Infant bonding and attachment to the caregiver: insights from basic and clinical science

Skin-to-skin contact at birth for very preterm infants and symptoms of depression and anxiety in parents during the first year - A secondary outcome of a randomized clinical trial

BACKGROUND

Mental health issues are common in parents to preterm infants. In the neonatal intensive care unit (NICU), skin-to-skin contact (SSC) as an avenue for parent-infant closeness may improve parental mental health. Few studies exist regarding its benefits when initiated immediately postbirth. The aim was to determine the effect of SSC for very preterm infants at birth on parents' mental health, by assessing symptoms of depression and anxiety within the first year.

METHODS

The Immediate Parent-Infant Skin-to-Skin Study was a randomized clinical trial conducted 2018-2021 at three NICUs in Sweden and Norway. Very preterm infants (28-33 weeks of gestation) were allocated to standard incubator care or SSC with either parent, initiated at birth and continued throughout the first 6 h. Symptoms of depression and anxiety in parents were assessed with the Edinburgh Postnatal Depression Scale and Spielberger State-Trait Anxiety Inventory.

RESULTS

The study included 91 infants (36 twins [40 %]) and 73 mothers and 73 fathers. Infants had a mean gestational age of 31 + 1 weeks and birthweight of 1534 g. Immediate SSC was found to significantly reduce depression symptoms in mothers and anxiety symptoms in fathers at one week after birth and depression and anxiety symptoms in fathers at term-equivalent age of infant.

LIMITATIONS

Limitations include a small sample size and limited background data on prenatal depression and anxiety.

CONCLUSIONS

Immediate parent-infant SSC following a very preterm birth may provide a protective effect on parents' mental health and should be supported in the clinical setting, alongside necessary nursing, and medical care.

Biological and Experiential Factors That Impact the Acceptance of Complementary Foods

BACKGROUND

Flavor, a complex sensation mediated by the chemical senses of taste, smell, and chemesthesis, is a primary driver of food acceptance. Because what we eat is an important influence on health in modern societies, we need to understand what shapes the acceptance of foods from an early age.

SUMMARY

As infants transition from an all-milk diet to one that contains complementary foods of varying flavors and textures, biological factors interact with early experiences in shaping the acceptance or rejection of these complementary foods. Children are naturally drawn to foods that taste sweet or salty. However, repeated exposures to more complex flavors, transmitted from the mother's diet to amniotic fluid and to human milk, and inherent in infant formulas and complementary foods (with 8-10 exposures or more), familiarize and facilitate children's acceptance of the varying sensory properties of foods. Family members modeling eating these foods also encourage acceptance in children. Such functional plasticity, one of the main characteristics of the brain, highlights the ability to change behavior based on experience.

Moral parenthood: not gestational

Parenting our biological children is a centrally important matter, but how, if it all, can it be justified? According to a contemporary influential line of thinking, the acquisition by parents of a moral right to parent their biological children should be grounded by appeal to the value of the intimate emotional relationship that gestation facilitates between a newborn and a gestational procreator. I evaluate two arguments in defence of this proposal and argue that both are unconvincing.

Optimizing infant neuroimaging methods to understand the neurodevelopmental impacts of early nutrition and feeding

There is strong evidence proper nutrition is imperative for healthy infant neurodevelopment, providing the neural foundations for later cognition and behavior. Over the first years of life infants are supported by unique sources of nutrition (e.g., human milk, alternative milk sources). It is during this time that the brain undergoes its most drastic changes during postnatal development. Past research has examined associations between infant feeding and nutrition and morphological features of the brain, yet there remains a paucity of information on functional characteristics of neural activity during feeding. Within this article, we discuss how neuroimaging modalities can be optimized for researching the impacts of infant feeding and nutrition on brain function. We review past research utilizing EEG and fNIRS and describe our efforts to further develop neuroimaging approaches that allow for measurement of brain activity during active feeding with greater spatial resolution (e.g., fMRI and OPM-MEG). We also discuss current challenges, as well as the scientific and logistical limitations of each method. Once protocols have been optimized, these methods will provide the requisite insight into the underlying mechanisms of nutritional and feeding impacts on neurodevelopment, providing the missing piece in the field's efforts to understand this essential and ubiquitous part of early life.

Mothering matters: Towards a better understanding of disrupted infant-caregiver relationships in both mother and offspring

The mother-infant bond is among the strongest social relationships formed in humans and nonhuman mammals. As such, disrupted infant-caregiver relationships have the capacity to result in potent adverse effects not only in the offspring, but also in the mother. Here, I provide a brief overview of my prior work showing adversity-induced alterations in offspring and maternal behavioral and brain function. I also share my vision for future directions for developmental and maternal neurobiology research in the context of stress and/or adversity exposure.

Infants show negative changes in affect and physiology when re-experiencing a stressor, its context, and a positive event 24-h later

Exposure to early life stress shapes further development, affects later stress reactivity, and mental health outcomes. Despite the central role of early experiences, there is little understanding of how these rapidly forgotten events gain their influence. An infant's ability to cope with everyday stressors is founded on successful co-regulation through mother-infant interaction. A significant disruption of this interaction through the Face-to-Face Still-Face paradigm elicits a well-documented behavioral and physiological stress response in infants. What has yet to be explored is whether infants show regulatory adaptions when encountering the situation over again. To fill this gap, 80 mother-infant dyads were observed in the lab on two consecutive days. Infants in the experimental condition (n = 40) were exposed to a double Still-Face paradigm on day one. Infants in the control group (n = 40) completed time-matched episodes of typical play during their first visit. Mother-infant dyads from both groups returned to the lab 24 h later and participated in the double Still-Face paradigm. Changes in behavior (positive and negative affect), physiology (heart rate), and salivary cortisol, compared to day one and between groups, were evaluated and used to infer adaption to the previous experienced laboratory visit. Infants in the experimental condition showed a significant decrease in positive affect (p = 0.016) and an increase in heart rate (p < 0.001) on day two, compared to controls, even during baseline measures and a neutral first play episode. Infants in the control condition showed a significant decrease in affect (p = 0.05) and non-significant increase in heart rate on day two when first encountering the Still-Face paradigm. Infants in the experimental condition showed significant higher heart rate on day two compared to the control group (p = 0.046). Infants in the experimental condition also exhibited a marginally significant increase in salivary cortisol on day two, compared to day one (p = 0.054). The change in infant heart rate was independent of maternal heart rate which did not differ between day one and day two, or between groups. Findings suggest that a previous stressful experience may elicit a behavioral and physiological adaption in infants 24 h later. Our results suggest that even a short, acute stressful event can elicit a lasting stress response in infants 24 h later. The effect we observed was specific to the context of the stressful event, not just the stressor. More precisely, the effect "spilled over" from the stressful experience on day one into the baseline measure of day two, usually a neutral experience. The results could have implications for further research on how stressful experiences may shape the stress response.

Probing the content of affective semantic memory following caregiving-related early adversity

Cognitive science has demonstrated that we construct knowledge about the world by abstracting patterns from routinely encountered experiences and storing them as semantic memories. This preregistered study tested the hypothesis that caregiving-related early adversities (crEAs) shape affective semantic memories to reflect the content of those adverse interpersonal-affective experiences. We also tested the hypothesis that because affective semantic memories may continue to evolve in response to later-occurring positive experiences, child-perceived attachment security will inform their content. The sample comprised 160 children (ages 6-12 at Visit 1; 87F/73 M), 66% of whom experienced crEAs (n = 105). At Visit 1, crEA exposure prior to study enrollment was operationalized as parental-reports endorsing a history of crEAs (abuse/neglect, permanent/significant parent-child separation); while child-reports assessed concurrent attachment security. A false memory task was administered online ∼2.5 years later (Visit 2) to probe the content of affective semantic memories-specifically attachment schemas. Results showed that crEA exposure (vs. no exposure) was associated with a higher likelihood of falsely endorsing insecure (vs. secure) schema scenes. Attachment security moderated the association between crEA exposure and insecure schema-based false recognition. Findings suggest that interpersonal-affective semantic schemas include representations of parent-child interactions that may capture the quality of one's own attachment experiences and that these representations shape how children remember attachment-relevant narrative events. Findings are also consistent with the hypothesis that these affective semantic memories can be modified by later experiences. Moving forward, the approach taken in this study provides a means of operationalizing Bowlby's notion of internal working models within a cognitive neuroscience framework. RESEARCH HIGHLIGHTS: Affective semantic memories representing insecure schema knowledge (child needs + needs-not-met) may be more salient, elaborated, and persistent among youths exposed to early caregiving adversity. All youths, irrespective of early caregiving adversity exposure, may possess affective semantic memories that represent knowledge of secure schemas (child needs + needs-met). Establishing secure relationships with parents following early-occurring caregiving adversity may attenuate the expression of insecure semantic memories, suggesting potential malleability. Affective semantic memories include schema representations of parent-child interactions that may capture the quality of one's own attachment experiences and shape how youths remember attachment-relevant events.

A comparative evaluation of the role of olfaction in attachment

Olfactory information plays an important role in the attachment and bonding processes for both humans and non-human animals. Odor cues obtained via individual body odor facilitate attachment and bonding processes across species with regard to both mate selection and mother-infant bonding. The purpose of the present paper is to summarize the role of odor as it pertains to bond formation and maintenance in the mother-infant bond for human infants and non-human animal infants, and for mate selection among human adults and non-human animals. We then synthesize this summary with literature on attachment and existing evidence for the relationships between olfaction and attachment processes. Finally, we suggest avenues for areas of future research.

Effect of Health Insurance Status and Visitation Restrictions on Virtual Visitation Technology in the Neonatal Intensive Care Unit

OBJECTIVE

 This study aimed to examine the relationship between virtual technology system utilization and insurance status or type of visitation restrictions in a single-center neonatal intensive care unit.

STUDY DESIGN

 Prospective cohort study with separate analyses performed based on insurance status (public vs. nonpublic) and "in effect" unit visitation restrictions. The three study epochs based on patient visitation restrictions were Epoch 1 (July to October 2019) with standard visitation restrictions, Epoch 2 (November 2019 to February 2020) with respiratory syncytial virus/influenza visitation restrictions, and Epoch 3 (March to June 2020) with coronavirus disease 2019 (COVID-19) visitation restrictions, respectively.

RESULTS

 Families of 357 infants used web-based cameras through most of the infant's hospitalization (median: 86.05%, Q3: 97.9%) with 165,795 total camera logins, indicating consistent utilization. There was a trend for fewer logins per infant and significantly longer time to consent (p = 0.03) in the Public Insurance group. Unit visitation restrictions impacted the time to consent, the shortest being in Epoch 3 during the COVID-19 pandemic (p = 0.03).

CONCLUSION

 Virtual visitation technology is well embraced by neonatal instensive care unit families; however, gaps in access and use among subgroups signals a form of social inequality that needs to be explored further.

KEY POINTS

· Virtual visitation technology can bridge the distance gap for families of hospitalized infants.. · Utilization of virtual technology is affected by socioeconomic factors and seasonal unit visitation restrictions.. · Factors influencing disparities in access and utilization of virtual technology need to be investigated further..

Neonatal family-centered care: evidence and practice models

Although advances in neonatology have reduced the mortality rate of high-risk infants, sick newborns or pre-mature infants undergo more intensive monitoring, pain-ful procedures, and lengthy hospitalization, leading to pro-longed separation from their parents. In recent decades, the importance of parent-infant closeness early in life has become more apparent, especially in preterm infants who are prone to neurodevelopmental deficits. There is an increasing body of evidence regarding the benefits of family-centered care (FCC) in neonatal intensive care units. Key aspects related to neonatal FCC include the parents' presence in the ward and their participation in infants' daily care and decision-making processes. In addition, an environment that supports a private and comfortable space for each family member and infant, such as a single-family room, should be provided. To successfully implement FCC in neonatal intensive care units, the culture of care and hospital policies should be changed to successfully implement FCC in neonatal intensive care units, and appropriate training for medical staff is also required.

Clinical Practice Guideline for Best Practice Management of Pediatric Patients by Chiropractors: Results of a Delphi Consensus Process

Objective: To build upon existing recommendations on best practices for chiropractic management of children by conducting a formal consensus process and best evidence synthesis. Design: Best practice guide based on recommendations from current best available evidence and formal consensus of a panel of experienced practitioners, consumers, and experts for chiropractic management of pediatric patients. Methods: Synthesis of results of a literature search to inform the development of recommendations from a multidisciplinary steering committee, including experts in pediatrics, followed by a formal Delphi panel consensus process. Results: The consensus process was conducted June to August 2022. All 60 panelists completed the process and reached at least 80% consensus on all recommendations after three Delphi rounds. Recommendations for best practices for chiropractic care for children addressed these aspects of the clinical encounter: patient communication, including informed consent; appropriate clinical history, including health habits; appropriate physical examination procedures; red flags/contraindications to chiropractic care and/or spinal manipulation; aspects of chiropractic management of pediatric patients, including infants; modifications of spinal manipulation and other manual procedures for pediatric patients; appropriate referral and comanagement; and appropriate health promotion and disease prevention practices. Conclusion: This set of recommendations represents a general framework for an evidence-informed and reasonable approach to the management of pediatric patients by chiropractors.

Sleep problems during early and late infancy: Diverse impacts on child development trajectories across multiple domains

OBJECTIVE

Child developmental rate holds predictive value for early-stage developmental trajectories, yet few studies explored how sleep problems during different infancy stages impact this rate. This study aims to investigate the correlation between sleep problems and child developmental trajectories.

METHODS

This study utilized a prospective national cohort of 5006 children in Taiwan. The developmental inventories covering motor, cognitive, language, and socioemotional domains were collected through questionnaire-based in-person home interviews conducted at 3, 12, 24, and 36 months. Sleep problems data, encompassing bedtime regularity, sleep duration, and sleep quality, were collected at 3 and 12 months. Child developmental rate was assessed by analyzing the slope of developmental ability estimates over a period of time.

RESULTS

Bedtime regularity and high-quality sleep at 3 and 12 months were found to be significantly associated with intercepts across all domains (estimate = -0.196∼0.233, p < 0.033). Children with high-quality sleep at 3 months showed enhanced developmental slopes in socioemotional domains (estimate = 0.032, p < 0.001). Atypical sleep duration at 3 and 12 months had differential detrimental association with child development in various domains (estimate = -0.108∼-0.016, p < 0.048).

CONCLUSION

The relationship between sleep problems and child development exhibited variability based on the timing of exposure to these issues. Early exposure to low-quality sleep was significantly related to developmental functions and socioemotional developmental rate, potentially leading to increased developmental disparities as children age. Inadequate sleep duration in late infancy and excessive sleep duration in early infancy were both negatively associated with child development trajectories. Policymakers can use these findings to design targeted sleep programs for optimal child development.

Parental experiences of home phototherapy for neonatal hyperbilirubinemia

Newborns with hyperbilirubinemia have traditionally received phototherapy in hospital. Hospital stays for infants, however, may negatively affect parent-infant bonding and induce anxiety and feelings of powerlessness in mothers. This study examined parent's experiences of providing phototherapy to their neonates at home instead. A descriptive qualitative study based on 15 interviews (8 mothers and 7 fathers) with parents of 8 children who had been randomised to home phototherapy was conducted during spring 2018 in Örebro county, Sweden. Inductive content analysis was used. The overall experience of home phototherapy was positive, and five categories were identified describing their experiences: continuing life at home, adjusting to having a newborn, feeling secure, experiencing parenthood and accessing information. The findings support the use of home phototherapy. Parents felt secure at home with their infants and emphasised the importance of clear information and round-the-clock access to hospital staff.

Automated maternal behavior during early life in rodents (AMBER) pipeline

Mother-infant interactions during the early postnatal period are critical for infant survival and the scaffolding of infant development. Rodent models are used extensively to understand how these early social experiences influence neurobiology across the lifespan. However, methods for measuring postnatal dam-pup interactions typically involve time-consuming manual scoring, vary widely between research groups, and produce low density data that limits downstream analytical applications. To address these methodological issues, we developed the Automated Maternal Behavior during Early life in Rodents (AMBER) pipeline for quantifying home-cage maternal and mother-pup interactions using open-source machine learning tools. DeepLabCut was used to track key points on rat dams (32 points) and individual pups (9 points per pup) in postnatal day 1-10 video recordings. Pose estimation models reached key point test errors of approximately 4.1-10 mm (14.39 pixels) and 3.44-7.87 mm (11.81 pixels) depending on depth of animal in the frame averaged across all key points for dam and pups respectively. Pose estimation data and human-annotated behavior labels from 38 videos were used with Simple Behavioral Analysis (SimBA) to generate behavior classifiers for dam active nursing, passive nursing, nest attendance, licking and grooming, self-directed grooming, eating, and drinking using random forest algorithms. All classifiers had excellent performance on test frames, with F1 scores above 0.886. Performance on hold-out videos remained high for nest attendance (F1 = 0.990), active nursing (F1 = 0.828), and licking and grooming (F1 = 0.766) but was lower for eating, drinking, and self-directed grooming (F1 = 0.534-0.554). A set of 242 videos was used with AMBER and produced behavior measures in the expected range from postnatal 1-10 home-cage videos. This pipeline is a major advancement in assessing home-cage dam-pup interactions in a way that reduces experimenter burden while increasing reproducibility, reliability, and detail of data for use in developmental studies without the need for special housing systems or proprietary software.

Determinants of infant behavior and growth in breastfed late preterm and early term infants: a secondary data analysis

BACKGROUND

Late preterm and early term infants are at increased risk of poor growth, behavioral problems, and developmental delays. This study aimed to investigate the impact of maternal and infant characteristics, feeding practices, and breastmilk composition on infant behavior following late preterm and early term delivery, and to evaluate the association between infant behavior and growth.

METHODS

Data from 52 Chinese mothers and their late preterm/early term infants participating in the Breastfeed a Better Youngster study were used. Maternal and infant characteristics were collected using questionnaires at 1 week postpartum. Breastmilk macronutrient content was measured using a human milk analyzer, and infant behavior was assessed using a 3-day infant behavior diary at 8 weeks postpartum. Feeding practices were collected at both time points using questionnaires. Multivariate models were used to assess associations between potential predictors and infant behavior and between infant behavior and growth.

RESULTS

Exclusive breastfeeding was associated with greater sleep duration (P = 0.02) and shorter crying duration (P = 0.01). Mothers with a vocational education reported greater distress duration (P = 0.006). Greater colic duration was associated with higher maternal annual income (P = 0.004). There was no significant association between infant behavior and growth (all P > 0.05).

CONCLUSIONS

Exclusive breastfeeding might promote more favorable infant behaviors in late preterm/early term infants, while the development of infant distress behaviors was associated with some maternal characteristics (maternal education and annual income). However, due to the limitations of diary methods, determinants of infant behavior should ideally be assessed using more objective measures in larger samples.

Perinatal palliative care: focus on comfort

Providing comfort while a patient is living with a life-limiting condition or at end of life is the hallmark of palliative care regardless of the patient's age. In perinatal palliative care, the patient is unable to speak for themselves. In this manuscript we will present guidelines garnered from the 15-year experience of the Neonatal Comfort Care Program at Columbia University Irving Medical Center, and how they provide care for families along the perinatal journey. We will describe essential tools and strategies necessary to consider in assessing and providing comfort to infants facing a life-limiting diagnosis in utero, born at the cusp of viability or critically ill where the burden of care may outweigh the benefit.

Dynamic developmental changes in neurotransmitters supporting infant attachment learning

Infant survival relies on rapid identification, remembering and behavioral responsiveness to caregivers' sensory cues. While neural circuits supporting infant attachment learning have largely remained elusive in children, use of invasive techniques has uncovered some of its features in rodents. During a 10-day sensitive period from birth, newborn rodents associate maternal odors with maternal pleasant or noxious thermo-tactile stimulation, which gives rise to a preference and approach behavior towards these odors, and blockade of avoidance learning. Here we review the neural circuitry supporting this neonatal odor learning, unique compared to adults, focusing specifically on the early roles of neurotransmitters such as glutamate, GABA (Gamma-AminoButyric Acid), serotonin, dopamine and norepinephrine, in the olfactory bulb, the anterior piriform cortex and amygdala. The review highlights the importance of deepening our knowledge of age-specific infant brain neurotransmitters and behavioral functioning that can be translated to improve the well-being of children during typical development and aid in treatment during atypical development in childhood clinical practice, and the care during rearing of domestic animals.

Creating Connections: A Feasibility Study of a Technology-Based Intervention to Support Mothers of Newborns during Pediatric Well-Visits

Objective

Intervention in the earliest period of parenthood can make a strong, positive impact on parenting, yet engaging parents of newborns in parenting interventions can be difficult. Technological adaptation of important interventions can improve early engagement. This study reports the initial feasibility of the Creating Connections intervention, a technology-based intervention developed to support mothers of newborns, and feasibility of evaluating the intervention through a randomized clinical trial in pediatric primary care. The intervention includes: 1) a brief tablet-based intervention delivered during a newborn well-child pediatric check-up, and 2) tailored text messages delivered thereafter to boost intervention content. Intervention content includes empirically-supported aspects of parenting behaviors known to positively influence children's social-emotional development.

Methods

Project recruitment took place in an ambulatory care pediatric clinic in a large Midwestern city. Mothers received information about infant soothing, book sharing, or both.

Results

One hundred and three parents learned about the program and 72 participated. Mothers were primarily Black/African American with incomes at or below $30,000. Only 50% of mothers that received text messages through the program completed follow-up, but these mothers gave overall positive ratings of text messages.

Conclusions

Program engagement and ratings of parents support feasibility, but retention rates need improvement. Based on barriers and successes of this investigation, lessons learned about feasibility and acceptability are discussed.

Infant factors that impact the ecology of human milk secretion and composition-a report from "Breastmilk Ecology: Genesis of Infant Nutrition (BEGIN)" Working Group 3

Infants drive many lactation processes and contribute to the changing composition of human milk through multiple mechanisms. This review addresses the major topics of milk removal; chemosensory ecology for the parent-infant dyad; the infant's inputs into the composition of the human milk microbiome; and the impact of disruptions in gestation on the ecology of fetal and infant phenotypes, milk composition, and lactation. Milk removal, which is essential for adequate infant intake and continued milk synthesis through multiple hormonal and autocrine/paracrine mechanisms, should be effective, efficient, and comfortable for both the lactating parent and the infant. All 3 components should be included in the evaluation of milk removal. Breastmilk "bridges" flavor experiences in utero with postweaning foods, and the flavors become familiar and preferred. Infants can detect flavor changes in human milk resulting from parental lifestyle choices, including recreational drug use, and early experiences with the sensory properties of these recreational drugs impact subsequent behavioral responses. Interactions between the infant's own developing microbiome, that of the milk, and the multiple environmental factors that are drivers-both modifiable and nonmodifiable-in the microbial ecology of human milk are explored. Disruptions in gestation, especially preterm birth and fetal growth restriction or excess, impact the milk composition and lactation processes such as the timing of secretory activation, adequacy of milk volume and milk removal, and duration of lactation. Research gaps are identified in each of these areas. To assure a sustained and robust breastfeeding ecology, these myriad infant inputs must be systematically considered.

Worth-Conscious theory: Understanding the role of birthright self-worth and application to clinical practice

In this article, we introduce a theory of worth consciousness that builds on the research from self-worth with attention to the importance of honoring birthright self-worth (BSW), which is foundational to human dignity. This new empirically testable construct, Worth-Conscious theory (WCT), concerns human worth and requires individuals to recognize and acknowledge their value and significance (i.e., worth) even when smaller (e.g., family) and larger (e.g., community and society) systems fail to support them in affirming and repairing their worth. Self-worth is the birthright of all individuals; hence our central aim is to introduce and explain the four pillars of self-worth, which are major tenets of WCT that align with Erikson’s developmental stages. These four pillars of self-worth (self-awareness, self-respect, self-esteem(ed), and self-confidence) are instrumental in understanding clients’ life challenges, presenting issues, and how to assist them in repairing and maintaining their worth. More specifically, many clients’ mental health issues, interpersonal conflicts, and other concerns can be directly or indirectly related to the experience of negative and critical beliefs about their worth and, more specifically, that their BSW has not been affirmed or realized throughout the lifespan.

Parent and interdisciplinary professional perceptions of family-centered care in Thai NICU: A qualitative study

BACKGROUND

Family-centered care (FCC) has been successfully incorporated into daily practice in many neonatal intensive care units (NICUs) worldwide. However, the implementation of FCC in lower-resourced settings, such as Thailand, can be challenging and needs to be further explored.

AIMS

To identify parents' and interdisciplinary professionals' perceptions of FCC and to describe the opportunities to improve FCC in a Thai NICU.

DESIGN

An exploratory qualitative approach was used.

METHODS

The data were collected through face-to-face, semi-structured, individual interviews based on an interview guide. This study was conducted before the outbreak of coronavirus disease 2019 (February 2020) in a hospital in southern Thailand. Inductive thematic analysis was used to analyse interview data.

RESULTS

Participants were parents (n = 9) and interdisciplinary professionals (n = 8). The results revealed four key themes: (a) Recognizing and responding to individual families' different readiness and their rights and values, (b) working in a parent-interdisciplinary partnership to provide care, (c) lacking resources and motivation and (d) understanding of care requirements and providing help/sympathy.

CONCLUSIONS

The interdisciplinary professionals accepted that FCC is necessary for clinical practice, but there are some challenges in the Thai NICUs context because of the system of health care delivery. The findings highlighted that interdisciplinary professionals often viewed parents' involvement as an obstacle to providing neonatal care.

RELEVANCE TO CLINICAL PRACTICE

Further research is recommended to investigate how FCC is operationalized by interdisciplinary professionals and how hospital administrators can be supported to implement the FCC approach into clinical practice in Thai NICUs.

A longitudinal study of the psychological impact of child-rearing difficulty and COVID-19 on mothers in the postpartum period in Japan

Background

Postpartum mothers may experience psychological stress due to the sudden changes in their bodies and situation. This study investigates the changes in depressive symptoms among nursing mothers and their child-rearing difficulties before and one month after the declared state of emergency due to COVID-19 pandemic in Japan. The study also assesses whether adding the stress induced by the pandemic to parenting difficulties affected women's depressive symptoms.

Method

An online survey was conducted with 309 postpartum women. Participants completed questionnaires that included the Quick Inventory of Depressive Symptomatology (QIDS-SR-J), draft version of the Comprehensive Scale for Parenting Resilience and Adaptation (CPRA+α), and original questions about the COVID-19 stress.

Results

A factor analysis was performed on CPRA+α, which found five main factors: difficulty in coping with child and oneself, dissatisfaction with husband, distrust in parents, being tired of the child, and distrust in physician. As a result of t-test of these five factors and the QIDS revealed that there was a significant difference in depressive symptoms before and after the COVID-19 outbreak. In addition to these five factors, the COVID-19 stress of impact on income and employment increased depressive symptoms, while the stress of refraining from going out decreased depressive symptoms.

Limitation

Differences in the characteristics of children and mothers were not considered in the study. Longitudinal studies focusing on the period after the declaration of a state of emergency in 2020 are considered necessary.

Conclusion

Childcare difficulties and the COVID-19 pandemic induced stress are associated with postpartum women's depressive symptoms.

Caregiver-child proximity as a dimension of early experience

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

Family-centred care change during COVID-19

BACKGROUND

Family-centred care (FCC) is an approach to promote family and health care provider partnership. This has been incorporated into neonatal intensive care units (NICUs) worldwide. However, FCC in low resource health settings, such as Thailand, is challenging and further impacted by coronavirus disease 2019 (COVID-19).

AIMS

To evaluate FCC innovations to improve respect, collaboration and support in a Thai NICU.

STUDY DESIGN

A quasi-experimental study was conducted in an NICU in southern Thailand. Pre-implementation was prior to COVID-19, and parental and staff perceptions of FCC were measured via Perceptions of Family Centred Care-Parent (PFCC-P) and -Staff (PFCC-S) survey. The FCC innovations were developed by stakeholders based on the COVID-19 restrictions, pre-survey results, parents' and clinicians' interviews and integrative review, then implemented via a flowchart. Post-implementation evaluation was via repeated surveys. Comparisons were made pre-and post-implementation, with Mann-Whitney U-test statistics for parents and Wilcoxon's Rank Sum for staff.

RESULTS

A total of 185 (85 pre; 100 post) parents and 20 (pre and post; paired group) health care professionals participated. Because of COVID-19, many planned interventions were unfeasible, however, other innovations achieved (e.g., structured telephone updates, information booklet revision). There was an increase in parents' perception of respect ([median] 2.50-3.50), collaboration (2.33-3.33) and support (2.60-3.60) domains and overall (2.50-3.43; p < .001; 95% CI: 2.93-3.11). Interdisciplinary professionals' perception of FCC did not significantly change pre-and post-implementation/COVID-19 pandemic for respect (3.00-2.92), collaboration (3.22-3.33), support (3.20-3.20) and overall (3.15-3.20; 95% CI: 3.10-3.25).

CONCLUSION

Despite the challenges of COVID-19 restricting NICU access, the provision of FCC was maintained and even improved.

RELEVANCE TO CLINICAL PRACTICE

Further research is necessary to develop FCC practice innovations associated with communication, across diverse health care systems and resources.

Automated procedure to assess pup retrieval in laboratory mice

All mammalian mothers form some sort of caring bond with their infants that is crucial to the development of their offspring. The Pup Retrieval Test (PRT) is the leading procedure to assess pup-directed maternal care in laboratory rodents, used in a wide range of basic and preclinical research applications. Most PRT protocols require manual scoring, which is prone to bias and spatial and temporal inaccuracies. This study proposes a novel procedure using machine learning algorithms to enable reliable assessment of PRT performance. Automated tracking of a dam and one pup was established in DeepLabCut and was combined with automated behavioral classification of "maternal approach", "carrying" and "digging" in Simple Behavioral Analysis (SimBA). Our automated procedure estimated retrieval success with an accuracy of 86.7%, whereas accuracies of "approach", "carry" and "digging" were estimated at respectively 99.3%, 98.6% and 85.0%. We provide an open-source, step-by-step protocol for automated PRT assessment, which aims to increase reproducibility and reliability, and can be easily shared and distributed.

Early Life Adversity and Males: Biology, Behavior, and Implications for Fathers' Parenting

Fathers have an important and unique influence on child development, but influences on fathers' parenting have been vastly understudied in the scientific literature. In particular, very little empirical research exists on the effects of early life adversity (ELA; e.g. childhood maltreatment, parental separation) on later parenting among fathers. In this review, we draw from both the human and non-human animal literature to examine the effects of ELA, specifically among males, in the following areas: 1) neurobiology and neurocognitive functioning, 2) hormones and hormone receptors, 3) gene-environment interactions and epigenetics, and 4) behavior and development. Based on these findings, we present a conceptual model to describe the biological and behavioral pathways through which exposure to ELA may influence parenting among males, with a goal of guiding future research and intervention development in this area. Empirical studies are needed to improve understanding of the relationship between ELA and father's parenting, inform the development of paternal and biparental interventions, and prevent intergenerational transmission of ELA.

The Impact of Prepartum Depression and Birth Experience on Postpartum Mother-Infant Bonding: A Longitudinal Path Analysis

INTRODUCTION

Negative effects of impaired postpartum mother-infant-bonding on mental health of mothers, their newborn children and subsequent child development are well documented. Previous research demonstrated an association between a negative birth experience and postpartum mental health affecting postpartum mother-infant bonding. This study investigates the extent to which prepartum depression and birth experience influence the postpartum mental health of mothers and their bonding toward their newborns, and whether these influences differ according to parity and self-reported prior mental health problems.

METHOD

Three hundred and fifty-four women (18-43 years; M = 30.13, SD = 5.10) filled in the Edinburgh Postnatal Depression Scale (EPDS), the Maternal-Fetal Attachment Scale (MFAS), Salmon's Item List (SIL) assessing the birth experience, and the Postpartum Bonding Questionnaire (PBQ) at pre- and postpartum; they were also asked about birth complications and parity status.

RESULTS

Primipara reported significantly more birth complications (p = 0.048), with path analysis confirming this result (p < 0.001). Birth complications were associated with a more negative rating of the overall birth experience (p < 0.001). Mothers with self-reported prior mental health problems had higher prepartum depression scores (p < 0.001) but did not differ in other variables from mothers without prior self-reported mental health problems. Differences in depression scores between mothers with self-reported prior mental health problems and those without vanished at postpartum assessment (p > 0.05). Path-analysis highlighted the key role of postpartum depression, which was the only significant predictor of postpartum impairment in maternal-child bonding (p < 0.001). Birth experience and prepartum depression scores exerted an indirect effect on postpartum maternal-child bonding, mediated by postpartum depression.

DISCUSSION

The present study demonstrates the relevance of prepartum mental health of expectant mothers, especially of those who self-report prior mental health problems. The results support that reducing mental health problems of pregnant mothers might contribute to a more positive birth experience and potentially reduce postpartum depressive symptoms. As postpartum depression is associated with impaired parent-child bonding, such targeted interventions could promote child development. Group differences between primiparous and multiparous mothers suggest that the birth experience may be an influential factor for postpartum mental health.

Consequences of Prematurity on Cortisol Regulation and Adjustment Difficulties: A 9-Year Longitudinal Study

A preterm birth represents a stressful event having potentially negative long-term consequences. Thirty-three children born preterm (<33 weeks gestational age) and eleven full-term children participated in a nine-year longitudinal study. Perinatal Risk Inventory (PERI) was used at birth to assess the perinatal stress. Salivary cortisol, collected four times a day over two consecutive days, was measured with radioimmunoassay technique at six months and nine years to assess the hypothalamic-pituitary-adrenal (HPA) axis. Mothers reported post-traumatic symptoms on a self-report questionnaire 12 months after their child's birth and children's adjustment problems at 9 years of child age on the Child Behavior Checklist. Results showed a significant difference in cortisol regulation at nine years between preterm and full-term children but no differences in adjustment problems. Whereas biological factors (i.e., PERI, cortisol regulation at six months) explained cortisol at nine years, maternal post-traumatic symptoms were predictive of adjustment problems in their child. In conclusion, very preterm birth has some long-term consequences on the HPA-axis regulation at nine years. Although cortisol regulation is mostly influenced by biological factors, the presence of maternal post-traumatic symptoms predicts the manifestation of adjustment problems in both groups. This shows the importance of maternal psychological well-being for child development. Further research is needed to understand the exact consequences of premature birth on cortisol regulation and the implication for the child's development and health.

Maternal chemosignals enhance infant-adult brain-to-brain synchrony

Maternal body odors serve as important safety-promoting and social recognition signals, but their role in human brain maturation is largely unknown. Utilizing ecological paradigms and dual- electroencephalography recording, we examined the effects of maternal chemosignals on brain-to-brain synchrony during infant-mother and infant-stranger interactions with and without the presence of maternal body odors. Neural connectivity of right-to-right brain theta synchrony emerged across conditions, sensitizing key nodes of the infant’s social brain during its maturational period. Infant-mother interaction elicited greater brain-to-brain synchrony; however, maternal chemosignals attenuated this difference. Infants exhibited more social attention, positive arousal, and safety/approach behaviors in the maternal chemosignals condition, which augmented infant-stranger neural synchrony. Human mothers use interbrain mechanisms to tune the infant’s social brain, and chemosignals may sustain the transfer of infant sociality from the mother-infant bond to life within social groups.

Parental Perspectives on the Postpartum Bonding Experience after Neonatal Intensive Care Unit Transfer to a Referral Hospital

OBJECTIVE

The aim of this study is to describe the postpartum bonding experience of parents whose newborns were transferred to a referral hospital while their mothers remained at the delivery hospital.

STUDY DESIGN

A total of 18 semi-structured interviews conducted with mothers within 2 weeks of birth were completed. Thematic analysis was performed.

RESULT

In total, 72% of mothers were unable to hold their newborns, and mothers spent a median of 15 minutes with their newborn prior to transfer. Thematic analysis revealed five themes: three barriers to bonding (medical, hospital, and family barriers) and two themes of interventions that helped promote bonding (parent and hospital-initiated interventions). Using technology such as bedside cameras, recording of heart beats, and video chatting on rounds were extremely popular.

CONCLUSION

Parents identified multiple barriers to maternal-infant bonding and suggested several parent-focused and hospital-focused interventions to enhance bonding. Strategies that address barriers should be used to help parents promote bonding during separation from their newborns.

KEY POINTS

· Transfer to referral neonatal intensive care units interrupts bonding.. · Interviews reveal multiple barriers to bonding.. · Interventions can be parent or hospital initiated.. · Technology is playing a growing role..

Postpartum Depressive Symptoms as a Mediator Between Intimate Partner Violence During Pregnancy and Maternal-Infant Bonding in Japan

Studies show that experiencing intimate partner violence (IPV) during pregnancy is related to poor maternal-infant bonding. However, the mechanisms underlying this relationship are unclear. This article aims to examine whether maternal postpartum depressive (PPD) symptoms mediate the association between pregnancy IPV and maternal-infant bonding, and whether the relationship differs by maternal-infant bonding subscales-lack of affection, anger/rejection. A survey was conducted among women who participated in a postpartum health check-up program in Aichi prefecture, Japan (N = 6,590) in 2012. We examined whether experiences of emotional and physical IPV were related to maternal-infant bonding and whether PPD symptoms mediated this relationship. Path analysis showed that emotional and physical IPV were associated with PPD symptoms, and PPD symptoms predicted poor bonding. The total effect of emotional IPV on poor bonding was significant, showing a marginally significant direct effect and statistically significant indirect effect. The total effect of physical IPV on poor bonding was not statistically significant. Emotional IPV was significantly associated with both lack of affection and anger/rejection bonding subscales, which were similarly mediated by PPD symptoms. Findings revealed a modest indirect association between IPV, emotional IPV in particular, and poor maternal-infant bonding, which was mediated by PPD symptoms. While prevention of IPV is the ultimate goal, the treatment of PPD symptoms among women who experience IPV during pregnancy may improve maternal-infant bonding and mitigate cross-generational effects of IPV. Identifying opportunities for detection of IPV and PPD symptoms, as well as prevention and early intervention, may improve maternal-infant bonding.

Association between newborn separation, maternal consent and health outcomes: findings from a longitudinal survey in Kenya

OBJECTIVES

Disrespectful and poor treatment of newborns such as unnecessary separation from parents or failure to obtain parental consent for medical procedures occurs at health facilities across contexts, but little research has investigated the prevalence, risk factors or associated outcomes. This study examined these experiences and associations with healthcare satisfaction, use and breast feeding.

DESIGN

Prospective cohort study.

SETTING

3 public hospitals, 2 private hospitals, and 1 health centre/dispensary in Nairobi and Kiambu counties in Kenya.

PARTICIPANTS

Data were collected from women who delivered in health facilities between September 2019 and January 2020. The sample included 1014 women surveyed at baseline and at least one follow-up at 2-4 or 10 weeks post partum. PRIMARY AND SECONDARY OUTCOME MEASURES: (1) Outcomes related to satisfaction with care and care utilisation; (2) continuation of post-discharge newborn care practices such as breast feeding.

RESULTS

17.6% of women reported newborn separation at the facility, of whom 71.9% were separated over 10 min. 44.9% felt separation was unnecessary and 8.4% reported not knowing the reason for separation. 59.9% reported consent was not obtained for procedures on their newborn. Women separated from their newborn (>10 min) were 44% less likely to be exclusively breast feeding at 2-4 weeks (adjusted OR (aOR)=0.56, 95% CI: 0.40 to 0.76). Obtaining consent for newborn procedures corresponded with 2.7 times greater likelihood of satisfaction with care (aOR=2.71, 95% CI: 1.67 to 4.41), 27% greater likelihood of postpartum visit attendance for self or newborn (aOR=1.27, 95% CI: 1.05 to 1.55), and 33% greater likelihood of exclusive breast feeding at 10 weeks (aOR=1.33, 95% CI: 1.10 to 1.62).

CONCLUSIONS

Newborns, mothers and families have a right to high-quality, respectful care, including the ability to stay together, be informed and properly consent for care. The implications of these experiences on health outcomes a month or more after discharge illustrate the importance of a positive experience of postnatal care.

Instrument Development and Psychometric Validation using Confirmatory Factor Analysis of the Breastfeeding Relationship Scale

BACKGROUND AND PURPOSE

The Breastfeeding Relationship Scale (BFRS) was developed to measure mother-infant mutual responsiveness during breastfeeding. The purpose of this study was to develop and test the psychometric properties of the BFRS.

METHODS

Construct validity of a 16-item three-factor model (Mother-Infant Breastfeeding Interaction, Perceived Adequate Milk Supply, and Breastfeeding Synchronicity) was assessed using confirmatory factor analysis (CFA) and reliability (Cronbach's alpha) across two independent samples.

RESULTS

CFA of the hypothesized three-factor model demonstrated good fit in both samples (comparative fit index > .90, root mean square error of approximation < .06, square root mean residual < .06l). Cronbach's alpha for the constructs ranged between .73 and .83.

CONCLUSION

The BFRS is a valid measure of breastfeeding relations between mother and infant. Reliability was acceptable for all constructs in both samples.

Physical contact in parent-infant relationship and its effect on fostering a feeling of safety

The infant-caregiver relationship involves physical contact for feeding, moving, and other cares, and such contact also encourages the infant to form an attachment, an emotional bond with the caregivers. Physical contact always accompanies somatosensory perception, which is detected by mechanosensory neurons and processed in the brain. Physical contact triggers sensorimotor reflexes such as Transport Response in rodent infants, and calm human infants while being carried. Tactile sensation and deep pressure in physical interactions, such as hugging, can function as emotional communication between infant and caregiver, which can alter the behavior and mood of both the infant and caregiver. This review summarizes the findings related to physical contact between the infant and the caregiver in terms of pleasant, noxious, and neutral somatosensation and discusses how somatosensory perceptions foster a feeling of safety that is important for infant's psychosocial development.

Postpartum bonding: the impact of stressful life events during pregnancy

OBJECTIVE

We aimed to determine if and to what extent a woman's exposure to stressful life events were associated with impaired maternal bonding by using a sample of high-income Italian women.

METHODS

In the second day postpartum, 425 healthy puerperae responded to Life Experiences Survey (LES), Mother-to-Infant Bonding Scale (MBS), and to the Edinburgh Postnatal Depression Scale (EPDS).

RESULTS

Analysis revealed that the stressful life events scored by LES were a significantly predictor of impaired bonding as measured by MIBS (β = 0.04; t = 3.45; p < .001) and of postpartum depression symptoms as measured by EPDS total score (β = 0.32; t = 4.86; p < .001) as well as its subscales Anhedonia (β = 0.059; t = 4.99; p < .001), Anxiety (β = 0.03; t = 5.72; p < .001), and Depression (β = 0.05; t = 6.53; p < .001). Moreover, the partial correlation between EPDS total score and MIBS accounting for LES positive and negative scores was statistically significant (r = 0.208; n = 332; p < .001).

CONCLUSION

The findings emphasize the importance of identifying mothers with negative experiences toward pregnancy and delivery to address possible interventions beyond hospital-based antenatal care to improve bonding and maternal mental outcomes.

Parental Acceptance of Children's Storytelling Robots: A Projection of the Uncanny Valley of AI

Parent-child story time is an important ritual of contemporary parenting. Recently, robots with artificial intelligence (AI) have become common. Parental acceptance of children's storytelling robots, however, has received scant attention. To address this, we conducted a qualitative study with 18 parents using the research technique design fiction. Overall, parents held mixed, though generally positive, attitudes toward children's storytelling robots. In their estimation, these robots would outperform screen-based technologies for children's story time. However, the robots' potential to adapt and to express emotion caused some parents to feel ambivalent about the robots, which might hinder their adoption. We found three predictors of parental acceptance of these robots: context of use, perceived agency, and perceived intelligence. Parents' speculation revealed an uncanny valley of AI: a nonlinear relation between the human likeness of the artificial agent's mind and affinity for the agent. Finally, we consider the implications of children's storytelling robots, including how they could enhance equity in children's access to education, and propose directions for research on their design to benefit family well-being.

Proximate and Ultimate Perspectives on Romantic Love

Romantic love is a phenomenon of immense interest to the general public as well as to scholars in several disciplines. It is known to be present in almost all human societies and has been studied from a number of perspectives. In this integrative review, we bring together what is known about romantic love using Tinbergen’s “four questions” framework originating from evolutionary biology. Under the first question, related to mechanisms, we show that it is caused by social, psychological mate choice, genetic, neural, and endocrine mechanisms. The mechanisms regulating psychopathology, cognitive biases, and animal models provide further insights into the mechanisms that regulate romantic love. Under the second question, related to development, we show that romantic love exists across the human lifespan in both sexes. We summarize what is known about its development and the internal and external factors that influence it. We consider cross-cultural perspectives and raise the issue of evolutionary mismatch. Under the third question, related to function, we discuss the fitness-relevant benefits and costs of romantic love with reference to mate choice, courtship, sex, and pair-bonding. We outline three possible selective pressures and contend that romantic love is a suite of adaptions and by-products. Under the fourth question, related to phylogeny, we summarize theories of romantic love’s evolutionary history and show that romantic love probably evolved in concert with pair-bonds in our recent ancestors. We describe the mammalian antecedents to romantic love and the contribution of genes and culture to the expression of modern romantic love. We advance four potential scenarios for the evolution of romantic love. We conclude by summarizing what Tinbergen’s four questions tell us, highlighting outstanding questions as avenues of potential future research, and suggesting a novel ethologically informed working definition to accommodate the multi-faceted understanding of romantic love advanced in this review.

Exploring Social Biomarkers in High-Functioning Adults with Autism and Asperger's Versus Healthy Controls: A Cross-Sectional Analysis

Biomarkers for autism spectrum disorder (ASD) are lacking but would facilitate drug development for the core deficits of the disorder. We evaluated markers proposed for characterization of differences in social communication and interaction in adults with ASD versus healthy controls (HC) for utility as biomarkers. Data pooled from an observational study and baseline data from a placebo-controlled study were analyzed. Between-group differences were observed in eye-tracking tasks for activity monitoring, biomotion, human activity preference, composite score (p = 0.0001-0.037) and pupillometry (various tasks, p = 0.017-0.05). Impaired olfaction was more common in the ASD sample versus HC (p = 0.018). Our preliminary results suggest the potential use for stratification and response sub-analyses outcome-prediction of specific eye-tracking tasks, pupillometry and olfaction tests in ASD trials.

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

COVID-19 has changed the way that newborn babies are cared for within the neonatal setting due to the introduction of social distancing and wearing of face masks to limit the spread of the infection. Potential implications exist related to the normal development of bonding and connections with others. This paper discusses the importance of face to face interactions for early attachment between babies and parents within the context of relevant underpinning developmental theory. Mask wearing can also potentially impact relational communication, requiring us to change our current ways of working. Decreasing face to face interactions and relational communication, along with key recommendations for both parents and health professionals are further highlighted to mitigate the potential negative effects of masks on long-term development related to human connection and attachment.

The role of insecure attachment and cognitive biases in the social functioning of schizophrenia spectrum patients

OBJECTIVE

The study investigates the relationship between cognitive biases and attachment styles and social functioning.

METHOD

Fifty-three patients (28 females, age M = 41.73, SD = 11.71) with the diagnosis of schizophrenia participated in the study. We measured attachment styles, cognitive biases, and social functioning using self-report questionnaires. Relationships among variables were investigated with correlational and regression analyses.

RESULTS

Correlation analysis indicated that social engagement, interpersonal behavior, pro-social activities, and independence-performance significantly correlate with both attachment styles and cognitive biases. However, in regression analysis, after controlling for attachment styles, only subjective cognitive problems turned out to be a significant predictor of social functioning.

CONCLUSIONS

These preliminary findings might suggest that both attachment styles and cognitive biases are associated with social functioning. Nonetheless, when considered together it might suggest attachment styles have a higher contribution than cognitive biases to social engagement, interpersonal behavior, and pro-social activities decline in schizophrenia spectrum disorders.

The social nature of mitochondria: Implications for human health

Sociality has profound evolutionary roots and is observed from unicellular organisms to multicellular animals. In line with the view that social principles apply across levels of biological complexity, a growing body of data highlights the remarkable social nature of mitochondria - life-sustaining endosymbiotic organelles with their own genome that populate the cell cytoplasm. Here, we draw from organizing principles of behavior in social organisms to reveal that similar to individuals among social networks, mitochondria communicate with each other and with the cell nucleus, exhibit group formation and interdependence, synchronize their behaviors, and functionally specialize to accomplish specific functions within the organism. Mitochondria are social organelles. The extension of social principles across levels of biological complexity is a theoretical shift that emphasizes the role of communication and interdependence in cell biology, physiology, and neuroscience. With the help of emerging computational methods capable of capturing complex dynamic behavioral patterns, the implementation of social concepts in mitochondrial biology may facilitate cross-talk across disciplines towards increasingly holistic and accurate models of human health.

Towards a Comprehensive Theory of Love: The Quadruple Theory

Scholars across an array of disciplines including social psychologists have been trying to explain the meaning of love for over a century but its polysemous nature has made it difficult to fully understand. In this paper, a quadruple framework of attraction, resonance or connection, trust, and respect are proposed to explain the meaning of love. The framework is used to explain how love grows and dies and to describe brand love, romantic love, and parental love. The synergistic relationship between the factors and how their variations modulate the intensity or levels of love are discussed.

Infants Show Physiological Responses Specific to Parental Hugs

Caregivers hug their infants to express affection and joy. However, it remains unknown how infants react to being hugged. Here we examined heart rate responses in first-year infants during a hug, hold, and tight hug from parents. Infants older than four months showed an increased R-R interval (RRI) during a hug, indicating reduced heart rates and pronounced parasympathetic activity. Few head movements predicted a higher RRI increase in infants during a parental hug compared with that during a hold and tight hug. Infants did not show an increased RRI during a hug from a female stranger. Infants younger than four months did not show RRI increase during parental hug but exhibited a decreased RRI correlated with contact pressure. Parents showed an increased RRI during hugging their infants. These results suggest the parent-infant hug underlies the parent-infant bonding and psychophysiological development of infants.

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We examined heart rate responses in first-year infants during hugs from parents

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Infants showed an RRI increase when hugged by parents but not by strangers

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Few head movements predicted higher RRI increase during a parental hug

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Parents also showed an increased RRI when hugging their infants

Mother Schema, Obstetric Dilemma, and the Origin of Behavioral Modernity

What triggered the emergence of uniquely human behaviors (language, religion, music) some 100,000 years ago? A non-circular, speculative theory based on the mother-infant relationship is presented. Infant "cuteness" evokes the infant schema and motivates nurturing; the analogous mother schema (MS) is a multimodal representation of the carer from the fetal/infant perspective, motivating fearless trust. Prenatal MS organizes auditory, proprioceptive, and biochemical stimuli (voice, heartbeat, footsteps, digestion, body movements, biochemicals) that depend on maternal physical/emotional state. In human evolution, bipedalism and encephalization led to earlier births and more fragile infants. Cognitively more advanced infants survived by better communicating with and motivating (manipulating) mothers and carers. The ability to link arbitrary sound patterns to complex meanings improved (proto-language). Later in life, MS and associated emotions were triggered in ritual settings by repetitive sounds and movements (early song, chant, rhythm, dance), subdued light, dull auditory timbre, psychoactive substances, unusual tastes/smells and postures, and/or a feeling of enclosure. Operant conditioning can explain why such actions were repeated. Reflective consciousness emerged as infant-mother dyads playfully explored intentionality (theory of mind, agent detection) and carers predicted and prevented fatal infant accidents (mental time travel). The theory is consistent with cross-cultural commonalities in altered states (out-of-body, possessing, floating, fusing), spiritual beings (large, moving, powerful, emotional, wise, loving), and reports of strong musical experiences and divine encounters. Evidence is circumstantial and cumulative; falsification is problematic.

Implementing Birthing on Country services for Aboriginal and Torres Strait Islander families: RISE Framework

BACKGROUND

Birthing on Country is an international movement to return maternity services to First Nations communities and community control for improved health and wellbeing.

QUESTION

How can we implement Birthing on Country services for Aboriginal and/or Torres Strait Islander families across Australia?

METHODS

We have developed a framework from theoretical, policy and research literature on Birthing on Country; Aboriginal and Torres Strait Islander voices from across Australia; reviews exploring programs that have improved outcomes for Indigenous mothers and infants; and the retrospective synthesis of learnings from two empirical studies that have redesigned maternal infant health services and improved outcomes for Aboriginal and Torres Strait Islander families.

RESULTS

The RISE Framework has four pillars to drive important reform: (1) Redesign the health service; (2) Invest in the workforce; (3) Strengthen families; and, (4) Embed Aboriginal and/or Torres Strait Islander community governance and control. We present the evidence base for each pillar and practical examples of moving from the standard 'western' model of maternity care towards Birthing on Country services.

CONCLUSIONS

Application of the RISE framework to plan, develop and monitor Birthing on Country services is likely to result in short and long-term health gains for Aboriginal and Torres Strait Islander families.

Oxytocin Receptor Binding Sites in the Periphery of the Neonatal Prairie Vole

The oxytocin receptor (OXTR) has been observed in the periphery of neonatal C57BL/6J mice (Mus musculus), including facial regions and the anogenital area. In those studies, ligand specificity was confirmed with a congenital OXTR knockout mouse as well as competitive binding techniques. The aim of this study was to determine if OXTR is present in the same peripheral sites in the neonatal prairie vole (Microtus ochrogaster) for cross-species comparisons. Receptor autoradiography was performed on 20 μm sagittal sections of whole postnatal day 0 (P0) male and female prairie voles using the ¹²⁵iodinated-ornithine vasotocin ([¹²⁵I]-OVTA) radioligand. A competition binding assay was used to assess the selectivity of [¹²⁵I]-OVTA for peripheral OXTR. Radioactive ligand (0.05 nM [¹²⁵I]-OVTA) was competed against concentrations of 0 and 1000 nM excess unlabeled oxytocin (OXT). Previously identified regions of significant OXTR ligand binding in the mouse were analyzed for comparison: rostral and lateral periodontium, olfactory epithelium, ciliary bodies of the eye, whisker pads, adrenal gland, and anogenital area. We also evaluated the liver and scapular brown adipose tissue, which displayed strong but non-specific signal on film in mice. While there were some areas that showed conserved OXTR ligand binding in the prairie vole (e.g., ciliary body of the eye and the anogenital area), areas showing OXTR ligand binding in the neonatal prairie vole were not identical to OXTR ligand binding in the periphery of the C57BL/6J neonatal mouse. Further, some of the regions measured in the prairie vole suggest sex differences in OXTR ligand binding. Collectively, as is well-established in the central nervous system, these data indicate that patterns of OXTR ligand binding in the infant periphery are species-specific.