tag:theconversation.com,2011:/ca/topics/infant-health-1251/articlesInfant health – The Conversation2023-11-09T01:26:42Ztag:theconversation.com,2011:article/2061822023-11-09T01:26:42Z2023-11-09T01:26:42ZIt’s hard to find a surrogate in Australia. But heading overseas comes with risks<figure><img src="https://images.theconversation.com/files/532120/original/file-20230615-27-n0wdqe.jpg?ixlib=rb-1.1.0&rect=21%2C133%2C4656%2C3331&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://unsplash.com/photos/FqqaJI9OxMI">Unsplash/Kelly Sikkema</a></span></figcaption></figure><p>Surrogacy offers the chance of parenthood for those who can’t carry a pregnancy for medical or social reasons. </p>
<p>In a surrogacy arrangement, a surrogate gives birth to a baby for the intended parents to raise. Most intended parents are heterosexual or gay couples, but single people can also use surrogacy to have a child. </p>
<p>In the 2021–2022 financial year, <a href="https://www.homeaffairs.gov.au/foi/files/2022/fa-220800210-document-released.PDF">213</a> Australian babies were born through international surrogacy – an arrangement between Australian intended parents and a foreign surrogate. Just <a href="https://npesu.unsw.edu.au/sites/default/files/npesu/data_collection/Assisted%20Reproductive%20Technology%20in%20Australia%20and%20New%20Zealand%202021.pdf">100</a> surrogacy births were reported by Australian and New Zealand fertility clinics in 2021. </p>
<p>Australian surrogacy laws and <a href="https://www.nhmrc.gov.au/about-us/publications/art">ethical guidelines</a> aim to protect the interest of everyone involved with surrogacy. They also recognise the most important consideration of all is the welfare of the children born.</p>
<p>However, children born through international surrogacy aren’t protected by Australian laws because they’re born overseas. Our new <a href="https://doi.org/10.1080/14647273.2023.2270157">research</a> shows this can increase the physical and psychological risks to the child. </p>
<p>Making surrogacy easier to access in Australia could protect future children born through surrogacy. </p>
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Read more:
<a href="https://theconversation.com/becoming-a-parent-through-surrogacy-can-have-ethical-challenges-but-it-is-a-positive-experience-for-some-167760">Becoming a parent through surrogacy can have ethical challenges – but it is a positive experience for some</a>
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<h2>How does international surrogacy impact children?</h2>
<p>We surveyed more than 300 Australians who were parents through surrogacy, or were planning on having a child via surrogacy. We asked if they had picked international or domestic surrogacy and why, and we asked about the fertility treatment they and their surrogate received.</p>
<p>Respondents who had a child through international surrogacy commonly reported using two fertility treatments currently <a href="https://www.nhmrc.gov.au/about-us/publications/art">banned</a> in Australia: multiple embryo transfer and anonymous egg donation. </p>
<p>Surrogates sometimes supply their own egg, but mostly the egg is supplied from one of the intended parents or a donor. Once the egg has been fertilised, the resulting embryo is then transferred to the surrogate.</p>
<p>In Australia, only one embryo can be transferred to surrogates at a time. This is because multiple embryo transfer <a href="https://doi.org/10.1080/14647273.2020.1785643">increases the risk</a> of twin, or even triplet, pregnancies. These pregnancies are linked to higher rates of complications for the pregnant woman and the baby, including preterm birth. Preterm birth is when a baby is born before 37 weeks of pregnancy and is the <a href="https://www.who.int/en/news-room/fact-sheets/detail/preterm-birth">main cause</a> of death in children below the age of five.</p>
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<img alt="Dad carries his twins in a field, while an older child runs ahead" src="https://images.theconversation.com/files/532123/original/file-20230615-27-5yx7gk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/532123/original/file-20230615-27-5yx7gk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/532123/original/file-20230615-27-5yx7gk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/532123/original/file-20230615-27-5yx7gk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/532123/original/file-20230615-27-5yx7gk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/532123/original/file-20230615-27-5yx7gk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/532123/original/file-20230615-27-5yx7gk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Multiple births are more likely with international surrogacy.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/O-RKu3Aqnsw">Unsplash/Juliane Liebermann</a></span>
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<p>Of the survey respondents who had completed international surrogacy, 37% reported multiple embryos had been transferred to their surrogate. Some 27% of parents through international surrogacy had a preterm baby and 11% had twins or triplets. In contrast, just 11% of parents through surrogacy in Australia had a preterm baby and none had twins or triplets. </p>
<p>If a donor egg is used in Australia, the donor-conceived person can access information about their donor once they turn 18. Anonymous donation is <a href="https://www.nhmrc.gov.au/about-us/publications/art">not allowed</a> because research shows many people born through egg or sperm donation <a href="https://pubmed.ncbi.nlm.nih.gov/22908619/">want to know</a> the identity of their donor. </p>
<p>Of the respondents who used donor eggs in international surrogacy, 47% said the identity of the donor was anonymous. Australians born through international surrogacy with anonymous egg donors may never know who their genetic mother is.</p>
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Read more:
<a href="https://theconversation.com/who-are-my-parents-why-new-zealands-creaky-surrogacy-laws-are-overdue-for-major-reform-166745">Who are my parents? Why New Zealand’s 'creaky' surrogacy laws are overdue for major reform</a>
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<h2>Why choose international surrogacy?</h2>
<p>The most popular reasons for picking international surrogacy were that surrogacy in Australia is long and complicated and it is difficult to find an Australian surrogate. </p>
<p>Most Australian surrogacy arrangements occur between <a href="https://sarahjefford.com/australian-surrogacy-statistics/">friends and family members</a>. If this is not possible, intended parents can join online communities to meet potential surrogates. However, the number of intended parents in these communities far <a href="https://www.surrogacyaustralia.org/surrogacy-process-chart/">outweighs</a> the number of surrogates.</p>
<p>For those lucky to find an Australian surrogate, they must complete a series of legal requirements as part of the arrangement. These requirements protect the interests of surrogacy participants and include legal advice, counselling and a court order to transfer parentage from the surrogate to the intended parents.</p>
<p>With international surrogacy, commercial agencies or brokers can match intended parents to a surrogate and the various Australian legal requirements may not be needed. </p>
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<img alt="Pregnant women holds her hands under her belly" src="https://images.theconversation.com/files/532122/original/file-20230615-23-whx9eu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/532122/original/file-20230615-23-whx9eu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/532122/original/file-20230615-23-whx9eu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/532122/original/file-20230615-23-whx9eu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/532122/original/file-20230615-23-whx9eu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/532122/original/file-20230615-23-whx9eu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/532122/original/file-20230615-23-whx9eu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">In some countries, you don’t have to go to court for legal parentage of babies born via surrogacy.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/WI-x1wo_Jm4">Unsplash/Omurden Cengiz</a></span>
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<h2>How can the risks of international surrogacy be reduced?</h2>
<p>Intended parents considering international surrogacy should choose single embryo transfers and, if required, a known donor. </p>
<p>However, intended parents may not always be equipped with the information or resources to make this choice. Known donors may not always be available overseas and some of our respondents said they transferred multiple embryos because they were following the advice of their doctor. </p>
<p>Most respondents said they would prefer to complete surrogacy in Australia if it were possible. This means if surrogacy was more accessible in Australia, fewer people might go overseas and more babies might be born in Australia where regulations protect the child’s physical and psychological health.</p>
<p>To make surrogacy more accessible, surrogacy laws should be reviewed by an inquiry by the Australian Law Reform Commission. The House of Representatives Standing Committee on Social Policy and Legal Affairs <a href="https://www.aph.gov.au/Parliamentary_Business/Committees/House/Social_Policy_and_Legal_Affairs/Inquiry_into_surrogacy">recommended</a> such an inquiry in 2016. This was never undertaken, but we don’t know why.</p>
<p>The Law Commission of England and Wales and the Scottish Law Commission <a href="https://www.lawcom.gov.uk/project/surrogacy/">recently published</a> recommendations for surrogacy law reform in the United Kingdom. One recommendation removes the need for a court to grant intended parents legal recognition. This is a <a href="https://www.lawgazette.co.uk/news/family-lawyers-welcome-revolutionary-surrogacy-recommendations/5115585.article">welcome</a> step forward. </p>
<p>However, the recommendations have also been <a href="https://www.progress.org.uk/law-commissions-proposals-wont-achieve-surrogacy-modernisation/">criticised</a> for not allowing surrogate compensation, which could discourage some people from becoming surrogates. Compensation is financial acknowledgement of the time and effort involved with the surrogacy pregnancy and is currently not allowed in Australia.</p>
<p>Law reform in Australia must address all barriers for domestic surrogacy, including the shortage of surrogates, to protect the welfare of children born through surrogacy.</p>
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Read more:
<a href="https://theconversation.com/surrogacy-shake-up-in-uk-would-create-uneven-treatment-for-birth-mothers-202872">Surrogacy shake up in UK would create uneven treatment for birth mothers</a>
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<p class="fine-print"><em><span>Ezra Kneebone receives funding from the Australian Government Department of Education. </span></em></p><p class="fine-print"><em><span>Karin Hammarberg works for the Victorian Assisted Reproductive Treatment Authority. </span></em></p><p class="fine-print"><em><span>Kiri Beilby does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Children born through international surrogacy aren’t protected by Australian laws.Ezra Kneebone, PhD Candidate, Monash UniversityKarin Hammarberg, Senior Research Fellow, Global and Women's Health, School of Public Health & Preventive Medicine, Monash UniversityKiri Beilby, Course Coordinator (Graduate Diploma of Reproductive Science), Monash UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2050312023-10-03T19:04:57Z2023-10-03T19:04:57ZNo, stress won’t dry up your milk. How to keep breastfeeding your baby in an emergency<figure><img src="https://images.theconversation.com/files/551576/original/file-20231002-29-1b6ak7.jpg?ixlib=rb-1.1.0&rect=53%2C0%2C6000%2C3997&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/newborn-baby-boy-sucking-milk-mothers-1981392881">Nastyaofly/Shutterstock</a></span></figcaption></figure><p>Bushfires <a href="https://www.theguardian.com/australia-news/2023/oct/02/australia-records-driest-september-since-observations-began-as-fires-rage-in-victoria-and-nsw">currently burning</a> in Victoria, New South Wales and Tasmania bring into sharp focus the fire risks Australian families face over the coming summer months.</p>
<p>Although babies don’t understand <a href="https://theconversation.com/babies-and-toddlers-might-not-know-theres-a-fire-but-disasters-still-take-their-toll-129699">the nature of emergencies</a> such as bushfires, floods and cyclones, they and their mothers are impacted. </p>
<p>During natural disasters, electricity, clean water and food supplies may be interrupted, and <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-019-7528-0">gastroenteritis is common</a>. At these times, breastfeeding provides babies with safe food, water, and <a href="https://waba.org.my/pdf/ilca-iycf-emergencies.pdf">protection from infection</a>, as well as a feeling of comfort and safety.</p>
<p>But mothers can find it difficult to breastfeed during emergencies, and may believe stress affects their milk supply. Some end up stopping even though they didn’t plan to and even though during a disaster is a particularly bad time to wean.</p>
<p>The good news is stress doesn’t reduce milk supply, and while breastfeeding during an emergency carries added challenges, mothers can and do breastfeed through even the worst of disasters.</p>
<h2>Demand and supply</h2>
<p>During pregnancy, hormones develop the milk-making structures inside women’s breasts. After birth, the breasts automatically make milk to feed the baby, but over time they change to a <a href="https://www.breastfeeding.asn.au/resources/how-breasts-make-milk">demand and supply</a> way of working. </p>
<p>This means that when the baby feeds and milk is removed from the breasts, the breasts make more milk. The more frequently milk is removed from the breasts, the more milk will be made.</p>
<p>Babies drink the milk made in the breasts with the help of a hormone called oxytocin. When babies suckle, oxytocin tells the muscle-like cells that surround the small structures <a href="https://link.springer.com/article/10.1007/s12015-023-10534-0">where milk is made and stored</a> to contract. This squeezes the milk towards the nipple where the baby can drink it. </p>
<p>Oxytocin is sometimes called the “<a href="https://www.health.harvard.edu/mind-and-mood/oxytocin-the-love-hormone">love hormone</a>” because it’s also produced when you feel lovingly towards someone. </p>
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Read more:
<a href="https://theconversation.com/i-regret-stopping-breastfeeding-how-do-i-start-again-143183">I regret stopping breastfeeding. How do I start again?</a>
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<h2>Stress doesn’t impact milk production</h2>
<p>There isn’t any way for stress to interfere with the demand and supply process of milk making.</p>
<p>However, <a href="https://www.cambridge.org/core/journals/public-health-nutrition/article/suboptimal-infant-and-young-child-feeding-practices-among-internally-displaced-persons-during-conflict-in-eastern-ukraine/9F4B0EA5F13A05B7724BC69AF98B593A">mothers often worry</a> that the stress of an emergency has <a href="https://www.breastfeeding.asn.au/sites/default/files/2023-06/BiBS%20Study%20Report%20Final.pdf">reduced their milk supply</a>. Usually, this is because they are noticing their baby’s behaviour has changed.</p>
<p>During emergencies, babies are often more unsettled, want to be held more, <a href="https://www.breastfeeding.asn.au/sites/default/files/2023-06/BiBS%20Study%20Report%20Final.pdf">feed more frequently</a>, may be fussy at the breast, and wake more overnight. All of this is a normal response to the disruption of an emergency. </p>
<p>Although stress won’t hamper a mother’s milk supply, it can <a href="https://journals.lww.com/greenjournal/abstract/1994/08000/influence_of_psychological_stress_on.21.aspx">temporarily reduce oxytocin release</a>, slowing the flow of milk. This is another reason a baby may be unsettled during feeding.</p>
<h2>Some challenges</h2>
<p>Emergencies like bushfires and floods are difficult for everyone, but can be <a href="https://theconversation.com/the-black-summer-bushfires-put-an-enormous-strain-on-families-with-young-children-we-cant-make-the-same-mistakes-again-205026">especially challenging</a> for parents of babies and toddlers.</p>
<p>For breastfeeding mothers, the busyness of an emergency and a lack of privacy may mean they miss their baby’s cues or delay breastfeeding. Less frequent breastfeeds <a href="https://www.ncbi.nlm.nih.gov/books/NBK153484/">can reduce milk supply</a>. </p>
<p>Another factor that can affect milk supply is dehydration. Mothers may not drink enough water during an emergency because they’re <a href="https://www.breastfeeding.asn.au/sites/default/files/2023-06/BiBS%20Study%20Report%20Final.pdf">focused on looking after their children</a>, water is limited, or they are restricting water intake because there are no toilets. </p>
<h2>How can I keep breastfeeding through an emergency?</h2>
<p>Expect your baby to breastfeed more often than usual during an emergency. They may breastfeed for comfort as well as food. Keeping your baby close, breastfeeding frequently, and drinking enough water will protect your milk supply. </p>
<p>Know the signs that your baby is getting enough milk. If they have at least five heavily wet nappies in 24 hours, their wee is pale (not dark) in colour, and their poo is runny if they are only breastfed or soft if they are also eating solid foods, you can be confident <a href="https://www.breastfeeding.asn.au/resources/baby-getting-enough-breastmilk">your baby is getting enough breastmilk</a>.</p>
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<img alt="A woman sits on a couch comforting two small children." src="https://images.theconversation.com/files/551577/original/file-20231002-23-1b6ak7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/551577/original/file-20231002-23-1b6ak7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/551577/original/file-20231002-23-1b6ak7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/551577/original/file-20231002-23-1b6ak7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/551577/original/file-20231002-23-1b6ak7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/551577/original/file-20231002-23-1b6ak7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/551577/original/file-20231002-23-1b6ak7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Emergencies can be stressful for parents of young children.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/mom-children-hug-together-on-couch-1658307964">Natalia Lebedinskaia/Shutterstock</a></span>
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<p>You can encourage the release of oxytocin and the flow of milk when you breastfeed by looking at your baby and thinking about how much you love them. This can also help you feel less stressed.</p>
<p>You can be reassured that if your milk supply has decreased because of less frequent breastfeeding or dehydration this can be easily reversed by <a href="https://www.breastfeeding.asn.au/resources/increasing-supply">feeding more often</a> and drinking water. If you stopped breastfeeding because of an emergency, <a href="https://theconversation.com/i-regret-stopping-breastfeeding-how-do-i-start-again-143183">it’s possible to start again</a> if you want to.</p>
<p>If you are concerned about your milk supply, seek help from a health worker. The free <a href="https://www.breastfeeding.asn.au/breastfeeding-helpline">national breastfeeding helpline</a> is available 24/7 and is a good place to find support.</p>
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<span class="attribution"><span class="source">Author provided</span></span>
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<h2>Preparing for an emergency</h2>
<p>Make an emergency plan that includes packing an <a href="https://www.breastfeeding.asn.au/emergency-resources-babies-and-toddlers">evacuation kit</a>, leaving early and evacuating to a relative or friend’s home rather than an evacuation centre if possible. Ensure your evacuation kit includes a baby sling to keep your baby safe and close, and some water and snacks for you. </p>
<p>If you are exclusively expressing milk, learn how to hand express and cup feed (even very young babies can be fed <a href="https://www.cdc.gov/nutrition/emergencies-infant-feeding/cup-feeding.html">using a cup</a>). Store some paper cups so you have all you need if you are without power and water for washing.</p>
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Read more:
<a href="https://theconversation.com/evacuating-with-a-baby-heres-what-to-put-in-your-emergency-kit-127026">Evacuating with a baby? Here's what to put in your emergency kit</a>
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<p>Anything emergency responders can do to reduce the burden of the emergency on mothers, such as prioritising them for services and offering them private spaces in evacuation centres, will help them to care for and breastfeed their babies. A free e-learning module for emergency responders on disaster support for babies, toddlers and their caregivers is <a href="https://www.aba.asn.au/emodule-prepare">available here</a>.</p><img src="https://counter.theconversation.com/content/205031/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Karleen Gribble is Project Lead on the Australian Breastfeeding Association's Community Protection for Infants and Young Children in Bushfire Emergencies Project and is an Australian Breastfeeding Association Scientific Advisor, Educator and Counsellor. Karleen is also on the steering committee of the international interagency collaboration the Infant and Young Child Feeding in Emergencies Core Group and has been involved in the development of international guidance and training on infant and young child feeding in emergencies for over a decade. She is a member of the Public Health Association of Australia. </span></em></p><p class="fine-print"><em><span>Michelle Hamrosi is the Community Engagement Officer on the Australian Breastfeeding Association's Community Protection for Infants and Young Children in Bushfire Emergencies Project. Michelle is also a General Practitioner and an International Board Certified Lactation Consultant, as well as a Clinical Lecturer for the Australian National University’s Rural Medical School. Michelle volunteers as an ABA Breastfeeding Counsellor and Group Leader for the Australian Breastfeeding Association Eurobodalla Group. She is also a member of Doctors for the Environment, Climate and Health Alliance and Australian Parents for Climate Action.</span></em></p><p class="fine-print"><em><span>Nina Chad is the Infant and Young Child Feeding Consultant for the Department of Nutrition and Food Safety at the World Health Organization. She has been a volunteer breastfeeding counsellor for the Australian Breastfeeding Association for more than 20 years. </span></em></p>Being caught up in an emergency like a bushfire can make breastfeeding more challenging – but there are ways to continue.Karleen Gribble, Adjunct Associate Professor, School of Nursing and Midwifery, Western Sydney UniversityMichelle Hamrosi, Clinical lecturer, Rural Clinical School, Australian National UniversityNina Jane Chad, Research Fellow, University of Sydney School of Public Health, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2118572023-08-28T12:01:32Z2023-08-28T12:01:32ZFDA’s greenlighting of maternal RSV vaccine represents a major step forward in protecting young babies against the virus<figure><img src="https://images.theconversation.com/files/544842/original/file-20230825-28-j8m5d5.jpg?ixlib=rb-1.1.0&rect=126%2C34%2C7542%2C4276&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Expecting parents and those with infants have new options to consider to protect against RSV.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/doctor-visiting-young-mother-at-home-for-routine-royalty-free-image/1471833049?phrase=respiratory+illness+infant&adppopup=true">martin-dm/E+ via Getty Images</a></span></figcaption></figure><p>With the Food and Drug Administration’s Aug. 21, 2023, <a href="https://www.fda.gov/news-events/press-announcements/fda-approves-first-vaccine-pregnant-individuals-prevent-rsv-infants?ftag=MSF0951a18">approval of the first vaccine against respiratory syncytial virus, or RSV</a>, for use during late pregnancy, the U.S. will soon have a major new tool at its disposal to protect infants against the highly contagious virus. </p>
<p>RSV is the <a href="https://doi.org/10.1016/S0140-6736(22)00478-0">most common cause of lower respiratory infections</a> in young children and can be especially severe for infants under 6 months of age. It is the leading cause of infant hospitalization in the U.S., according to the Centers for Disease Control and Prevention. Each year, RSV is associated with <a href="https://doi.org/10.1056/NEJMoa0804877">half a million emergency room visits</a>, nearly 100,000 hospitalizations and 300 deaths in young U.S. children. </p>
<p>The vaccine, sold under the brand name Abrysvo, is approved for use between 32 and 36 weeks of pregnancy to protect infants from birth through 6 months of age.</p>
<p>The CDC plans to meet in October to set recommendations for the use of Abrysvo. That means this vaccine could become available for use during pregnancy in a matter of months.</p>
<p>In mid-July, the FDA also approved a <a href="https://www.fda.gov/news-events/press-announcements/fda-approves-new-drug-prevent-rsv-babies-and-toddlers">long-acting, single-dose monoclonal antibody</a>, called nirsevimab, which is sold as Beyfortus, for newborns and young children up to the age of 2 years old.</p>
<p>We are an <a href="https://www.usfca.edu/faculty/annette-regan">infectious disease epidemiologist</a> and <a href="https://www.bcm.edu/people-search/flor-munoz-rivas-27227">pediatric infectious disease physician</a>. We have experienced the frustration of previously limited options available for the prevention of RSV, especially during the <a href="https://theconversation.com/rsv-a-pediatric-disease-expert-answers-5-questions-about-the-surging-outbreak-of-respiratory-syncytial-virus-193275">heavier-than-usual RSV season</a> in late 2022. The approval of a maternal vaccine and monoclonal antibody signals a major milestone in the medical profession’s ability to prevent RSV disease in children.</p>
<p>With these two new options soon to be available, parents of young children, along with people who are currently expecting, are likely wondering about the pros and cons of each and which to take to best protect their child from RSV.</p>
<h2>A game-changer in the fight against RSV</h2>
<p>The newly approved protein-based vaccine takes a similar approach as the <a href="https://www.cdc.gov/vaccines/pregnancy/hcp-toolkit/tdap-vaccine-pregnancy.html">Tdap, or whooping cough, vaccine</a>, which is given between 27 and 36 weeks of pregnancy <a href="https://www.cdc.gov/vaccines/pregnancy/hcp-toolkit/tdap-vaccine-pregnancy.html">to protect babies against tetanus, diphtheria and pertussis (whooping cough)</a>. Abrysvo stimulates the mother’s immune system to produce antibodies that cross the placenta and offer protection to the newborn against RSV illness, starting at birth.</p>
<p>The FDA based its approval on clinical trial data from more than 7,000 participants across 18 countries who either received the RSV vaccine between 24 and 36 weeks of pregnancy or received a placebo shot. In the trial, the maternal RSV vaccine <a href="https://doi.org/10.1056/NEJMoa2216480">prevented 82% of severe lower-respiratory illnesses</a> caused by RSV in infants in the first 3 months of life, and 69.4% through 6 months of age. </p>
<p>While there were <a href="https://doi.org/10.1056/NEJMoa2216480">no vaccine-related safety concerns raised in the trial</a>, including preterm birth, low birth weight, birth defects, developmental delay or death, the vaccine will come with a warning about a less-than-1% increase in preterm birth that was seen in the group that received the RSV vaccination in the clinical trial. There is currently no proof that the vaccine is causally linked with preterm birth, and the 1% increase was not significant.</p>
<p>The FDA also requires the vaccine manufacturer to continue monitoring the safety of the vaccine for use during pregnancy. </p>
<p>Abrysvo <a href="https://www.nytimes.com/2023/05/31/health/fda-rsv-vaccine-older-adults.html">was also approved by the FDA</a> in May 2023 to prevent RSV illness in adults 60 years and older.</p>
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<figcaption><span class="caption">There are now tools available to protect the most vulnerable members of the population – infants and older Americans – against RSV.</span></figcaption>
</figure>
<h2>Monoclonal antibodies also provide protection</h2>
<p>For those who are unable to get the RSV vaccine during their pregnancy, there is also an option to provide ready-made antibodies to protect the baby.</p>
<p>Nirsevimab, also known as Beyfortus, is a monoclonal antibody approved for babies up to 8 months of age during the RSV season and children up to 24 months of age who are at high risk of severe RSV. Beyfortus is given as a single shot of laboratory-made human antibodies. These antibodies help protect against lower-respiratory tract disease, including <a href="https://www.mayoclinic.org/diseases-conditions/bronchiolitis/symptoms-causes/syc-20351565#">bronchiolitis</a> and <a href="https://www.nhlbi.nih.gov/health/pneumonia#">pneumonia</a>, caused by RSV. </p>
<p>Clinical trial data <a href="https://doi.org/10.1056/NEJMoa2110275">from 350 sites across 31 countries</a> showed that Beyfortus was 75% effective against RSV-associated lower respiratory illness and 62% effective against RSV-associated hospitalization in the first 5 months after birth. Mild adverse reactions associated with Beyfortus included rashes and swelling or pain at the place where the injection was made. </p>
<p>There are some children who should not receive Beyfortus or should be cautious about receiving Beyfortus, including those with a history of serious reactions to the ingredients in that medication and children with bleeding disorders.</p>
<h2>Parsing the differences</h2>
<p>Both the maternal vaccine and the monoclonal antibody have been shown to work in reducing the risk of severe RSV disease in young infants, and the efficacy and duration of protection appears to be similar. Clinical trials showed that the vaccine was protective up to <a href="https://doi.org/10.1056/NEJMoa2216480">6 months of age</a> and the antibody up to <a href="https://www.beyfortus.com/hcp/?">5 months of age</a>. </p>
<p>While Abrysvo stimulates the production of the mother’s own antibodies that get passed on to the baby, Beyfortus is not actually a vaccine. It instead provides ready-made antibodies given as an injection to protect the child. Beyfortus will go to work immediately after administration, and babies of mothers who are vaccinated during pregnancy will be protected from birth, but Abrysvo takes approximately 14 days after the shot to build up effective antibodies in the mother. The vaccine should be taken at least 14 days before expected delivery – and ideally even before then – in order to adequately protect the baby.</p>
<p>Both the vaccine and the monoclonal antibody target the F-protein of the virus, the protein that helps the virus enter cells and spread infection. However, the vaccine creates antibodies that target all sites on the F-protein, while Beyfortus antibodies target a single site – known as “site zero” – of the F-protein. Both result in passive immunity to the baby, providing protection during a time that babies are most susceptible to severe RSV disease. </p>
<p>When mothers are vaccinated within the specified window and babies are born at term, the protection from Abrysvo is sufficient for the babies. When the mother is not vaccinated in pregnancy, then Beyfortus is available for infants from birth.</p>
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<figcaption><span class="caption">Beyfortus can prevent RSV in children up to age 2.</span></figcaption>
</figure>
<p>Another big difference between the two products is cost. Pre-prepared antibodies like Beyfortus can be expensive to produce and carry a higher cost compared to the Abrysvo vaccine – about <a href="https://www.cnn.com/2023/08/03/health/rsv-infant-nirsevimab-beyfortus-acip/index.html">US$395 to $500</a> per Beyfortus shot compared to <a href="https://www.cbsnews.com/news/cost-of-vaccines-vary-by-virus-and-health-insurance-status-kff/">$180 to $295</a> per Abrysvo shot. The cost of Abrysvo and how it will be covered by insurance will depend on what the CDC says in October. Regardless, both shots need to be given by a health care professional, which will require a medical visit.</p>
<p>While both provide a substantial opportunity to prevent severe illness associated with RSV in newborns and young infants, most children will not need both. </p>
<p>In special cases, Beyfortus could be offered to an infant of a mother who received the vaccine. For example, this might be appropriate if birth occurs less than 14 days after the administration of the vaccine, or if the baby is born prematurely. In addition, the monoclonal antibody can be given to protect infants with high-risk conditions for RSV, such as immune deficiency and chronic lung or heart disease, through their second year of life. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/544817/original/file-20230825-17-nt7ejh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A pregnant mother gazes down at her arm as she receives a shot from a medical provider." src="https://images.theconversation.com/files/544817/original/file-20230825-17-nt7ejh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/544817/original/file-20230825-17-nt7ejh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/544817/original/file-20230825-17-nt7ejh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/544817/original/file-20230825-17-nt7ejh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/544817/original/file-20230825-17-nt7ejh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/544817/original/file-20230825-17-nt7ejh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/544817/original/file-20230825-17-nt7ejh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The newly approved maternal vaccine can be taken between 32 and 36 weeks of pregnancy.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/expectant-mother-watches-as-tech-gives-her-vaccine-royalty-free-image/1340094898?phrase=maternal+RSV+vaccine&adppopup=true">SDI ProductionsE+ via Getty Images</a></span>
</figcaption>
</figure>
<h2>The bottom line</h2>
<p>Both products are safe and effective, and it is important to protect young infants and children at risk from RSV. </p>
<p>Until now, effective monoclonal antibodies were only available for the most premature babies. But many of the infants who <a href="https://doi.org/10.1016/S2213-2600(22)00414-3">get RSV are born full term</a>. </p>
<p>Families should discuss their options for RSV prevention with their pregnancy care provider and pediatrician.</p><img src="https://counter.theconversation.com/content/211857/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Annette Regan receives funding from the National Institute of Allergy and Infectious Diseases, the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the US Centers for Disease Control and Prevention, and the Pan American Health Organization.</span></em></p><p class="fine-print"><em><span>Flor M. Munoz is a member of the data safety committee or advisory boards to Pfizer, Sanofi, AztraZeneca, GSK, Moderna, and Meissa vaccines. She receives research funding from the National Institutes of Health, the US Centers for Disease Control and Prevention, Pfizer and Gilead. She is a member of the board of the National Foundation of Infectious Diseases (NFID).</span></em></p>Nearly 100,000 US children under age 5 are hospitalized each year for an RSV infection.Annette Regan, Associate Professor of Epidemiology, University of San FranciscoFlor M. Munoz, Associate Professor of Pediatric Infectious Diseases, Baylor College of Medicine Licensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2054772023-08-18T02:08:23Z2023-08-18T02:08:23ZCurious Kids: why do babies cry when they come out of their mum?<figure><img src="https://images.theconversation.com/files/543119/original/file-20230816-21-5r1861.jpg?ixlib=rb-1.1.0&rect=2%2C0%2C995%2C664&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/newborn-baby-78559918">Shutterstock</a></span></figcaption></figure><blockquote>
<p>Why do babies always cry when they come out of their mum? – Nam, 12, Hanoi, Vietnam</p>
</blockquote>
<p><a href="https://theconversation.com/au/topics/curious-kids-36782"><img src="https://images.theconversation.com/files/291898/original/file-20190911-190031-enlxbk.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=90&fit=crop&dpr=1" width="100%"></a></p>
<p>When babies are born, they all seem to cry. We see this a lot <a href="https://www.goldderby.com/gallery/best-tv-births-ranked-worst-to-best/tvs-most-memorable-births-little-house-ont-the-prarie/">on TV</a>.</p>
<p>But not all newborn babies cry straight away. Here’s what’s going on.</p>
<h2>What happens at birth?</h2>
<p>When a baby is born, they move from their mum’s warm body, and out of their dark, watery world into a much cooler, drier and brighter one.</p>
<p>It’s a bit of a squeeze. As the baby comes out from their mum, the cooler air hits their wet skin. </p>
<p>The cooler air makes them gasp. They also gasp when the midwife or doctor touches their body to help them come into the world.</p>
<p>That gasp is their first breath, which usually comes with a cry. And when this happens the gasp or cry triggers an amazing <a href="https://www.youtube.com/watch?v=zTXmaVgobNw">change</a> in how the baby gets oxygen and moves it around their body.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/curious-kids-why-do-we-cry-119814">Curious Kids: why do we cry?</a>
</strong>
</em>
</p>
<hr>
<h2>What changes?</h2>
<p>In the womb, babies depend on their mum for oxygen – via the <a href="https://theconversation.com/explainer-what-is-placenta-28851">placenta</a> and <a href="https://theconversation.com/ive-always-wondered-whats-behind-the-belly-button-84598">umbilical cord</a>.</p>
<p>The placenta looks a bit like a pancake and filters oxygen-rich blood from the mum. The umbilical cord then pumps that to the unborn baby.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/543140/original/file-20230817-17-84peqv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Unborn baby with umbilical cord and placenta" src="https://images.theconversation.com/files/543140/original/file-20230817-17-84peqv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/543140/original/file-20230817-17-84peqv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/543140/original/file-20230817-17-84peqv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/543140/original/file-20230817-17-84peqv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/543140/original/file-20230817-17-84peqv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/543140/original/file-20230817-17-84peqv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/543140/original/file-20230817-17-84peqv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The placenta, on the left, and the umbilical cord work together to send oxygen from the mum’s blood to the unborn baby.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-illustration/3d-rendered-medically-accurate-illustration-fetus-727111807">Shutterstock</a></span>
</figcaption>
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<p>But once babies are born, their first breath or cry triggers a whole range of changes to the way their heart moves blood around their body. So, rather than breathing fluid from the womb, they can now breathe air and get oxygen into their lungs just like we do. </p>
<p>The process of being born also squeezes water out of the baby’s lungs, allowing them to work properly.</p>
<p>A newborn baby crying is a sound parents and health workers are very <a href="https://www.romper.com/p/why-do-babies-cry-at-birth-the-answer-will-probably-surprise-you-18746386">happy</a> to hear. That’s because it usually means the baby is well and won’t need any extra help to breathe.</p>
<p>But not all newborn babies cry. And it’s not always something to be worried about.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/curious-kids-is-it-true-that-male-seahorses-give-birth-92843">Curious Kids: Is it true that male seahorses give birth?</a>
</strong>
</em>
</p>
<hr>
<h2>Why don’t all babies cry?</h2>
<p>Sometimes this switch to moving oxygen around the body just like us <a href="https://www.hopkinsmedicine.org/health/conditions-and-diseases/persistent-pulmonary-hypertension#:%7E:text=In%20persistent%20pulmonary%20hypertension%2C%20also,difficult%20birth%2C%20or%20birth%20asphyxia.">does not happen smoothly</a>.</p>
<p>There might be problems with the baby’s heart, or there may have been a difficult birth. For instance, the baby might have been very short of oxygen in the womb and need some help to start breathing when they are born. </p>
<p>Sometimes there’s a delay in babies crying. </p>
<p>Babies born by caesarean section – when doctors operate on the mum to lift the baby out of her womb – might be <a href="https://link.springer.com/article/10.1007/s00404-019-05208-7">slower</a> to breathe and cry. That’s because they don’t have the fluid squeezed from the lungs like they do when born through the vagina. </p>
<p>Sometimes newborn babies don’t cry at all.</p>
<p>Babies born in water (known as a <a href="https://www.bellybelly.com.au/birth/doulas/preparing-for-a-water-birth/">waterbirth</a>) may have lots of warm water around them and not even realise they are born. That’s because they don’t feel cold air as they come into the world; they are often in their mother’s arms in the water. So they tend to just <a href="https://www.sarawickham.com/questions-and-answers/whats-an-aqua-apgar/">breathe quietly</a>, and turn pink (showing they are getting enough oxygen), without crying.</p>
<hr>
<p><em>Hello, Curious Kids! Do you have a question you’d like an expert to answer? Ask an adult to send your question to curiouskids@theconversation.edu.au</em></p><img src="https://counter.theconversation.com/content/205477/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Hannah Dahlen receives funding from NHMRC and ARC. She is affiliated with The Australian College of Midwives</span></em></p>Crying triggers changes in how a newborn baby gets their oxygen. But not all new babies cry, and it’s not always a problem.Hannah Dahlen, Professor of Midwifery, Associate Dean Research and HDR, Midwifery Discipline Leader, Western Sydney UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2037452023-08-03T12:25:11Z2023-08-03T12:25:11ZUS preterm birth and maternal mortality rates are alarmingly high, outpacing those in all other high-income countries<figure><img src="https://images.theconversation.com/files/537367/original/file-20230713-19-6sry09.jpg?ixlib=rb-1.1.0&rect=183%2C15%2C4928%2C3395&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Maternal and infant health crises are growing worse in the U.S.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/black-mother-cuddling-sleeping-baby-son-on-sofa-royalty-free-image/758282421?phrase=african+american+baby+sleeping&adppopup=true">LWA/Dann Tardif/Digital Vision via Getty Images</a></span></figcaption></figure><p>Every two minutes, in about the time it takes to read a page of your favorite book or brew a cup of coffee, a woman dies during pregnancy or childbirth, according to a <a href="https://www.who.int/publications/i/item/9789240068759">February 2023 report</a> from the World Health Organization. The report reflects a shameful reality in which maternal deaths have either increased or plateaued worldwide between 2016 and 2020.</p>
<p>On top of that, of every 10 babies born, one is preterm – and every 40 seconds, <a href="https://www.who.int/news/item/09-05-2023-152-million-babies-born-preterm-in-the-last-decade">one of those babies dies</a>. Globally, preterm birth is the <a href="https://www.who.int/news-room/fact-sheets/detail/preterm-birth#">leading cause</a> of death in children under the age of 5, with complications from preterm birth resulting in the death of 1 million children under age 5 each year. </p>
<p>The WHO has designated preterm birth an “<a href="https://www.who.int/news/item/15-11-2022-who-advises-immediate-skin-to-skin-care-for-survival-of-small-and-preterm-babies">urgent public health issue</a>” in recognition of the threat it poses to global health. </p>
<p>Those numbers reflect a worldwide problem, but the U.S. in particular has an abysmal record on both preterm births and maternal mortality: Despite significant medical advancements in recent years, the U.S. suffers from the <a href="https://tcf.org/content/commentary/worsening-u-s-maternal-health-crisis-three-graphs/">highest maternal mortality rate</a> among high-income countries globally. And the 2022 March of Dimes Report Card, an evaluation of maternal and infant health, gave the United States <a href="https://www.marchofdimes.org/peristats/reports/united-states/report-card">an extremely poor “D+” grade</a>. That data also revealed that the national preterm birth rate spiked to 10.5% in 2021, representing a record 15-year high. </p>
<p>We are maternal <a href="https://physiology.med.wayne.edu/profile/ad8024">fetal medicine experts</a> and <a href="https://womenshealth.wayne.edu/about/leadership/">scholars of women’s health</a> who focus on treatments and programs to help women have better maternal health, especially those that reduce preterm birth.</p>
<p>Our <a href="https://womenshealth.wayne.edu/">Office of Women’s Health</a> leads the <a href="https://today.wayne.edu/medicine/news/2023/07/11/wsu-leads-statewide-network-to-combat-high-rates-of-pre-term-birth-53745?wonderplugin-box-action=READ+PRESS+RELEASE">SOS Maternity Network</a>, which stands for the Synergy of Scholars in Maternal and Infant Health Equity, a research alliance of maternal fetal medicine physicians across the state of Michigan. </p>
<p>Maternal and infant death are the <a href="https://doi.org/10.1016/S2352-4642(20)30369-2">worst possible outcomes of pregnancy</a>. These numbers make clear just how crucial it is to change this trajectory and to ensure all Americans have practical access to quality reproductive health care.</p>
<h2>Dire state of maternal health care</h2>
<p>Tori Bowie, an elite Olympic athlete, <a href="https://www.npr.org/2023/06/13/1181971448/tori-bowie-an-elite-olympic-athlete-died-of-complications-from-childbirth">tragically lost her life</a> at just age 32 because of complications of pregnancy and childbirth. </p>
<p>Bowie’s story drives home the devastating state of maternal health in the U.S. Maternal mortality is a sad and unexpected ending to the often beautiful journey of pregnancy and childbirth. It means that a baby has to go without its mother’s love, care and comforting touch and at the same time the family has to mourn the sudden loss of their loved one. Unless substantial progress is made for lowering maternal deaths, the lives of over <a href="https://www.who.int/publications/i/item/9789240068759">1 million more women</a> like Bowie could be at risk by the year 2030, if current trends continue. </p>
<p>Unfortunately, the <a href="https://www.marchofdimes.org/peristats/reports/united-states/report-card">maternal and infant health crises are worsening</a> in the U.S., and this association is far from being an unfortunate coincidence. There is an important link between infant health and maternal health, as they both rely on the <a href="https://www.ajmc.com/view/us-has-highest-infant-maternal-mortality-rates-despite-the-most-health-care-spending">accessibility and quality of health care</a>. These U.S. rates have been increasing since 2018, when improved reporting of maternal deaths was adopted. </p>
<p>In 2020, the U.S. maternal mortality rate was 23.8 deaths per 100,000 live births – nearly three times as high as the country with the next-highest rate of 8.7 deaths per 100,000 live births, France.</p>
<p>The number of women who died within a year after pregnancy <a href="https://doi.org/10.1001/jama.2023.9043">more than doubled in the U.S.</a> over the 20-year period of 1999 to 2019. And there are significant racial disparities in this statistic: The highest number of pregnancy-related deaths were recorded among Black women, increasing from 26.7 per 100,000 births to 55.4 per 100,000 during that same time period. </p>
<p>Worse yet, the Centers for Disease Control and Prevention has determined that about <a href="https://www.cdc.gov/reproductivehealth/maternal-mortality/docs/pdf/Pregnancy-Related-Deaths-Data-MMRCs-2017-2019-H.pdf">84% of such maternal deaths</a> <a href="https://theconversation.com/more-than-4-in-5-pregnancy-related-deaths-are-preventable-in-the-us-and-mental-health-is-the-leading-cause-193909">are preventable</a>.</p>
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<figcaption><span class="caption">The U.S. maternal mortality rate for Black women is nearly three times higher than that of white women.</span></figcaption>
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<h2>Tragic rates of infant mortality and preterm birth</h2>
<p>Notably, in 2020 the U.S. also experienced the <a href="https://www.ajmc.com/view/us-has-highest-infant-maternal-mortality-rates-despite-the-most-health-care-spending">highest infant mortality rate</a> of all high-income countries. The U.S infant mortality rate was 5.4 deaths per 1,000 live births, in contrast to the 1.6 deaths per 1,000 live births in Norway, the country with the lowest infant mortality rate. </p>
<p>You may have heard the term “preemie” before, perhaps when a loved one delivered a baby more than three weeks before the expected due date. A premature birth is one that occurs before the 37th week of pregnancy. Preterm-related causes are responsible for <a href="https://www.marchofdimes.org/peristats/reports/united-states/prematurity-profile">35.8% of infant deaths in the U.S</a>. </p>
<p>Preterm babies are often not fully physiologically prepared for delivery, which can result in a range of medical complications. While preterm births lead to rising infant mortality rates, even those who survive can face health problems such as breathing difficulties, problems with feeding, significant developmental delay and more <a href="https://www.cdc.gov/reproductivehealth/maternalinfanthealth/pretermbirth.htm#">throughout their lives</a>. Preterm birth also presents additional risks for the mother, as women who deliver preterm are at higher risk for cardiovascular complications later in life.</p>
<p>Thus, preterm birth <a href="https://doi.org/10.1002/14651858.CD007235.pub4">takes a significant toll</a> on families and their communities, with serious ramifications in medical, social, psychological and financial contexts. </p>
<h2>Maternal care during pregnancy is key</h2>
<p>Maternal care appointments and screenings are essential to prevent prenatal complications and a women’s increased risk for developing <a href="https://doi.org/10.1161/CIR.0000000000000961">long-term complications such as cardiovascular disease</a>. For that reason, patients should secure prenatal care as early as possible in the pregnancy and continue to regularly have prenatal care appointments. </p>
<p>Preterm birth can occur unexpectedly in an otherwise normal-seeming pregnancy. It looks no different from the early signs of a typical labor, except that it occurs before 37 weeks of pregnancy. The symptoms of premature labor can include contractions, unusual vaginal discharge, the feeling of pressure in the pelvic area, low dull backache or cramps in the uterus or abdomen. A person who experiences these symptoms during pregnancy should seek medical attention.</p>
<p>Some people are more predisposed to preterm birth based on individual risk factors like substance use, multiple pregnancy – such as twins – infections, race, a medical history of prior preterm delivery and heightened stress levels. Our research team and others have shown that <a href="https://doi.org/10.1080/14767058.2023.2199343">COVID-19 is a known risk factor</a> for preterm birth.</p>
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<figcaption><span class="caption">Be aware of the risk factors for preterm birth.</span></figcaption>
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<p>It’s important to speak with your primary care provider to assess how your current health may affect future pregnancy and whether lifestyle changes – such as adopting a healthy diet and active lifestyle and avoiding smoking and drinking alcohol – can improve your likelihood of a full-term delivery.</p>
<h2>Preterm birth prevention</h2>
<p>The more that pregnant women take ownership of their health and ask their doctors to perform a simple cervical length screening during their pregnancy, the earlier preterm birth can be detected and prevented and the more lives will be saved.</p>
<p>Evidence has shown that patients with a short cervix face a greater risk of the <a href="https://doi.org/10.1002/uog.7673">cervix’s opening too early</a> in pregnancy, resulting in preterm birth and other adverse outcomes. The cervix is the lower section of the uterus, which connects to the vaginal canal. As pregnancy progresses, it stretches, softens and ultimately opens in the process of normal childbirth.</p>
<p>All patients – even those who are seemingly low risk – should ask their doctors to have their cervical length checked by transvaginal ultrasound during pregnancy between 19 and 24 weeks. A short cervical length indicates a high risk of a premature delivery. Luckily, there are treatments available, such as vaginal progesterone, which can prevent preterm birth in women found by ultrasound to have a short cervix. This treatment can <a href="https://doi.org/10.1002/uog.9017">reduce the risk of preterm birth by more than 40%</a>.</p>
<p>We are optimistic that with greater awareness of these issues and a shift in the focus to evidence-based practices coupled with increased access to vulnerable populations, the U.S. can begin to give women like Bowie and so many others the health care they and their infants deserve. </p>
<p><em>This article has been updated to highlight the most recent trends in maternal mortality that were reported on July 3, 2023, and to highlight the stark racial disparities.</em></p><img src="https://counter.theconversation.com/content/203745/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sonia Hassan receives funding from Wayne State University. The Office of Women's Health receives funding from the Total Health Care Foundation and the Detroit Medical Center Foundation. </span></em></p><p class="fine-print"><em><span>Hala Ouweini does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>A March of Dimes report gave the US a grade of D+ for maternal and infant health care, highlighting that the national preterm birth rate hit 10.5% in 2021, a record 15-year high.Sonia Hassan, Professor of Obstetrics and Gynecology and Maternal Fetal Medicine, Wayne State UniversityHala Ouweini, Research Associate in Women's Health, Wayne State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2088552023-07-26T00:32:56Z2023-07-26T00:32:56ZRSV is everywhere right now. What parents need to know about respiratory syncytial virus<figure><img src="https://images.theconversation.com/files/538668/original/file-20230721-21-8jb0lp.jpg?ixlib=rb-1.1.0&rect=1%2C4%2C997%2C661&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/newborn-baby-weakened-bronchitis-getting-oxygen-1022883532">Shutterstock</a></span></figcaption></figure><p>This winter, we’re having to get our heads around another respiratory virus – RSV.</p>
<p>It’s less well known than COVID or flu, but it’s also responsible for unplanned visits to the GP or emergency department, and days off school, childcare and work.</p>
<p>It’s the <a href="https://pubmed.ncbi.nlm.nih.gov/31383776/">most common</a> cause of hospitalisation in infants. Most children have at least one RSV infection by the age of three years and yet, many Australians have not heard of RSV or know little about this potentially serious winter virus.</p>
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Read more:
<a href="https://theconversation.com/mondays-medical-myth-you-can-catch-a-cold-by-getting-cold-2488">Monday's medical myth: you can catch a cold by getting cold</a>
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<h2>What is RSV?</h2>
<p>RSV stands for respiratory syncytial (pronounced sin-CITY-al) virus. This common respiratory virus usually causes a mild cold with symptoms such as a fever, runny nose, coughing, decreased appetite and a wheeze. </p>
<p>Adults can be infected with RSV but usually recover in a few days.</p>
<p>But in young babies RSV can cause more severe respiratory illnesses such as <a href="https://www.rch.org.au/kidsinfo/fact_sheets/pneumonia/">pneumonia</a> or <a href="https://www.rch.org.au/kidsinfo/fact_sheets/bronchiolitis/">bronchiolitis</a>. These cause babies to breathe rapidly, stop breathing for a few seconds (apnoeas) and/or feed poorly. RSV in infancy can also potentially affect a child’s long-term health, increasing their risk of asthma, wheezing and allergies. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1676938514951462912"}"></div></p>
<p>In Australia, a wave of RSV infections typically begins in late autumn (April-May) and peaks in June-July. Cases are <a href="https://nindss.health.gov.au/pbi-dashboard/">starting to decline</a> in Australia now.</p>
<p>Because health staff have to report cases of RSV, we can keep track of <a href="https://nindss.health.gov.au/pbi-dashboard/">known cases</a>. But we suspect most go unreported as they are mild and/or doctors don’t always test for the virus.</p>
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<strong>
Read more:
<a href="https://theconversation.com/heard-of-kindy-flu-theres-no-such-thing-but-kids-are-at-risk-this-flu-season-for-one-simple-reason-207825">Heard of 'kindy flu'? There's no such thing. But kids are at risk this flu season for one simple reason</a>
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<h2>Who’s most at risk?</h2>
<p>Both young and old people are most at risk of severe disease. </p>
<p>For children, those <a href="https://adc.bmj.com/content/107/4/359.long">most at risk</a> of severe disease include babies under two months old, premature infants, those with other medical conditions, or ones infected with another virus at the same time. First Nations children are <a href="https://pubmed.ncbi.nlm.nih.gov/31066061/">three to six times</a> more likely to be hospitalised with bronchiolitis caused by RSV than non-First Nations children.</p>
<p>Otherwise healthy children under 12 months old (usually under six months old) are the ones most often admitted to hospital. Of children admitted to hospital, <a href="https://pubmed.ncbi.nlm.nih.gov/35168504/">about a quarter</a> (26%) will be admitted to intensive care.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/538662/original/file-20230721-28237-d8ek9e.jpg?ixlib=rb-1.1.0&rect=4%2C0%2C994%2C667&q=45&auto=format&w=1000&fit=clip"><img alt="Male toddler with oxygen mask over face in hospital bed" src="https://images.theconversation.com/files/538662/original/file-20230721-28237-d8ek9e.jpg?ixlib=rb-1.1.0&rect=4%2C0%2C994%2C667&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/538662/original/file-20230721-28237-d8ek9e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/538662/original/file-20230721-28237-d8ek9e.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/538662/original/file-20230721-28237-d8ek9e.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/538662/original/file-20230721-28237-d8ek9e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/538662/original/file-20230721-28237-d8ek9e.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/538662/original/file-20230721-28237-d8ek9e.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Young children and the elderly are most at risk.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/2-years-old-asian-toddler-boy-1163046754">Shutterstock</a></span>
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<h2>Why are we seeing so many cases now?</h2>
<p>RSV is spread via coughing and sneezing so it’s easy to see how the virus can spread among children inside during winter months.</p>
<p>But measures earlier in the COVID pandemic limited the spread of RSV.</p>
<p>There was very little RSV circulating in 2020 during the harshest lockdowns. However, in New South Wales and Western Australia (in late 2020) and in Victoria (early 2021) there was an <a href="https://www.nature.com/articles/s41467-022-30485-3">out-of-season re-emergence</a> of RSV, overwhelming hospitals and health-care facilities.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1531461682307821570"}"></div></p>
<p>In 2022, RSV settled back into the usual winter peak. However, many states are experiencing a winter surge in cases and hospitalisations attributed to it this year – bigger than before the pandemic.</p>
<p>This may relate to <a href="https://www.health.gov.au/diseases/respiratory-syncytial-virus-rsv-infection">new reporting requirements</a> for RSV and more testing for it.</p>
<p>However, reduced immunity in young infants due to lower maternal and infant exposure may have contributed to the record number of cases.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/ive-had-covid-and-am-constantly-getting-colds-did-covid-harm-my-immune-system-am-i-now-at-risk-of-other-infectious-diseases-188899">I've had COVID and am constantly getting colds. Did COVID harm my immune system? Am I now at risk of other infectious diseases?</a>
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<h2>Is there a vaccine?</h2>
<p>There are no vaccines to protect against RSV in Australia.</p>
<p>Australia’s only currently available preventative medicine is <a href="https://www.rch.org.au/rchcpg/hospital_clinical_guideline_index/Palivizumab_for_at-risk_patients/">palivizumab</a>, which is a long-acting monoclonal antibody given monthly during the RSV season. Due to its cost, it is reserved for infants at highest risk for severe RSV infection and is usually given in hospital. </p>
<p>However, several new preventative agents are in the pipeline. </p>
<p><a href="https://www.fda.gov/news-events/press-announcements/fda-approves-first-respiratory-syncytial-virus-rsv-vaccine">In May this year</a>, the US Food and Drug Administration approved the RSV vaccine Arexvy for people aged 60 and over. It is being <a href="https://www.tga.gov.au/resources/prescription-medicines-under-evaluation/arexvy-glaxosmithkline-australia-pty-ltd">considered for use</a> in Australia.</p>
<p>Results from clinical trials for RSV vaccines given to pregnant women to protect their baby for the first six months are promising. The maternal Pfizer vaccine <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2216480">has demonstrated</a> greater than 80% effectiveness against severe lower respiratory tract illness in their infants for the 90 days after birth.</p>
<p>However, safety data is being closely examined, including a <a href="https://www.bmj.com/content/381/bmj.p1021">potential risk</a> of premature birth. </p>
<p>The long-acting monoclonal antibody nirsevimab, (given as a single injection at the beginning of the RSV season) has regulatory approval in Europe and the US. It is currently <a href="https://www.tga.gov.au/resources/prescription-medicines-under-evaluation/beyfortus-astrazeneca-pty-ltd">being considered</a> for Australian children.</p>
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<strong>
Read more:
<a href="https://theconversation.com/fdas-approval-of-the-worlds-first-vaccine-against-rsv-will-offer-a-new-tool-in-an-old-fight-4-questions-answered-205111">FDA's approval of the world's first vaccine against RSV will offer a new tool in an old fight – 4 questions answered</a>
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<h2>How can I protect my children in the meantime?</h2>
<p>Parents can minimise the risk of RSV by using many of the measures we’ve been using during the COVID pandemic. Encourage children to cover their mouths and noses when coughing or sneezing, and regularly wash their hands.</p>
<p>Ensuring kids stay away from school, childcare or other children when sick helps prevent the spread of many viruses, including RSV.</p>
<p><a href="https://www.rch.org.au/kidsinfo/fact_sheets/Respiratory_syncytial_virus_RSV/">Viral symptoms</a> to watch out for include difficulty feeding, cough, irritability and/or rapid breathing. If parents notice these signs or are worried about their child they should seek urgent medical assessment and not delay.</p><img src="https://counter.theconversation.com/content/208855/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jane Tuckerman is an investigator on a project grant sponsored by Industry. Her institution has received funding from Industry (GSK) for investigator led research. She does not receive any personal payments from Industry. </span></em></p><p class="fine-print"><em><span>Ashleigh Rak receives funding from NHMRC and the Victorian Government.</span></em></p><p class="fine-print"><em><span>Danielle Wurzel receives funding from NHMRC, MRFF and has received honoraria and/or consultancy fees from MSD, Sanofi, GSK which have been paid into her research fund.</span></em></p><p class="fine-print"><em><span>Margie Danchin receives funding from NHMRC, MRFF, WHO, DFAT and the Victorian Government. She is chair, Australian Regional Immunisation Alliance. </span></em></p>Even otherwise healthy children can end up in hospital with this winter respiratory virus.Jane Tuckerman, Senior Research Officer, Murdoch Children's Research InstituteAshleigh Rak, Research Nurse Coordinator, Murdoch Children's Research InstituteDanielle Wurzel, Paediatric Respiratory Physician, and Honorary Fellow Manager, Murdoch Children's Research InstituteMargie Danchin, Paediatrician at the Royal Childrens Hospital and Associate Professor and Clinician Scientist, University of Melbourne and MCRI, Murdoch Children's Research InstituteLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2047852023-05-29T19:50:46Z2023-05-29T19:50:46ZPandemic babies’ developmental milestones: Not as bad as we feared, but not as good as before<figure><img src="https://images.theconversation.com/files/528474/original/file-20230526-23-qh7azn.jpg?ixlib=rb-1.1.0&rect=301%2C760%2C3838%2C2282&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Scientists and physicians raised concerns early in the pandemic that increased parental stress, COVID infections, reduced interactions with other babies and adults, and changes to health care may affect child development.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/pandemic-babies--developmental-milestones--not-as-bad-as-we-feared--but-not-as-good-as-before" width="100%" height="400"></iframe>
<p>The COVID-19 pandemic created conditions that <a href="https://doi.org/10.1017/S2040174420000847">threatened children’s healthy development</a>. </p>
<p>Scientists and physicians raised concerns early in the pandemic, pointing out that increased parental stress, COVID infections, reduced interactions with other babies and adults and changes to health care <a href="https://doi.org/10.1111%2Fcdev.13653">could affect child development</a>. Furthermore, some children could be especially vulnerable to the pandemic circumstances. </p>
<p>With these concerns in mind, we started a <a href="https://doi.org/10.2196/25407">longitudinal study of pregnant Canadians</a> to understand how pandemic stressors might influence later child development. </p>
<p><a href="https://doi.org/10.1016/j.jad.2020.07.126">Our initial findings</a> were alarming: the rates of anxiety and depression among pregnant individuals were two to four times higher during the early phase of the pandemic compared to numerous pregnancy studies prior to the pandemic. This worrisome increase in mental health problems <a href="https://doi.org/10.1016/j.psychres.2021.113912">was seen worldwide</a>. </p>
<h2>Impact on children’s development</h2>
<p>To determine how the pandemic might be affecting children’s development, we measured developmental milestones in 3,742 12-month-old infants born during the first 18 months of the pandemic. We then compared these infants to a similar group of 2,898 Canadian infants born between 2015 and 2018. </p>
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<img alt="A pregnant woman and a doctor both wearing face masks in the doctor's office" src="https://images.theconversation.com/files/528483/original/file-20230526-27-wmxs0a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/528483/original/file-20230526-27-wmxs0a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/528483/original/file-20230526-27-wmxs0a.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/528483/original/file-20230526-27-wmxs0a.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/528483/original/file-20230526-27-wmxs0a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/528483/original/file-20230526-27-wmxs0a.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/528483/original/file-20230526-27-wmxs0a.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Rates of anxiety and depression among pregnant individuals were two to four times higher during the early phase of the pandemic compared to numerous pregnancy studies prior to the pandemic.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
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</figure>
<p>The study evaluated developmental milestones using the <a href="https://agesandstages.com/products-pricing/asq3/">Ages and Stages Questionnaire-3</a>. The ASQ-3 is a parent report of child behaviour that can help identify children at risk of developmental delays in five separate domains: Communication, Gross Motor, Fine Motor, Personal-Social and Problem Solving.</p>
<p>In a study to be published in the <em>Journal of Developmental and Behavioral Pediatrics</em>, we found that most children born during the pandemic were doing fine, with almost 90 per cent meeting their key developmental milestones in each area. This should be reassuring for parents, caregivers and communities, because it suggests that most children are developing normally despite adverse early circumstances.</p>
<p>However, a slightly higher proportion of children born during the pandemic were at risk of developmental delay in Communication, Gross Motor and Personal-Social domains, compared to children born before the pandemic. Our findings <a href="https://doi.org/10.1097/jxx.0000000000000653">are consistent</a> with <a href="https://doi.org/10.1101/2021.08.10.21261846">prior smaller studies</a> showing <a href="https://doi.org/10.1001/jamapediatrics.2021.5563">only small increases in the risk</a> for poor verbal, motor and cognitive performance among 12-month-old infants born during the pandemic.</p>
<figure class="align-center ">
<img alt="A woman smiling and playing with her baby in her lap" src="https://images.theconversation.com/files/528494/original/file-20230526-27-cc84m2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/528494/original/file-20230526-27-cc84m2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/528494/original/file-20230526-27-cc84m2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/528494/original/file-20230526-27-cc84m2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/528494/original/file-20230526-27-cc84m2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/528494/original/file-20230526-27-cc84m2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/528494/original/file-20230526-27-cc84m2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Engaging an infant in conversation or song (even a pre-verbal infant) is a powerful way to encourage language learning.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>The largest effects we observed were in the Communication and Personal-Social domains. Infants born during the pandemic were almost twice as likely to score below cutoffs compared to pre-pandemic infants. </p>
<p>This represents an increase of about one to two additional children in 100 who are at risk, but highlights some potentially concerning effects of the pandemic on early child development. Across Canada, this could result in service demands for 20,000-40,000 additional preschool children.</p>
<p>Although small in absolute terms, these increases have important implications, since already limited resources will need to increase to meet the needs of more children. Certainly, it will be important to continue monitoring infants/children born during the pandemic to determine how long-lasting these effects are. </p>
<p>Reassuringly, <a href="https://doi.org/10.1016/S0749-3797(02)00655-4">early interventions</a> can be <a href="https://doi.org/10.1016/j.ehb.2009.01.002">highly effective</a> for children who are struggling. </p>
<h2>Concerns about child development</h2>
<figure class="align-center ">
<img alt="A smiling baby crawling towards the camera in the foreground, and a young man smiling in the background" src="https://images.theconversation.com/files/528624/original/file-20230526-15-805x46.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/528624/original/file-20230526-15-805x46.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/528624/original/file-20230526-15-805x46.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/528624/original/file-20230526-15-805x46.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/528624/original/file-20230526-15-805x46.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/528624/original/file-20230526-15-805x46.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/528624/original/file-20230526-15-805x46.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Provide your child with many opportunities for one-on-one interaction with a caring and responsive adult.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>Parents should be mostly reassured by these findings. Despite the disruptions to nearly every aspect of life during the pandemic, the majority of children continue to show healthy development. Parents with concerns about their child’s development may find these suggestions helpful:</p>
<ol>
<li><p>Provide your child with many opportunities for one-on-one interaction with a caring and responsive adult. The <a href="https://developingchild.harvard.edu/resourcetag/serve-and-return/">Harvard Center on the Developing Child</a> describes the back-and-forth interactions that form the key processes of child development as “serve and return.” </p></li>
<li><p>Believe in “ordinary magic.” This is the phrase that child development expert <a href="https://doi.org/10.1037//0003-066x.56.3.227">Ann Masten</a> uses to describe how resilience emerges from ordinary, everyday processes and interactions. Children develop resilience when they have access to the right environments, the right relationships and the right chances to be able to safely explore themselves and the world around them.</p></li>
<li><p>Talk and sing with your child. Engaging an infant in conversation or song (even a pre-verbal infant) is a powerful way to encourage <a href="https://doi.org/10.1016/j.dr.2005.11.002">language learning</a>.</p></li>
<li><p>There is a wide range of development that is considered “normal.” It is okay for your child to be at a different stage than other children their age, as long as your child is still showing signs of development. </p></li>
<li><p>If you are concerned about your child’s development after some time of monitoring, discuss your concerns with a qualified health professional to determine if further investigation is needed.</p></li>
</ol>
<p>Overall, the findings of our study (and others) suggest that the effects of the pandemic on infant development (at least to one year of age) have not been as bad as we feared. However, a greater number of children will likely require further evaluation and support compared to pre-pandemic.</p><img src="https://counter.theconversation.com/content/204785/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Gerald Giesbrecht receives funding from the Canadian Institutes of Health Research (CIHR) and the Alberta Children's Hospital Foundation. </span></em></p><p class="fine-print"><em><span>Catherine Lebel receives funding from the Canadian Institutes of Health Research (CIHR), the Natural Sciences and Engineering Research Council (NSERC), Brain Canada, the Azrieli Foundation, Alberta Children's Hospital Foundation, and the Canada Research Chairs program.</span></em></p><p class="fine-print"><em><span>Lianne Tomfohr-Madsen receives funding from the Canadian Institutes of Health Research (CIHR), the Social Sciences and Humanities Research Council (SSHRC), Brain Canada, Calgary Health Trust, the Alberta Children's Hospital Foundation and the Weston Foundation. </span></em></p>Research findings are mostly reassuring for parents — despite the disruptions to nearly every aspect of life during the COVID-19 pandemic, most children continue to show healthy development.Gerald Giesbrecht, Associate Professor of Pediatrics, University of CalgaryCatherine Lebel, Associate Professor of Radiology, University of CalgaryLianne Tomfohr-Madsen, Associate Professor, Canada Research Chair in Mental Health and Intersectionality, University of British ColumbiaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2010852023-03-23T12:42:19Z2023-03-23T12:42:19ZInfant formula shortages forced some parents to feed their babies in less healthy ways<figure><img src="https://images.theconversation.com/files/515955/original/file-20230316-2480-ieroj6.jpg?ixlib=rb-1.1.0&rect=16%2C0%2C5267%2C3500&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Babies still need to eat even when formula is hard to come by.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/shelves-are-empty-as-natalia-restrepo-a-member-of-la-news-photo/1240791802">Joseph Prezioso/AFP via Getty Images</a></span></figcaption></figure><p><em>The <a href="https://theconversation.com/us/topics/research-brief-83231">Research Brief</a> is a short take about interesting academic work.</em> </p>
<h2>The big idea</h2>
<p>One third of families who relied on formula to feed their babies during the COVID-19 pandemic were forced by severe infant formula shortages to <a href="https://doi.org/10.1111/mcn.13498">resort to suboptimal feeding practices</a> that can harm infant health, according to our research published in the journal Maternal and Child Nutrition.</p>
<p>Infant formula shortages left <a href="https://www.kff.org/medicaid/issue-brief/key-characteristics-of-infants-and-implications-of-the-recent-formula-shortage/">70% of U.S. store shelves bare</a> in May 2022, with 10 states reporting out-of-stock rates of <a href="https://news.bloomberglaw.com/health-law-and-business/us-baby-formula-shortages-hit-74-despite-biden-action">90% or greater</a>.</p>
<p><a href="https://scholar.google.com/citations?user=hI28SJIAAAAJ&hl=en&oi=ao">As psychology</a> <a href="https://jessicamarinocom.wordpress.com">researchers</a> who study breastfeeding, this situation left us concerned for the safety of infant nutrition. With two <a href="https://scholar.google.com/citations?user=mrwyVwIAAAAJ&hl=en&oi=ao">colleagues who focus</a> <a href="https://scholar.google.com/citations?user=NChgQR4AAAAJ&hl=en">on public health</a>, we conducted an online survey of over 300 infant caregivers in the U.S. to understand how many families had trouble obtaining infant formula and what they fed their babies when they did.</p>
<p><iframe id="dxSI9" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/dxSI9/5/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<p>Considering the scope of the formula shortages, we were not surprised that 31% of the formula-feeding families we surveyed reported challenges obtaining infant formula, the most common being that it was sold out and they had to travel to more than one store.</p>
<p>But their babies still needed to eat. Being unable to get their hands on infant formula pushed caregivers to potentially unhealthy or even dangerous stopgaps. For example, 11% of the formula-feeding families surveyed said they practiced “formula-stretching” – diluting infant formula with extra water to make formula supplies last longer, which provides a baby with less nutrition in each bottle.</p>
<p>Furthermore, 10% of formula-feeding families reported substituting cereal for infant formula in bottles, 8% prepared smaller bottles and 6% skipped formula feedings for their infants, which all provide infants with less nutritious meals.</p>
<p>Exclusively breastfeeding families were insulated against these supply disruptions. Almost half of breastfeeding families surveyed reported that COVID-19 lockdowns actually allowed them time to increase their milk supply. </p>
<h2>Why it matters</h2>
<p>Our study suggests that the waves of formula shortages from 2020 to 2022 in the U.S. were more than just an inconvenience for parents. Instead, this study is the first to document that formula shortages likely had real and widespread adverse impacts on infant nutrition, given that a large proportion of parents surveyed resorted to feeding their baby in ways that can harm infant health.</p>
<p>For instance, studies have shown that adding extra water to “stretch” formula can result in infant <a href="https://wicworks.fns.usda.gov/sites/default/files/media/document/infant-feeding-guide.pdf">malnutrition, growth and cognitive delays</a> and even <a href="https://doi.org/10.1542/peds.100.6.e4">seizures and death</a> in extreme cases. Adding cereal to bottles increases the risk of <a href="https://wicworks.fns.usda.gov/sites/default/files/media/document/infant-feeding-guide.pdf">choking-related deaths</a> and <a href="https://wicworks.fns.usda.gov/sites/default/files/media/document/infant-feeding-guide.pdf">severe constipation</a>. Moreover, feeding infants age-inappropriate foods can have lifelong consequences for <a href="https://doi.org/10.1111/nure.12102">cognitive development</a> and <a href="https://doi.org/10.1093/ajcn/87.6.1852">growth</a>, leading to a higher <a href="https://doi.org/10.1159/000351486">risk for chronic illnesses</a> like obesity and cardiovascular disease.</p>
<p>Given that <a href="https://www.cdc.gov/breastfeeding/data/reportcard.htm">approximately 75% of infants</a> in the U.S. are fed with infant formula in the first six months of life, formula shortages could put roughly 2.7 million babies each year at risk for suboptimal feeding practices.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/515957/original/file-20230316-28-iyram7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A formally dressed man with gray hair seated in front of a screen that says 'Operation Fly Formula'" src="https://images.theconversation.com/files/515957/original/file-20230316-28-iyram7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/515957/original/file-20230316-28-iyram7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/515957/original/file-20230316-28-iyram7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/515957/original/file-20230316-28-iyram7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/515957/original/file-20230316-28-iyram7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/515957/original/file-20230316-28-iyram7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/515957/original/file-20230316-28-iyram7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">President Biden met with baby formula manufacturers in June 2022 to discuss shortages.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/president-joe-biden-meets-virtually-with-baby-formula-news-photo/1400488773">Kevin Dietsch/Getty Images</a></span>
</figcaption>
</figure>
<h2>What’s next</h2>
<p>A perfect storm of formula recalls, ingredient shortages and shipping delays <a href="https://theconversation.com/whats-causing-the-us-baby-formula-shortage-and-how-to-make-sure-it-doesnt-happen-again-182929">contributed to COVID-19-related formula shortages</a> in the U.S. Although President Joe Biden’s administration has taken some steps to <a href="https://highways.dot.gov/newsroom/biden-administration-announces-new-protect-formula-program-73-billion-bipartisan">improve distribution infrastructure</a>, the U.S. does not currently have infant nutrition disaster plans in place beyond <a href="https://www.hhs.gov/formula/index.html">common-sense recommendations for individuals</a>.</p>
<p>Unfortunately, <a href="https://theconversation.com/breastfeeding-can-help-tackle-climate-crisis-but-its-on-governments-not-mums-to-save-the-world-124676">climate change will likely increase the risk</a> of formula-supply disruptions over the next century because of the <a href="https://e360.yale.edu/features/how-climate-change-is-disrupting-the-global-supply-chain">increased frequency of natural disasters</a>.</p>
<p>The best way to protect infant nutrition from supply chain issues is to promote and support breastfeeding, which provides optimal infant nutrition and insulates infants from those disruptions. Since <a href="https://www.healthgrades.com/right-care/pregnancy/9-reasons-you-may-not-be-able-to-breastfeed">not all babies can be breastfed</a>, though, governmental policies could help prevent and address acute formula shortages and ensure equitable formula access for all.</p><img src="https://counter.theconversation.com/content/201085/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Many families in the US encountered empty shelves when they went in search of infant formula during COVID-19.Jessica A. Marino, Doctoral Student in Health Psychology, University of California, MercedJennifer Hahn-Holbrook, Assistant Professor of Psychology, University of California, MercedLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1975162023-03-14T19:23:12Z2023-03-14T19:23:12ZPregnant during the pandemic: Long-term effects and the importance of social support<figure><img src="https://images.theconversation.com/files/515004/original/file-20230313-22-qhm8v.jpg?ixlib=rb-1.1.0&rect=368%2C116%2C3530%2C2478&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Results of a new study show the need for more, easily accessible mental health and social support services for pregnant and postpartum people and their families.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/pregnant-during-the-pandemic--long-term-effects-and-the-importance-of-social-support" width="100%" height="400"></iframe>
<p>The COVID-19 pandemic brought changes to many people’s daily lives, and resulted in <a href="https://doi.org/10.1186/s12992-020-00589-w">high levels</a> of <a href="https://doi.org/10.1186/s12992-020-00589-w">mental health problems</a>. The pandemic was especially difficult for <a href="https://doi.org/10.3389/fpsyg.2020.617001">pregnant people</a>. <a href="https://doi.org/10.1016/j.earlhumdev.2022.105606">New research</a> investigates the long-term impact of the pandemic on pregnant and postpartum people and their infants.</p>
<p>There is concern that the difficulties experienced by pregnant people during the pandemic could be related to <a href="https://globalnews.ca/news/8890300/canada-covid-pandemic-babies/">issues down the road</a>.
Experiencing disaster-related stress during pregnancy, like that felt during the <a href="https://www.cbc.ca/news/canada/montreal/ice-storm-1998-1.4469977">January 1998 ice storm in Québec</a>, can have a lasting impact on <a href="https://www.mcgill.ca/projetverglas/icestorm">parents and their children</a>. How can we help people begin to recover from the pandemic and support pregnant and postpartum people during future large-scale disasters?</p>
<h2>Research over the last two years</h2>
<p>The <a href="https://dpresearchcentre.com/current-research-projects">COVID-19 Wellbeing and Stress Study</a> is an ongoing study conducted in partnership between researchers at Mount Saint Vincent University, McMaster University and Toronto Metropolitan University. The research team began following 304 pregnant women from Ontario in the spring and summer of 2020. </p>
<p>Participants completed surveys during pregnancy, and at six weeks, six months and 15 months postpartum. </p>
<p>We wanted to know how the COVID-19 pandemic affected access to prenatal care and how self-reported anxiety, depression and stress affected birth outcomes. We also wanted to know how participants’ mental health fared as the pandemic continued, and what could potentially protect them from the negative impact of the pandemic.</p>
<h2>Prenatal disruptions</h2>
<figure class="align-center ">
<img alt="A woman lying on a clinic bed getting an abdominal ultrasound while a technician in scrubs points to an image on a screen" src="https://images.theconversation.com/files/515006/original/file-20230313-24-sov37a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/515006/original/file-20230313-24-sov37a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=316&fit=crop&dpr=1 600w, https://images.theconversation.com/files/515006/original/file-20230313-24-sov37a.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=316&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/515006/original/file-20230313-24-sov37a.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=316&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/515006/original/file-20230313-24-sov37a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=398&fit=crop&dpr=1 754w, https://images.theconversation.com/files/515006/original/file-20230313-24-sov37a.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=398&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/515006/original/file-20230313-24-sov37a.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=398&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Almost all study participants were not allowed to bring a support person to their prenatal appointments at some point during their pregnancy in 2020.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>According to <a href="https://doi.org/10.1016/j.earlhumdev.2022.105606">study participants</a>, access to social and health services during their pregnancies was disrupted. </p>
<p>Almost all participants (91.7 per cent) were not allowed to bring a support person to their prenatal appointments at some point during pregnancy (in 2020). Nearly one-quarter (23 per cent) had prenatal appointments cancelled, and almost half (47.9 per cent) had trouble accessing prenatal classes.</p>
<p>Our research looked at the effects of these disruptions to care on mental health. Disruptions were linked to elevated levels of self-reported anxiety and depressive symptoms. These results are similar to the findings of a <a href="https://doi.org/10.3389/fgwh.2021.648428">national study</a>.</p>
<h2>Birth experiences</h2>
<p>Disruptions also extended to birthing experiences. The majority (60.8 per cent) of participants experienced a change to their birth plan, affecting things like delivery location, support people or child-care arrangements for other children. </p>
<p>More than one-quarter (28 per cent) of parents reported that their infant experienced problems during delivery, and nearly one-half of infants (46.6 per cent) had at least one problem after birth, such as jaundice or difficulties breathing. Importantly, however, <a href="https://www150.statcan.gc.ca/t1/tbl1/en/tv.action?pid=1310040401">infant birth weight</a> and rates of <a href="https://www150.statcan.gc.ca/t1/tbl1/en/tv.action?pid=1310042501">preterm birth</a> were similar to Canadian rates prior to the pandemic.</p>
<p>We then looked at how psychological factors were associated with birth outcomes. Some participants self-reported pregnancy-specific anxiety — things like feeling anxious about the health of the baby, miscarriage and experiencing difficulties during birth. These feelings were associated with lower infant birth weight, preterm birth and more infant birth problems.</p>
<p>This was not surprising. Other <a href="https://doi.org/10.1016/j.jad.2021.03.083">research</a> has shown that mental health problems during pregnancy are <a href="https://doi.org/10.4088/JCP.17r12011">associated with these same adverse birth outcomes</a>.</p>
<h2>Long-term impact</h2>
<figure class="align-center ">
<img alt="A woman slightly out of focus in the background with an infant asleep on her shoulder in the foreground" src="https://images.theconversation.com/files/515009/original/file-20230313-19-v919ju.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/515009/original/file-20230313-19-v919ju.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=398&fit=crop&dpr=1 600w, https://images.theconversation.com/files/515009/original/file-20230313-19-v919ju.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=398&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/515009/original/file-20230313-19-v919ju.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=398&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/515009/original/file-20230313-19-v919ju.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=500&fit=crop&dpr=1 754w, https://images.theconversation.com/files/515009/original/file-20230313-19-v919ju.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=500&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/515009/original/file-20230313-19-v919ju.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=500&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">On average, from pregnancy to the postpartum, more than half of participants (50 to 58 per cent) self-reported high levels of depressive symptoms.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>We followed the study group for more than a year after they gave birth. Participants had reported high rates of anxiety, depressive and stress symptoms during pregnancy, and these rates declined over the first 15 months of their infants’ life. However, participants did continue to experience these symptoms in the postpartum period. </p>
<p>On average, from pregnancy to the postpartum, more than half of participants (50 to 58 per cent) self-reported high levels of depressive symptoms. Up to one-third (24 to 36 per cent) reported moderate to severe anxiety symptoms. High levels of stress were also reported (13 to 18 per cent). </p>
<p>In comparison, prior to the COVID-19 pandemic, <a href="https://doi.org/10.1111/jocn.16121">global postpartum depression rates are estimated at 14 per cent</a>.</p>
<h2>Importance of social support</h2>
<p>Despite these high numbers, one thing was clear: participants who were able to seek support from their family, friends and significant other had <a href="https://doi.org/10.1016/j.jad.2021.01.027">lower levels of anxious, depressive and stress symptoms during pregnancy</a>. Those who were able to use other <a href="https://doi.org/10.1007/s00737-021-01135-2">effective coping strategies</a> (for example, reframing thoughts, problem solving and seeking support) showed lower mental health and distress symptoms. The importance of social support to protect against the negative impact of the pandemic has been <a href="https://doi.org/10.3389/ijph.2022.1604608">noted by others as well</a>.</p>
<p>These results tell us that we need more, easily accessible mental health and social support services for pregnant and postpartum people and their families. Social support and mental health programs are essential in anticipation of future — possibly long-lasting — public health crises.</p><img src="https://counter.theconversation.com/content/197516/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jennifer E. Khoury receives funding from the Canada Research Chair Program (Tier II) in Interdisciplinary Studies in Neurosciences, the Canada Foundation for Innovation (CFI), the Social Sciences and Humanities Research Council of Canada (SSHRC), the Canadian Institutes of Health Research (CIHR), the National Institute of Child Health and Human Development (NICHD), and Research Nova Scotia.
The work discussed in this publication was funded by a Canadian Institutes of Health Research (CIHR) Project Grant - PA: Pandemic and Health Emergencies Research (465280). This work was also supported by a Tier II CRC awarded to Dr. Jennifer Khoury and a Tier II CRC awarded to Dr. Andrea Gonzalez.</span></em></p><p class="fine-print"><em><span>Kiera O'Neil does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Being pregnant and giving birth during the pandemic meant disruptions in pregnancy care and birth experiences, as well as detrimental effects on mental health and birth outcomes.Kiera O'Neil, Manager, Developmental Psychobiology Research Centre, Mount Saint Vincent UniversityJennifer E. Khoury, Assistant Professor, Tier II Canada Research Chair in Interdisciplinary Neuroscience, Mount Saint Vincent UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1982332023-02-26T19:06:02Z2023-02-26T19:06:02ZIs there a vaccine for RSV or respiratory syncytial virus? After almost 60 years, several come at once<figure><img src="https://images.theconversation.com/files/510804/original/file-20230217-22-p39gna.jpg?ixlib=rb-1.1.0&rect=1%2C4%2C997%2C556&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/close-asian-little-baby-boy-treated-1589743531">Shutterstock</a></span></figcaption></figure><p>You might not have heard of respiratory syncytial virus, or RSV. But it caused more than <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)00478-0/fulltext">100,000 global deaths</a> in 2019, making it a leading cause of death in children under one year old.</p>
<p>In Australia, child deaths are thankfully <a href="https://pubmed.ncbi.nlm.nih.gov/34845151/">rare</a>. But infection sends thousands to hospital each year, particularly <a href="https://www.mja.com.au/journal/2019/210/10/respiratory-syncytial-virus-associated-hospitalisations-australia-2006-2015">babies and young children</a>.</p>
<p>So for kids, this virus is a very big deal. And despite almost 60 years of research, there are no licensed vaccines to prevent it.</p>
<p>That may change soon. We’ve recently had results of late-stage clinical trials of RSV vaccines from <a href="https://www.statnews.com/2023/01/17/moderna-says-rsv-vaccine-worked-setting-stage-for-competition-with-gsk-and-pfizer/">Pfizer, Moderna and GSK</a>. These vaccines are being assessed (or will be shortly) for regulatory approval in the United States.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1627678804960497664"}"></div></p>
<p>However, these trials were conducted in adults and pregnant women, not children. So we still have a way to go before RSV vaccines are tested in children, shown to be safe and effective, are approved for use, then become widely available.</p>
<p>Here’s why it’s taken so long to develop a RSV vaccine and what we can expect next.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/rsv-experts-explain-why-rates-of-this-virus-are-surging-this-year-194403">RSV: experts explain why rates of this virus are surging this year</a>
</strong>
</em>
</p>
<hr>
<h2>What is RSV?</h2>
<p>RSV is a contagious virus causing respiratory infections in both adults and children.</p>
<p>The virus is transmitted from person to person by droplets when someone coughs or sneezes, or by touching their nose or eyes after touching contaminated surfaces.</p>
<p>Infections usually surge in winter, causing symptoms such as a runny nose, sneezing, sore throat, fever, headache and cough. Adults and children can be hospitalised with RSV and its complications, which include pneumonia and <a href="https://www.rch.org.au/kidsinfo/fact_sheets/Bronchiolitis/">bronchiolitis</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/rsv-faq-what-is-rsv-who-is-at-risk-when-should-i-seek-emergency-care-for-my-child-195292">RSV FAQ: What is RSV? Who is at risk? When should I seek emergency care for my child?</a>
</strong>
</em>
</p>
<hr>
<h2>We’ve had a few setbacks</h2>
<p>The <a href="https://journals.asm.org/doi/10.1128/CVI.00609-15">first RSV vaccine</a> was given to infants and children in the mid-1960s. </p>
<p>Although this inactivated vaccine (composed of dead RSV particles) seemed to be well tolerated, it later caused a rare side effect called vaccine-enhanced disease. This is where the vaccine caused more serious RSV symptoms when infants and toddlers caught the virus, instead of protecting them.</p>
<p>This was almost 60 years ago, and the science of vaccine development has come a long way. Even though scientists later found new vaccine strategies, this disaster has unfortunately slowed down RSV vaccine research and development.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/randomised-control-trials-what-makes-them-the-gold-standard-in-medical-research-78913">Randomised control trials: what makes them the gold standard in medical research?</a>
</strong>
</em>
</p>
<hr>
<h2>Newer technologies, fresh hope</h2>
<p>Advances in what we know about the virus, and newer vaccine technologies, mean researchers are now more optimistic about the prospect of a RSV vaccine.</p>
<p>Ten years ago, <a href="https://www.science.org/doi/10.1126/science.1234914">scientists identified</a> the structure of the RSV viral protein it uses to attach and enter human host cells. This allowed scientists to change strategies and develop protein-based RSV vaccines.</p>
<p>Protein-based vaccines consist of injecting a purified protein from the target virus that stimulates the immune cells. This technology is used in many existing vaccines, such as those for hepatitis B and pertussis (whooping cough).</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1605357061583147009"}"></div></p>
<p>But it’s not been plain sailing for protein-based vaccines either.</p>
<p>In 2019, Novavax <a href="https://ir.novavax.com/2019-02-28-Novavax-Announces-Topline-Results-from-Phase-3-PrepareTM-Trial-of-ResVax-TM-for-Prevention-of-RSV-Disease-in-Infants-via-Maternal-Immunization">announced</a> its prototype protein-based RSV vaccine (ResVax) failed to prevent “medically significant” RSV in babies born to mothers who had been given the vaccine as part of a late-stage clinical trial.</p>
<p>Although the vaccine was shown to be safe, and protected babies from severe RSV, including hospitalisations, the vaccine has not yet made it to market, and further clinical trials <a href="https://www.precisionvaccinations.com/vaccines/resvax-rsv-vaccine">are ongoing</a>.</p>
<p>In recent years, we’ve seen another major technology development – mRNA vaccines. These have proved effective and robust during the COVID pandemic. </p>
<p>These mRNA vaccines involve injecting the information required for the human host cells to produce the viral protein, to later stimulate immune cells.</p>
<p>The front-runner RSV candidate vaccines – from GSK, Pfizer and Moderna – are either protein-based or use mRNA technology.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-fascinating-history-of-clinical-trials-139666">The fascinating history of clinical trials</a>
</strong>
</em>
</p>
<hr>
<h2>The GSK vaccines</h2>
<p>GSK is going with protein-based technology for two of its candidate RSV vaccines.</p>
<p>One (known as RSVPreF3 OA), has had good results in late-stage clinical trials in adults 60 years or older, with data published <a href="https://www.nejm.org/doi/10.1056/NEJMoa2209604">in recent weeks</a>. The US Food and Drug Administration (FDA) <a href="https://www.gsk.com/en-gb/media/press-releases/gsk-s-rsv-oa-vaccine-candidate-granted-priority-review-by-us-fda/">is reviewing</a> the vaccine, with results expected in May.</p>
<p>Another of GSK’s candidate RSV vaccines (GSK3888550A, RSVPreF3) is taking a different approach. The idea is to vaccinate pregnant women to confer immunity to the unborn baby.</p>
<p>Results of late-stage trials in healthy pregnant women aged 18-49 years are <a href="https://www.gsk.com/en-gb/media/press-releases/gsk-starts-phase-3-study-of-rsv-maternal-candidate-vaccine/">set to report in 2024</a>. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9200160/">Earlier studies</a> in non-pregnant women showed the vaccine was well tolerated and activated a good immune response.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/511905/original/file-20230223-24-5r593v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Pregnant Muslim woman clutching belly looking at phone in hand in front of window" src="https://images.theconversation.com/files/511905/original/file-20230223-24-5r593v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/511905/original/file-20230223-24-5r593v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/511905/original/file-20230223-24-5r593v.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/511905/original/file-20230223-24-5r593v.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/511905/original/file-20230223-24-5r593v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/511905/original/file-20230223-24-5r593v.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/511905/original/file-20230223-24-5r593v.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Some candidate RSV vaccines are given to pregnant women to protect their babies.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-pregnant-arab-woman-hijab-using-1407599552">Shutterstock</a></span>
</figcaption>
</figure>
<h2>The Pfizer vaccine</h2>
<p>Pfizer has also gone with a protein-based RSV vaccine (RSVpreF). But this time it’s a bivalent vaccine. It contains proteins to stimulate immune protection against two types of RSV – RSV A and B. Again, the idea again is to vaccinate pregnant women to immunise their babies in the womb.</p>
<p>In November 2022, Pfizer <a href="https://www.pfizer.com/news/press-release/press-release-detail/pfizer-announces-positive-top-line-data-phase-3-global">announced</a> interim results of its <a href="https://clinicaltrials.gov/ct2/show/NCT04424316?term=RSVpreF+pfizer&phase=2&draw=2&rank=2">late-stage clinical trial</a> showing 81.8% efficacy in protecting against severe disease in babies (one to 90 days old) of vaccinated pregnant women. Over time, that immunity decreased.</p>
<p>Final clinical trial results are expected <a href="https://www.pfizer.com/news/press-release/press-release-detail/us-fda-accepts-biologics-license-application-pfizers">any day now</a>, and the vaccine is being submitted to the FDA for priority review, with a result expected in August.</p>
<h2>The Moderna vaccine</h2>
<p>Moderna is using mRNA technology for its candidate RSV vaccine (called mRNA-1345). It uses similar technology to its COVID mRNA vaccines.</p>
<p>It has been tested in <a href="https://clinicaltrials.gov/ct2/results?term=mRNA-1345&age_v=&gndr=&type=&rslt=&Search=Apply">late-stage clinical trials</a> in people over the age of 60. The <a href="https://investors.modernatx.com/news/news-details/2023/Moderna-Announces-mRNA-1345-an-Investigational-Respiratory-Syncytial-Virus-RSV-Vaccine-Has-Met-Primary-Efficacy-Endpoints-in-Phase-3-Trial-in-Older-Adults/default.aspx">company announced</a> earlier this year that the vaccine was mostly well tolerated and had an efficacy of 83.7%.</p>
<p>The company is set to make a <a href="https://investors.modernatx.com/news/news-details/2023/Moderna-Granted-FDA-Breakthrough-Therapy-Designation-for-mRNA-1345-An-Investigational-Respiratory-Syncytial-Virus-RSV-Vaccine-Candidate/default.aspx">full submission</a> to the FDA in the first half of 2023.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/3-mrna-vaccines-researchers-are-working-on-that-arent-covid-157858">3 mRNA vaccines researchers are working on (that aren't COVID)</a>
</strong>
</em>
</p>
<hr>
<h2>Several hurdles ahead</h2>
<p>Another candidate vaccine, <a href="https://www.janssen.com/janssen-announces-respiratory-syncytial-virus-rsv-adult-vaccine-candidate-maintains-high-efficacy">from Janssen</a>, uses a different type of technology (adenovirus vector technology), and is not so far advanced through clinical trials as the others. But it has shown <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9417128/">promising preliminary results</a> <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2207566?query=recirc_curatedRelated_article">to date</a> in adults.</p>
<p>And that’s the sticking point with all the RSV vaccines mentioned. They’ve only been tested in adults. To have the greatest impact, the vaccines must also be evaluated in young children and infants. </p>
<p>The biggest question is what age should a baby be vaccinated against RSV once it loses the immunity from its mother?</p>
<p>While we wait for RSV vaccines, the best way of slowing the spread of this viral illness are measures we’ve become used to during COVID. If you or your children have RSV, make sure you wear a mask, wash your hands and maintain your distance from others.</p>
<hr>
<p><em>We would like to thank Masters (Doctor of Medicine) student Chloe Scott from Griffith University for her critical review and assistance with this article.</em></p><img src="https://counter.theconversation.com/content/198233/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lara Herrero receives funding from NHMRC
</span></em></p><p class="fine-print"><em><span>Wesley Freppel does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Here’s why it’s taken so long to develop a vaccine for respiratory syncytial virus and what we can expect next.Lara Herrero, Research Leader in Virology and Infectious Disease, Griffith UniversityWesley Freppel, Research Fellow, Institute for Glycomics, Griffith UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1990992023-02-20T01:52:55Z2023-02-20T01:52:55ZCovering your baby’s pram with a dry cloth can increase the temperature by almost 4 degrees. Here’s what to do instead<figure><img src="https://images.theconversation.com/files/510995/original/file-20230219-5543-fwtd60.jpg?ixlib=rb-1.1.0&rect=17%2C0%2C5778%2C3867&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/close-mens-hands-stroller-young-father-2136246595">Shutterstock</a></span></figcaption></figure><p>We like to think of babies as tiny versions of ourselves. But babies aren’t simply miniature adults, especially when it comes to coping in the heat. Babies are at greater risk of overheating and need different cooling strategies to those that work for adults. </p>
<p>Parents have long covered prams and strollers with cloth to shade the carriage from the hot sun. However, our recent <a href="https://pubmed.ncbi.nlm.nih.gov/36688597/">study</a> <a href="https://www.sydney.edu.au/medicine-health/our-research/research-centres/heat-and-health-research-incubator.html">showed</a> this can substantially increase temperatures inside the stroller. </p>
<p>After just 20 minutes – the time it takes to go to the shop or drop your child off at daycare – the stroller carriage was 3.7°C hotter than outside when draped with a dry flannelette cloth and 2.6°C when draped with dry muslin. </p>
<p>Attaching a battery-operated fan to the stroller wasn’t very effective either at reducing the stroller temperature, cooling the carriage by just 0.1°C relative to outside. </p>
<p>But dampening the cloth can reduce the temperature in the carriage.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/top-10-tips-to-keep-cool-this-summer-while-protecting-your-health-and-your-budget-193723">Top 10 tips to keep cool this summer while protecting your health and your budget</a>
</strong>
</em>
</p>
<hr>
<h2>Why are babies vulnerable in the heat?</h2>
<p>There are three main reasons why babies might struggle more in hot weather compared to adults. </p>
<p>First, their body shape is very different. Infants have a much greater area of skin surface available to exchange heat with the surrounding environment, compared to their body mass. This means in very hot conditions their body temperature can warm up at a much faster rate. </p>
<figure class="align-center ">
<img alt="Woman pushes pram with muslin cloth" src="https://images.theconversation.com/files/510997/original/file-20230220-4295-lfjtbu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/510997/original/file-20230220-4295-lfjtbu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/510997/original/file-20230220-4295-lfjtbu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/510997/original/file-20230220-4295-lfjtbu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/510997/original/file-20230220-4295-lfjtbu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/510997/original/file-20230220-4295-lfjtbu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/510997/original/file-20230220-4295-lfjtbu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Babies can’t regulate their own temperature.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/slim-woman-walking-baby-pram-green-2167254147">Shutterstock</a></span>
</figcaption>
</figure>
<p>Second, infants can’t sweat as much as mum or dad and are therefore less able to cool down by sweat evaporation. This is the main physiological disadvantage that places them at greater risk in hot weather. </p>
<p>Finally – and possibly most importantly – babies are almost entirely dependent on someone else to keep them cool. Other than crying, babies can’t communicate that they are too hot. On a hot day, it is the parents who have to check for signs of distress, choose suitable clothing, and make sure shade is found during the hottest part of the day (normally noon to 3pm). Babies can’t do any of this for themselves.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/curious-kids-what-happens-in-the-body-when-we-sweat-85831">Curious Kids: What happens in the body when we sweat?</a>
</strong>
</em>
</p>
<hr>
<h2>So, what <em>can</em> be done to keep baby strollers cool?</h2>
<p>In our same study, we also showed some strategies are really effective at cooling strollers down even on hot and sunny days. </p>
<p>Loosely draping a <em>damp</em> muslin cloth over the stroller reduced the temperature inside the stroller by 3°C. </p>
<p>This cooling effect was even greater when a damp cloth was combined with a clip-on fan, reducing the stroller temperature by 4.7°C compared with outside.</p>
<p>This method harnesses the power of evaporation. Just like we lose body heat when sweat evaporates from our skin, the evaporation of water from the damp cloth removes heat from the air inside the stroller and lowers the temperature inside.</p>
<p>Using a spray bottle to regularly top-up the water in the cloth every 15-20 minutes will prevent it drying out and increase the amount of time this method will provide cool relief. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/511019/original/file-20230220-22-fx1tdt.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/511019/original/file-20230220-22-fx1tdt.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/511019/original/file-20230220-22-fx1tdt.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=331&fit=crop&dpr=1 600w, https://images.theconversation.com/files/511019/original/file-20230220-22-fx1tdt.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=331&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/511019/original/file-20230220-22-fx1tdt.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=331&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/511019/original/file-20230220-22-fx1tdt.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=416&fit=crop&dpr=1 754w, https://images.theconversation.com/files/511019/original/file-20230220-22-fx1tdt.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=416&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/511019/original/file-20230220-22-fx1tdt.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=416&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption"></span>
<span class="attribution"><span class="license">Author provided</span></span>
</figcaption>
</figure>
<h2>How else can I protect my baby from the heat?</h2>
<p>Minimise the time spent outside with your infant during hot weather – get from A to B as quickly as possible. </p>
<p>Babies should never be left in a stationary stroller in the sun (even if covered with a damp cloth) as this reduces air movement through the stroller and increases the speed at which it heats up. </p>
<p>Any time infants or children are exposed to the heat, it’s important to keep them well hydrated. Drinking water or breastfeeds should be offered frequently. Infants will need more fluids during hot weather.</p>
<figure class="align-center ">
<img alt="Baby laughs after drinking water from a bottle" src="https://images.theconversation.com/files/510998/original/file-20230220-4140-jr4a86.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/510998/original/file-20230220-4140-jr4a86.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/510998/original/file-20230220-4140-jr4a86.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/510998/original/file-20230220-4140-jr4a86.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/510998/original/file-20230220-4140-jr4a86.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/510998/original/file-20230220-4140-jr4a86.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/510998/original/file-20230220-4140-jr4a86.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Make sure babies are well hydrated when it’s hot.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/child-baby-carriage-standing-outside-store-2203456173">Shutterstock</a></span>
</figcaption>
</figure>
<p>It’s also important to regularly check infants for signs of heat illness. The most common are: </p>
<ul>
<li>being overly warm to touch</li>
<li>hot, red and dry skin</li>
<li>irritability</li>
<li>looking generally unwell and/or lethargic. </li>
</ul>
<p>If your baby is showing signs of heat illness, find cool relief immediately and seek medical help.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/evacuating-with-a-baby-heres-what-to-put-in-your-emergency-kit-127026">Evacuating with a baby? Here's what to put in your emergency kit</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/199099/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>James Smallcombe receives funding from National Health and Medical Research Council (NHMRC). </span></em></p><p class="fine-print"><em><span>Ollie Jay receives funding from National Health and Medical Research Council, Wellcome Trust, NSW Health, NSW Dept of Planning, Industry and Environment, and the NSW Reconstruction Authority (formerly Resilience NSW). </span></em></p><p class="fine-print"><em><span>Mohammad Fauzan Bin Maideen does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Draping a dry flannelette cloth over a stroller can increase the heat in the carriage by 3.7 degrees celsius.James Smallcombe, Post-doctoral Research Associate, University of SydneyMohammad Fauzan Bin Maideen, Associate Lecturer in Paediatric Physiotherapy, University of SydneyOllie Jay, Professor of Heat & Health; Director of Heat & Health Research Incubator; Director of Thermal Ergonomics Laboratory, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1963932022-12-14T06:15:17Z2022-12-14T06:15:17ZWhat is meningococcal disease? What symptoms should I look out for? And how can I prevent it?<figure><img src="https://images.theconversation.com/files/500634/original/file-20221213-1960-92q4xe.jpg?ixlib=rb-1.1.0&rect=301%2C684%2C6408%2C3782&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/unhappy-young-adolescent-12s-kid-girl-1971214970">Shutterstock</a></span></figcaption></figure><p>Parents and doctors alike fear meningococcal infection, which has been <a href="https://www.abc.net.au/news/2022-12-06/nsw-meningococcal-disease-kills-young-woman-third-death-this-yea/101736686">in the news</a> again. Doctors never want to miss a diagnosis, as early treatment with antibiotics may be life-saving. Parents fear the disease because <a href="https://doi.org/10.1016/j.vaccine.2019.04.020">up to 10%</a> of children who become infected die from the disease and its complications.</p>
<p>Another <a href="https://doi.org/10.1097/INF.0000000000000043">40% of children</a> will have ongoing disability from one or more complications. These include deafness, blindness, skin scarring, or surgical amputation of limbs that may be required to save the child’s life in some situations. </p>
<p>In other cases, children will initially be acutely unwell but then recover within a few days of starting antibiotics. Many, though, will have ongoing fatigue, forgetfulness and difficulty concentrating. For most, it’s a life-changing illness.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/we-can-expect-more-colds-and-flu-as-covid-restrictions-lift-5-germs-to-look-out-for-170263">We can expect more colds and flu as COVID restrictions lift. 5 germs to look out for</a>
</strong>
</em>
</p>
<hr>
<h2>What causes it and who most at risk?</h2>
<p>Meningococcal disease is caused by the meningococcus bacteria, also known as <em>Neisseria meningitidis</em>. The bacterial infection causes meningitis (infection of the lining around the brain) and/or sepsis (blood poisoning).</p>
<p>The <a href="https://doi.org/10.33321/cdi.2022.46.46">highest risk</a> of disease is in children under four years, and adolescents and young adults aged 15-24. </p>
<figure class="align-center ">
<img alt="Teens in a school corridor" src="https://images.theconversation.com/files/500871/original/file-20221213-20493-98k2cy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/500871/original/file-20221213-20493-98k2cy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/500871/original/file-20221213-20493-98k2cy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/500871/original/file-20221213-20493-98k2cy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/500871/original/file-20221213-20493-98k2cy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/500871/original/file-20221213-20493-98k2cy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/500871/original/file-20221213-20493-98k2cy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Australian adolescents are now offered a vaccine to protect against four types of the disease.</span>
<span class="attribution"><a class="source" href="https://www.pexels.com/photo/students-in-the-school-hallway-8419516/">Rodnae Productions/Pexels</a></span>
</figcaption>
</figure>
<p>Aboriginal infants and young people are at <a href="https://www1.health.gov.au/internet/main/publishing.nsf/Content/cda-cdi4001e.htm">higher risk</a> of meningococcal disease than non-Indigenous children.</p>
<h2>What are the symptoms?</h2>
<p>Young infants who become unwell with this infection usually develop symptoms such as a fever, irritability, vomiting and poor feeding.</p>
<p>Young people who develop the infection may complain of a headache, neck stiffness, fever, vomiting or feeling generally tired and unwell with “flu-like” symptoms.</p>
<p>Unfortunately, these symptoms are fairly general and occur with many other infections, making this disease hard to diagnose. This may result in delayed diagnosis and treatment.</p>
<p>A more unusual symptom children or young people may experience is feeling they have cold hands and feet. </p>
<p>The classic <a href="https://www.doctorsofsouthmelbourne.com.au/meningococcal-rash/#:%7E:text=A%20meningococcal%20rash%20is%20caused,bleeding%20occurs%20(i.e.%20haemorrhages).">dark red-purple rash</a> associated with the infection is often a later sign of the disease. Ideally, antibiotic treatment should be started before the rash appears, to combat the infection as early as possible.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/explainer-whats-meningococcal-meningitis-and-what-are-the-signs-64170">Explainer: what's meningococcal meningitis and what are the signs?</a>
</strong>
</em>
</p>
<hr>
<h2>How does it spread?</h2>
<p>The meningococcus bacteria usually enter the bloodstream through the throat.</p>
<p>The bacteria live quite happily <a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/meningococcal-disease">in the throat</a> of around 10% of the population, without causing any symptoms. Young people in particular have a higher chance of having the bacteria in their throat and passing it to each other through air droplets from coughing or through kissing.</p>
<figure class="align-right ">
<img alt="Teens legs in photo booth" src="https://images.theconversation.com/files/500644/original/file-20221213-1960-zinfze.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/500644/original/file-20221213-1960-zinfze.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=900&fit=crop&dpr=1 600w, https://images.theconversation.com/files/500644/original/file-20221213-1960-zinfze.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=900&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/500644/original/file-20221213-1960-zinfze.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=900&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/500644/original/file-20221213-1960-zinfze.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1131&fit=crop&dpr=1 754w, https://images.theconversation.com/files/500644/original/file-20221213-1960-zinfze.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1131&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/500644/original/file-20221213-1960-zinfze.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1131&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Young people pass it to each other through coughing or kissing.</span>
<span class="attribution"><a class="source" href="https://www.pexels.com/photo/person-in-blue-denim-jeans-and-white-sneakers-4858872/">Cottonbro studio/Pexels</a></span>
</figcaption>
</figure>
<p><em>N. meningitidis</em> is often referred to as an “accidental pathogen” because it prefers to live at the back of the throat, with no intent to cause meningitis or sepsis. It can invade the lining of the throat during a throat infection, which disrupts the barrier in the throat and allows the bacteria to enter the bloodstream.</p>
<p>It may also be more likely to invade the bloodstream and multiply if the person has a problem with their immune system.</p>
<p>Once in the bloodstream, the bacteria multiply very quickly and the body reacts with a very robust immune response, which unfortunately can contribute to some of the complications.</p>
<p>The bacteria primarily damage the walls of the blood vessels in the body and the blood vessels become leaky. This results in bleeding into the skin, which causes a rash, and lack of blood supply to the limbs, resulting in breakdown of the tissues in the limb. Sometimes this requires surgical amputation of the limb or multiple limbs to save the child’s life.</p>
<h2>What are the different types of meningococcal disease?</h2>
<p>There are <a href="https://immunisationhandbook.health.gov.au/contents/vaccine-preventable-diseases/meningococcal-disease">13 different types</a> of meningococcus, however almost all disease in humans is caused by six groups: A, B, C, W, Y and X.</p>
<p>Group W is <a href="https://doi.org/10.1016/j.vaccine.2019.04.020">associated with</a> a higher risk of dying from the infection (around 10-15%), whereas with group B there is a lower risk of dying (around 5-10%).</p>
<p>In Australia, group B causes the <a href="https://www1.health.gov.au/internet/main/publishing.nsf/Content/2A15CD097063EF40CA2587CE008354F1/$File/australian_meningococcal_surveillance_programme_annual_report_2021.pdf">highest number</a>, however there are significant differences between different states. Most cases in temperate climates occur in winter and early spring. Viral infections, in particular influenza, <a href="https://doi.org/10.1016/j.cmi.2020.01.004">increase the risk</a> of meningococcal infection. </p>
<h2>How can you protect against it?</h2>
<p>The best way to protect against meningococcal disease is through vaccination.</p>
<p>From 2003 to 2013 in Australia, there was a <a href="https://doi.org/10.5694/mja2.51463">decrease</a> in meningococcal disease cases, following the introduction of the free meningococcal C vaccine onto the National Immunisation Program for children aged 12 months.</p>
<figure class="align-center ">
<img alt="Baby's leg after a vaccination" src="https://images.theconversation.com/files/500635/original/file-20221213-1960-saad3b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/500635/original/file-20221213-1960-saad3b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/500635/original/file-20221213-1960-saad3b.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/500635/original/file-20221213-1960-saad3b.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/500635/original/file-20221213-1960-saad3b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/500635/original/file-20221213-1960-saad3b.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/500635/original/file-20221213-1960-saad3b.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Babies are routinely vaccinated against four types.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/baby-bandaid-after-vaccination-needle-sore-261449495">Shutterstock</a></span>
</figcaption>
</figure>
<p>A free, combined meningococcal ACWY vaccine is now available on the National Immunisation Program for all children at 12 months of age (this replaced the meningococcal C vaccine) and for adolescents aged 14-16 years through a school-based program from April 2019. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/health-check-which-vaccinations-should-i-get-as-an-adult-81400">Health Check: which vaccinations should I get as an adult?</a>
</strong>
</em>
</p>
<hr>
<p>A meningococcal B vaccine has been more difficult to produce and requires a different vaccine manufacturing approach. Two meningococcal B vaccines are available and licensed in Australia.</p>
<p>One of these meningococcal B vaccines is now provided on the National Immunisation Program for Aboriginal and Torres Strait Islander infants due to their higher risk of meningococcal B than non-Indigenous infants.</p>
<p>In South Australia, where historically most cases have been caused by group B, the meningococcal B vaccine is <a href="https://doi.org/10.1016/S1473-3099(21)00754-4">provided free</a> through a state-funded program for infants from six weeks of age and for Year 10 students through the school immunisation program.</p>
<p>This followed a large study I led in South Australia of 35,000 senior school students across SA. It <a href="https://doi.org/10.1056/nejmoa1900236">showed</a> the meningococcal B vaccine was highly effective in preventing meningococcal B disease but not in reducing the number of young people carrying the disease-causing bacteria in their throat. So the vaccine needs to be given to age groups at highest risk of disease rather than expecting a herd immunity effect by reducing the number of young people carrying the disease causing bacteria in their throats.</p>
<p>In other states, the meningococcal B vaccine <a href="https://immunisationhandbook.health.gov.au/contents/vaccine-preventable-diseases/meningococcal">can be purchased</a> for around A$120-$140 per dose and is provided through a script from a GP.</p><img src="https://counter.theconversation.com/content/196393/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Helen Marshall receives funding from the National Health and Medical Research Council. Her institution receives funding from GSK, Sanofi-Pasteur and Pfizer for clinical vaccine trials of which Helen Marshall is an investigator. The herd immunity study in South Australia was sponsored by The University of Adelaide and funded by GSK.</span></em></p>Early treatment with antibiotics can be life-saving.Professor Helen Marshall, Professor in Vaccinology, University of AdelaideLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1946432022-12-01T02:46:43Z2022-12-01T02:46:43ZWhy do nurse home visits stop a few weeks after giving birth? Extending them to 2 years benefits the whole family<figure><img src="https://images.theconversation.com/files/498167/original/file-20221130-26-xgedg.jpg?ixlib=rb-1.1.0&rect=35%2C17%2C5955%2C3970&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.pexels.com/photo/mother-with-baby-in-arms-7282407/">Pexels/Sarah Chai</a></span></figcaption></figure><p>Bringing home a new baby can be one of the most exciting and stressful times in your life. A nurse might visit a couple of times, then other than routine check-ups at the nurse’s office, you’re largely on your own. </p>
<p>Some people have a particularly hard time with a new baby because the challenges of parenting come on top of existing adversity, such as financial hardship, or poor physical or mental health. </p>
<p>Experiencing adversity from when a baby is conceived can affect the child’s <a href="https://www.rch.org.au/uploadedFiles/Main/Content/ccchdev/CCCH-The-First-Thousand-Days-An-Evidence-Paper-Summary-September-2017.pdf">health and development</a> as they grow older. So rather than stopping nurse visits a week or two after bringing a new baby home, we investigated whether extending these visits from pregnancy until children turned two made a difference. </p>
<p>The nurse visits focused on areas fundamental for children’s development: how a parent cares for and responds to their child, and their home environment. </p>
<p>We found home visits with nurses helps parenting and family relationships, and women’s mental health, wellbeing and confidence.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1380610832485154816"}"></div></p>
<h2>What happens when the nurse visits?</h2>
<p>Sustained nurse home visiting provides intensive services in a family’s home during pregnancy and the first two years of the child’s life. During this time, the child’s brain develops more rapidly than any other time in their life. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-do-i-know-if-my-child-is-developing-normally-129137">How do I know if my child is developing normally?</a>
</strong>
</em>
</p>
<hr>
<p>International studies of sustained nurse home visiting programs show <a href="https://onlinelibrary.wiley.com/doi/10.1111/jan.14576">they can help families</a> with parenting, children’s behaviour and academic skills. However, most have only measured impacts up to when children turn three. </p>
<p>Programs differ depending on how they work to support families. They generally engage highly-trained nurses who can listen without judgement, offer practical, evidence-informed advice, and remind parents they’re doing a good job.</p>
<h2>Our study</h2>
<p>Our randomised controlled trial of <a href="https://www.rch.org.au/ccch/research-projects/right-at-home/">right@home</a> is Australia’s longest and largest trial of nurse home-visiting, starting in 2013. </p>
<p>The program supports parents with evidence-based techniques that promote parenting that responds to the child’s needs, safe homes, regular routines, and children’s learning and language development. The program starts in pregnancy and offers 25 home visits (60-90 minutes each) with a specially trained nurse until the children turn two. </p>
<p>The right@home program was designed for delivery through Australia’s existing child and family health nursing services, which are free for families with children from birth to school age. These existing services typically offer a handful of appointments (of around 20-40 minutes) that mostly take place in local clinics. Some also offer more intensive services.</p>
<figure class="align-center ">
<img alt="Toddler reads from a board book" src="https://images.theconversation.com/files/498181/original/file-20221130-16-qnisxd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/498181/original/file-20221130-16-qnisxd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/498181/original/file-20221130-16-qnisxd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/498181/original/file-20221130-16-qnisxd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/498181/original/file-20221130-16-qnisxd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/498181/original/file-20221130-16-qnisxd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/498181/original/file-20221130-16-qnisxd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Existing nurse services only offer a handful of appointments from birth to school age.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/u0zTce7KNlY">Unsplash/Stephen Andrews</a></span>
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<p>We invited women into the right@home study if they were experiencing two or more factors that can make it more difficult to parent. These include having low social support, poor physical or emotional health, or no household employment. We found <a href="https://onlinelibrary.wiley.com/doi/10.1111/jpc.13860">almost 40%</a> of pregnant women experienced at least two of these factors. </p>
<p>In total, 722 women and families living across Victoria and Tasmania took part in the study. Half were randomly allocated (like tossing a coin) to receive the right@home program and half received their local child and family health nursing service. </p>
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<strong>
Read more:
<a href="https://theconversation.com/parents-have-the-biggest-influence-over-their-childs-language-and-emotional-development-55823">Parents have the biggest influence over their child's language and emotional development</a>
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<h2>What did we find?</h2>
<p>Researchers who were separate to the nurse teams interviewed the families twice a year (one at home and one by phone) until children started school. </p>
<p>When the right@home program ended (at children’s second birthdays), the evaluation showed it <a href="https://doi.org/10.1542/peds.2018-1206">offered benefits</a> over and above the usual services. Parents had more confidence and skills in caring for their children, responding sensitively and providing a nurturing and stimulating home. </p>
<p>This pattern <a href="https://publications.aap.org/pediatrics/article/147/2/e2020025361/77055/Nurse-Home-Visiting-and-Maternal-Mental-Health-3">continued</a>. At three years, parents who received the right@home program reported benefits to their mental health, wellbeing, and self-confidence. </p>
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<img alt="Parents snuggle their newborn baby" src="https://images.theconversation.com/files/498176/original/file-20221130-14-qnisxd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/498176/original/file-20221130-14-qnisxd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/498176/original/file-20221130-14-qnisxd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/498176/original/file-20221130-14-qnisxd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/498176/original/file-20221130-14-qnisxd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/498176/original/file-20221130-14-qnisxd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/498176/original/file-20221130-14-qnisxd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Nurses can remind new parents they’re doing a good job.</span>
<span class="attribution"><a class="source" href="https://www.pexels.com/photo/cheerful-young-multiethnic-parents-admiring-sleeping-baby-on-bed-6392952/">Pexels/William Fortunato</a></span>
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<p>Our latest paper, <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0277773">published in PLOS ONE</a>, shows that right@home offered lasting impacts to four and five years, which is two and three years after the program ended. </p>
<p>Some 5-10% more families had regular mealtimes, bedtimes and bedtime routines by the time the children turned five.</p>
<p>Around 9% more women reported very good health and parenting confidence. The proportions of women experiencing stress, and emotional abuse from an intimate partner were 7% and 11% lower, respectively. </p>
<p>There were additional benefits for children’s and women’s mental health, parenting, and women’s wellbeing, quality of life and relationship with their child. These impacts were evident for families regardless of where they lived across the seven regional and metropolitan areas in the two states.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/having-problems-with-your-kids-tantrums-bed-wetting-or-withdrawal-heres-when-to-get-help-125299">Having problems with your kid's tantrums, bed-wetting or withdrawal? Here's when to get help</a>
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<hr>
<h2>Levelling the playing field for kids</h2>
<p>A goal of the program is to address the challenging circumstances that disrupt parenting and affect children’s health and development.</p>
<p>If Australia did this, and provided support according to need, we could reduce children’s poor developmental outcomes by <a href="https://doi.org/10.1093/ije/dyy087">50%-70%</a>.</p>
<p>Providing equitable support is especially important as we <a href="https://bmjpaedsopen.bmj.com/content/6/1/e001390">emerge from the COVID pandemic</a>, which has <a href="https://doi.org/10.5694/mja2.51368">disproportionately affected</a> families already experiencing adversity. </p>
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<img alt="Mother wipes ice cream from her daughter's chin" src="https://images.theconversation.com/files/498372/original/file-20221201-16-iq7whf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/498372/original/file-20221201-16-iq7whf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=377&fit=crop&dpr=1 600w, https://images.theconversation.com/files/498372/original/file-20221201-16-iq7whf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=377&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/498372/original/file-20221201-16-iq7whf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=377&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/498372/original/file-20221201-16-iq7whf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=474&fit=crop&dpr=1 754w, https://images.theconversation.com/files/498372/original/file-20221201-16-iq7whf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=474&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/498372/original/file-20221201-16-iq7whf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=474&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Greater early support boosts mothers’ mental wellbeing.</span>
<span class="attribution"><a class="source" href="https://www.pexels.com/photo/attentive-asian-mother-cleaning-face-of-cute-daughter-5094378/">Kamaji Ogino/Pexels</a></span>
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<p>Almost no other public health program delivered during the early years has evidence of such a broad range of gains. </p>
<p><a href="https://bmjopen.bmj.com/content/11/12/e052156">Our economic evaluation</a> of right@home at three years showed delivering these benefits through the right@home program costs A$7,700 extra per family compared with the usual service.</p>
<p>Research from the US shows the benefits of <a href="http://www.wsipp.wa.gov/BenefitCost/Program/35">similar programs</a> accrue for families and taxpayers over a child’s lifetime, producing positive returns on investment, from improved mental health and more employment, among other benefits.</p>
<p>Australia is fortunate to have nationwide child and family health nursing services. These are the perfect platform for delivering an extended program like right@home. When so few programs make a difference for families experiencing adversity, we should maximise the reach of those that do.</p>
<p><em>Diana Harris, Lead for Knowledge Translation at the Australian Research Alliance for Children & Youth, coauthored this article.</em></p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/stressed-about-managing-your-childs-behaviour-here-are-four-things-every-parent-should-know-104481">Stressed about managing your child's behaviour? Here are four things every parent should know</a>
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</em>
</p>
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<img src="https://counter.theconversation.com/content/194643/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>right@home is supported by the state governments of Victoria and Tasmania, the Ian Potter Foundation, Sabemo Trust, Sidney Myer fund, the Vincent Fairfax Family Foundation, and the National Health and Medical Research Council (NHMRC, 1079148). The MCRI administered the research grant for the study and provided infrastructural support to its staff but played no role in the conduct or analysis of the trial. Research at the MCRI is supported by the Victorian Government's Operational Infrastructure Support Program. SG was supported by NHMRC Practitioner Fellowship (1155290).
The “right@home” sustained nurse home visiting trial is a research collaboration between the Australian Research Alliance for Children and Youth (ARACY); the Translational Research and Social Innovation (TReSI) Group at Western Sydney University; and the Centre for Community Child Health (CCCH), which is a department of The Royal Children's Hospital and a research group of Murdoch Children’s Research Institute. Ownership of the right@home implementation and support license, which is purchased by Australian state governments for roll out for fidelity support, is shared between institutes.</span></em></p><p class="fine-print"><em><span>The MECSH home visiting program upon which right@home is based is trademarked and licenced by Western Sydney University and was developed by UNSW Australia. Western Sydney University is a member of the right@home consortium that receives funding from Australian state governments to support the implementation of the program. Western Sydney University also licenses the MECSH program to government and non-government providers of home visiting services in the UK and USA. </span></em></p><p class="fine-print"><em><span>Sharon Goldfeld receives funding from ARC and NHMRC.</span></em></p>Extending visits from nurses who can listen without judgement and offer practical, evidence-informed advice helps new parents who are experiencing adversity.Anna Price, The Erdi Foundation Child Health Equity (COVID-19) Scholar, Centre for Community Child Health | Honorary, Department of Paediatrics, University of Melbourne | Team Leader / Senior Research Officer, Murdoch Children's Research InstituteLynn Kemp, Director of the Translational Research and Social Innovation group, School of Nursing and Midwifery, Western Sydney UniversitySharon Goldfeld, Director, Center for Community Child Health Royal Children's Hospital; Professor, Department of Paediatrics, University of Melbourne; Theme Director Population Health, Murdoch Children's Research InstituteLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1932752022-10-26T12:27:41Z2022-10-26T12:27:41ZRSV: A pediatric disease expert answers 5 questions about the surging outbreak of respiratory syncytial virus<figure><img src="https://images.theconversation.com/files/491720/original/file-20221025-4775-4olusf.jpg?ixlib=rb-1.1.0&rect=0%2C110%2C4934%2C3279&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Babies and young children are most at risk for serious cases of RSV.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/doctor-listening-to-boy-with-infection-royalty-free-image/160428861?phrase=baby%20coughing&adppopup=true">Peter Dazeley/The Image Bank via Getty Images</a></span></figcaption></figure><p><em>Respiratory syncytial virus, more commonly known as RSV, sends thousands of children to the hospital every year in the U.S. But during September and October 2022, health professionals across the country have watched an unprecedented spike in the number of cases of this usually mild, but occasionally dangerous, respiratory infection in children. <a href="https://scholar.google.com/citations?user=G2EkJJ0AAAAJ&hl=en&oi=ao">Jennifer Girotto</a> is a pharmacist who studies pediatric infectious diseases. She explains how RSV infects the human body, who is most at risk and what might be causing this year’s outbreak to be worse than normal.</em></p>
<h2>1. What is respiratory syncytial virus?</h2>
<p>RSV is a common, <a href="https://doi.org/10.1099%2Fjgv.0.000959">RNA respiratory virus</a> that affects about <a href="https://www.cdc.gov/rsv/research/us-surveillance.html">2 million children under 5 years old annually</a> nationwide. Researchers think that most children have been infected by age 2. Like the flu, in most areas of the U.S., RSV usually circulates from November through March and then mostly disappears during the summer months, with only sporadic cases being seen.</p>
<h2>2. Who is most at risk?</h2>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/491725/original/file-20221025-13-vjkl0a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A microscope image of thin blue lines among cells." src="https://images.theconversation.com/files/491725/original/file-20221025-13-vjkl0a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/491725/original/file-20221025-13-vjkl0a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/491725/original/file-20221025-13-vjkl0a.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/491725/original/file-20221025-13-vjkl0a.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/491725/original/file-20221025-13-vjkl0a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/491725/original/file-20221025-13-vjkl0a.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/491725/original/file-20221025-13-vjkl0a.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Respiratory syncytial virus – highlighted in blue – infects cells in a person’s lungs, throat and nose and can lead to anything from a mild cold to pneumonia and croup in more severe cases.</span>
<span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/File:Human_Respiratory_Syncytial_Virus_(RSV)_(33114415716).jpg#/media/File:Human_Respiratory_Syncytial_Virus_(RSV)_(33114415716).jpg">National Institute of Allergy and Infectious Diseases/Wikimedia Commons</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
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<p>For most people, especially those who have had an RSV infection in the past, the virus only causes <a href="https://www.cdc.gov/rsv/clinical/index.html">mild symptoms like cough, runny nose and fever</a>, with instances of wheezing and decreased appetite more common in young children. </p>
<p>But young infants, especially those under 6 months old, born prematurely or with congenital heart, lung or other health issues are <a href="https://www.cdc.gov/rsv/clinical/index.html">at increased risk for more severe symptoms</a>. The U.S. Centers for Disease Control and Prevention estimates that 1% to 2% of infants younger than 6 months who get infected with RSV require hospitalization. In an average year, around <a href="https://doi.org/10.1542%2Fpir.35-12-519">250 children die from the disease</a>.</p>
<p>In recent years, researchers have found that RSV can also <a href="https://www.cdc.gov/rsv/high-risk/older-adults.html">cause severe disease in high-risk adults and people older than 65.</a>.</p>
<h2>3. How does RSV make people sick?</h2>
<p>The main reason RSV sends babies and young children to the hospital is because the virus infects and kills surface cells within small sacs of the lungs. The body responds by <a href="https://doi.org/10.1542%2Fpir.35-12-519">increasing the production of mucus and fluid</a> in these areas. But the extra mucus can plug up and obstruct these parts of the lung and make it so that an infant <a href="https://www.statpearls.com/articlelibrary/viewarticle/28424/">doesn’t get enough oxygen</a>. </p>
<p>A second common cause for hospitalization due to RSV is pneumonia, where a person’s lungs fill up with fluid. The pneumonia can either be triggered by the virus itself or by a <a href="http://dx.doi.org/10.1136/thx.2005.048397">secondary, bacterial infection</a>. Finally, some infants get so sick that they struggle to eat and are unable to take in sufficient nutrients, eventually landing them in the hospital.</p>
<p><iframe id="BVCWg" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/BVCWg/1/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<h2>4. How concerning is this year’s outbreak?</h2>
<p>On average, RSV sends about <a href="https://www.cdc.gov/rsv/research/us-surveillance.html">60,000 young children to the hospital</a> each year in the U.S. In 2022, however, the virus has hit early and hard. According to the CDC, doctors have found <a href="https://www.cdc.gov/surveillance/nrevss/images/trend_images/RSV14Num_Nat.htm">more cases in each week of October</a> than any week in the prior two years. </p>
<p>Health officials aren’t yet sure why the outbreak is so bad this year, but the COVID-19 pandemic may have something to do with it. Some research has shown that <a href="https://doi.org/10.1007/s15010-022-01794-y">seasonality of RSV has shifted</a>. In 2021, RSV infections started much earlier than normal, and over the summer of 2022, they never quite went away. One theory as to why RSV season is starting earlier and hitting harder is that, due to social distancing measures since 2020, an unusually high number of infants and children are experiencing their first exposures and infections at once.</p>
<h2>5. How can you protect against catching RSV?</h2>
<p>Like colds and the flu, RSV infections spread when people touch dirty surfaces or from respiratory droplets, when an infected person coughs or sneezes. </p>
<p>Health professionals recommend that premature infants and infants with certain medical conditions <a href="https://doi.org/10.1542/peds.2009-2345">take a monthly monoclonal antibody medication, called Palivizumab, during the RSV season</a> to help keep them out of the hospital. There are a <a href="https://media.path.org/documents/RSV_Vaccine_and_mAb_Snapshot_September_9_2022.pdf?_gl=1*16baoqs*_ga*MjE0OTYwMjQ3LjE2NjY3MTEzMjk.*_ga_YBSE7ZKDQM*MTY2NjcxMTMyOS4xLjAuMTY2NjcxMTMzNS4wLjAuMA">few RSV vaccines under development</a>, but none are yet approved. For now, preventative measures are the best way to avoid an infection.</p>
<p>If someone is sick with symptoms that look like a cold, it may be best to avoid close contact until they feel better, especially if you have young children or high-risk people around.</p><img src="https://counter.theconversation.com/content/193275/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jennifer Girotto does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Tens of thousands of children have tested positive for respiratory syncytial virus in the last months in what is the largest outbreak of the virus in recent years.Jennifer Girotto, Clinical Professor of Pharmacy Practice, University of ConnecticutLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1852152022-07-19T02:56:18Z2022-07-19T02:56:18ZCOVID vaccines for children under 5 are almost here. Here’s what parents need to know<figure><img src="https://images.theconversation.com/files/470496/original/file-20220623-51812-40p93u.jpg?ixlib=rb-1.1.0&rect=2%2C1%2C995%2C661&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/portrait-cute-happy-8-month-old-213114688">Shutterstock</a></span></figcaption></figure><p>COVID vaccines for children as young as six months look set to be available in the coming months, now the Therapeutic Goods Administration has <a href="https://www.tga.gov.au/media-release/tga-provisionally-approves-moderna-covid-19-vaccine-spikevax-use-children-6-months">approved</a> the Moderna vaccine for babies and young children.</p>
<p>The vaccine has been approved for children aged six months to five years. However, we need to wait for advice from the Australian Technical Advisory Group on Immunisation (ATAGI) to provide further scientific advice and recommendations around an immunisation program. Given no vaccines are currently manufactured in Australia, we will also need to wait for availability of supply before the program can commence.</p>
<p>Australia’s approval of the Moderna vaccine for this age group follows a <a href="https://www.cdc.gov/media/releases/2022/s0618-children-vaccine.html">similar move</a> in the United States in June.</p>
<p>Here’s what parents need to know ahead of Australia’s rollout of the Moderna vaccine to these younger children, the last remaining age group to receive COVID vaccines.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/covid-19-in-babies-heres-what-to-expect-181940">COVID-19 in babies – here's what to expect</a>
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<h2>Why vaccinate this age group?</h2>
<p>COVID case numbers are still high. So with the threat of <a href="https://theconversation.com/why-are-there-so-many-new-omicron-sub-variants-like-ba-4-and-ba-5-will-i-be-reinfected-is-the-virus-mutating-faster-182274">Omicron sub-variants</a> and other potential variants, expansion of COVID vaccines to young children will be a welcome relief for many concerned parents and families.</p>
<p>Children are less likely to have severe outcomes or complications from COVID compared with adults. However, they continue to experience <a href="https://www.health.gov.au/health-alerts/covid-19/case-numbers-and-statistics">high levels of infection</a>. This disrupts their schooling, childcare and other activities. When they are sick, their parents need to take time off work to care for them.</p>
<p>Severe disease can also happen in <a href="https://www.nature.com/articles/s41467-022-29951-9">previously healthy children</a>, and not just in children at higher risk because of underlying medical conditions.</p>
<p>While the total number of admissions to hospital from COVID infection in children is small, <a href="https://www.ncirs.org.au/covid-19-in-schools">a large proportion</a> of these have been children under five years. </p>
<p>That’s because they are more likely to need supportive care, such as observation and hydration, than older children.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/470494/original/file-20220623-51865-ah9l7b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Preschoolers playing at daycare with blocks at table" src="https://images.theconversation.com/files/470494/original/file-20220623-51865-ah9l7b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/470494/original/file-20220623-51865-ah9l7b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=443&fit=crop&dpr=1 600w, https://images.theconversation.com/files/470494/original/file-20220623-51865-ah9l7b.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=443&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/470494/original/file-20220623-51865-ah9l7b.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=443&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/470494/original/file-20220623-51865-ah9l7b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=557&fit=crop&dpr=1 754w, https://images.theconversation.com/files/470494/original/file-20220623-51865-ah9l7b.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=557&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/470494/original/file-20220623-51865-ah9l7b.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=557&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">When preschoolers are sick, they lose opportunities to learn and play with their friends.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/nursery-children-playing-teacher-classroom-1241605294">Shutterstock</a></span>
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<p>Children are also at risk of a severe COVID complication known as <a href="https://theconversation.com/more-than-100-australian-kids-have-had-multisystem-inflammatory-syndrome-after-covid-what-should-parents-watch-for-183533">multi-system inflammatory syndrome</a>. This requires admission to hospital and possibly the intensive care unit. We know <a href="https://www.cdc.gov/vaccines/acip/meetings/downloads/slides-2022-05-19/02-COVID-Link-Gelles-508.pdf">vaccination protects</a> children from this life-threatening condition.</p>
<p>The long-term effects and implications of COVID in children are also still not fully understood. Long COVID appears to be much less common in children than in adults, occurring in <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8575095/">less than 2–3%</a> of children. So, prevention of infection in children is still a priority.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/do-kids-get-long-covid-and-how-often-a-paediatrician-looks-at-the-data-166277">Do kids get long COVID? And how often? A paediatrician looks at the data</a>
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<hr>
<h2>My child’s had COVID. Do they still need a shot?</h2>
<p>Many parents may be unsure of the benefit of vaccines if their child has already had COVID, especially if they weren’t that unwell. </p>
<p>However, the World Health Organization <a href="https://www.who.int/news/item/01-06-2022-interim-statement-on-hybrid-immunity-and-increasing-population-seroprevalence-rates">says</a> protection from vaccinating someone who has already caught COVID (known as providing hybrid immunity) is stronger than that provided by either vaccination or infection alone.</p>
<p>Importantly, hybrid immunity offers <a href="https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(22)00143-8/fulltext">superior protection</a> against severe COVID compared with infection-induced or vaccine-induced immunity alone. However, it is unclear whether this hybrid immunity will persist with new variants.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/if-ive-already-had-covid-do-i-need-a-vaccine-and-how-does-the-immune-system-respond-an-expert-explains-164236">If I've already had COVID, do I need a vaccine? And how does the immune system respond? An expert explains</a>
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<h2>The wider family and community benefit too</h2>
<p>The benefits of vaccination extend beyond direct protection. The mRNA vaccines (Moderna, Pfizer) <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2116597">reduce transmission</a> of SARS-CoV-2, the virus that causes COVID, although less so with the Omicron variant.</p>
<p>Nevertheless, the vaccines remain an important way to protect both young children and those around them.</p>
<p>They can help to ensure young kids can still go to kindergarten, play with their friends, travel and visit their grandparents.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/471745/original/file-20220630-14-3x0m57.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Grandmother cuddling young grandson, nose to cheek" src="https://images.theconversation.com/files/471745/original/file-20220630-14-3x0m57.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/471745/original/file-20220630-14-3x0m57.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/471745/original/file-20220630-14-3x0m57.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/471745/original/file-20220630-14-3x0m57.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/471745/original/file-20220630-14-3x0m57.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/471745/original/file-20220630-14-3x0m57.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/471745/original/file-20220630-14-3x0m57.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Vaccinated young children protects vulnerable people around them.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/happy-loving-family-grandmother-grandson-having-1987660103">Shutterstock</a></span>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/should-my-child-have-a-covid-vaccine-heres-what-can-happen-when-parents-disagree-174395">Should my child have a COVID vaccine? Here's what can happen when parents disagree</a>
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<h2>Does the vaccine work?</h2>
<p>The Moderna vaccine is available for children from six months to five years, with two doses needed to complete the course. </p>
<p>The dose is one-quarter of the adult dose (25 micrograms instead of 100 micrograms), and should be given at least four weeks apart. </p>
<p>The Moderna clinical trials demonstrated adequate vaccine effectiveness in younger infants and children. <a href="https://www.cdc.gov/vaccines/acip/meetings/downloads/slides-2022-06-17-18/04-COVID-Das-508.pdf">It showed</a> a 51% effectiveness against COVID infection in children between six months to two years, and 37% effectiveness in children between two and five years.</p>
<p>It’s too soon to say how much protection vaccination will protect preschoolers against multi-system inflammatory syndrome, but we do expect some protection.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/more-than-100-australian-kids-have-had-multisystem-inflammatory-syndrome-after-covid-what-should-parents-watch-for-183533">More than 100 Australian kids have had multisystem inflammatory syndrome after COVID. What should parents watch for?</a>
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<h2>Is the vaccine safe?</h2>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/471749/original/file-20220630-22-f3ya3j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Health worker putting on bandaid on upper arm of young child after vaccination" src="https://images.theconversation.com/files/471749/original/file-20220630-22-f3ya3j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/471749/original/file-20220630-22-f3ya3j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/471749/original/file-20220630-22-f3ya3j.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/471749/original/file-20220630-22-f3ya3j.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/471749/original/file-20220630-22-f3ya3j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/471749/original/file-20220630-22-f3ya3j.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/471749/original/file-20220630-22-f3ya3j.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">The most common side effects include a painful arm, mild fever, headache and tiredness.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/doctor-puts-patch-on-childs-shoulder-2094936937">Shutterstock</a></span>
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<p>Of course, we need to balance the benefits with any risks, and all vaccines have side effects. </p>
<p>In both <a href="https://www.cdc.gov/vaccines/acip/meetings/downloads/slides-2022-06-22-23/03-COVID-Shimabukuro-508.pdf">real-world data and clinical trials</a>, the number and rate of reports of side effects from COVID vaccines in young children are lower than for adults.</p>
<p>Most of the common and expected side effects in young children occur in the first 24–48 hours and include a fever, painful arm, headache and tiredness.</p>
<p>There were <a href="https://www.cdc.gov/vaccines/acip/meetings/downloads/slides-2022-06-17-18/06-COVID-Oliver-508.pdf">no serious adverse events</a> such as myocarditis (heart inflammation), anaphylaxis (life-threatening immune reaction) or multi-system inflammatory syndrome detected during the clinical trials for this age group for either vaccine.</p>
<p>There are also no currently detected longer-term safety concerns with mRNA vaccines in the paediatric age group.</p>
<p>Once the COVID vaccines are available for this age group, side effects will be monitored and documented through <a href="https://ausvaxsafety.org.au">AusVaxSafety</a> and other surveillance systems, as they have been for <a href="https://ausvaxsafety.org.au/covid-19-vaccines/pfizer-covid-19-vaccine-paediatric-formulation-5-11-years">other age groups</a>, and other childhood vaccines.</p>
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<p><em>Reliable information about COVID vaccines for children is available from the <a href="https://mvec.mcri.edu.au/references/covid-19-vaccination-in-children/">Melbourne Vaccine Education Centre</a>, the Australian <a href="https://www.health.gov.au/initiatives-and-programs/covid-19-vaccines/who-can-get-vaccinated">department of health</a> and your child’s GP.</em></p><img src="https://counter.theconversation.com/content/185215/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Margie Danchin receives funding from Commonwealth and State Governments, NHMRC, DFAT and WHO. She is chair, Collaboration in Social Science and Immunisation (COSSI). </span></em></p><p class="fine-print"><em><span>Daryl Cheng does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>It’s natural to have questions about the risks and benefits of COVID vaccines in young children. Here’s what you need to know ahead of Australia’s rollout.Daryl Cheng, Consultant Paediatrician & Medical Lead, Melbourne Vaccine Education Centre, Murdoch Children's Research InstituteMargie Danchin, Paediatrician at the Royal Childrens Hospital and Associate Professor and Clinician Scientist, University of Melbourne and MCRI, Murdoch Children's Research InstituteLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1829292022-05-12T13:09:02Z2022-05-12T13:09:02ZWhat’s causing the US baby formula shortage – and how to make sure it doesn’t happen again<figure><img src="https://images.theconversation.com/files/462578/original/file-20220511-18-x6ls08.jpg?ixlib=rb-1.1.0&rect=53%2C341%2C6000%2C3646&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">No easy formula.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/grocery-store-shelves-where-baby-formula-is-typically-news-photo/1240603860?adppopup=true">Stefani Reynolds/AFP via Getty Images</a></span></figcaption></figure><p><em>A <a href="https://www.nytimes.com/2022/05/10/us/baby-formula-shortage.html">baby formula shortage</a> has added to the woes of American parents already confronted with the pressures of <a href="https://www.theatlantic.com/culture/archive/2021/03/isolation-becoming-new-parent-during-pandemic/618244/">raising an infant during a pandemic</a> in a country <a href="https://www.forbes.com/sites/marybethferrante/2019/06/21/unicef-study-confirms-the-u-s-ranks-last-for-family-friendly-policies/?sh=176ff24133ba">ranked low for family-friendly policies</a>.</em></p>
<p><em>Media reports have highlighted the plight of mothers, fathers and caregivers across the U.S. who have <a href="https://www.seattletimes.com/seattle-news/baby-formula-shortage-in-washington-has-caregivers-parents/">scrambled to find scarce supplies</a>, or <a href="https://www.wfaa.com/article/news/local/texas/lake-jackson-texas-mom-drives-hour-baby-formula-amid-shortage/287-d1638ecb-4153-415d-ab63-58e342ec764f">driven long distances</a> to buy formula.</em></p>
<p><em>But what is behind the shortage? And how can it be prevented from happening again? The Conversation asked Dr. Steven Abrams, a leading <a href="https://dellmed.utexas.edu/directory/steven-a-abrams">expert on pediatric health</a> at the University of Texas who has advised both the formula industry and government on infant nutrition, these questions along with what advice he could give parents facing problems getting adequate supplies of infant formula.</em> </p>
<h2>1. Why there is a shortage of formula now?</h2>
<p>There are really two factors that have driven the current shortage. First, we have the <a href="https://theconversation.com/4-reasons-americans-are-still-seeing-empty-shelves-and-long-waits-with-christmas-just-around-the-corner-168635">supply chain problem</a>, which has affected all manner of goods since the onset of the pandemic. It eased off a little, but then at the beginning of 2022 it <a href="https://www.wired.com/story/supply-chain-crisis-data/">became worse</a>.</p>
<p>Then in February a <a href="https://wwmt.com/news/local/baby-formula-shortage-crisis-intensifies-as-sturgis-plant-remains-shut-down">major baby formula manufacturing plant in U.S. went down</a>. The FDA <a href="https://www.nbcboston.com/news/national-international/fda-to-allow-closed-abbott-plant-to-release-baby-formula-supply-amid-shortage/2717440/">shut down Abbott Nutrition’s factory</a> in Michigan. The closure came after Abbott’s nationwide <a href="https://www.similacrecall.com/us/en/home.html">recall of multiple brands of formula</a>, including routine Similac cow milk-based formulas such as Similac Advance and several specialty formulas for allergic babies, including Similac Alimentum and and Similac EleCare.</p>
<p>Closing the factory had to be done amid an <a href="https://www.fda.gov/food/outbreaks-foodborne-illness/fda-investigation-cronobacter-infections-powdered-infant-formula-february-2022">investigation into bacterial infections</a> in connection to powdered formula produced at the plant, and the deaths of at least two babies. The problem is there just isn’t much redundancy in U.S. infant formula production. In other words, there aren’t enough other factories to pick up the slack when one goes down. The Michigan plant is the largest producer in the country, so when it goes down, it put added strain on the entire U.S. formula distribution system, especially for certain formulas for babies with high-risk allergic diseases and metabolic disorders.</p>
<p>Over the last couple of weeks the shortage has gotten worse. I can’t say for sure why this has happened. But I suspect there has been some hoarding going on as parents get anxious. Stores can limit the amount of formula that people can buy, but that doesn’t stop people going online to buy more.</p>
<p>On top of that, the shortage has gained wide publicity in newspapers, on TV and in political speeches. All that publicity feeds into public sense that the system is failing, prompting more panic buying and hoarding.</p>
<h2>2. Who is the shortage affecting?</h2>
<p>A majority of parents will feed babies with formula at some point to meet their nutritional needs, especially older infants. At birth and in days immediately after, around 80% of babies receive <a href="https://www.cdc.gov/breastfeeding/data/reportcard.htm">all their nutrition through breast milk</a>. But by the age of 6 months, the <a href="https://www.cdc.gov/breastfeeding/data/reportcard.htm">majority of babies get at least some formula</a>. The proportion of year-old babies receiving formula is even higher. This is largely the result of social dynamics and pressures - mothers going back to work after giving birth, but not receiving sufficient support to produce and store sufficient amounts of breast milk.</p>
<p>But the shortage will affect some parents more than others. Not surprisingly, the most affected parents are those on the lowest income. The federal food program for poorer women, infants and children, <a href="https://www.fns.usda.gov/wic">called WIC</a>, provides formula for a majority of babies in low-income families. But costs have gone up and formula has become scarcer.</p>
<p>I’m hearing of some families driving two hours to find stores selling formula. Obviously that will be harder to do for poorer families as there are costs involved. Likewise, more affluent parents may be able to buy more expensive, so-called elite brand formulas.</p>
<p>The other thing to note is that the shortage is affecting both regular infant formula, and <a href="https://www.fda.gov/news-events/press-announcements/fda-takes-important-steps-improve-supply-infant-and-specialty-formula-products">specialized versions</a>. Regular or standard formula is the type most families are familiar with, and around 95% of formula-fed babies get the standard type. Specialized formula is for babies with unusual requirements, due to allergies, damaged intestines or special nutritional needs. Before the Michigan factory closed, it made most of the specialized infant formula used in the U.S. So it is an absolute crisis for families needing that type of formula.</p>
<h2>3. What are the potential consequences of the shortage?</h2>
<p>In the first six months, babies should <a href="https://www.cdc.gov/breastfeeding/faq/index.htm">only have breast milk or formula</a> – anything else fed to them will be nutritionally incomplete. So there is a risk that a shortage will mean that babies will not be getting the nutrition they need to develop. That could lead to a range of health problems affecting their physical growth and brain development.</p>
<p>Then there are concerns that parents may be using unsafe alternatives, like watering down their baby’s formula. People have been known to try and make their own by mixing powdered milk or vegan milk with vitamins. Not only are these alternatives <a href="https://www.cdc.gov/mmwr/volumes/70/wr/mm7033a4.htm">not nutritionally complete</a>, they may not be entirely sterile.</p>
<p>After the age of six months, things get a little better once the infant is able to start eating solid food. But even then, formula or breast milk remains the primary source of nutrition. So there may still be a risk of nutritional deficiencies, such as iron deficiencies.</p>
<h2>4. Are there any viable alternatives?</h2>
<p>Over the age of six months of age, for only reasonably short periods of time, <a href="https://healthychildren.org/English/tips-tools/ask-the-pediatrician/Pages/Are-there-shortages-of-infant-formula-due-to-COVID-19.aspx#.Ynr6sYw9zEQ.twitter">parents can feed infants whole cow milk</a> and look into iron supplements.</p>
<p>It isn’t ideal, and only applies for older babies. For those under six months old, cow milk is a real problem. It doesn’t have the right protein blend for babies and has next to no iron – risking anemia in very young babies. Cow milk also has a misbalance of minerals, especially for younger babies.</p>
<h2>5. So what guidance is there for low-income parents?</h2>
<p>It is challenging and I can’t provide a magic answer. But food banks and the WIC program have been a crucial lifeline. The WIC program in particular has proved itself to be very flexible during this shortage. When Abbott had to recall products and then couldn’t provide enough non-recalled formulas in states in which they were the WIC provider, WIC was able to change providers and reprogram EBT cards to allow low-income parents to buy different brands.</p>
<h2>6. What can be done to prevent this situation happening again in the U.S.?</h2>
<p>First we need to help families regain confidence in the formula production and supply system. This will prevent problems such as hoarding or making home brew formulas.</p>
<p>Then we need to look at how to make sure one plant going down doesn’t affect the whole system. The federal government can’t stockpile formula in the same way it might stockpile oil, as formula has a shelf life. But diversifying infant formula production is a possibility. This would involve making sure multiple factories and companies are making the formulas that this country needs. This doesn’t necessarily mean increased costs – competition could potentially drive down prices.</p>
<p>I believe America also needs to look at the country’s breast feeding support system. Don’t get me wrong, some parents will always need formula. But those who want to breast feed need everything possible done to support them. That includes better family leave policies, and help for low-income mothers who want to pump and store milk while they work.</p><img src="https://counter.theconversation.com/content/182929/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Steven A. Abrams received funding from Perrigo Nutrition for research related to food insecurity in Austin during the COVID-19 pandemic and has given paid presentations on nutritional physiology to Abbott Nutrition's educational unit, ANHI.</span></em></p>An infant nutrition expert explains what is behind the current formula shortage and what can be done to support hard-pressed parents.Steven A. Abrams, Professor of Pediatrics, The University of Texas at AustinLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1821752022-05-03T13:26:29Z2022-05-03T13:26:29ZExercising during pregnancy: what to consider<figure><img src="https://images.theconversation.com/files/460989/original/file-20220503-20-vqx0xu.jpg?ixlib=rb-1.1.0&rect=0%2C17%2C5894%2C3870&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">There's no need to stop exercising if you're able to.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/active-pregnant-woman-running-outdoor-sport-1415641412">Leszek Glasner/ Shutterstock</a></span></figcaption></figure><p>While exercise is often said to be safe to do while pregnant, with so much information out there, it can be hard to figure out just how much exercise you should do – and if there are certain exercises to avoid. </p>
<p>Exercise is good for the mother and her baby, but given all the changes that happen to the body during pregnancy, it is advisable to take it a bit easier when exercising.</p>
<p>One of these changes is how our cardiovascular system functions. Because the baby needs a constant supply of oxygen to develop – and because of how quickly it grows – the mother will experience a <a href="http://thehubedu-production.s3.amazonaws.com/uploads/4234/78ef71e5-2ce1-491e-b6f4-c7690c7f7016/Hemodynamic_changes_in_pregnancy.pd">45-50% increase</a> in blood volume to carry this much-needed oxygen to the baby. </p>
<p>The <a href="https://www.scopus.com/record/display.uri?eid=2-s2.0-84867746119&origin=inward&featureToggles=FEATURE_NEW_DOC_DETAILS_EXPORT:1">mother’s heart rate</a> also increases to ensure the baby gets enough oxygen. This could put an extra strain on the woman’s heart and lungs when doing any sort of activity.</p>
<p>The respiratory system is also affected. The <a href="http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.994.4602&rep=rep1&type=pdf">amount of oxygen</a> a mother can inhale increases by around 40-50% to give the baby the oxygen it needs. This change also happens because the growing baby <a href="https://link.springer.com/article/10.1186/2047-783X-15-S2-189">affects lung function</a> by reducing the space in which the mother’s lungs can inflate. These changes may see the mother experience more shortness of breath – which will make even everyday tasks more demanding.</p>
<p>The body’s <a href="https://onlinelibrary.wiley.com/doi/pdf/10.1016/j.pmrj.2018.06.012">joints also relax</a> – partly due to the mother’s <a href="https://www.mdpi.com/2411-5142/4/4/72/htm">centre of mass changing</a>, and because the pelvis has tilted. The way the body fuels itself also changes. When we eat foods, the body stores these byproducts (typically glucose or carbohydrates) in our liver and muscles so that our body can draw upon these stores for energy when needed (such as when we exercise). When pregnant, there is <a href="https://www.researchgate.net/profile/Daniel-Mintz-2/publication/16202011_Blood_Glucose_Control_During_Pregnancy/links/54c9b5750cf298fd26269e74/Blood-Glucose-Control-During-Pregnancy.pdf">less glucose available</a> to draw on for energy. This is because the baby needs this energy to develop. As a result, the mother might feel more fatigued more quickly when they’re doing any type of task – including exercise.</p>
<h2>Keep moving</h2>
<p>But all these changes don’t mean you shouldn’t exercise during pregnancy.</p>
<p>Studies show that <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD000180.pub2/pdf/full">doing aerobic exercise</a> (such as walking, jogging or swimming) during pregnancy for at least 150 minutes a week can improve fitness, increase <a href="https://www.scopus.com/record/display.uri?eid=2-s2.0-84870055782&origin=inward&featureToggles=FEATURE_NEW_DOC_DETAILS_EXPORT:1">muscle tone and strength</a> and reduce weight gain. Exercise may also lower the risk of <a href="https://link.springer.com/article/10.1007/s12178-008-9021-8">experiencing back pain</a>, which is a common problem for many pregnant women.</p>
<p>There’s also some limited evidence that following an exercise plan during pregnancy can help some women <a href="https://www.ajpmonline.org/article/S0749-3797(16)30204-5/pdf">experience shorter labour</a> – and decrease the likelihood of needing a caesarean section. It’s currently unclear why this link may exist.</p>
<p>Not only is exercise safe for the mother, it’s also safe for the baby. Although exercise can directly affect the baby (such as the baby’s <a href="https://www.sciencedirect.com/science/article/abs/pii/S1701216316303097">heart rate increasing</a> when the mother exercises), researchers have shown exercise causes <a href="https://www.sciencedirect.com/science/article/pii/S0266613807000459">no symptoms or signs of stress</a> to the baby. Exercising regularly during pregnancy may also lower the likelihood of the baby <a href="https://www.ahajournals.org/doi/full/10.1161/circulationaha.109.906081">being overweight</a> in adulthood.</p>
<figure class="align-center ">
<img alt="A pregnant woman lifts a barbell in the gym." src="https://images.theconversation.com/files/460990/original/file-20220503-31848-9imgcj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/460990/original/file-20220503-31848-9imgcj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/460990/original/file-20220503-31848-9imgcj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/460990/original/file-20220503-31848-9imgcj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/460990/original/file-20220503-31848-9imgcj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/460990/original/file-20220503-31848-9imgcj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/460990/original/file-20220503-31848-9imgcj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Weight lifting can still be safe to do.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/pregnant-woman-exercising-gym-fitness-healthy-602774699">ZephyrMedia/ Shutterstock</a></span>
</figcaption>
</figure>
<p>But though exercise is safe for both mother and baby, some activities may need to be avoided. Somewhat obviously, combat sports or those that may have an increased risk of falling (such as horse riding or mountain biking) should be avoided.</p>
<p>If you enjoy lifting weights, it’s still considered a safe and effective form of exercise to do during pregnancy. But it may be best to lift with a friend or personal trainer and avoid excessive loads, as these increase the risk of muscle and joint injuries.</p>
<p>You should also avoid exercising in <a href="https://onlinelibrary.wiley.com/doi/pdf/10.1111/jmwh.13286">hot temperatures</a> (especially those above 32◦C) because of the extra stress this could place on you and your baby’s heart. Something else to consider carefully is any form of exercise that requires the mother to lie flat on her stomach or back – such as during yoga or pilates. The reason for this is there’s an <a href="https://link.springer.com/article/10.1186/1532-429X-13-31">increased chance of hypotension</a> (a rapid drop in blood pressure) that may increase the risk of fainting when standing up.</p>
<p>So while you might need to take it a bit easier if you want to exercise while pregnant (especially during the second and third trimester), this doesn’t mean you need to work out less than you did before. Generally, people are recommended to get at least 150 minutes of cardiovascular exercise a week. The same is true for women who are pregnant, though you may need to lower the intensity you exercise at.</p>
<p>And if you do decide to exercise during pregnancy, it’s important to make sure you’re <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/j.1467-3010.2006.00541.x">eating and drinking enough</a> since exercise requires more energy. The more demanding the exercise, the more calories you’ll need to consume afterwards.</p><img src="https://counter.theconversation.com/content/182175/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Exercising during pregnancy is safe – and can have many benefits for both mother and baby.Dan Gordon, Associate Professor: Cardiorespiratory Exercise Physiology, Anglia Ruskin UniversityMatthew Slater, PhD Candidate and Vascular Healthcare Scientist, Anglia Ruskin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1739752022-03-03T13:27:09Z2022-03-03T13:27:09ZInfants need lots of active movement and play – and there are simple ways to help them get it<figure><img src="https://images.theconversation.com/files/441827/original/file-20220120-9087-1togzru.jpg?ixlib=rb-1.1.0&rect=38%2C7%2C5075%2C3396&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Experts believe that infants should get some interactive floor-based physical activity two to three times a day.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/mother-watching-baby-playing-with-ball-royalty-free-image/135385235?adppopup=true">Sam Edwards/OJO Images via Getty Images</a></span></figcaption></figure><p>When people set personal fitness goals and establish their physical exercise routines, there’s a group of cuddly individuals that is often left out – infants! </p>
<p>Historically, infant active movement has been perceived as a <a href="https://doi.org/10.1186/s12889-017-4503-5">personality characteristic</a>. It’s assumed that infants are plenty active on their own, without needing adult intervention to encourage movement.</p>
<p>However, research is revealing that the choices, behaviors and everyday habits of adults have a big influence on how much infants move.</p>
<p>I’m a <a href="https://www.unomaha.edu/college-of-education-health-and-human-sciences/health-kinesiology/about-us/directory/danae-dinkel.php">physical activity teacher</a> and <a href="https://scholar.google.com/citations?hl=en&user=T2U7pXkAAAAJ&view_op=list_works&alert_preview_top_rm=2&sortby=pubdate">researcher</a>. For the past five years I’ve conducted several studies exploring infant movement, seeking to identify what supports the development of lifelong physical activity habits. </p>
<p>I’ve learned that many parents and other caregivers want to encourage infants to actively play and move. However, they often don’t know for sure how much physical activity an infant needs, nor do they often recognize how their own behaviors might be limiting an infant’s physical activity. Fortunately, there are several easy – and fun – ways to add more physical activity to an infant’s daily life.</p>
<h2>Why infants need movement – and how much</h2>
<p>Study of infant movement is a relatively new field, so there is still a lot to learn. However, one of the field’s foundational studies was published in 1972, and it found that increased infant physical activity can <a href="https://journals.lww.com/nursingresearchonline/Abstract/1972/05000/THE_IMPACT_OF_PHYSICAL_PHYSIOLOGICAL_ACTIVITY_ON.3.aspx">improve motor development</a>. More recent research shows that increased infant movement can improve <a href="https://doi.org/10.1371/journal.pone.0082098">bone health</a> and <a href="https://doi.org/10.1186/s12966-022-01248-6">personal-social development</a> – skills related to improving their independence or interacting with others, such as feeding themselves or waving goodbye.</p>
<p>The <a href="https://apps.who.int/iris/handle/10665/311664">World Health Organization</a> suggests that infants should be physically active several times a day, especially through interactive floor-based play. Similarly, the <a href="https://www.healthychildren.org/English/healthy-living/fitness/Pages/Making-Fitness-a-Way-of-Life.aspx">American Academy of Pediatrics</a> recommends opportunities for interactive play throughout the day, along with at least 30 minutes of “tummy time” with an adult – which I’ll talk more about below.</p>
<p>Yet half the parents participating in our research reported that they <a href="https://doi.org/10.1111/jspn.12315">hadn’t heard</a> of these recommendations and did desire <a href="https://doi.org/10.1111/jspn.12315">more specific guidelines</a> on encouraging active play. </p>
<h2>What are the barriers?</h2>
<p>While research is ongoing, I and other researchers have identified three major barriers to infant active movement: screen time, restrictive devices and “gendered play” – gender-related stereotypes, beliefs and practices in relation to how children play. </p>
<p>The American Academy of Pediatrics and other organizations <a href="https://doi.org/10.1542/peds.2016-2591">discourage allowing infants any screen time</a> other than video chatting. However, a recent review found that children ages 0 to 2 years may be getting <a href="https://doi.org/10.1016/j.ypmed.2015.07.019">between 36 and 330 minutes of screen time per day</a>. A 2019 analysis of data gathered between 2008 and 2010 found that <a href="https://doi.org/10.1001/jamapediatrics.2019.4488">children’s screen time increased</a> from 53 minutes a day at age 1 to more than 150 minutes per day by age 3, which suggests that screen time habits begin taking shape at very early ages.</p>
<p>Furthermore, the <a href="https://apps.who.int/iris/handle/10665/311664">World Health Organization</a> suggests that infants should spend no more than one hour at a time in a restrictive device. Yet many adults overuse car seats, strollers, high chairs or other “containers” that constrain movement. For instance, in a 2018 study of child care centers in the U.S., Canada and Australia, <a href="https://doi.org/10.1016/j.infbeh.2017.11.008">only 38% to 41% of the facilities</a> followed this WHO guideline.</p>
<figure class="align-center ">
<img alt="Mother playing face to face with baby son on floor." src="https://images.theconversation.com/files/442392/original/file-20220124-13-aq1z6j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/442392/original/file-20220124-13-aq1z6j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/442392/original/file-20220124-13-aq1z6j.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/442392/original/file-20220124-13-aq1z6j.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/442392/original/file-20220124-13-aq1z6j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/442392/original/file-20220124-13-aq1z6j.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/442392/original/file-20220124-13-aq1z6j.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Researchers have found that when infants get increased tummy time, they move more overall, and their gross motor skills and development improve.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/mother-playing-face-to-face-with-baby-son-on-floor-royalty-free-image/672158475?adppopup=true">JGI/Jamie Grill via Getty Images</a></span>
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<p>Research into adult physical activity consistently shows that <a href="https://doi.org/10.1038/nature23018">males are more active than females</a>, regardless of age. <a href="https://doi.org/10.1016/j.infbeh.2020.101440">Our research suggests</a> this gap may begin during infancy and be related to gendered play. </p>
<p>In our 2020 study exploring infant motor development in relation to parents’ promotion of play, we found that parents of male infants more often encouraged play that <a href="https://doi.org/10.1016/j.infbeh.2020.101440">promoted gross motor skills</a>: movement involving the large muscles that support activities like walking, running or kicking. Parents of female infants more often made statements that promoted fine motor skills, which involve smaller movements of the hands and arms and support activities like reaching and grasping. We found that females had significantly higher fine motor skills than male.</p>
<p>We’ve documented <a href="https://doi.org/10.1186/s12889-021-10286-x">additional barriers as well</a>, including time spent eating, tending to the infant’s sleeping schedule or other care needs; a need to baby-proof surroundings; or weather and other environmental concerns.</p>
<h2>How to support infant movement</h2>
<p>Fortunately there are many ways to break down these barriers – and none requires buying expensive baby gear. </p>
<ul>
<li><p>Encourage tummy time: Two to three times a day, place an awake infant <a href="https://www.healthychildren.org/English/ages-stages/baby/sleep/Pages/Back-to-Sleep-Tummy-to-Play.aspx">on their tummy</a> for a few minutes, and then play and engage with them. This is the primary method of supporting movement for infants who are <a href="https://doi.org/10.1542/peds.2019-2168">not yet mobile</a>. </p></li>
<li><p>Explore movement together: Doing activities that help infants <a href="https://doi.org/10.1123/krj.2.4.221">learn about movement</a>, such as bouncing the child on one’s lap and <a href="https://www.alabamapublichealth.gov/healthystart/assets/PhysicalActivityPresentation.pdf">singing and playing patty-cake or peekaboo</a>, can encourage infants to move. Infants also watch what the adults around them do – including how active they are! In one of our studies, many mothers reported <a href="https://doi.org/10.1186/s12889-017-4503-5">being physically active themselves</a>, but few realized it was <a href="https://doi.org/10.1186/s12966-020-00966-z">important to role-model</a> regular physical activity for infants. </p></li>
<li><p>Create safe play space: As infants <a href="https://www.healthychildren.org/English/ages-stages/baby/Pages/Movement-4-to-7-Months.aspx">learn to move</a> and get better at controlling their feet and hands, even normal household objects, such as small items they can shove into their mouths and choke on, become potential hazards requiring adult intervention. Protect them by clearing clutter and removing potentially dangerous objects from a space that’s at least <a href="https://www.healthychildren.org/English/healthy-living/growing-healthy/Pages/baby-activity.aspx">5 feet by 7 feet</a>.</p></li>
<li><p>No equipment? No problem!: It doesn’t take new or costly gear to encourage infant movement. Use things around the house: Pillows can be piled into a “mountain” to crawl over. Mixing bowls and measuring cups can double as toys. Adults can also turn their own bodies into an infant climbing gym. For example, sit on the floor with legs spread out and encourage the infant to pull themselves up or crawl over them.</p></li>
<li><p>Get outside: National guidelines recommend <a href="http://nrckids.org/CFOC/Database/3.1.3.1">taking infants outside two to three times per day</a>, weather permitting. Our research suggests children are more physically active <a href="https://doi.org/10.1080/1350293X.2019.1579550">when they play in parks</a>, playgrounds and other open areas that allow for gross motor activities like crawling and walking. The <a href="https://doi.org/10.1080/00094056.2016.1251793">benefits of active outdoor play</a> may also include improved self-control, attention, communication and social development. </p></li>
</ul>
<p>To help motivate us, my family is taking the <a href="https://www.1000hoursoutside.com/">1,000 Hours Outside</a> challenge, a project encouraging both kids and adults to spend at least as much time outdoors as we do staring at screens.</p>
<p>[<em>Over 150,000 readers rely on The Conversation’s newsletters to understand the world.</em> <a href="https://memberservices.theconversation.com/newsletters/?source=inline-150ksignup">Sign up today</a>.]</p>
<p>Finally, it need not be up to parents alone. Research has linked social support by <a href="https://www.mdpi.com/2227-9067/6/10/115">siblings and peers</a>, <a href="https://doi.org/10.1177/1356336X19835240">child care providers</a> and <a href="https://doi.org/10.1186/1479-5868-10-68">teachers</a> with increased physical activity in children. </p>
<p>Trust me: As both a physical activity researcher and a working mother of three, including an 11-month-old just learning to walk, I can attest that when adults and older children play with my baby, it gives me an opportunity to accomplish something on my to-do list, and provides my infant with more opportunities to enjoy moving.</p><img src="https://counter.theconversation.com/content/173975/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Danae Dinkel receives funding from the National Institutes of Health. </span></em></p>Even babies who are not yet standing or walking get lots of benefits from active movement – but most infants aren’t getting enough physical activity.Danae Dinkel, Associate Professor, Department of Health and Kinesiology, University of Nebraska OmahaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1560082021-03-01T14:16:35Z2021-03-01T14:16:35ZWhy breastfed babies have improved immune development – new findings<figure><img src="https://images.theconversation.com/files/386995/original/file-20210301-17-65q5na.jpg?ixlib=rb-1.1.0&rect=40%2C0%2C6669%2C4476&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Our study revealed breastfed babies had twice the number of regulatory T cells.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/serious-calm-careful-young-black-mom-1426845311">SeventyFour/ Shutterstock</a></span></figcaption></figure><p>Life outside the womb is tough – not least because of the many bacteria, viruses, and other pathogens that can harm a baby. Not only does a baby’s immune system need to be able to recognise and eliminate pathogens, it also needs to be able to distinguish harmless substances and helpful bacteria important for health – such as those in our gut microbiome, which help break down foods and protect us from pathogens. </p>
<p><a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)01024-7/fulltext">Breastfeeding</a> is known to be important for a baby’s immune development, and is also linked to numerous long-term health benefits, such as lower rates of obesity, asthma and autoimmune disorders compared to those who were formula fed. But until recently, researchers haven’t quite known why the immune systems of breastfed babies are better equipped compared to formula-fed infants.</p>
<p>Our <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/all.14736">latest study</a> may have the answer. We found that breastfeeding is important for helping babies to develop important immune cells in their first weeks of life. These immune cells, known as regulatory T cells, provide balance in the immune system by controlling its response to pathogens, and preventing autoimmune responses (where the immune system mistakenly attacks your body).</p>
<p>We studied blood and stool samples from a cohort of 38 healthy mother and baby pairs. All babies in the study were born by elective Caesarean section and samples were taken at birth and at three weeks of life.</p>
<p>We found that the population of regulatory T cells was nearly twice as abundant in breastfed babies at three weeks of age compared to babies who were formula-fed. This shows that these babies’ immune systems are better equipped to know which pathogens they should attack and which pathogens are harmless to the body. We demonstrated that this change is likely to be driven by interaction with the mother’s cells during breastfeeding.</p>
<figure class="align-center ">
<img alt="An image of regulatory T cells." src="https://images.theconversation.com/files/386996/original/file-20210301-19-bpwqbi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/386996/original/file-20210301-19-bpwqbi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=360&fit=crop&dpr=1 600w, https://images.theconversation.com/files/386996/original/file-20210301-19-bpwqbi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=360&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/386996/original/file-20210301-19-bpwqbi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=360&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/386996/original/file-20210301-19-bpwqbi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=452&fit=crop&dpr=1 754w, https://images.theconversation.com/files/386996/original/file-20210301-19-bpwqbi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=452&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/386996/original/file-20210301-19-bpwqbi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=452&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Regulatory T cells balance the immune system.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-illustration/tregt-lymphocytest-cells-3d-render-1233772858">ratlos/ Shutterstock</a></span>
</figcaption>
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<p>During pregnancy, the immune systems of the mother and baby are known to interact via cells moving through the placenta. Our results show that their immune systems continue interacting after birth via breastfeeding. We uncovered this by isolating immune cells from both the mother and baby, and growing them together in the lab. </p>
<p>The baby’s cells were less likely to see the mother’s cells as foreign if the baby was breastfed compared to formula-fed – an effect mediated by regulatory T cells. This means that the baby’s immune system “tolerates” these maternal cells from breastmilk and does not launch an immunological reaction, like it would do with any other foreign cell.</p>
<p>The early development of regulatory T cells is likely to be a key element in effective immune function in later life. This response is essential in <a href="https://www.jacionline.org/article/S0091-6749(16)30499-7/abstract">preventing allergies</a>, where the immune system mounts an undesirable response against harmless substances, and decreasing the risk of <a href="https://www.sciencedirect.com/science/article/abs/pii/S0896841120300779">autoimmune disorders</a>, where the immune system reacts against the body’s own cells. </p>
<p>Regulatory T cells are also of great importance in <a href="https://www.sciencedirect.com/science/article/abs/pii/S1044532311001540?via%3Dihub">building an effective gut microbiome</a>, which evolves gradually after birth. If the immune system eliminated, rather than tolerated, these gut microbes in early life, several of their beneficial health effects would be hindered. For example, this could lead to digestive problems, or could increase the risk of intestinal infections.</p>
<p>We also examined the composition of the gut microbiome in stool samples collected from babies at three weeks of age to understand how it is linked with immune development. We found subtle but important differences between breastfed and formula-fed babies. Two distinct bacterial strains, <em>Veillonella</em> and <em>Gemella</em>, were more abundant in samples of breastfed babies. These strains are known to produce short-chain fatty acids which are essential for the <a href="https://www.nature.com/articles/nature12726">development and normal function</a> of regulatory T cells. Greater presence of these strains in the gut may contribute to regulatory T cells being more abundant in blood samples of breastfed babies. </p>
<p>Although the number of participants in our study may appear small, we worked with a unique cohort of babies, creating the largest study of its kind to date. But our study also had some other shortcomings. For instance, we only followed up participants up to three weeks of life. It will be interesting to see in future studies how long the observed changes are present for in the immune system, and whether the number of regulatory T cells equalises in later life between breastfed and formula-fed babies. </p>
<p>And while we intentionally studied babies born by Caesarean section to observe a group exposed to as similar birthing conditions as possible, it will also be interesting for future studies to see whether our observations are also true for babies born by normal delivery.</p>
<p>While breastfeeding is recommended for infant nutrition by the <a href="https://www.who.int/health-topics/breastfeeding#tab=tab_1">World Health Organization</a>, there are of course many reasons why a mother may need to formula-feed her baby. And in most developed countries, this alternative is safe for babies, and the composition of many infant formulas is frequently changed to be as close to breastmilk as possible. Although it’s unlikely that breastmilk can ever be fully mimicked, research like ours may help to guide the tailoring of formula milk to offer better health advantages to all babies.</p><img src="https://counter.theconversation.com/content/156008/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Gergely Toldi does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Until now, researchers haven’t quite known why the immune systems of breastfed babies are better equipped.Gergely Toldi, Consultant Neonatologist, University of BirminghamLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1554432021-02-22T13:26:06Z2021-02-22T13:26:06ZHow safe is your baby food?<figure><img src="https://images.theconversation.com/files/385363/original/file-20210219-19-p33c1o.jpg?ixlib=rb-1.1.0&rect=92%2C423%2C4552%2C2996&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">One study found that 95% of baby foods tested contained at least one heavy metal.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/baby-being-fed-royalty-free-image/522813035">Plume Creative via Getty Images</a></span></figcaption></figure><p>Heavy metals including lead, arsenic and mercury can be found in commercial baby foods at levels well above what the federal government considers safe for children, a new <a href="https://oversight.house.gov/sites/democrats.oversight.house.gov/files/2021-02-04%20ECP%20Baby%20Food%20Staff%20Report.pdf">congressional report</a> warns.</p>
<p>Members of Congress asked seven major baby food makers to hand over test results and other internal documents after a <a href="https://www.healthybabyfood.org/sites/healthybabyfoods.org/files/2019-10/BabyFoodReport_FULLREPORT_ENGLISH_R5b.pdf">2019 report</a> found that, out of 168 baby food products, 95% contained at least one heavy metal. Foods with rice or root vegetables, like carrots and sweet potatoes, had some of the highest levels, but they weren’t the only ones. </p>
<p>How concerned should parents be and what can they do to reduce their child’s exposure?</p>
<p>As a professor and pharmacist, I have investigated health safety concerns for several years <a href="https://doi.org/10.1177/1060028019881692">in drugs</a> and <a href="https://doi.org/10.1177/1060028019900504">dietary supplements</a>, including contamination with heavy metals and the chemical <a href="http://doi.org/10.1001/jamanetworkopen.2020.35158">NDMA</a>, a likely carcinogen. Here are answers to four questions parents are asking about the risks in baby food.</p>
<h2>How do heavy metals get into baby food?</h2>
<p>Heavy metals come from the natural erosion of the <a href="http://doi.org/10.1155/2011/870125">Earth’s crust</a>, but humans have dramatically accelerated environmental exposure to heavy metals, as well. </p>
<p>As <a href="https://www.eia.gov/energyexplained/coal/coal-and-the-environment.php">coal</a> is burned, it releases heavy metals into the air. Lead was commonly found in gasoline, paint, pipes and pottery glazes for decades. A pesticide with both <a href="http://doi.org/10.1289/ehp.114-a470">lead and arsenic</a> was widely used on crops and in orchards until it was banned in 1988, and phosphate-containing fertilizers, including organic varieties, still contain small amounts of <a href="https://doi.org/10.1007/BF00747683">cadmium, arsenic, mercury and lead.</a> </p>
<p>These heavy metals still contaminate soil, and irrigation can expose more soil to heavy metals in water.</p>
<p>When food is grown in contaminated soil and irrigated with water containing heavy metals, the food becomes contaminated. Additional heavy metals can be introduced during manufacturing processes.</p>
<p>The United States has made major strides to reduce the use of fossil fuels, filter pollutants and remove lead from many products such as gasoline and paint. This reduced exposure to <a href="https://www.epa.gov/air-trends/lead-trends">lead in the air</a> by 98% from 1980 to 2019. Processes can now also remove a proportion of the heavy metals from <a href="http://doi.org/10.1016/j.chemosphere.2019.04.198">drinking water</a>. However, the heavy metals that accumulated in the soil over the decades is an ongoing problem, especially in <a href="http://doi.org/10.1021/es400521h">developing countries</a>. </p>
<h2>How much heavy metal is too much?</h2>
<p>The <a href="https://apps.who.int/food-additives-contaminants-jecfa-database/search.aspx">World Health Organization</a> and the <a href="https://www.fda.gov/food/metals-and-your-food/survey-data-lead-womens-and-childrens-vitamins">Food and Drug Administration</a> have defined tolerable daily intakes of heavy metals. However, it’s important to recognize that for many heavy metals, including lead and arsenic, there is no daily intake that is completely devoid of long-term health risk.</p>
<p>For lead, the FDA considers 3 micrograms per day or more to be cause for concern <a href="https://www.fda.gov/food/metals-and-your-food/lead-food-foodwares-and-dietary-supplements">in children</a>, well below the level for adults (12.5 micrograms per day).</p>
<p>Young children’s bodies are smaller than adults, and lead can’t be <a href="http://doi.org/10.1515/intox-2015-0009">stored as readily in the bone</a>, so the same dose of heavy metals causes much greater blood concentrations in young children where it can do more damage. In addition, young brains are more rapidly developing and are therefore at greater risk of neurological damage.</p>
<figure class="align-center ">
<img alt="Baby food jars" src="https://images.theconversation.com/files/385364/original/file-20210219-23-8bp35z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/385364/original/file-20210219-23-8bp35z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=404&fit=crop&dpr=1 600w, https://images.theconversation.com/files/385364/original/file-20210219-23-8bp35z.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=404&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/385364/original/file-20210219-23-8bp35z.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=404&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/385364/original/file-20210219-23-8bp35z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=507&fit=crop&dpr=1 754w, https://images.theconversation.com/files/385364/original/file-20210219-23-8bp35z.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=507&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/385364/original/file-20210219-23-8bp35z.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=507&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Root vegetables, such as sweet potatoes and carrots, have some of the highest levels of heavy metals.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/hand-spooning-baby-food-royalty-free-image/95468925">Tetra Images via Getty Images</a></span>
</figcaption>
</figure>
<p>These lead levels are <a href="https://www.fda.gov/food/metals-and-your-food/lead-food-foodwares-and-dietary-supplements">about one-tenth</a> of the dose needed to achieve a blood lead concentration associated with major neurological problems, including the development of behavioral issues like aggression and attention deficit disorder. That doesn’t mean lower doses are safe, though. Recent research shows that <a href="http://doi.org/10.1515/intox-2015-0009">lower blood lead levels</a> still impact neurological function, just not as dramatically.</p>
<p>For other heavy metals, the daily intake considered tolerable is based on <a href="https://apps.who.int/food-additives-contaminants-jecfa-database/search.aspx">body weight</a>: mercury is 4 micrograms per kilogram of body weight; arsenic is not currently defined but before 2011 it was 2.1 micrograms per kilogram of body weight. </p>
<p>Like with lead, there is a considerable safety margin between the tolerable dose and the dose that poses high risk of causing neurological harm, <a href="http://doi.org/10.1515/intox-2015-0009">anemia</a>, <a href="http://doi.org/10.1155/2011/870125">liver and kidney damage and an increased risk of cancer</a>. But even smaller amounts still carry risks.</p>
<p>One example of the exposure infants can face is a <a href="https://www.healthybabyfood.org/sites/healthybabyfoods.org/files/2019-10/BabyFoodReport_FULLREPORT_ENGLISH_R5b.pdf">brand of carrot baby food</a> found to have 23.5 parts of lead per billion, <a href="http://www.endmemo.com/sconvert/ppbug_g.php">equivalent</a> to 0.67 micrograms of lead per ounce. Since the average 6-month-old eats 4 ounces of vegetables a day, that would be 2.7 micrograms of lead a day – almost the maximum tolerable daily dose.</p>
<h2>What can parents do to reduce a child’s exposure?</h2>
<p>Since the amount of heavy metals varies so dramatically, food choices can make a difference. Here are a few ways to reduce a young child’s exposure.</p>
<p>1) Minimize the use of <a href="https://www.fda.gov/regulatory-information/search-fda-guidance-documents/guidance-industry-action-level-inorganic-arsenic-rice-cereals-infants?">rice-based products</a>, including rice cereal, puffed rice and rice-based teething biscuits. Switching from rice-based products to those made with oats, corn, barley or quinoa could reduce the ingestion of arsenic by 84% and total heavy metal content <a href="https://www.healthybabyfood.org/sites/healthybabyfoods.org/files/2019-10/BabyFoodReport_FULLREPORT_ENGLISH_R5b.pdf">by about 64%</a>, according to the study of 168 baby food products by the group Healthy Babies Bright Futures.</p>
<p>Using frozen banana pieces or a clean washcloth instead of a rice cereal based teething biscuit was found to reduce the total heavy metal exposure <a href="https://www.healthybabyfood.org/sites/healthybabyfoods.org/files/2019-10/BabyFoodReport_FULLREPORT_ENGLISH_R5b.pdf">by about 91%</a>.</p>
<p>2) Switch from fruit juices to water. Fruit juice is not recommended for small children because it is laden with sugar, but it also is a source of heavy metals. Switching to water could reduce the intake of heavy metals <a href="https://www.healthybabyfood.org/sites/healthybabyfoods.org/files/2019-10/BabyFoodReport_FULLREPORT_ENGLISH_R5b.pdf">by about 68%</a>, according to the report.</p>
<p>3) Alternate between root vegetables, such as carrots and sweet potatoes, and other vegetables. The roots of plants are in closest contact with the soil and have higher concentrations of heavy metals than other vegetables. Switching from carrots or sweet potatoes to other vegetables could decrease the total heavy metal content on that day <a href="https://www.healthybabyfood.org/sites/healthybabyfoods.org/files/2019-10/BabyFoodReport_FULLREPORT_ENGLISH_R5b.pdf">by about 73%</a>. Root vegetables have vitamins and other nutrients, so you don’t have to abandon them altogether, but use them sparingly.</p>
<p>Making your own baby food may not reduce your child’s exposure to heavy metals. It depends on the heavy metal dosage in each of the ingredients that you are using. Organic may not automatically mean the heavy metal content is lower because soil could have been contaminated for generations before its conversion, and neighboring farm water runoff could contaminate common water sources.</p>
<h2>Is anyone doing anything about it?</h2>
<p>The <a href="https://oversight.house.gov/sites/democrats.oversight.house.gov/files/2021-02-04%20ECP%20Baby%20Food%20Staff%20Report.pdf">congressional report</a> calls for the FDA to <a href="https://www.fda.gov/food/cfsan-constituent-updates/fda-response-questions-about-levels-toxic-elements-baby-food-following-congressional-report">better define acceptable limits</a> for heavy metals in baby food. It points out that the heavy metal levels found in some baby foods far exceed the maximum levels allowed in bottled water. It also recommends standards for testing in the industry, and suggests requiring baby food makers to report heavy metals amounts on their product labels so parents can make informed choices.</p>
<p>Baby food manufacturers are also discussing the issue. The <a href="https://www.edf.org/media/baby-food-council-taking-challenge-reducing-heavy-metals-young-kids-food">Baby Food Council</a> was created in 2019 to bring together major infant and toddler food companies and advocacy and research groups with the goal of reducing heavy metals in baby food products. They created a <a href="https://foodscience.cals.cornell.edu/industry-partnership-program/cifs-ipp-councils/">Baby Food Standard and Certification Program</a> to work collaboratively on testing and certification of raw ingredients. Ultimately, baby food makers will need to consider changing farm sources of raw ingredients, using fewer seasonings and altering processing practices.</p>
<p>The U.S. has made important inroads in reducing heavy metals in air and water since the 1980s, dramatically lowering exposure. With additional focus, it can further reduce heavy metal exposure in baby food, too.</p>
<p>[<em>Understand new developments in science, health and technology, each week.</em> <a href="https://theconversation.com/us/newsletters/science-editors-picks-71/?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=science-understand">Subscribe to The Conversation’s science newsletter</a>.]</p><img src="https://counter.theconversation.com/content/155443/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>C. Michael White does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Reports from baby food companies show questionable levels of arsenic, lead and other heavy metals. Here’s what parents need to know.C. Michael White, Distinguished Professor and Head of the Department of Pharmacy Practice, University of ConnecticutLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1496812020-12-07T15:27:45Z2020-12-07T15:27:45ZThe rise of commercial milk formulas matters for women and children<figure><img src="https://images.theconversation.com/files/369277/original/file-20201113-21-4pdes4.jpg?ixlib=rb-1.1.0&rect=46%2C0%2C5184%2C3453&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Infant formula sales have doubled between 2005 and 2019.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/preparation-mixture-baby-feeding-on-wooden-554077681">279photo Studio/ Shutterstock</a></span></figcaption></figure><p><a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)00210-5/fulltext">Breastfeeding</a> can play an especially important role in early-life nutrition. It can <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6486667/">benefit</a> children’s future school performance and economic prospects in later life, as well as the mother’s health. </p>
<p>Health authorities across the world endorse the World Health Organization’s (WHO) <a href="https://www.who.int/health-topics/breastfeeding#tab=tab_2">recommendation</a> that newborns should where possible exclusively breastfeed from the first hour of life until six months of age, and thereafter receive safe and nutritious foods with continued breastfeeding up to two years of age or beyond.</p>
<p>Despite this, our <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/mcn.13097">recent study</a> shows that global commercial milk formula sales are booming. Between 2005 and 2019, world milk formula sales more than doubled from 3.5kg to 7.4kg per child. Total sales grew from 1 million tonnes to 2.1 million tonnes.</p>
<p>This growth in sales was seen in all types of formula, including “standard” formula for infants (0-6 months), “follow-up” formula (7-12 months), toddler milks (13-36 months), and so-called “specialised” formulas. So more children from a wider range of age groups are consuming formula. </p>
<p>Rapid growth <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/mcn.13097">has occurred</a> in many highly-populated countries, including the Middle East, north Africa, eastern Europe, central Asia, and parts of Latin America. The most remarkable growth has been in east and south-east Asia. China, in particular, accounted for only 14% of global formula sales in 2005 – but now accounts for 33% of all sales. </p>
<p>In south Asia and west and central Africa, the amount sold to each customer remains low and show no signs of growth. In Europe and North America, although per customer sales volumes remain high, they plateaued or slightly decreased between 2005-2019. </p>
<h2>Behind the sales ‘boom’</h2>
<p>There are <a href="https://www.who.int/nutrition/publications/infantfeeding/WHO_NMH_NHD_09.01/en/">medical reasons</a> for using safe and adequate breastmilk substitutes. And some women find continuing breastfeeding difficult depending on their circumstances, and may use formula as an alternative or complement to breastfeeding. <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/mcn.13097">Our study</a> also shows decisions and practices around formula use can be strongly shaped by wider societal forces, such as commercial marketing, rather than individual choice.</p>
<p>It’s known that milk formula sales increase as countries become richer and more urbanised, and as more mothers enter into formal employment. Asia’s formula sales boom may be partly explained by millions of women entering the paid workforce, especially in the region’s vast manufacturing zones.</p>
<p>Millions of women worldwide also lack adequate <a href="https://www.who.int/bulletin/volumes/98/6/19-229898/en/">paid maternity leave and social protection</a>. This means the decision to formula feed may only be done out of necessity, to avoid losing employment and income. We also know that many hospitals and healthcare settings aren’t equipped to help women establish breastfeeding, with few maternal and newborn care facilities worldwide meeting <a href="https://www.who.int/nutrition/publications/infantfeeding/bfhi-implementation/en/">standards</a> of care for breastfeeding mothers and newborns.</p>
<p>Commercial factors are also important. Just five companies control 57% of the global formula milk industry, worth US$56.6 billion (£42.5 billion) The industry spends <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/mcn.13097">an estimated US$5 billion on marketing every year</a>, which <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/mcn.12962">powerfully shapes social norms</a> about <a href="https://pubmed.ncbi.nlm.nih.gov/26314734/">feeding babies and children</a>. </p>
<p>Marketing messages can portray formula as modern, scientific and comparable or superior to breastmilk. The growth of social media enables companies to <a href="https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-020-00597-w#:%7E:text=Formula%20marketing%2C%20as%20for%20other,a%20brand%20and%20generic%20level.">target mothers</a> with personalised product offerings and ads.</p>
<p>Hospitals are a key marketing channel, too. Companies often engage health professionals to promote formula feeding. In many countries, health professionals are directly compensated to promote formula. But more commonly, companies influence health professionals indirectly by <a href="https://pubmed.ncbi.nlm.nih.gov/31401600/">sponsoring</a> their associations, conferences and education.</p>
<figure class="align-center ">
<img alt="A grocery store aisle full of baby and toddler formula products." src="https://images.theconversation.com/files/369278/original/file-20201113-23-cn8j5l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/369278/original/file-20201113-23-cn8j5l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=382&fit=crop&dpr=1 600w, https://images.theconversation.com/files/369278/original/file-20201113-23-cn8j5l.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=382&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/369278/original/file-20201113-23-cn8j5l.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=382&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/369278/original/file-20201113-23-cn8j5l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=481&fit=crop&dpr=1 754w, https://images.theconversation.com/files/369278/original/file-20201113-23-cn8j5l.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=481&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/369278/original/file-20201113-23-cn8j5l.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=481&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Companies cross-promote products by using the same packaging.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/toronto-canada-november-22-2014-baby-233666974">ValeStock/ Shutterstock</a></span>
</figcaption>
</figure>
<p>Companies also <a href="https://www.who.int/nutrition/publications/infantfeeding/information-note-cross-promotion-infant-formula/en/#:%7E:text=In%20summary%2C%20the%20now%20common,to%20breastfeeding%20and%20infant%20health.&text=As%20a%20result%2C%20young%20infants,cannot%20meet%20their%20nutritional%20needs.">cross-promote</a> their entire product range of follow-up and toddler milks by using packing and labelling that resembles standard infant formula. This allows companies to get around the stricter prohibitions on infant formula marketing.</p>
<p>Marketing regulations are also important. The fact that formula sales are booming in China but have flat-lined at low levels in India partly reflects contrasting regulatory environments – with regulations on marketing being stricter and more comprehensive in India. </p>
<p>Despite <a href="https://www.unicef.org.uk/babyfriendly/baby-friendly-resources/international-code-marketing-breastmilk-substitutes-resources/the-code/">an international code</a> to stop <a href="https://www.who.int/nutrition/publications/infantfeeding/breastmilk-substitutes-FAQ2017/en/">aggressive and inappropriate marketing</a> of breast-milk substitutes, most governments haven’t fully incorporated it <a href="https://www.who.int/publications/i/item/9789240006010">into law</a>. And even when laws exist, marketing violations by formula companies often go unpunished. The formula industry has also been able to lobby against any strengthening of regulation, partly by promoting their own – much weaker – corporate policies on marketing.</p>
<h2>Health concerns</h2>
<p>Breastmilk and breastfeeding where it is possible has numerous advantages over formula and bottle feeding – which is why the growth of formula sales is concerning.</p>
<p>Breastfeeding has been shown to reduce the likelihood of children developing infections, and reduces a child’s risk of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6735804/#:%7E:text=Globally%2C%20595%20379%20childhood%20deaths,type%20II%20diabetes%20each%20year">developing chronic disease like obesity and diabetes</a> later in life. Breastfeeding is also associated with lower risk of developing <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)01024-7/fulltext">breast and cervical cancer, or diabetes</a> among mothers.</p>
<p>Rising consumption of formula milk by toddlers and young children is also a worry, as these products are often <a href="https://theconversation.com/the-rise-of-ultra-processed-foods-and-why-theyre-really-bad-for-our-health-140537#:%7E:text=We%20found%20that%20more%20ultra,%2C%20salt%20and%20trans%2Dfats.">ultra-processed</a>, expensive, loaded with sugar and can introduce <a href="https://www.vichealth.vic.gov.au/media-and-resources/media-releases/high-sugar-toddler-milks-overpriced-harmful">poor dietary habits</a>. Their increased use could further contribute to increases of overweight and obese children globally.</p>
<p>Formula isn’t a sterile product and can be dangerous when prepared in unhygienic conditions, or when over-diluted or over-concentrated. It lacks the immune-boosting and other important elements of breastmilk, further increasing the risk of malnutrition and infectious illness. As a result, universal breastfeeding in place of formula use could prevent an estimated <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)01024-7/fulltext">823,000 child deaths every year</a> (mainly in low- and middle-income countries), including 595,000 deaths from diarrhoea and pneumonia, and an estimated 20,000 maternal deaths from breast cancer (mainly in high income countries).</p>
<p>The global surge in formula sales is clearly a problem for global health. Given the power of the corporate milk formula industry to influence behaviour and understanding, more needs to be done to ensure that all mothers and children are protected from inappropriate promotion, and that they are enabled to breastfeed as long as they want to. This means <a href="https://www.who.int/nutrition/netcode/en/">strengthening laws</a> that ban harmful marketing practices, expanding access to paid maternity leave, and ensuring that all <a href="https://www.who.int/nutrition/publications/guidelines/breastfeeding-facilities-maternity-newborn/en/">healthcare facilities</a> meet global standards.</p><img src="https://counter.theconversation.com/content/149681/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>David McCoy has recently received funding from the World Health Organization to conduct research on infant and young child feeding. He is also involved in a WHO-sponsored study on the marketing of breastmilk substitutes in the UK. He is a member of Medact, a UK-based charity that works on the upstream determinants of global health; and a Fellow of the UK Faculty of Public Health, the professional association for public health specialists, which supports implementation of the International Code of Marketing of Breastmilk Substitutes. </span></em></p><p class="fine-print"><em><span>Julie P. Smith receives funding from the Australian Research Council and the Australian National University Gender Institute. She has led consultancies on breastfeeding for the World Health Organization and the Australian Department of Health. She is a member of the Australian Breastfeeding Association and the Animal Justice Party. </span></em></p><p class="fine-print"><em><span>Phillip Baker currently receives funding from the World Health Organization to conduct research on infant and young child feeding. He has received funding from the Food and Agricultural Organization, World Bank, UNICEF, Department of Foreign Affairs and Trade, and the Australian Research Council. He is a member of the Independent Expert Group of the Global Nutrition Report. The findings of the research reported in this article, and the views expressed, are his alone and not necessarily those of the above organisations.</span></em></p>Industry marketing can shape beliefs about formula feeding.David McCoy, Professor of Global Public Health, Queen Mary University of LondonJulie P. Smith, Honorary Associate Professor, Australian National UniversityPhillip Baker, Research Fellow, Institute for Physical Activity and Nutrition, Deakin University, Deakin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1476392020-10-19T13:11:31Z2020-10-19T13:11:31ZBabies born by caesarean develop slower in first year than those born naturally – new findings<figure><img src="https://images.theconversation.com/files/364224/original/file-20201019-21-1n44odd.jpg?ixlib=rb-1.1.0&rect=16%2C16%2C5557%2C3694&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Babies born via caesarean had lower scores in fine motor skills and communication.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/baby-girl-playing-educational-toy-nursery-372315763">Oksana Kuzmina/ Shutterstock</a></span></figcaption></figure><p>The number of caesarean sections being performed globally every year <a href="https://doi.org/10.1371/journal.pone.014834">is increasing</a>. But while caesarean sections can be lifesaving for both mother and baby, an increasing number of them aren’t being performed for a medical reason. </p>
<p>Fear of pain, and misconceptions that caesarean sections are safe for the baby and more convenient are just <a href="https://doi.org/10.1371/journal.pone.0148343">some of the reasons</a> women may opt to have one. But there are of course risks with having one – and our <a href="https://doi.org/10.1186/s12884-020-03253-8">recently published study</a> found that planned caesarean sections appear to have a negative impact on the baby’s development between four and 12 months of age compared to babies born naturally.</p>
<p>We looked at 66 babies born by planned caesarean section and compared them with 352 babies born vaginally. The babies were enrolled at birth and the first evaluation of their development was performed at four months. We then followed up when they were 12 months. To understand the impact the delivery method has on the infant’s development, we had parents answer questions using the “ages and stages questionnaire”. </p>
<p>This questionnaire and contains 30 questions that score infant development in five areas: communication, fine motor skills, <a href="https://www.understood.org/en/learning-thinking-differences/child-learning-disabilities/movement-coordination-issues/all-about-gross-motor-skills">gross motor skills</a>, problem solving and personal social ability. So for example, at four months of age, the questionnaire asked parents whether their baby grabs or scratches their clothes, or if the baby looks at the toy when it’s put in their hand. This questionnaire has been shown to have good correlation with developmental testing performed by medical professionals, and is commonly used by both researchers and child health care centres.</p>
<p>We found that babies born via planned caesarean section had poorer scores in all five developmental areas at four months of age. The largest differences were noticed in fine motor skills, while the smallest differences were reported in communication as compared to vaginally born babies. However, at 12 months of age, these differences diminished for all but gross motor skills (such as whether the baby could walk with or without support) which remained better in vaginally born babies.</p>
<figure class="align-center ">
<img alt="Mother holds baby's hands to help them walk." src="https://images.theconversation.com/files/364225/original/file-20201019-21-tknh5u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/364225/original/file-20201019-21-tknh5u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/364225/original/file-20201019-21-tknh5u.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/364225/original/file-20201019-21-tknh5u.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/364225/original/file-20201019-21-tknh5u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/364225/original/file-20201019-21-tknh5u.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/364225/original/file-20201019-21-tknh5u.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Differences in gross motor skills remained at 12 months.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/family-child-childhood-parenthood-concept-happy-516706894">Syda Productions/ Shutterstock</a></span>
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<p>Our findings are in line with previous research from <a href="http://dx.doi.org/10.1007/s00127-019-01798-4">the UK</a>, <a href="https://doi.org/10.1016/j.earlhumdev.2018.12.021">the US</a>, <a href="https://doi.org/10.1186/s12884-017-1304-x">Sweden</a>, <a href="https://doi.org/10.1542/peds.2016-2002">and</a> <a href="https://www.nature.com/articles/s41598-017-10831-y">Australia</a>, which have all shown that children born via planned caesarean section have a small, elevated risk of poor development and/or performance at school age. Other studies have found that babies born by planned caesarean have an increased risk of <a href="https://doi.org/10.1136/bmj.39405.539282.BE">breathing problems</a> after birth, and an increased risk of <a href="https://www.bmj.com/content/350/bmj.h2410">childhood obesity, asthma and diabetes</a>. </p>
<p>But one problem when studying child development is that many factors – such as when the tests were performed, and the mother’s age and weight – can impact the results. In the vaginally born group, the tests were performed two days later at the four months testing, and three days later at the 12 months testing. As such, we had to adjust for this in the study. This reduced the difference between the groups, especially at 12 months. </p>
<p>The mothers who had a caesarean section were also on average 1.9 years older and had a higher body mass index (BMI). But these differences did not affect the baby’s development. The relatively small sample size in the caesarean section group was another limitation of the study.</p>
<h2>Brain development</h2>
<p>One explanation for the differences that we found may be because of how caesarean sections change the way the baby adapts its blood circulation and breathing to live outside the mother’s womb. Babies born via caesarean aren’t subjected to the <a href="https://doi.org/10.1111/apa.13615">strain or stress</a> of vaginal delivery. This stress helps the baby to adapt its circulation and breathing outside the womb. </p>
<p>Vaginal birth also seems to <a href="https://doi.org/10.1111/j.1651-2227.2009.01371.x">programme the genes</a> of the baby through the process of DNA‐methylation. <a href="https://theconversation.com/difficult-childhood-experiences-could-make-us-age-prematurely-new-research-102807">DNA-methylation</a> is part of the system which directs which genes are switched “on” in the body, and which are “off”. Researchers don’t yet know why this process doesn’t take place the same way during a caesarean section.</p>
<p>The baby also doesn’t come into contract with the <a href="http://dx.doi.org/10.1136/gutjnl-2012-303249">mother’s natural bacterial flora</a> during a caesarean. In recent years it’s been shown that gut bacteria <a href="https://doi.org/10.1111/jcpp.13156">affect development</a> as well as behaviour through the so-called “<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4367209/">gut-brain axis</a>”. </p>
<p>While our research shows that birth method can affect early brain development, <a href="https://www.cdc.gov/ncbddd/childdevelopment/early-brain-development.html">other factors</a> such as genetics, nutrition and the child’s experiences all have an impact too. Even the <a href="https://theconversation.com/why-we-should-be-concerned-with-the-rise-and-rise-of-early-planned-births-68427">timing for planned caesarean sections</a> is crucial. These operations are usually booked ten to 14 days before the due date so women don’t spontaneously go into labour.</p>
<p>In our study, babies born via caesarean were delivered on average 8.4 days earlier compared to babies born naturally. So the difference in questionnaire scores could be due to earlier delivery. Waiting a few more days before performing a planned caesarean may improve scores. Currently, there’s <a href="https://doi.org/10.1016/j.wombi.2019.06.011">no consensus among obstetricians</a> on optimal timing of caesareans. However, <a href="https://doi.org/10.1542/peds.2016-2002">one study</a> of 153,730 infants found that development was affected in all children born before week 39 – with the effect more pronounced in babies born via caesarean section.</p>
<p>Our study adds to the growing body of evidence highlighting the potential negative effects of non-essential planned caesareans. And though our study was small, these findings do show development differences evident even as early as four months. More research will be needed to confirm if these findings are shown on a larger scale, and if any developmental differences persist after 12 months. </p>
<p>Mothers requiring a caesarean for medical reasons shouldn’t worry as these are performed to protect their health, and the health of their child. It’s also important to remember that many factors affect development – including nutrition, childhood experiences and genetics – which are all key in helping babies keep up with others their age.</p><img src="https://counter.theconversation.com/content/147639/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ola Andersson has research grants from Swedish Society of Medical Research and Swedish Society of Medicine. </span></em></p><p class="fine-print"><em><span>Mehreen Zaigham receives funding from the Medical Faculty of Lund University (ALF). </span></em></p>Our study joins a growing body of evidence that suggests caesarean sections may have more consequences than previously thought.Ola Andersson, Associate professor, Neonatologist, Lund University/Skåne University Hospital, Lund UniversityMehreen Zaigham, Postdoctoral Research Fellow, Obstetric & Gynecology, Skåne University Hospital, Lund UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1431832020-09-23T19:58:37Z2020-09-23T19:58:37ZI regret stopping breastfeeding. How do I start again?<figure><img src="https://images.theconversation.com/files/359483/original/file-20200923-24-5kjiuy.jpg?ixlib=rb-1.1.0&rect=0%2C1%2C998%2C658&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/breastfeeding-278668676">Shutterstock</a></span></figcaption></figure><p>Many women find breastfeeding <a href="https://www.aihw.gov.au/reports/mothers-babies/2010-australian-national-infant-feeding-survey/contents/table-of-contents">difficult</a> and stop before they planned. Some women are relieved to stop. But others regret it.</p>
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<p>If you regret stopping, you may be able to give it another go, even if you no longer have any milk. This may be possible even if it’s been weeks or months since you last breastfed.</p>
<h2>Why? From COVID-19 to sick babies</h2>
<p>Women want to start breastfeeding again for a variety of reasons. Some babies don’t do well on infant formula. Others become sick and their mothers want to give them breastmilk to help them recover.</p>
<p>If a mother found breastfeeding challenging the first time around, a change in circumstance, a little more sleep, or just the passage of time can bring a different perspective. </p>
<p>Women might also want to restart breastfeeding if they’re in an <a href="http://helid.digicollection.org/en/d/Js8230e/2.1.1.html">emergency situation</a> without services like water or power, such as a bushfire or cyclone.</p>
<p>Since the beginning of the COVID-19 pandemic, mothers have contacted the <a href="https://www.breastfeeding.asn.au/">Australian Breastfeeding Association</a> about starting breastfeeding again <a href="https://www.medrxiv.org/content/10.1101/2020.07.18.20152256v1">because</a> they wanted to protect their babies from infection or were concerned about the availability of infant formula.</p>
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<p>Almost any mother who wants to start breastfeeding again can. There are only a small number of health conditions that make breastfeeding <a href="https://www.who.int/nutrition/publications/infantfeeding/WHO_NMH_NHD_09.01/en/">inadvisable for medical reasons</a>. </p>
<p>However, relactation needs to be something you want to do because it is unlikely to succeed if your heart isn’t really in it.</p>
<h2>How can I start breastfeeding again?</h2>
<p>When you stop breastfeeding, a <a href="https://www.who.int/nutrition/publications/infantfeeding/9789241597494.pdf">protein</a> in the milk signals your breasts to stop making milk. This decrease in milk production usually takes weeks. </p>
<p>If there is still some milk in your breasts, you can start rebuilding your supply by removing milk from your breasts as often as you can. You can do this by breastfeeding, if your baby is still willing, or by <a href="https://vimeo.com/423863333">expressing milk by hand</a> or with a breast pump.</p>
<p>If your breasts aren’t making milk any more, you can restore your supply by <a href="https://www.who.int/maternal_child_adolescent/documents/who_chs_cah_98_14/en/">relactation</a>.</p>
<p>To start, you will need to stimulate your nipples frequently by encouraging your baby to suck at your breasts or by using a breast pump. This triggers the release of a hormone called <a href="https://www.who.int/maternal_child_adolescent/documents/who_chs_cah_98_14/en/">prolactin</a> that develops the milk-making structures in your breast to start producing milk. Once milk secretion begins, removing the milk from the breast signals your breasts to make more milk.</p>
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Read more:
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<p>If your baby is willing to suckle, this is the easiest way to relactate. The more frequently they do this, the stronger the message to your breasts to develop and start making milk again. </p>
<p>Providing extra milk to your baby at the breast while they suck can help them suck for longer. You can provide this milk using a <a href="https://www.breastfeeding.asn.au/bf-info/using-breastfeeding-supplementer">breastfeeding supplementer</a>. This is a container with a tube that carries expressed breastmilk or formula to your nipple. When your baby sucks at the breast, milk is drawn through the tube into your baby’s mouth, along with any milk from your breast.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/359481/original/file-20200923-16-1atdtqi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Woman breasfeeding baby using a breastfeeding supplementer" src="https://images.theconversation.com/files/359481/original/file-20200923-16-1atdtqi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/359481/original/file-20200923-16-1atdtqi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/359481/original/file-20200923-16-1atdtqi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/359481/original/file-20200923-16-1atdtqi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/359481/original/file-20200923-16-1atdtqi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/359481/original/file-20200923-16-1atdtqi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/359481/original/file-20200923-16-1atdtqi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">A breastfeeding supplementer, which delivers extra milk, can help babies suckle for longer.</span>
<span class="attribution"><span class="source">Leanda Cochrane/Studio 22 Photography, Armidale</span>, <span class="license">Author provided</span></span>
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<p>Alternatively, you can <a href="https://www.facebook.com/watch/?v=179036263409862">drip milk over</a> your breast while your baby sucks.</p>
<p>However, some babies used to bottle feeding may be reluctant to breastfeed at first. It’s important to not try to force your baby. A breastfeeding counsellor or lactation consultant can suggest ways to encourage them. </p>
<p>In the meantime, you can use a breast pump to stimulate the nipples and remove milk from your breasts. You can then give that expressed milk to your baby in a bottle or cup.</p>
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Read more:
<a href="https://theconversation.com/want-to-breastfeed-these-five-things-will-make-it-easier-109507">Want to breastfeed? These five things will make it easier</a>
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<h2>How long does relactation take?</h2>
<p>You can start making milk within a few days or weeks. This depends on how long it has been since your baby last breastfed and how often you stimulate your nipples.</p>
<p>If your baby is willing to suckle, you will need to breastfeed at least eight times in 24 hours for the first few weeks to get milk-making started and to increase your milk supply.</p>
<p>Allowing your baby to breastfeed as often as they want to, even if they are only comfort-sucking, will speed up the process. It also <a href="https://pubmed.ncbi.nlm.nih.gov/17004343/">helps to keep your baby close</a> to your body as much as you can, day and night. This helps to maximise opportunities for suckling. Using a baby sling or carrier can help.</p>
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Read more:
<a href="https://theconversation.com/is-it-safe-to-drink-alcohol-while-breastfeeding-120559">Is it safe to drink alcohol while breastfeeding?</a>
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<p>If your baby isn’t ready to suckle yet, an electric breast pump that expresses both breasts at once is more effective than a single-electric (expresses one breast at a time) or manual pump. You’ll need to use the pump for 10-20 minutes, six to eight times in 24 hours. </p>
<p><a href="https://www.breastfeeding.asn.au/bfinfo/hand-expressing">Expressing milk by hand</a> after breastfeeds or using a breast pump can help remove any remaining milk. The emptier the breasts, the stronger the message they receive to make more milk. </p>
<p>You can also ask your GP about using a medication to increase your body’s production of <a href="https://www.thewomens.org.au/images/uploads/fact-sheets/Domperidone-for-increasing-breast-milk-supply-260219.pdf">prolactin</a>, which can make relactation a little quicker.</p>
<h2>Does it work?</h2>
<p>If your baby is willing to suck frequently, the process can be quite simple. But other mothers and babies find it more challenging. For instance, sometimes making milk is easy but it takes more time for your baby to be willing to breastfeed. </p>
<p>If you stopped breastfeeding because of a problem, such as persistent nipple pain or <a href="https://theconversation.com/explainer-what-is-mastitis-108686">mastitis</a>, you might need some help to prevent this recurring. Every situation is different. </p>
<p>Having a <a href="https://www.facebook.com/groups/BreastfeedingwithABA">support network to cheer you on</a> as well as practical support from family and friends — such as making meals, helping with housework, or entertaining older children while you’re occupied — will make the process much easier.</p>
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<p><em>A lactation consultant or <a href="https://www.breastfeeding.asn.au/">Australian Breastfeeding Association</a> counsellor can support you to start breastfeeding again.</em></p><img src="https://counter.theconversation.com/content/143183/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Karleen Gribble is a member of the international interagency collaboration the Infant and Young Child Feeding in Emergencies Core Group. She has been involved in the development of international guidance and training on infant feeding in emergencies and and has acted as a consultant to UNICEF, WHO, and Save the Children on this subject. She is also an Australian Breastfeeding Association Community Educator and Counsellor and a member of the Public Health Association of Australia. Karleen has received funding from the Sydney Partnership for Health, Education, Research and Enterprise to research women's experiences of pregnancy, birth, and breastfeeding during the COVID-19 Pandemic.. </span></em></p><p class="fine-print"><em><span>Nina J Chad worked as Infant and Young Child Feeding in Emergencies Consultant to Save the Children in Myanmar following Cyclone Nargis. She is a qualified breastfeeding counsellor, community educator, and Trainer & Assessor with The Australian Breastfeeding Association. She volunteers on the National Breastfeeding Helpline. Dr Chad is a member of the Public Health Association of Australia, the World Public Health Nutrition Association, and the Australian Breastfeeding Association.</span></em></p>Women want to start breastfeeding again for a range of reasons, including during the COVID-19 pandemic. Here’s what’s involved.Karleen Gribble, Adjunct Associate Professor, School of Nursing and Midwifery, Western Sydney UniversityNina Jane Chad, Research Fellow, Sydney School of Public Health, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1405492020-06-15T02:42:41Z2020-06-15T02:42:41ZWe don’t know if breastfeeding is rising or falling in Australia. That’s bad for everyone<figure><img src="https://images.theconversation.com/files/341424/original/file-20200612-93551-15ieidt.jpg?ixlib=rb-1.1.0&rect=7%2C87%2C4881%2C2653&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Kevin Liang/Unsplash</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>As the COVID-19 pandemic has taught us all too well, good health policy depends on prior planning, decisive action, and a willingness to spend money.</p>
<p>But there’s another area where Australia’s willingness to plan and spend has fallen far short: monitoring breastfeeding rates.</p>
<p>A <a href="https://www.worldbreastfeedingtrends.org/uploads/resources/document/making-a-difference-wbti-eval-report-2020.pdf">newly released international report</a> reveals that 41% of babies worldwide are exclusively breastfed for their first six months – well short of the World Health Assembly’s target of 50% by 2025. <a href="https://wbtiaus.com/2018/05/24/australia-report-card-2018/">Australian data</a> are missing from the latest report because the infant feeding data have not been collected.</p>
<p>Breastfeeding is important, just like immunisation. It protects children against illness and disease, such as gastroenteritis and <a href="https://pubmed.ncbi.nlm.nih.gov/26869575/">later life diabetes</a>. Women who breastfeed are <a href="https://pubmed.ncbi.nlm.nih.gov/26869575/">less likely to suffer breast cancer in later life</a>. Investing in breastfeeding will <a href="https://pubmed.ncbi.nlm.nih.gov/12530799/">save the health system money</a> in years to come.</p>
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Read more:
<a href="https://theconversation.com/want-to-breastfeed-these-five-things-will-make-it-easier-109507">Want to breastfeed? These five things will make it easier</a>
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<p>In 2019 a long-awaited <a href="http://www.coaghealthcouncil.gov.au/Portals/0/Australian%20National%20Breastfeeding%20Strategy%20-%20FINAL%20.pdf">Australian National Breastfeeding Strategy</a> proposed a national monitoring system for breastfeeding rates.</p>
<p>Governments have been <a href="https://www1.health.gov.au/internet/main/publishing.nsf/Content/62672740D891CA2CCA257BF0001C673F/$File/breastfeeding.pdf">talking about this for nearly two decades</a>. Yet still there is no funding available for a national data collection network, despite its importance for women and children.</p>
<p>Without rigorous data, we can’t tell whether Australia’s breastfeeding rates are improving or getting worse, which groups of people need help, or whether existing programs to encourage breastfeeding are working.</p>
<h2>Good data is crucial for good health care</h2>
<p>Some local data in NSW and <a href="https://www.bettersafercare.vic.gov.au/sites/default/files/2019-02/Vic%20perinatal%20services%20performance%20indicators%202017-18.pdf">Victoria</a> suggest that in recent years fewer women get off to a good start with exclusive breastfeeding.</p>
<p>The percentage of babies fully breastfed at the time of discharge from hospital in NSW fell from <a href="https://www.health.nsw.gov.au/hsnsw/Publications/mothers-and-babies-2015.pdf">82.1% in 2011</a> to <a href="https://www.health.nsw.gov.au/hsnsw/Publications/mothers-and-babies-2018.pdf">72.6% in 2018</a>.</p>
<p>We also don’t know how COVID-19 has affected breastfeeding rates. Some women have been hindered by reduced access to breastfeeding support, as hospitals and community services divert resources towards dealing with the pandemic. On the other hand, there are anecdotal reports of mothers enjoying the less hectic pace of life during lockdown to establish breastfeeding.</p>
<p>But the problem is, without routine surveys of breastfeeding rates among large samples of the population, we just don’t know.</p>
<p>In 1995, 2001 and 2005, National Health Surveys collected data on infant feeding. In 2008 one of us (Lisa), together with colleague Susan Donath, <a href="https://www.mja.com.au/journal/2008/189/5/socioeconomic-status-and-rates-breastfeeding-australia-evidence-three-recent">used these data to show</a> that breastfeeding rates did not improve, and the gap between high- and low-income families had widened during the decade spanned by these surveys. It was a shocking indictment.</p>
<p>Despite this, the 2007-08 National Health Surveys did not collect infant feeding data. The 2014-15 and 2016-17 surveys each only collected infant feeding data on about 1,500 children – not enough for a rigorous analysis of the nationwide trend.</p>
<p>Australia’s first and only comprehensive infant feeding survey <a href="https://www.aihw.gov.au/reports/mothers-babies/2010-australian-national-infant-feeding-survey/contents/table-of-contents">happened in 2010</a>, in response to a <a href="https://trove.nla.gov.au/work/8215376?selectedversion=NBD42202999">recommendation</a> from the Parliamentary Best Start Inquiry.</p>
<p>This survey sampled 52,000 infants aged up to 24 months. It was intended as a baseline for future surveys, but the follow-up surveys never happened.</p>
<p>The <a href="https://www.coaghealthcouncil.gov.au/Portals/0/Australian%20National%20Breastfeeding%20Strategy%20-%20Final.pdf">National Breastfeeding Strategy</a> released last year by federal, state and territory governments pledged to routinely collect data on breastfeeding rates via the Child Digital Health Record program, which is still under development. It also promised to deliver a full nationwide survey every five years.</p>
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Read more:
<a href="https://theconversation.com/the-national-breastfeeding-strategy-is-a-start-but-if-we-really-valued-breast-milk-wed-put-it-in-the-gdp-121302">The National Breastfeeding Strategy is a start, but if we really valued breast milk we'd put it in the GDP</a>
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<h2>Knowledge is power</h2>
<p>Routine data collection has several advantages. It is more cost-effective than standalone surveys, and it is population-wide, meaning it can include people who are otherwise under-represented in survey data.</p>
<p>It is also a powerful research tool. Routine data on preterm versus full-term births in Belgium, for instance, <a href="https://www.bmj.com/content/346/bmj.f441">revealed</a> the dramatic effect of tobacco control policies on preventing premature births.</p>
<p>Australia already routinely collects childhood health data, perhaps most notably on <a href="https://data.gov.au/dataset/ds-dga-8937acdc-98ae-492e-bbc3-5c4f484d7651/details?q=immunisation">immunisation rates</a>. Policy-makers can use this valuable data to ensure adequate coverage against childhood infections and to ensure existing policies are effective.</p>
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Read more:
<a href="https://theconversation.com/breastfeeding-improves-iq-now-have-we-got-your-attention-16514">Breastfeeding improves IQ – now have we got your attention?</a>
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<p>The first step to investing in breastfeeding will be to fund proper data collection – both via routine data collection and regular in-depth national surveys. But so far no one has backed breastfeeding with the necessary dollars.</p>
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<p><em>This article is based on a <a href="https://crawford.anu.edu.au/news-events/events/16582/protecting-womens-reproductive-rights-policy-and-resourcing-decisions-need">presentation</a> hosted by the Crawford School of Public Policy, Australian National University, and <a href="https://www.savethechildren.org.au/">Save the Children</a>.</em></p><img src="https://counter.theconversation.com/content/140549/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Julie Smith receives funding from the Australian Research Council under an ARC Future Fellowship for 'Research to enhance measurement, understanding, and policy regulatory approaches to emerging markets and trade in mothers' milk'</span></em></p><p class="fine-print"><em><span>Lisa Amir does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Breastfeeding is important for infant and maternal health. But without national data non breastfeeding rates, we have no idea whether things are improving or getting worse.Lisa Amir, Professor in Breastfeeding Research, La Trobe UniversityJulie P. Smith, Honorary Associate Professor, Australian National UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1380902020-05-27T17:14:29Z2020-05-27T17:14:29ZPeanuts, eggs and your baby: How to introduce food allergens during the coronavirus pandemic<figure><img src="https://images.theconversation.com/files/337093/original/file-20200522-124826-1wdo67v.jpg?ixlib=rb-1.1.0&rect=49%2C0%2C5193%2C3637&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Recommendations suggest babies be introduced to food allergens around age six months.</span> <span class="attribution"><span class="source">(Pixabay)</span></span></figcaption></figure><p>The best way to prevent food allergies is to introduce the most common allergenic foods to babies early in life, as <a href="https://www.doi.org/10.1001/jama.2016.12623">research evidence for peanut and egg has shown</a>. Even during the current COVID-19 pandemic, the benefits of allergy prevention outweigh the very small risk of a severe reaction.</p>
<p>As clinicians and researchers in the field of allergy and infant nutrition, we are worried that COVID-19 may lead parents to delay the introduction of allergens to their babies. Parents may not feel comfortable taking their baby to an emergency room because of potential exposure to COVID-19, so they don’t want to risk a severe allergic reaction requiring a hospital visit.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/335092/original/file-20200514-77243-1yqe5xr.jpg?ixlib=rb-1.1.0&rect=31%2C146%2C3463%2C2551&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/335092/original/file-20200514-77243-1yqe5xr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=463&fit=crop&dpr=1 600w, https://images.theconversation.com/files/335092/original/file-20200514-77243-1yqe5xr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=463&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/335092/original/file-20200514-77243-1yqe5xr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=463&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/335092/original/file-20200514-77243-1yqe5xr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=582&fit=crop&dpr=1 754w, https://images.theconversation.com/files/335092/original/file-20200514-77243-1yqe5xr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=582&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/335092/original/file-20200514-77243-1yqe5xr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=582&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">The most common food allergens are cow’s milk, eggs, peanuts and tree nuts, sesame seeds, fish and shellfish, soy and wheat.</span>
<span class="attribution"><span class="source">(Unsplash)</span></span>
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</figure>
<p>The <a href="https://doi.org/10.1093/pch/pxy195">most recent Canadian recommendations</a> continue to apply during the COVID-19 pandemic. The recommendations encourage parents to introduce allergenic foods to babies as soon as they start eating solids around six months, but not before four months of age. This applies to lower-risk infants as well, but is especially important for babies who are at higher risk of allergy due to eczema, other food allergies or an immediate family history of an allergic condition. </p>
<h2>Should I delay introduction of allergens?</h2>
<p>Many parents may be wondering if they should hold off on introducing allergens to their baby because of COVID-19. The answer is no. Despite the pandemic and some families trying to avoid the risk of an emergency room visit, introducing allergens to babies <a href="https://www.cps.ca/en/blog-blogue/can-we-continue-to-recommend-early-allergenic-food-introduction-during-a-pandemic">without delay</a> is recommended. The risk of a severe allergic reaction when eating a new food for the first time <a href="http://www.doi.org/10.1056/NEJMoa1414850">is extremely low — well below two per cent</a>. </p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/337095/original/file-20200522-124832-13c5g6g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/337095/original/file-20200522-124832-13c5g6g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/337095/original/file-20200522-124832-13c5g6g.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/337095/original/file-20200522-124832-13c5g6g.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/337095/original/file-20200522-124832-13c5g6g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/337095/original/file-20200522-124832-13c5g6g.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/337095/original/file-20200522-124832-13c5g6g.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">The risk of a severe allergic reaction to a new food is very low.</span>
<span class="attribution"><span class="source">(Unsplash)</span></span>
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<p>Delaying the introduction might put children at higher risk of allergies. If not introduced in infancy, the risk of an allergic reaction as a child gets older is increased, so it’s better to introduce early and not delay. There is evidence that in higher-risk infants, peanut introduction during infancy <a href="http://www.doi.org/10.1056/NEJMoa1414850">reduces the risk of peanut allergy by up to 80 per cent</a>.</p>
<h2>What if my baby has an anaphylactic reaction?</h2>
<p>It’s very unlikely that infants will react so severely to a new food that they will need an emergency trip to the hospital. To put it further into perspective, <a href="https://doi.org/10.1001/jama.2010.582">food allergies affect around two per cent to 10 per cent</a> of Canadians, so even most older children will not have an allergic reaction to foods. The chance of a severe allergic reaction such as anaphylaxis is much less than two per cent, even in higher risk infants.</p>
<p>In the unlikely event that infants have a severe reaction and need to go to the emergency room, <a href="https://doi.org/10.1016/j.jiph.2020.03.019">the risk of acquiring COVID-19 is also extremely low when proper infection control measures are adhered to</a>. The risk of an infant dying from COVID-19 in the unlikely event that it is acquired while visiting the emergency room is even more remote <a href="http://www.doi.org/10.1097/INF.0000000000002700">since children have milder disease symptoms</a>.</p>
<h2>How should I introduce allergens?</h2>
<p>In Canada, the most common allergens are cow’s milk, eggs, peanuts and tree nuts, sesame seeds, fish and shellfish, soy and wheat. Puréed foods, smooth nut butters diluted with breast milk or formula, or ground nuts mixed in purées are great ways for parents to introduce allergens safely in non-choking form for babies.</p>
<p>It’s important that the allergen be introduced orally, meaning that the infant eats the food. We don’t recommend rubbing it on the skin or lips to test for an allergic reaction as that may cause irritation that could be misinterpreted as allergy.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/337150/original/file-20200523-124810-1ohh493.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/337150/original/file-20200523-124810-1ohh493.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/337150/original/file-20200523-124810-1ohh493.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/337150/original/file-20200523-124810-1ohh493.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/337150/original/file-20200523-124810-1ohh493.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/337150/original/file-20200523-124810-1ohh493.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/337150/original/file-20200523-124810-1ohh493.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Allergens can be introduced in puréed foods. Smooth peanut butter can be diluted with breast milk or formula.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
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<p>Parents can introduce these foods one at a time, always in an age-appropriate way for their baby, and without delays between the introduction of new foods. Allergic reactions usually appear very quickly, so parents can gauge reaction within a couple of hours following the meal. </p>
<p><a href="https://foodallergycanada.ca/food-allergy-basics/preventing-and-treating-allergic-reactions/reaction-signs-and-symptoms/">Allergic reactions in infants will usually affect</a> the skin (hives, itchiness, rash), gastrointestinal tract (vomiting, diarrhea) or respiratory system (wheezing). Parents should monitor the signs closely and take pictures of skin reactions as they seek advice from their family doctor. If there is a reaction, the food should be avoided until parents have consulted their health-care team, and decided on the next best steps to take. </p>
<p>Once an allergen has been introduced safely, it is very important to keep offering and serving it to the baby a few times a week to maintain tolerance. Aiming to include these allergens in the regular family diet is a practical way for parents to offer it often to baby. </p>
<p>The benefit of preventing the development of food allergy (which can affect the quality of life of the whole family for many years) is far greater in our professional opinion than the very small risk of experiencing a life-threatening allergic reaction and potentially exposing infants to COVID-19.</p><img src="https://counter.theconversation.com/content/138090/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Maude Perreault was a Vanier Scholar and received funding from the Canadian Institutes of Health Research, and the Canadian Child Health Clinician Scientist Program.</span></em></p><p class="fine-print"><em><span>Edmond S. Chan has received research support from DBV Technologies; has been a member of advisory boards for Pfizer, Pediapharm, Leo Pharma, Kaleo, DBV, AllerGenis; is a member of the healthcare advisory board for Food Allergy Canada; was an expert panel and coordinating committee member of the National Institute of Allergy and Infectious Diseases (NIAID)-sponsored Guidelines for Peanut Allergy Prevention; and was co-lead of the CSACI oral immunotherapy guidelines.</span></em></p><p class="fine-print"><em><span>Elissa Abrams is a member of theHealthcare advisory board for Food Allergy Canada. </span></em></p>Introducing food allergens early is the best way to prevent food allergies from developing. Even in a pandemic, the benefits outweigh the very small risk of a severe reaction requiring emergency care.Maude Perreault, Registered dietitian and Research Associate, McMaster UniversityEdmond S. Chan, Pediatric Allergist; Head & Clinical Associate Professor, Division of Allergy & Immunology, Department of Pediatrics, Faculty of Medicine; Investigator, BC Children's Hospital Research Institute, University of British ColumbiaElissa M. Abrams, Asssistant Professor, Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba, Johns Hopkins UniversityLicensed as Creative Commons – attribution, no derivatives.