Welcome to our New Year’s News Letter January 2017
MORE COHESIVE FAMILIES
Two decades after a group of Colombian parents were shown how to keep their perilously tiny babies warm and nourished through breastfeeding and continuous skin-to-skin contact, a new ground breaking study finds that as young adults their children continue to benefit from having undergone the technique known as Kangaroo Mother Care.
In young adulthood, they are less prone to aggressive, impulsive and hyper-active behaviour compared to a control group of premature and low birth weight contemporaries who received “traditional” inpatient incubator care. They are gmore likely to have survived into their 20s. Their families are more cohesive and their brains are larger.
Supported by the Government of Canada through Grand Challenges Canada’s “Saving Brains” program, as well as Colombia’s Administrative Department of Science, Technology and Innovation (COLCIENCIAS), the study is published in the journal Pediatrics.
“This study indicates that Kangaroo Mother Care has significant, long-lasting social and behavioural protective effects 20 years after the intervention,” says lead researcher Dr. Nathalie Charpak, of the Kangaroo Foundation in Bogotá.
The technique’s early impact was still present 20 years later for those who started life as the most fragile individuals, she says. Families trained in Kangaroo Mother Care were more likely to remain together and to be more protective and nurturing, reflected in their children’s lower school absenteeism, ability to express feelings, and reduced hyperactivity, aggressiveness and antisocial conduct as young adults.
“A premature infant is born somewhere in the world every two seconds,” says Dr. Peter A. Singer, Chief Executive Officer of Grand Challenges Canada. “This study shows that Kangaroo Mother Care gives premature and low birth weight babies a better chance of thriving. Kangaroo Mother Care saves brains and makes premature and low birth weight babies healthier and wealthier.”
KANGAROO MOTHER CARE FOR TRAUMATISED BABIES?
About 15 million premature infants are born each year, according to the World Health Organization. Preterm birth complications are the leading cause of death among children under 5, responsible for nearly 1 million deaths in 2015; many survivors face a lifetime of disability, including learning disabilities and visual and hearing problems.
Premature and low birth weight infants generally require extra care to avoid illness and death from secondary, preventable complications such as hypothermia and infection. This is a particular problem in developing countries, where incubators and similar technologies are often scarce, overcrowded or unreliable, as well as costly.
A trained Kangaroo Mother Care parent or caregiver becomes a child’s incubator and its main source of food and stimulation. The technique involves continuous skin-to-skin contact between caregiver and infant, with the baby nested in a “kangaroo” position on the caregiver’s chest as soon as possible after birth. The technique is accompanied by exclusive breastfeeding.
Kangaroo Mother Care also requires and prepares the mother and child to go home as soon as possible from the hospital, after which there is rigorous monitoring of baby and mother until the infant reaches one year of corrected age (the baby’s age based on due date rather than date of birth). Family solidarity around the frail child is a key element in the success of the Kangaroo Mother Care technique.
REVISITING KANGAROO MOTHER CARE 20 YEARS ON
The Kangaroo Foundation research compared 18 to 20 year olds who, as premature and low birth weight infants, had been randomized at birth to receive either Kangaroo Mother Care (KMC) or traditional incubator care until they could maintain their own body temperature.
During that initial randomized control trial in 1993-96, researchers documented the short and mid-term benefits of KMC training on the infants’ survival, brain development, breastfeeding and the quality of mother-infant bonding.
In 2012-2014, 264 of the original participants who weighed less than 1800 grams at birth were re-enrolled (61% of infants that qualified).
Looking at mortality, the research found that KMC offered significant protection against early death. The mortality rate in the control group (7.7 percent) was more than double that of the KMC group (3.5 percent).
Among other results of the study:
School: The KMC group spent about 23 percent more time in preschool and had less than half the rate of school absenteeism compared to the control group.
Work: As young workers, their average hourly wages were almost 53 percent higher.
Family: A higher percentage of KMC children (almost 22 percent) grew up living with both parents. The families of KMC children were found to be more stimulating, protective, and dedicated to their children compared to the families in the control group.
Behaviour: Scores for aggressiveness and hyperactivity were 16 percent lower in the KMC group, particularly among less-educated mothers. Scores for externalization (the ability to express feelings, especially negative feelings), a trait associated with risk of juvenile delinquency, academic failure, and inadequate social adjustment, were 20 percent lower in the KMC group on average.
The parents of KMC children also reported that their children exhibited less antisocial behaviour compared to the reports of the parents of the counter-parts in the control group.
Cerebral development: Compared with those in the control group, KMC participants had larger brains — significantly larger volumes of total grey matter, cerebral cortex, and left caudate nucleus, which plays a vital role in how the brain learns, specifically related to the storing and processing of memories.
Overall IQ: Tests after 20 years show a small but significant (3.6 percent) advantage in overall intelligence (IQ) for the most fragile KMC babies (those with an abnormal or transient neurological exam at 6 months) compared to similar infants in the control group.
THE WORLD NEEDS KANGAROO MOTHER CARE FOR ALL BABIES
Dr. Charpak notes that as neonatal technology becomes more accessible throughout the world, more premature and low birth weight infants are saved with fewer serious consequences in later years.
“That is why the detection of ‘minor’ consequences in early life becomes important,” she says. “Minor effects like mild cognitive deficits, lack of fine coordination, poor hearing or eyesight and attention deficit can often go undetected but have a profound effect on the lives of families.
“The findings of our 20-year KMC study should inform the modalities of medical, psychological and social postnatal interventions such as Kangaroo Mother Care so that we can continue to reduce the disorders caused by prematurity and low birth weight.”
Dr. Charpak says that this new knowledge must be used to extend KMC coverage to the 18 million premature and low birth weight infants born each year who are candidates for the technique.
“We firmly believe that this is a powerful, efficient, scientifically based health care intervention that can be used in all settings, from those with very restricted to unrestricted access to health care,” she says.
“This study demonstrates that Kangaroo Mother Care can make all the difference in the world for premature and low birth weight infants,”
So says Dr. Karlee Silver, Vice President Programs at Grand Challenges Canada. “Kangaroo Mother Care is a cost-effective, modern method of care that can and should be applied in every country.”
SKIN-TO-SKIN CONTACT FOR TRAUMATISED BABIES
Physical contact with babies is essential for their physical and psychological development. This lesson has been learned the hard way, as infants neglected in hospitals and orphanages developed many problems, ranging from depression to a more global failure to thrive. But, what types of contact are necessary and what are the beneficial effects of enriching physical contact?
In a new study, Dr. Ruth Feldman, a Professor at Bar-Ilan University, and her colleagues studied the impact of different levels of physical contact on prematurely born infants.
“In this decade-long study, we show for the first time that providing maternal-newborn skin-to-skin contact to premature infants in the neonatal period improves children’s functioning ten years later in systems shown to be sensitive to early maternal deprivation in animal research,” said Feldman.
Specifically, the researchers compared standard incubator care to a novel intervention called “Kangaroo Care” (KC), which was originally developed to manage the risk for hypothermia in prematurely born babies in Colum-bia, where they struggled with a lack of access to incubators. This method, in essence, uses the mother’s body heat to keep their babies warm.
They asked 73 mothers to provide skin-to-skin contact (KC) to their premature infants in the neonatal unit for one hour daily for 14 consecutive days. For comparison, the researchers also assessed 73 premature infants who received standard incubator care. Children were then followed seven times across the first ten years of life.
They found that during the first half-year of life, mothers in the KC group were more sensitive and expressed more maternal behavior toward their infants. Children in the KC group showed better cognitive skills and executive abilities in repeated testing from six months to ten years.
At ten years of age, children who received maternal contact as infants showed more organized sleep, better neuroendocrine response to stress, more mature functioning of the autonomic nervous system, and better cognitive control.
“This study reminds us once again of the profound long-term consequences of maternal contact,” commented Dr. John Krystal, Editor of Biological Psychiatry. “The enhanced level of stimulation provided by this contact seems to positively influence the development of the brain and to deepen the relationship between mother and child.”
Premature birth is a major health concern worldwide, with approximately 12% of infants born prematurely in industrial societies and significantly more in developing countries.
While modern medicine has substantially increased the number of surviving premature infants, many suffer long-term cognitive difficulties and problems in neurobiological systems that support stress regulation and the organization of arousal and attention.
Feldman highlights that “Kangaroo Care is an easy-to-apply intervention with minimal cost and its multi-dimensional long-term impact on child development calls to integrate this intervention in the care-practices of premature infants across the world.”
Reference:Ruth Feldman, Zehava Rosenthal, Arthur I. Eidelman. Maternal-Preterm Skin-to-Skin Contact Enhances Child Physiologic Organization and Cognitive Control Across the First 10 Years of Life. Biological Psychiatry
CHILDREN MORE PRONE TO UNHAPPY LIFESTYLES
According to researchers at King’s College London a simple 45 minute test at the age of three can help predict those children who are more likely to have difficulties and suffer more in later adult life.
That a variety of elementary observations on language abilities, motor skills, frustration levels and impulsiveness can determine which children are more likely to fall within a 26 per cent adult category more likely to smoke, take prescription drugs and find dissatisfaction in their work and home life and suffer from obesity.
These findings are controversial because they indicate patterns affecting lifestyles can be set in the early months and years. Although we know this to be true (1001 critical days) it only shows that those infants identified are more prone to being affected not necessarily that they will be, in later adult life.
Nonetheless knowing this can be the case is an early initiative to help identify children more prone to unhappy lifestyles and present a window of opportunity in early childhood to help turn this around.
Professor Terrie Moffitt, of King’s College and Duke University in North Carolina, US, said: ‘About 20 per cent of adults use the most in public services including the NHS, criminal courts, claims for disabling injury, pharmaceutical prescriptions and social welfare benefits.
Looking back into the childhoods of the people within our study, we find that this 20 per cent began their lives with mild problems of brain function and brain health when they were very young children, around three years of age.
Our results show that children with lower brain function at the age of three were 38 per cent more likely to claim benefits their chances of being a smoker were 25 per cent higher and they were 15 per cent more likely to end up obese.
This was based on four key tests, including the Peabody picture vocabulary test, which asks children to name images, and the Reynell test of speech, asking them to describe pictures in more depth
The children’s motor skills were also checked by asking them to walk in a straight line or stand on one leg and crucially, during these tests these children were monitored for how well they managed their emotions during stressful tasks, including their frustration, restlessness, impulsivity and persistence.
Explaining the results, co-author Professor Avshalom Caspi, of King’s College and Duke’s University, said: ‘Essentially these children were functioning like a two-and-a-half-year-old’s not three year olds, they were six months behind’.
It’s considered that these early difficulties can have a snowballing effect and for those affected the ability to master new skills is more difficult which can limit their opportunities making their life more of an uphill battle.
The first 1001 days is the time during which initiatives can be instigated that will make the most difference in terms of not only the lives of the children themselves but also overall benefits to social resources.
Knowing this, perhaps this is something that should be given more consideration. And to regard those affected by infant trauma in later adult life with compassion rather than blame for needing government support.
However much transformation occurs in later development the infant mother/father/caregiver attachment relationship is the core around which all other experience is structured.
Sroufe et al 2005
The feeling that binds us to each other is reinforced by touch and learnt from our mother/father/caregiver from birth. All children learn the patterning of relating and dyadic emotion regulation through experience, learning, by virtue of their early relationships, that when one person is needy the other responds.
During the first six months of a baby’s life, just picking up a crying baby promptly, is associated with four major outcomes before the end of the first year of that baby’s life.
• First, the baby will cry less.
• Second, the baby will have learnt to self soothe.
• Third, when needing to be soothed the baby responds more promptly to the caregiver.
• Fourth, the caregiver who has responded promptly and warmly most of the time to their baby’s cry’s, will have created an organised and secure attachment with all it’s benefits.
Some Benefits to the Child
Children with secure histories who are effectively dependent become infants who are effectively independent.
• Become ego resilient and respond flexibly to frustrating and challenging requirements
Sroufe et al ‘83
• Grow to believe they can successfully influence their world.
• Do not seek teacher attendance
• Show less dependency on adults
• Are more empathetic
Sroufe and Fleeson ‘86
• Are less likely to become frightened or frightening caregivers
• Abide more by the rules of gender peer groups
• Exhibit higher social confidence Bowlby
• More active participants in peer groups and less frequently isolated
• Fare well in situations of novelty, high stimulation, object mastery and cognitive challenge
• Higher on empathy with deeper more mutual relationships
• Security of attachment related to the emotional tone of adult romantic relationships
• Are more goal directed and achievement oriented
Oppenheim, Sagi and Lamb ‘88
• Are more resistant to stress
Pianta Egeland and Sroufe 90
• Show faster recovery following behavioural difficulties
• Infants who are securely attached have a history of more sensitive and cooperative interactions
• Secure attachment nurtures
• Use positive affect to sustain and build peer interactions
Sroufe et al 2005
• Have more positive expectations regarding relationships with others
FOR ‘IN-HOUSE’ BABY MASSAGE TEACHER TRAININGS
Online Clinic for Mothers with Babies with
Developmental Delay using Skype and Face/Time
2017 – BREATHE OUT FOR PEACE
Editor Peter Walker 2017