Introduction: There has been a lack of longitudinal studies on maternal and infant factors associated with feeding difficulties. Feeding difficulties are common, cause much anxiety for parents, and are associated with a range of child health and behavioural outcomes. This study aims to gain an understanding of the prevalence and type of feeding difficulties found in a community sample, the prevalence of maternal mental ill-health and identify maternal and infant factors predictive of feeding difficulties. A final aim is to identify factors associated with successful and unsuccessful feeding experiences from a maternal perspective. Method: A short questionnaire with questions about support and help-seeking was compiled, and several standardised measures were included in the pack; a measure of maternal mood (DASS-21), social support (SOS-S), and eating disorder symptomatology (EAT-26). Questionnaires were given to mothers in pregnancy, and again when infants were around 3 and 7 months old. An adapted version of the Child Feeding Assessment Questionnaire, and the food fussiness subscale from the Children’s Eating Behaviour Questionnaire examined feeding behaviour and maternal response. The Infant Temperament Questionnaire examined maternal perception of infant temperament. Content analysis was used to identify themes in mother’s narrative about factors which help feeding and barriers to a successful feeding experience. A within subjects design was employed to examine predictors of infant feeding difficulties. Results: 23% of mothers of 3 to 5 month old infants, and 13% of mothers of 7 to 10 month olds reported their child as having one or more feeding difficulties. Levels of stress remained stable across the length of the study, but prevalence of maternal anxiety and depression reduced. 47% of those mothers who breast fed found breast feeding difficult or very difficult. Maternally identified barriers to successful feeding with feeding were child illness, and painful or difficult breastfeeding. Mothers wanted an improvement in support and knowledge of health professionals, and a reduction in pressure from health professionals in relation to feeding method. Maternal depression and stress were correlated with severity of food refusal in infants, as well as maternal anxiety and food fussiness, prior to post-hoc analyses. Following post-hoc analyses these relationships were no longer significant. Discussion: Relationships between infant behaviour, maternal health and feeding difficulties are explored. The low prevalence of feeding difficulties and reasons for negative findings in relation to predictors of feeding difficulties are discussed. Implications for health services are presented in the light of maternal views about support and barriers to successfully feeding their child.

Introduction: Inconsolable infant fussing and/or crying is a common reason for parent´s to seek help with professionals and is a cause of great stress within the family. Aim: To produce and evaluate a leaflet about infantile colic and elucidate how parents experienced their child’s colic period. Method: The study was based on a descriptive survey containing thirteen open questions assessing parents’ experiences of the colic period and the support from the Child Health Care (CHC) nurse. The questions also addressed the design and content of the leaflet. Ten mothers completed the survey and the results were analysed using qualitative content analysis. Results: The main theme found was; “The infantile colic overshadowed everything – and created feelings of insufficiency in the parenting role”. Seven categories were identified; Wessel’s definition of infantile colic agreed, Sleep- and breastfeeding experiences, Thought´s about the colic period, Strong emotions developed during the colic period, Coping strategies, Support and advice, Content in the information brochure.   Conclusion: Infantile colic effected the entire family, caused crisis and strong feelings such as powerlessness when nothing would calm or ease the baby´s cry. The feeling of being insufficient would create problems with the attachment to the baby. The CHC nurse should support the family members and strengthen them in their ability to cope with their baby´s cry. The leaflet “Infantile colic – the infant´s cry the first months in life” could reduce parents’ self-accusation and feelings of insufficiency. It could help parents´ attain a sense of control over the situation and encourage the development of a secure attachment. The leaflet will be corrected with advice of using a diary to elucidate the time of crying. It will also contain information about the risk of shaken baby syndrome.

The present study is an investigation of certain aspects of the relationship which exists between the development of language of a child and the speech of his mother. An attempt was made to investigate the evolving speech pattern of the child as he is influenced by the speech patterns of his mother. Can one determine the age at which infants begin to develop speech similar to the speech patterns (intonation, phonemic content, distinctive feature content, place and manner of articulation) of their mother's speech?

This thesis is about infancy, independence, and how medicalisation shapes mothers' perceptions of their infants. It draws on ethnographic research in Cardiff, undertaken during a period of heightened concern about the Sudden Infant Death Syndrome (SIDS), and funded by the Foundation for the Study of Infant Deaths. Three "cultural constructions" of infancy are juxtaposed: the vulnerable and constantly accompanied Bangladeshi infant, the Welsh or English infant encouraged towards independence, and the autonomous infant of epidemiological analysis. The thesis shows how the processes of medicalisation brought contrasting perceptions of infancy to light, suggesting that Bangladeshi women taking part in an "English for Pregnancy" project were not only learning language, but also learning about medicalised infant care. It argues too that health professionals shape the way in which mothers perceive their infants through the introduction of the language of "risk factors". The infant body itself emerged at the boundary of powerful systems of meaning. If the boundaries of the Bangladeshi infant body were blurred through constant contact, those of the Welsh or English infant were marked intermittently through alternating periods of solitude with "attention". Some Welsh and English mothers spoke of infants and their care in terms of the care of domestic animals, and the mothers' own ambivalence about their own animality, while some Bangladeshi mothers spoke of the spiritual power and vulnerability of infants, and in doing so articulated their links with Bangladesh. For health professionals the infant body was a site for demonstrating expertise through both research (which constructed ethnic minorities as 'natural') and recommendations for action. The thesis discusses the location of contemporary anthropology at cultural boundaries. Juxtaposing contrasting beliefs about infancy revealed very different perceptions of independence, marked in particular by contrasting perceptions of time, space, and the infant body itself.

Children, 12 to 24 months of age, were presented with three tasks: two detour problems and a spatial task. The aim of the study was to assess the performance on each task and to consider the relationship between performance on the two detour problems and the relationship between spatial knowledge and detour ability. The two detour tasks (the lever task and the bent wire task) shared a common feature in that the object rather than the subject had to be moved in the detour. The results of the lever task indicated that age, experimental group (three lever designs were used) and the sex of subjects were influential variables. Analysis of the bent-wire data showed that as hypothesised age was the most important variable, accounting for qualitative and quantitative differences in performance. The results from the detour tasks were discussed with reference to the attainment of skilled behaviour and the relationship between cognitive development and detour ability. Spatial task results indicated that performance was related to age and that the type of error recorded was also related to the age of the subject. The hypothesised relationship between the two detour tasks was not supported by the data. Furthermore, the anticipated relationship between detour ability and spatial knowledge failed to emerge. These results were discussed in relation to the issue of developmental synchrony and the structuralist's view of development.

Thesis (M.S.)--Boston University / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / 2031-01-01

Extensive research and literature exists emphasising that the quality of the early infant attachment style and psychic structure developments are dependent on the quality of maternal care received by an infant. Infants’ who experience consistent, sensitive, and reliable care are more likely to develop secure attachments and healthy psychic structures which will positively influence their future abilities to function healthily in their environments and to experience healthy interpersonal relationships. The importance, therefore, for the development and assessment of parent-infant interventions focused on improving the quality of maternal care available to infants, is clear. The Ububele Baby Mat Project, implemented at the Alexandra Health Care Clinic in Johannesburg, is one such intervention and no evaluation of this intervention has been conducted. It was deemed necessary by the team providing the service for them to gain some idea of the way in which their service is being received in the community it is serving as well as to assist them in developing their intervention further. The current research aimed to get insight into the mothers’ experiences and perceptions of the Baby mat. The form of data included 8 semi-structured in-depth interviews of women who had accessed the Baby mat and thematic content analysis was used to interpret the results. The findings indicated that overall the mothers received the Baby mat very positively and spoke of the service being invaluable to them, especially in the face of the adverse conditions in which they live. Suggestions for the Ububele Baby Mat Project team are also provided.

Globally, child mortality is a great concern, especially in resource-limited settings. The Millennium Development Goal (MDG) 4 was set with an aim to reduce under-5 child mortality by two-thirds between 1990 and 2015. This study examines mortality trends in infants, 1-4 and above 5-year-old children in rural KwaZulu-Natal, South Africa, the causes of death as well as the association of maternal HIV status and Antiretroviral Treatment (ART) usage to child mortality. We use a longitudinal birth cohort study design of children born between 1st January 2004 and 31st December 2010, in the Africa Centre Demographic Surveillance Area (DSA) in rural KwaZulu-Natal, South Africa. Children had to have been resident in the DSA at the time of birth. A total of 12,413 children born in the study period were eligible for this study. The main outcome measure was mortality either in infancy, the 1-4 year period or at 5 and above years of age, while assessing its association with maternal HIV and Antiretroviral Treatment uptake (ART) status on a time-varying basis. A total of 619 children died during the study period and mortality was observed to be highest in the infant group with 67% of the children dying in infancy. Fifteen percent of mothers were HIV positive at the time of birth of the child, about 59% were HIV negative while the HIV status of the rest was unknown. There was a three-fold increase in mortality observed for both infants and 1-4 year olds, who had mothers who were HIV infected compared to children whose mothers were HIV negative (p<0.05). Children whose mothers were on Antiretroviral Treatment (ART) however had a reduced mortality compared to those whose mothers were not on treatment. Infants and 1-4year olds whose mothers HIV status was not reported had a two-fold increase in mortality. Low maternal education, single motherhood, multiple births and parity of four or more children were also associated with increased child mortality. We concluded that although mortality varied by the age of the child, children born to mothers who were HIV positive had higher mortality rates than children born to HIV negative mothers but being on Anti Retroviral Treatment (ART) reduced children mortality. Interventions targeting HIV positive pregnant women and mothers should be carried out in the study area, with specific emphasis on reducing child mortality associated with maternal HIV status.

Jaundice is probably the most common newborn infant problem dealt with on a daily basis by the family practitioner and paediatrician. Jaundice occurs when the liver cannot clear a sufficient amount of bilirubin from the plasma. When the problem is excessive bilirubin formation or limited uptake or conjugation, unconjugated (i.e., indirect reacting) bilirubin appears in the blood and indirect hyperbilirubinemia is the predominant form of jaundice found in the newborn infant. In the vast majority of newborns, hyperbilirubinemia is transient and benign but, in rare cases, the serum bilirubin rises to a level that is toxic to the central nervous system. Understanding the pathogenesis and epidemiology of neonatal hyperbilirubinemia; recognizing, the problems involved in appropriate surveillance and monitoring of the jaundiced infant and the factors contributing to bilirubin encephalopathy; and implementing treatment of the jaundiced neonate in a timely fashion, are issues that have engaged clinicians and researchers for some 6 decades. This work will summarize my contributions to the field of neonatal hyperbilirubinemia and it includes papers published between 1971 and 2007. The description of this work will not follow its chronological sequence, but will be divided into the categories of diagnosis, epidemiology, pathogenesis, management, treatment, and bilirubin encephalopathy.

MSc (Med) (Population-Based Field Epidemiology), Faculty of Health Sciences, University of the Witwatersrand / Introduction: Studies of factors affecting infant mortality have rarely considered the role of birth order. Despite the recent gains in child mortality in Tanzania, infant mortality rate is still high (68 per 1000 live births) according to the Tanzania Demographic Health Survey (2004-5). This study investigated the risk factors associated with infant mortality in Ifakara Health and Demographic Surveillance Systems area in rural Tanzania from January 2005 to December 2007 with specific reference to birth order, and identified causes of infant death for the study period. Materials and Methods: The study was a secondary analysis of existing data from the Ifakara Health and Demographic Surveillance Systems (HDSS). Child data for 8916 live births born from 1st January 2005 to 31st December 2007 were extracted for analysis. The binary outcome variable was infant mortality. Tables and graphs were used to describe the distribution of maternal demographic and study population characteristics. Poisson regression analyses were used to establish the association between infant mortality and exposure variables. Results: We recorded 562 infant deaths. Neonatal mortality rate was 38 per 1000 person-years while infant mortality rate was 70 per 1000 person-years. Birth order of 2nd to 5th was associated significantly with 22% reduced risk of infant mortality (IRR=0.78, 95%CI: 0.64, 0.96; p=0.02) compared with first births. The infant mortality rates per 1000 person-years for first births was 84, 2nd to 5th was 66 and sixth and higher was 71 per 1000 person-years. Male infants were 17% more at risk of infant deaths as compared to their female counterparts, but not statistically significant (IRR=1.17, 95%CI: 0.99, 1.38; p=0.06). Mothers aged 20 to 34 years had 19% reduced risk of infant death (IRR=0.81, 95%CI: 0.65, 1.00; p=0.05) as compared v to mother of less than 20 years of age. Singleton births had 71% reduced risk of infant mortality (IRR=0.29, 95%CI: 0.22, 0.37; p<0.001) compared with twin births. Mothers who did not attend antenatal care had 2% reduced risk of infant deaths (IRR=0.98, 95%CI: 0.49, 1.97) but not statistically significant compared with mothers who attended antenatal care. Mothers who delivered at home were 1.05 times more at risk of infant deaths but not statistically significant (IRR=1.05, 95%CI: 0.89, 1.24; p=0.56). Mothers who had no formal education were 1.41 times more likely to have infant deaths (IRR=1.41, 95%CI: 0.72, 2.79; p=0.32) as compared to those who had education beyond primary. When adjusted for sex, maternal age and twin births, second to fifth birth order had 20% reduced risk of infant death (IRR=0.80, 95%CI: 0.61, 1.03; p=0.08), but statistically not significant as compared to first births. Malaria (30%), Birth injury/asphyxia (16%), Pneumonia (10%), Premature and/or low birth weight (8%), Anaemia (3%) and Diarrhoeal diseases (2%) were the major causes of infant deaths from 2005 to 2007. Discussion and conclusion: First births and higher birth orders were associated with higher infant mortality. Twin birth was a risk factor for infant mortality. The health systems should be strengthened in providing care for mothers and child survival. We recommend that the high-risk group, first or sixth or higher pregnancies, need special care and the existing health management system may be strengthened to create awareness among potential mothers for seeking appropriate health care from the beginning of pregnancy. Also, antenatal care follow-up can be emphasized for high-risk mothers. Efforts to control mosquitoes must be accelerated in the Ifakara sub-district.