Betsy Lozoff

Infant care: Cache or carry*

To test the hypothesis that a characteristic infant-care pattern existed during most of human history, contemporary hunter-gatherers in a representative sample of world cultures were examined. Numerically coded measures of infant care revealed a uniform pattern. Mothers are the principal caregivers, providing extensive body contact day and night and prolonged breast-feeding. When not carried, the baby of hunter-gatherers has complete freedom of movement. Care is consistently affectionate, with immediate nurturant response to crying. Nonetheless, in most groups, children achieve early independence and by 2 to 4 years spend more than half the time away from the mother. In the United States this pattern of carrying that endured for one to three million years has been replaced by one resembling nesting or caching. Infants spend little time in body contact with caregivers and their movements are restricted by playpens, high chairs, or cribs. Of the minority who are breast-fed, half are weaned within a few weeks. Separate sleeping arrangements and delayed response to crying are regularly recommended. These remarkable transformations may profoundly alter infant development and maternal involvement.

Object Attachment, Thumbsucking, and the Passage to Sleep

Cross-cultural studies suggest that children who sleep in the same room as their parents and who are breast-fed are less likely to use an attachment object. The present study examined childrearing practices that emphasize physical proximity of parent and child and use of an attachment object and thumbsucking at bedtime with 126 healthy U.S. infants. Four child-rearing practices were focused on: presence or absence of a caregiver when the child actually fell asleep; mode of feeding; location of the childs bed or sleeping place; whether or not the child slept with the parents during the night. Children who had an adult present as they fell asleep were less likely to use an attachment object or suck their thumbs. In contrast to cross-cultural research, the results of the present study suggest that where a child sleeps during the night or how the child is fed is not as important an influence on the bedtime use of an attachment object or thumbsucking as whether an adult is present as the child actually falls asleep.

Iron-deficient anemic infants at play.

The purpose of this study was to determine whether iron-deficient anemic infants show affective and attentional disturbances during play. The behavior of 21 iron-deficient anemic and 21 non-anemic 6-to 24-month-old Guatemalan infants and their mothers was analyzed during a videotaped 8-minute free-play session. There were no statistically significant differences between the two groups in measures of infant irritability, distractibility, or apathy. There were differences, however, in measures of spatial relations. In 71 % of the anemic infants, the duration of child-initiated body contact with their mothers was high, compared with a high level of contact in only 26% of the nonanemic babies (p = 0.01). Mothers of anemic infants spent less time at a distance from them, were less likely to break close contact, and were more likely to reestablish close contact if the baby moved away (p < 0.03). The increase in body contact was interpreted as a reflection of fearfulness, hesitance, or inactivity. The results suggest that the specific behavioral manifestations of iron deficiency anemia in infancy may vary with the context, differing in free play and structured developmental testing.

Methodologic issues in studying behavioral effects of infant iron-deficiency anemia.

Methodologic challenges proving that iron-deficiency anemia (IDA) adversely affects infant behavior and development are examined. This community-based study in Costa Rica included 191 infants aged 12-23 mo with varying degrees of iron deficiency. The Bayley Scales of Infant Development were administered before and both 1 wk and 3 mo after intramuscular or oral administration of iron. Appropriate placebo-treatment control infants were also tested. Infants with IDA showed significantly lower mental and motor test scores, even after factors relating to birth, nutrition, family background, parental IQ, and the home environment were considered. The methodologic issues raised by the study point to the need to assess behavioral effects in a prospective, randomized trial of measures to prevent iron-deficiency anemia in infancy.

BIRTH AND ‘BONDING’ IN NON‐INDUSTRIAL SOCIETIES

To determine whether women giving birth in traditional societies maintained early and extended skin‐to‐skin contact with their neonates and nursed them immediately, descriptions of childbirth in 186 non‐industrial societies were examined. Most cultures made no special effort to get mothers in body contact with infants in the minutes after birth: almost always the neonate was bathed, generally by a female birth assistant and in 54 per cent the baby was placed in a cradle or basket. Skin‐to‐skin contact was uncommon, since the infant was given nude to the mother in only 14 per cent of societies. However, in 98 per cent mother and baby subsequently rested together. In only 27 per cent were fathers allowed to be present during childbirth. Few cultures permitted immediate postpartum nursing, and the first breast‐feeding was delayed 24 hours or more in 52 per cent. On anthropological ratings, there was no increase in maternal affection in societies which fostered mother‐infant body contact, in paternal involvement when fathers were allowed at childbirth, or in breast‐feeding duration in those which permitted early nursing.

Early genital naming.

To evaluate the clinical impression that young girls are given little or confusing information about their genitals, a sample of 117 mothers with 1− to 4-year-old children were asked which words for genitals, if any, they used with their children. The ethnically and socioeconomically heterogeneous sample was composed of 63 girls and 54 boys, with the average ages of 26 and 29 months, respectively. Neither boys nor girls were likely to be given a standard anatomical genital term, although many children received colorful colloquial expressions. However, girls were less likely than boys to receive a term for their genitals. Receiving names for genitals was related to certain family circumstances, such as higher parental education, exposure to adult male nudity, having a sibling of the opposite sex, and cosleeping. Pediatric health professionals have the opportunity to contribute to early sex education by conveying accurate information regarding genital terms in the course of routine physical examinations.

Thalassemia in Southern India Interaction of Genes for β+-, β°-, and δ° β°-ThaIassemia

Two families from southern India with members having the clinical manifestations of thalassemia intermedia are presented. Hematologic and globin chain synthesis data indicated that in one family the a

WHO GETS IRON DEFICIENCY ANEMIA (IDA) IN INFANCY

The purpose of the proposed study was to identify nutritional and social influences on IDA in infancy. A community project in Costa Rica on the behavioral effects of IDA provided an unusual opportunity to examine such influences, since the 191 12-to 23-month-old infants were all healthy, with birth weights ≥ 2.5kg, without previous iron therapy, and living in a country in which breast feeding was the norm and iron-fortified formula or cereal extraordinarily rare. Factors that were hypothesized to effect IDA (defined as a Hb ≤ 10.5 g/dl and a low ferritin and either a high FEP or low transferrin saturation) were grouped conceptually into five stages on the basis of their remote to immediate influence on IDA: family background, neonatal factors, age and sex, caregiving conditions, and current physiologic status of the child, using weight/length percentile and whole blood lead level. Structural modeling (LISREL) was used to develop and test a model of direct and indirect effects. Direct effects were that infants with IDA had lower birth weights (p=0.03), consumed greater amounts of cows milk/day (p=0.01), were breast fed for shorter times (p=0.02), had poorer home environments (HOME scale) (p<0.01), and had their grandparents in the home (p=0.02). Indirect effects were that the lower the mothers IQ the poorer the quality of home and the more likely for grandparents to be living in the household; younger mothers were more likely to live with their parents. These results suggest that preventing and treating IDA requires not only appropriate doses of medicinal iron but also attention to feeding practices and disadvantaged conditions in the home environment.