Infant Care and Infant Health
Since NICHD's founding in 1962, infant death rates in the United States have dropped significantly and many infant health outcomes have improved greatly. Much of this progress can be attributed to the application of research on infant health and care from NICHD.
The NICHD, along with its federal partners as well as professional organizations and foundations, has advanced science to improve infant health and care, and it has spearheaded campaigns to deliver information to providers and families, helping to put research advances into action.
Through its research agenda, NICHD is fulfilling its mission to "ensure that all children have the chance to achieve their full potential for healthy and productive lives, free from disease or disability."
- Well-baby visit or exam
- Baby care
- Pediatric care
- Newborn care
Medical or Scientific Names
- Infant health and infant care
- Neonatal care
Infant Care and Infant Health: Condition Information
What is infancy?
Infancy is generally considered to be the period from birth until age 2 years. It is a time of rapid growth and change for children and families.
This health topic covers some of the many issues related to infant health and infant care, including:
- Promoting Infant Health Before Birth
- Newborn Screening
- Basics of Infant Health
- Sudden Infant Death Syndrome (SIDS)
- Car Safety
- Well-Child Health Care
- Dental Health
This health topic is not meant to provide all the information you need to care for your infant. More information and resources can be found on the Resources and Publications page.
What can parents do to promote their infant’s health before the child is born?
What is pre-pregnancy care?
Pre-Pregnancy care is the care a woman gets before she becomes pregnant.
- Develop a plan for their reproductive life.
- Increase their daily intake of folic acid (one of the B vitamins) to at least 400 micrograms.
- Make sure their immunizations are up-to-date.
- Control their diabetes and other medical conditions.
- Avoid smoking, drinking, and drug use.
- Strive to get to a healthy weight.
- Learn about their family health history and that of their partner.
- Avoid stress by getting mentally healthy.
It is also important that women contact their health care provider as soon as they think they might be pregnant. That way, they can confirm their pregnancy and schedule their first prenatal exam.
What is prenatal care?
Women can increase their chances for a healthy pregnancy by getting regular prenatal care starting early in their pregnancy, eating right, exercising, and not smoking.
Prenatal (pronounced PREE-neyt-l) care is the care a woman gets during pregnancy. Early and regular prenatal visits to a health care provider are important for the health of both the mother and her developing fetus. According to the U.S. Department of Health and Human Services, women who do not seek prenatal care are three times as likely to deliver a low-birth-weight infant as those who do. Lack of prenatal care can also increase the risk of infant death.2
Both the length of prenatal visits and what happens during these visits vary depending on the week of pregnancy. Generally, at each visit, women provide a urine sample, and a nurse checks their weight and blood pressure. They also meet with their health care provider to discuss how their pregnancy is progressing.
Pregnant women need more folic acid (a B vitamin) and certain other nutrients in their diet to help ensure that their infant is born healthy. Research shows that taking supplements of folic acid during pregnancy can prevent a type of birth defect called neural tube defects. Usually, a pregnant woman's health care provider will advise her to take a prenatal vitamin supplement.
The American Congress of Obstetricians and Gynecologists (ACOG) recommends that pregnant women who were of normal weight before pregnancy increase their food intake by about 300 calories per day.3 The total amount of weight a woman should gain during pregnancy depends on her pre-pregnancy weight. Women whose weight was in the healthy range before becoming pregnant should gain between 25 and 35 pounds while pregnant. The advice is different for those who were overweight or underweight before becoming pregnant.4
The U.S. Department of Agriculture offers an online tool (https://www.choosemyplate.gov/browse-by-audience/view-all-audiences/adults/moms-pregnancy-breastfeeding) that can help women who are pregnant or breastfeeding plan their meals to ensure that their nutrition is optimal as judged by intake of specific food groups and stage of pregnancy.
More information about weight gain during pregnancy is available in the "How much weight should I gain during pregnancy?" section.
Exercise During Pregnancy
For most women, ACOG recommends exercising 30 minutes or more each day during pregnancy. Exercise can help improve many unpleasant symptoms experienced by some women (such as bloating, swelling, and backaches). It may also improve women's ability to cope with labor.5
Exercise is an important way to prevent or treat gestational diabetes, a condition that poses risks to the developing fetus.6
Some forms of activity should be avoided during pregnancy because they pose a high risk that the woman will fall and injure herself, her fetus, or both. It's also important to avoid getting dehydrated or overheated. The ACOG offers some specific recommendations for activities that are safe during pregnancy .6
Preparing for Baby's Arrival
Infants depend on their caregivers to meet all of their needs. Learning about your infant's care and health is an important first step in making sure that he or she has the best health outcomes. Because you and other members of the family are the main caregivers for your child, it is important for all of you to know about what's involved in caring for your infant and ensuring that the child receives regular health care.
Infants need frequent checkups and vaccinations, and they sometimes get sick.
Before the infant is born, it is a good idea to choose a health care provider—a pediatrician, family physician, or pediatric nurse practitioner—who specializes in the care of infants and children. A directory of pediatricians is available through the American Academy of Pediatrics.
What care do newborns receive in the hospital?
Newborn screening is the practice of testing newborns for certain disorders and conditions in the first 24 to 48 hours after they are born. In some cases, infants seem healthy at birth, but if they have these disorders or conditions they can develop serious medical problems later in infancy or childhood.
A complete list of the conditions for which infants are screened in each state can be found at Baby's First Test .
Newborn screening helps reduce and sometimes prevent negative outcomes by identifying conditions early. This may allow treatment to begin early enough to prevent damage. Newborn screening helps infants who, not very long ago, might have died in infancy or early childhood to grow to healthy adulthood.
Some male infants will be circumcised shortly after birth. Circumcision (pronounced sur-kuhm-SIZH-uhn) is a surgical procedure that removes foreskin from the penis. Foreskin is the fold of skin that covers the tip of the penis of an uncircumcised male.1
According to the American Academy of Pediatrics (AAP), scientific evidence shows some potential medical benefits of male circumcision. Possible benefits include a lower risk of urinary tract infections, penile cancer, and sexually transmitted diseases. On the other hand, there is a possibility that the infant will experience pain, and there is a low risk of bleeding or infection.2 The AAP states that the health benefits of newborn male circumcision justify access to the procedure for those families who choose it.3
Parents and families should start thinking about circumcision before the infant is born. To make an informed choice, parents of all male infants should be given accurate information about the potential risks and benefits of the procedure. They should also have an opportunity to discuss the decision with health care providers.
If the parents decide to have their son circumcised, the procedure usually is performed in the first 48 hours after birth, before discharge from the hospital. Some boys are circumcised in the first few days after birth at home as part of religious or cultural traditions. Some form of pain relief, such as a numbing cream, can be used to minimize the discomfort of circumcision.1
Preterm infants (born before 37 completed weeks of pregnancy) and infants born with health problems should not be circumcised until their condition is stable.1
Parents and caregivers should follow advice from their infant's health care provider about how to care for the penis as it heals from a circumcision.
If a male infant is not circumcised, the parent or caregiver can wash the penis with soap and water without pulling back (retracting) the foreskin. A newborn's foreskin may not retract completely. Over time it retracts on its own.1
What are some of the basics of infant health?
Some physical conditions and issues are very common during the first couple of weeks after birth. Many are normal, and the infant's caregivers can deal with them if they occur. Mostly, it is a matter of the caregivers learning about what is normal for their infant and getting comfortable with the new routine in the household.
New parents and caregivers often have questions about several aspects of their infant's health and well-being.
- Bowel Movements
- Care of the Umbilicus
- Diaper Rash
- Spitting Up/Vomiting
Infants' bowel movements go through many changes in color and consistency, even within the first few days after birth. It's important to keep track of your infant's bowel movements. Some things to look for include:
- Color. A newborn's first bowel movements usually consist of a thick, black or dark green substance called meconium (pronounced mi-KOH-nee-uhm). After the meconium is passed, the stools ("poop") will turn yellow-green. The stools of breastfed infants look mustard-yellow with seed-like particles.
- Consistency. Until the infant starts to eat solid foods, the consistency of the stool can range from very soft to loose and runny. Formula-fed infants usually have stools that are tan or yellow in color and firmer than those of a breastfed infant. Whether your baby is breastfed or bottle-fed, hard or very dry stools may be a sign of dehydration.
- Frequency. Infants who are eating solid foods can become constipated if they eat too many constipating foods, such as cereal or cow's milk, before their system can handle them. The U.S. Food and Drug Administration (FDA) and the American Academy of Pediatrics (AAP) do not recommend cow's milk for babies under 12 months.
Also, because an infant's stools are normally soft and a little runny, it's not always easy to tell when a young infant has mild diarrhea. The main signs are a sudden increase in the number of bowel movements (more than one per feeding) and watery stools.
Diarrhea can be a sign of intestinal infection, or it may be caused by a change in diet. If the infant is breastfeeding, diarrhea can result from a change in the mother's diet. The main concern with diarrhea is the possibility that dehydration can develop. If fever is also present and your infant is less than 2 months old, you should call your health care provider. If the infant is over 2 months old and the fever lasts more than a day, check the infant's urine output and rectal temperature and consult a health care provider. Make sure the infant continues to feed often.
Starting around the age of 3 to 6 weeks, some breastfed babies have only one bowel movement a week. This is normal because breast milk leaves very little solid waste to pass through the digestive system. Formula-fed infants should have at least one bowel movement a day. If a formula-fed infant has fewer bowel movements than this and appears to be straining because of hard stools, constipation may be the cause. Check with your health care provider if there are any changes in or problems with your infant's bowel movements.
The umbilical cord delivers oxygen and nutrients to the fetus while it is in the womb. After delivery, the umbilical cord is cut. The remaining part of the cord dries and falls off in about 10 days, forming the belly button (navel).
Follow your health care provider's recommendations about how to care for the umbilicus. This care might include:
- Keeping the area clean and dry.
- Folding down the top of the diaper to expose the umbilicus to the air.
- Cleaning the umbilicus gently with a baby wipe or with a cotton swab dipped in rubbing alcohol.
Contact your health care provider if there is pus or redness.1
Many infants are fussy in the evenings, but if the crying does not stop and gets worse throughout the day or night, it may be caused by colic (pronounced KOL-ik). According to the AAP, about one-fifth of all infants develop colic, usually starting between 2 and 4 weeks of age. They may cry inconsolably or scream, extend or pull up their legs, and pass gas. Their stomachs may be enlarged. The crying spells can occur anytime, although they often get worse in the early evening.
The colic will likely improve or disappear by the age of 3 or 4 months. There is no definite explanation for why some infants get colic. Sometimes, in breastfeeding babies, colic is a sign of sensitivity to a food in the mother's diet. Rarely, colic is caused by sensitivity to milk protein in formula. Colic could be a sign of a medical problem, such as a hernia or some type of illness.
If your infant shows signs of colic, the first step is to consult with your health care provider. Sometimes changing the diet of a breastfeeding mother or changing the formula for bottle-fed infants can help. Some infants seem to be soothed by being held, rocked, or wrapped snugly in a blanket. Some like a pacifier.2,3
A rash on the skin covered by a diaper is quite common. It is usually caused by irritation of the skin from being in contact with stool and urine. It can get worse during bouts of diarrhea. Diaper rash usually can be prevented by frequent diaper changes.
Your health care provider can recommend care for diaper rash, which may include:
- Rinsing the skin with warm water, using soap only after bowel movements. Because baby wipes may leave a film of bacteria on the skin, their use is often not recommended.
- Exposing the rash to air as much as possible by loosely attaching the diaper at the waist, or removing the diaper entirely during naps.
- Laying the infant on a towel to absorb urine.
Caregivers should contact a health care provider if the rash is not better in 3 days or if the child becomes worse.4
Spitting up is a common occurrence for newborns and is usually not a sign of a more serious problem. After feeding, try to keep the infant calm and in an upright position for a little while. Keep a burp towel handy, just in case. Contact your health care provider immediately if your infant5:
- Is not gaining weight
- Is spitting up so forcefully that stomach contents shoot out of the infant's mouth
- Spits up green or yellow liquid, blood, or a substance that looks like coffee grounds
- Has blood in the stool
- Shows other signs of illness, such as fever, diarrhea, or difficulty with breathing
Some parents worry that their infant will spit up and choke if they are put to sleep on their backs, but this is not the case. Healthy infants naturally swallow or cough up fluids—it's a reflex all people have. Where the opening to the windpipe is located in the body makes it unlikely for fluids to cause choking. Babies may actually clear such fluids better when on their backs.
The NICHD's Safe to Sleep® Campaign (formerly the Back to Sleep campaign) recommends placing infants to sleep on their backs to reduce the risk for sudden infant death syndrome (SIDS). Since the recommendation for back sleeping began in 1992, the number of fatal choking deaths has not increased. In fact, in most of the few reported cases of fatal choking, an infant was sleeping on his or her stomach.1
Although newborns usually have no visible teeth, baby teeth begin to appear generally about 6 months after birth. During the first few years, all 20 baby teeth will push through the gums, and most children will have their full set of these teeth in place by age 3.
An infant's front four teeth usually appear first, at about 6 months of age, although some children don't get their first tooth until 12 or 14 months. As their teeth break through the gums, some infants become fussy, sleepless, and irritable; lose their appetite; or drool more than usual. If an infant has a fever or diarrhea while teething or continues to be cranky and uncomfortable, contact your baby's health care provider.6
The FDA does not recommend gum-numbing medications with an ingredient called benzocaine because they can cause a potentially fatal condition in young children. Talk to your health care provider for advice on using these products for your teething infant.7 Other potential forms of relief for your infant include a chilled teething ring or gently rubbing the child's gums with a clean finger.7
Infants urinate as often as every 1 to 3 hours or as infrequently as every 4 to 6 hours. In case of sickness or if the weather is very hot, urine output might drop by half and still be normal.
Urination should never be painful. If you notice any signs of distress while your infant is urinating, notify your child's health care provider because this could be a sign of infection or some other problem in the urinary tract. In a healthy child, urine is light to dark yellow in color. (The darker the color, the more concentrated the urine; the urine is more concentrated when the child is not drinking much liquid.) The presence of blood in the urine or a bloody spot on the diaper is not normal and should prompt a call to the health care provider. If this bleeding occurs with other symptoms, such as abdominal pain or bleeding in other areas, immediate medical attention is needed.8
Jaundice (pronounced JAWN-diss) can cause an infant's skin, eyes, and mouth to turn a yellowish color. The yellow color is caused by a buildup of bilirubin, a substance that is produced in the body during the normal process of breaking down old red blood cells and forming new ones.
Normally the liver removes bilirubin from the body. But, for many infants, in the first few days after birth, the liver is not yet working at its full power. As a result, the level of bilirubin in the blood gets too high, causing the infant's color to become slightly yellow—this is jaundice.
Although jaundice is common and usually not serious, in some cases, high levels of bilirubin could cause brain injury. All infants with jaundice need to be seen by a health care provider.
Many infants need no treatment. Their livers start to catch up quickly and begin to remove bilirubin normally, usually within a few days after birth. For some infants, health care providers prescribe phototherapy—a treatment using a special lamp—to help break down the bilirubin in their bodies.
If your infant has jaundice, ask your health care provider how long the child's jaundice should last after leaving the hospital, and schedule a follow-up appointment as directed. If the jaundice lasts longer than expected, or an infant who did not have jaundice starts to turn yellowish after going home, a health care provider should be consulted right away. If you intend to get discharged early, particularly within 48 hours of birth, your infant's jaundice may peak later in the first week.
It is almost impossible to say how severe the jaundice level is by just looking at the baby's skin, especially for infants of color. Therefore, make every effort to keep follow-up appointments so the health care provider can check the level of jaundice with a simple blood test.
What are the best strategies for feeding?
Breastfeeding, also called nursing, is the process of feeding human breast milk to an infant, either directly from the breast or by expressing (pumping out) the milk from the breast and bottle-feeding it to the infant. Milk from the breast provides an infant with essential calories, nutrients, and antibodies to protect against some infections.1
For women in the United States, the American Academy of Pediatrics (AAP) currently recommends1:
- Infants should be fed breast milk exclusively for the first 6 months after birth. Exclusive breastfeeding means that the infant does not receive any additional foods (except vitamin D) or fluids unless medically recommended.
- After the first 6 months and until the infant is 1 year old, the AAP recommends that the mother continue breastfeeding while gradually introducing solid foods into the infant's diet.
- After 1 year, breastfeeding can be continued if mutually desired by the mother and her infant.
According to the AAP, breastfeeding reduces the risk of sudden infant death syndrome (SIDS) by more than one-third. Also, adolescent and adult obesity is reduced by up to nearly one-third in breastfed infants compared with those who are not breastfed.1 NICHD-supported research suggests that some of the fatty acids contained in breast milk play important roles in helping brain development.2
Breastfeeding is beneficial to the mother, too:
- Nursing helps a woman's body secrete hormones, causing her uterus to contract and heal. These hormones also postpone the restarting of menstruation.
- Breastfeeding reduces the chance of postpartum depression, enhances mother-infant bonding, and can create a sense of accomplishment and satisfaction.
- Some authorities believe that breastfeeding women have lower risks of developing breast and uterine cancers.
About 75% of mothers initiate breastfeeding for their newborn infants.1 Mothers who are interested in breastfeeding should discuss it with their health care providers both before the baby is born and while in the hospital.1 Visit the Breastfeeding: Resources and Publications section for organizations that can assist with breastfeeding.
In addition, the Breastfeeding health topic provides detailed information about breastfeeding and related issues. The U.S. Department of Agriculture offers an online tool (https://www.choosemyplate.gov/browse-by-audience/view-all-audiences/adults/moms-pregnancy-breastfeeding) that can help women who are breastfeeding plan their meals to ensure that their nutrition is optimal using references to specific food groups.
When should solid foods be introduced?
The AAP recommends breastfeeding as the sole source of nutrition for infants for at least 6 months. As solid foods are added to the infant's diet, breastfeeding should continue until at least 12 months. Breastfeeding may go on after 12 months, if desired by the mother and infant.3
The AAP offers specific recommendations about the variety of foods that an infant's diet should include starting after about 6 months of age, though solids may be introduced a bit earlier.3 Also, the AAP recommends limiting fruit juices in infants' and children's diets.4 Special care needs to be used when selecting and preparing "finger foods" that infants can handle themselves. Such items could lead some infants to choke on them.
What is sudden infant death syndrome (SIDS)?
SIDS is the sudden death of an infant younger than 1 year of age that is still unexplained after a complete investigation. This investigation can include an autopsy, a review of the death scene, and taking complete family and medical histories.1
NICHD leads federal research on SIDS, including ways to reduce the risk of SIDS. For more information, visit the SIDS A to Z topic.
NICHD also leads the Safe to Sleep® campaign to educate parents, caregivers, and health care providers about ways to reduce the risk of SIDS and other sleep-related causes of infant death, such as accidental suffocation. Visit the Safe to Sleep® website for more information.
What are some ways to promote infant safety in a car?
Infant Car Seats
Car crashes are the number one killer of children ages 1 to 12 years in the United States.1 Proper use of car seats helps keep children safe. The type of seat your child needs depends on several things, including your child's size and the type of vehicle you have. With so many different car seats on the market, many parents find the job of choosing a car seat to be confusing.2
The National Highway Traffic Safety Administration provides a set of guidelines (PDF - 1.16 MB) regarding infant car seats. The guidelines are consistent with the recommendations of the American Academy of Pediatrics (AAP) about choosing the most appropriate car seat for your child. AAP provides a listing of car seats and safety seat manufacturers.
Newer cars and trucks are equipped with the LATCH system for installing child safety seats (LATCH stands for Lower Anchors and Tethers for Children). Special anchors, instead of safety belts, keep the seat safely in place. If your car or safety seat does not use the LATCH system, you will have to use the vehicle's safety belts to secure an appropriate car seat.3
Be sure that everyone who transports your infant uses an approved safety seat that is properly installed—every time.
Hyperthermia and Heat-Related Illness
The term hyperthermia (pronounced high-purr-THER-mee-yah) refers to heat-related illness—or those illnesses associated with exposure to high temperatures in the environment, causing high body temperature.
When the body is exposed to high temperatures, as on a hot day, the body normally cools itself using different mechanisms, such as heavy sweating and losing heat through the skin. But in certain situations, such as when a person is inside a parked car when it is warm or sunny, sweating and other mechanisms may not be enough to cool high body heat. As a result, the body's temperature rises quickly and may damage the brain and other organs in the body. Normal body temperature is 98.6 degrees Fahrenheit.
Hyperthermia occurs when the body heats up to 104 degrees Fahrenheit. A body temperature of 107 degrees is usually fatal.
Infants' immature body systems are not able to cope with high temperatures, and infants are not able to communicate if they are too warm. That's why they are at especially high risk of hyperthermia.
According to the AAP, deaths from hyperthermia have increased in the last decade, especially among children and pets, mainly as a result of their being left alone in a car for even short periods of time. Even when the air outside is at "room temperature" (about 72 degrees Fahrenheit), the temperature inside a car can increase to more than 100 degrees Fahrenheit in just 30 minutes. One study showed that on a sunny, 72-degree day, the temperature inside a car can reach 117 degrees Fahrenheit, and cracking the windows did not decrease the rate of the rise in temperature.4 Thus, even when the weather is comfortable outside, children are at high risk for heat stroke and death from being left alone in a car.
Parents and caregivers should never leave a child alone in a car, not even with the windows down, and not even for a minute. In addition, parents and caregivers should develop plans for getting everyone out of the car to ensure that they all exit the car safely and no one is left in the car accidentally.
If you see a child left alone in a parked car, you should call 911 to request emergency help. It could mean the difference between life and death for that child. For more information, visit the National Weather Service Heat Advisory page or the AAP Extreme Temperature Exposure page.
What can parents expect during their infant’s well-child visits?
Your infant should be examined by a health care provider regularly because growth and development occur so quickly in the first 2 years after birth.
Your child's first exam will occur shortly after birth. Your pediatric health care provider will probably schedule a visit just a few days after the infant is brought home from the hospital. A typical schedule for infants, based on recommendations of the American Academy of Pediatrics, might look like this1:
- By 1 month
- 2 months
- 4 months
- 6 months
- 9 months
- 1 year
- 15 months
- 18 months
- 2 years
Each visit includes a complete physical examination. The health care provider will check the infant's growth and development and will record your child's height, weight, and other important information. Tests for hearing, vision, and other functions will be part of some visits. Immunizations and preventive care are important to keep children healthy.1
Well-child visits are key times for communication. Ideally, both parents should attend these early visits to the health care provider. These appointments give you and your pediatrician a chance to get to know each other and exchange questions and answers. Expect to receive information about normal development, nutrition, sleep, safety, diseases that are going around, and other important topics. Sometimes it helps to write down questions and concerns before the visit.1,2
Special attention is paid to whether the child is meeting normal developmental milestones. The height, weight, and head circumference are recorded on a growth chart, which the health care provider keeps with the child's medical record. This can be a great start for a discussion about your child's health.1
In addition to taking part in these scheduled well-child visits, call and visit a health care provider any time your infant seems ill or if you are worried about his or her health or development.
Why are immunizations important for my infant’s health?
Immunization (pronounced im-yuh-nuh-ZEY-shuhn), also called vaccination or shots, is an important way to protect an infant's health. Vaccinations can prevent more than a dozen serious diseases. Failure to vaccinate may mean putting children at risk for serious and sometimes fatal diseases.1
Infants are particularly vulnerable to infections; that is why it is so important to protect them with immunization. Immunizations help prevent the spread of disease and protect infants and toddlers against dangerous complications.1
The Centers for Disease Control and Prevention (CDC) provides a list of diseases that can be prevented with vaccines, as well as the benefits and risks of vaccination.
The CDC publishes a schedule of immunizations recommended for infants. These recommendations are approved by the CDC, the American Academy of Pediatrics, and the American Academy of Family Physicians.
The CDC also offers an immunization schedule that can be customized for each child.
Infant Care and Infant Health: NICHD Research Goals
Since the NICHD's founding in 1962, infant death rates in the United States have dropped more than 70%. Contributing to this decline has been the application of NICHD research on infant health and care. The NICHD's research portfolio includes many aspects of infant health and leads and supports studies that improve infant health, reduce the risk of complications and morbidities, and advance our knowledge.
Specific goals of the NICHD for infant health include, but are not limited to:
- Reduce infant mortality by understanding ways to prevent or reduce the risk for various causes of infant mortality, such as sudden infant death syndrome (SIDS).
- Expand knowledge about nutrition and how it can promote infant health.
- Identify ways to reduce the risk for, prevent, and intervene in problems related to birth and infant health, such as neural tube defects and cerebral palsy.
- Explore ways to stimulate and promote learning, social well-being, and emotional health, as well as ways to promote interventions for improving these factors in all infants.
- Determine the best ways to promote healthy physical growth and development.
- Identify interventions during the infant period that can improve long-term health outcomes.
Infant Care and Infant Health: Research Activities and Scientific Advances
Several organizational units within the NICHD support and conduct research on various aspects of infant care and infant health.
Pregnancy and Perinatology Branch (PPB)
The mission of the NICHD's PPB is to improve the health of mothers and children, with focuses on maternal health, pregnancy, fetal well-being, labor and delivery, and the developing child. The PPB supports research to determine the basic mechanisms of normal and disease processes; identify new treatments, methodologies, and preventive strategies; assess the dissemination and actual impact of therapeutic and preventive interventions; and increase scientific resources through recruitment and training of investigators.
The NICHD, led by the PPB, has been the primary federal resource for research on sudden infant death syndrome (SIDS) since the SIDS Act of 1974 was passed. Its efforts have included and still include studies on the causes of SIDS, ranging from basic research with animal models to more applied methods involving responses to environmental risk factors; research on the incidence and prevalence of SIDS, especially among certain portions of the U.S. population; and outreach designed to educate parents, caregivers, and health care providers about ways to reduce the risk of SIDS, especially among those populations in which incidence is higher. Additional research strives to identify infants at risk for SIDS and to develop preventive approaches.
Through its program on Disorders of the Newborn, the PPB focuses on basic and clinical studies concerned with the etiology, pathophysiology, therapy, and follow-up of conditions such as disordered adaptation to extrauterine life, hyperbilirubinemia, and sequelae of prematurity (e.g., asphyxia, respiratory distress, bronchopulmonary dysplasia, hypoglycemia, anemia, and infection), that are associated with the perinatal and neonatal period.
The PPB also studies issues related to preterm labor and birth, currently a primary cause of neonatal mortality, with significant short- and long-term morbidities for those who survive. Research supported by the PPB is contributing to the state of understanding of optimal care (medical and behavioral-based care) of the preterm infant.
Recent PPB advances in infant health research include:
- Back to Sleep becomes Safe to Sleep. The NICHD and its collaborators recently expanded the Back to Sleep campaign into the Safe To Sleep® campaign to more accurately reflect its broad focus on SIDS risk reduction and safe sleep environments. The Safe to Sleep® campaign incorporates the NICHD's research findings on SIDS, as well as the latest safe sleep recommendations.
- Benefits of higher oxygen, breathing device persist after infancy. By the time they reached toddlerhood, very preterm infants originally treated with higher oxygen levels continued to show benefits when compared to a group treated with lower oxygen levels, according to a follow-up study by the NICHD-funded Neonatal Research Network (NRN) that confirfbas earlier network findings, Moreover, infants treated with a respiratory therapy commonly prescribed for adults with obstructive sleep apnea fared as well as those who received the traditional therapy for infant respiratory difficulties, the new study found. Read more about this study.
- Iron-fortified formula may contribute to developmental problems. A recent study supported by the NICHD PPB found that healthy children who received iron-fortified formula in infancy had more developmental problems related to intelligence quotient (IQ), achievement in arithmetic, and motor coordination than did infants fed low-iron formula. To learn more, read the study.
- New findings on infection treatment for preterm infants. A recent study by researchers with the NRN detected similar morbidity and mortality rates in very low birthweight (VLBW) infants infected with methicillin-susceptible Staphylococcus aureus (MSSA) and in VLBW infants with methicillin-resistant S. aureus (MRSA). The study results suggest that health care providers should focus equally on preventing and managing both MRSA and MSSA infections among VLBW infants. Learn more about these infections by reading the study.
Pediatric Growth and Nutrition Branch (PGNB)
The NICHD's PGNB is supporting several areas of research pertinent to infant care and infant health. For example, the Growth and Development program is focusing on basic research about growth-promoting polypeptides and hypothalamic-releasing factors that interact to influence normal growth and physiological development. Basic and clinical studies of the etiology of growth retardation and treatment for this disorder are also being supported.
The PGNB's Nutrition program is studying the complex nutritional relationships between the mother and her fetus, the placental transfer of nutrients, and the role of nutrition in infant development. Research interests focus on the nutrient requirements of normal, premature, and growth-retarded infants and on the contributions of human milk and its components to optimal infant nutrition. Researchers are encouraged to assess how maternal factors affect milk composition and lactation performance. Read about a recent PGNB-supported finding within this research area:
- Protein in human milk affects infant weight gain. An increasing number of children worldwide are overweight or obese. Overweight and obese children are at a higher risk for a range of medical problems, including type 2 diabetes. Previous studies have indicated that children who were breastfed were less likely to become obese in early life, compared with children who were fed with infant formula. Scientists questioned whether adinopectin, a protein found in breast milk, could account for the lower weight in children who were breastfed. To better understand the relationship between breastfeeding and childhood obesity, researchers examined weight gain for the first 2 years after birth in 192 infants.
Scientists found that high levels of adinopectin in breast milk were associated with lower infant weight during the first 6 months after birth, but also with accelerated weight gain in the second year after birth. Combined, these results indicate that human milk adinopectin may help reduce weight gain early, but the infants may "catch up" and gain weight faster after breastfeeding has ended. Understanding these complex interactions may help reduce the risk of childhood obesity in the future. Learn more about this study.
As a complement to its studies on nutrition, the PGNB is supporting research into the normal development of the infant gastrointestinal system and digestive function, including research on necrotizing enterocolitis (NEC), which remains a major cause of morbidity in the neonatal period. The PGNB began funding seven projects on NEC in 2008.
The research priorities of the Prevention of Chronic Disease program include obesity, hyperlipidemia, and insulin resistance in childhood and adolescence. Special emphasis is placed on developing methods for detecting children with potential diabetes and for developing successful techniques of immunomodulation to prevent or mitigate the body's immune attack on the pancreatic beta cell. Similarly, studies of obesity and hyperlipidemia focus on the etiology, consequences, and prevention of childhood obesity and hyperlipidemia.
Intellectual and Developmental Disabilities Branch (IDDB)
Newborn screening research initiatives within the IDDB have experienced considerable growth and reemphasis. Newborn screening enables the identification of infants who are at risk for congenital disorders (often biochemical, endocrinologic, and/or genetic) for which early interventions and treatments have the potential to reduce morbidity and mortality.
Although routine screening has occurred at the state level since the 1970s, the screening tests available have historically varied significantly by state; similarly, few states have systematically evaluated the rationale for or efficacy of the tests. Because these programs screen more than 4 million infants per year, newborn screening represents the most common form of genetic testing performed in the United States.
Division of Intramural Research (DIR)
Research within the NICHD's DIR includes the development of vaccines for bacterial diseases, especially those found in children.
DIR investigators study, uncover, and reevaluate clinical, epidemiologic, and immunologic data. They evaluate investigational vaccines suitable for clinical study in experimental animals and then submit them to the appropriate institutional review board and the U.S. Food and Drug Administration for evaluation of their safety and immunogenicity in adults, children, and infants, and, finally, for their efficacy. Surface polysaccharides of gram-negative pathogens, capsules, or lipopolysaccharides are essential virulence factors (factors that enable the development of disease within the host) and protective antigens. The immunogenicity of polysaccharides can be improved by binding to carrier proteins. Bacterial toxins or toxoids and viral capsid proteins may be protective antigens and may serve as carrier proteins.
Division of Intramural Population Health Research (DIPHR)
The mission of the DIPHR includes the design and conduct of original and collaborative research in reproductive, perinatal, and pediatric health; the determinants of health behavior; and statistical theory and methodology relevant to these problems.
The Upstate New York Infant Development Screening Program aims to determine whether infertility treatments, such as ovulation-stimulating medications and various assisted reproductive technologies, adversely affect the growth and motor and social development of children from birth through age 3 years. The study is also addressing the question of whether these technologies are associated with differences in the timing or rates of infant and child development, including motor and social development; the development of major and, especially; and minor neurodevelopmental impairments, and with physical growth patterns (e.g., length, weight, head circumference) and proportionality (weight for length).
- The Best Pharmaceuticals for Children Act (BPCA) Program, which dates from 2002, focuses on the drugs used for children. The goal of BPCA activities at the NICHD, which are conducted through the Obstetric and Pediatric Pharmacology and Therapeutics Branch, is to improve pediatric therapeutics through preclinical and clinical drug trials that lead to changes in drug labeling.
- In 1994, the NICHD and its partners, including the American Academy of Pediatrics, launched the Safe to Sleep® Campaign (formerly the Back to Sleep campaign) to raise awareness about SIDS and to educate parents, caregivers, and health care providers on ways to reduce the risk of SIDS. Since then, the U.S. SIDS rate has declined by 50%, and the percentage of infants placed on their backs to sleep has more than tripled.
In addition, the NICHD supports the two networks described below with the aim of increasing our understanding of preterm labor and birth and identifying their causes as well as improving treatment for preterm infants.
- The Neonatal Research Network (NRN), funded by the PPB, was initiated in 1986 to conduct multicenter clinical trials and observational studies in neonatal medicine to reduce infant morbidity and mortality and promote healthy outcomes. Several important studies are under way at NRN centers, including a trial called "Optimizing hypothermia as neuroprotection at <6 hours of age for neonatal hypoxic ischemic encephalopathy."
- The Newborn Screening Translational Research Network (NBSTRN) , funded through the IDDB, seeks to improve the health outcomes of newborns with genetic or congenital disorders through an infrastructure that provides the research community with access to robust resources for newborn screening.