Babies use expectations about what they perceive to shape their brains

A study show that infants can use what they perceive and their expectations about what they perceive to develop their brains.

Infants can use their expectations about the world to rapidly shape their developing brains, researchers have found.

A series of experiments with infants ages 5 to 7 months has shown that portions of babies' brains responsible for visual processing respond not just to the presence of visual stimuli, but also to the mere expectation of visual stimuli, according to the researchers from Princeton University, the University of Rochester and the University of South Carolina.

That type of sophisticated neural processing was once thought to happen only in adults and not infants, whose brains are still developing important neural connections.

"We show that in situations of learning and situations of expectations, babies are in fact able to really quickly use their experience to shift the ways different areas of their brain respond to the environment," said Lauren Emberson, one of the researchers, who will join the Princeton faculty Sept. 1 as an assistant professor of psychology. She comes to Princeton from the University of Rochester, where she is a postdoctoral associate.

The research is described in the article, "Top-down modulation in the infant brain: Learning-induced expectations rapidly affect the sensory cortex at 6 months," published online June 20 in the Proceedings of the National Academy of Sciences. The other authors are John Richards of the University of South Carolina and Richard Aslin of the University of Rochester.

The researchers exposed one group of infants to a pattern that included a sound -- like a honk from a clown horn or a rattle -- followed by an image of a red cartoon smiley face. Another group saw and heard the same things, but without any pattern.

The researchers used functional near-infrared spectroscopy, a technology that measures oxygenation in regions of the brain using light, to assess brain activity as the infants were exposed to the sounds and images.

After exposing the infants to the sounds and images for a little over a minute, the researchers began omitting the image. For the infants who had been exposed to the pattern, brain activity was detected in the visual areas of the brain even when the image didn't appear as expected.

"We find that the visual areas of the infant brain respond both when they see things, which we knew, but also when they expect to see things but don't," Emberson said.

The finding could help shed light on the mysteries of neural development, the researchers said.

"Part of the reason I wanted to establish this type of phenomenon in infants is because I think it's a really good candidate mechanism for how infants are using their experiences to develop their brains," Emberson said. "There's a lot of work that shows babies do use their experiences to develop. That's sort of intuitive, especially if you're a parent, but we have no idea how the brain is actually using the experiences."

The findings offer insights that can shape future research in the area, said Janet Werker, a professor and Canada research chair in the Department of Psychology at the University of British Columbia who studies the roots of language acquisition.

"Most exciting to me is the evidence this work provides that from very early in infancy, the cortex is able to set up expectations about incoming events," said Werker, who was not involved in the research. "This shows that infants not only learn about their external worlds, but are ready -- from very early in life -- to make predictions about the co-occurrence of events on the basis of very brief previous experience. This work thus has the potential to transform future research on infant learning to focus not on just what infants can learn, but to look at learning as a more active process, focusing more on how learning begets subsequent learning."

Emberson is continuing to explore the topic by examining the phenomenon in infants who are at risk for poor developmental outcomes, specifically those who were born prematurely. She also is examining whether infants' visual expectations boost their visual abilities.

The research was primarily funded by the National Institutes of Child Health and Development.

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Above average vision may be an early sign of autism

Research shows that above average vision as early as nine months old could be indicative of autism.

Exceptional visual perception might be an early hallmark of autism, which could help predict a child will be diagnosed with the developmental disability, a new British study suggests.

Infants who more quickly perceived a mismatched symbol on a screen when they were 9 months old were more likely to receive an autism diagnosis by age 2, the researchers found.

"Although atypical perception, such as better visual search and hypersensitivity to sounds, are common in autism, they were rarely considered as a core feature in early development," said study lead author Teodora Gliga of Birkbeck Babylab at the University of London. "Our finding is therefore striking since it strongly suggests atypical perception may be a driving force of later poor social interaction and communication symptoms."

Most autism research to date has focused on difficulties children have with social interactions, behavior and communication, such as poor eye contact, the authors noted in their study. Focusing on above-average perceptual skills is a new direction to research.

These findings might also help clinicians eventually make diagnoses earlier since most children cannot receive a full clinical assessment until they are 2 or 3 years old, said study co-author Rachael Bedford, a postdoctoral researcher in psychiatry, psychology and neuroscience at King's College London.

"It is difficult to know whether early impairments, such as communication difficulties, are specific to autism development, or might actually relate to a range of different developmental disorders," Bedford said. "Our finding that infants' superior perceptual abilities relate to autism might offer a more selective target for screening."

This is the first time an enhanced early ability relates to early autism symptoms, she added.

The findings were published June 11 in the journal Cell Press.

It's estimated that one in 68 U.S. children has an autism spectrum disorder. While there is no cure, early identification and services can improve a child's development, according to the U.S. Centers for Disease Control and Prevention.

For the experiment, the researchers presented 109 infants with a screen showing a circle of Xs along with either an O, S, V or + sign as part of the circle. Then they used eye-tracking technology to time how quickly the odd letter out drew the infants' attention at 9 months of age.

The infants also underwent standard assessments for autism symptoms at 9 months, 15 months and 2 years. Of the full group, 82 were at high risk for autism because an older sibling had been diagnosed with it. The other 27 children were at low risk.

By the time they turned 2 years old, 20 percent of the at-risk children had been diagnosed with autism, and another 30 percent showed several increased symptoms of autism, the researchers said.

When the researchers compared the children's speed at noticing the letter that did not match the Xs, they found that children who saw it the fastest at 9 months old had more autism symptoms at 15 months and 2 years old.

"People with autism have both difficulties and strengths compared to the rest of us," Gliga said. "We know some of the difficulties can be detected fairly early in life, but this study shows that unusual strengths can also be seen in infants."

This doesn't mean that every eagle-eyed infant will develop autism. While the study shows an association between a superior visual skill and later autism, it cannot show that children with exceptional visual perception will definitely develop autism, cautioned Dr. Glen Elliott, chief psychiatrist and medical director of Children's Health Council in Palo Alto, Calif.

"It is far too early to tell whether this methodology will lead to earlier diagnosis of children at risk for development of autism," said Elliott, who was not part of the research. "The sample size is too small and too narrow to permit generalizations about the utility of the technique, and much more information is needed for a diagnosis of autism spectrum disorder."

That additional information reduces the chance that someone with autism is missed or that someone without autism is incorrectly diagnosed with it. At the same time, he added, this method is simple and noninvasive, making it valuable if the findings hold up in future studies and in the real world.

"This discovery potentially allows us to design future therapies around these infants' strengths in order to enhance the later quality of life for individuals with the condition," Gliga said.

The study was funded by Britain's Medical Research Council.

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Study: A mother's presence soothes infants' brains

A study shows that a mother's presence and care can make an infant's pain go away and changes the infant's brain activity.

A mother's "TLC" not only can help soothe pain in infants, but it may also impact early brain development by altering gene activity in a part of the brain involved in emotions, according to new study from NYU Langone Medical Center.

By carefully analyzing what genes were active in infant rat brains when the mother was present or not present, the NYU researchers found that several hundred genes were more, or less, active in rat infants experiencing pain than in those that were not. With their mothers present, however, fewer than 100 genes were similarly expressed.

According to senior study investigator and neurobiologist Regina Sullivan, PhD, who is scheduled to present her team's findings at the Society for Neuroscience annual meeting in Washington, D.C., on Nov. 18, the research is believed to be the first to show the short-term effects of maternal caregiving in a distressed infant pup's brain. The study was also designed to support her research into the long-term consequences of differences in how mammals, including humans, are nurtured from birth.

"Our study shows that a mother comforting her infant in pain does not just elicit a behavioral response, but also the comforting itself modifies -- for better or worse -- critical neural circuitry during early brain development," says Sullivan, a professor at the NYU School of Medicine and its affiliated Nathan S. Kline Institute for Psychiatric Research.

For the study, researchers performed genetic analyses on tissue from the almond-sized amygdala region of the infant rat pups' brains that is responsible for processing emotions, such as fear and pleasure.

Sullivan, whose earlier research showed how the mother's presence controlled electrical signaling in the infant pup's brain, says her latest findings shed insight on the complexity of treating pain in newborns.

"Nobody wants to see an infant suffer, in rats or any other species," says Sullivan. "But if opiate drugs are too dangerous to use in human infants because of their addictive properties, then the challenge remains for researchers to find alternative environmental stimuli, including maternal presence, coddling, or other cues, such as a mother's scent, that could relieve the pain."

Sullivan cautions, however, that the long-term consequences of these genetic modifications must also be compared to the short-term benefits for tying pain stimuli during infancy to such a powerful symbol of safety and security as the infant's mother.

"The more we learn about nurturing the infant brain during infancy, the better prepared we are to deal long-term with treating problems that arise from pain, and physical and mental abuse experienced during infancy," says Sullivan.

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Safe sleep for infants

This article discusses Sudden Infant Death Syndrome (SIDS) and how to keep an infant's sleep safe.

The number of infants who die each year from sudden infant death syndrome (SIDS) has decreased in recent decades as awareness of safe sleeping habits has increased. Yet each year, babies still die from sudden, unexplained causes.

Most parents know that it's best for infants to sleep on their backs, rather than on their sides or bellies. But other caregivers may not -- especially if they raised their children in a time when there was less awareness about safe sleeping habits.

Leigh Brown, a health educator at Penn State Hershey Children's Hospital's Pediatric Trauma Injury Prevention Program, said a baby's sleeping environment during the first year of life is one of the biggest factors in SIDS deaths.

"It's confusing for parents because in the media you see these cribs that look all cute and soft and comfortable, when all you really need is a mattress with a tight-fitting sheet," she said.

Items such as crib bumpers, extra bedding, stuffed animals and loose sheets and blankets can cause suffocation for infants who aren't yet able to roll or extract themselves from dangerous situations.

"People have the misconception that babies are freezing, but overheating them is a risk factor as well," Brown said. "If you are comfortable in your house, they probably are as well."

If you must use a blanket with an infant, she suggests tucking it in tightly along the sides and bottom of the crib and no higher than the infant's armpit so it doesn't get near the face.

Brown says parents shouldn't bother to spend their money on items such as sleep positioners, which claim to reduce the risk of SIDS or create a safe environment.

"Those items haven't proven to be safe," she said.

Nor do parents need to worry about the infant rolling from back to side or belly during sleep. If the child is able to roll, he or she is likely able to avoid suffocation.

Many SIDS deaths occur when parents practice bed sharing -- placing the baby between the parents in a regular bed. If parents want their baby to be nearby, it's best to practice room sharing instead by placing the baby in a separate crib or cradle near but not in the adult bed.

Mothers who tend to drift off to sleep while breastfeeding their babies run the risk of having their babies wedge into the crevice of their arm and suffocate.

Exposure to secondhand smoke on an adult's clothing or in the home environment can also increase the chances of a SIDS death.

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Caffeine therapy, preemies, and sleep trouble

A study found that preemies are at risk for having sleep issues and sleep disorders later in life, regardless of any caffeine therapy they may have had in the NICU.

Using caffeine to treat premature newborns for apnea - dangerous pauses in breathing during sleep - does not have long-term harmful effects on their sleep or breathing patterns, according to research led by Children's Hospital of Philadelphia. 

But the new study also found that prematurity itself is a risk factor for sleep disorders years later. Children born preterm had high rates of obstructive sleep apnea and periodic limb movement during sleep, whether or not they had caffeine therapy in the neonatal intensive care unit.

The very idea of caffeinating fragile preemies may sound misguided. But eight years ago, an international study that compared the stimulant to a placebo found it had benefits, including relieving sleep apnea.

Still, there were lingering concerns. Caffeine works in the brain, blocking a molecule that promotes sleep. Animal studies suggest that such early biochemical tinkering can lead to permanent sleep and breathing abnormalities.

"I think we all know from daily life the effect that caffeine has on us," said lead author Carole L. Marcus, a pediatric pulmonologist and director of the sleep center at Children's Hospital. "We give the equivalent of six cups of coffee a day for a week or more - and these are little babies whose brains are still developing."

The new study, published Friday in the American Journal of Respiratory and Critical Care Medicine, tracked down 201 of the original 2006 premature babies, now ages 5 to 12. Half had gotten caffeine therapy, the other half a placebo.

For two weeks, the children wore a noninvasive sensor at night to monitor their sleep. The parents also filled out questionnaires.

There were no differences in the children's sleep patterns, including how long they took to fall asleep and how soundly they slept.

But both caffeine and placebo groups had high rates of sleep disorders. Overall, about 10 percent had periodic limb movement disorder (episodes of involuntary movement, usually of the legs), and 14 percent had obstructive sleep apnea. In general, less than 4 percent of school-age children have apnea, and 5 percent to 8 percent have the limb movement disorder.

Obstructive sleep apnea is different from the apnea of prematurity. In the obstructive form, the throat airway collapses or becomes blocked. In preemies, breathing stops because their immature nervous systems cannot yet enable continuous respiration.

Obstructive apnea can lead to daytime sleepiness, learning problems, high blood pressure, and heart disease. Limb movement disorder is less understood but has been linked to attention deficit hyperactivity disorder and a serious sleep problem called restless leg syndrome.

If caffeine isn't a culprit, why are sleep disorders common in former premature babies?

One possibility, the researchers noted, is enlarged tonsils. About a quarter of the children had already undergone tonsillectomies, the primary treatment for childhood obstructive sleep apnea.

"We're thinking the rate of apnea would have been even higher if not for the tonsillectomies," Marcus said.

The limb movement may be related, at least partly, to iron deficiency. Low blood iron levels were found in the children with the movement disorder who underwent testing.

All the children with apnea or limb movement disorder were referred for more testing and treatment, but most former preemies are not even checked for such problems. The study suggests that should change.

"We should be screening these children," Marcus said. "Then we could prevent problems, or treat them earlier."

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Breastfeeding while taking epilepsy medication does not harm infant

Brain development of breastfed infants is not harmed by the mother taking epilepsy medications.

Taking epilepsy drugs while breast-feeding does not appear to harm the developing brains of young children, a new study finds.

There have been concerns that using epilepsy drugs while breast-feeding could pose a threat to youngsters because it's been shown that some epilepsy drugs can cause cell death in young animals' brains.

And in spite of the fact that epilepsy experts recommend breast-feeding, "it is still a sensitive topic among women with epilepsy," noted one expert, Dr. Patricia Dugan, assistant professor of neurology at the Comprehensive Epilepsy Center at NYU Langone Medical Center, New York City.

"Despite reassuring published data, such as this article, patients frequently tell us that they receive contradictory advice from their obstetricians and pediatricians, resulting in a significant amount of distress for the mother," said Dugan, who was not connected to the new research. "Hopefully, papers such as these will encourage everyone involved in the care of women with epilepsy to promote breast-feeding," she said.

The new study included 181 children of mothers who had epilepsy and took drugs to control the condition. Nearly 43 percent of the children were breast-fed for an average of seven months.

IQ tests conducted on the children when they were 6 years old found no differences between those who were breast-fed and those who were not, according to the study published online June 16 in JAMA Pediatrics.

"Our study does not provide a final answer, but we recommend breast-feeding to mothers with epilepsy, informing them of the strength of evidence for risks and benefits," wrote a team led by Dr. Kimford Meador, of Stanford University in California

Another expert said the study offers valuable information.

"The authors controlled for many of the factors that might influence the intellectual outcome of this large number of children," noted Dr. Ian Holzman, chief of the division of newborn medicine at the Kravis Children's Hospital at Mount Sinai in New York City.

"By following these children through age 6, they were able to present information relevant to the important issue of school performance," he said. "This study allows us to counsel mothers who are planning to breast-feed that there doesn't seem to be any harm [in taking epilepsy medications]."

Dugan said the study also hinted at other benefits for breast-fed children.

"It also showed that testing of breast-fed children at 6 years old -- an age when more meticulous testing can be performed -- reflected beneficial effects of breast-feeding, with higher IQ and better verbal abilities than nonbreast-fed children," she said.

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Snoring in Children

This article discusses what is important to know about snoring in children.

Snoring in children is a common event, with estimates placing it at about 12 to 15 percent. Most of these children are healthy, show no symptoms and have primary snoring. Snoring happens during sleep due to a blockage of air when breathing as it passes through the back of the mouth. The loudness is affected by how much air passes through and how fast the throat tissue is vibrating. Snoring can be due to an upper respiratory infection, allergies, or it can be a sign of obstructive sleep apnea (OSA).

Infants and toddlers spend over half of their lives sleeping and, by adolescence, greater than on third of our lives are spent sleeping. Quality sleep is essential for proper development and daily functioning. Proper sleep helps with learning, consolidating memories, physical growth, recharging the body and helping our bodies fight infections.

Approximately 2 to 3 percent of children have OSA, which occurs when the posterior air collapses and blocks the throat. Frequent pauses in breathing, lasting from several seconds to a minute, often lead to the brain briefly waking up and causing us to breathe. This leads to gasping or snorting, waking us up and re-breathing. This can occur all through out the night.

Interrupted sleep can lead to behavioral issues, problems with social function, poor school performance and poor growth. These children are also more likely to be hyperactive and have trouble paying attention in school, mimicking signs of attention-deficit hyperactivity disorder (ADHD).

Studies also show that children with OSA are at risk of developing heart and lung problems which can lead to serious consequences later in life if it goes undetected. Untreated OSA, in the short term, often leads to daytime sleepiness, morning headaches, irritability, bed wetting and mouth breathing. The risk of apnea is higher in overweight children.

Other signs might include large tonsils and/or adenoids with frequent mouth breathing, restless sleep or sleep in abnormal positions, sleep in elevated position or with neck extended, excessive sweating during sleep, nasal speech, poor weight gain or being overweight, and high blood pressure. Even primary snoring (i.e. snoring without breathing pauses, frequent arousals, or drips in oxygen levels), which was once thought to be normal, still can lead to problems in school performance or behavior issues.

If you suspect your child may have symptoms of OSA don’t assume his or her snoring will go away on its own. Talk to your child’s doctor. The American Academy of Pediatrics has recognized this as a serious problem and has published recent guidelines for screening of obstructive sleep apnea, which will help doctors recognize, diagnose, and treat children with OSA.

Testing can be done if your child is suspected of having OSA, including an overnight sleep study. You may also videotape your child’s sleep to bring to the doctor for review. Night-time pulse oximetry to measure oxygen levels is also a useful tool. Your doctor may refer your child to a sleep specialist as well, as sometimes these tests are normal even when your child may still have OSA.

Once your child has been found to have obstructive sleep apnea syndrome, referral to doctors who specialize in treating OSA include pediatric otolaryngologists (ENT), pulmonologists and neurologists. Treatment options usually include removing enlarged tonsils and adenoids (T&A). Often removing the tonsils and adenoids stops the snoring and helps with improved appetite and growth in young children. It also improves academic performance and behavior in school-aged children as they get more uninterrupted, quality sleep. Other options include treating allergies or helping children lose weight. A night-time treatment called continuous positive airway pressure (CPAP) therapy is another option for children who can’t have surgery or have persistent OSA even after a T&A has been performed.

Remember to be suspicious that your child may have OSA if he or she regularly snores and has apnea, daytime sleepiness or school/behavior problems. If detected early, treatment of this problem may be reversible.

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Study shows that infants with autism divert gaze while people are speaking

A study claims that six month olds who have autism do not look at a person's face when the person is speaking.

From birth, infants naturally show a preference for human contact and interaction, including faces and voices. These basic predispositions to social stimuli are altered in individuals diagnosed with autism spectrum disorders (ASD). A new study now reports that 6-month-old infants later diagnosed with autism divert their gaze from facial features when that face is speaking.

A new study published in Biological Psychiatry this week, from researchers at the Yale University School of Medicine, now reports that 6-month-old infants later diagnosed with autism divert their gaze from facial features when that face is speaking.

One of the best methods to examine autism in very young infants is the use of eye-tracking. This technology uses advanced video monitoring and special software that tracks and 'maps' exactly where the eyes were focused and for how long.

Dr. Frederick Shic and his colleagues used this method to examine how 6-month-old infants looked at videos of still, smiling, and speaking faces. The infants were later assessed at 3 years of age and divided into groups based on based on their diagnosis of ASD, other developmental delays, or typical development.

Infants who later developed ASD not only looked at all faces less than other infants, but also, when shown a face that was speaking, looked away from key facial features such as the eyes and mouth.

"These results suggest that the presence of speech disrupts typical attentional processing of faces in those infants later diagnosed with ASD," said Shic. "This is the first study to isolate an atypical response to speech as a specific characteristic in the first half year after birth that is associated with later emerging ASD."

These findings indicate that infants who later develop ASD have difficulty maintaining attention to relevant social information as early as 6 months of age, a phenomenon that could reduce the quality of their social and communicative exchanges with others and, consequently, the trajectory of their social development.

Autism typically can't be diagnosed until at least two years of age, but this and other studies confirm that abnormalities in behavior and attention can be detected as early as 6 months of age.

"It seems clear that brain changes related to autism appear much earlier than we traditionally diagnose this disorder," commented Dr. John Krystal, Editor of Biological Psychiatry. "This study elegantly illustrates that autism-related disturbances in social relatedness are present very early in life, shaping one's most fundamental social contacts."

These affected infants may be experiencing an altered social experience at a critical developmental point. The hope is that this and further research can help clarify how and when the developmental trajectory is altered in children who develop autism and, potentially, develop targeted interventions that could normalize their developmental processes.

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Lack of eye contact in the first month of life may indicate autism

A study claims that certain signs of autism may be seen as early as the first month of life. Specifically, lack of eye contact at that age may indicate autism in a young child.

The first signs of autism may be visible as early as the first month of a child's life, according to a study published Wednesday in the scientific journal Nature.

"These are the earliest signs of autism ever observed," says lead study author Warren Jones.

Researchers at the Marcus Autism Center in Atlanta followed 110 children from birth to age 3, at which point a diagnosis of autism was ascertained. Fifty-nine babies were considered "high risk" for developing an autism spectrum disorder (ASD) because they had siblings with autism; 51 were considered "low risk" because they did not have first, second or third-degree relatives with ASD.

Data was collected at 2, 3, 4 ,5, 6, 9, 12, 15 and 24 months of age. Each time, the children watched videos showing actresses playing the role of a caregiver. "Every baby watched the same videos, and then we could measure what was different about the responses of infants later diagnosed with autism versus infants who were typically-developing," Jones says.

Lack of eye contact is one of the red flags when it comes to autism - a group of neurodevelopmental disorders that can cause significant social, communication and behavioral challenges.

Jones, who is the director of research at Marcus Autism Center and assistant professor in the Department of Pediatrics at Emory University School of Medicine, says he really expected the children later diagnosed with autism would have diminished eye contact from birth. Instead, he and his colleagues measures how much time each baby was looking at the eyes of the caregiver in the video.

"Basically from birth, (all) babies will look more at the eye part of faces," says Jones. But at about 4 to 6 weeks, he says the attention to eyes decreases, then in typical babies picks up again at 2 months. Jones found, "in the first 6 months of life we're seeing a decline in the amount of looking at other people's eyes in children who later are diagnosed with autism."

The research suggests that a baby's initial eye contact ability may be an almost a reflex-like behavior, but then there may be a second phase of development that depends on different brain and gene systems which lead to social interaction, Jones says. That's where a typically developing child's development may differ from a child with autism.

The study authors conclude that "the observation of this decline in eye fixation - rather than outright absence - offers a promising opportunity for early intervention."

This is not something parents are going to see by just holding their baby, Jones points out.  This type of eye-tracking requires sophisticated technology that can track even the slightest movement of the eye.

"It's a very interesting study with intriguing results. " says Wendy Stone, a longtime autism researcher and director of the Research in Early Autism Detection & Intervention (READI) lab at the University of Washington. But, she adds, "many researchers in this field have not seen behaviors under 6 months to be predictive of later diagnosis."

She also cautions that babies looking at videos of their mothers are not the same as the actual stimuli created by a mom interacting with her baby. "Are these babies less interested in eyes because mouths are more interesting to look at and more attractive because there's more movements? To me that's one of the big questions," says Stone.

Dr. Max Wiznitzer, a pediatric neurologist and autism specialist at the Rainbow and Babies Children's Hospital in Cleveland, Ohio, says this new study is a continuation of previous work in babies. He says this research makes sense to him. "There's a decrease in the amount of attention to eyes as an early marker of social behavior (think of it as a primitive level of socialization)." Wiznitzer suggests the failure to establish these early social skills has ramifications later as "social behavior shifts into more sophisticated patterns."

If this research bears out, then maybe at some point a pediatric practice could track eye movements as one way to diagnose a child with autism, says Stone. "But we're really, really far away from that."

Wiznitzer says this may explain why the autism symptoms may be more apparent at 18 to 24 months, "even though 'subclinical' onset was months earlier." He also suggests these study results may offer another explanation why the measles, mumps and rubella vaccine, which isn't administered until a baby is at least 12 months old, cannot be blamed for causing autism.

Everyone agrees this research needs to be replicated in bigger studies with more children, Wiznitzer says. "The authors are correct that a replication study using a larger number (of children) is necessary. Before that time, I would not devote extensive resources towards assessing eye attention in infants or designing major intervention programs."

Jones says, "what we really want to do is create growth charts for social behavior, just like we have growth charts for charting a child's height and weight." He says these those are the kind of tools that pediatricians need and parents are looking for.

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Why Babies in Finland Sleep in Cardboard Boxes

Finnish babies sleep in cardboard boxes and it greatly reduces their risk of dying from Sudden Infant Death Syndrome (SIDS).

In Finland expecting mothers can count on a baby shower gift from the government, ABC News reported.

The women are sent a box containing items such as reusable diapers, snowsuits, and other basic needs. The box comes with a mattress in the bottom and is meant to be used as a crib.

Finnish mothers-to-be get to choose between the box, or 140 euros.

Out of the 60,000 maternity grants that are issued every year, 40,000 of them are the care packages.

"The maternity box promotes [having a separate] bed for the newborn instead of sleeping in the same bed with other siblings and/or parents," said Mika Gissler, a research professor for the Finland National Institute for Health and Welfare.

The box may seem like a strange place for a baby to sleep, but it can greatly reduce the risk of sudden infant death syndrome.

"One thing we know about baby's sleep patterns [is that] there's a connection between [Sudden Infant Death Syndrome] and sleep environment," said Dr. Dennis Rosen, the associate medical director of Pediatric Sleep Disorders at Boston Children's hospital. "You want to keep the baby on relatively firm bedding. You don't want to cover the baby up too much...you want to keep the baby on their backs."

The government has been distributing the packages since 1937 when the Maternity Grants Act was passed in an effort to lower the infant mortality rate.

In the 1930s the mortality rate in Finland was about 65 deaths per 1,000, today that number has fallen to 3.38 deaths.

Currently, 100 percent of Finland's women receive prenatal care, which is a big jump since the 1940's when only 20 percent got help.

"[The box] can be seen as a symbol of transformation from a poor agriculture country to a [richer] industrial, welfare state," Gissler said. "It also highlights that the government's will to increase the fertility in Finland and thus it can be seen...as a guarantee for future of the country."

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Factors affecting a baby's naps and sleep at night

Genetics play a role in if a baby sleeps through the night, but sleep habits determine how well a baby naps during the day.

Genes play the biggest role in getting toddlers to sleep through the night, but environmental factors are more important for daytime naps, a twin study showed.

Genetic influences explained about half the variability in nighttime sleep duration from ages 6 months through 2 years, Jacques Montplaisir, MD, PhD, of Sacré-Coeur Hospital in Montreal, and colleagues reported in the June issue of Pediatrics.

There was a window of greater influence from surroundings and family habits at 18 months, which accounted for 48% of variability at that time. Environmental factors also accounted for up to almost 80% of variation in how long toddlers napped during the day by age 2.

Age 18 months may be a good opportunity to intervene for kids who don't sleep through the night, suggested Shalini Paruthi, MD, a pediatric sleep specialist at Saint Louis University in St. Louis.

"You really want to make sure your environment is as good as it can be," she told MedPage Today, which might include "keeping a dark and quiet room for them to sleep in and making sure they have their own sleep space so they're not bumping into a sibling on the mattress or on the bed."

"That doesn't mean every child in the same family is going to have the same sleep patterns," Paruthi noted, cautioning against overinterpretation.

The study also shouldn't be generalized to older children, she added.

Environment seems the biggest contributor to how long adults sleep at night, with a prior adult twin study suggesting less than 45% heritability.

Teens and pre-teens seem to follow adults in that pattern. However, young children haven't been followed longitudinally in the same way through the period when sleep is shifting toward a mature circadian rhythm.

Montplaisir's study included 995 sets of twins (405 identical) in the population-based Quebec Newborn Twin Study, which included pairs born without major medical conditions in the greater Montreal area from November 1995 through July 1998.

Mothers reported on their twins' sleep at 6, 18, 30, and 48 months of age, with a 2-week period between assessment for the two children to minimize homogenization of answers.

Genetics explained 47% of variability in how long kids slept without waking up their parents at 6 months of age, 58% at 30 months, and 54% at 48 months.

Sleep appeared to be more fragmented than parents were aware of, though, because video recordings in a subgroup showed that even "good sleepers" woke up three times a night on average.

With regard to daytime naps, environmental influences shared by the twins appeared to explain more of the variance in sleep duration as they got older.

These factors accounted for 33% of nap duration at 18 months of age, 48% at 30 months, and 79% at 2 years.

Nap duration seemed moderately stable through age 2 and declined gradually over time, with only 4% having a faster than normal trajectory in that regard.

Only 4% had stopped taking naps by age 2.

Little variation in either daytime or nighttime sleep appeared linked to environmental factors unique to one twin, not shared with the other.

However, the researchers cautioned that the heritability estimate may have been inflated by using a single "informant" for the twin pairs.

Another limitation was use of ordinal categories for daytime and nighttime sleep duration, so the study needs replication with quantitative measures, such as actigraphy or polysomnography, they noted.

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10 Reasons Babies Wake Up At Night

Most babies wake up at night, and this article discusses 10 common reasons why they do.

Most babies wake up at night. And although some superhero babies sleep 10-12 hours straight starting around 3-4 months of age, most infants wake up during the night and cry out for their parents. There are scientific reasons and some developmental and behavioral explanations for these awakenings. I spoke with my friend Dr. Maida Chen, a pediatric pulmonologist, mother to three and director of the Pediatric Sleep Disorders Center in Seattle. I put this list together regarding why babies wake up at night. I'll author a follow-up blog on ways you can help your baby when they wake up, too.

10 Reasons Babies Wake Up At Night:

1. Sleep Cycle: Babies wake up during the night primarily because their brain waves shift and change cycles as they move from REM (rapid eye movement) sleep to other stages of non-REM sleep. The different wave patterns our brains make during certain periods define these sleep cycles or "stages" of sleep. As babies move from one stage of sleep to another during the night, they transition. In that transition, many babies will awaken. Sometimes they call out or cry. Sometimes they wake hungry. It's normal for babies (and adults) to wake 4-5 times a night during these times of transition. However, most adults wake up and then fall back to sleep so rapidly that we rarely remember awakening. At 4 months of age, many parents notice awakenings after a first chunk of deeper sleep. This is normal, and often due to development of delta wave sleep (deep sleep). The trick for parents is to do less and less as each month of infancy unfolds during these awakenings; we want to help our babies self-soothe more and more independently (without our help) during these awakenings so that sleeping through the night becomes a reality.

2. Brain Waves: The majority of babies are really capable of sleeping for a prolonged 6+ hour period of time 1/2 way through infancy, around 6 months. As Dr. Chen explains, "When doing sleep studies we follow brain wave activity." After 6 months of age she says, "We see brain waves at 6 months of age and up that are similar in pattern to that of adults." Now that doesn't mean that babies that wake throughout the night have abnormal brain waves, but it does mean as they progress through infancy, they get more and more mature when it comes to sleep. Dr Chen says, "If you look at sleep studies on newborns and infants, they will look very different compared to older children. But by 6 months of age, the baby's brain wave patterns will look much like an 18-year-olds." That being said, unlike an 18-year-old, once some babies are awakened during transitions, they may call out for your help!

3. "Good Sleepers" Versus "Bad Sleepers": Some babies are just better sleepers right out of the gate. Dr Chen reminded me, "There are good sleepers and there are bad sleepers. Part of that is organically hard-wired. But there are also good sleepers with bad habits." Our job as parents is to do the best we can in creating good sleep habits. Most of that has to do with consistency from one night to the next. Some babies make habitual associations like always nursing to sleep, always being rocked to sleep or always being held to fall asleep. Then, when they have awakenings at night, they may cry out to have those associations (bottle, nursing or rocking to sleep) to get back to sleep. These associations can cause a good sleeper to have bad sleep, because of the habit.

4. Crying Is Part Of Being A Baby: There is a pretty serious ongoing debate and national dialogue between parents, psychologists, pediatricians, lactation consultants and scientists about letting babies cry-it-out versus not cry-it out. I'll not delve into much of the debate here, but if you're worried that letting your baby cry-it-out will damage them, try to relax. Dr Chen says, "We don't think that some crying is bad for a baby. The evidence to support long-term damage from crying at night is nil." Many pediatricians recommend letting your baby gradually learn to self-soothe or cry-it-out once they have self-soothing skills (turning over, sucking on fingers or hand, and more mobility) starting somewhere around 4-6 months of age.

5. Mom or Dad's Role At Night: Studies have evaluated how parents can change an infant's sleep. Studies have found that infant sleep disorders are affected by how many times a parent comforts them at night. The more parents camp out (remain in the room until baby is asleep), the more parents transfer the baby into the crib after asleep and the more they picked the baby up at night, the more likely the baby has sleep challenges. And although most studies have evaluated a mother's role in overnight awakenings, a2010 Tel Aviv study found that when fathers were more involved in infant care (day and night), in addition to mothers, their babies had fewer overnight awakenings. Take turns!

6. Development: Developmental milestones shift and change sleep. As described in the video, after 4 months of age, most babies have a prolonged period of sleep and then wake up every couple of hours because of sleep cycle changes. Sometimes they will wake up and roll over and then freak out and cry when they get stuck or move into a new position. The rolling milestone may translate into awakenings. At 6 months of age, babies are exploring the world, putting all sorts of objects and germs in their mouths, and subject to more infection. They're also learning to sit at 6 months of age and this milestones often triggers awakenings. At 9 months of age, babies learn how to pull themselves up in the crib and stand-up -- don't be surprised if they are awake more. Most parents are unpleasantly surprised to find their 9-month-old up and awake in the middle of the night standing up, ready to rock and roll.

7. Teething: There's no question that teething wakes children at night and disrupts sleep. Teething typically commences around 6 months of age but I hear about teething waking babies all the way through their toddlerhood. Acetaminophen is the only medication I recommend for teething.

8. Behavioral Changes: Many babies will have more frequent awakenings around 6 or 9 months of age due to advancing sense of independence and self-awareness. At 6 months of age, I often hear from parents their babies will wake up in the middle of the night and start talking, just go through their different sounds. No need to go to them if they are not fussing! When babies develop separation anxiety around 9 months of age, they will often change their sleep patterns. Often during those times of behavior change they will wake and scream out when they realize you're not at their side.

9. Infection: Infants and children typically have an upswing in infections after 6 months of age. This occurs primarily because once a baby reaches 6 months, they are capable of putting lots of new objects (including their hands) in their mouths, so their exposure to germs increases dramatically. Many babies who have colds or upper respiratory infections will wake due to congestion or coughing. Fever, vomiting and diarrhea will awaken babies at night, too. Hang on and support your baby with a little TLC. Sleep schedules typically go back to normal within a few weeks after the illness began, especially if you can keep up good sleep routines.

10. Pacifiers/Bottle: Many babies are conditioned to fall asleep (or fall back to sleep) while sucking on something. This starts just after birth, when newborns instantly fall asleep with breastfeeding or a bottle in their mouth. Many infants who use a pacifier will wake up between 6-12 months of age when the pacifier falls out. The easiest solution is to get rid of it all together! But remember, big habits die hard, if a baby learns to fall asleep sucking and does so for 6+ months, it can take awhile to unlearn the habit.

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CDC study shows Autism is not caused by too many vaccines

The idea that 'too many vaccines too soon' causes autism has been proven false by research done by the Centers for Disease Control and Prevention.

Although scientific evidence suggests that vaccines do not cause autism, approximately one-third of parents continue to express concern that they do; nearly 1 in 10 parents refuse or delay vaccinations because they believe it is safer than following the Centers for Disease Control and Prevention's (CDC) schedule. A primary concern is the number of vaccines administered, both on a single day and cumulatively over the first 2 years of life. In a new study scheduled for publication in The Journal of Pediatrics, researchers concluded that there is no association between receiving "too many vaccines too soon" and autism.

Dr. Frank DeStefano and colleagues from the CDC and Abt Associates, Inc. analyzed data from 256 children with autism spectrum disorder (ASD) and 752 children without ASD (born from 1994-1999) from 3 managed care organizations. They looked at each child's cumulative exposure to antigens, the substances in vaccines that cause the body's immune system to produce antibodies to fight disease, and the maximum number of antigens each child received in a single day of vaccination.

The researchers determined the total antigen numbers by adding the number of different antigens in all vaccines each child received in one day, as well as all vaccines each child received up to 2 years of age. The authors found that the total antigens from vaccines received by age 2 years, or the maximum number received on a single day, was the same between children with and without ASD. Furthermore, when comparing antigen numbers, no relationship was found when they evaluated the sub-categories of autistic disorder and ASD with regression.

Although the current routine childhood vaccine schedule contains more vaccines than the schedule in the late 1990s, the maximum number of antigens that a child could be exposed to by 2 years of age in 2013 is 315, compared with several thousand in the late 1990s. Because different types of vaccines contain varying amounts of antigens, this research acknowledged that merely counting the number of vaccines received does not adequately account for how different vaccines and vaccine combinations stimulate the immune system. For example, the older whole cell pertussis vaccine causes the production of about 3000 different antibodies, whereas the newer acellular pertussis vaccine causes the production of 6 or fewer different antibodies.

An infant's immune system is capable of responding to a large amount of immunologic stimuli and, from time of birth, infants are exposed to hundreds of viruses and countless antigens outside of vaccination. According to the authors, "The possibility that immunological stimulation from vaccines during the first 1 or 2 years of life could be related to the development of ASD is not well-supported by what is known about the neurobiology of ASDs." In 2004, a comprehensive review by the Institute of Medicine concluded that there is not a causal relationship between certain vaccine types and autism, and this study supports that conclusion.

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Attention Deficits Seen in Babies who Develop Autism

Babies who have deficits in attention have a higher occurrence of eventually developing autism.

Researchers at Yale School of Medicine are able to detect deficits in social attention in infants as young as six months of age who later develop Autism Spectrum Disorders (ASD). Published in the current issue of Biological Psychiatry, the results showed that these infants paid less attention to people and their activities than typically developing babies.

Katarzyna Chawarska, associate professor at the Yale Child Study Center, and her colleagues investigated whether six-month-old infants later diagnosed with ASD showed prodromal symptoms -- early signs of ASD such as an impaired ability to attend to social overtures and activities of others. Before this study, it had not been clear whether these prodromal symptoms were present in the first year of life.

"This study highlights the possibility of identifying certain features linked to visual attention that can be used for pinpointing infants at greatest risk for ASD in the first year of life," said Chawarska. "This could make earlier interventions and treatments possible."

Chawarska and her team administered an eye-tracking task to 67 infants at high risk for developing autism, and 50 low-risk infants. The three-minute video was designed to capture the ebbs and flows of social events, depicting a woman engaged in several familiar activities such as making a sandwich, looking at toys, or speaking. While making sandwiches, the actress occasionally looked at the camera and tried to engage the babies by making eye contact and saying "How are you, baby?" "You are so cute!" and "Did you see the tigers?" There were no breaks in the video to re-engage or re-center the babies' attention, requiring them to attend to whatever they found interesting in their visual field, as they would in real-life social situations. Chawarska and her team used eye-tracking technology to monitor how often the infants looked at the scene, the toys, the woman, and her eyes and mouth.

Compared with the control groups, six-month-old infants later diagnosed with ASD looked less at the social scene, and when they did pay attention to the scene, they spent less time monitoring the woman's face. The team is now working on determining the specific causes that lead to decrease of social attention in infants with emerging social vulnerabilities.

"This work is highly consequential for identifying new treatment targets and early intervention strategies," said Chawarska.

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Study: Changes in Anti-Epilepsy Treatment Options for Infants

New treatment options may be available for infants with epilepsy based on treatment for a similar condition.

A pilot study to determine the best hormonal treatment for infantile spasms (IS) that may lead to changes in prescribing practices for hormone therapy is being presented for the first time at the American Epilepsy Society's 66th Annual Meeting in San Diego California.

In a study of 30 infants, researchers from the division of Pediatric Neurology of Mattel Children's Hospital at UCLA in Los Angeles found very high dose prednisolone to be a reasonable alternative to adrenocorticotropic hormone treatment (ACTH) for children with infantile spasms . Using a standardized protocol in which ACTH is reserved for infants who do not respond to prednisolone, they yielded a favorable overall response rate of 77%, and were able to successfully forego ACTH therapy in 18 patients, thus avoiding more than 1000 intramuscular injections and achieving more than 2 million dollars in short-term cost savings. The results indicate that further research is warranted to determine whether high dose prednisolone is truly equivalent is ACTH, as 5 infants in this study responded to ACTH after failing prednisolone.

"In the absence of a definitive clinical trial, I encourage practitioners to use the treatment protocol set forth in our study to mitigate the risks and cost of traditional ACTH therapy. However, I do not advocate that ACTH therapy be completely abandoned. A head-to-head trial of high-dose prednisolone versus ACTH is required to resolve the uncertainly that remains." said Dr. Shaun Hussain of the Division of Neurology, Mattel Children's Hospital at UCLA, the lead author of the study.

The study was presented at a session of pediatric highlights at the AES Annual Meeting.

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Study: Autism Risk for Developing Children Exposed to Air Pollution

This study discusses a possible link between exposure to air pollution during pregnancy or while an infant and the development of autism in the child. Is this another epigenetic factor? JR

Research conducted by University of Southern California (USC) and Children's Hospital Los Angeles scientists demonstrates that polluted air -- whether regional pollution or coming from local traffic sources -- is associated with autism.

The study titled "Traffic Related Air Pollution, Particulate Matter, and Autism," shows that exposure to traffic-related air pollution during pregnancy and the first year of life is associated with a more than two-fold risk of autism. In addition, exposure to regional pollution consisting of nitrogen dioxide (NO₂) and small particles -- particulate matter less than 2.5 and 10 microns in diameter (PM2.5 and PM10) -- is also associated with autism even if the mother did not live near a busy road. The study is published in theArchives of General Psychiatry, a sister publication of the Journal of the American Medical Association.

"This work has broad potential public health implications," said the study's principal investigator, Heather Volk, Ph.D., assistant professor of preventive medicine at the Keck School of Medicine of USC and investigator in the Division of Research on Children, Youth and Families at Keck School-affiliated Children's Hospital Los Angeles. "We've known for a long time that air pollution is bad for our lungs, and especially for children. We're now beginning to understand how air pollution may affect the brain."

The research is the first to look at the amount of near-roadway traffic pollution individuals were exposed to and combine that with measures of regional air quality. The study builds on previous research by Volk and colleagues that examined how close subjects lived to a freeway, said Volk, who also has appointments at the Keck School's Zilkha Neurogenetic Institute and Department of Pediatrics.

"We took into account how far away people lived from roads, meteorology such as which way the wind was blowing, how busy the road was, and other factors to study traffic-related pollution," she said. "We also examined data from air quality monitors, which measure pollution over a larger region that could come from traffic, industry, rail yards, or many other sources."

In the 2012 study, Volk and colleagues from USC and the University of California, Davis examined data on 279 autism cases and 245 control subjects enrolled in the California-based Childhood Autism Risks from Genetics and the Environment (CHARGE) study. Mothers' addresses from birth certificates and addresses reported from a residential history were used to estimate exposure during each trimester of pregnancy and the first year of life. The researchers used air pollution levels derived from the Environmental Protection Agency's Air Quality System to determine exposure to NO2, PM2.5, and PM10. They also applied dispersion models to estimate the amount of traffic the mothers and children were exposed to.

Particularly interesting was the effect of mothers' and children's exposure to particles, both PM10 and PM2.5. PM10 includes both coarse and fine particles, while PM2.5 includes only the smaller (fine) particles, which are most likely to have deleterious effects on the human body.

"From studies conducted in the lab, we know that we can breathe in tiny particles and they can produce inflammation," said Volk. "Particles have varied composition, and there are many chemicals that can bind to them. The components of these particles could be hazardous to the brain."

Other researchers who participated in the study include Irva Hertz-Picciotto, University of California, Davis; Rob McConnell from USC; and Fred Lurmann and Bryan Penfold from Sonoma Technology, Inc.

The research was funded by the National Institute of Environmental Health Sciences (grant 1 R21 ES019002-01).

Volk and colleagues are now at work on a study of how genes related to autism may be affected by environmental exposures to try to identify if there are factors that make people are genetically more vulnerable to particular pollutants.

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