Caregiving and infants' neurodevelopment in rural Costa Rica: Results from the Infants' Environmental Health Study (ISA).

Early caregiving is one of the strongest influences on children's development, and among the most significant modifiable environmental factor. The aim of this study was to explore the association between quality of caregiver-infant interactions and neurodevelopment of infants living in banana-growing communities in rural Costa Rica characterized as having environmental toxic exposures. Home visits were conducted with 94 caregiver-infant dyads from the Infants' Environmental Health Study (ISA), living within Matina county, Limón province. One-year infant neurodevelopmental outcomes were assessed using the Bayley Scales of Infant and Toddler Development®, Third Edition (Bayley-III). Quality of caregiver-infant interaction was assessed with a standardized observational task: Nursing Child Assessment Satellite Training Teaching scale (NCATS) at around two years of age. Multiple regression analyses examined associations between components of caregiver-infant interactions and neurodevelopmental outcomes, adjusting for mancozeb and manganese exposure and other potential confounders. Compared to NCATS normative data for U.S. Hispanic mothers, 35% of the sample had overall caregiving interaction scores ≤10th percentile cut-off, indicating less than optimal interactions. Higher quality of caregiver-infant interaction was associated with higher expressive communication ability in infants [ß = 0.03 (95% CI: 0.01, 0.06)], controlling for pesticide exposure and confounders. Aspects of caregiving such as stimulation and growth-fostering of infants were most strongly associated with language outcomes. Results suggest an association between positive caregiving on language development for infants living in a rural agricultural area in Costa Rica, and highlight aspects of caregiving that could be targeted to improve resilience of these children who live in vulnerable conditions.

Childhood behavior problems and unintentional injury: a longitudinal, population-based study.

OBJECTIVE: Although an association between behavior problems and childhood injuries has been established, the majority of studies have been cross-sectional and comorbidity has not been taken into account. The purpose of this study was to prospectively assess the relationship between behavior problems and the risk of unintentional injury in a population-based sample of Canadian children aged 4 to 11 years. METHOD: This prospective cohort study considered data from Cycles 1 and 2 of the Canadian National Longitudinal Survey of Children and Youth. The outcome was injury in Cycle 2 (2 years later). The exposure was the presence of behavior problems in Cycle 1, defined as children with hyperactivity only, aggression only, anxiety only, hyperactivity with aggression, hyperactivity with anxiety, aggression with anxiety, and hyperactivity with aggression and anxiety. All groups were compared to children with no behavior problems. Covariates included child-related, parental, and social-environmental factors. RESULTS: The final weighted longitudinal sample included 2,209,886 children, of which 11.4% were injured in Cycle 2. None of the behavior groups were at significant risk of injury 2 years later. However, children who lived with a single/no parent and children who did not live with a biological parent had a significantly greater risk of injury. After controlling for confounders, children who lived with a single/no parent had more than twice the risk of having an injury. CONCLUSION: We need to look beyond behavior problems, and possibly at family and environmental factors, to reduce the burden of injuries in the Canadian population.