To date, there is limited research that examined the extent to which infants can retain emotion information acquired in a social referencing encounter. The purpose of this study was to examine infants’ memory process for emotion acquired in a social referencing paradigm and the longevity of these memories. We predicted that infants would approach objects paired with a positive and avoid objects paired with a negative emotion. Furthermore, we examined the relationships between looking behaviors at encoding and subsequent behaviors during retrieval after a 10-minute delay. Ten- to fourteen- month-old were exposed to a social referencing paradigm with their encoding behaviors recorded on an eye tracker, then after a 10-minute delay infants were presented with the objects and their retrieval behaviors towards each object were recorded. There were no significant differences in encoding and retrieval behaviors between emotion conditions. However, there were significant correlations between encoding and retrieval behaviors between positive and negative conditions such as quicker latency towards the target at encoding resulted in a longer touch duration towards the object during retrieval in the positive condition and longer looking duration towards the target object at encoding resulted in more avoidance behaviors towards the object during retrieval in the negative condition. Results from the study add to our understanding of infants’ memory for emotion and its processes suggesting a relationship encoding and subsequent retrieval behaviors. Key words: memory, infants, emotion, social referencing

A nutritional method commonly used to deliver feedings to premature infants is the use of a gavage tube. To measure for any undigested breastmilk or formula, a gastric aspirate is checked prior to the next feeding. There is a gap in practice as to what to do if these aspirates signify feeding intolerance. The project question centered on identifying evidence-based guidelines in the literature that would help to define best practices related to feeding intolerance of gavage-fed infants. The Johns Hopkins Nursing Evidence-Based Practice model and the Appraisal of Guidelines Research and Evaluation provided the frameworks for gathering and evaluating evidence as well as the process used in forming the practice guideline. The primary methods employed were a team approach that included a Neonatal Intensive Care Unit (NICU) Project Team and NICU expert opinion along with a literature review conducted by the doctor of nursing practice student. The NICU Project Team collected the NICU experts' input via surveys they developed and distributed as well as e-mails to authors identified from the literature review. The surveys yielded a 76% response rate from the registered nurses and a 59% response rate from the medical providers. All data collected were shared and descriptive statistics were used to evaluate the data. One of the central research findings was that gastric aspirates should no longer be routinely obtained on stable infants and, if used in evaluating feeding intolerance, they must be used in combination with other indicators. An enteral feeding guideline was developed to reflect this finding that can be shared with other NICUs and nurseries in the United States and globally to decrease the morbidity and mortality of neonates.

Thesis (PhD. (Clinical Psychology)) --University of Limpopo, 2008 / Low-birth-weight/premature children seem to be vulnerable to psychiatric, neuropsychological and other deficiencies. Limited research is available in the South African context about these ever-increasing phenomena. The aim of this study was to investigate the magnitude and characteristics of internalising (Separation Anxiety, Overanxious and Major Depressive Disorders) and externalising symptoms (Attention-Deficit/Hyperactivity, Oppositional Defiant and Conduct Disorders) among low-birth-weight children in comparison with normal-birth-weight children, as well as to establish neuropsychological deficiencies (motor, visual-spatial, memory and executive functioning) between the birth weight groups, analysed as a function of gender and age. The sample (158 children) was selected from nine urban mainstream primary schools in the Tshwane North and South districts by means of stratified random sampling. Low-birth-weight children (weighing below 2 000 g) (N=79) were matched with normal-birth-weight children (above 3 000 g) (N=79) according to age, gender, language and socio-economic status. The neuropsychological test battery and self-reporting questionnaire were individually administered to the sample at the selected schools during school hours. Teachers and parents of selected participants were requested to complete a rating scale. As expected, low birth weight is associated with a tendency towards increased internalising and externalising psychological symptoms, as well as poorer neuropsychological functioning. This was particularly significant in the domains of internalising symptoms (depression), externalising symptoms (hyperactivity/impulsiveness, inattention, Oppositional Defiant Disorder and Conduct Disorder) and neuropsychological impairments (motor, visual-spatial/visual-motor, memory and executive functioning). The neuropsychological impairments observed in this study among the LBW children probably increase the risk of subsequent externalising (conduct and oppositional behavioural problems) and internalising (depressive) psychological symptoms. These impairments are possibly exacerbated by inattention and hyperactivity/ impulsiveness. Reciprocal interaction seems to take place between the psychological symptoms andneuropsychological functions. Only a few gender differences were observed. Neuropsychological deficits were observed both in the 6 to 9 and 10 to 13 age groups, indicating deficient resolution of impairments with increasing age. Increased pre-, peri- and postnatal complications in the low-birth-weight group may predispose these children biologically to neuropsychological deficiencies and subsequent internalising/externalising symptoms. These impairments most probably affect academic, emotional, social and other significant areas of functioning, increasing public health cost.

Infant health care use has rarely been examined empirically. A growing literature links maternal health and psychosocial variables to broadly defined pediatric health care use. The Common Sense Model of health and illness behaviors (CSM) provides a framework from which to view the role of the maternal psychosocial variables examined (i.e. maternal negative affect, lay consultation and parenting self-efficacy) in infant health care decision-making. Findings for infant health care use are reported specific to referral source (i.e. mother versus physician initiated infant health care). Physician initiated visits were not significantly predicted by the models tested, consistent with the independence of predictor variables from initiation source (i.e. mothers versus physicians). Mother initiated visits were significantly predicted by the model containing the Lay Consultation worry item, which was also the only variable that significantly predicted infant health care use in the model. The main dissertation study finding is the independence of infant health care use decision-making from most of the maternal psychosocial, demographic and enabling variables examined. The finding is positive for the health care system as it suggests that mothers generally do not seek infant health care for their own emotional regulation and/or reassurance in their parenting competency. The contextual component of the CSM, as measured by lay consultation, received support from the findings, suggesting that mothers' perceived worry of her lay consults results in greater infant health care use. Implications for mothers and infants include community psychoeducation programs and home visiting programs focusing on infant health and development psychoeducation.

The attempt to identify risk factors or correlates of intraventricular hemorrhage (IVH) has been constrained by conflicting research findings, changing hypotheses about the etiology of IVH, and by the exceedingly complex nature of this neurological disorder. In addition, few studies have investigated the possibility that antenatal factors might predispose the infant to IVH. Thus, research aimed at identifying IVH correlates from all time periods in which stress could occur to the neonate needs to be undertaken. This study was conducted for the purpose of identifying and quantifying correlates of IVH by constructing an interactive statistical model to predict the occurrence, severity, and onset of IVH. The study sample was composed of inborn neonates admitted to the University of Utah Medical Center's Neonatal Intensive Care Unit from July 1985 to June 1987. Ultrasound brain scans were used to assigned 150 infants into two groups of equal numbers: an IVH group and a nonIVH group. Forty-three maternal, 17 obstetric, and 35 neonatal variables were collected from the infants' and infants' mothers' medical records and included demographic, medical, and behavioral data. The mean birthweights and gestational ages for the IVH and non-IVH groups were 1413 g, 29.9 weeks, and 1573 g 31.3 weeks, respectively. Factors found to be associated with IVH were neonatal hypotension, bronchopulmonary dysplasia, lower hematocrit percent, pulmonary interstitial emphysema, severe respiratory distress syndrome, shorter gestational ages, lower 5-minute Apgar score, pneumothorax, shorter umbilical cord lengths, and lower maternal hemoglobin concentrations. No obstetric factors were found to be related to IVH. A second-order, interactive model used to predict IVH occurrence and severity explained 90.9% of the total variability. The attempt to predict the onset time of IVH was unsuccessful. While the condition of the neonate immediately following birth is the best predictor of IVH, maternal or antenatal factors may interact to contribute to the development of this neurological disorder.

Technological advances in neonatal care have dramatically improved the survival and disability rates among low birthweight infants (LBW). One common factor associated with later problems among these babies is intraventricular hemorrhage (IVH). A meta-analysis was conducted among LBW infants with and without IVH to determine developmental outcome. More than 450 studies were located. Only 125 studies met inclusion criteria. Mean effect sizes were computed by comparing the LBW group to either a fullterm children, LBW children scored worse in all areas except gross motor skills. Cognitive assessment was done commonly up to 6 years of age. LBW infants scored about 1/2 standard deviation below their comparison group. A positive linear trend was found for severity of IVH: those children without an IVH scored comparably to fullterm children, while those with severe bleeds were about one standard deviation behind. Assessment of academic skills was done with the 8- to 11-year olds. There was no information given on presence/severity of IVH. Very few assessments were done. On general academic measures, the LBW children scored about 1/2 standard deviation behind the comparison group. Over 80% of the language assessments were done at 15- to 38-months of age. LBW children tended to score 1/2 to 3/4 of a standard deviation below the comparison group. The severity of hemorrhage did not mediate these results. Fine motor assessments were performed on children 9 months to 11 years old. LBW children were about 2/3 of a standard deviation behind the comparison group. These skills were not affected by severity of IVH. Gross motor abilities were typically measured before the children were 24 months old. LBW children showed more deficits in this area than in any other: almost 90% of a standard deviation behind. Gross motor skills appear to be strongly impacted both by being low birthweight and by the severity of IVH. Results indicate that IVH is a mediating factor in outcome among LBW infants. More research needs to be conducted on these children when they are school age, so long-term effects of low birthweight can be determined.

Background To date, the vast majority of studies on infant feeding behavior of Chinese population have been conducted in Asian and some western countries but not the U.S. As the fastest growing Asian subgroup and with the largest Chinese community outside of Asia, studies that focus on their health choices in the U.S. are long overdue. Where studies are available, the overseas Chinese population is often regarded as high formula feeding and low breastfeeding. Chinese mothers often cite family, cultural, and social expectations as the determining factors for their choice of infant feeding. Given the cultural beliefs and traditions of Chinese immigrant population in the U.S., this study argues for the importance of including the input of the overall community, as opposed to only mothers, as a more data-based explanation of the prevalence of formula feeding among the Chinese community in New York City, and in addition, why this community continues to accept formula feeding as the norm. Methods Guided by Theory of Planned Behavior, this study incorporated both quantitative and qualitative components. A total of 434 surveys and 20 in-person interviews were collected in Chinese populated areas in New York City. Results In examining the prevalence of formula feeding in the Chinese community, both quantitative and qualitative findings consistently identified the central role friends and family played in motivating certain groups to use formula. These less acculturated, educated, and China-born subgroups are likely to conform to the idea that breast milk supplemented by infant formula is necessary in order to meet the nutritional demand of a growing infant. For the first-generation immigrants who breastfeed for health benefits and tradition, their attitudes towards infant feeding shifted after seeing other formula-fed children in populated Chinese communities as evident by shorter breastfeeding durations for the child born in the U.S. as compared to previous child born in China. As for the second-generation, who are more acculturated and educated, although they are aware of the benefits of breastfeeding and intend to breastfeed, they are expected by the older generation to continue the formula feeding tradition in the family. Conclusion When investigating why infant formula remained as the popular choice of feeding and is often perceived as the norm by this community, the current study identified the psychosocial variables that motivated individual subgroups and the context underlay. The findings provided new insights to the current literature and are intended to help guide future studies and to develop educational policy interventions to improve the overall infant feeding experiences for the Chinese community in New York City.

Includes list of publications arising from the thesis. Bibliography: leaves 327-341. Examines the effect of adverse storage on the immunogenicity of pertussis, diphtheria and tetanus vaccines, the protective efficacy of pertussis vaccines and the effect of premature birth on antibody response to routine childhood immunisations.

Doctor of Philosophy (PhD) / An in-depth, longitudinal study of the speech and oral language development of eight infants with a profound hearing loss who receive early interventions focused on developing their auditory, speech and oral language capacity is presented in this thesis. Infants were tracked for two years, during the period when they are changed from a hearing aid to a cochlear implant. All infants in this study had their hearing loss identified early and were fitted with hearing aids between 1 and 7 months of age and received their cochlear implant between 8 and 16 months of age. They attended a number of different auditory-verbal early intervention programs (depending on where they lived) all of which focused on developing speech and language skills through listening. Attendance at their particular early intervention program at least once a week was in addition to weekly attendance the Sydney Cochlear Implant Centre for therapy and audiological services. A broad range of measures has been used to track the infants’ acquisition of oral language skills, including measures of communicative intention, pre-speech and speech development, and oral language development. Despite a wide range of individual differences across the group of infants, the results suggest some general trends. In the area of communicative intent most infants followed typical development patterns in terms of both the types (e.g. requesting, answering etc) and forms (gestural, vocal, verbal) used, but they showed delays in their frequency of usage of these types and forms. For speech development the infants demonstrated typical speech skills by 18-months post-cochlear implantation in the areas of consonant inventories, severity of phonological involvement (speech intelligibility) and phonological process development, but they showed delays in vowel and consonant acquisition. Finally, for language development the infants were delayed relative to typical development at 18 months post-implantation. The findings support and extend previous studies which have demonstrated the benefits of early intervention for communication development in infants with hearing loss (Calderon & Naidu, 2000; Mayne, Yoshinaga-Itano & Sedey, 2000; Moeller, 2000; Yoshinaga-Itano & Apuzzo, 1998). However, the delays in the oral communication skills of the infants in the current study suggest that more intensive long-term intervention is required if the infants are to attain typical oral speech and language development. The findings capture the complexity of early oral language development, which has been lacking in previous studies of infants with significant hearing loss, receiving a cochlear implant (Dettman, Briggs, & Dowell, 2005; Houston, Ying, Pisoni, & Iler Kirk, 2003; Schauwers, Gillis, Daemers, De Beukelaer, & Govaerts, 2004). The present data also provide some limited support for earlier implantation, that is, before 12 months of age, as the infants made little progress in oral language development while using hearing aids. The reduced amount of auditory signal available to them prior to implantation may be the determining factor in their inability to follow typical rates and patterns of development. However, rates of development with the implant were not straightforward and further research on this population is needed. Universal neonatal screening programs for hearing loss will potentially provide a larger population of early identified infant for future research. This will create the opportunity for large scale, prospective, longitudinal, studies examining the acquisition of speech and oral language development. Limitations of this study, tracking the early stages of speech and language development over a two year period are identified. Future studies are needed to follow the infants for a longer time to determine if their rate of development is sufficient for them to catch up in areas of delay and maintain their performance in areas where they match their typically developing peers.

The prevalence of childhood obesity is escalating rapidly and it considered to be a major public health problem. Diet is a recognised precursor of fatness, and current evidence supports the premise that in Westernised countries, the dietary intakes of children are likely to be important in obesity genesis. However, we have a relatively poor understanding of the environments in which a child’s eating is learnt and maintained. Much of the existing work in this area is based on small-scale or experimental studies, or has been derived from homogeneous populations within the USA. Despite these limitations, there is evidence that aspects of the child’s family environment are likely to be important in determining obesity risk in children. This thesis examines the impact of the family food environment on a child’s eating through two related studies. The first study, titled the Children and Family Eating (CAFÉ) study comprised three phases. Phase one involved qualitative interviews with 17 parents of 5-6 year-old children to explore parental perceptions regarding those factors in a child’s environment believed to influence the development of their child’s eating habits. These interviews were used to inform the development of quantitative measures of the family food environment. The second phase involved the development of a Food Frequency Questionnaire (FFQ) to assess dietary intake in 5-6 year-olds. The FFQ was informed by analysis of 1995 Australian National Nutrition Survey data. In the final phase the relationships between dietary intakes of 5-6 year-old children, and potential predictors of dietary intake were examined in a cross-sectional study of 560 families. Predictors included measures of: parental perceptions of the adequacy of their child’s diet; food availability and accessibility; child-feeding; the opportunities for parental modelling of food intake; a child’s television exposure; maternal Body Mass Index; and maternal education. Analysis of the CAFÉ data provides unique information regarding the relationships between a child’s family food environment and their food consumption. Models developed for a range of dietary outcomes considered to be predictive of increased risk for obesity, including total energy and fat intakes, vegetable variety, vegetable consumption, and high-energy (non-dairy) fluid consumption, explained between 11 and 20 percent of the variance in dietary intake. Two aspects of the family food environment, parental perception of a child’s dietary adequacy, and the total minutes of television viewed per day, were frequently found to be predictive of dietary outcomes likely to promote fatness in these children. The second study, titled the Parent Education and Support (PEAS) Feeding Intervention Study, was a prospective pre/post non-randomised intervention trial that assessed the impact of a feeding intervention to 240 first-time mothers of one-year-old children. This intervention focused on one aspect of the family food environment, child-feeding, which has been proposed as influential in the development of obesogenic eating behaviours. In this study, Maternal and Child Health Nurses (MCHNs), using a ‘Division of Responsibility’ model of feeding, taught parents to provide nutritious food at regular intervals and to let children decide if to eat and how much to eat. Thus parents were encourages to food their child without exerting pressure, or employing coercion or rewards (controlling behaviours). The aim was to influence parental attitudes and beliefs regarding child-feeding. Through the use of these feeding techniques, this intervention also aimed to increase the variety of fruits and vegetables a child consumed by teaching parents to persist with offering these foods, over the year of the intervention, in non-emotive environments. Fruits and vegetables were chosen in this intervention because they are likely to be protective in the development of obesity. Analysis of the PEAS data suggests that this low-level feeding intervention, delivered through existing Maternal and Child Health services, was modestly effective in changing parental attitudes and beliefs regarding the feeding of young children. Further, the validity of fruits offered to intervention group children increased. This thesis expands the existing knowledge base by providing a comprehensive analysis of the relative impact of aspects of the family environment on dietary intakes of 5-6 year-olds. Further, the analysis of a feeding intervention in first-time parents provides important insights regarding the potential to influence child-feeding and the impact this may have on the promotion of eating behaviours protective against obesity.