tag:theconversation.com,2011:/es/topics/babies-2292/articlesBabies – The Conversation2024-03-20T14:18:39Ztag:theconversation.com,2011:article/2240002024-03-20T14:18:39Z2024-03-20T14:18:39ZWhy do children laugh? It’s not always because they’re happy<figure><img src="https://images.theconversation.com/files/582537/original/file-20240318-16-afui6s.jpg?ixlib=rb-1.1.0&rect=0%2C8%2C3000%2C1985&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/es/image-photo/portrait-african-baby-toddler-smiling-sitting-1942419196">Prostock-studio/Shutterstock</a></span></figcaption></figure><p>Though it may seem like a paradox, children do not laugh for joy. Scientific studies, including my own, show that there is something much deeper than joy or mirth in a child’s laughter.</p>
<p>Adults’ laughter is equally complex. In a <a href="https://www.sciencedirect.com/science/article/abs/pii/S0732118X22000472">previous study on the meaning of laughter in adults</a>, I concluded that it is an <a href="https://theconversation.com/why-do-we-laugh-new-study-considers-possible-evolutionary-reasons-behind-this-very-human-behaviour-190193">evolutionary response</a> to something confusing or unexpected. It is a powerful “all clear” signal to ourselves and others that a potential threat is, in fact, harmless.</p>
<p>Building on this research, <a href="https://www.risu.biz/wp-content/uploads/2024/02/Bellieni-RISU-71-2024.pdf">my most recent study</a> focuses on laughter in children and babies. I find that it is closely connected to brain and personality development: children laugh for very different reasons at different stages of development, long before they can grasp abstract concepts like wordplay, punchlines, or even language.</p>
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Leer más:
<a href="https://theconversation.com/why-do-we-laugh-new-study-considers-possible-evolutionary-reasons-behind-this-very-human-behaviour-190193">Why do we laugh? New study considers possible evolutionary reasons behind this very human behaviour</a>
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<h2>Laughter’s evolutionary benefits</h2>
<p>Laughter stems from our ability to subconsciously understand and judge the incongruities in a joke or action: it is our response to an instant transition between astonishment and resolution.</p>
<p>Laughter in adults therefore <a href="https://theconversation.com/why-do-we-laugh-new-study-considers-possible-evolutionary-reasons-behind-this-very-human-behaviour-190193">signals the passing of threat or fear</a>, both to ourselves and those around us. That is also why children – and many adults – laugh on rollercoasters or in similar situations: instead of crying in fear, they pass from bewilderment and terror to resolution. Laughter is the signal of this passage.</p>
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<figcaption><span class="caption">This moment in British sitcom The Vicar of Dibley is a classic moment of physical comedy: the split-second shock is quickly offset by the (relatively) harmless consequences.</span></figcaption>
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<p><a href="https://pubmed.ncbi.nlm.nih.gov/26010066/">Several studies</a> show that this process is the mechanism behind successful comedy, especially physical comedy. French philosopher Henri Bergson <a href="https://www.gutenberg.org/files/4352/4352-h/4352-h.htm">first proposed and explained this mechanism in 1900</a> with regard to slapstick: “The laughable element … consists of a certain mechanical inelasticity, just where one would expect to find the wide-awake adaptability and the living pliableness of a human being.”</p>
<h2>Babies learn how to laugh</h2>
<p>Laughter begins soon after birth. Infants learn to laugh because they want to imitate their parents, and to receive approval from them. This is the way babies learn everything at first: through imitation and receiving the approval of adults around them.</p>
<p>But as they grow, babies come out of the symbiosis with their parents that characterises the first months of life. They learn to distinguish their own person from their parents and the world around them. <a href="https://pubmed.ncbi.nlm.nih.gov/24364812/">Once they begin to behave autonomously</a> – from age 2 to 5 – they begin to feel a new sensation for the first time: certain things may seem cold, strange, or out of place, and this shocks, confuses and amazes them.</p>
<p>This is where laughter comes in: after a moment of hesitation, they understand that what seemed frightening or unexpected is actually harmless. </p>
<p>For example, a child laughs when they see their father with a fake clown nose. Why? Because for a split second they felt embarrassed: that nose is not a “live” nose. When they understand it was just dad’s joke, they calm down and laugh. They may also laugh when their older brother makes a silly face, and the process is the same: amazement, reassurance, laughter.</p>
<h2>Grasping logic allows children to understand jokes</h2>
<p>From age 5 or 6 and up, children learn to handle abstract concepts, meaning they can grasp and “get” jokes. This happens when they overcome the earlier <a href="https://link.springer.com/referenceworkentry/10.1007/978-0-387-79061-9_2228">stage of egocentrism</a>, which hinders their understanding of others’ reasoning.</p>
<p>At this stage, laughter arises with the same criteria as that of adults, that is, to disapprove what they find cold and false, not only in other people, but also in processes of reasoning. This mental process forms the basis of a good punchline: incongruence, astonishment and resolution.</p>
<p>These three stages of laughter development – imitation and approval, amazement, disapproval – are good indicators of child’s mental growth and development.</p>
<h2>Parents’ laughter can help babies develop</h2>
<p>The laughter of parents, as well as babies, is important for development, but why do parents instinctively laugh at their babies? We can easily understand that a mother or father joyfully smiles at their baby, but laughter is more complex.</p>
<p>When looking at their child, a parent cannot help but have a moment of perplexity: babies are strange by nature because they resemble adults, but do not speak or behave like one. This momentary amazement lasts a fraction of a second before being immediately overcome: it is just their beloved baby!</p>
<p>This should encourage all parents to engage in laughter with their babies, to not feel self conscious or scared, and to be their “laughter companions”. Such interactions can improve babies’ behaviour and wellbeing – <a href="https://pubmed.ncbi.nlm.nih.gov/18955287/">laughter is a proven ally to our immune system</a> – and help them to develop a natural, healthy relationship with this complex human response.</p><img src="https://counter.theconversation.com/content/224000/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Carlo Valerio Bellieni no recibe salario, ni ejerce labores de consultoría, ni posee acciones, ni recibe financiación de ninguna compañía u organización que pueda obtener beneficio de este artículo, y ha declarado carecer de vínculos relevantes más allá del cargo académico citado.</span></em></p>Laughter is one of the healthiest things a child can do, but it means very different things at different stages of brain development.Carlo Valerio Bellieni, Professor of Pediatrics, Università di SienaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2083402024-03-01T13:43:16Z2024-03-01T13:43:16ZGut microbiome: meet Bifidobacterium breve, keeping babies healthy<figure><img src="https://images.theconversation.com/files/539057/original/file-20230724-21-ezb4di.jpg?ixlib=rb-1.1.0&rect=40%2C0%2C4500%2C2997&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-illustration/bacteria-bifidobacterium-grampositive-anaerobic-rodshaped-which-1036394278">Kateryna Kon/Shutterstock</a></span></figcaption></figure><p><em>Bifidobacterium breve</em>, or <em>B breve</em> for short, is a bacterial species that’s found in the human intestine. It’s especially relevant <a href="https://www.frontiersin.org/articles/10.3389/fmicb.2016.01204/full">in early life</a>, being one of the most abundant bacteria in the newborn gut.</p>
<p><em>B breve</em> is a species of the genus <em>Bifidobacterium</em> and is considered key in the development of a healthy gut. It has been studied extensively over the years to uncover how it benefits us from our first days of life.</p>
<p>Some of the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4908950/">benefits</a> associated with this species include protection against pathogens, modulation of the immune system, and provision of nutrients through the breakdown of non-digestible carbohydrates from the diet.</p>
<p>We’re still learning about the origin of <em>B breve</em>. But <a href="https://journals.asm.org/doi/10.1128/AEM.02037-15">vertical transmission</a>, where the origin is the mother and the transfer to the baby occurs either during or after birth, is understood to be the main source of microbes at an early age.</p>
<p>A <a href="https://www.nature.com/articles/s41467-023-38694-0">study</a> carried out by MicrobeMom (a project I was part of during my PhD) has shown that <em>Bifidobacterium</em> strains including <em>B breve</em> are indeed transferred from mother to infant. We didn’t investigate the precise mode of transfer, but one of the key factors influencing the outcome was vaginal birth, so it’s likely these bacteria are passed on during childbirth.</p>
<p>Our research also showed that <em>B breve</em> was the most frequently isolated of the <em>Bifidobacterium</em> species. It was present in vaginal samples from the mother, stool samples from the infant and the mother, as well as breast milk. In fact, <em>B breve</em> represented 80% of the total <em>Bifidobacterium</em> isolated from breast milk.</p>
<p>This highlights the pivotal role that the mother’s gut microbiome has in fostering a baby’s gut health.</p>
<h2><em>Bifidobacterium</em> and the infant gut</h2>
<p><em>Bifidobacterium</em> in general are known for being one of the first <a href="https://journals.asm.org/doi/full/10.1128/mmbr.00036-17">colonisers</a> of the infant gut. This is because of their important role degrading carbohydrates from the diet that the infant gut cannot digest. </p>
<p>This has a positive effect not only on the development of the gut but also the baby’s <a href="https://www.cell.com/cell/pdf/S0092-8674(21)00660-7.pdf">immune system</a>. The mechanism for this is quite complex, but in general terms <em>Bifidobacterium</em> have been shown to interact with human immune cells and to modify <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5722804/">immune responses</a>.</p>
<p>The human microbiome changes constantly, and <em>Bifidobacterium</em> is a good example of this. The amount of <em>Bifidobacterium</em> in our gut changes during our lifespan, as does the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4990546/">composition</a> of specific <em>Bifidobacterium</em> species, in response to our diet.</p>
<p><em>Bifidobacterium</em> is the most abundant bacteria in the first months of life, when a baby is breastfed, and when microbial diversity (the variety of bacteria, viruses and other microbes we carry) is still very low. The <a href="https://www.bmj.com/content/361/bmj.k2179">microbiota</a> begins to change when solid food is introduced, and we have less <em>Bifidobacterium</em> as we get older when the <a href="https://www.frontiersin.org/articles/10.3389/fmicb.2016.01204/full">microbial diversity</a> in our gut increases.</p>
<p>Species such as <em>Bifidobacterium adolescentis</em> and <em>Bifidobacterium longum</em> are typically associated with adulthood, due to their ability to degrade plant-derived carbohydrates found in fruit and vegetables. But <em>B breve</em> and certain other species are generally associated with infancy. </p>
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Read more:
<a href="https://theconversation.com/why-breastfed-babies-have-improved-immune-development-new-findings-156008">Why breastfed babies have improved immune development – new findings</a>
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<h2>Breast milk</h2>
<p>Human milk is a complex fluid capable of satisfying all the nutritional requirements of a newborn. It also provides extensive <a href="https://www.nhs.uk/conditions/baby/breastfeeding-and-bottle-feeding/breastfeeding/benefits/">health benefits</a>, such as reduced risk of various infections. Its composition changes over the period of lactation, adapting to the requirements of the infant. </p>
<p>Breast milk is one of the <a href="https://pubmed.ncbi.nlm.nih.gov/32552141/">main factors</a> that influences the infant microbiota, as breastfeeding <a href="https://www.nature.com/articles/s41564-021-00970-4">increases the number</a> of <em>Bifidobacterium</em> in the infant gut.</p>
<p>One specific component of breast milk that affects the composition of the microbiome is <a href="https://academic.oup.com/glycob/article/22/9/1147/1988076?login=true">human milk oligosaccharides</a>, which are the most abundant carbohydrates present in breast milk after lactose.</p>
<p>These carbohydrates cannot be digested by the human gut, which is where <em>B breve</em> plays an important role. It’s among the microbes that can degrade <a href="https://www.nature.com/articles/srep38560">human milk oligosaccharides</a>, and in this way, they promote its persistence in the gut.</p>
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<img alt="A woman sitting on a couch breastfeeding her baby." src="https://images.theconversation.com/files/539059/original/file-20230724-29-8askj2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/539059/original/file-20230724-29-8askj2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/539059/original/file-20230724-29-8askj2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/539059/original/file-20230724-29-8askj2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/539059/original/file-20230724-29-8askj2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/539059/original/file-20230724-29-8askj2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/539059/original/file-20230724-29-8askj2.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"><em>B breve</em> helps to break down certain carbohydrates present in breast milk.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/newborn-baby-boy-sucking-milk-mothers-1968728029">Nastyaofly/Shutterstock</a></span>
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<h2>Prebiotics and probiotics</h2>
<p>Human milk oligosaccharides are considered prebiotics – carbohydrates, indigestible by the human gut, that promote the growth of beneficial bacteria in the gut, such as <em>B breve</em>.</p>
<p><em>B breve</em> is regarded as a <a href="https://isappscience.org/for-scientists/resources/probiotics/">probiotic</a> – a bacterial species whose intake has a benefit for the host.</p>
<p>Nowadays, human milk oligosaccharides can be found in formula milk, aiming to facilitate the same changes in the microbiota through their prebiotic effects.</p>
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Read more:
<a href="https://theconversation.com/gut-instinct-how-the-way-youre-born-and-fed-affect-your-immune-system-65104">Gut instinct: how the way you're born and fed affect your immune system</a>
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<p><em>B breve</em> is used as <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6265827/">a supplement</a> to treat and prevent gastrointestinal problems such as diarrhoea, often administered in combination with other probiotic bacteria such <em>Lactobacillus</em> or other <em>Bifidobacterium</em> species. It’s also commercially available in combination with prebiotics.</p>
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<p><em>This article is part of <a href="https://theconversation.com/uk/topics/meet-your-gut-microbes-150943?utm_source=InArticleTop&utm_medium=TCUK&utm_campaign=Health2024">Meet Your Gut Microbes</a>, a series about the rich constellation of bacteria, viruses, archaea and fungi that live in people’s digestive tracts. Scientists are increasingly realising their importance in shaping our health – both physical and mental. Each week we will look at a different microbe and bring you the most up-to-date research on them.</em></p>
<hr><img src="https://counter.theconversation.com/content/208340/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Rocío Sánchez Gallardo receives funding from a peer reviewed research grant from Science Foundation Ireland (SFI).</span></em></p>B breve has benefits for a baby from their first days of life.Rocío Sánchez Gallardo, PhD candidate, School of Microbiology & APC Microbiome Institute, University College CorkLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2190052023-12-14T19:19:48Z2023-12-14T19:19:48ZEggs from men, sperm from women: how stem cell science may change how we reproduce<figure><img src="https://images.theconversation.com/files/564442/original/file-20231208-17-22yb4u.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C1000%2C748&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-illustration/morula-early-stage-embryo-consisting-cells-776035219">nobeastsofierce/Shutterstock</a></span></figcaption></figure><p>It may soon be possible to coax human skin cells into becoming functional eggs and sperm using a technique known as “in vitro gametogenesis”. This involves the creation (genesis) of eggs and sperm (gametes) outside the human body (in vitro). </p>
<p>In theory, a skin cell from a man could be turned into an egg and a skin cell from a woman can become a sperm. Then there’s the possibility of a child having multiple genetically-related parents, or only one.</p>
<p>Some scientists believe human applications of in vitro gametogenesis are a <a href="https://www.statnews.com/2023/10/02/ivg-ivf-replacement-reproductive-technology-hype/">long way off</a>. </p>
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<p>However, scientists who work on human stem cells are <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10579208/">actively working</a> on overcoming the barriers. <a href="https://www.statnews.com/2023/04/08/ivf-eggs-hormones-gameto-reproductive-fertilo/">New</a> <a href="https://www.technologyreview.com/2021/10/28/1038172/conception-eggs-reproduction-vitro-gametogenesis/">biotechnology</a> <a href="https://www.newyorker.com/magazine/2023/04/24/the-future-of-fertility">start-ups</a> are also seeking to commercialise this technology.</p>
<p>Here’s what we know about the prospect of human in vitro gametogenesis and why we need to start talking about this now.</p>
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Read more:
<a href="https://theconversation.com/explainer-what-are-stem-cells-14391">Explainer: what are stem cells?</a>
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<h2>Is the technology available?</h2>
<p>In vitro gametogenesis begins with “pluripotent stem cells”, a kind of cell that can develop into many different cell types. The aim is to persuade these stem cells to become eggs or sperm.</p>
<p>These techniques could use stem cells taken from early embryos. But scientists have also worked out how to <a href="https://www.eurostemcell.org/stemcellshorts-what-are-induced-pluripotent-stem-cells">revert adult cells</a> to a pluripotent state. This opens up the possibility of creating eggs or sperm that “belong to” an existing human adult.</p>
<p>Animal studies have been promising. In <a href="https://www.nature.com/articles/490146b">2012</a>, scientists created live-born baby mice using eggs that began their life as skin cells on a mouse tail.</p>
<p>More recently, the technique has been used to facilitate same-sex reproduction. Earlier this year, scientists created mouse pups with <a href="https://www.nature.com/articles/d41586-023-00717-7">two genetic fathers</a> after transforming skin cells from male mice into eggs. Mouse pups with <a href="https://www.nature.com/articles/d41586-018-06999-6">two genetic mothers</a> have also been created.</p>
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<figcaption><span class="caption">How scientists bred mice with two fathers.</span></figcaption>
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<p>Scientists have not yet managed to adapt these techniques to create human gametes. Perhaps because the technology is still in its infancy, Australia’s legal and regulatory systems do not address whether and how the technology should be used. </p>
<p>For example, the National Health and Medical Research Council’s <a href="https://www.nhmrc.gov.au/about-us/publications/art">assisted reproduction guidelines</a>, which were updated in 2023, do not include specific guidance for in vitro-derived gametes. These guidelines will need to be updated if in vitro gametogenesis becomes viable in humans.</p>
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Read more:
<a href="https://theconversation.com/the-future-of-stem-cells-tackling-hype-versus-hope-72052">The future of stem cells: tackling hype versus hope</a>
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<h2>The potential</h2>
<p>There are three distinct clinical applications of this technology.</p>
<p>First, in vitro gametogenesis could streamline IVF. Egg retrieval currently involves repeated hormone injections, a minor surgical procedure, and the <a href="https://www.mayoclinic.org/diseases-conditions/ovarian-hyperstimulation-syndrome-ohss/symptoms-causes/syc-20354697">risk</a> of overstimulating the ovaries. In vitro gametogenesis could eliminate these problems.</p>
<p>Second, the technology could circumvent some forms of medical infertility. For example, it could be used to generate eggs for women born without functioning ovaries or following early menopause.</p>
<p>Third, the technology could allow same-sex couples to have children who are genetically related to both parents.</p>
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Read more:
<a href="https://theconversation.com/promising-assisted-reproductive-technologies-come-with-ethical-legal-and-social-challenges-a-developmental-biologist-and-a-bioethicist-discuss-ivf-abortion-and-the-mice-with-two-dads-208276">Promising assisted reproductive technologies come with ethical, legal and social challenges – a developmental biologist and a bioethicist discuss IVF, abortion and the mice with two dads</a>
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<h2>Legal, regulatory and ethical issues</h2>
<p>If the technology becomes viable, in vitro gametogenesis will alter the dynamics of how we create families in unprecedented ways. How we should respond requires careful consideration.</p>
<p><strong>1. Is it safe?</strong></p>
<p>Careful trials, rigorous monitoring, and follow-up of any children born will be essential – as it has been for other <a href="https://theconversation.com/maeves-law-would-let-ivf-parents-access-technology-to-prevent-mitochondrial-disease-heres-what-the-senate-is-debating-176668">reproductive</a> <a href="https://theconversation.com/rest-assured-ivf-babies-grow-into-healthy-adults-23432">technologies</a>, including IVF.</p>
<p><strong>2. Is it equitable?</strong></p>
<p>Other issues relate to access. It might seem unjust if the technology is only available to the wealthy. Public funding could help – but whether this is appropriate depends on whether the state <a href="https://theconversation.com/ideas-for-australia-rethinking-funding-and-priorities-in-ivf-should-the-state-pay-for-people-to-have-babies-57036">ought to support</a> people’s reproductive projects.</p>
<p><strong>3. Should we restrict access?</strong></p>
<p>For instance, pregnancy is rare in older women, largely because egg count and quality <a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/age-and-fertility">decline with age</a>. In vitro gametogenesis would theoretically provide “fresh” eggs for women of any age. But helping older women become parents is <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5566409/">controversial</a>, due to physical, psychological and other factors associated with having babies later in life.</p>
<p><strong>4. We’d still need surrogates</strong></p>
<p>If we took skin cells from each male partner and created an embryo, that embryo would still need a surrogate to carry the pregnancy. Unfortunately, Australia has a shortfall of surrogates. International surrogacy provides an alternative, but carries <a href="https://theconversation.com/its-hard-to-find-a-surrogate-in-australia-but-heading-overseas-comes-with-risks-206182">legal, ethical and practical difficulties</a>. Unless access to surrogacy is improved domestically, benefits to male couples will be limited. </p>
<p><strong>5. Who are the legal parents?</strong></p>
<p>In vitro gametogenesis also raises questions about who are the future child’s legal parents. We already see related legal debates surrounding non-traditional families formed through surrogacy, egg donation and sperm donation. </p>
<p>In vitro gametogenesis could theoretically also be used to create children with more than two genetic parents, or with only one. These possibilities likewise require us to update our current understandings of parenthood.</p>
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Read more:
<a href="https://theconversation.com/we-may-one-day-grow-babies-outside-the-womb-but-there-are-many-things-to-consider-first-125709">We may one day grow babies outside the womb, but there are many things to consider first</a>
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<h2>How far is too far?</h2>
<p>Of the potential uses already mentioned, same-sex reproduction is the most controversial. The reproductive limitations imposed by being in a same-sex relationship are sometimes seen as a “social” form of infertility the medical profession is not obligated to fix.</p>
<p>The moral stakes, however, are virtually identical regardless of whether in vitro gametogenesis is used by same-sex or opposite-sex couples. Both uses of the technology fulfil exactly the same goal: helping couples fulfil their desire to have a child genetically related to both parents. It would be unjust to deny access to only one of these groups.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/564457/original/file-20231208-21-83z5z9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Same-sex female couple cooking in kitchen, one feeding the other fruit" src="https://images.theconversation.com/files/564457/original/file-20231208-21-83z5z9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/564457/original/file-20231208-21-83z5z9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/564457/original/file-20231208-21-83z5z9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/564457/original/file-20231208-21-83z5z9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/564457/original/file-20231208-21-83z5z9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/564457/original/file-20231208-21-83z5z9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/564457/original/file-20231208-21-83z5z9.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">Who should have access to this technology? How about same-sex couples?</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/lesbian-couple-cooking-kitchen-together-1071305168">Rawpixel.com/Shutterstock</a></span>
</figcaption>
</figure>
<p>But same-sex reproduction is only the tip of the iceberg. In vitro gametogenesis could theoretically facilitate “<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6973109/">solo reproduction</a>” by deriving both eggs and sperm from the same individual. Interestingly, a child created this way would not be a clone of its parent, since the process of gamete formation would shuffle the parent’s genetic material and create a genetically distinct individual.</p>
<p>Or people could engage in “<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4215291/">multiplex parenting</a>” combining genetic material from more than two individuals. Imagine, for example, that two couples create embryos via IVF. In vitro gametogenesis could then be used to derive eggs and sperm from each of these two separate embryos, which could subsequently be used to conceive a single child that is genetically related to all four adults.</p>
<p>Finally, in vitro gametogenesis could revolutionise prenatal genetic selection. We’d have <a href="https://rmanetwork.com/blog/number-of-eggs-good-ivf-in-vitro-fertilization/">many more embryos</a> than available during regular IVF to screen for genetic diseases and traits.</p>
<p>So it would be urgent to discuss “designer babies”, eugenics, and whether we have a <a href="https://bioedge.org/bioethics-d75/savulescu-interviewed-on-procreative-beneficence/">moral obligation</a> to conceive children with the best chance of a good life.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/worlds-first-synthetic-embryo-why-this-research-is-more-important-than-you-think-188217">World's first 'synthetic embryo': why this research is more important than you think</a>
</strong>
</em>
</p>
<hr>
<h2>We need to start talking about this now</h2>
<p>Both law and ethics can lag behind new technologies, particularly when their implications are as profound and far-reaching as the implications of in vitro gametogenesis.</p>
<p>We need to discuss how this technology should be regulated before it is rolled out. Given how rapidly the science is developing, we should begin this discussion now. </p>
<hr>
<p><em>Laura Smith, a masters student from Monash University, contributed to this article.</em></p><img src="https://counter.theconversation.com/content/219005/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Julian Koplin receives research funding from Ferring Pharmaceuticals for an unrelated project.</span></em></p><p class="fine-print"><em><span>Neera Bhatia receives funding from UKRI Arts and Humanities Research Council for an unrelated project.</span></em></p>The technology may be here sooner than we think. But we have so much to discuss first.Julian Koplin, Lecturer in Bioethics, Monash University & Honorary fellow, Melbourne Law School, Monash UniversityNeera Bhatia, Associate Professor in Law, Deakin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2169062023-12-06T22:04:49Z2023-12-06T22:04:49Z5 expert tips on how to look after your baby in a heatwave<figure><img src="https://images.theconversation.com/files/562908/original/file-20231201-21-qxkftk.jpg?ixlib=rb-1.1.0&rect=1%2C0%2C997%2C667&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/baby-being-washed-face-down-during-2217329091">b-finity/Shutterstock</a></span></figcaption></figure><p>Extreme heat events are becoming more <a href="https://www.acs.gov.au/pages/heatwaves">frequent and intense</a> in Australia. This can cause illness or worsen existing conditions. During hot weather, hospital admissions and deaths <a href="https://www.climatechange.environment.nsw.gov.au/impacts-climate-change/weather-and-oceans/heatwaves">increase</a>.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1732139339596083256"}"></div></p>
<p>Babies are among those particularly vulnerable.</p>
<p>Looking after a baby during extreme heat takes a little planning and a lot of patience. Here are five practical tips.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/extreme-weather-is-landing-more-australians-in-hospital-and-heat-is-the-biggest-culprit-216440">Extreme weather is landing more Australians in hospital – and heat is the biggest culprit</a>
</strong>
</em>
</p>
<hr>
<h2>Why are babies particularly at risk?</h2>
<p>Babies are more vulnerable to extreme heat for several reasons.</p>
<p>They have a <a href="https://www.science.org/doi/10.1126/science.abe5017">higher metabolic rate</a> than older children and adults, so their body generates more internal heat. </p>
<p>They also have a larger surface area compared with the volume of their body. So they <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6770410">adsorb heat</a> more easily from the environment. </p>
<p>Their sweat glands are <a href="https://www.livescience.com/newborns-no-tears-or-sweat.html">not fully developed</a>. So they cannot lose heat by sweating as easily as older children and adults.</p>
<p>Babies also have to rely on adults to keep them safe when the weather is hot. They cannot move to a cooler place or drink more fluids without help from their parents or caregivers.</p>
<h2>1. Plan ahead</h2>
<p>Knowing if hot weather is coming allows you to prepare and avoid, or reduce, your baby’s exposure to heat. </p>
<p>So keep an eye on forecasts from the <a href="http://www.bom.gov.au/">Bureau of Meteorology</a> (including its <a href="http://www.bom.gov.au/australia/heatwave/">heatwave warning service</a>). Your local <a href="https://www.abc.net.au/local">ABC radio station</a> broadcasts emergency information, and you can search for emergency conditions on the <a href="https://www.abc.net.au/emergency">ABC website</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/worried-about-heat-and-fire-this-summer-heres-how-to-prepare-212443">Worried about heat and fire this summer? Here's how to prepare</a>
</strong>
</em>
</p>
<hr>
<h2>2. Keep your home cool</h2>
<p>On hot days, close windows, blinds and curtains early in the day and keep outside doors shut. If you live in a multi-storey building, stay downstairs where the air will be cooler. </p>
<p>Air conditioning will keep you cool if you have it. Staying in one part of the house and closing doors to the rest, can make air conditioning more effective and reduce your energy use. Take care to ensure rooms do not become too cold and ensure air flow from air conditioners or fans is not directed at your baby. That’s because babies also have difficulty <a href="https://www.chop.edu/conditions-diseases/warmth-and-temperature-regulation">regulating their temperature</a> in the cold and their temperature can quickly drop. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/562923/original/file-20231201-25-pkaqll.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Fan on chest of drawers, cot in background" src="https://images.theconversation.com/files/562923/original/file-20231201-25-pkaqll.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/562923/original/file-20231201-25-pkaqll.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/562923/original/file-20231201-25-pkaqll.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/562923/original/file-20231201-25-pkaqll.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/562923/original/file-20231201-25-pkaqll.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/562923/original/file-20231201-25-pkaqll.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/562923/original/file-20231201-25-pkaqll.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">Make sure your fan isn’t blowing directly at your baby.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/modern-fan-on-commode-baby-room-1897747780">New Africa/Shutterstock</a></span>
</figcaption>
</figure>
<p>Power blackouts are <a href="https://www.energynetworks.com.au/resources/fact-sheets/heatwaves-and-energy-supply-explained/#:%7E:text=Heatwaves%20are%20three%20or%20more,faults%2C%20bushfires%20or%20generator%20faults.">common</a> during extreme heat events. So, think about what you’ll do if you can’t use air conditioning because of a blackout.</p>
<p>If you cannot keep cool at home, try to find somewhere you can go that is air conditioned. This could be a public building, such as a library or shopping centre, or the home of a friend or relative. </p>
<p>Some communities have “<a href="https://www.smh.com.au/national/nsw/no-way-to-escape-the-heat-push-for-havens-to-stop-australia-s-silent-killer-20230816-p5dwzl.html">heat havens</a>” or “<a href="https://www.smh.com.au/national/nsw/homes-aren-t-safe-western-sydney-prepares-evacuation-shelters-for-hot-summers-20220505-p5aioj.html">heat shelters</a>” where vulnerable people, including pregnant women and families with babies, can go during extreme heat.</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>
<h2>3. Take care if you need to go out</h2>
<p>If you do have to go out, ensure your baby is sheltered from the sun and heat as much as possible. </p>
<p>Use a sunshade on car windows to protect you baby from direct sunlight. Never leave a baby or young child <a href="https://raisingchildren.net.au/toddlers/safety/car-pedestrian-safety/never-leave-children-in-cars">in a parked car</a>.</p>
<p>You can help keep your baby cool in their pram by covering it with a light, damp cloth and spraying it with water every 15-20 minutes. Don’t let the cloth dry out completely because this can <a href="https://theconversation.com/covering-your-babys-pram-with-a-dry-cloth-can-increase-the-temperature-by-almost-4-degrees-heres-what-to-do-instead-199099">increase the temperature</a> in the pram.</p>
<p>Once the day starts to cool down, playing with water in a shady spot outside is a great way to cool down. Always supervise babies in or near water.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1629708787866038272"}"></div></p>
<h2>4. Offer babies extra fluids</h2>
<p>Babies need extra fluids during hot weather, but their pattern of feeding can change when it’s hot.</p>
<p>For breastfed babies this often means they start fussing or crying at the breast after just a few minutes, then want to breastfeed again as soon as 30-40 minutes later. </p>
<p>Mothers may worry their breasts have run out of milk, but they haven’t. These short feeds provide milk that is <a href="http://www.foodandnutritionjournal.org/volume2number2/importance-of-exclusive-breastfeeding-and-complementary-feeding-among-infants/">higher in water</a> than a longer breastfeed. </p>
<p>Just like adults, babies don’t want to eat a full meal when they’re hot. Once the day starts to cool down, most babies will have several <a href="https://www.breastfeeding.asn.au/resources/breastfeeding-hot-weather">longer, more satisfying feeds</a>.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1730246909317579131"}"></div></p>
<p>Similarly, formula-fed babies will often take less milk at a feed during the heat of the day but look for another feed sooner than usual.</p>
<p>Instead of trying to make a baby finish a whole bottle, try splitting their usual feed into two. If the baby finishes the first bottle, you can top it up from the second bottle or keep it in the fridge and warm it up again when they start <a href="https://www.breastfeeding.asn.au/resources/feeding-cues">looking hungry</a> again. Just like breastfed babies, they will usually be looking for slightly bigger feeds as the day starts to cool. </p>
<p>Do NOT give babies under six months old water as this can make them very ill. Their kidneys are not mature and <a href="https://www.reuters.com/article/us-water-babies-idUSCOL16728820080521">cannot handle the extra water</a>.</p>
<p>You can tell your baby is getting enough fluids if they have <a href="https://www.breastfeeding.asn.au/resources/baby-getting-enough-breastmilk">five heavy, wet disposable nappies</a> in 24 hours, their urine is pale yellow and doesn’t have a strong smell. </p>
<p>If this isn’t happening, your baby <a href="https://www.health.nsw.gov.au/environment/beattheheat/Pages/babies-children-hot-weather.aspx">needs more fluids</a> and you need to offer more frequent feeds. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/562925/original/file-20231201-23-pkaqll.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Baby chewing on water melon outside in grassy garden or park" src="https://images.theconversation.com/files/562925/original/file-20231201-23-pkaqll.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/562925/original/file-20231201-23-pkaqll.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=397&fit=crop&dpr=1 600w, https://images.theconversation.com/files/562925/original/file-20231201-23-pkaqll.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=397&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/562925/original/file-20231201-23-pkaqll.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=397&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/562925/original/file-20231201-23-pkaqll.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=499&fit=crop&dpr=1 754w, https://images.theconversation.com/files/562925/original/file-20231201-23-pkaqll.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=499&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/562925/original/file-20231201-23-pkaqll.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=499&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">For older babies, try offering watermelon or strawberries.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/little-boy-eating-watermelon-red-garden-459152617">Dudaeva/Shutterstock</a></span>
</figcaption>
</figure>
<p>From six months, babies can be given small amounts of <a href="https://www.health.tas.gov.au/publications/drinking-water-babies-fact-sheet">cooled boiled water</a> in addition to breastmilk or formula. You can also offer foods containing lots of water, such as watermelon or strawberries, or iceblocks made with breastmilk, formula or diluted fruit juice. Chewing on a cold, wet face washer is another way older babies can get extra fluids.</p>
<p>Remember to look after yourself when the weather gets hot. Have a glass of water at least every time your baby feeds. If you are breastfeeding and the heat makes skin contact uncomfortable for you and your baby, you can put a light cloth or damp hand-towel between you, or you can lie down to feed so your baby is next to your body instead of on it.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/health-check-how-do-i-tell-if-im-dehydrated-107437">Health Check: how do I tell if I'm dehydrated?</a>
</strong>
</em>
</p>
<hr>
<h2>5. Prepare for sleep</h2>
<p>Everyone struggles to sleep in hot weather. A lukewarm bath may help your baby cool off enough to fall asleep. However, avoid cold baths as your baby’s temperature may drop too much. </p>
<p>Nobody sleeps well on hot nights and we all need to catch up on sleep when the weather cools.</p>
<hr>
<p><em>In extreme heat, if your baby won’t feed well, is limp or floppy, has dull sunken eyes and a sunken soft spot in the skull (fontanelle), seek medical treatment straight away. In an emergency, call 000.</em></p><img src="https://counter.theconversation.com/content/216906/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 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.
</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. Michelle volunteers as a 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 an infant and young child feeding consultant for the World Health Organization. She is a member of the Public Health Association of Australia, the World Public Health Nutrition Association, and the Australian Breastfeeding Association.</span></em></p>Looking after a baby during extreme heat events takes a little planning and a lot of patience. Here are some practical steps you can take.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/2141312023-11-23T23:39:00Z2023-11-23T23:39:00ZIs sleeping with your baby a good idea? Here’s what the science says<figure><img src="https://images.theconversation.com/files/549663/original/file-20230918-21-ueto34.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5552%2C3709&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Scientific evidence allows parents to choose the sleeping arrangement that's right for them and their family.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>Sleeping with your baby is not life-threatening, but it’s not essential either. Rather, it’s a family choice that you should make with your partner. </p>
<p>However, in order to make the right decision you need to have access to reliable information. The choice of sleeping arrangements at the beginning of your child’s life depends on a multitude of factors. So-called co-sleeping has become a polarizing subject. The important questions surrounding the practice are often drowned out in a whirlwind of information and opinions. Parents can quickly find themselves struggling over the best choice.</p>
<p>As researchers at the Université du Québec à Trois-Rivières and experts in early childhood and the sleep of children and teenagers, we’ve surveyed the scientific studies on co-sleeping in order to show both sides of the coin.</p>
<h2>What do we mean by co-sleeping?</h2>
<p>To start with, co-sleeping is a sleeping arrangement. It is not a method used for falling asleep, <a href="https://sleeponitcanada.ca">although sleeping arrangements strongly influence this</a>. </p>
<p>There are <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7246529/">two types of co-sleeping</a>:</p>
<ol>
<li><p>Co-sleeping on a shared surface, as in sharing the same bed; and</p></li>
<li><p>Co-sleeping in the same room, which involves sharing the same sleeping area.</p></li>
</ol>
<p>A <a href="https://www150.statcan.gc.ca/n1/en/catalogue/82-003-X201900700002">recent Canadian study</a> reported that about a third of mothers co-sleep on the same surface, while 40 per cent said they had never co-slept at all. A <a href="https://www.jesuisjeserai.stat.gouv.qc.ca/publications/baby_no4.pdf">Québec study</a> in the late 1990s revealed that one-third of mothers co-slept in the same room.</p>
<p>The <a href="https://caringforkids.cps.ca/handouts/pregnancy-and-babies/safe_sleep_for_babies">Canadian Paediatric Society states</a>: “For the first 6 months, the safest place for your baby to sleep is on their back, in a crib, cradle or bassinet that is in your room (room sharing).”</p>
<h2>Two schools of thought</h2>
<p>After it came to light in the late 2000s that Canada had <a href="https://publications.gc.ca/collections/collection_2015/aspc-phac/HP35-51-2014-eng.pdf">high mortality rates among infants</a> (one per thousand), society adopted a rather alarmist view of co-sleeping. </p>
<p>The first school of thought focuses on the medical aspects of co-sleeping linked to the risks of sleeping with a baby, such as choking, crushing or <a href="https://www.canada.ca/en/public-health/services/health-promotion/childhood-adolescence/stages-childhood/infancy-birth-two-years/safe-sleep/safe-sleep-your-baby-brochure.html#">sudden infant death syndrome</a>. </p>
<p>The second school aims to facilitate the <a href="https://www.sciencedirect.com/science/article/abs/pii/S1087079216000265?via%3Dihub%5D">practice of breastfeeding and the inclusion of cultural and family values</a> and believes that co-sleeping promotes them.</p>
<p>These two main schools of thought coexist, which explains why the choice of sleeping arrangements in the early months can become so challenging for parents. </p>
<h2>Better for breastfeeding and communication</h2>
<p>Does co-sleeping promote breastfeeding during the night? Yes, <a href="https://www.sciencedirect.com/science/article/abs/pii/S1087079218300844?via%3Dihub">according to scientific studies</a>. But it’s hard to say whether it’s breastfeeding <a href="https://www.sciencedirect.com/science/article/abs/pii/S0163638319301237?via%3Dihub">that favours this practice or whether it’s the other way around</a>. In any case, breastfeeding is the main reason <a href="https://www150.statcan.gc.ca/n1/en/catalogue/82-003-X201900700002">why mothers choose shared-surface co-sleeping</a>.</p>
<p>However, no difference was found between breastfeeding at night <a href="https://academic.oup.com/ejo/article/44/1/110/6293736?login=false">and the two types of co-sleeping</a>. In other words, sleeping in the same room is just as conducive to breastfeeding as is sleeping on a shared surface.</p>
<p>The same applies to meeting the child’s needs. <a href="https://www.sciencedirect.com/science/article/abs/pii/S0163638319301237?via%3Dihub">According to a scientific study</a>, physical contact and proximity in the same room promote the synchronization of the child’s circadian rhythm with that of the parent. This helps the baby consolidate their sleep. This would make parents more alert to the infant’s signals in both types of sleep arrangement. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6163497/">And that, in turn, would help communication</a> and <a href="https://link.springer.com/article/10.1007/s10995-014-1557-1">make it possible to respond easily and quickly to the baby’s needs</a>.</p>
<figure class="align-center ">
<img alt="A baby lying on a bed is held by a woman lying next to him" src="https://images.theconversation.com/files/548829/original/file-20230918-17-jublh5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/548829/original/file-20230918-17-jublh5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=394&fit=crop&dpr=1 600w, https://images.theconversation.com/files/548829/original/file-20230918-17-jublh5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=394&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/548829/original/file-20230918-17-jublh5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=394&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/548829/original/file-20230918-17-jublh5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=495&fit=crop&dpr=1 754w, https://images.theconversation.com/files/548829/original/file-20230918-17-jublh5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=495&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/548829/original/file-20230918-17-jublh5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=495&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Proximity would promote synchronization of the child’s circadian rhythm to that of the parent.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<h2>Less stress</h2>
<p>While co-sleeping is known to reduce a baby’s stress, it depends on the level.</p>
<p><a href="https://academic.oup.com/ejo/article/44/1/110/6293736?login=false">One study that asked parents about this subject</a> found that children who had experienced one of two co-sleeping arrangements had lower anxiety levels at preschool age compared with those who had co-slept for less than six months. </p>
<p><a href="https://www.sciencedirect.com/science/article/abs/pii/S0306453011001065?via%3Dihub">Another study</a> showed that children who slept with a parent had a lower stress response at 12 months of age compared with those who did not. However, when comparing a higher stress situation (e.g. getting a vaccination) to a moderate stress situation (e.g. during bath time), the difference between the two groups was smaller. It should be noted that several variables still need to be tested in order to fully understand this relationship, and that the two types of co-sleeping arrangements were not compared.</p>
<h2>More disturbed and fractured sleep</h2>
<p>Babies who co-sleep wake up more often than those who sleep alone at the beginning of life. <a href="https://journals.lww.com/jrnldbp/abstract/2022/01000/bed_sharing_in_the_first_6_months__associations.11.aspx">This is also true for parents</a>. </p>
<p><a href="https://academic.oup.com/sleep/article/41/2/zsx207/4753805">A study</a> measuring the amount of sleep at six, 12 and 18 months showed that the group of children co-sleeping on a shared surface or in the same room had more nocturnal arousals, measured by <a href="https://stanfordhealthcare.org/medical-tests/s/sleep-disorder-tests/procedures/actigraphy.html">actigraphy</a> at six months. They also had more arousals measured by the mothers’ sleep diaries at six, 12 and 18 months, compared with the group of children sleeping alone. </p>
<p>At 12 months, the solitary sleepers had a longer average sleep time. These results were obtained after controlling for type of feeding (breast or bottle). However, the study did not investigate whether sleep characteristics differed between the two types of co-sleeping. </p>
<p>Mothers who co-sleep on a shared surface report that their babies fall asleep more easily and quickly, but wake up more frequently. They say they choose this arrangement <a href="https://link.springer.com/article/10.1007/s10995-014-1557-1">to improve their family’s sleep</a>. </p>
<p>Mothers generally perceive <a href="https://www.jpeds.com/article/S0022-3476(22)00076-2/fulltext">no sleep difficulties in their babies</a>. But when mothers’ sleep is measured by actigraphy, it is <a href="https://academic.oup.com/sleep/article/41/2/zsx207/4753805?login=false">more fragmented and disturbed for the first 18 months</a> compared with those who opted for a solitary sleep arrangement. </p>
<p><a href="https://www.jpeds.com/article/S0022-3476(22)00076-2/fulltext">Another objective study</a> reveals that co-sleeping on a shared surface over the longer term (for the first two years of the child’s life) is associated with a shorter sleep duration at night, a greater need for naps during the day, and a higher proportion of difficulties falling asleep.</p>
<h2>Attachment: no clear answers</h2>
<p>Is co-sleeping on a shared surface associated with stronger attachment to the child? </p>
<p>This subject is controversial. </p>
<p>Some studies have reported a stronger attachment bond in babies who co-slept on a shared surface <a href="https://www.sciencedirect.com/science/article/abs/pii/S0163638319301237?via%3Dihub">compared with those who slept alone</a>. </p>
<p>Others report no link, either positive or negative, between parent-child attachment and <a href="https://journals.lww.com/jrnldbp/abstract/2022/01000/bed_sharing_in_the_first_6_months__associations.11.aspx">sleep arrangement after the child’s first six months of life</a>. </p>
<h2>Parents’ choice</h2>
<p>This scientific data will help parents choose the sleeping arrangement that’s right for them and their family. The decision remains a parental choice. </p>
<p>If you opt for a co-sleeping arrangement, you can find the safety measures to put in place <a href="https://www.canada.ca/content/dam/hc-sc/migration/hc-sc/cps-spc/alt_formats/pdf/pubs/cons/child-enfant/sleep-coucher-eng.pdf">on the Health Canada site</a> in order to make sure everyone gets a good night’s sleep.</p><img src="https://counter.theconversation.com/content/214131/count.gif" alt="La Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Evelyne Touchette has received funding from the Fonds de recherche du Québec and the Social Sciences and Humanities Research Council.</span></em></p><p class="fine-print"><em><span>Gabrielle Fréchette-Boilard ne travaille pas, ne conseille pas, ne possède pas de parts, ne reçoit pas de fonds d'une organisation qui pourrait tirer profit de cet article, et n'a déclaré aucune autre affiliation que son organisme de recherche.</span></em></p>Questions about co-sleeping are often drowned out in a whirlwind of information and opinions. But science can provide some answers.Gabrielle Fréchette-Boilard, Doctorante en psychoéducation, Université du Québec à Trois-Rivières (UQTR)Evelyne Touchette, Adjunct professor, département de psychoéducation, Université du Québec à Trois-Rivières (UQTR)Licensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2119722023-11-09T14:15:03Z2023-11-09T14:15:03ZHow autistic parents feel about breastfeeding and the support they receive – new research<figure><img src="https://images.theconversation.com/files/550058/original/file-20230925-15-aytg7n.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5020%2C3321&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Almost half the study's respondents found breastfeeding to be a positive experience most or all of the time. </span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-mother-breastfeeding-her-newborn-child-516261334">Lolostock/Shutterstock</a></span></figcaption></figure><p>Surprisingly little is still known about autism and breastfeeding. A few years ago, <a href="https://journals.sagepub.com/doi/full/10.1177/13623613221089374">we reviewed</a> all of the research evidence and found limited information about the experiences of autistic parents – beyond highlighting that the sensory differences when breastfeeding could be very challenging for them. We also found that communication by health professionals didn’t always meet the <a href="https://www.autisticuk.org/post/autistic-mothers-experiences-of-breast-and-formula-feeding-babies-what-does-the-evidence-s">needs</a> of autistic parents.</p>
<p>So, for our newly released <a href="https://doi.org/10.1111/mcn.13581">study</a>, we asked 152 autistic parents from across the UK about their breast- and formula-feeding experiences. Some 87% of those who breastfed were strongly motivated to keep breastfeeding even if they ran into difficulties, while only 54% of all the parents we interviewed used any infant formula. This is a substantially lower rate of formula use than we’d typically see in the UK, where <a href="https://doc.ukdataservice.ac.uk/doc/7281/mrdoc/pdf/7281_ifs-uk-2010_report.pdf">88% of babies</a> receive some infant formula during their first six months.</p>
<p>Almost half of our respondents found breastfeeding to be a positive or enjoyable experience most or all of the time. This included the experience of feeling bonded with their baby and enjoying learning about breastfeeding.</p>
<p>That said, many of these autistic parents described experiencing sensory difficulties, with touch-related issues being their most frequently reported challenge. These issues ranged from discomfort caused by “little hands” touching their skin, to pain from infants suckling, biting and “latching on” to the breast. </p>
<p>Some 10% of our participants expressed breastmilk all of the time. This is higher than we would expect in an average group of parents, as expressing milk for every feed is <a href="https://onlinelibrary.wiley.com/doi/10.1111/j.1365-2648.2012.06035.x">usually only done</a> when babies are premature or parents have returned to work. On the other hand, the feeling and sound of breast pumps could be unbearable for some of the parents we interviewed.</p>
<h2>Interoception</h2>
<p>Most people know about the five basic human senses: touch, sight, sound, smell and taste. But we also have three other senses that are just as important. The <a href="https://www.sciencedirect.com/topics/neuroscience/vestibular-system">vestibular system</a> helps us keep our balance and move around safely; <a href="https://www.sciencedirect.com/topics/neuroscience/proprioception#:%7E:text=Proprioception%20refers%20to%20the%20sense,have%20receptors%20involved%20in%20proprioception.">proprioception</a> lets us know how our muscles and joints are moving; and <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/interoception">interoception</a> tells us about what is happening inside our bodies, such as our heart rate, breathing and digestion.</p>
<p>Autistic people often have <a href="https://www.sciencedirect.com/science/article/abs/pii/S073657481630096X">different interoceptive experiences</a> to non-autistic people – such as either not knowing or being acutely aware that they are hungry, thirsty or need the toilet. </p>
<p>With regard to breastfeeding, 41% of our participants who breastfed told us that their interoceptive experiences relating to the <a href="https://www.breastmilkcounts.com/breastfeeding-basics/the-let-down/">milk let-down reflex</a> (the response from your body that causes breastmilk to flow) was uncomfortable or painful always or most of the time. This included having “a feeling of dread” or the let-down reflex feeling odd in some way. One of our parents noted that “it felt like I had an old-fashioned telephone ringing in my breasts”.</p>
<h2>Adaptation strategies</h2>
<p>Whether our parents breast- or formula-fed, the intensity of babies’ frequent feeding could be overwhelming – a <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1468-2397.2009.00684.x">well-known issue</a> among the general population of parents too. However, for autistic parents, carefully developed strategies to stay regulated and de-stress, such as going for a walk or watching an episode of a favourite TV show, could be disrupted by the busy routine of new parenthood.</p>
<figure class="align-left ">
<img alt="A woman looks at her phone while breastfeeding her baby." src="https://images.theconversation.com/files/550067/original/file-20230925-25-cnncei.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/550067/original/file-20230925-25-cnncei.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=899&fit=crop&dpr=1 600w, https://images.theconversation.com/files/550067/original/file-20230925-25-cnncei.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=899&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/550067/original/file-20230925-25-cnncei.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=899&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/550067/original/file-20230925-25-cnncei.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1130&fit=crop&dpr=1 754w, https://images.theconversation.com/files/550067/original/file-20230925-25-cnncei.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1130&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/550067/original/file-20230925-25-cnncei.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1130&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="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/portrait-young-confident-woman-modern-living-2049690128">BAZA Production/Shutterstock</a></span>
</figcaption>
</figure>
<p>The parents in our study had done a lot of problem-solving to reduce the sensory challenges of feeding their babies. This included adapting their clothing and distracting themselves during feeding by looking at a mobile phone, for example. </p>
<p>There is evidence that bonding is <a href="https://onlinelibrary.wiley.com/doi/10.1111/nhs.12918">not negatively impacted</a> by the use of smartphones when breastfeeding in a general population. So, these types of distraction should be encouraged for all parents who are finding breastfeeding hard but want to continue doing so.</p>
<p>While 76% of our parents had received some form of breastfeeding support, nearly three-quarters of these parents (71%) still reported feeling unsupported. Issues included there not being enough breastfeeding support available, and health professionals providing conflicting information – concerns that also found in the accounts of <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/mcn.13355">non-autistic parents</a>.</p>
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Read more:
<a href="https://theconversation.com/dehumanising-policies-leave-autistic-people-struggling-to-access-health-education-and-housing-new-review-202997">'Dehumanising policies' leave autistic people struggling to access health, education and housing – new review</a>
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<p>It also appears that those supporting infant feeding, such as midwives and health visitors, did not have a good understanding of autistic communication. For example, some parents felt they were not listened to or that their concerns were dismissed.</p>
<p>Furthermore, some parents felt that staff did not appear to understand the specific sensory and interoceptive differences that could affect autistic people while breastfeeding.</p>
<h2>Room for improvement</h2>
<p>Overall, our study suggests there is a need for better understanding of autism among those providing infant feeding support. The national autism training <a href="https://www.annafreud.org/training/national-autism-trainer-programme/">programme</a>, which is developed and delivered by autistic adults, aims to improve this situation across England. Ideally, similar programmes should be implemented in the other UK nations.</p>
<p>A second area for improvement is for autistic parents, their partners and other people supporting them to be aware of potential feeding issues in advance, so they can be better prepared. Our project provides a <a href="https://www.youtube.com/@AutismMenstruationToMenopause/videos">suite of videos</a>, designed and created by autistic health professionals and parents, to help provide this information in an autism-friendly way.</p><img src="https://counter.theconversation.com/content/211972/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Aimee Grant receives funding from UKRI and the Wellcome Trust. She is a non-executive director of Disability Wales. We wish to thank Prof Amy Brown, who was also part of the research team.</span></em></p><p class="fine-print"><em><span>Kathryn Williams receives funding for her PhD studentship from the Economic and Social Research Council. She is affiliated with Autistic UK CIC, where she is a voluntary non-executive director.</span></em></p><p class="fine-print"><em><span>Catrin Griffiths 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>New research sheds light on how autism affects how we feed our babies, and vice versa.Aimee Grant, Senior Lecturer in Public Health and Wellcome Trust Career Development Fellow, Swansea UniversityCatrin Griffiths, Research Officer, Swansea UniversityKathryn Williams, PhD Candidate, Cardiff UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2143032023-10-05T15:14:59Z2023-10-05T15:14:59ZBaby formula preparation machines might not reach NHS recommended temperatures for killing bacteria – new research<figure><img src="https://images.theconversation.com/files/550876/original/file-20230928-21-25f2uo.jpg?ixlib=rb-1.1.0&rect=46%2C0%2C5184%2C3445&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The NHS recommends using water heated to at least 70C for mixing with formula powder.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/preparation-mixture-baby-feeding-on-white-556921537">279photo Studio/Shutterstock</a></span></figcaption></figure><p>When you have a new baby, it can feel as though there are suddenly thousands of things to worry about. One of the biggest concerns for parents in the early weeks is feeding.</p>
<p>Our <a href="https://doi.org/10.1111/mcn.13567">new study</a> has raised questions about one popular feeding device – the formula preparation machine. We found that only 15% of formula preparation machines tested dispensed water that appeared to be hot enough to meet NHS recommendations for preparing baby formula. In comparison, a majority of samples prepared using a kettle did meet the recommended temperature.<br>
Almost <a href="https://doc.ukdataservice.ac.uk/doc/7281/mrdoc/pdf/7281_ifs-uk-2010_report.pdf">three quarters</a> of babies in the UK receive some formula in the first six weeks after birth. This goes up to 88% within the first six months. Infant formula comes ready to drink in bottles and powdered, which parents need to mix with very hot water. Around <a href="https://static1.squarespace.com/static/59f75004f09ca48694070f3b/t/6053645514d0f3072adec94e/1616077909798/Marketing_of_infant_milk_in_the_UK-what_do_parents_see_and_believe_finala.pdf">80%</a> of parents who use formula use a powdered version at least half the time.</p>
<p>NHS guidance states that formula should be prepared using a kettle <a href="https://www.nhs.uk/conditions/baby/breastfeeding-and-bottle-feeding/bottle-feeding/making-up-baby-formula/">to boil</a> 1 litre of water, leaving the water to cool for no more than 30 minutes before adding it to the formula. This is so that it remains at a temperature of at least 70C when it is mixed with the powder. This is needed to <a href="https://www.who.int/publications/i/item/9789241595414">kill any bacteria</a>. </p>
<h2>Formula preparation machines</h2>
<p>In recent years, a range of formula preparation machines have been sold in the UK. Some dispense a small amount of hot water to which powder should be added, the bottle shaken and then the bottle topped up with cold water. Other machines dispense prepared formula in to a bottle. Our past <a href="https://static1.squarespace.com/static/59f75004f09ca48694070f3b/t/6053645514d0f3072adec94e/1616077909798/Marketing_of_infant_milk_in_the_UK-what_do_parents_see_and_believe_finala.pdf">research</a> suggests that more than half of parents use a formula preparation machine. </p>
<p>Some <a href="https://www.southtees.nhs.uk/services/maternity/infant-feeding/formula-feeding/">NHS trusts</a> (as well as the <a href="https://www2.hse.ie/babies-children/bottle-feeding/preparing-baby-formula/#:%7E:text=The%20Food%20Safety%20Authority%20of,for%20preparing%20your%20baby's%20bottle.">Irish government</a>), have stated that parents should not use these machines to prepare formula, due to there being problems with these devices that could lead to babies becoming unwell. This may be based on concerns that the water may not remain at a <a href="https://static1.squarespace.com/static/59f75004f09ca48694070f3b/t/5f58858c11457f399bae4a61/1599636878436/Bacterial_contamination_Aug20.pdf">hot enough temperature</a> to kill any bacteria in the powder. This matters because it increases the risk of gastrointestinal infection. </p>
<figure class="align-center ">
<img alt="A man feeds a baby with a bottle." src="https://images.theconversation.com/files/550878/original/file-20230928-27-d1ixap.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/550878/original/file-20230928-27-d1ixap.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/550878/original/file-20230928-27-d1ixap.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/550878/original/file-20230928-27-d1ixap.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/550878/original/file-20230928-27-d1ixap.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/550878/original/file-20230928-27-d1ixap.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/550878/original/file-20230928-27-d1ixap.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">shutterstock.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/family-parenthood-people-concept-close-father-1152717200">Ground Picture/Shutterstock</a></span>
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<p>Formula-fed babies are <a href="https://www.unicef.org.uk/wp-content/uploads/sites/2/2012/11/Preventing_disease_saving_resources.pdf">more likely</a> to get bacterial gastrointestinal infections than breastfed babies. There are two main ways that bacteria can get into formula. Firstly, powdered formula itself cannot be made sterile because of how it is manufactured, meaning it can get <a href="https://www.cdc.gov/cronobacter/infection-and-infants.html#:%7E:text=Powdered%20formula%20is%20not%20sterile,processing%20facilities%20that%20make%20it.">contaminated</a>. This means that a brand new, unopened tub of formula <a href="https://static1.squarespace.com/static/59f75004f09ca48694070f3b/t/624edeb6873c47686bd34825/1649335991943/Bacterial+contamination_April+22.pdf">can contain</a> harmful bacteria such as <em>Salmonella</em> and <em>Cronobacter</em>. </p>
<p>Secondly, bacteria can be introduced into the formula in the home <a href="https://www.nature.com/articles/s41598-019-46181-0">by parents</a> or carers if they do not wash their hands or adequately sterilise all feeding equipment before making a bottle.</p>
<p>Using water boiled in a kettle and cooled to above 70C <a href="https://iris.who.int/bitstream/handle/10665/43659/9789241595414_eng.pdf?isAllowed=y&sequence=1">kills</a> harmful bacteria that cause gastrointestinal infections. Because of this, it is the only method of preparing formula which is currently <a href="https://www.nhs.uk/conditions/baby/breastfeeding-and-bottle-feeding/bottle-feeding/making-up-baby-formula/">recommended</a> by the NHS.</p>
<p>However, <a href="https://static1.squarespace.com/static/59f75004f09ca48694070f3b/t/6053645514d0f3072adec94e/1616077909798/Marketing_of_infant_milk_in_the_UK-what_do_parents_see_and_believe_finala.pdf">we found</a> that many parents do not feel confident about preparing bottles of formula safely.</p>
<h2>What we found</h2>
<p>We asked 143 parents to test the temperature of the water they used to prepare a bottle of formula at home. <a href="https://doi.org/10.1111/mcn.13567">We found</a> that only 15% of the 74 infant formula preparation machines tested appeared to produce water that reached NHS recommended temperatures for preparing bottles of formula.</p>
<p>But among the parents in our study who used a kettle to make up their formula, 78% of temperatures reported were above the recommended NHS level. </p>
<p>This is concerning, as temperatures below 70C can be harmful to babies’ health, and also given such a high number of parents use formula preparation machines. </p>
<h2>Advice</h2>
<p>If you are formula feeding, more information and support about preparing bottles is available on the <a href="https://www.nhs.uk/conditions/baby/breastfeeding-and-bottle-feeding/bottle-feeding/making-up-baby-formula/">NHS website</a>. The NHS guide recommends using a kettle to boil the water.</p>
<p>The Food Standards Agency (FSA) <a href="https://www.swansea.ac.uk/press-office/news-events/news/2023/10/study-raises-concerns-over-powdered-infant-formula-preparation-machines.php">recommend</a> that if you already have a formula preparation machine, you use a food thermometer to test the temperature of the water it produces. If you do this, do not put the thermometer into the bottle that you use to feed your baby, as the thermometer could introduce bacteria, so you will need to do this separately to making a bottle. </p>
<p>If your thermometer shows the water is below 70C, the machine should not be used to prepare bottles of formula and you should use a kettle instead. The FSA recommend that parents should notify both the manufacturer and their <a href="https://www.gov.uk/find-local-trading-standards-office">local trading standards</a> department or <a href="https://www.citizensadvice.org.uk/">Citizens Advice</a>. </p>
<p>We have shared our results with the <a href="https://www.gov.uk/government/organisations/office-for-product-safety-and-standards">Office for Product Safety and Standards</a>, the UK’s product safety regulator, who have purchased examples of formula preparation machines to assess compliance. We have also shared our findings with the <a href="https://www.food.gov.uk/">FSA</a>, who safeguard public health and protect consumers in relation to food across the UK.</p><img src="https://counter.theconversation.com/content/214303/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Aimee Grant receives funding from UKRI and the Wellcome Trust. She has previously received funding from the NIHR, HEFCW, and public health charities. Aimee is affiliated with Disability Wales. The Finding the Formula study, which is reported on in this article, was funded by UKRI and the Food Standards Agency. We wish to thank Dr Vicky Sibson, Dr Rebecca Ellis, Abbie Dolling, Tara McNamara, Jonie Cooper, Susan Dvorak, Sharon Breward, Phyll Buchanan and Dr Emma Yhnell who were also part of the study team, and the parents who provided data for this study.
</span></em></p><p class="fine-print"><em><span>Amy Brown has received research funding from UKRI, HEFCW, Infant feeding charities, local councils, health trusts and Public Health Wales. </span></em></p><p class="fine-print"><em><span>Sara Jones was paid for her time as a study manager from the UKRI funding for this project. She has also received funding from MRC and infant feeding charities.</span></em></p>New research finds that 85% of formula preparation machines tested were dispensing water that did not appear to reach NHS recommended temperatures for preparing bottles of formula.Aimee Grant, Senior Lecturer in Public Health and Wellcome Trust Career Development Fellow, Swansea UniversityAmy Brown, Professor of Child Public Health, Swansea UniversitySara Jones, Senior lecturer at Lactation and Infant Feeding Translational research centre, Swansea UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2127152023-09-07T13:28:04Z2023-09-07T13:28:04ZWhy mothers and babies will suffer more as Africa grows hotter<p><em>As Africa gets hotter, mothers and babies are most at risk. Why is this and what can be done about it? Matthew Chersich, a specialist in climate change and maternal health, explains the reasons to health editor Nadine Dreyer.</em></p>
<h2>What makes pregnant women particularly vulnerable to extreme heat?</h2>
<p>Many women in Africa have little or no protection against extreme heat events, with pregnancy being an particularly vulnerable period. High ambient temperatures may overwhelm the capacity of the maternal thermoregulatory mechanisms to dissipate heat in pregnancy.</p>
<p>Foetal metabolism generates considerable heat in the mother’s body. Then there is the strain from additional weight gain in pregnancy, fat deposits that retain heat, and the major exertion of labour and childbirth. </p>
<p>The foetus remains around 0.5°C warmer than the mother and thus if a mother has heat stress or a fever, the foetal temperature quickly reaches dangerous levels. </p>
<p>The most dangerous period is likely during <a href="https://obgyn.onlinelibrary.wiley.com/doi/full/10.1002/ijgo.14381#:%7E:text=Extreme%20heat%20can%20overwhelm%20thermoregulatory,%2C%20preterm%20birth%2C%20and%20stillbirth.">childbirth</a>, when women generate remarkable levels of heat from the labour process. If this occurs during a heatwave it can increase complications, such as prolonged labour, increased emergency caesarean sections and maternal haemorrhage.</p>
<h2>What makes babies particularly vulnerable?</h2>
<p>Infants are dependent on their carers for protecting them against heat exposure. Some practices, such as over-swaddling, pose considerable risks as global temperatures rise. </p>
<p>Dehydration is also a major concern for young children, due to water loss through sweating or from gastroenteritis, which increases as food- and water-borne pathogens replicate more frequently and survive longer during warm weather.</p>
<p>Mothers may also supplement breastfeeding with water. In many areas, water is unsafe because of poor infrastructure. </p>
<p>Infants may breastfeed for shorter periods during hot weather as feeding can be uncomfortable for baby and mother in the heat. </p>
<p>In one of our studies in <a href="https://bmjopen.bmj.com/content/12/10/e061297">Burkina Faso</a>, breastfeeding duration was about 25 minutes shorter on hot days compared to cold days.</p>
<h2>It is possible to quantify the effect of climate change on pregnant women and newborn babies?</h2>
<p>We are able to calculate the relative risk of adverse birth outcomes, such as preterm birth, which increases about <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10087975/">1.15 fold during heatwaves</a>. The key gap in the field is quantifying the absolute number of additional adverse outcomes that are occurring because of climate change. </p>
<p>Those figures would help people to appreciate the implications of climate change for maternal and child health. There are real concerns that extreme heat may reverse the previous gains made in maternal and child health, from childhood vaccines, for example.</p>
<p>In some of our work we estimated how many additional child deaths occurred in Africa from heat exposure. We showed that there were between 7,000 and 11,000 deaths from heat exposure in children in Africa annually that could be attributed to climate change. Unless we curb carbon emissions dramatically, <a href="https://iopscience.iop.org/article/10.1088/1748-9326/ac7ac5">heat-related child mortality</a> in Africa may reach over 38,000 a year in 2049. </p>
<p>A study of <a href="https://www.sciencedirect.com/science/article/pii/S0013935122009239">pregnant women in Johannesburg</a> showed that rates of severe hypertensive disorders in pregnancy increase by as much as 80% when temperatures exceed 23°C in early pregnancy. </p>
<h2>Do different health issues affect mothers and children?</h2>
<p>While the harms of exposure to extreme heat in pregnancy are well known, we do not yet have easy ways of calculating how much of that additional burden of disease is due to climate change, as opposed to natural variations in temperature. The methods for doing so are improving rapidly, however. </p>
<p>What is clear is that if South Africa experiences the kinds of temperatures that were seen in Europe and North America in 2023, there will be many thousands of additional pregnancy complications, all of which will be directly attributable to climate change.</p>
<h2>What are some practical solutions?</h2>
<p>There are a number of relatively simple, low cost <a href="https://journals.co.za/doi/full/10.18772/26180197.2022.v4n3a7#:%7E:text=Then%2C%20during%20actual%20heatwaves%2C%20interventions,also%20may%20have%20high%20e%EF%AC%83cacy.">“cooling” interventions</a> which could be implemented at scale if countries in the global north kept to their funding commitments. </p>
<p>Each year high-income countries make major promises about climate financing, but have yet to deliver. They committed US$100 billion a year in the 2015 Paris Agreement and have delivered only a <a href="https://www.greenclimate.fund/about/resource-mobilisation/irm">tiny fraction</a> of that amount. </p>
<p>Low-cost interventions include painting roofs of houses or health facilities with white reflective paint, fans with evaporative cooling, providing cool water for women during labour and making “cooling centres” where women could go during a heatwave.</p>
<h2>What can pregnant women and communities do to reduce risks?</h2>
<p>On a local level there are behavioural changes that can benefit maternal health. Many pregnant women continue physical work even late in pregnancy, including walking long distances to collect water and firewood. A <a href="https://ehp.niehs.nih.gov/doi/abs/10.1289/isee.2021.O-SY-049">project</a> in Burkina Faso and Kenya tested a community-mobilisation intervention that aimed to reduce heavy workloads during pregnancy and early motherhood. Results of the project are promising.</p>
<p>Major changes must be made to built environments. The temperatures in many informal settlements are <a href="https://pubmed.ncbi.nlm.nih.gov/32832385/">higher indoors</a> than they are outdoors, which can be devastating for expectant mothers. Higher night-time temperatures are especially concerning. Many healthcare facilities are similarly ill-equipped to provide pregnant women with cooler environments. </p>
<p>All the interventions mentioned above can provide some degree of protection against the current level of heat exposure women face, but will be poorly effective against the kinds of temperatures that we will experience in five to 10 years’ time. </p>
<p>We know almost nothing about what could be done to prevent mass mortality events at temperatures around 50-55°C in settings where air conditioning is not feasible and the population is not accustomed to those temperatures.</p><img src="https://counter.theconversation.com/content/212715/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Matthew Chersich receives funding from the Wellcome Trust, US National Institutes of Health and the European Union </span></em></p>Africa has made good progress towards reducing maternal mortality and newborn deaths over the past decade. But climate change is reversing the gains.Matthew Cherisch, Associate Professor at the Wits Reproductive Health & HIV Institute, University of the WitwatersrandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2068152023-08-29T15:34:39Z2023-08-29T15:34:39ZWomen still feel like they aren’t listened to when they give birth – here’s what could help change things<figure><img src="https://images.theconversation.com/files/529567/original/file-20230601-21-fbfne2.jpg?ixlib=rb-1.1.0&rect=0%2C8%2C5800%2C3846&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/new-born-baby-hand-hold-mum-1968250909">Ratchat/Shutterstock</a></span></figcaption></figure><p>Women often report that they are <a href="https://www.sciencedirect.com/science/article/pii/S0266613815002302?casa_token=Y3U5qP_CLgkAAAAA:X8XttGQrojxZWapFx7YeRifVidoBXfmfGV32ocbTW7Fjoe2IttRprpfSeUB5khvaBAHArawbaXjT#bib3">not listened to or given choices</a> about what happens during their own labour. But studies have long shown that <a href="https://www.gov.uk/government/publications/womens-health-strategy-for-england">feeling heard and having choice</a> during childbirth enhances women’s wellbeing.</p>
<p>These findings led to changes in NHS policy and guidelines beginning with the landmark report <a href="https://www.sciencedirect.com/science/article/pii/S0266613813003537?casa_token=0w-T3zF3BcoAAAAA:v9TE8QFF0IugEcSaQI6_run7w420zDhU3LzN1qg7hk1fsUr6-sfR00wEvvJQExwNFiFaLgTsby31#bib4">Changing Childbirth in the 1990s</a>.</p>
<p>However, our recent research has revealed a disconnect between policy and the reality of how decision making happens. This could help explain why women <a href="https://www.theguardian.com/lifeandstyle/2023/mar/16/i-kept-begging-for-pain-relief-the-women-forced-to-give-birth-without-gas-and-air">still say they feel ignored</a> when they ask for pain relief during labour. </p>
<hr>
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<img alt="" src="https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?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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<p><em>This article is part of <a href="https://theconversation.com/uk/topics/womens-health-matters-143335">Women’s Health Matters</a>, a series about the health and wellbeing of women and girls around the world. From menopause to miscarriage, pleasure to pain the articles in this series will delve into the full spectrum of women’s health issues to provide valuable information, insights and resources for women of all ages.</em></p>
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<hr>
<p>Our team of sociologists and midwives examined 37 video or audio recordings of labour and birth in <a href="https://www.journalslibrary.nihr.ac.uk/hsdr/FPFP4621/#/abstract">English midwife-led units</a> (where midwives support low risk births). </p>
<p>Although the women wrote that they expected and wanted to be involved in decision making when they went into labour in pre-birth questionnaires, this generally didn’t happen on the day. Nevertheless, when many of the mothers filled in follow-up questionnaires about six weeks after birth, they mostly reported being satisfied with their experience. </p>
<p>However, some women faced various forms of resistance from midwives about pain relief over a long period of time and were less pleased with how things went.</p>
<p>A key limitation of our study is that the 36 of the 37 mothers in the study were white. This is important to note beacuse black and Asian women in the UK are <a href="https://www.npeu.ox.ac.uk/assets/downloads/mbrrace-uk/reports/maternal-report-2022/MBRRACE-UK_Maternal_MAIN_Report_2022_UPDATE.pdf">more likely to die</a> in childbirth than white women. </p>
<h2>Complexity of pain relief decisions</h2>
<p>No one <a href="https://www.spectator.co.uk/article/why-is-the-nhs-denying-women-pain-relief-in-childbirth/">should be denied pain relief</a> without explanation, but our study findings show how complex decisions about pain actually are.</p>
<p>For example, increased pain is a sign the woman may be close to delivering her baby. If women <a href="https://www.nhs.uk/pregnancy/labour-and-birth/what-happens/the-stages-of-labour-and-birth/">take opiates during the second</a>, “pushing” stage of labour, there is a chance the baby could be born with opiates in their system, which sometimes means <a href="https://www.nhsinform.scot/ready-steady-baby/labour-and-birth/labour/pain-relief-in-labour">newborns need help to start breathing</a>. It can also interfere with breastfeeding. </p>
<p>One woman, who we called Fiona, requested opiate pain relief 18 times over an hour and a half. A key issue for Fiona was a shift change, shortly after an agreement to administer pain relief depending on the outcome of a vaginal examination (to check that Fiona was not “ready to push baby out”). </p>
<p>The outgoing midwife left before conducting the examination and Fiona reissued her request for opiates almost as soon as the new midwife entered the room. The midwife asked what form of pain relief Fiona had in her previous labour and the nature of her current pains. Then she asserted a need to conduct clinical observations (such as blood pressure). </p>
<p>Nevertheless, the midwife kept the matter open by saying: “Bear with me and then we’ll keep having a bit more of a chat about your options.” The situation continued to unfold in this way, with Fiona requesting opiates and the midwife deferring the decision. </p>
<p>It was some time before the midwife outlined the risks involved with opiates. </p>
<p>Fiona hesitated but agreed to forgo opiates and delivered her baby around ten minutes later. In her post-birth questionnaire, Fiona said she did not regret going without opiates but added:</p>
<blockquote>
<p>I don’t feel that the midwife in the later stages of my labour listened to what I was saying. All in all the experience was positive. However, I asked for increased pain relief around 6.30am and repeatedly after that, and the midwife did not have a discussion with me about why it would be advisable not to have the pain relief until around 8.20am. In the meantime I was very frustrated that no one was listening.</p>
</blockquote>
<h2>Midwives lead most decisions</h2>
<p>The way a person initiates a conversation can open up or close the opportunity for the other person to participate. For example, a pronouncement – <a href="https://www.tandfonline.com/doi/abs/10.1080/10410236.2017.1350913?journalCode=hhth20">saying that something is going to or needs to happen</a> – conveys that the decision has already been made unilaterally. </p>
<p>When midwives made an offer (such as “do you want me to give you a bit of a massage?” and gave <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/1467-9566.12766">option-lists</a>, on the other hand, they set up an opportunity for women to make a choice. When we examined how midwives initiated decisions, the majority (57%) were unilateral. But this is not necessarily a bad thing. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/529568/original/file-20230601-25-xaxev9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Mother with her newborn baby at the hospital" src="https://images.theconversation.com/files/529568/original/file-20230601-25-xaxev9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/529568/original/file-20230601-25-xaxev9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/529568/original/file-20230601-25-xaxev9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/529568/original/file-20230601-25-xaxev9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/529568/original/file-20230601-25-xaxev9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/529568/original/file-20230601-25-xaxev9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/529568/original/file-20230601-25-xaxev9.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">Birth is one of the most intense experiences a person can have.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/mother-her-newborn-baby-hospital-day-1839847582">Lopolo/Shutterstock</a></span>
</figcaption>
</figure>
<p>Pronouncements occurred a lot in <a href="https://www.nice.org.uk/guidance/cg190">relation to fetal monitoring</a>. For example, midwives saying “I’m just going to listen to baby, lovely.” These declarations place little pressure on women to respond, and the frequent use of “just” conveys that monitoring will involve minimal disruption. </p>
<p>The value of <a href="https://www.cochrane.org/CD010088/PREG_routine-vaginal-examinations-labour">routine vaginal examinations</a> is contested among researchers. However, <a href="https://www.nice.org.uk/guidance/cg190/chapter/Recommendations#first-stage-of-labour">NHS guidelines</a> state they should be offered every four hours in the first stage of labour. </p>
<p>Midwives did occasionally offer explicit choice about whether a vaginal examination should take place, but only in early labour when they suspected there was no progress. Otherwise, decisions about examinations tended to be pronounced, but always involved an explicit consent check beforehand.</p>
<p>Overall in our recordings, birth partners typically deferred to midwives and confined themselves to providing support for their partners.</p>
<p>In the third stage of labour (the time between the baby’s birth and delivery of the placenta), the cutting of the cord is the only moment where birth partners – fathers in our dataset – were treated as decision makers. </p>
<p>Midwives routinely offered birth partners the opportunity to cut the cord. While women in our study did not seem to mind, <a href="https://academic.oup.com/shm/article/30/2/389/2669697?login=false/j.1365-2648.2012.05978.x?casa_token=POTutaB_2GUAAAAA:-T5NiJ1y-eQmrytMGJ4Q9O8no4HJPSvmbjLR48coTYezz5M2JaHClzuUxjoylEhDpZbA3EfNmZe6eB4">there are potential conflicts</a> between involving fathers in pregnancy and birth and maintaining women’s bodily autonomy. </p>
<h2>The difficulty of providing choice</h2>
<p>Our findings illustrate how difficult it is for midwives to promote patient involvement in a context where guidelines and clinical knowledge indicate particular things should happen. </p>
<p>The fact that the length of labour is inherently uncertain does not help. We suggest that midwives would benefit from better support and training to manage these tensions and that it would be helpful if these conflicts were recognised more explicitly within policy.</p>
<p>Our findings also highlight the need to improve communication during decisions about pain relief. Delaying or deferring decisions can leave women feeling unheard during one of the most, if not the most, vulnerable times of their lives.</p><img src="https://counter.theconversation.com/content/206815/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Clare Jackson receives funding from National Institute for Health and Care Research. </span></em></p><p class="fine-print"><em><span>Ellen Annandale receives funding from the National Institute for Health Research. She is Chair of Trustees for the Foundation for the Sociology of Health and Illness. </span></em></p><p class="fine-print"><em><span>Sian Beynon-Jones receives funding from National Institute for Health and Care Research.</span></em></p>Midwives get blamed but contradictions in policy sometimes tie their hands.Clare Jackson, Senior Lecturer in Sociology, University of YorkEllen Annandale, Professor of Sociology, University of YorkSian Beynon-jones, Senior Lecturer in Sociology, University of YorkLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2113152023-08-29T15:34:37Z2023-08-29T15:34:37ZBreastfeeding increased during the pandemic but what does that tell us about how to improve rates?<figure><img src="https://images.theconversation.com/files/541982/original/file-20230809-25-3v08a2.jpg?ixlib=rb-1.1.0&rect=20%2C30%2C6689%2C4436&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/serious-calm-careful-young-black-mom-1426845311">SeventyFour/Shutterstock</a></span></figcaption></figure><p>During the pandemic, there had been concerns from healthcare professionals that the restrictions placed on daily life would lead to a disruption in breastfeeding. But <a href="https://bmjpaedsopen.bmj.com/content/7/1/e001907.full#ref-13">our new research</a> shows that the number of women who continued to exclusively breastfeed for six months increased. </p>
<p>And in fact, women were 40% more likely to exclusively breastfeed for six months during COVID than they were before the pandemic or now, post-pandemic. </p>
<p>The World Health Organization (WHO) <a href="https://www.who.int/health-topics/breastfeeding#tab=tab_2">recommends</a> exclusively breastfeeding for the first six months of a baby’s life. But the UK has had the <a href="https://www.unicef.org.uk/babyfriendly/about/breastfeeding-in-the-uk/">lowest</a> breastfeeding rates globally. Only <a href="https://www.thelancet.com/series/maternal-and-child-nutrition">0.5% of women breastfed</a> their baby until they were one year old in the UK. This is compared to 27% of mothers in the <a href="https://www.thelancet.com/series/maternal-and-child-nutrition">United States</a>, 35% in <a href="https://www.thelancet.com/series/maternal-and-child-nutrition">Norway</a> and 44% in <a href="https://www.thelancet.com/series/maternal-and-child-nutrition">Mexico</a>, who were still breastfeeding after one year. </p>
<p>When COVID hit, there had been concern that the virus could be <a href="https://link.springer.com/article/10.1007/s42399-020-00498-4">passed</a> from mothers to babies. </p>
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<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?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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<p><em>This article is part of <a href="https://theconversation.com/uk/topics/womens-health-matters-143335">Women’s Health Matters</a>, a series about the health and wellbeing of women and girls around the world. From menopause to miscarriage, pleasure to pain the articles in this series will delve into the full spectrum of women’s health issues to provide valuable information, insights and resources for women of all ages.</em></p>
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<hr>
<p>Numerous studies reported a lack of support for expectant and new mothers who were breastfeeding during the pandemic. For instance, <a href="https://www.sciencedirect.com/science/article/pii/S019566632031607X?via%3Dihub">one in three</a> women intending to breastfeed reported lacking assistance with proper positioning, while <a href="https://www.sciencedirect.com/science/article/pii/S019566632031607X?via%3Dihub">one in four</a> women stated insufficient hospital-based breastfeeding support. This was probably due to strained healthcare systems and the push to minimise infection risks. </p>
<p>Support for new mothers lessened, which hindered breastfeeding. And pregnant women reported very high levels of <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0267176">anxiety and stress</a>, including uncertainty about the <a href="https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-022-07856-8">vaccine</a>. </p>
<p>We conducted surveys with women who gave birth in Wales between 2018 and 2021 and we examined anonymised NHS breastfeeding health data collected by midwives and health visitors. </p>
<p>Surprisingly, breastfeeding rates up to six months peaked in 2020, a time of strict pandemic restrictions. This conflicts with the anticipated decrease in breastfeeding rates due to reduced access to professional and social support. </p>
<p><a href="https://bmjpaedsopen.bmj.com/content/7/1/e001907.full">Our research</a> also shows that approximately six in ten women in Wales breastfeed for their baby’s first feed, but only three in ten are still breastfeeding at ten weeks. And more than 80% of women are not breastfeeding at all by six months. </p>
<p>This finding has surprised us and others working in healthcare since the pandemic had such a profound impact on daily life worldwide.</p>
<figure class="align-center ">
<img alt="A mother holds the hand of her baby who is breastfeeding." src="https://images.theconversation.com/files/544600/original/file-20230824-28-x6xlx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/544600/original/file-20230824-28-x6xlx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/544600/original/file-20230824-28-x6xlx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/544600/original/file-20230824-28-x6xlx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/544600/original/file-20230824-28-x6xlx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/544600/original/file-20230824-28-x6xlx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/544600/original/file-20230824-28-x6xlx.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">Breastfeeding rates up to six months peaked at the height of the pandemic.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/newborn-baby-boy-sucking-milk-mothers-1968727780">Nastyaofly/Shutterstock</a></span>
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</figure>
<p><a href="https://bmjpaedsopen.bmj.com/content/7/1/e001907.full#ref-13">Our study</a> also shows that when pregnant women report that they do not intend to breastfeed, then they are very unlikely to start breastfeeding. About 30% of women do not intend to breastfeed at all. </p>
<p>However, when women say in pregnancy that they intend to breastfeed, then approximately 90% of these women do start doing so. They are also 27 times more likely to breastfeed for six months compared to women who did not intend to breastfeed. </p>
<h2>The time factor</h2>
<p>But what is it that helps women who do want to breastfeed, do so for longer? We know that even without the support systems and training by midwives, more women who wanted to breastfeed were able to for longer during the pandemic. </p>
<p>These findings could mean that one thing women really need to help them to breastfeed is more time at home with their baby, more time with their partner at home with them, more privacy and more flexible working. </p>
<p>If we want to increase breastfeeding levels, it is possible that what the pandemic has taught us is the need to address working environments as well as medical services. </p>
<h2>Breastfeeding benefits</h2>
<p>Breastfeeding has many benefits, including fewer <a href="https://bmcpediatr.biomedcentral.com/articles/10.1186/s12887-019-1693-2">infections</a>, increased <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8894195/#:%7E:text=Breastfeeding%20was%20positively%20associated%20with,%2Dbreastfed%20participants%20(19).">intelligence</a> and the prevention <a href="https://jamanetwork.com/journals/jamapediatrics/fullarticle/1107563#:%7E:text=Breastfed%20babies%20seem%20to%20be,she%20is%206%20months%20old.">obesity and diabetes</a>. Breastfeeding also has <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)01024-7/fulltext">advantages for mothers</a> as it lessens the risk of cancers, postpartum bleeding and helps with weight loss after birth. </p>
<p>It is better for the <a href="https://www.unicef.org.uk/babyfriendly/breastfeeding-and-climate-change/#:%7E:text=Breastfeeding%20also%20requires%20less%20water,footprint%20(Binns%2C%202021).">environment</a> and can be cheaper for some families.</p>
<p>But a <a href="https://www.nature.com/articles/s41372-023-01646-z">study</a> by Yale School of Medicine earlier this year found that a year of breastfeeding can also cost families up to US$11,000 (£8,700) with increased food intake, vitamins, supplements and supplies. It stressed that the barrier of cost may impact a mother’s decision to breastfeed. </p>
<p>But the cost of breastfeeding involves more than just money. Another more hidden cost is the time dedicated to breastfeeding or pumping breast milk. This highlights how women need more time at home and how we should be reassessing working environments, especially for lower income families.</p>
<p>The short term gains of getting parents back to work should not outweigh the long term benefits to our society from having healthier families. If we want to improve breastfeeding rates in the UK, then we need to look at the working lives of women and their partners across the nation.</p><img src="https://counter.theconversation.com/content/211315/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>This work is funded by the National Centre for Population Health and Wellbeing Research and the National Core Studies funded by the Medical Research Council.</span></em></p><p class="fine-print"><em><span>Sinead Brophy receives funding from Health Care Research Wales for Born In Wales and the National Centre for Population Health, MRC for Health Data Research UK, ESRC for Administrative Data Research. </span></em></p>New research shows that breastfeeding rates peaked in 2020, a time of strict COVID restrictions.Hope Jones, Research Assistant at the National Centre for Population Health and Wellbeing Research, Swansea UniversitySinead Brophy, Professor in Public Health Data Science, Swansea UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2047162023-08-14T19:37:44Z2023-08-14T19:37:44ZCanada’s welfare system is failing mothers with infants<figure><img src="https://images.theconversation.com/files/541320/original/file-20230805-15-xi8j4t.jpg?ixlib=rb-1.1.0&rect=0%2C82%2C3670%2C2351&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Food insecurity can impact both a mother’s ability or decision to breastfeed, and also the ability to purchase baby formula.</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/canadas-welfare-system-is-failing-mothers-with-infants" width="100%" height="400"></iframe>
<p>The Canadian government issued a <a href="https://theconversation.com/federal-budget-2023-grocery-rebate-is-the-right-direction-on-food-insecurity-but-theres-a-long-road-ahead-201926">one-time grocery rebate</a> in July, targeted at low-income Canadians. While the rebate provided some relief to people struggling with soaring inflation, <a href="https://theconversation.com/federal-budget-2023-grocery-rebate-is-the-right-direction-on-food-insecurity-but-theres-a-long-road-ahead-201926">it is far from enough</a> to address the depth of poverty and intensity of food insecurity faced by the lowest income Canadians. </p>
<p>During the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4981537/">most vulnerable time of life</a>, mothers and infants living on welfare are experiencing food insecurity, which can have <a href="https://www.healthaffairs.org/doi/10.1377/hlthaff.2015.0645">lifelong impacts</a>. Governments need to make policy changes to better serve mothers and their children. </p>
<h2>Infant food insecurity</h2>
<p>Food insecurity is defined as having “<a href="https://proof.utoronto.ca/food-insecurity/">inadequate or insecure access to food due to financial constraints</a>.” Maternal food insecurity can result in many health-damaging effects, ranging from <a href="https://bmjopen.bmj.com/content/10/1/e033296">adverse birth outcomes</a> to <a href="https://www.healthaffairs.org/doi/10.1377/hlthaff.2015.0645">mental health issues</a>. Infant food insecurity can result in long-term developmental impacts, including effects on <a href="https://doi.org/10.1016/j.pcl.2019.12.004">cognition and brain development</a>. </p>
<p>Experts have outlined how <a href="https://theconversation.com/why-are-babies-going-hungry-in-a-food-rich-nation-like-canada-165789">food insecurity can impact a mother’s ability or decision to breastfeed</a>. Food-insecure mothers might cease breastfeeding much sooner because they feel they have inadequate breastmilk supply. In addition, they might struggle to afford infant formula.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/524793/original/file-20230508-29-dhs4uw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A woman feeding a baby from a bottle." src="https://images.theconversation.com/files/524793/original/file-20230508-29-dhs4uw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/524793/original/file-20230508-29-dhs4uw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/524793/original/file-20230508-29-dhs4uw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/524793/original/file-20230508-29-dhs4uw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/524793/original/file-20230508-29-dhs4uw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/524793/original/file-20230508-29-dhs4uw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/524793/original/file-20230508-29-dhs4uw.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">Mothers and infants living on welfare are experiencing food insecurity, which can have lifelong impacts.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>While food-insecure mothers initiate breastfeeding at the same rate as food-secure mothers, <a href="https://www.ctvnews.ca/health/study-finds-moms-living-in-poverty-struggle-to-breastfeed-their-babies-longer-1.3853616?cache=yes">rates drop steeply within the first two months</a>. Mothers who are undernourished themselves might perceive they have less than adequate milk supply and often stop breastfeeding for this reason, <a href="https://www.ubcpress.ca/out-of-milk">believing the baby will suffer because they have an inadequate diet</a>. </p>
<p>For low-income mothers, breastfeeding might seem to be the most cost-effective way of feeding their infants. However, other research shows that <a href="https://pubmed.ncbi.nlm.nih.gov/32162282/">both formula and breastfeeding are unaffordable to mothers who receive welfare</a>. </p>
<h2>Problems with the welfare system</h2>
<p>Approximately <a href="https://maytree.com/wp-content/uploads/Social_Assistance_Summaries_All_Canada.pdf">four to six per cent of people</a> in most provinces and territories receive welfare benefits. The number is slightly lower in the Yukon and Alberta and significantly higher in Nunavut where it is just under 28 per cent. </p>
<p>While some provinces and territories provide more financial resources to pregnant women and mothers than others, incomes remain low and inadequate to achieve food security. </p>
<p>For example, Nova Scotia welfare recipients receive a total of <a href="https://novascotia.ca/coms/employment/documents/ESIA_Program_Policy_Manual.pdf">$51 per month in maternal nutrition allowance</a> during pregnancy and up to 12 months after birth. However, this is often not enough support for low-income mothers to adequately feed their infants.</p>
<p><a href="https://proof.utoronto.ca/2023/new-data-on-household-food-insecurity-in-2022/">COVID-19 increased household food insecurity rates for households with children in both Canada</a> and the <a href="https://www.ers.usda.gov/amber-waves/2022/february/food-insecurity-for-households-with-children-rose-in-2020-disrupting-decade-long-decline/">United States</a></p>
<p>Allowances for pregnant women and mothers of infants receiving welfare are similarly low across Canada. These low rates create food insecurity for these vulnerable families and must be rectified via provincial, territorial and federal government policies. </p>
<h2>Charity alone is not enough</h2>
<p>Some might assume that charities and food banks will provide vital support for low-income families. A recent study found that during the peak of the COVID-19 pandemic, many community organizations <a href="https://doi.org/10.1080/14927713.2022.2054460">answered the increased call for food</a>. </p>
<p>While community organizations were critical in filling pandemic gaps, they alone cannot address the root cause of food insecurity: inadequate incomes. That problem continues, and the number of people relying on food banks has <a href="https://www.cbc.ca/news/canada/toronto/60-rise-use-of-food-banks-programs-canada-2023-1.6711094">increased exponentially in the past couple of years</a>.</p>
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Read more:
<a href="https://theconversation.com/as-governments-shirk-their-responsibilities-non-profits-are-more-important-than-ever-205169">As governments shirk their responsibilities, non-profits are more important than ever</a>
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</em>
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<p>Additionally, many food banks are <a href="https://ca.style.yahoo.com/at-breaking-point-canadian-food-banks-struggling-insecurity-inflation-214221464.html">struggling to provide enough food</a>. The demand for food now far outstrips the donations most food banks receive. A sustainable solution to food insecurity is needed, particularly for pregnant women and mothers of infants. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/541322/original/file-20230805-21-3ju57z.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A person in a grey t-shirt placing food items on a shelf" src="https://images.theconversation.com/files/541322/original/file-20230805-21-3ju57z.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/541322/original/file-20230805-21-3ju57z.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=402&fit=crop&dpr=1 600w, https://images.theconversation.com/files/541322/original/file-20230805-21-3ju57z.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=402&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/541322/original/file-20230805-21-3ju57z.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=402&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/541322/original/file-20230805-21-3ju57z.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=505&fit=crop&dpr=1 754w, https://images.theconversation.com/files/541322/original/file-20230805-21-3ju57z.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=505&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/541322/original/file-20230805-21-3ju57z.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=505&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">A volunteer places products on shelves at a food bank in Ottawa. Food banks alone cannot address the root cause of food insecurity: inadequate incomes.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Adrian Wyld</span></span>
</figcaption>
</figure>
<h2>Child welfare laws</h2>
<p>In addition, child welfare laws need to be changed to stop them from unfairly penalizing poorer parents. In Nova Scotia, the <a href="https://policyalternatives.ca/sites/default/files/uploads/publications/Nova%20Scotia%20Office/2023/03/CCPAChildPovertyReportCardFINAL.pdf"><em>Children and Family Services Act</em> stipulates</a> that parents’ failure to provide adequate nutrition is grounds for child apprehension.</p>
<p><a href="https://policyalternatives.ca/sites/default/files/uploads/publications/Nova%20Scotia%20Office/2023/03/CCPAChildPovertyReportCardFINAL.pdf">The 2022 Report Card on Child and Family Poverty in Nova Scotia</a> recommended removing this stipulation. <a href="https://fernwoodpublishing.ca/book/ineligible">Experts have highlighted</a> the punitive nature of such requirements. These kinds of regulations punish mothers for their poverty and food insecurity, rather than increasing the financial support they receive.</p>
<h2>Impact of inflation</h2>
<p>There are also reforms that need to take place around welfare rates that would create a more liveable income source for mothers and infants in particular. </p>
<p>As the 2022 report card on poverty in Nova Scotia shows, welfare rates are not indexed to inflation in the province. This has resulted in <a href="https://www.cbc.ca/news/canada/nova-scotia/ns-income-assistance-rates-unchanged-1.6788662">benefits stagnating</a> despite a few modest increases in the past several years. Only three provinces and territories <a href="https://maytree.com/wp-content/uploads/Welfare_in_Canada_2021.pdf">index welfare rates to inflation:</a> New Brunswick, Québec and the Yukon. In Québec, <a href="https://inroadsjournal.ca/quebecs-distinct-welfare-state-on-poverty-among-families-with-children-quebec-%E2%80%A8and-the-rest-of-canada-have-taken-different-paths/">this has resulted in lower income inequality</a>. </p>
<p>The province has also recently launched a <a href="https://www.cbc.ca/news/canada/montreal/quebec-basic-income-program-begins-advocates-say-many-low-income-people-excluded-1.6730003">basic income program</a> and although the eligibility requirements exclude many, it does increase income recipients would otherwise receive from welfare benefits.</p>
<p>With inflation affecting the price of food, the depth of food insecurity for mothers receiving welfare payments will only grow. Welfare rates must reflect the income necessary to feed pregnant and new mothers and provide them the support they need to care for their children.</p><img src="https://counter.theconversation.com/content/204716/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Laura Fisher receives funding from the Social Sciences and Humanities Research Council of Canada.</span></em></p>Low-income mothers with infants are struggling with food insecurity, which can lead to long-term health impacts for both mothers and children.Laura Fisher, PhD student, Sociology, Dalhousie UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2078152023-08-09T12:31:31Z2023-08-09T12:31:31ZBabies almost all try crawling to get from Point A to Point B, but CDC says it’s not a useful developmental milestone<figure><img src="https://images.theconversation.com/files/541295/original/file-20230804-27-srqigc.jpg?ixlib=rb-1.1.0&rect=0%2C1439%2C4181%2C2735&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Babies are curious about their world and want to explore.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/studio-shot-of-babies-in-diapers-crawling-royalty-free-image/73230112">Jose Luis Pelaez Inc/DigitalVision via Getty Images</a></span></figcaption></figure><p>Infant milestones can be a source both of pride and anxiety for a new parent. Baby’s firsts – first tooth, first steps, first word – are moments of joy that many parents immediately compare with charts listing “normal” age ranges for each achievement to occur.</p>
<p>For a pediatrician, these milestones are useful indicators of typical or atypical development. When they occur outside that normal range, it might be time to look for some underlying cause, which could enable early detection and intervention if something’s amiss.</p>
<p>Since 2004, the U.S. Centers for Disease Control and Prevention has published a <a href="https://www.cdc.gov/ncbddd/actearly/milestones/index.html">set of milestone checklists</a> as part of its “<a href="https://www.cdc.gov/ncbddd/actearly/index.html">Learn the Signs. Act Early</a>” program. Important skills are listed for a series of ages, enabling anxious parents to know whether baby is developing typically.</p>
<p>In early 2022, the CDC <a href="https://doi.org/10.1542/peds.2021-052138">published a major update to the milestones</a>. The new version has a much stronger basis in research evidence and has attempted to simplify language and help caregivers know when to contact a health care provider. Among all the changes, a major milestone was removed. Crawling no longer appears in the milestone checklists.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/541297/original/file-20230804-27-3rcku2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="baby crawls toward camera with woman out of focus in background" src="https://images.theconversation.com/files/541297/original/file-20230804-27-3rcku2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/541297/original/file-20230804-27-3rcku2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/541297/original/file-20230804-27-3rcku2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/541297/original/file-20230804-27-3rcku2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/541297/original/file-20230804-27-3rcku2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/541297/original/file-20230804-27-3rcku2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/541297/original/file-20230804-27-3rcku2.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">About 80% of babies give hands-and-knees crawling a try.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/two-mothers-meeting-for-play-date-with-babies-at-royalty-free-image/1153668944">monkeybusinessimages/iStock via Getty Images Plus</a></span>
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</figure>
<h2>Crawling to get from here to there</h2>
<p>As infants develop awareness of the world around them, they naturally start wanting to explore it. Mobility is the gateway to that exploration. Crawling is typically an infant’s first efficient strategy to get from Point A to Point B, and it often means that new parents must suddenly baby-proof their home and make sure all the Point Bs are safe.</p>
<p>Crawling is a transitional phase of mobility – children and adults are capable of crawling but choose to walk if they’re able to do so – and it often overlaps with precursors to walking such as pulling-to-stand and “cruising” while holding on to furniture. </p>
<p>Studies have indicated that <a href="https://doi.org/10.1016/j.earlhumdev.2013.04.010">over 80% of infants progress through hands-and-knees crawling</a> during development of locomotion. Others <a href="https://doi.org/10.1111/j.1365-2214.1984.tb00189.x">use alternative crawling strategies</a> like scooting along on their bottoms, or rolling.</p>
<p>The World Health Organization studied hundreds of children around the world and found that, on average, children develop <a href="https://doi.org/10.1111/j.1651-2227.2006.tb02379.x">hands-and-knees crawling by 8.5 months of age</a>. But that’s just an average. Of course babies each develop on their own schedule. The range for starting to crawl (the 1st percentile to the 99th) was 5.2 to 13.5 months. And 4.3% of the babies in the study skipped hands-and-knees crawling altogether.</p>
<p>Clinicians who work with children have long recognized the importance of motor development. Scientists have called motor behaviors the “<a href="https://doi.org/10.1002/wcs.1430">raw material for perception, cognition, and social interaction</a>.” In particular, crawling can be an early window to <a href="https://doi.org/10.1016/j.earlhumdev.2013.04.010">understanding a child’s problem-solving strategies</a>. And researchers have used <a href="https://doi.org/10.1073/pnas.95.23.13982">movement analysis at 4-6 months</a>, when some babies are getting close to hands-and-knees crawling, for early diagnosis of disorders such as autism and cerebral palsy.</p>
<p><a href="https://doi.org/10.1097/PEP.0000000000000937">Therapists worry that removing crawling</a> from the milestone list means it will be devalued and the important physical, sensory and cognitive benefits it affords for the baby will be missed when evaluating childhood development.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/541298/original/file-20230804-15-vw0ayr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="baby standing holding onto side of bed, looking back at camera" src="https://images.theconversation.com/files/541298/original/file-20230804-15-vw0ayr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/541298/original/file-20230804-15-vw0ayr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/541298/original/file-20230804-15-vw0ayr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/541298/original/file-20230804-15-vw0ayr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/541298/original/file-20230804-15-vw0ayr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/541298/original/file-20230804-15-vw0ayr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/541298/original/file-20230804-15-vw0ayr.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">Pulling up to stand is a developmental milestone that typically happens at a predictable age.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/adorable-baby-boy-in-white-sunny-bedroom-in-winter-royalty-free-image/961494366">tatyana_tomsickova/iStock via Getty Images Plus</a></span>
</figcaption>
</figure>
<h2>Off the evidence-based list of milestones</h2>
<p>Much of the <a href="https://doi.org/10.1097/PEP.0000000000000937">CDC’s reasoning</a> for removing crawling from the milestone list is centered on data.</p>
<p>Pediatricians have charts that say how fast children typically walk based on their age, but no such normative data exists for crawling. There are no clear, laboratory-based descriptions of the various types of crawling. We lack long-term studies that show when babies transition between patterns. And there are very few studies on the implications of skipping crawling and going straight to walking.</p>
<p>Despite these data gaps, <a href="https://doi.org/10.1111/j.1467-8624.1998.tb06213.x">crawling has been studied for nearly a century</a>, and researchers have used it to <a href="https://doi.org/10.1111/j.1467-8624.1993.tb04193.x">understand the complex development</a> of multiple neuromotor systems. Crawling is also important in understanding developmental continuity, or where new skills grow from.</p>
<p>Nonetheless, the CDC is correct: There are no age-based normative data charts for crawling as there are for walking.</p>
<h2>Locomotion in the lab</h2>
<p>As a biomedical engineer who <a href="https://scholar.google.com/citations?user=C7j3KnYAAAAJ&hl=en">specializes in pediatric locomotion biomechanics</a>, I have firsthand knowledge of this lack of crawling data.</p>
<p>I’ve used a technique called <a href="https://www.gillettechildrens.org/conditions-care/gait-and-motion-analysis">3D motion analysis</a> for decades to gather minute details on the walking of children with limb loss, cerebral palsy and other neuromotor conditions, all in an effort to help improve their mobility. My colleagues and I attach small markers to skeletal landmarks like hips and knees, and special cameras track the markers and reconstruct skeletal movement.</p>
<p>But among all my lab’s studies on walking, I’ve completed only <a href="https://doi.org/10.1097/JPO.0b013e3181cc57bc">one 3D motion analysis study on crawling</a>. We examined the motion of very young children with limb loss in a new prosthetic treatment protocol developed here at Children’s Healthcare of Atlanta – but it was really tricky to do.</p>
<p>We had to create new musculoskeletal models for our analysis system. We had to use tiny reflective markers, because babies make more contact with the ground than older kids, and a big marker might be uncomfortable. We had to position cameras at new angles to track those tiny markers. Diapers created a big challenge, given their movement relative to the baby’s skeleton.</p>
<p>And as any parent or caregiver can attest, babies can be a tough population to work with. They don’t follow directions well, they’re temperamental, and they’ll pull a reflective marker off their skin and pop it in their mouth in a second if you let them. We had to watch our study subjects like hawks.</p>
<p>In short, crawling is just more difficult to study than walking.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/541290/original/file-20230804-26-kmpnwr.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="baby crawling on a pathway in distance, with a computer readout of measurements of the baby's pressure on the path" src="https://images.theconversation.com/files/541290/original/file-20230804-26-kmpnwr.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/541290/original/file-20230804-26-kmpnwr.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/541290/original/file-20230804-26-kmpnwr.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/541290/original/file-20230804-26-kmpnwr.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/541290/original/file-20230804-26-kmpnwr.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=504&fit=crop&dpr=1 754w, https://images.theconversation.com/files/541290/original/file-20230804-26-kmpnwr.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=504&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/541290/original/file-20230804-26-kmpnwr.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=504&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">A new study is collecting crawling biomechanic data using a pressure-sensing pathway.</span>
<span class="attribution"><span class="source">Mark Geil</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<h2>Collecting crawling data</h2>
<p>To address this challenge, my colleagues and I are now embarking on what we believe is the largest lab-based study of infant crawling development. We’re studying babies from their first crawling attempts all the way through their transition to walking.</p>
<p>This study relies on a new technique with a pressure-sensing pathway that avoids the complications of 3D motion capture. We’ll see 75 typically developing infants, and also study children with limb loss and cerebral palsy. </p>
<p>Our goal is to gain insights into how children transition from crawling to walking, with the hope they will one day help health care providers understand early motor development and spot neuromotor issues earlier. </p>
<p>We’re also hopeful that these hundreds of visits to the lab will result in the first normative data set on crawling development, addressing some of the issues that prompted the CDC to remove crawling from the milestone list. So, while our lab stays full of toys, Cheerios and baby wipes for a few years, we’re generating data that might improve parents’ and clinicians’ understanding of early motor development.</p><img src="https://counter.theconversation.com/content/207815/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Mark Geil receives funding from The Gerber Foundation. </span></em></p>Revisions to the CDC’s developmental milestone checklists removed crawling as a skill that babies pick up at a typical age. A biomedical engineer describes how more research may clarify its role.Mark Geil, Associate Dean for Research and Professor of Biomechanics, Kennesaw State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2050592023-07-28T12:52:44Z2023-07-28T12:52:44ZBreastfeeding: mothers taking prescription medicines faced with a lack of information – new review<figure><img src="https://images.theconversation.com/files/534299/original/file-20230627-15-svfyno.jpg?ixlib=rb-1.1.0&rect=85%2C0%2C9504%2C6260&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Most medicines are safe for most breastfed babies, while serious harm to infants is rare.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/mother-son-sitting-on-sofa-breastfeeding-2251534251">Krakenimages.com/Shutterstock</a></span></figcaption></figure><p>Breastfeeding is a cornerstone of early childhood nutrition and development. However, taking prescription medicines can reduce breastfeeding rates because parents who take such medications often face a lack of information about their potential impact on babies or how medicines affect lactation. </p>
<p>To better understand the effects of medicines on breastfeeding, we conducted a <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0284128">systematic review</a> of the available information. We scoured electronic databases for research on the impact of prescription medicines on breastfeeding. These studies examined how medicines affected milk composition, milk production and the health of breastfed infants. </p>
<p>We found a limited number of high-quality studies, with only ten established databases reporting on breastfeeding, medicines and infant outcomes together. And, unfortunately, none of these studies covered educational outcomes, making it difficult to assess potential long-term risks, harms and benefits.</p>
<p>Our research shows that more data collection is needed. And our work and <a href="https://doi.org/10.1371/journal.pone.0225133">other research</a> highlights there is a need for additional support to help breastfeeding mothers overcome physical barriers, including delayed milk production and <a href="https://pubmed.ncbi.nlm.nih.gov/28027444/">anxiety</a> about the use of prescription medicine.</p>
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<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?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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<p><em>This article is part of <a href="https://theconversation.com/uk/topics/womens-health-matters-143335">Women’s Health Matters</a>, a series about the health and wellbeing of women and girls around the world. From menopause to miscarriage, pleasure to pain the articles in this series will delve into the full spectrum of women’s health issues to provide valuable information, insights and resources for women of all ages.</em></p>
<p><em>You may be interested in:</em></p>
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<hr>
<h2>Safety</h2>
<p>Most medicines are safe for most breastfed babies, while serious harm to infants is rare. In most cases, the benefits of breastfeeding outweigh the risks of harms associated with medicine use. Still, this can be a complex issue and it’s essential to weigh the benefits and risks carefully.</p>
<p>There are some medicines that require extra checks on infants and their ability to breastfeed. For example, infants whose mothers use antibiotics such as amoxicillin and erythromycin (which are known to be safe to use during breastfeeding), should be checked for oral thrush and diarrhoea, as prompt treatment is important. </p>
<p>The <a href="https://bnf.nice.org.uk">British National Formulary</a> (BNF) offers advice on the prescribing and administration of medicines. Infants of mothers taking certain medicines, such as those for epilepsy, mental health conditions, sedatives, or opioids, should be monitored for signs of sedation, sleepiness, poor feeding, weight loss and irritability. </p>
<p>Health professionals should also assess how effectively the baby is feeding by observing suckling and attachment to the breast. This is important because these types of medicines can interfere with an infant’s ability to feed and receive adequate nutrition.</p>
<p>The BNF expresses reservations regarding prescribing some sedative medicines that pass into breastmilk, where there is a risk of infant sedation, as with benzodiazepines (such as diazepam), and some anti-seizure medicines such as phenobarbital or primidone. </p>
<p>It recommends avoiding certain medicines during breastfeeding altogether, including some antipsychotics, such as olanzapine and clozapine, and the antidepressants escitalopram and fluoxetine. But other antidepressants, such as citalopram, may be used with caution. Most antipsychotic injections should be avoided during breastfeeding too, as should fingolimod which is used to treat multiple sclerosis. </p>
<p>Breastfeeding while using many medicines for serious illness, such as cancer, should be discussed with medical professionals. There may be little or no information from human studies, and there may be too little information to guarantee safety. Examples include many monoclonal antibodies used to treat cancer, and the immunosuppressant, mycophenolate mofetil, which is used to prevent the rejection of kidney, heart or liver transplants.</p>
<h2>Advice</h2>
<p>Mothers taking medicines should not blame themselves for being hesitant towards breastfeeding. Medical advice should be sought before birth. And families should not feel compelled to choose between breastfeeding and continuing with prescription medicines.</p>
<p>It’s essential for doctors, pharmacists and other health professionals to consult reliable information sources, including <a href="https://wicworks.fns.usda.gov/resources/lactmed">LactMed</a> and <a href="https://www.e-lactancia.org/">E-lactancia</a>, or contact the <a href="https://www.breastfeedingnetwork.org.uk/detailed-information/drugs-in-breastmilk/">Drugs in Breastmilk helpline</a>.</p>
<p>To help families who need prescription medicines, it is crucial for public health teams controlling the collection of routine healthcare data to treat data collection on medicine use during and after pregnancy and during labour as a priority. This would allow research into the benefits and harms of medicine use before and during breastfeeding. </p>
<p>Such information would help parents make informed decisions regarding their medical treatment, breastfeeding and monitoring infants. It would also help minimise parental anxiety and potentially harmful false dilemmas.</p><img src="https://counter.theconversation.com/content/205059/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sue Jordan receives funding from the ConcePTION project. The ConcePTION project has received funding from the Innovative Medicines Initiative 2 Joint Undertaking under grant agreement No 821520. This Joint Undertaking receives support from the European Union’s Horizon 2020 research and innovation programme and EFPIA. Funding was awarded to SJ, SLL. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. </span></em></p><p class="fine-print"><em><span>Sophia Komninou 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>Not enough data is being collected about the impact taking prescription medication has on breastfeeding.Sophia Komninou, Lecturer in Public Health Nutrition, Swansea UniversitySue Jordan, Professor of Medicines Management and Health Services Research, Swansea 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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<hr>
<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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<p>
<em>
<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>
</strong>
</em>
</p>
<hr>
<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>
<figcaption>
<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>
</figcaption>
</figure>
<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>
</strong>
</em>
</p>
<hr>
<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>
<hr>
<p>
<em>
<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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</em>
</p>
<hr>
<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/2083322023-07-07T14:19:46Z2023-07-07T14:19:46ZPandemic babies behind on communication at age two – but other developmental areas remain unaffected<figure><img src="https://images.theconversation.com/files/536115/original/file-20230706-23-go0p6m.jpg?ixlib=rb-1.1.0&rect=9%2C0%2C6631%2C3733&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/childcare-concept-portrait-cute-little-african-1980128651">Prostock-studio/Shutterstock</a></span></figcaption></figure><p>The world changed for all of us when we were suddenly plunged into a pandemic in 2020. COVID sent us into a series of lockdowns in a bid to control the spread of the virus until a vaccine could be developed. </p>
<p>Most of us knew that a vaccine would be the key to our post-pandemic lives. But what about those of us who knew nothing of the world before COVID? </p>
<p>Our research group wanted to understand what life was like for babies born during the pandemic, and what it might mean for their general health and development. </p>
<p>In our <a href="https://adc.bmj.com/content/early/2023/06/20/archdischild-2022-325271">latest paper</a>, we found that by age two, with the important exception of communication, these pandemic babies were very similar to babies born before the pandemic in behaviour and development. </p>
<p>We followed families of babies born in Ireland in the first three months of the pandemic, between March and May 2020. A total of 354 families and their babies visited us at six, 12 and 24 months of age. </p>
<p>The visits, particularly the earlier ones, were sometimes the only trips the families made outside the home. We were struck by some babies’ wariness towards our experienced paediatric staff, which was often explained by comments from parents like “she hasn’t been out much”.</p>
<p>At each of the visits, we asked the parents for lots of information on their babies’ lives and development by way of questionnaires.</p>
<p>Usually, in a study like this, it’s best to compare the babies to a control group of other babies born at the same time but without the same challenges. As most of the world was in lockdown, we did the next best thing. We compared the lockdown babies to <a href="https://www.infantcentre.ie/research/research-studies/baseline/">a similar group of babies</a> born in Ireland before the pandemic. This is a limitation of our study, but there were no comparable groups of babies available at the same time.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/generation-covid-pregnancy-birth-and-postnatal-life-in-the-pandemic-160644">Generation COVID: pregnancy, birth and postnatal life in the pandemic</a>
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</p>
<hr>
<h2>Social lives and development</h2>
<p>We found these lockdown babies had <a href="https://pubmed.ncbi.nlm.nih.gov/35984697/">tiny social circles</a>. Because of COVID restrictions, activities such as parent and baby groups were called off, and there were no visits to other homes. </p>
<p>At six months, an average of only three people had kissed the babies, including their parents – suggesting they hadn’t met many relatives or family friends. One in four babies had not met another child their own age by their first birthday.</p>
<p>We also asked parents what it felt like to raise a baby during the pandemic. Words such as “lonely”, “isolating” and “challenging” appeared repeatedly. Some positive themes emerged too, including parental bonding with the new baby and more family time due to the lockdown restrictions.</p>
<figure class="align-center ">
<img alt="A woman on the floor at home with her baby who is playing with toys." src="https://images.theconversation.com/files/536117/original/file-20230706-29-5vhlx9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/536117/original/file-20230706-29-5vhlx9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/536117/original/file-20230706-29-5vhlx9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/536117/original/file-20230706-29-5vhlx9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/536117/original/file-20230706-29-5vhlx9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/536117/original/file-20230706-29-5vhlx9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/536117/original/file-20230706-29-5vhlx9.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">Our research sought to understand how ‘pandemic babies’ have fared.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/joyful-mother-baby-boy-playing-toys-2293650585">StockPhotoDirectors/Shutterstock</a></span>
</figcaption>
</figure>
<p>We looked at ten developmental milestones <a href="https://pubmed.ncbi.nlm.nih.gov/36220496/">at the babies’ first birthday</a>. Among these, fewer pandemic babies had said their first word, could point or wave “bye-bye”, and slightly more babies could crawl. </p>
<p>This makes sense when you think about it. Babies were probably hearing fewer words since they were getting out and about less. Also, the pandemic babies were likely to be very familiar with their home so there were few new things to point to. And as parents were working from home and visitors didn’t generally come to the house, there may have been less need to learn how to wave goodbye. It’s possible more pandemic babies crawled because they were more likely to have spent more time at home exploring.</p>
<p>At <a href="https://adc.bmj.com/content/early/2023/06/20/archdischild-2022-325271">age two</a>, we were interested to see whether these developmental differences had shifted. We asked parents questions about communication at this point including whether the child could say two or three words together to convey an idea, whether they could correctly point at something when asked (for example, point at the ball), and whether they could follow a simple command (for example, put the toy on the table).</p>
<p>The children born during the pandemic again had slightly lower scores in the communication portion of the questionnaire, even after we adjusted for factors such as the mother’s education level and the child’s age when the questionnaire was completed.</p>
<p>But reassuringly, the pandemic babies had similar scores to those born before COVID in the other developmental areas we looked at, including motor skills and problem-solving ability.</p>
<p>We were also relieved to see no differences in reported behaviour between pandemic-born babies and those born earlier. We asked parents almost 100 questions about their child’s behaviour including about sleep problems, anxious behaviour, how emotionally reactive they were, and whether they were socially withdrawn.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/pandemic-babies-how-covid-19-has-affected-child-development-155903">Pandemic babies: how COVID-19 has affected child development</a>
</strong>
</em>
</p>
<hr>
<h2>What can we do?</h2>
<p>Research groups in <a href="https://pubmed.ncbi.nlm.nih.gov/34982107/">other countries</a> have also shown that babies born shortly before or during the pandemic had <a href="https://www.frontiersin.org/articles/10.3389/fped.2021.662165/full">slightly lower developmental scores</a>.</p>
<p>Now that pandemic measures are gone, it’s really important for all babies born during the pandemic to explore the exciting world. Families should meet with relatives and friends to expose their babies to a wider range of people, and babies should meet their peers at play groups. We also know that <a href="https://pubmed.ncbi.nlm.nih.gov/37188518/">talking to babies</a> and reading to small children is <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6927670/">highly beneficial</a>. </p>
<p>All babies should have developmental screening, which is often provided by national programmes. If families have any particular concerns it’s important they contact their healthcare provider to discuss the child’s development in more detail. This enables early and directed support to be provided to children who are found to have a specific developmental issue.</p><img src="https://counter.theconversation.com/content/208332/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>How did this strange new world affect babies born during the height of the pandemic? Our research sought to find out.Susan Byrne, Senior Lecturer, Department of Paediatrics and Future Neuro, RCSI University of Medicine and Health SciencesJonathan Hourihane, Head of Paediatrics, RCSI University of Medicine and Health SciencesLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2080892023-07-03T12:05:53Z2023-07-03T12:05:53ZVaccination in pregnancy greatly reduces risk of severe illness and death from COVID-19, and protects babies up to 6 months after birth<figure><img src="https://images.theconversation.com/files/534923/original/file-20230629-17-ey9jrq.jpg?ixlib=rb-1.1.0&rect=100%2C191%2C6438%2C4275&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Extensive evidence shows COVID-19 vaccinations in pregnancy are safe, when given at any time during the pregnancy.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>From the early days of the pandemic, it has been evident that a COVID-19 infection in pregnancy can be serious. Hundreds of studies from around the world have consistently shown that a COVID-19 infection in pregnancy carries <a href="https://doi.org/10.1093/cid/ciac544">significantly higher risk</a> for <a href="https://doi.org/10.1136/bmj.m3320">admission to intensive care units (ICU), invasive ventilation, preeclampsia and death</a>, compared to other COVID-19 patients. </p>
<p>The data is stark: there is a <a href="https://doi.org/10.1001/jamapediatrics.2021.1050">five times higher risk of ICU admission and 22 times higher risk of maternal mortality</a> due to COVID-19 infections in pregnancy. There are also <a href="https://doi.org/10.1016/j.xagr.2021.100049">considerable risks to the fetus</a>, with a higher risk of preterm delivery, low birth weight as well as serious fetal outcomes such as stillbirth, and neonatal mortality. </p>
<p>Interestingly, and not entirely surprisingly, studies have found that stillbirths and neonatal deaths occurred predominantly in <a href="https://doi.org/10.1038/s41591-021-01666-2">those who were unvaccinated </a> against SARS-CoV-2 at the time of infection. The same study also showed that 90 per cent of all hospitalizations and 98 per cent of critical care hospitalizations in pregnancy due to COVID-19 infection were also in the unvaccinated.</p>
<h2>Safety of COVID-19 vaccines in pregnancy</h2>
<p>As a science communicator and a Doctor of Public Health student, a lot of my work has focused specifically on understanding vaccine hesitancy. Despite the overwhelming data on the risks of COVID-19 infection in pregnancy, many have still been reluctant to get vaccinated, <a href="https://doi.org/10.1186/s12889-022-14617-4">citing safety concerns</a>.</p>
<p>We now have extensive evidence that shows COVID-19 vaccinations in pregnancy are safe, when given at any time during the pregnancy. </p>
<p>Globally, multiple meta-analyses have confirmed that there is <a href="https://doi.org/10.1038/s41467-022-30052-w">no evidence of a higher risk of adverse outcomes</a> in either the pregnant person or the infant. No differences were found in miscarriage, earlier gestation at birth, placental abruption, postpartum hemorrhage, maternal death, lower birthweight or neonatal intensive care unit admission with a COVID-19 vaccine given in pregnancy. </p>
<p>In fact, most of these studies found that <a href="https://doi.org/10.1001/jamapediatrics.2022.3456">vaccination offered positive</a> health outcomes: those who were vaccinated had a lower risk for stillbirths, preterm births and neonatal intensive care unit admission and more favourable <a href="https://www.aboutkidshealth.ca/Article?contentid=427&language=English">Apgar scores</a>.</p>
<h2>Infants protected by transfer of antibodies across placenta</h2>
<p>Several <a href="https://doi.org/10.1016/j.ajogmf.2021.100481">studies</a> have documented the presence of SARS-CoV-2 antibodies in umbilical cord blood after <a href="https://doi.org/10.1172/jci150319">maternal vaccination</a>. This confirms that there is an added benefit of vaccination, with SARS-CoV-2 IgG antibodies - which are the most common type of antibody found in blood, and protect against infections - <a href="https://doi.org/10.1038/s41467-022-32188-1">transferring across the placenta from mother to fetus</a>, particularly when vaccination occurs <a href="https://doi.org/10.1093/cid/ciac135">in the third trimester of pregnancy</a>.</p>
<figure class="align-center ">
<img alt="An infant in arms" src="https://images.theconversation.com/files/534932/original/file-20230629-27-krbk5b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/534932/original/file-20230629-27-krbk5b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=444&fit=crop&dpr=1 600w, https://images.theconversation.com/files/534932/original/file-20230629-27-krbk5b.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=444&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/534932/original/file-20230629-27-krbk5b.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=444&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/534932/original/file-20230629-27-krbk5b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=558&fit=crop&dpr=1 754w, https://images.theconversation.com/files/534932/original/file-20230629-27-krbk5b.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=558&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/534932/original/file-20230629-27-krbk5b.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=558&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">There is an added benefit of COVID-19 vaccination in pregnancy: SARS-CoV-2 IgG antibodies transfer across the placenta from mother to fetus, particularly when vaccination occurs in the third trimester of pregnancy.</span>
<span class="attribution"><span class="source">(Unsplash)</span></span>
</figcaption>
</figure>
<p>What was unknown until very recently, however, is whether vaccination in pregnancy generates functional antibodies that are detectable in the infant post-birth and, if so, do they confer any benefit to the infant in terms of protection from COVID-19 infection or severity of infection. </p>
<p>Recent studies have shown that these IgG antibodies transferred to the fetus can remain in the baby for several months after birth. One study showed <a href="https://doi.org/10.1001/jama.2022.1206">57 per cent of infants</a> born to vaccinated mothers had detectable antibodies at six months. </p>
<p>A study conducted by the Centers for Disease Control and Prevention (CDC) published in the <em>Morbidity and Mortality Weekly Report</em> (MMWR) showed that COVID-19 mRNA vaccination during pregnancy was <a href="https://doi.org/10.15585/mmwr.mm7107e3">61 per cent effective</a> in preventing COVID-19-related hospitalization in infants aged less than six months. </p>
<p>A recently published study from Ontario assessed the effectiveness of maternal mRNA COVID-19 vaccination during pregnancy against Delta and Omicron variants in preventing hospital admission in infants younger than six months of age. </p>
<p>The study found that vaccine effectiveness against hospital admission in infants from two maternal doses was <a href="https://doi.org/10.1136/bmj-2022-074035">97 per cent for Delta variant and 53 per cent for Omicron</a>. Vaccine effectiveness against infant Omicron infection was found to be highest for the first eight weeks of life, but then declined in a stepwise manner. </p>
<p>While COVID-19-related infections in the pediatric population are generally mild, there is considerable variability and a small — but real — number of children get <a href="https://doi.org/10.1080/24694193.2021.1930288">moderate or severe disease</a>. </p>
<p>Children younger than six months have the highest risk for <a href="https://doi.org/10.3389/fped.2021.674899">severe outcomes</a> associated with COVID-19 infections, including <a href="https://data.cdc.gov/NCHS/Provisional-COVID-19-Death-Counts-by-Age-in-Years-/3apk-4u4f/data">hospitalizations and death</a>. </p>
<h2>Benefits of a COVID-19 booster in pregnancy</h2>
<p>Recently the <a href="https://cdn.who.int/media/docs/default-source/immunization/sage/2023/march-2023/sage_march_2023_meeting_highlights.pdf?sfvrsn=a8e5be9_3">World Health Organization</a> recommended a COVID-19 booster during pregnancy if the last dose was over six months ago. </p>
<p>It is abundantly clear that COVID-19 infection in pregnancy carries considerable risk to the pregnant person and the fetus. Given the high efficacy of COVID-19 vaccinations in preventing severe illness in the pregnant woman, as well as the substantive benefits for the infant, there is a robust and evidence-driven indication to recommend a COVID-19 booster routinely in all pregnancies, particularly if the last dose was more than six months ago. </p>
<p>Recommending additional boosters will allow families a superior opportunity to protect themselves and their babies in the fourth year of the pandemic. We have in our arsenal an intervention that has the potential to make a meaningful impact on maternal and infant health. So I ask, what are we waiting for?</p><img src="https://counter.theconversation.com/content/208089/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sabina Vohra-Miller 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>COVID-19 vaccination has been shown to be safe in pregnancy, and protects both the mother and infant from severe disease. It’s now also clear that infants’ antibody protection continues after birth.Sabina Vohra-Miller, Doctor of Public Health Student, University of TorontoLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2050262023-06-25T20:03:52Z2023-06-25T20:03:52ZThe Black Summer bushfires put an enormous strain on families with young children. We can’t make the same mistakes again<figure><img src="https://images.theconversation.com/files/529740/original/file-20230602-27-y427tr.png?ixlib=rb-1.1.0&rect=16%2C0%2C1862%2C1081&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Author provided</span></span></figcaption></figure><p>Floods, bushfires, heatwaves, cyclones. Australia is no stranger to emergencies. But during disasters we’re <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-019-7528-0">better prepared</a> to support pet owners than families with babies and toddlers. </p>
<p>Until now, the experiences and needs of families with very young children during emergencies have been largely invisible and overlooked.</p>
<p>Our new <a href="https://www.breastfeeding.asn.au/resources-community-protection-infants-and-young-children-bushfire-emergencies-project">research</a>, a collaboration between the <a href="https://www.breastfeeding.asn.au/">Australian Breastfeeding Association</a> and Western Sydney University, highlights the challenges faced by the parents of very young children in disasters, and how we need to support them.</p>
<p>We looked at families affected by Australia’s catastrophic Black Summer bushfires of 2019-20. However, there are lessons for how we prepare for, and manage, any type of future emergency.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/200-experts-dissected-the-black-summer-bushfires-in-unprecedented-detail-here-are-6-lessons-to-heed-198989">200 experts dissected the Black Summer bushfires in unprecedented detail. Here are 6 lessons to heed</a>
</strong>
</em>
</p>
<hr>
<h2>What we did and what we found</h2>
<p>We surveyed and interviewed 256 parents of children from newborn to four years old at the time of the Black Summer bushfires, and 63 emergency responders.</p>
<p>We found caring for a very young child profoundly impacted parents’ bushfire experiences. Preparing to evacuate was more complex and physically difficult. Parents were under-prepared. Many did not have an evacuation plan and found it difficult to gather what they needed when they had to leave.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/529746/original/file-20230602-15-1y7tye.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Woman with young baby in baby carrier packing to leave" src="https://images.theconversation.com/files/529746/original/file-20230602-15-1y7tye.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/529746/original/file-20230602-15-1y7tye.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/529746/original/file-20230602-15-1y7tye.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/529746/original/file-20230602-15-1y7tye.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/529746/original/file-20230602-15-1y7tye.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/529746/original/file-20230602-15-1y7tye.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/529746/original/file-20230602-15-1y7tye.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>
<figcaption>
<span class="caption">What to pack in an emergency? Many parents found they were under-prepared.</span>
<span class="attribution"><span class="source">M. George</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<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>
<h2>Evacuation centres weren’t child-friendly</h2>
<p>Women commonly evacuated on their own with their partner staying behind to protect property. </p>
<p>These mothers found it difficult to keep their children safe in large evacuation centres due to overcrowding, the presence of strangers and animals, and because there were limited resources for caring for children.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/529743/original/file-20230602-17-o1il2g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Van at evacuation centre with toddler" src="https://images.theconversation.com/files/529743/original/file-20230602-17-o1il2g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/529743/original/file-20230602-17-o1il2g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=800&fit=crop&dpr=1 600w, https://images.theconversation.com/files/529743/original/file-20230602-17-o1il2g.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=800&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/529743/original/file-20230602-17-o1il2g.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=800&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/529743/original/file-20230602-17-o1il2g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1005&fit=crop&dpr=1 754w, https://images.theconversation.com/files/529743/original/file-20230602-17-o1il2g.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1005&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/529743/original/file-20230602-17-o1il2g.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1005&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">When parents evacuated, spaces weren’t always suitable for young children.</span>
<span class="attribution"><span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>Some emergency responders were aware of the vulnerability of children and their caregivers in large evacuation centres. </p>
<p>They described child protection concerns and physical dangers. They described unsafe practices by unsupported caregivers, such as washing baby bottles in toilet sinks, and unsafe sleep situations. They highlighted a need to proactively support parents.</p>
<p>Parents and emergency responders repeatedly said evacuation centres should have a separate space for families with very young children.</p>
<p>Families who could evacuate to the home of family or friends or to child-friendly venues such as preschools or doctors’ surgeries fared much better. One parent who was evacuated to a preschool told us:</p>
<blockquote>
<p>to the children it was like a holiday because they had all the play equipment, they had a huge, big play area out the back.</p>
</blockquote>
<p>The kindness of emergency responders, strangers and community members was greatly appreciated. One woman described how a shop employee, after seeing her with her toddler and realising she had evacuated, immediately offered her home saying:</p>
<blockquote>
<p>Do you need somewhere to stay? […] I live just walking distance […] here’s my key.</p>
</blockquote>
<h2>Pregnant women were at risk</h2>
<p>Women prioritised their children’s wellbeing over their own and often did not eat or drink properly. This was particularly concerning for pregnant and breastfeeding women. </p>
<p>Two of the five pregnant women we interviewed fainted while queuing for food and assistance. One of these women told us:</p>
<blockquote>
<p>I was so worried about my kids. I’d given them water, supplied them with food […] that I would just forget […] to eat myself, to drink […] The ambulance people asked me, ‘Have you had anything to drink today?’ […] I couldn’t even answer the question. I was like, ‘I don’t even remember if I have or not’.</p>
</blockquote>
<h2>Feeding infants could be hard</h2>
<p>Parents often found it difficult to access the resources they needed to care for their children.</p>
<p>Those who were formula feeding found it particularly difficult as infant formula, water, detergent and electricity were often not available. One parent told us:</p>
<blockquote>
<p>I had absolutely no way to ensure the bottles were cleaned as we only had a bit of water and paper towel to wipe them out with. The bottles did not have any contact with detergent on over six days.</p>
</blockquote>
<p>Those distributing infant formula did not always check whether parents had resources such as clean water or a way of heating water. Donations of infant formula were often out-of-date, not in the location needed, or more than required. One mother told us:</p>
<blockquote>
<p>People were trying to help. However it was an overwhelming amount of formula.</p>
</blockquote>
<p>Women who were breastfeeding were often grateful they had a secure food supply for their baby. One woman said:</p>
<blockquote>
<p>I am so lucky I was still breastfeeding […] I could comfort my baby and make her feel sense of normality, I was also able to feed my child without needing to worry about safe food or bottle preparation and supplies.</p>
</blockquote>
<p>Some mothers found it difficult to breastfeed in crowded evacuation centres, became dehydrated or interpreted infant fussiness and frequent feeding as meaning there was a problem with their milk. </p>
<p>They needed support to be able to continue breastfeeding that was not always available and some stopped breastfeeding as a result.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/babies-and-toddlers-might-not-know-theres-a-fire-but-disasters-still-take-their-toll-129699">Babies and toddlers might not know there's a fire but disasters still take their toll</a>
</strong>
</em>
</p>
<hr>
<h2>We need to do better in future emergencies</h2>
<p>When asked what they would do differently if they were in another emergency, parents said pack an evacuation kit and leave earlier. </p>
<p>But the onus shouldn’t be just on parents. Australian emergency planning and response needs an overhaul to better protect infants and young children, and their caregivers. </p>
<p>Existing emergency policies, planning, and guidance should be evaluated with a “young child lens” and adjusted to ensure families are properly supported. People who are experts on young children should be involved in this work.</p><img src="https://counter.theconversation.com/content/205026/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. She 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. The research described in this article was supported by an Australian Government Protecting Australian Communities-Local Stream Grant.</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>Naomi Hull is an RN, IBCLC, and has an MPH. She works for the Australian Breastfeeding Association (ABA) as Senior Manager, Breastfeeding Information and Research. Naomi volunteers as a Breastfeeding Counsellor on the ABA National Breastfeeding Helpline and as the National Coordinator for the World Breastfeeding Trends Initiative Australia. Naomi is also a member of the Public Health Association of Australia. </span></em></p>Parents and emergency responders repeatedly said evacuation centres should have a separate space for families with very young children. Here’s what else we could do.Karleen Gribble, Adjunct Associate Professor, School of Nursing and Midwifery, Western Sydney UniversityMichelle Hamrosi, Clinical lecturer, Rural Clinical School, Australian National UniversityNaomi Hull, Research Assistant, Australian National UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2038282023-06-05T12:06:11Z2023-06-05T12:06:11ZBirth of a story: How new parents find meaning after childbirth hints at how they will adjust<figure><img src="https://images.theconversation.com/files/529856/original/file-20230602-19-u8qb1f.jpg?ixlib=rb-1.1.0&rect=94%2C549%2C4418%2C2943&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Having a new baby can upend everything about your old life.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/newborn-baby-boy-being-cradled-by-new-parents-in-royalty-free-image/1307728623">Cavan Images/Cavan via Getty Images</a></span></figcaption></figure><p>Gather a group of new parents and the conversation will likely turn to their childbirth stories – ranging from the joyful to the gnarly to the positively traumatic. <a href="https://slate.com/human-interest/2022/01/birth-stories-feminist-history-internet-sharing.html">Birth story podcasts and websites</a> feature a curated range of birth experiences, and you can buy embossed leather “birth story” journals as a baby shower gift. People are fascinated by this pivotal, emotionally complex and literally life-and-death experience.</p>
<p>Birth narratives might also contain clues about how the adjustment to parenthood will go.</p>
<p><a href="https://www.penguinrandomhouse.com/books/203434/the-uses-of-enchantment-by-bruno-bettelheim/">People have long used stories</a> to understand difficult experiences. Stories may be particularly valuable as a source of “meaning-making,” the process of finding order in chaos by making sense of unexpected events, identifying silver linings and discovering the patterns and connections that thread seemingly random events together into a coherent narrative.</p>
<p>In a new study led by <a href="https://scholar.google.com/citations?user=YRIcV6YAAAAJ&hl=en&oi=ao">Geoffrey Corner</a>, a former graduate student in <a href="https://dornsife.usc.edu/nestlab/">my lab</a>, we found that the levels of meaning-making in the stories new parents told about their baby’s birth <a href="https://doi.org/10.1037/fam0001062">predicted their relationship quality and parenting stress</a> in the child’s first months.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/529857/original/file-20230602-23-6cutjo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="three moms with infants on mats facing an instructor with a doll in a baby yoga class" src="https://images.theconversation.com/files/529857/original/file-20230602-23-6cutjo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/529857/original/file-20230602-23-6cutjo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/529857/original/file-20230602-23-6cutjo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/529857/original/file-20230602-23-6cutjo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/529857/original/file-20230602-23-6cutjo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/529857/original/file-20230602-23-6cutjo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/529857/original/file-20230602-23-6cutjo.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">When new moms come together, the talk often turns to their childbirth stories.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/baby-massage-class-switzerland-new-mothers-learn-how-to-news-photo/629429057">BSIP/Universal Images Group via Getty Images</a></span>
</figcaption>
</figure>
<h2>Constructing meaning in your own life</h2>
<p>Finding meaningful themes and patterns in life’s seeming randomness is a fundamentally human activity. As writer Joan Didion put it, “<a href="https://www.penguinrandomhouse.com/books/40775/we-tell-ourselves-stories-in-order-to-live-by-joan-didion-introduction-by-john-leonard/">we tell ourselves stories in order to live</a>.”</p>
<p>“Meaning-making” can buffer despair in the wake of tragedy. Holocaust survivor Victor Frankl’s memoir, “<a href="http://www.beacon.org/Mans-Search-for-Meaning-P602.aspx">Man’s Search for Meaning</a>,” argued that meaning and purpose can prevent the bitterness and disillusionment that can otherwise fester after great loss. Research on what psychologists call <a href="https://doi.org/10.1207/s15327965pli1501_01">post-traumatic growth</a> has found that the level of “meaning-making” in people’s narratives about a difficult event predicts their mental health over time.</p>
<p>For example, studies have found <a href="https://doi.org/10.1037/a0018301">links between meaning-making and resilience</a> in cancer patients, bereaved parents and caregivers. Cancer survivors might discover that their chemo ordeal brought them closer to friends and family, or helped them step back from the hustle of everyday life and embrace a slower pace.</p>
<p>Although childbirth is typically experienced as a joyful rather than a tragic event, it can still be unpredictable, frightening and even life-threatening. Indeed, psychologists have begun to recognize that particularly difficult labors <a href="https://doi.org/10.1080/02646838.2015.1031646">can trigger post-traumatic stress symptoms</a>, not just in mothers but in their partners as well. Even normal, nontraumatic births require parents to cope with hours, sometimes days, of pain and discomfort. Therefore, we hypothesized that meaning-making might be an important part of couples’ birth narratives, potentially promoting resilience in new parents.</p>
<p>To test these hypotheses, we collected birth stories from 77 couples who were participating in our lab’s <a href="https://dornsife.usc.edu/nestlab/research/">longitudinal study of the transition to parenthood</a>. We visited couples at the hospital within a day or two of their infant’s birth, and audio-recorded them sharing their stories together. We told couples, “We’d like to hear you tell the story of your birth experience. Start from the beginning and tell us as much as you remember.”</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/529858/original/file-20230602-29-rszklh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="three masked medical workers hold newborn above mother's body during C-section operation" src="https://images.theconversation.com/files/529858/original/file-20230602-29-rszklh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/529858/original/file-20230602-29-rszklh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=443&fit=crop&dpr=1 600w, https://images.theconversation.com/files/529858/original/file-20230602-29-rszklh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=443&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/529858/original/file-20230602-29-rszklh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=443&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/529858/original/file-20230602-29-rszklh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=557&fit=crop&dpr=1 754w, https://images.theconversation.com/files/529858/original/file-20230602-29-rszklh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=557&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/529858/original/file-20230602-29-rszklh.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>
<figcaption>
<span class="caption">Parents may need to process even a normal childbirth with healthy outcomes.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/caesarian-babys-first-breath-royalty-free-image/125951777">Peter Dazeley/The Image Bank via Getty Images</a></span>
</figcaption>
</figure>
<h2>Listening for meaning-making in birth stories</h2>
<p>A team of coders listened to each story and recorded examples of meaning-making, using three categories established in the research literature:</p>
<ul>
<li><p>Sense-making: Identifying reasons that an event might have unfolded the way it did or making connections that show why an event was meaningful. For example, one mother in our sample found meaning in her long labor, describing her baby as “very brave and tough” because she survived hours of pushing. </p></li>
<li><p>Benefit-finding: Pointing out silver linings or unexpected positive effects of a difficult experience. For example, after a difficult birth, one parent in our sample stated, “It was scary, but the nurses and the doctors were so nice to us.”</p></li>
<li><p>Change in identity: Describing how an event has transformed one’s sense of self. As a parent in our sample said, “I feel like my life has changed completely with the baby now here.”</p></li>
</ul>
<p>Although couples told their story together, we tracked meaning-making separately for each partner. We also rated how much each partner participated in telling their story so we could adjust for their levels of engagement in sharing their birth narrative.</p>
<p>The couples in our <a href="https://doi.org/10.1037/fam0001062">sample were avid “meaning makers”</a>: Almost all the participants made at least some meaning-making statements in their birth stories. Of the three categories of meaning-making, “change in identity” language surfaced least often, appearing in about 37% of the birth stories. Mothers tended to use more “sense-making” and “benefit-finding” language than fathers. And both members of a couple tended to use similar amounts of meaning-making language. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/529859/original/file-20230602-27-200pws.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="infant on mother's chest in hospital bed with father smiling down at baby" src="https://images.theconversation.com/files/529859/original/file-20230602-27-200pws.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/529859/original/file-20230602-27-200pws.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=487&fit=crop&dpr=1 600w, https://images.theconversation.com/files/529859/original/file-20230602-27-200pws.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=487&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/529859/original/file-20230602-27-200pws.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=487&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/529859/original/file-20230602-27-200pws.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=612&fit=crop&dpr=1 754w, https://images.theconversation.com/files/529859/original/file-20230602-27-200pws.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=612&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/529859/original/file-20230602-27-200pws.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=612&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">A new parent’s meaning-making can affect them and their partner.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/mixed-race-family-admiring-their-newborn-baby-at-royalty-free-image/1248789907">SelectStock/E+ via Getty Images</a></span>
</figcaption>
</figure>
<h2>Becoming mom or dad</h2>
<p>After we had coded all of the narratives, we next looked to see whether “meaning-making” predicted relationship satisfaction and parenting stress in our couples. The transition to parenthood can be a “<a href="https://doi.org/10.2307/347802">crisis event” for the couple relationship</a> and is often linked with <a href="https://theconversation.com/have-children-heres-how-kids-ruin-your-romantic-relationship-57944">declines in relationship quality</a>.</p>
<p>But when mothers used more “sense-making” and “benefit-finding” language, they showed a smaller drop in their relationship satisfaction than moms who used less. Fathers who used more “sense-making” and “benefit-finding” language reported lower parenting stress at six months postpartum than dads who used less.</p>
<p>And partners of fathers who used more “change in identity” language also reported lower parenting stress later on, suggesting that dads who experience the transition to parenthood as transformative may be able to help mothers cope better with new parenthood. On the flip side, though, when mothers showed more meaning-making, their partners actually reported more parenting stress at six months postpartum. It may be that when mothers find the birth experience to be more personally meaningful, partners feel left out or pressured to step up their own parenting.</p>
<p>Overall, these results supported our initial hunch that meaning-making might be detectable in birth narratives and forecast parents’ psychological adjustment after birth. Greater meaning-making language seemed to benefit the couple relationship and largely buffer parenting stress.</p>
<p>This study was limited by a fairly small sample of cohabiting heterosexual parents. Nevertheless, it highlights the value of stories in shaping family transitions. For therapists working with new parents in the wake of a difficult birth, encouraging couples to seek meaning in their birth story may help ease their transition to parenthood. Journaling and storytelling exercises may help couples process their feelings about their childbirth experiences. After all, the birth of a baby is also the birth of a story – and that story is well worth telling.</p><img src="https://counter.theconversation.com/content/203828/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Darby Saxbe receives funding from the National Institutes of Health and the National Science Foundation. </span></em></p>How you tell the story of a momentous event can help you make sense of what happened. Research finds new moms’ and dads’ narratives around childbirth held clues about their transition to parenthood.Darby Saxbe, Associate Professor of Psychology, USC Dornsife College of Letters, Arts and SciencesLicensed 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>
<figure class="align-center ">
<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">
<figcaption>
<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>
</figcaption>
</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/2048732023-05-19T12:40:40Z2023-05-19T12:40:40ZTalking puppy or finger puppet? 5 tips for buying baby toys that support healthy development<figure><img src="https://images.theconversation.com/files/525990/original/file-20230512-25-2f6227.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Tech toys may claim to be educational – but those claims often aren't backed by science. </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/cute-little-boy-playing-with-a-railroad-train-toy-royalty-free-image/1281267794">boonchai wedmakawand/Moment Collection/Getty Images</a></span></figcaption></figure><p>Picking out a baby toy – whether it’s for your own child or a friend’s kid or the child of a family member – can be overwhelming. Although Americans spend <a href="https://www.statista.com/outlook/dmo/ecommerce/toys-hobby-diy/toys-baby/united-states">US$20 billion</a> a year on baby toys, it’s difficult to know which toy will be fun, educational and developmentally appropriate. The options seem endless, with search results at common retail sites in the hundreds, if not thousands. Is price a reliable indicator of quality? Are technological enhancements useful? </p>
<p>Our <a href="https://www.museumofplay.org/app/uploads/2023/04/15-1-Article-2-Transforming-Toybox.pdf">peer-reviewed study</a> – published in the American Journal of Play in April 2023 – surveyed the toy market for babies and toddlers age 0-2 at two major U.S. national retailers, with an eye toward differences between battery-powered toys, like the <a href="https://store.leapfrog.com/en-us/store/p/speak-learn-puppy/_/A-prod80-610100">LeapFrog Speak and Learn Puppy</a>, and traditional toys, such as the <a href="https://www.homefurniturelife.com/shop/magic-years-jungle-animals-finger-puppets-4-pc-set/">Magic Years Jungle Finger Puppet</a>. </p>
<p>We found significant differences between these two toy types in terms of how they’re marketed – with more traditional toys marketed as supporting physical development and more technological toys aimed at cognitive development. However, these companies do not always have researchers investigating whether the toys actually help children learn.</p>
<p>As <a href="https://scholar.google.com/citations?hl=en&user=KhghzJQAAAAJ&view_op=list_works&sortby=pubdate">researchers who study toys</a> and <a href="https://scholar.google.com/citations?user=5KTeq2UAAAAJ&hl=en">how children learn and play</a>, we offer five tips before you buy your next baby toy.</p>
<h2>1. Consider your goal</h2>
<p>When purchasing a toy, consider whether you have any particular developmental goal in mind. For instance, do you want your baby to develop fine motor skills by playing with a <a href="https://reachformontessori.com/busy-boards/">busy board</a>, or to <a href="https://doi.org/10.1111/mono.12280">practice spatial skills</a> by building a block tower? </p>
<h2>2. Look for open-ended toys</h2>
<p>Many parents and caregivers know that children often <a href="https://theconversation.com/when-kids-like-the-box-more-than-the-toy-the-benefits-of-playing-with-everyday-objects-202301">love playing with the box</a> more than the toy inside it. One reason is that boxes are open-ended toys – they can become anything a young child dreams up. Conversely, a toy cellphone directs the type of play much more rigidly. </p>
<p>A good rule of thumb is to choose toys that require <a href="https://www.brookings.edu/blog/education-plus-development/2018/12/10/the-science-of-toys-a-guide-for-the-perplexed-shopper/">90% activity from the child and only about 10% input from the toy</a>. For example, infants can explore a set of realistic miniature animals sensorially – usually by putting them in their mouths – and then later use them for pretend play, or even to create animal footprints in play dough. Contrast this experience with a large plastic elephant that needs to sit on the floor and lights up and makes elephant sounds. Here, a child is limited in play, with the goal being to make the object light up or play a sound. </p>
<figure class="align-center ">
<img alt="Father and young son play together with toy cars" src="https://images.theconversation.com/files/526565/original/file-20230516-27-epnrbq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/526565/original/file-20230516-27-epnrbq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/526565/original/file-20230516-27-epnrbq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/526565/original/file-20230516-27-epnrbq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/526565/original/file-20230516-27-epnrbq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/526565/original/file-20230516-27-epnrbq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/526565/original/file-20230516-27-epnrbq.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">Parents tend to talk to kids more when they play together with traditional toys versus tech toys.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/cute-little-african-kid-son-playing-toy-cars-with-royalty-free-image/1158481693">iStock / Getty Images Plus</a></span>
</figcaption>
</figure>
<h2>3. Recognize gender biases</h2>
<p>Several major retailers have <a href="https://www.latimes.com/business/la-fi-target-gender-labeling-20150810-story.html">removed gender-based toy sections</a> over the past decade, opting for “kids” instead of “boys” and “girls.” </p>
<p>However, if you enter the store of one of those major toy retailers today, you will still find some aisles filled with pink toys and dolls, while other aisles feature monster trucks and primary-colored blocks. A toy sword might not be labeled as “for boys,” yet shoppers often perceive it that way based on <a href="https://doi.org/10.1007/s11199-017-0858-4">their own gender socialization and beliefs</a>. If you look only in certain aisles or at stereotypical toys, you might miss out on toys that your child would enjoy regardless of gender. </p>
<h2>4. Be wary of marketing claims</h2>
<p>The makers of tech toys often make claims about their educational potential that are not backed by science. For example, an electronic shape sorter might claim to help children develop emotional skills because the toy says “I love you!” </p>
<p>Be skeptical of such claims, and use your own experience and insights to evaluate the educational potential of a toy. You might read the retailer and manufacturer descriptions, but also see what the toy actually does. If it fosters caregiver-child interactions or helps to develop a specific skill – like how building blocks support spatial skills, and finger puppets build fine motor skills – then it is likely a toy worth considering. </p>
<h2>5. Prioritize human interactions</h2>
<p>Keep in mind that toys are not chiefly designed to create baby geniuses – they are meant to be fun! So think broadly about whether you want a new toy to support physical, social, emotional, cognitive or creative development while keeping it fun. And remember that no toy can replace <a href="https://doi.org/10.1111/infa.12378">joyful, high-quality interactions</a> between caregivers and children.</p>
<p>Research suggests that <a href="https://doi.org/10.1542/peds.2018-3348">caregivers are less responsive and communicative</a> when playing with tech toys versus traditional toys with their children. So choosing traditional toys, such as nonelectronic shape sorters and building blocks, may be one way to foster the types of interactions that support healthy development.</p>
<p>Overall, research suggests that, in most cases, traditional toys provide <a href="https://www.doi.org/10.1542/peds.2018-3348">better interactions and experiences</a> than technological toys. When purchasing a toy, think through the experiences you want the baby in your life to have, think broadly about the goals of a particular toy, try to provide opportunities for <a href="https://doi.org/10.3389/fpsyg.2018.01124">high-quality interactions</a> and remember to have fun.</p><img src="https://counter.theconversation.com/content/204873/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jennifer M. Zosh has consulted for the Lego Group. </span></em></p><p class="fine-print"><em><span>Brenna Hassinger-Das 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>Two experts on children’s play explain why you should be skeptical of toys that are advertised as being educational, and what to look for instead.Brenna Hassinger-Das, Assistant Professor of Psychology, Pace University Jennifer M. Zosh, Professor of Human Development and Family Studies, Penn StateLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2050622023-05-15T15:43:20Z2023-05-15T15:43:20ZReusable nappies can reduce the environmental footprint of parenting – but only if they’re used with care<figure><img src="https://images.theconversation.com/files/525867/original/file-20230512-7689-sqf4xc.jpg?ixlib=rb-1.1.0&rect=20%2C0%2C6639%2C4476&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Disposable nappies are a major source of plastic pollution.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/mother-changing-her-babys-diaper-on-1719589099">New Africa/Shutterstock</a></span></figcaption></figure><p>Around the world, another <a href="https://ourworldindata.org/world-population-growth#how-has-world-population-growth-changed-over-time">45 babies are born</a> every ten seconds. Each of these babies will require nappies that need to be changed frequently. So it’s understandable that new parents want to do what’s best for their baby – and the planet – when it comes to the all-important nappy change. </p>
<p>With the advent of disposable nappies, the experience of wrestling children into rubbery triangles of cloth while attempting to pin everything in place has become a thing of the past. These single-use nappies are more absorbent and are designed for quick and easy changing. </p>
<p>Disposable nappies have transformed the lives of busy parents. But this popular option has its drawbacks. Disposable nappies are difficult to recycle. Many end up being <a href="https://www.theguardian.com/environment/2021/nov/20/disposable-nappies-plastic-waste-diapers">dumped in the environment</a> or sent to landfill. <a href="https://bbia.org.uk/wp-content/uploads/2020/11/A-Circular-Economy-for-Nappies-final-oct-2020.pdf">One study</a> found that more than 300,000 disposable nappies are incinerated, sent to landfill or end up in the environment every minute. </p>
<p>These nappies also contain several different plastics which <a href="https://www.channelnewsasia.com/asia/indonesia-diaper-evacuation-brigade-clean-up-rivers-1941671">take years to break down</a>, and when they do they release harmful microplastics. The waste – and <a href="https://www.researchgate.net/publication/346641495_Disposable_Diapers_Impact_of_Disposal_Methods_on_Public_Health_and_the_Environment">chemicals</a> – inside the nappy itself can also end up leaching out into the environment and contaminating soil and water sources. </p>
<p>However, there are potentially more sustainable alternatives. One is biodegradable nappies. But even these nappies have been <a href="https://www.which.co.uk/news/article/why-biodegradable-nappies-might-not-be-as-eco-friendly-as-you-think-aK1SK3T9QWBm#:%7E:text=There%20isn%27t%20currently%20a%20UK%20standard%20that%20nappy,open%20air%2C%20not%20those%20disposed%20of%20in%20landfill.">met with criticism</a> – all biodegradable nappies contain some plastic materials (like sticky tabs made from polyurethane) so will take many years to break down.</p>
<p>Increasing uptake of reusable nappies is another option. It would certainly generate less plastic waste, but whether reusable nappies are truly a better environmental choice is unclear.</p>
<h2>Environmental footprint of nappies</h2>
<p>In 2008, the Environment Agency carried out a <a href="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/291130/scho0808boir-e-e.pdf">study</a> comparing the lifecycle environmental footprint of different nappy options in the UK. This study found little difference between the environmental impact of disposable and reusable nappies. </p>
<p>This study has been recently updated. The <a href="https://randd.defra.gov.uk/ProjectDetails?ProjectId=20622">new report</a> analysed the carbon footprint of reusable and disposable nappies in greater detail and considered how things have changed 15 years on. </p>
<p>Both options are now more sustainable. We have <a href="https://gridwatch.co.uk/">more renewable energy</a> in our energy mix, so the production, packaging and transportation of nappies is now more efficient. Disposable nappies are also <a href="https://pure.manchester.ac.uk/ws/files/81715879/Eco_efficiency_of_diapers.pdf">lighter and more compact</a> than they were before, so require less packaging and energy to transport.</p>
<p>The environmental impact of both reusable and disposable nappies is, however, still relatively large. The carbon footprint of using disposable nappies for one child up to the age of two and a half is now the equivalent of 457 kg of CO₂ (although this is 27% less than in 2008). Reusable nappies (which this time considered more reusable nappy options than the original study) had 25% less global heating potential – but their carbon footprint was still the equivalent of 345 kg of CO₂. </p>
<p>Disposables performed worse on six environmental impact categories. This was mostly down to how the nappy was produced and disposed of. </p>
<p>Due to the use of plastics, disposable nappies were associated with 40% more fossil fuel use than reusables. The environmental impact of single-use nappies was also much higher when it came to disposal. These nappies had a 26% higher impact on freshwater eutrophication (where water is overloaded with nutrients). </p>
<p>So, does this mean that new parents should rush out and buy reusable nappies? Maybe, but with a note of caution. Reusable nappies were outperformed by disposables on 11 of the 18 environmental factors considered. </p>
<p>This was associated mainly with the electricity and detergent used to wash and dry them. The latter caused 333% more marine pollution than the use of disposable nappies.</p>
<h2>Reducing your footprint</h2>
<p>The good news is that this impact is something that we can control. Parents can lower their impact by washing nappies at lower temperature settings or in more efficient machines, avoiding the tumble drier and extending their use by passing them on to other children. </p>
<p>Another option is washing nappies together in full washing loads. But this would require having sufficient nappies available to allow storage of used nappies while also having a clean and dry supply for your baby. </p>
<p>One way of making sure the laundry is done efficiently is to sign up to a <a href="https://www.babycentre.co.uk/a560107/using-a-nappy-laundry-service">local nappy laundry service</a> if there is one nearby. These companies collect your dirty nappies and give you freshly-laundered ones in return. </p>
<p>Whichever type of nappy we use, a final thing we could do is to toilet train our children earlier. The updated study revealed that, since 2008, parents have shifted to potty training their children at a later stage in their development. Around 37% of children aged two and a half, for example, are still wearing disposable nappies, while 35% were still in reusable nappies – 19.4% and 17.4% more than in 2008 respectively. This means that we are producing, using and transporting more nappies, and using more water and energy to wash them.</p>
<figure class="align-center ">
<img alt="Clothes line full of reusable baby diapers in front of a clear blue sky." src="https://images.theconversation.com/files/525872/original/file-20230512-17-ao5g7w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/525872/original/file-20230512-17-ao5g7w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=345&fit=crop&dpr=1 600w, https://images.theconversation.com/files/525872/original/file-20230512-17-ao5g7w.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=345&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/525872/original/file-20230512-17-ao5g7w.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=345&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/525872/original/file-20230512-17-ao5g7w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=433&fit=crop&dpr=1 754w, https://images.theconversation.com/files/525872/original/file-20230512-17-ao5g7w.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=433&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/525872/original/file-20230512-17-ao5g7w.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=433&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Parents can reduce their impact by air drying reusable nappies.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/clothes-line-full-reusable-baby-diapers-12791776">Robin Phinizy/Shutterstock</a></span>
</figcaption>
</figure>
<p>Reusable nappies can help to lower our carbon footprint. But only if we wash at lower temperatures, with efficient equipment and avoid tumble drying. In the UK, especially in winter, this last point could be an issue, so having a mixed approach would be a suitable compromise. </p>
<p>Parents could continue to choose disposable nappies when line drying is difficult. There are also several steps we can take to lessen the environmental impact of disposable nappies are their use. Not dumping them in the environment is a good start – but making sure they go to a waste-to-energy incinerator, or even better, there are now <a href="https://diaperrecyclingeurope.eu/en/recycling-process/">ways to recycle</a> them and turn them into something new.</p><img src="https://counter.theconversation.com/content/205062/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sharon George receives funding from Research England for energy-related research.</span></em></p>How to be more a more eco-friendly parent – it’s not as simple as ditching disposable nappies.Sharon George, Research Chair, Indigenous Approaches to Environmental Management, Keele UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2032222023-04-16T12:19:13Z2023-04-16T12:19:13ZAn emergency in the making: Ending pandemic prenatal health coverage for uninsured people is both costly and dangerous<figure><img src="https://images.theconversation.com/files/521097/original/file-20230414-28-nn18d8.jpg?ixlib=rb-1.1.0&rect=39%2C45%2C3675%2C2369&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Research shows that uninsured people are more likely to get care later in pregnancy, and less care overall. This increases risks for mothers and babies.
</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/an-emergency-in-the-making--ending-pandemic-prenatal-health-coverage-for-uninsured-people-is-both-costly-and-dangerous" width="100%" height="400"></iframe>
<p>On March 31, 2023 the Ford government in Ontario <a href="https://health.gov.on.ca/en/pro/programs/ohip/bulletins/redux/bul230305.aspx">ended the expanded health-care funding</a> it put in place when the COVID-19 pandemic began in March 2020. </p>
<p>This funding allowed everyone in Ontario to access essential health care. For the <a href="https://www.hnuc.org/reports">hundreds of thousands of people living in the province without health insurance</a>, this meant access to necessary surgeries, emergency care and labour and delivery services without thousands of dollars in <a href="https://www.qch.on.ca/WithoutInsuranceChildbirthFees">hospital and physician bills</a>.</p>
<p>As a midwife who has worked in Toronto for over 20 years, largely with uninsured populations, and an associate professor who has focused my research and activism on this issue, I am acutely aware of how these cuts will impact pregnant people and ultimately all Canadians.</p>
<h2>Insurance status</h2>
<p>There are many reasons someone <a href="https://doi.org/10.29173/alr778">may not have health insurance</a>. These can include homelessness; mental health issues; addiction; <a href="https://static1.squarespace.com/static/63aeec46560bfa003a5030f6/t/63c49984c13ada20b0eb222f/1673828740700/famvio.pdf">having documents withheld by an abusive partner</a>, <a href="https://doi.org/10.1007/s10903-021-01273-w">landlord or employer</a>; and, for a growing number of people who live and work across Canada, <a href="http://dx.doi.org/10.1080/13621020902850643">lack of legal immigration status</a>. </p>
<p>Increasingly, people may spend years with precarious immigration status, all the while building a life here and eagerly waiting for applications to come through. For example, <a href="https://www.cic.gc.ca/english/helpcentre/answer.asp?qnum=492&top=15">a student applying for a work permit</a> may fall out of status while one application expires and another comes through. </p>
<p>Research shows that uninsured people are more likely to <a href="https://doi.org/10.1016/j.jogc.2018.10.008">get care later in pregnancy and less care overall</a>. It is well accepted across medicine that <a href="https://www.canada.ca/en/public-health/services/publications/healthy-living/maternity-newborn-care-guidelines-chapter-3.html">prenatal care is linked to healthier outcomes</a> for <a href="https://www.americanprogress.org/article/ensuring-healthy-births-prenatal-support/">pregnant people and babies</a>. In particular, prenatal care is associated with <a href="https://doi.org/10.1016/j.ajog.2010.03.001">dramatically lower rates of preterm birth</a> and low birth weight babies.</p>
<p>Health-care costs for babies born too small and too early are among the highest of all health-care expenditures. It’s estimated that <a href="https://doi.org/10.9778%2Fcmajo.20170128">Canada spends about $8 billion per year in health costs related to preterm babies</a>. Babies born too small and too early are also among the most likely to have lifelong health issues, including profound cognitive and physical impairment. </p>
<p>There is a simple bottom line argument here: prenatal care is cheap and sick babies are very expensive.</p>
<h2>Refugees in all but name</h2>
<p>With <a href="https://www.cbc.ca/news/politics/roxham-road-global-migration-analysis-wherry-1.6759766">increasing global health and economic disparities</a>, we are seeing more people cross and/or stay within our borders to work and live. Like many others who work with these populations, I can say that many who do not have refugee status are refugees in all but name: <a href="https://theconversation.com/refugee-stories-reveal-anxieties-about-the-canada-u-s-border-127394">escaping impossible conditions</a> and trying to build a future here. </p>
<p>The same week the Ontario government discontinued its expanded health-care coverage, <a href="https://www.thestar.com/news/canada/2023/03/31/authorities-in-akwesasne-hunt-for-missing-child-after-six-bodies-found-in-quebec-marsh.html">eight people drowned trying to cross the St. Lawrence River</a> in Québec while trying to escape deportation. These are the acts of desperate people. </p>
<p>While hospitals are not going to turn people away in emergencies, many pregnant people need access to hospital-based care before there is an emergency, and in fact to avoid an emergency. For example, someone who needs a caesarean section because labour would be too risky, may be <a href="https://toronto.ctvnews.ca/uninsured-patients-denied-scheduled-c-sections-unless-they-pay-6-000-midwife-says-1.6338249">required to pay $6,000</a> or <a href="https://www.qch.on.ca/WithoutInsuranceChildbirthFees">even more</a> before they can access a provider. </p>
<p>For some people, this could mean deciding between rent, feeding their children or getting basic health care.</p>
<h2>Inevitable emergencies</h2>
<p>It is inevitable that many people will not have access to prenatal care and will wind up in an emergency department, where the hospital will be <a href="https://www.health.gov.on.ca/en/pro/programs/ohip/bulletins/redux/bul230305.aspx">ethically required to provide care anyway</a>. Hospitals requiring advance payment does not make people less pregnant, less high-risk or less in need of a caesarean. It means people going without care and coming to the hospital in need of emergency surgery, which has the <a href="https://secure.cihi.ca/free_products/Costs_Report_06_Eng.pdf">highest cost</a> and <a href="https://doi.org/10.33314/jnhrc.v18i2.2093">risks of any birth</a>. </p>
<p>Adding another layer of complexity to this puzzle is that, as <a href="http://dx.doi.org/10.1136/bmjgh-2021-005671">global caesarean section rates skyrocket</a>, more and more undocumented migrants in Canada have had a previous caesarean section. For many, this means the safest option for delivery is a <a href="https://doi.org/10.1503/cmaj.170371">repeat caesarean section</a>.</p>
<p>Putting all the pieces together, discontinuing expanded health-care funding means higher numbers of already marginalized people having less prenatal care, more preterm births and low birth weight babies, and more emergency caesarean sections for delivery — all of which result in worse outcomes, more cost on the system and more moral distress on health care providers. How is this a good idea from any angle?</p>
<p><a href="https://static1.squarespace.com/static/63aeec46560bfa003a5030f6/t/64179ae782bfa26c01352025/1679268584210/A+Bridge+to+Universal+Healthcare.pdf">A study released just one week before these cuts were announced</a> showed the many benefits of having the expanded funding in place, including improved access to prenatal care. It also demonstrated the relief health-care providers felt at not having the moral distress of having to decide who was able to access necessary care. </p>
<h2>Lessons learned</h2>
<p>The expanded funding put in place during COVID-19 revealed a few things. </p>
<p>First, the fact that it was implemented is an acknowledgement that it was needed. If we have universal health coverage for all who live here, why did we need the program in the first place? </p>
<p>Second, it demonstrated that it was not a massive burden to our health-care system to provide this care. The Ontario Medical Association estimated this program cost <a href="https://ottawacitizen.com/news/local-news/provinces-move-to-cut-payment-for-people-without-health-cards-concerns-doctors-association-head">$15 million over three years</a>. Even if it was several times more, this is very little of our <a href="https://budget.ontario.ca/2022/fallstatement/chapter-3.html">health-care budget</a>. By providing primary and preventive care, as well as prenatal care, the program likely saved money by <a href="https://static1.squarespace.com/static/63aeec46560bfa003a5030f6/t/64179ae782bfa26c01352025/1679268584210/A+Bridge+to+Universal+Healthcare.pdf">avoiding more expensive acute and emergency care</a>, and it certainly saved lives.</p>
<p>Third, this program brought <a href="https://www.ontariomidwives.ca/sites/default/files/Policy%20positions%20and%20submissions/Non-insured-collective-Statement-Final-with-logos%20330%20pm%20March%2029%202023.pdf">caregivers and organizations together</a>, with health-care associations asserting that this is a <a href="https://static1.squarespace.com/static/63aeec46560bfa003a5030f6/t/63c48fcd5edaa632a269ea1e/1673826253563/Equitable-Access-to-OHIP-Registration-for-Newborns-.pdf">health equity issue, not a medical tourism issue</a>. Immigration status has long been established as a <a href="https://doi.org/10.1007/s10903-021-01273-w">social determinant of health</a>, along with factors including poverty, racialization and education level. It is about time we address this issue in Canada.</p>
<p>The decision to discontinue extended care is going to cost us. Not just in terms of health-care dollars — it is always better to treat high blood pressure than manage a stroke — but in terms of our ethics. </p>
<p>Several decades ago, we decided as a country that everyone — rich or poor — deserves access to health care. <a href="https://www150.statcan.gc.ca/n1/daily-quotidien/210928/dq210928c-eng.htm">Canadians have taken pride</a> in this and it is part of our national identity. Until everyone is covered, we need to acknowledge that we do not, in fact, have universal health care, and decide what this means to us as a country. </p>
<p><em>This article was co-authored by Shezeen Suleman of Toronto Metropolitan University, and Rachel Spitzer, AJ Mata and Jenny Yang Klimis of University of Toronto.</em></p><img src="https://counter.theconversation.com/content/203222/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Manavi Handa 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>Discontinuing expanded health-care funding will result in less prenatal care for uninsured patients, more health risks, higher costs to the health system, and moral distress for health-care providers.Manavi Handa, Associate Professor, Midwifery Education Program, Toronto Metropolitan UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2033012023-04-11T11:24:35Z2023-04-11T11:24:35ZNearly a quarter of people in the UK flush wet wipes down the toilet – here’s why they shouldn’t<figure><img src="https://images.theconversation.com/files/519787/original/file-20230406-18-hx8ppo.jpg?ixlib=rb-1.1.0&rect=61%2C7%2C5028%2C3380&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/father-changing-newborn-babys-diaper-on-1450033853">Shutterstock/BigLike Images</a></span></figcaption></figure><p>Whether you’re cleaning your house, your car or your child, there are a variety of wet wipes manufactured for the job. Wet wipes are small, lightweight and extremely convenient. They have become a staple in most of our lives, particularly so during and since the COVID-19 pandemic. </p>
<p>But according to Water UK, an organisation representing the water industry, flushing wet wipes down the toilet is responsible for <a href="https://www.theguardian.com/environment/2017/dec/12/baby-wipes-93-percent-matter-causing-uk-sewer-blockages">93% of sewer blockages</a> and costs around £100 million each year to sort out. And the majority of these wipes, about 90%, contain plastic.</p>
<p><a href="https://www.water.org.uk/news-item/bin-the-wipe/#:%7E:text=%E2%80%9CBin%20the%20Wipe%E2%80%9D%20is%20a,wet%20wipes%20down%20the%20toilet.">Water UK</a> also found that 22% of people admit to flushing wipes down the toilet, even though most of them knew they posed a hazard. And it’s estimated that <a href="https://www.water.org.uk/news-item/bin-the-wipe/#:%7E:text=%E2%80%9CBin%20the%20Wipe%E2%80%9D%20is%20a,wet%20wipes%20down%20the%20toilet.">300,000</a> sewer blockages occur every year because of “<a href="https://theconversation.com/microplastic-pollution-and-wet-wipe-reefs-are-changing-the-river-thames-ecosystem-119400">fatbergs</a>”, with wet wipes one of the main causes. </p>
<p>But it seems wet wipes <a href="https://www.independent.co.uk/news/uk/home-news/wet-wipe-ban-uk-alternative-environmentally-friendly-b2314365.html">could soon be banned</a> in England - well, at least the ones that contain plastic – as the government has said it will launch a public consultation on wet wipes in response to mounting concerns about water pollution and blockages. This follows pledges made by <a href="https://www.tescoplc.com/news/2022/tesco-to-ban-wet-wipes-containing-plastic/">major retailers</a>, including Boots and Tesco, to discontinue the sale of such products.</p>
<p><a href="https://www.nonwovens-industry.com/issues/2018-4/view_features/four-trends-shaping-the-future-of-nonwoven-wipe-demand/">Market projections</a> show that 1.63 million tons of material will be produced in 2023 for wet wipes globally – an industry worth approximately $2.84 billion (£2.04 billion). Though these figures are likely to be on the conservative side as manufacturers increased the production of disinfecting wipes in 2020 <a href="https://www.nonwovens-industry.com/issues/2020-06/view_features/household-wipes-demand-soars-amid-covid-19-pandemic/">during the pandemic</a> – and have remained at the same level since. </p>
<p>Despite the popularity and wide use of wet wipes, not a lot is known about their environmental footprint. This is because manufacturers are not obliged to state what the wipes are made from on the packaging, only the intentionally added ingredients. This creates a challenge for both scientists and consumers alike. </p>
<h2>What we know</h2>
<p>Wet wipes are made from non-woven fibres that are fused together either mechanically or with the aid of chemicals or heat. The individual fibres can be made from either natural (regenerated cellulose or wood pulp) or petroleum-based (plastic) materials, including polyester and polypropylene. </p>
<p>Most wet wipes are a mixture of natural and synthetic fibres – and the majority contain plastic. As well as the fibres, wet wipes also contain chemicals, including cleaning or disinfecting agents which are impregnated into the material. </p>
<figure class="align-center ">
<img alt="Wet wipes, disinfecting wipes." src="https://images.theconversation.com/files/519793/original/file-20230406-440-1breg8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/519793/original/file-20230406-440-1breg8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=312&fit=crop&dpr=1 600w, https://images.theconversation.com/files/519793/original/file-20230406-440-1breg8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=312&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/519793/original/file-20230406-440-1breg8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=312&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/519793/original/file-20230406-440-1breg8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=392&fit=crop&dpr=1 754w, https://images.theconversation.com/files/519793/original/file-20230406-440-1breg8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=392&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/519793/original/file-20230406-440-1breg8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=392&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Wet wipes can cause a lot of issues for our sewerage system.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-vector/3d-mock-wet-wipes-pouch-pack-1928801144">JoyImage/Shutterstock</a></span>
</figcaption>
</figure>
<p>Some wipes are designed to be “flushable” and contain <a href="https://www.proquest.com/docview/2771905908/">chemical binding agents</a> that are designed to release the fibres of the wipe when they are exposed to water. This means that if wipes are not disposed of correctly, they can create both a plastic and a chemical hazard to the environment. </p>
<p>It’s well known that plastic breaks down extremely slowly and persists for centuries <a href="https://www.mdpi.com/1660-4601/19/20/13223">in landfill</a>. And if plastic-containing wipes are released into the environment – either through littering or via the sewerage system – they can pose a number of hazards. </p>
<h2>The plastic problem</h2>
<p>When wet wipes reach the environment – including soil, rivers and the ocean – they generate microplastic pollution in the form of microfibers. Microfibers are one of the most prevalent types of plastic pollution in the <a href="https://www.sciencedirect.com/science/article/abs/pii/S0025326X19300451">aquatic environment</a> and affect ecosystems as well as potentially human health through their introduction into the <a href="https://www.sciencedirect.com/science/article/abs/pii/S0048969720374039">food chain</a>. </p>
<p>The problem has been exacerbated by these “flushable” wipes. <a href="https://link.springer.com/article/10.1007/s11356-018-2400-9">One study</a> identified seven different types of plastics as potential components of flushable wipes – meaning that they still risk being a source of microplastic pollution. <a href="https://www.sciencedirect.com/science/article/pii/S0043135420305583">Recent work</a> has confirmed that wet wipes (along with sanitary products) are an underestimated source of white microfibers found in the marine environment. </p>
<p>Data on the environmental impact of the associated chemicals is lacking, but this is something <a href="https://www.bristol.ac.uk/people/person/Charlotte-Lloyd-49c92f3e-0f6e-482f-961d-3fe5a34fe6c3/">my research group</a> is currently working on. What is known though is that plastics have the ability to absorb other contaminants such as <a href="https://pubs.acs.org/doi/10.1021/acs.est.7b00635">metals</a> and <a href="https://www.sciencedirect.com/science/article/abs/pii/S0025326X10000366">pesticides</a> as well as <a href="https://portlandpress.com/emergtoplifesci/article-abstract/6/4/349/231918/Pathogens-transported-by-plastic-debris-does-this?redirectedFrom=fulltext">pathogens</a>. And this provides a way for pollution to be <a href="https://pubs.acs.org/doi/10.1021/acs.est.5b06069">transported</a> large distances through the environment. </p>
<figure class="align-center ">
<img alt="Flushable wipe going down the toilet." src="https://images.theconversation.com/files/519795/original/file-20230406-18-9lvw61.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/519795/original/file-20230406-18-9lvw61.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/519795/original/file-20230406-18-9lvw61.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/519795/original/file-20230406-18-9lvw61.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/519795/original/file-20230406-18-9lvw61.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/519795/original/file-20230406-18-9lvw61.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/519795/original/file-20230406-18-9lvw61.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">Are flushable wipes really flushable?</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/closeup-young-man-throwing-wet-wipe-1448959583">Shutterstock/nito</a></span>
</figcaption>
</figure>
<p>Driven by environmental concerns as well as impending legislation, many plastic-free wipe products are now available or being developed. But even products made from natural fibres can still pose a problem to sewerage systems and so safe disposal – in a bin – is key.</p>
<p>The scientific evidence surrounding the environmental effects of bio-based plastics (plastics made from non-petroleum sources such as corn or potato starch) is also lacking, so caution is needed when thinking about simply switching from petroleum-based to bio-based plastics. </p>
<p>With this in mind, reusable washable products are a great alternative to disposables and have a much smaller environmental footprint. They are particularly handy around the home when washing is convenient. </p>
<p>That said, there will remain a market for disposables, but manufacturers should have to clearly label what the wipes are made from so that consumers can make a more informed choice.</p><img src="https://counter.theconversation.com/content/203301/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Charlotte Lloyd receives research funding from The Royal Society and UKRI Natural Environmental Research Council. </span></em></p>It’s estimated that 1.63 million tons of material will be produced in 2023 for wet wipes.Charlotte Lloyd, Royal Society Dorothy Hodgkin Research Fellow and Lecturer in Environmental Chemistry, University of BristolLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2028722023-03-30T16:28:22Z2023-03-30T16:28:22ZSurrogacy shake up in UK would create uneven treatment for birth mothers<figure><img src="https://images.theconversation.com/files/518518/original/file-20230330-1068-4tislc.jpg?ixlib=rb-1.1.0&rect=39%2C39%2C4322%2C2857&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Proposed UK surrogacy law changes raise concerns over unequal treatment of birth mothers</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/close-pregnant-woman-holding-ultrasound-scan-132280757">Phil Jones/Shutterstock</a></span></figcaption></figure><p>Surrogacy, where a woman agrees to carry and give birth to a child for another person or couple to raise, is <a href="https://brilliantbeginnings.co.uk/new-data-family-court-350-percent-growth-surrogacy/">growing in popularity</a>. There aren’t any comprehensive figures on the number of cases (partly because some surrogacy arrangements are <a href="https://uk.practicallaw.thomsonreuters.com/8-560-0205?transitionType=Default&contextData=(sc.Default)">made informally</a>) but it’s clear it’s something more and more couples and individuals are considering.</p>
<p>In the UK, surrogacy laws go back to the 1980s – and are long overdue an update. This is why the Law Commission – which keeps the law under review and recommends reform where it’s needed – has proposed <a href="https://s3-eu-west-2.amazonaws.com/lawcom-prod-storage-11jsxou24uy7q/uploads/2023/03/3.-Surrogacy-draft-bill.pdf">changes to the law</a> that aim to make the process smoother and more secure for everyone involved. </p>
<p>Surrogacy laws vary from country to country, but <a href="https://www.legislation.gov.uk/ukpga/1985/49">under the law currently in the UK</a>, the woman who gives birth to a child is always the legal parent at first. However, under the new surrogacy bill, couples or individuals using a surrogate would be the child’s legal parents right from the moment of birth. This change would put UK surrogacy law out of line with UK adoption laws in a concerning way.</p>
<p>Currently, all women who give birth in the UK have the same default rights to the child. This is regardless of whether they’re planning to give the child up for adoption or surrogacy – and whether they’ve used their own egg, a donor’s, or the would-be mother’s egg. But the new bill would create a disparity in how we treat birth mothers in surrogacy cases. </p>
<h2>Here’s why</h2>
<p>Under the current system, the so-called intending parents – the ones using a surrogate to have a baby – apply for what’s known as a parental order six weeks after the child’s birth. This transfers legal parenthood from the surrogate (and her husband or civil partner, if she has one) to the intended parents. </p>
<p>This process can be lengthy: on average it’s around six months, but it can take up to a year <a href="https://www.independent.co.uk/news/uk/home-news/surrogacy-laws-uk-criticism-babies-health-risk-b2233078.html">in some cases</a>. And during this time, the surrogate remains the legal mother – which can cause issues in medical emergencies.</p>
<figure class="align-center ">
<img alt="Couple receiving ultrasound picture from surrogate expectant mother." src="https://images.theconversation.com/files/518514/original/file-20230330-26-tkkbre.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/518514/original/file-20230330-26-tkkbre.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/518514/original/file-20230330-26-tkkbre.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/518514/original/file-20230330-26-tkkbre.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/518514/original/file-20230330-26-tkkbre.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/518514/original/file-20230330-26-tkkbre.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/518514/original/file-20230330-26-tkkbre.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">Surrogacy law changes in UK could deliver an uneven playing field for birth mothers.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/happy-married-couple-receiving-ultrasound-picture-1095110102">Olena Yakobchuk/Shutterstock</a></span>
</figcaption>
</figure>
<p>Under the proposed new system the need for a parental order is scrapped: the intending parents would have legal parental rights from the moment the child is born. If the surrogate changes her mind and wants to keep the baby, she would have up to six weeks after the birth to apply for a parental order herself. But the intending parents would still retain the legal status they gained when the child was born. </p>
<p>In such a case, the courts would then have to determine whether the intending parents should keep the child, or if the surrogate should be given parental status - so, the reverse of what the UK has at the moment. </p>
<h2>Adoption v surrogacy</h2>
<p>Pre-birth adoption contracts are illegal in the UK – and in fact, across most of the world. Even when a pregnant woman firmly intends to give up the child for adoption, she can only legally consent to this <a href="https://www.legislation.gov.uk/ukpga/2002/38/section/52/enacted?view=plain">six weeks</a> after the birth – just like surrogates under the current law. </p>
<p>The six-week period is an <a href="https://rm.coe.int/1680084823">international standard</a> which is meant to make sure that the birth mother’s consent to adoption is freely given. This allows some time to recover from childbirth and conditions like post-partum depression, which might make the decision more difficult. </p>
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<iframe width="440" height="260" src="https://www.youtube.com/embed/Rop3QyKh90k?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
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<p>Birth parents have a right to change their minds about adoption and legally this trumps the <a href="https://www.todaysparent.com/family/our-long-road-to-adoption/">grief and disappointment</a> prospective adoptive parents feel at being told the birth mother has decided to keep the baby. But in contrast, the new surrogacy proposals could make it harder for surrogate mothers who no longer want to give up their baby.</p>
<p>It seems that <a href="https://s3-eu-west-2.amazonaws.com/lawcom-prod-storage-11jsxou24uy7q/uploads/2019/06/Surrogacy-consultation-paper.pdf">very few</a> surrogates change their mind and want to keep the child. The same is true in adoption, where only a <a href="https://helpinggrowfamilies.com/can-a-birth-mother-change-her-mind-we-find-out/">small percentage</a> of women change their minds after giving birth. But their right to do so is fundamentally protected in both instances - for now. Under the proposed changes this may not still be the case. </p>
<h2>‘It’s not the same’</h2>
<p>A major difference between adoption and surrogacy is that in surrogacy, one or both of the intending parents are related to the child genetically. But it doesn’t make sense from an ethical perspective to think that this should change the legal rights of the birth mother. </p>
<p>Indeed, <a href="https://www.gov.uk/legal-rights-for-egg-and-sperm-donors#:%7E:text=Egg%20donors,when%20using%20a%20donated%20egg.">as it currently stands</a> if you give birth to a child, you’re always considered the legal mother in UK law – even when using a donated egg. The new proposals would change this blanket rule to make an exception in the case of surrogacy. </p>
<p>But if childbirth is an important enough connection to keep these default rights in the case of adoption, then why not in surrogacy? And if people who sign up to adopt a child accept the risk that a pregnant woman might change her mind about keeping the baby, why not in surrogacy?</p>
<p>Turning parenthood into a contractual agreement may seem like a common-sense fix to surrogacy dilemmas. But if surrogacy is made to be more about contracts, it might lead to risky situations with surrogates treated unfairly. And ethically, surely all birth mothers should have the same legal protection, regardless of their plans after the baby is born.</p><img src="https://counter.theconversation.com/content/202872/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Teresa Baron 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>UK surrogacy law reform: what you need to know about the proposed changes and how they could affect you.Teresa Baron, Nottingham Research Fellow in the Department of Philosophy, University of NottinghamLicensed 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.