The suggestion, which goes against health warnings, suggests that babies’ hearts are under more stress if they are left to sleep on their own.

It claims that sleeping on their mother’s chest provides young babies with a better rest than being put in a cot for the night.

The suggestion comes from Dr Nils Bergman, a paediatrician at the University of Cape Town in South Africa, who found that sleeping alone makes it harder for the mother to bond with her child.

Brain development can also be damaged by nightly separation, which can lead to behavioural problems in later life, the research claims.

But letting a newborn sleep in his or her mother’s bed goes against previous warnings on the controversial issue, which urge parents to let babies sleep in their own cots.

It follows years of mounting concerns over cot deaths in Britain, and the risk that a mother could injure or suffocate her child while sleeping.

A recent study of sudden infant deaths in the UK found that almost two-thirds of unexplained deaths happened when bed-sharing was involved.

While the National Childbirth Trust is in favour of newborns sleeping in their mothers’ beds, under a strict set of guidelines, the Foundation for the Study of Infant Deaths remains against it.

It recommends that the safest place for a baby to sleep is in a cot in his or her parent’s room – but not in their bed.

Dr Bergman, however, insisted that cot deaths and other infant injuries were not caused by the presence of the mother.

“When babies are smothered and suffer cot deaths, it is not because their mother is present,” he told the Daily Mail.

“It is because of other things: toxic fumes, cigarettes, alcohol, big pillows and dangerous toys.”

Dr Bergman, who founded a movement called ‘Kangaroo Mother Care’, emphasising the benefits of skin-to-skin contact between a mother and her newborn, studied the sleeping patterns of 16 infants for the research.

He found that the babies hearts were under up to three times more stress when they slept in a cot, rather than on their mother’s chest.

Just six babies in the research group had a quiet night’s sleep on their own.

The study also revealed disruption to the brain sleep cycle, which is vital in the organ’s development, in babies sleeping in cots.

Dr Bergman warned that a lack of sleep at this stage could cause behavioural problems for the child in later life.

Disrupted sleep and stress to the heart could make it difficult for them to form relationships, he claimed.

Source: Sarah Rainey, The Telepragh

Public health efforts, such as the successful AAP co-sponsored “Back to Sleep” campaign, have resulted in a 50 percent reduction in the SIDS rate. More recently, the Cribs for Kids program provides safe cribs to low-income families, but there is no data to support the programs effect on the rate of SIDS. Despite the success of the “Back to Sleep” campaign, SIDS is the leading cause of death for infants under one year of age.

In the new study, researchers reviewed 91 deaths of children younger than age 1 in New Mexico between 2006 and 2010, of which 59 were SUID/SIDS and 28 were undetermined. Of these, 52 percent of the infants had been placed to sleep in a non-supine position, and 71 percent had been found on an unsafe sleep surface.

A shared sleep surface was the site of death in 50 percent of the cases. Having a crib in the home, however, was not a predictor of safe sleep habits. Of the 71 percent of infants found in an un-safe sleep environment, a crib was present in the home in 57 percent of these cases. In 30 percent of these homes, the crib was being used for another purpose.

“Despite the success of sleeping awareness campaigns, many of the remaining SIDS cases involve prone sleeping and unsafe sleeping environments, such as bed sharing and infants being put to sleep outside of a crib or bassinet,” said lead study author Jessica Black. “Continued educational efforts on safe sleep practices for infants are essential in the efforts to prevent these infant deaths.”

Source: Susan Martin, American Academy of Pediatrics, via EurekAlert

While there is no concrete understanding of the cause of SIDS there are a few theories including stress caused by infection or other stress related factors, birth defect, failure to develop, a susceptible time period such as a rapid growth period. It is possible that with more research it may be discovered that SIDS has more than one cause.

SIDS cannot be prevented but there have been some studies that have been able to determine some risk factors such as infants who sleep on their sides or stomachs, infants who sleep on a soft surface or that have soft objects or loose bedding in the crib, infants born to mothers who smoked during pregnancy, and infants who share a bed with others. Some studies have concluded that infants who are put to bed with pacifiers have a reduced risk for SIDS.

SIDS is a medical condition and not abuse. Infants who succumb to SIDS appear to be healthy prior to death. SIDS cannot be predicted or prevented. The infant who dies from SIDS does not suffer as death occurs during sleep and is a rapid death.

SIDS is not caused by external suffocation, vomiting or choking. SIDS is not contagious. SIDS is not a new sleep disorder it occurred and was recorded during biblical times as referenced in 1 Kings 3:19 in the Old Testament.

It is generally thought that the lower the birth weight the higher the risk for SIDS. Those babies born less than 3.5 pounds at birth have 4 times the risk of babies who were born at more than 5.5 pounds. Generally those infants with SIDS on a whole gained the normal range of weight after birth.

Most SIDS deaths occur between the ages of 2 months and 4 months.

Some babies who later die from SIDS experience an apparent life-threatening event (ALTE), which is when babies experience an episode of “stopped breathing”. Babies who experience multiple ALTE’s are at greater risk for SIDS.

There does seem to be a connection with heredity and SIDS as it can occur with subsequent siblings.

Male babies tend to do worse in regards to most diseases, have a greater mortality, more congenital defects and a higher overall infant mortality as well as the incidence of SIDS. More male infants die of SIDS than female infants in the first year of life.

Source: Natural Holistic Health

That’s because many parents are under the impression that a soft sleeping environment means the baby will be more comfortable or will be protected from injuries, said Dr. Rachel Moon.

“There’s this impression that soft is safe,” said Moon, one of the authors of the new study from Children’s National Medical Center in Washington, D.C.

“But when it comes to babies’ sleep environment, soft is not safe, it’s actually dangerous.”

Researchers know that black babies are at least twice as likely as white, Latino, and Asian babies to die of accidental suffocation, strangulation or sudden infant death syndrome (SIDS) —also known as “crib death.” While some of that higher incidence may be related to genetics, much of it is probably due to parents unknowingly putting infants in a dangerous sleeping place or position, Moon said.

To find out whether black families know about the risks, Moon and her colleagues conducted one-on-one interviews and small group discussions with 83 black mothers in D.C. and Maryland with a new baby at home.

The researchers asked women if they used soft bedding and bumper pads in their baby’s crib or other sleeping location — and why or why not.

More than of half of the moms reported using soft bedding for their baby, according to findings published in Pediatrics. They told researchers they wanted to make sure the kids were comfortable and warm, or that they used pillows as a barricade on beds and sofas, or to prop babies up.

“We were surprised that people use (soft bedding) because they think it’s going to make their baby safer,” Moon told Reuters Health. “We weren’t that surprised that people use it to make the babies comfortable.”

Some mothers thought doctors’ recommendations to use a “firm sleep surface” included a bed where a sheet was tucked tightly over pillows — but that’s still a dangerous sleep situation, the researchers warned.

Moms also used bumper pads on cribs if they worried that a baby would hit its head on the railings or get an arm or leg stuck. Some, the researchers found, also thought the bumper pads were cute.

But just like with pillows and blankets, bumper pads pose a suffocation risk to babies, Moon said. “There really isn’t any need for bumper pads,” especially for very young babies, she added.
SIDS — a sudden and unexplained infant death — kills about 2,500 babies each year in the U.S.

Putting babies to sleep on their sides or stomachs is known to increase the risk of SIDS, as is having them share mom and dad’s bed.

Dr. Fern Hauck, a SIDS researcher at the University of Virginia in Charlottesville, said she understood the desire to make babies comfortable with soft bedding in hopes that they’ll sleep better and longer.

But, “babies can pretty much sleep anywhere,” she told Reuters Health. “If you get them used to a firm crib mattress, they’re going to sleep fine on a firm crib mattress.”

She said that pediatricians have to talk to new parents about all SIDS and suffocation risks, and “really get a little more of a dialogue going” about the safest way for a baby to sleep.

Grandparents, friends, and anyone else who would be taking care of the baby also need to have that conversation, Hauck added.

And it’s important to know that although the interviews were only done with black mothers, parents of all races may misinterpret a pediatrician’s recommendations or what constitutes a safe sleeping environment, said Dr. Debra Weese-Mayer, a pediatrician at Northwestern University Feinberg School of Medicine in Chicago.

The study “is a very humbling lesson that even though we think we’re giving a very clear message (about sleep surfaces), if the parent and the caretaker are interpreting it in a way different from what we intended, we’re not doing a very good job,” Weese-Mayer said.

“If it can save some babies because we do a better job of translating our recommendations, that’s wonderfully important.”

Source: Fox Health News

The findings appear in the journal Child Development. The study was conducted by researchers at the Oregon Social Learning Center, University of Leicester, Cardiff University, University of Pittsburgh, University of California at Davis, The Pennsylvania State University, University of New Orleans, and Yale Child Study Center.

The researchers sought to assess the relationship between marital instability-for example, parents who were contemplating divorce-and children’s sleep problems-namely, difficulties getting to sleep or staying asleep. Their inquiry was based, in part, on the possibility that changes in the brain systems involved in how children develop and regulate their sleep patterns reflect the impact of family stress on children.

They followed more than 350 families starting when their babies were 9 months old and continuing over a nine-month period. The researchers chose to study adoptive families to rule out the possibility that any ties between parents’ behavior and children’s sleep were due to shared genes; previous studies into this issue have looked at families who were biologically related.

The researchers found that marital instability when the children were 9 months old predicted increases in children’s sleep problems when they were 18 months old. This finding held true even after taking into consideration such factors as children’s difficult temperaments, parents’ anxiety levels, and birth order. But the researchers also found that the inverse wasn’t true-that is, children’s sleep problems didn’t predict marital instability.

“Our findings suggest that the effects of marital instability on children’s sleep problems emerge earlier in development than has been demonstrated previously,” according to Anne M. Mannering, who was a research associate at the Oregon Social Learning Center when she worked on the study; she is currently with Oregon State University. “Parents should be aware that marital stress may affect the well-being of their children even in the first year or two of life.”

Source: Sarah Hutcheon, Society for Research in Child Development via EurekAlert

A bit of parental wisdom known to most moms and dads: If you want to get a good night’s sleep yourself, just keep your kids running all day long. An early night and undisturbed sleep are almost guaranteed. But is it true?

New research says it is. A study in the journal Archives of Disease in Childhood came to the following conclusion: Active children fall asleep faster and sleep longer than children who get less exercise.

The researchers followed nearly 600 New Zealand 7-year-olds. They had the parents answer a questionnaire on their children’s sleeping habits. They also had the kids wear monitors around their waists over one 24-hour period to measure their activity levels each minute of the day.

7 steps to better sleep

Here’s what the study found: It took an average of 26 minutes for a child to fall asleep. But for every hour a youngster was inactive during the day, it took three minutes longer. For active children, it worked the other way: The more activity, the less time it took to fall asleep.

Obviously, a child’s sleep pattern affects the parents too. A child who wakes up often during the night can wreak havoc on grown-ups’ need for rest. But there is also a significant impact on the child. Poor sleep habits have been associated with behavioral problems, low grades in school, and even an increased risk of being overweight.

According to the article, some 16% of parents of school-age children report that their kids have trouble falling asleep. The study, the authors noted, “emphasizes the importance of physical activity for children, not only for fitness, cardiovascular health, and weight control, but also for sleep.”

5 ways you can get a better night’s sleep

It seems logical that kids who run around all day are more tired and therefore sleep better. But consider: Perhaps it’s the other way around. Maybe children who get a lot of sleep have more energy to run around all the time. In fact, researchers are not sure what causes what in this chicken-egg scenario.

Still, we know exercise is good for kids, so encourage your children to be active-to run, play soccer, swim, hit a tennis ball, whatever will keep them moving. Even if it doesn’t knock them out at bedtime, they’ll be healthier, and that should let everyone in the household sleep easier.

Source: Dr. Ranit Mishori, PARADE

Anyone who grew up in a large family likely remembers hearing “Don’t wake the baby.” While it reinforces the message to older kids to keep it down, research shows that sleep also is an important part of how infants learn more about their new world.

Rebecca Gomez, Richard Bootzin and Lynn Nadel in the psychology department at the University of Arizona in Tucson found that babies who are able to get in a little daytime nap are more likely to exhibit an advanced level of learning known as abstraction.

Nadel, a Regents’ Professor at the UA, will describe the group’s work (Early Learning in Infants May Depend on Sleep) in a session at the American Association for the Advancement of Science annual meeting in San Diego on Sunday, Feb. 21, starting at 8:30 a.m., Pacific time.

In their research, Nadel and his colleagues played recordings of “phrases” created from an artificial language to four dozen 15-month-old infants during a learning session. Their methodology included repeatedly playing phrases like “pel-wadim-jic” until the babies became familiar with them.

These phrases contained three units, with the first and last unit forming a relationship. In this example, the first word, “pel,” predicts the last, “jic.” Even though these are nonsensical sounds, the language created for the test shares some similarity with structure commonly found in subject-verb agreement in English sentences.

Prior to being tested, some infants learning this faux language took their normally scheduled naps. Others were scheduled at a time when they would not nap following the session. When the infants returned to the lab, they again heard the recordings – along with a set of different phrases in which the predictive relationship between the first and last words were new.

By carefully watching the babies’ facial expressions as they listened to both old and new phrases, the researchers were able to rate their level of attention. They found that babies’ longer gazes at a flashing light that coincided with the phrases signaled attention, which indicated that they had learned a particular phrase or relationship.

Differences arose between the infants who had napped and those who had not. The infants who did not sleep after the sessions still recognized the phrases they had learned earlier. But those babies who had slept in between sessions were able to generalize their knowledge of sentence structure to draw predictive relationships to the new phrases. This suggests that napping supports abstract learning – that is, the ability to detect a general pattern contained in new information.

In follow-up work, the UA researchers have shown that infants must have their naps within four hours of listening to the artificial language in order for them to demonstrate this beneficial abstraction effect. Those who failed to nap within that time, but slept normally that evening, failed to show the abstraction effect the next day.

“It’s a fairly nuanced story,” Nadel said. “What we know is that infants have mostly REM sleep, given the type of sleep they have, given how their brains are developed at that point. And they have to get some of that sleep within a reasonable amount of time after inputting information in order to be able to do abstracting work on it. If they don’t sleep within four to eight hours, they probably just lose the entire thing,” he said.

What this should reinforce for parents, he said, is that while it obviously is important to give infants and young children the kind of stimulation that comes from reading, talking and exposing them to lots of words, thise stimuli need to happen within the context of a reasonably well-regulated daily cycle that includes adequate sleep.

In 2005, according to the CDC, 2,234 infants died of SIDS in the United States. Forty-four of those deaths occurred in New Jersey. The study notes that the incidence of SIDS has declined by more than 50 percent since the onset of public health initiatives during the 1990s, most notably the AAP’s “Back-to-Sleep” campaign, to raise awareness of infant care practices that elevate the risk of SIDS. However, the study indicates that risk-reduction education needs to be more comprehensive.

“It is important that health care providers communicate all of the risk factors of SIDS ideally during the prenatal period as well as at birth and throughout the first year of an infant’s life,” said Dr. Ostfeld, who also is program director of the SIDS Center of New Jersey.

“Risk-reduction education of new parents and all other caregivers, such as grandparents and babysitters should be detailed,” said Dr. Hegyi, who also serves as the medical director of the SIDS Center of New Jersey. “Parent’s questions and concerns should be addressed thoroughly.”

The authors note that guidance to parents regarding safe sleep practices should address the importance of “Back-to-Sleep,” the position associated with the lowest risk, but also should cover all other practices that have been identified as lowering the risk of SIDS according to the guidelines of the American Academy of Pediatrics. These include, but are not limited to, avoidance of exposure to tobacco smoke, elimination of the use of pillows, quilts and soft or loose bedding in the infant’s sleep environment, avoidance of any face covering, and avoidance of the use of a shared sleep surface during sleep.

SIDS is defined as a sudden and unexpected death of an infant before the first birthday that remains unexplained even after a comprehensive evaluation consisting of a complete autopsy, a death scene investigation and a review of medical history of the infant and the family. Many studies now suggest that one of the potential causes may be an abnormality in the brainstem that would prevent an infant from responding to breathing challenges, such as those posed by prone (on the stomach) sleep in soft bedding. However, until the biological bases for SIDS are fully defined and can lead to the identification and treatment of living infants who may be vulnerable, risk-reducing practices, often defined as safe sleep practices, remain the most effective intervention to date.

The SIDS Center of New Jersey (SCNJ) was established in 1988 and operates under a grant to UMDNJ-Robert Wood Johnson Medical School from the New Jersey Department of Health and Senior Services. An additional site based at The Joseph M. Sanzari Children’s Hospital at Hackensack University Medical Center receives funding from the CJ Foundation for SIDS. The program provides families with bereavement support and information about sudden infant death, educates the health care community about methods for reducing the risk for SIDS, and monitors the epidemiology of SIDS in New Jersey. Since the onset of the program, the rate of SIDS in New Jersey has declined by more than half and remains below the national rate. Compliance with risk reducing infant care practices has also improved.

UMDNJ-ROBERT WOOD JOHNSON MEDICAL SCHOOL

As one of the nation’s leading comprehensive medical schools, UMDNJ-Robert Wood Johnson Medical School is dedicated to the pursuit of excellence in education, research, health care delivery, and the promotion of community health. In cooperation with Robert Wood Johnson University Hospital, the medical school’s principal affiliate, they comprise New Jersey’s premier academic medical center. In addition, Robert Wood Johnson Medical School has 34 other hospital affiliates and ambulatory care sites throughout the region.

As one of the eight schools of the University of Medicine and Dentistry of New Jersey with 2,800 full-time and volunteer faculty, Robert Wood Johnson Medical School encompasses 22 basic science and clinical departments, hosts centers and institutes including The Cancer Institute of New Jersey, the Child Health Institute of New Jersey, the Center for Advanced Biotechnology and Medicine, the Environmental and Occupational Health Sciences Institute, and the Stem Cell Institute of New Jersey. The medical school maintains educational programs at the undergraduate, graduate and postgraduate levels for more than 1,500 students on its campuses in New Brunswick, Piscataway, and Camden, and provides continuing education courses for health care professionals and community education programs.

Source: Robert Wood Johnson Medical School

The brains of infants who die of sudden infant death syndrome (SIDS) produce low levels of serotonin, a brain chemical that conveys messages between cells and plays a vital role in regulating breathing, heart rate, and sleep, reported researchers funded by the National Institutes of Health.

SIDS is the death of an infant before his or her first birthday that cannot be explained after a complete autopsy, an investigation of the scene and circumstances of the death, and a review of the medical history of the infant and of his or her family. According to the National Center for Health Statistics, SIDS is the third leading cause of infant death, claiming more than 2,300 lives in 2006.

The researchers theorize that this newly discovered serotonin abnormality may reduce infants’ capacity to respond to breathing challenges, such as low oxygen levels or high levels of carbon dioxide. These high levels may result from re-breathing exhaled carbon dioxide that accumulates in bedding while sleeping face down. The findings appear in the Feb. 3 issue of The Journal of the American Medical Association.

“We have known for many years that placing infants to sleep on their backs is the single most effective way to reduce the risk of SIDS,” said Alan E. Guttmacher, M.D., acting director of the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), the NIH institute that funded the research. “The current findings provide important clues to the biological basis of SIDS and may ultimately lead to ways to identify infants most at risk as well as additional strategies for reducing the risk of SIDS for all infants.”

NICHD’s Back to Sleep campaign urges parents and caregivers to place infants to sleep on their backs. Following the campaign’s launch in 1994, the rate of SIDS dropped by more than 50 percent. Widespread adoption of back sleeping appears to have reduced the occurrence of SIDS, but has not eliminated it.

For this study, senior author Hannah C. Kinney, M.D., of Harvard Medical School and Children’s Hospital Boston, and her colleagues examined small samples of tissue from the medulla, a region at the base of the brain that regulates basic functions such as body temperature, breathing, blood pressure, and heart rate. The researchers analyzed brain tissue from infants who died from SIDS and controls who died of other causes. Included in the analysis were 35 infants who died of SIDS, 5 infants who died unexpectedly of other causes, and 5 infants who were hospitalized and died for reasons associated with a lack of oxygen.

The researchers found that serotonin levels were 26 percent lower in tissue from infants who died of SIDS than in tissue from the group of infants who had otherwise died unexpectedly. Measurements of tryptophan hydroxylase, an enzyme needed to make serotonin, also were 22 percent lower.

In earlier work comparing SIDS cases with other infant deaths, Kinney and her coauthors showed that the brains of infants who died of SIDS had higher concentrations of cells that use serotonin in the medulla oblongata, a region of the brain stem. For the current study, the researchers set out to see if this meant the SIDS infants’ brains in fact had altered levels of the brain chemical.

This abnormality appears to fit into the triple-risk model of SIDS, which holds that SIDS occurs only when three elements come together: an infant with an underlying vulnerability, a critical period of development, and an external stressor. The researchers speculate in this case that the low serotonin level would cause the underlying vulnerability. The first year of life is the critical period of development for stabilizing vital functions such as breathing. The final element of the model, sleeping face down, might provide the external stressor.

“Our research suggests that sleep unmasks the brain defect,” Dr. Kinney said. “When the infant is breathing in the face-down position, he or she may not get enough oxygen. An infant with a normal brainstem would turn his or her head and wake up in response. But a baby with an intrinsic abnormality is unable to respond to the stressor.”

“It’s no one single factor but a culmination of abnormalities that result in the death,” Dr. Kinney said. In fact, in 88 percent of the SIDS cases they examined, the researchers found two or more risk factors, such as the infant’s sleep position, an illness, or exposure to cigarette smoke.

Kinney hopes these findings will one day lead to a test that measures infants’ serotonin levels in the blood or other tissues that reflect brain serotonin levels. Such a test might make it possible to identify those at the highest risk for SIDS so that additional steps could be taken to protect them. In the near term, the findings will provide the basis for the development of animal models with serotonin deficiencies, to mimic what occurs in SIDS in human beings.

Source: Robert Bock, NIH/National Institute of Child Health and Human Development

Multiple studies have shown that placing infants on their backs to sleep limits the risk of SIDS, the leading cause of death among children in the U.S. under the age of 1.

In a study available online and in the December issue of Archives of Pediatric and Adolescent Medicine, researchers, including Dr. George Lister, chairman of pediatrics at UT Southwestern and an author of the study, identify three reasons a caregiver might or might not follow the recommendation: concerns for an infant’s comfort; fear that the infant might choke while sleeping on his or her back; and whether a physician advised the caregiver to always place an infant on his or her back to sleep.

“We know that placing infants on their backs to sleep is by far the single most effective way to reduce the risk of SIDS, but the number of deaths has leveled off in recent years,” Dr. Lister said. “We wanted to know why in order to develop practical advice that caregivers will follow.

“Our findings suggest that a physician’s counsel makes a substantial difference when a caregiver is determining whether to place an infant to sleep on its tummy, side or back.”

The Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHHD) first launched the “Back to Sleep” campaign in 1994. Since then, the number of babies who are placed on their backs to sleep has jumped from 25 percent to 70 percent, while the rate of SIDS has plummeted by more than 50 percent. Despite the overall decrease, however, the rate of SIDS among African-American infants continues to be more than twice as high as among white and Hispanic infants.

For the current study, researchers analyzed data obtained from the National Infant Sleep Position Study from 1993 to 2007 to learn which factors influence a caregiver’s decision whether to follow the recommendation. The national phone study, which is conducted annually, involves interviewing caregivers of infants born within the past seven months. More than 1,000 interviews were conducted each year.

The researchers found that while the number of babies placed to sleep on their backs increased substantially between 1993 and 2001, this number has since stabilized. In addition, the study showed that between 2003 and 2007 only about 54 percent of study participants reported that a physician advised them to only put their infants to sleep on their backs.

Dr. Lister said families who adhered to the “Back to Sleep” recommendation were unlikely to express concerns about their baby choking or being uncomfortable sleeping in that position. These families were more likely, though, to report that a physician recommended the practice as the only option.

The study also found that African-American infants are less likely to be placed to sleep on their backs than either Hispanics or whites. “We estimate that there would have been at least 700 fewer deaths of African-American infants over a five-year period if they were placed on their backs to sleep at the same rate as white infants,” Dr. Lister said.

Dr. Lister said the findings indicate that a possible solution to further reducing the rate of SIDS depends on physicians promoting the “Back to Sleep” recommendation as the only option, while also addressing any potential concerns about choking and comfort.

“Physicians need to be proactive by consistently telling parents and caregivers that infants must always be placed on their backs and on a firm mattress to sleep, even for naps,” Dr. Lister said. “They must also continue to remind caregivers to remove extra blankets, pillows and stuffed animals from the crib during sleep time.”

The next step is for researchers to conduct face-to-face interviews with mothers both before and after delivery to gauge their intentions regarding sleep positions and whether those plans are modified after delivery.

Researchers from Yale University, Boston University and the Massachusetts Department of Health contributed to the report.

The study was supported by the NICHHD.

Source: UT Southwestern Medical Center