We assessed respiratory symptoms in 50 infants with CF and 50 healthy matched controls from two prospective birth cohort studies. Respiratory symptoms and respiratory rate were documented by standardized weekly interviews throughout the first year. Infants performed multiple breath washout in the first weeks of life. We analyzed 4552 data points (2217 in CF). Respiratory symptoms (either mild or severe) were not more frequent in infants with CF (OR:1.1;95% CI:[0.76, 1.59]; p=0.6). Higher lung clearance index and higher respiratory rate in infants with CF were not associated with respiratory symptoms. We found no difference in respiratory symptoms between healthy and CF infants. These data indicate that early CF lung disease may not be captured by clinical presentation alone. [ABSTRACT FROM AUTHOR]

[Display omitted] • Associations between caregiver-infant behaviours during social interactions and brain development outcomes were investigated. • Caregivers' and infants' behaviours in interactions related to children's structural, functional and connectivity measures. • Concurrent associations between behavioural and brain measures were apparent as early as three months postnatally. • Long-term associations between behaviours in early interactions and brain development outcomes were observed decades later. • Individual differences in early interactions and associated brain development is an important avenue for further research. From birth, interactions with others are an integral part of a person's daily life. In infancy, social exchanges are thought to be critical for optimal brain development. This systematic review explores this association by drawing together infant studies that relate adult-infant behaviours – coded from their social interactions - to children's brain measures collected during a neuroimaging session in infancy, childhood, adolescence or adulthood. In total, we identified 55 studies that explored associations between infants' social interactions and neural measures. These studies show that several aspects of caregiver-infant behaviours are associated with, or predict, a variety of neural responses in infants, children and adolescents. The presence of both concurrent and long-term associations - some of which are first observed just a few months postnatally and extend into adulthood - open an important research avenue and motivate further longitudinal studies. [ABSTRACT FROM AUTHOR]

Purpose: Ketogenic dietary therapies (KDT) are high-fat and low-carbohydrate diets that may achieve seizure control and improve cognitive state. We describe our KDT experience in infants (children less than two years of age).Research Methods& Procedures: We conducted a retrospective, descriptive and observational study of 42 infants treated with KDT between 2000-2018.Results: The types of KDT started were: classic ketogenic diet ratio 3:1 (40), ratio 4:1 (1) and modified ketogenic diet with medium-chain triglycerides (1). Four patients switched to a modified Atkins diet. During follow-up, 79%, 57%, 38% and 17% of infants remained on KDT at 3, 6, 12 and 24 months, respectively. Seizure reduction ≥50% compared to baseline was achieved in 50%, 45%, 38% and 17% at 3, 6, 12 and 24 months, respectively. Seizure control was excellent (reduction >90%) in 33%, 31%, 26% and 12%, and seizure-free infants were 9, 9, 10 and 4, at different follow-up intervals, respectively. Sixty-three percent of infants with West syndrome were responders to KDT. Mean length of KDT was 390 days (16 days-4.9 years). Ineffectiveness was the reason for withdrawal in 50% of patients. Early adverse effects (during first month) occurred in 40% of infants. The most frequent early side effects were asymptomatic hypoglycemia and gastrointestinal disturbances. Late-onset side effects occurred in 55-14% of infants during therapy, and most frequent were hypercalciuria and dyslipidaemia.Conclusion: KDT are useful and effective treatments in infancy. Side effects are frequent but mild and easy to manage. [ABSTRACT FROM AUTHOR]

Background: Infants are born with the biological predisposition to reject bitterness. Dark green vegetables contain essential nutrients but also bitter compounds, making them more difficult to like.Objective: The Good Tastes Study was designed to determine whether reducing bitterness by adding small amounts of sugar or salt would alter infant acceptance of kale purées.Methods: Caregivers (n = 106, 94% mothers, 82% Non-Hispanic White) and children (53% male, aged 6-24 mo) participated in a videorecorded laboratory visit during which infants were offered 4 versions of puréed kale: plain, 1.2% or 1.8% added sugar, or 0.2% added salt. Caregivers rated their children's liking for each kale version. Videos were coded for the number of tastes accepted and for children's behaviors and acceptance of each kale version. A multilevel ordered logistic model was fit for the number of accepted tastes and caregiver ratings of child liking of kale versions with age, breastfeeding history, order effects, and kale version as predictors.Results: Infants 6 to <12 mo accepted more tastes (b = 2.911, P < 0.001) and were rated by caregivers as liking the kale more than older toddlers (≥18 mo; b = 1.874, P = 0.014). The plain kale was more likely to be accepted (P < 0.001); also, the first version offered was more likely to be rejected (b = -0.586, P < 0.007). Older infants (≥18 mo) exhibited more avoidant behaviors (b = 1.279, P < 0.001), more playing (b = 2.918, P < 0.001), and more self-feeding (b = 1.786, P = 0.005) than younger infants (6 to <12 mo). Children who were reported to have been breastfed more in the last 7 d were more likely to self-feed (b = 0.246, P < 0.001) and play with food (b = 0.207, P < 0.005).Conclusions: Our findings support that there may be a sensitive period, during the early phase of complementary feeding, to improve success of introducing a novel, bitter, more difficult-to-like food. When low levels of sugar or salt were added, no advantage of bitterness reduction was observed. This study has been registered with ClinicalTrials.gov as NCT04549233. [ABSTRACT FROM AUTHOR]