Anxiety Symptoms in Young Children Are Associated With a Maladaptive Neurobehavioral Profile of Error Responding.

BACKGROUND: Childhood anxiety symptoms have been linked to alterations in cognitive control and error processing, but the diverse findings on neural markers of anxiety in young children, which vary by severity and developmental stage, suggest the need for a wider perspective. Integrating new neural markers with established ones, such as the error-related negativity, the error positivity, and frontal theta, could clarify this association. Error-related alpha suppression (ERAS) is a recently proposed index of post-error attentional engagement that has not yet been explored in children with anxiety. METHODS: To identify neurobehavioral profiles of anxiety in young children by integrating ERAS with the error-related negativity, error positivity, frontal theta, and post-error performance indicators, we employed K-means clustering as an unsupervised multimetric approach. For this, we first aimed to confirm the presence and scalp distribution of ERAS in young children. We performed event-related potentials and spectral analysis of electroencephalogram data collected during a Go/NoGo task (Zoo Task) completed by 181 children (ages 4-7 years; 103 female) who were sampled from across the clinical-to-nonclinical range of anxiety severity using the Child Behavior Checklist. RESULTS: Results confirmed ERAS, showing lower post-error alpha power, maximal suppression at occipital sites, and less ERAS in younger children. K-means clustering revealed that high anxiety and younger age were associated with reduction in ERAS and frontal theta, less negative error-related negativity, enlarged error positivity, more post-error slowing, and reduced post-error accuracy. CONCLUSIONS: Our findings indicate a link between ERAS, maladaptive neural mechanisms of attention elicited by errors, and anxiety in young children, suggesting that anxiety may arise from or interfere with attention and error processing.

Measuring Early Relational Health Using PediaTrac TM in a Diverse Sample of Infant-Caregiver Dyads.

OBJECTIVE: Early relational health (ERH) is a key developmental predictor and outcome in infancy and early childhood that reflects social-emotional well-being and promotes resilience throughout childhood. Currently, there is no gold-standard developmental screening tool for ERH in pediatric care settings. This study examined the psychometric properties of items assessing ERH that are part of a web-based, caregiver-report screening tool called PediaTrac TM . It was hypothesized that ERH could be reliably estimated and that second-order factors would be revealed within the latent construct ERH. METHOD: Participants included 571 caregivers of term (n = 331; ≥37 weeks) and preterm (n = 240; <37 weeks) infants recruited shortly after birth from several academic medical centers and a community health clinic. Caregivers completed PediaTrac modules at birth and 2, 4, 6, 9, 12, 15, and 18 months; data for this study are from the newborn through 12-month periods. RESULTS: Results from Item Response Theory Graded Response Modeling revealed excellent reliability for the PediaTrac ERH domain at all time points, ranging from 0.96 to 0.98. Exploratory factor analyses revealed 4 to 5 second-order factors, representing Parent-Child Relationship, Parent Distress, Parenting Stress, Parenting Efficacy, Sensitivity, and Perceptions of Child, depending on period. CONCLUSION: The caregiver-report developmental screening tool, PediaTrac, reliably measures ERH during the first year of life. The measure has promising clinical utility in pediatric clinic settings for tracking ERH over time to ensure early social-emotional well-being and to identify concerns as early as possible.

Unique Characteristics of Women and Infants Moderate the Association between Depression and Mother-Infant Interaction.

Research has shown mixed results regarding the association between women's postpartum depression and mother-infant interactions, suggesting that a woman's unique experience and context may moderate how depression shapes these interactions. We examined the extent to which a woman's comorbid anxiety, her exposure to adversity, and infant characteristics moderate the relationship between depressive symptoms of women and interactions with their infants at 6 (n = 647) and 12 months (n = 346) postpartum. The methods included standardized coding of mother-infant interactions and structural regression modeling. The results at 6 months of infant age indicated that infant male sex and infant negative affectivity were risk factors for mothers' depression being associated with less optimal interactions. At 12 months of infant age, two moderators appeared to buffer the influence of depression: a woman's history of trauma and infant preterm birth (≤37 weeks gestation). The results reinforce the salience of infant characteristics in the relationship between maternal depression and mother-infant interactions. The findings also suggest that experiences of trauma may offer opportunities for psychological growth that foster constructive management of depression's potential effect on mother-infant interactions. Further research is needed to clarify the underlying processes and mechanisms that explain the influence of these moderators. The ultimate goals are to reduce the risk of suboptimal interactions and reinforce healthy dyadic relations.

Randomized pilot trial of the "Mom Power" trauma- and attachment-informed multi-family group intervention in treating and preventing postpartum symptoms of depression among a health disparity sample.

Introduction: Perinatal depression, a common complication related to childbearing, impacts mothers, children, and families. Efficacious interventions reduce perinatal depression symptoms; effort is needed to prevent the onset of perinatal depression. To determine feasibility and preliminary efficacy in reducing perinatal depression, we conducted a community-based, randomized parallel open pilot trial of Mom Power, a group-based intervention to improve mental health and parenting in mothers with young children. Methods: Mom Power consists of 10 group sessions, focused on parenting, child development and self-care and three individual sessions, to build rapport and provide personalized referrals. Control group participants received psychoeducational mailings. Computer-based urn randomization assigned mothers with experiences of interpersonal violence, depression, or other traumatic experiences to Mom Power (68) or control (54). Results: At 3-months post-treatment, the 31 retained women assigned to Mom Power were half as likely to meet criteria for probable depression (26%) as the 22 women retained in the control group (55%), with treatment predicting lower incidence of probable depression (OR = 0.13, p = 0.015). Moreover, among the 23 women who did not meet criteria for depression diagnosis at baseline, no women in the treatment group developed depression (n = 0, 0%) compared to control group women (n = 3, 30%). Logistic regression controlling for selective attrition confirmed the treatment effect on preventing new onset of depression (OR = 0.029, p = 0.012). Conclusion: These findings support the use of Mom Power for both treatment and prevention of perinatal depression. Clinical trial registration: https://classic.clinicaltrials.gov/ct2/show/NCT01554215, NCT01554215.

Developmental trajectories of eating behaviors and cross-lagged associations with weight across infancy.

Examining typical developmental trajectories of infant eating behaviors, correlates of those trajectories, and cross-lagged associations between eating behaviors and anthropometry, is important to understand the etiology of these behaviors and their relevance to growth early in the lifespan. Mothers (N = 276) completed the Baby Eating Behavior Questionnaire (BEBQ) and infant anthropometrics were measured at ages 1, 2, 4, 6, and 10 months. Infant and maternal characteristics were collected by maternal report. Trajectories of eating behaviors were identified using latent class growth modeling and bivariate analyses examined associations of infant eating behavior trajectory membership with infant and maternal characteristics. Cross-lagged analyses examined associations between BEBQ subscales and infant weight-for-length z-score. Infant eating behavior trajectories included: Consistently High (62%) and Consistently Moderate (38%) Enjoyment of Food; Consistently High (9%), Moderate & Decreasing (43%), and Low & Decreasing (48%) Food Responsiveness; and Consistently High (62%) and Moderate & Decreasing (38%) General Appetite. Trajectory group membership was not associated with infant sex, gestational age, birthweight, or having been exclusively fed breastmilk at 2 months. Consistently High trajectories for Enjoyment of Food, Food Responsiveness, and General Appetite were associated with maternal demographic markers of psychosocial risk (e.g., lower maternal age and educational attainment). Food Responsiveness and General Appetite tracked strongly across infancy within individuals. Cross-lagged associations of Enjoyment of Food, Food Responsiveness, and General Appetite with weight-for-length z-score across infancy were generally null. Much additional work is needed to understand eating behaviors in infancy, their development, and their etiology. Further understanding of infant eating behaviors will provide the basis for future interventions to improve life course nutrition, growth, and health.

Food addiction and dietary restraint in postpartum women: The role of childhood trauma exposure and postpartum depression.

The early postpartum period is a sensitive time for understanding women's high-risk eating (i.e., eating behavior associated with negative health outcomes) given potential long-term eating behavior implications for infants. Food addiction and dietary restraint are two high-risk eating phenotypes associated with long-term negative health outcomes that have been theoretically linked. Yet, no research has considered how much these constructs overlap during the early postpartum period. The present study sought to characterize these two high-risk eating phenotypes in postpartum women to examine whether these are distinct constructs with specific etiologies and to inform future targets of intervention. Women (N = 277) in the early postpartum period reported on high-risk eating, childhood trauma exposure, depression symptoms, and pre-pregnancy weight. Women's height was measured and pre-pregnancy BMI was calculated. We conducted bivariate correlations and path analysis to characterize the relationship between food addiction and dietary restraint, controlling for pre-pregnancy BMI. Results showed that food addiction and dietary restraint were not significantly associated and that women's childhood trauma exposure and postpartum depression were associated with food addiction but not dietary restraint. Sequential mediation revealed that higher levels of childhood trauma exposure were associated with worse postpartum depression and, in turn, greater food addiction during the early postpartum period. Findings suggest that food addiction and dietary restraint have distinct psychosocial predictors and etiological pathways, which suggests important construct validity differences between the two high-risk eating phenotypes. Interventions seeking to address food addiction in postpartum women and mitigate the impact of this high-risk eating phenotype on the next generation may benefit from treating postpartum depression, especially in women with histories of childhood trauma exposure.

Longitudinal associations between parental reflective functioning and maternal mind-mindedness.

Little work has examined longitudinal associations between parental reflective functioning (PRF) and mind-mindedness (MM), limiting the understanding of separate or bidirectional trajectories of these related but distinct forms of mentalization. We examined cross-lagged associations between PRF, assessed via interview, and MM, coded from play interactions, over 12 months among 90 parents (86% female; 57% White, 43% Black) of infants (Mage = 10.56 months, SD = 8.20) who were participating in The Michigan Model of Infant Mental Health Home Visiting. Data were collected at study enrollment Time 1 (T1) and at 6-month Time 2 (T2) and 12-month Time 3 (T3) postenrollment. Mind-minded comments were coded as appropriate, reflecting accurate interpretation of mental states or nonattuned, characterizing inaccurate interpretations. PRF and appropriate MM each remained stable over time. PRF at the T1 positively predicted appropriate MM at T2. No other cross-lagged associations between PRF and appropriate MM were significant. Concurrent correlations between appropriate MM and PRF were significant only at T3. Nonattuned MM showed stability from T1 to T2 but nonattuned MM at the T2 did not predict nonattuned MM at T3. Greater PRF at T1 predicted less nonattuned MM at T2. No other cross-lagged associations between PRF and nonattuned MM were significant. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Capacity for Regulation of Energy Intake in Infancy.

Importance: The capacity for regulation of energy intake (REI) to match energy needs is thought to contribute to differences in weight gain, and preventing excess infant weight gain is a priority. Objective: To determine capacity for REI across infancy. Design, Setting, and Participants: For this cohort study, a convenience sample of mother-infant dyads was recruited from the community in Michigan between 2015 and 2019. Inclusion criteria were healthy, full-term infants with weight appropriate for gestational age; biological mothers who were 18 years or older, English speaking, and a legal and custodial guardian; and infant having had consumed 2 oz or more in 1 feeding from an artificial nipple at least once per week. Infants were followed in the home setting with staff support for up to 12 months. Interventions: Mother-infant dyads participated at infant age 1, 2.5, 5, 7, 10, and 12 months. In the intervention condition, mothers offered a feeding every hour for 6 hours. In the control condition, mothers fed infants as they typically would for 6 hours. Intake was recorded and kilocalories calculated. Main Outcomes and Measures: Capacity for REI was indexed as the difference in intake in kilocalories per kilogram of body weight (intervention minus control condition); a value of 0 indicated perfect REI. Maternal and infant characteristics were obtained by questionnaire, and anthropometry was measured. Using multiple imputation, the intercept and slope for difference in kilocalories per kilogram across the 6 age points were estimated using mixed models accounting for repeated measures within participants. Statistical analyses were conducted between September 2021 and February 2023. Results: The sample included 175 infants (87 [49.71%] female, 88 [50.29%] male; 494 pairs of intervention and control conditions and 4630 feedings). The mean (SD) 12-month weight-for-age z score was 0.1 (0.8). Mean (SD) gestational age as 39.55 (1.05) weeks, and mean (SD) birth weight was 3.43 (0.41) kg. Mean (SD) breastfeeding duration for those who reported stopping by 12 months was 17.83 (12.03) weeks. As designed, the intervention (compared with control) condition included more feedings at shorter intervals. After collapsing the data across age points in a mixed model accounting for repeated measures within participants, the REI estimate at 1 month differed from 0. On average, infants ate 5.21 kcal/kg (95% CI, 2.89-7.54 kcal/kg) more in the frequent feeding intervention condition than in the ad lib feeding control condition. This difference did not significantly change over 12 months of infancy (REI slope = -0.01 kcal/kg per month; 95% CI, -0.02 to 0.03 kcal/kg per month). Conclusions and Relevance: The study's findings suggested that, on average, when offered more frequent feedings, healthy, full-term infants may overeat. The results provide support for responsive feeding as a strategy for preventing excess infant weight gain.

Associations of maternal food addiction, dietary restraint, and pre-pregnancy BMI with infant eating behaviors and risk for overweight.

Maternal food addiction, dietary restraint, and pre-pregnancy body mass index (BMI) are associated with high-risk eating behaviors and weight characteristics in children and adolescents. However, little is known about how these maternal factors are associated with individual differences in eating behaviors and risk for overweight in infancy. In a sample of 204 infant-mother dyads, maternal food addiction, dietary restraint and pre-pregnancy BMI were assessed using maternal self-report measures. Infant eating behaviors (as measured by maternal report), objectively measured hedonic response to sucrose, and anthropometry were measured at 4 months of age. Separate linear regression analyses were used to test for associations between maternal risk factors and infant eating behaviors and risk for overweight. Maternal food addiction was associated with increased risk for infant overweight based on World Health Organization criteria. Maternal dietary restraint was negatively associated with maternal report of infant appetite, but positively associated with objectively measured infant hedonic response to sucrose. Maternal pre-pregnancy BMI was positively associated with maternal report of infant appetite. Maternal food addiction, dietary restraint, and pre-pregnancy BMI are each associated with distinct eating behaviors and risk for overweight in early infancy. Additional research is needed to identify the mechanistic pathways driving these distinct associations between maternal factors and infant eating behaviors and risk for overweight. Further, it will be important to investigate whether these infant characteristics predict the development of future high-risk eating behaviors or excessive weight gain later in life.

Relationships reduce risks for child maltreatment: Results of an experimental trial of Infant Mental Health Home Visiting.

Background: Research examining the effectiveness of home visiting programs that reduce child maltreatment or associated risks yield mixed findings; some find positive significant impacts on maltreatment, whereas others find small to no effects. The Michigan Model of Infant Mental Health Home Visiting (IMH-HV) is a manualized, needs-driven, relationship-focused, home-based intervention service that significantly impacts maternal and child outcomes; the effect of this intervention on child maltreatment has not been sufficiently evaluated. Objective: The current study examined associations between treatment and dosage of IMH-HV and child abuse potential in a longitudinal, randomized controlled trial (RCT). Participants and setting: Participants included 66 mother-infant dyads (Mother M age = 31.93 years at baseline; child M age = 11.22 months at baseline) who received up to 1 year of IMH-HV treatment (Mdn = 32 visits) or no IMH-HV treatment during the study period. Methods: Mothers completed a battery of assessments including the Brief Child Abuse Potential Inventory (BCAP) at baseline and at the 12-month follow-up assessment. Results: Regression analyses indicated that after controlling for baseline BCAP scores, those who received any IMH-HV treatment had lower 12-month BCAP scores compared to those who received no treatment. Additionally, participation in more visits was associated with lower child abuse potential at 12 months, and a reduced likelihood of scoring in the risk range. Conclusion: Findings suggest that greater participation in IMH-HV is associated with decreased risk for child maltreatment 1 year after initiating treatment. IMH-HV promotes parent-clinician therapeutic alliance and provides infant-parent psychotherapy which differentiate it from traditional home visiting programs.

Characterization of a Vigorous sucking style in early infancy and its predictive value for weight gain and eating behaviors at 12 months.

This study sought to identify sucking profiles among healthy, full-term infants and assess their predictive value for future weight gain and eating behaviors. Pressure waves of infant sucking were captured during a typical feeding at age 4 months and quantified via 14 metrics. Anthropometry was measured at 4 and 12 months, and eating behaviors were measured by parent report via the Children's Eating Behavior Questionnaire-Toddler (CEBQ-T) at 12 months. Sucking profiles were created using a clustering approach on the pressure wave metrics, and utility of these profiles was assessed for predicting which infants will have weight-for-age (WFA) percentile changes from ages 4-12 months that exceed thresholds of 5, 10, and 15 percentiles, and for estimating each CEBQ-T subscale score. Among 114 infants, three sucking profiles were identified: Vigorous (51%), Capable (28%), and Leisurely (21%). Sucking profiles were found to improve estimation of change in WFA from 4 to 12 months and 12-month maternal-reported eating behaviors above infant sex, race/ethnicity, birthweight, gestational age, and pre-pregnancy body mass index alone. Infants with a Vigorous sucking profile gained significantly more weight during the study period than infants with a Leisurely profile. Infant sucking characteristics may aid in predicting which infants may be at greater risk of obesity, and therefore sucking profiles deserve more investigation.

University-Community Partnerships to Support Responsive Caregiving: The Hearts and Minds on Babies Implementation Story.

Consistent, sensitive caregiving across home and childcare contexts supports optimal development. In this paper, we share the story of the development of Hearts and Minds on Babies (HMB) for Early Head Start (EHS) administrators, teachers, and parents. HMB was designed to support caregiver reflective functioning and sensitivity and reduce caregiver stress. This paper describes a series of Plan-Do-Study-Act cycles used to adapt an existing parenting intervention into the HMB programming for EHS. Throughout the paper, we present HMB concepts and learning objectives and share teachers' and parents' feedback and adaptations to content and delivery options that support implementation by EHS programs. Feedback from the final cycle suggests that HMB supports EHS administrators, teachers, and parents in their roles and improves relationships. The paper highlights the importance of research-practice partnerships in developing programming that meets the needs of EHS.

Self-regulation and Psychopathology in Young Children.

The current study examined concurrent relationships between children's self-regulation, measured behaviorally and by parent-report, and children's internalizing and externalizing symptoms. The aim was to distinguish which components of self-regulation (attention vs. inhibitory control, "hot" vs. "cool" regulation) best predict dimensional symptomatology and clinical disorders in young children. The participants were 120 children, ages 4-8 years old. Results showed that greater parent-reported attention was associated with fewer internalizing and externalizing symptoms. Behaviorally-measured hot inhibitory control related to fewer internalizing symptoms, whereas parent-reported inhibitory control related to fewer externalizing symptoms. Similar patterns emerged for clinical diagnoses, with parent-rated attention most strongly predicting disorders across domains. Results support prior evidence implicating self-regulatory deficits in externalizing problems, while also demonstrating that components of self-regulation are impaired with internalizing symptoms. Further, different sub-components of self-regulation relate to different dimensions of psychopathology in children. Interventions should target these areas in children at-risk for disorders.

Characteristics of eating behavior profiles among preschoolers with low-income backgrounds: a person-centered analysis.

BACKGROUND: Individual differences in eating behaviors among young children are well-established, but the extent to which behaviors aggregate within individuals to form distinct eating behavior profiles remains unknown. Our objectives were to identify eating behavior profiles among preschool-aged children and evaluate associations with temperament and weight. METHODS: A secondary, cross-sectional analysis of baseline data from 2 cohort studies was conducted involving 1004 children aged 3-4 years and their parents with low-income backgrounds. Children's eating behaviors and temperament were assessed by parental report. Body mass index z-scores and weight status were calculated using measured heights and weights. Latent profile analysis (LPA) was used to generate profiles and bivariate analyses were used to evaluate associations with temperament and weight status. RESULTS: LPA revealed the presence of 3 eating behavior profiles among children. Children with High Food Approach profiles (21.2%) had lower temperamental inhibitory control and the highest percent of children with obesity relative to the other profiles. Children with High Food Avoidant profiles (35.6%) had lower temperamental impulsivity and lower BMI z-scores relative to the other profiles, whereas children with Moderate Eating profiles (intermediary levels of all behaviors; 43.2%) had higher temperamental inhibitory control and lower anger/frustration, than other profiles. CONCLUSIONS: Young children's eating behaviors appear to aggregate within individuals to form empirically distinct profiles reflecting food approach, food avoidance, and moderate approaches to eating that are differentiated by aspects of temperament and weight. Future work should seek to understand the extent to which health promotion and obesity prevention approaches should be tailored to take into account children's fundamental dispositions towards eating.

From zero to thrive: A model of cross-system and cross-sector relational health to promote early childhood development across the child-serving ecosystem.

Early relational health between caregivers and children is foundational for child health and well-being. Children and caregivers are also embedded within multiple systems and sectors, or a "child-serving ecosystem", that shapes child development. Although the COVID-19 pandemic has made this embeddedness abundantly clear, systems remain siloed and lack coordination. Fostering relational health amongst layers of this ecosystem may be a way to systematically support young children and families who are facing adversity. We integrate theory, examples, and empirical findings to develop a conceptual model informed by infant mental health and public health frameworks that illustrates how relational health across the child-serving ecosystem may promote child health and well-being at a population level. Our model articulates what relational health looks like across levels of this ecosystem from primary caregiver-child relationships, to secondary relationships between caregivers and child-serving systems, to tertiary relationships among systems that shape child outcomes directly and indirectly. We posit that positive relational health across levels is critical for promoting child health and well-being broadly. We provide examples of evidence-based approaches that address primary, secondary, and tertiary relational health, and suggest ways to promote relational health through cross-sector training and psychoeducation in the science of early development. This model conceptualizes relational health across the child-serving ecosystem and can serve as a template for promoting child health and well-being in the context of adversity.

La salud de la temprana relación entre quienes prestan cuidado y los niños es fundamental para la salud y el bienestar del niño. Los niños y quienes les cuidan forman parte de múltiples sistemas y sectores, o un "ecosistema de servicio al niño," que moldea el desarrollo del niño. Aunque la pandemia del COVID-19 ha demostrado abundante y claramente esta pertenencia, los sistemas permanecen aislados y les hace falta coordinación. Fomentar la salud de la relación entre las capas del ecosistema pudiera ser una manera de apoyar sistemáticamente a los niños pequeños y familias que se enfrentan con situaciones adversas. Presentamos un modelo conceptual con base en marcos de trabajo de la salud mental infantil y la salud pública que ilustra cómo la salud de la relación a lo largo del ecosistema de servicio al niño pudiera promover el desarrollo del niño al nivel de grupo de población. Nuestro modelo articula cómo aparece la salud de la relación a lo largo de los niveles del ecosistema desde las relaciones entre quien presta el cuidado primario y el niño, hasta las relaciones secundarias entre quienes prestan el cuidado y loa sistemas de servicio al niño, y las relaciones terciarias entre sistemas que amoldan directa e indirectamente los resultados en el niño. Una positiva salud de la relación a través de todos los niveles es esencial para promover la salud y el bienestar del niño de manera amplia. Describimos ejemplos específicos de salud de la relación primaria, secundaria y terciaria, y sugerimos maneras de promover la salud de la relación a través del entrenamiento intersectorial y la educación sicológica dentro de la ciencia del desarrollo temprano. Este modelo conceptualiza la salud de la relación a lo largo del ecosistema de servicio al niño y puede ser un esquema patrón para promover el desarrollo del niño dentro del contexto de situaciones adversas.

La Santé Relationnelle Précoce entre les personnes prenant soin des enfants et les enfants est fondamentale pour la santé de l'enfant et son bien-être. Les enfants et les personnes prenant soin d'eux sont encastrés dans de multiples systèmes et des secteurs, ou un « écosystème ¼ servant l'enfant qui forme le développement de l'enfant. Bien que la pandémie du Covid19 ait rendu cet encastrement très clair, les systèmes demeurent compartimentés et manquent de coordination. Cultiver la santé relationnelle au sein des couches de l'écosystème pourrait s'avérer être une manière de soutenir des jeunes enfants et les familles faisant face aux obstacles. Nous présentons un modèle conceptuel informé par les structures de la santé mentale du nourrisson et de la santé publique qui illustre la manière dont la santé relationnelle au travers de l'écosystème servant les enfants peut promouvoir le développement de l'enfant au niveau de la population. Notre modèle articule ce à quoi la santé relationnelle ressemble au travers des niveaux de l'écosystème, des relations entre la personne principale qui s'occupe de l'enfant et l'enfant aux relations secondaires entre les personnes prenant soin de l'enfant et les systèmes servant l'enfant, jusqu'aux relations tertiaires entres les systèmes qui donnent forme aux résultats directement et indirectement. Une santé relationnelle positive au travers de tous les niveaux est critique pour la promotion de la santé de l'enfant et de son bien-être en général. Nous décrivons des exemples spécifiques de santé relationnelle primaire, secondaire et tertiaire, et suggérons des manières de promouvoir la santé relationnelle au travers de la formation entre secteurs et de la psychoéducation dans la science du développement précoce. Ce modèle conceptualise la santé relationnelle au travers de l'écosystème servant l'enfant et peut servir de modèle pour la promotion du développement de l'enfant dans le contexte de l'adversité.

In-the-moment ratings on the Early Relational Health Screen: A pilot study of application in home visiting and primary care.

Early infant-parent interaction sets a critical foundation for young children's well-being, and evidence regarding the protective role of secure early relationships has led to increased interest in effective screening and promotion of early relational health in pediatric primary care and home visiting settings. We report findings from two pilot studies conducted in the United States that describe the reliability and validity of a relational health screening tool, the Early Relational Health Screen (ERHS), implemented in two different contexts: an innovative model of relational health promotion in pediatric primary care (Study 1) and an Infant Mental Health Home Visiting (IMH-HV) model (Study 2). Across both studies, a trained clinician rated the ERHS following real-time observation of interaction (i.e., "in-the-moment" ratings). Reliability was assessed by comparing "in-the-moment" ERHS ratings to subsequent coding of the same interaction from video by an independent evaluator. In addition, Study 2 data permitted evaluation of the validity of "in-the-moment" ERHS ratings. Results from both studies indicated reliability of "in-the-moment" ERHS ratings. In addition, Study 2 clinician "in-the-moment" ratings were associated with maternal depression and ratings of child-parent interaction derived from a separate observational task coded by independent evaluators using a different well-validated research-based measure. Discussion highlights the potential of the ERHS as a screening, promotion, and prevention tool that may be feasibly administered by providers across pediatric primary care and home visiting settings.

La temprana interacción infante-progenitor establece una fundación esencial para el bienestar de los niños pequeños, y la evidencia sobre el papel de protección de tempranas relaciones receptivas ha aumentado el interés en la efectiva detección y promoción de la salud de la relación en el cuidado pediátrico primario y los escenarios de visitas a casa. Reportamos los resultados de dos estudios experimentales que describen la confiabilidad y validez de la Temprana Detección de la Salud de la Relación (ERHS) implementada en dos contextos: un modelo innovador de promoción de la salud de la relación en el cuidado primario (Estudio 1) y un modelo de salud mental infantil de visitas a casa (Estudio 2). A lo largo de ambos, un profesional clínico entrenado evaluó ERHS siguiendo una observación de interacción en tiempo real (v.g. puntajes asignados "en el momento"). Se evaluó la confiabilidad por medio de una comparación entre los puntajes del profesional clínico y los subsecuentes puntajes de la misma interacción en video por un evaluador independiente. Adicionalmente, los datos del Estudio 2 permitieron la evaluación de la validez de los puntajes de ERHS. Los resultados de ambos estudios indicaron la confiabilidad de los puntajes ERHS "en el momento." Es más, los puntajes del profesional clínico del Estudio 2 se asociaron con la depresión materna y los puntajes de la interacción niño-progenitor derivados de una tarea separada usando una medida bien validada basada en la investigación. Las discusiones subrayan el potencial de ERHS como una herramienta de detección, promoción y prevención que puede ser administrada factiblemente por los proveedores tanto en el cuidado primario como en los casos de visitas a casa.

L'interaction précoce nourrisson-parent jette les bases essentielles du bien-être du jeune enfant et l'évidence concernant le rôle protecteur des relations précoces sécures a mené à un intérêt plus grand pour le dépistage efficace et la promotion de la santé relationnelle précoce dans les soins de santé primaire en pédiatrie ainsi que les contextes de visites à domicile. Nous rapportons ici les résultats de deux études pilotes faites aux Etats-Unis d'Amérique, qui décrivent la fiabilité et la validité d'un outil de dépistage de la santé relationnelle, le Dépistage Précoce de Santé Relationnelle (en anglais Early Relational Health Screen dont nous gardons l'abréviation ici, ERHS), mis en place dans deux contextes différents: un modèle innovateur de promotion de la santé relationnelle précoce en soin pédiatrique primaire (Etude 1) et un modèle de visite à domicile pour la santé mentale du nourrisson (Etude 2). Au travers de ces deux études un clinicien entraîné a évalué l'ERHS après une observation en temps réel de l'interaction (c'est-à-dire, des scores "sur le moment"). La fiabilité a été évaluée en comparant l'ERHS "sur le moment" au codage ultérieur de la même interaction à partir d'une vidéo, par un évaluateur indépendant. De plus les données de l'Etude 2 ont permis l'évaluation de la validité des scores ERHS "sur le moment." Les résultats des deux études ont indiqué la fiabilité des scores ERHS "sur le moment." De plus les scores "sur le moment" du clinicien de l'Etude 2 étaient liés à la dépression maternelle et aux scores d'interaction enfant-parent dérivés d'une tâche observationnelle séparée codée par des évaluateurs indépendants en utilisant une mesure basée sur les recherches différente et communément validée. La discussion met en lumière le potentiel de l'ERHS en tant qu'outil de dépistage, de promotion et de prévention qui peut être réalistement utilisé par les professionnels au sein des soins primaires pédiatriques et des contextes de visites à domicile.

Infant Distress in a Food Delay Task Changes With Development and Predicts Amount Consumed.

Objective: Eating behavior regulation emerges during early development and involves general self-regulation (emotional, behavioral), appetite regulation (homeostatic metabolic need) and appetite self-regulation (including both Bottom-Up Food Approach and Bottom-Up Food Avoidance and top-down purposeful self-control of eating). Limited research has investigated developmental trajectories of the regulation of eating behavior before the preschool years. The current study used a novel food delay task to assess infant distress as an early emerging marker of eating behavior regulation constructs across early infancy and examine associations with amount of milk consumed. Method: Mother-infant dyads (n = 179) completed the Ability to Delay Gratification for Food in Infants Task (ATDG-FIT) at 2 weeks, 8 weeks, and 16 weeks of age. The ATDG-FIT required infants to wait before being fed while their bottle was present, but not accessible (3-min Pre-Feeding Delay). After this, the infant was fed for 1 min, then the feeding was paused for 30 s (Mid-Feeding Delay). Infant distress was coded during each feeding delay period and the amount of milk consumed was measured. Results: The mean proportion of distress during the Pre-Feeding Delay period decreased from 8 to 16 weeks of age (F(2,230) = 15.02, p < 0.001), whereas the mean proportion of distress during the Mid-Feeding Delay increased from 2 to 8 weeks of age (F(2,230) = 27.04, p < 0.001). There was a positive interaction between distress during Mid-Feeding Delay and infant age predicting the amount consumed in the protocol (ß = 0.30, p = 0.022), suggesting that the association between distress during this part of the task and amount consumed strengthens as infants get older. Conclusion: The ATDG-FIT may be an effective method to assess emerging eating behavior regulation constructs during early infancy.