by Vanessa LoBue

We are soon approaching the 3-year anniversary of the start of the global COVID-19 pandemic. Since its inception, the pandemic is responsible for 600 million cases and over 6 million deaths worldwide. It has also seriously impacted economic, social, and educational institutions all over the world. As developmental researchers, many of us are obviously interested in the impact of the pandemic on development. Indeed, a google scholar search of COVID-19 yields over 5 million publications, covering a wide range of topics, both in and outside the area of child development. In 2021, the journal Child Development even published a special issue on the developmental impact of COVID-19, but the issue covered a broad range of topics relevant to children and families of all ages. What are the unique impacts of the COVID-19 pandemic on our youngest and most vulnerable population?

To address this question, last month, Infancy published their own special issue on the impacts of the pandemic on babies, which I had the pleasure of editing with Koraly Perez-Edgar, Natasha Kirkham, and Jane Herbert, featuring 10 papers from researchers in countries across the globe—including the US, Canada, France, Switzerland, the UK, and Israel—providing readers with a broad perspective on how the pandemic has differentially affected infants from a range of backgrounds. Here is a summary of what we found out.

Infants were resilient from the direct effects of the pandemic

The most notable finding from this collection of work is that infants were fairly resilient from the direct effects of the pandemic. For example, two papers examined the effects of mask-wearing on infant learning. Sperber et al. found that mask wearing had no effect on US infants’ language skills or socioemotional development, and Wermelinger and colleagues reported no effect on Swiss infants’ gaze-following behavior based on whether they were tested pre- or post-pandemic.

Two additional papers examined the impact of mask-wearing on infant face processing, finding little evidence for an impact. For example, Galusca et al. (2023) provides evidence that 9- and 12-month-old infants (but not 3- and 6-month-old infants) had a novelty preference for inverted masked faces when presented next to the same face upright, suggesting (consistent with previous research) that by 9 months, infants recognized that a masked image was indeed a face. Further, DeBolt and Oakes (2023) reported that US 6- and 9-month-old infants were able to remember masked faces when the faces were later presented unmasked.

Similar non-effects were found for the social-emotional domain. For example, Shakiba et al. (2023) reported no differences in Israeli parents’ emotional availability to their 3- to 12-month-old infants after the onset of the pandemic, and a normative increase in infants’ social responsiveness over time. Similarly, MacNeill et al. (2023) reported no differences in the impact of stress in pregnancy on US infants tested pre- and post -pandemic.

The pandemic negatively impacted caregivers’ mental health

Although there was little evidence in the special issue that infants were negatively impacted by the pandemic directly, the same was not true for parents. Sperber et al. (2023) reported that US mothers of 12- and 24-month-old infants who felt that the pandemic disrupted their lives also experienced more anxiety and depression than parents who did not feel the same disruption. Further, Reinelt et al. (2023) found that Swiss mothers who reported having a maladaptive response to the pandemic also reported a decrease in their well-being.

Despite negative impacts only being observed in parents, there was some evidence that parents’ negative responses to the pandemic might have indirectly affected their infants.  Reinelt et al. (2023) for example, reported that mothers who distanced themselves from infants during the pandemic had infants with more regulatory problems. Similarly, UK mothers who reported greater distress during the pandemic had infants who experienced higher externalizing and internalizing problems, as well as difficulties with executive function (Hendry et al., 2023).

There are ways to buffer infants from negative impacts

The news for caregivers isn’t all bad. Some of the papers suggested that there are ways that caregivers can buffer infants from the indirect effects of the pandemic on infants’ well-being. Hendry et al. (2023) found that engaging infants with enriching activities could act as a buffer, and Roche et al. (2023) also found that video chat interactions with others—grandparents for example—could also help buffer infants from any negative socioemotional outcomes of isolation. Finally, Rattaz et al. (2023) found that Swiss infants—who likely spent more time with both their mother and father than usual during lockdowns—were better able to regulate their emotions in triadic interactions than pre-pandemic infants.

The main take home message here is that although infants in our special issue did not necessarily show evidence of experiencing direct negative effects of the pandemic, parents certainly showed evidence of a negative emotional impact, which could in turn affect infants indirectly. Indeed, there is an abundance of evidence that depression and anxiety in parents have long-term impacts on their children, regardless of whether parents are coping with a global pandemic. Thus, support for parents during these stressful times is an important step we can take to protect parents, and in turn,  infants.

For more information or to read these papers, you can find the full special issue (Infancy, 2023, Volume 28, Issue 1) here: https://onlinelibrary.wiley.com/toc/15327078/2023/28/1

About the Author

by Nancy Aaron Jones, Jillian Hardin, and Joy Longo 

Parturition as well as the days and weeks that follow are transitional experiences for families. The interactive “dance” between mothers and infants as well as shared encounters with other family members sets the stage for socio-emotional success and neurodevelopmental progress. Newborns need care and affection! Collectively research has shown that lack or reduced socio-emotional interchanges (e.g. in groups that have illness, depression or other risks) has been shown to negatively affect the infant’s development (Feldman & Eidelman 2009; Hardin et al., 2021; Jones et al. 2004) while opportunities for optimal early socio-interactive experiences can benefit responsiveness as well as stimulate infant brain and behavioral function of mother-infant dyads (Hardin et al., 2020).

The onset of the COVID-19 world-wide pandemic has not only increased levels of maternal stress, depression, and anxiety (Cameron et al., 2020; Fernandes, Canavarro, & Moreira, 2021 ) but has also reduced opportunities for socio-emotional interactions with others. Further, interactive contact and care between mothers and the healthcare professionals who support mothers and their newborns has been impacted and changed by the pandemic (Sweet et al., 2021). So, over the last two years as COVID obstructed the normal delivery of care in health systems, we asked: What is the experience of mothers who delivered an infant in a healthcare setting during COVID-19?  Specifically our research questions were:

1. how has the pandemic changed social interaction opportunities of families surrounding childbirth and postnatal care? and
2. how has the pandemic changed the care and perceived care, delivered by health care professionals in maternity settings?

Collecting and Listening to the Stories of New Mothers and Professionals that Support Birth and Newborn Care during COVID-19

In today’s world, new parents often turn to chat rooms, blogs, and Facebook/Instagram posts, to express parenting joys, distress, and concerns. Parents also may consult websites to fulfill the need for current and cohort-normative social information about infant care practices.  In this qualitative analysis (Hsieh & Shannon, 2005) we collected public posts and searched sites online to learn what new parents and maternal-child healthcare professionals were experiencing, what they were concerned about, and what they wanted to convey to others as pivotal in their stories of childbirth and infant care during the COVID-19 pandemic.

Our examination of the narratives focused on topics such as breastfeeding, hospital practices, and other online sites that provided information about care and support practices. Content analysis was performed to arrive at themes.

What DO parents and maternity services practitioners have to say about COVID-era births and babies?

The topics uncovered from the experiences of mothers and maternity services professionals suggest the pandemic influenced this group in a dynamic and novel way. In the early months of the pandemic, the narratives of the birth and postnatal hospital care were negative and included haphazard reactions to the contagious nature of the virus as well as the concern surrounding the serious consequences from the virus. As a consequence there were many procedural changes during birth and postpartum hospital stays, including: the complete or partial barring of father’s attendance at the birth, the family’s reduced or dissuaded ability to visit when bringing the baby home and/or when having to remain in the hospital, the accelerated timing of discharge after delivery, the inability to utilize additional experts in childbirth  or infant care (e.g., doulas, midwives, and lactation consultants) and the inability to elicit help of the extended family from childbirth and across the postpartum period.

Upon review of the public posts, four consistent themes emerged in our analysis. The first common theme noted was the alteration of care by professionals to accommodate families. In one instance, a mother indicated “It was very much uncharted waters for everyone. Everyone is walking this line of trying to protect you and the baby, and the protocols are being written in the moment.”  

A second theme noted from the narratives was that the main focus was to ensure the safety of mothers and infants during the pandemic, with a healthcare professional stating: ““The recommendation is to limit visitors at this time. . . parents need to screen their visitors and limit them to one or two people at a time…”.

The third, and not unexpected, theme documented across many of the posts was that having a baby during the pandemic produced a significant amount of emotional upheaval..  As one mother noted “Everyone is so sad. Everyone tries to say, ‘Oh, she’s so cute,’ but the conversation turns to coronavirus concerns in two seconds. I feel like I’ve been robbed of the joy that comes with having a baby.'”

Finally, the fourth and final theme we noted was that families were able to successfully adapt to the circumstances and some mothers even reported a potential benefit to the closeness of the family. For example, a healthcare professional stated: “There may also be some good things including more time to be at home to rest and less pressure to be dressed up and doing it all. Your partner may be around more to help.”

Ultimately from this analysis of the narratives, a spectrum of experiences emerged among parents and maternal-child healthcare professionals, including negative as well as some—surprisingly–positive effects on family interactive and psychosocial experiences.

Conclusions: How Does this Inform Families and Professionals for Understanding Development?

Collecting, examining and absorbing the information available in the online comments made by families and maternity services professionals made us acutely aware that there were various responses to COVID-19 across the world and across the spectrum of individual settings (Sweet et al., 2021).  The themes uncovered by our analysis did inform and bring attention to the important role of professionals to support mothers during childbirth and during infant postnatal care. The narratives show that both families and healthcare personnel experienced significant emotional and psychosocial effects due to the pandemic but both groups also adjusted their practices to support the mother-infant dyad to keep them safe. There were circumstances where policies were being developed and modified based on new evidence but ultimately, families adapted and were supported as needed (Foye et al., 2021).

Finally, the narratives that were reviewed may have implications for the development of hospital, health care, or social policies. It may be necessary to prepare ourselves and the institutions we’ve established to respond to the needs of mothers and infants by making sure the policies are in place to deal with future pandemics. Our institutions should be prepared to attenuate the negative effects of these crises in families as neurodevelopmental foundations and affiliative bonds leading to attachment are influenced and established at early developmental periods (Diamond et al., 2020: Hardin et al., 2021).

References

Cameron, E. E., Joyce, K. M., Delaquis, C. P., Reynolds, K., Protudjer, J. L. P., & Roos, L. E. (2020). Maternal psychological distress & mental health service use during the COVID-19 pandemic. Journal of Affective Disorders, 276, 765–774. https://doi.org/10.1016/j.jad.2020.07.081

Diamond, R. M., Brown, K. S., & Miranda, J. (2020). Impact of covid-19 on the perinatal period through a biopsychosocial systemic framework. Contemporary Family Therapy, 42(3), 205–216. https://doi.org/10.1007/s10591-020-09544-8 

Feldman, R., & Eidelman, A. I. (2009). Biological and environmental initial conditions shape the trajectories of cognitive and social-emotional development across the first years of life. Developmental Science, 12(1), 194–200. https://doi.org/10.1111/j.1467-7687.2008.00761.x

Fernandes, D. V., Canavarro, M. C., & Moreira, H. (2021). Postpartum during COVID‐19 pandemic: Portuguese mothers’ mental health, mindful parenting, and mother–infant bonding. Journal of Clinical Psychology, 77(9), 1997–2010. https://doi.org/10.1002/jclp.23130

Foye, U., Dalton‐Locke, C., Harju‐Seppänen, J., Lane, R., Beames, L., Vera San Juan, N., Johnson, S., & Simpson, A. (2021). How has Covid‐19 affected mental health nurses and the delivery of Mental Health Nursing Care in the UK? results of a mixed‐methods study. Journal of Psychiatric and Mental Health Nursing, 28(2), 126–137. https://doi.org/10.1111/jpm.12745

Hardin, J., Jones, N.A., Mize, K.D., & Platt, M. (2020). Parent-training with Kangaroo Care impacts mother-infant neuroendocrine activity & infant neurophysiological development. Infant Behavior and Development, 58, 101416, https://doi.org/ 10.1016/j.infbeh.2019.101416

Hardin, J., Jones, N.A., Mize, K.D., & Platt, M. (2021). Affectionate touch in the context of breastfeeding and maternal depression influences infant neuro-developmental and temperamental substrates. Neuropsychobiology, 80:158–175. http://dx.doi.org/10.1159/000511604

Jones, N.A., McFall, B.A., & Diego, M.A. (2004). Patterns of brain electrical activity in infants of depressed mothers who breastfeed and bottle feed: the mediating role of infant temperament. Biological Psychology, 67, 103-124. https://doi.org/10.1016/j.biopsycho.2004.03.010

Sweet, L., Bradfield, Z., Vasilevski, V., Wynter, K., Hauck, Y., Kuliukas, L., Homer, C. S. E., Szabo, R. A., & Wilson, A. N. (2021). Becoming a mother in the ‘new’ social world in Australia during the first wave of the COVID-19 pandemic. Midwifery, 98, 102996. https://doi.org/10.1016/j.midw.2021.102996

About the Author

by Abigail Fiske, Gaia Scerif, & Karla Holmboe

There is no question that the COVID-19 pandemic has changed the world. It is hard to ignore the visible impact – the rising and falling of infection rates, the “stay at home” restrictions, and the incredible scientific advances that brought us life-saving vaccines. Yet there are some impacts which, although not so visible, have nonetheless changed everyday life profoundly. This is particularly true for mothers and their infants. A world that was once in three-dimensions, with a social support network, grandparents offering hug and kisses in abundance, the freedom to run, play, and share new adventures each day. An entire world that, at the start of the pandemic, was reduced to two-dimensions: living and learning through a computer screen, from behind masks and closed doors — a whole new world.

It is therefore not surprising that early in the pandemic, there were emerging reports of increased depressive symptoms and anxiety in mothers of young children around the globe¹.  In light of the well-known links between maternal mental health and early childhood temperament ^2–4, we must consider the potential consequences that changes in maternal mental health could have on the development of temperament in early childhood.

In this blog post, and in our recent research study, we probe the question: “What impact has the COVID-19 pandemic had on maternal mental health and early childhood temperament?”

Capturing the experiences of mothers with young children

In March 2020 in the United Kingdom, the pandemic was unfolding at an alarming rate. Schools, pre-schools, and nurseries were closed, and the public were instructed by law to stay at home and remain socially distant from their families. We wanted to capture this unprecedented situation and the impact that this could have on the lives of families with young children. To do so, we developed the “COVID-19 Impact Questionnaire for Families with Young Children” which assessed the specific pandemic-related impacts on maternal mental health as well as on everyday family life.

During the first (April 2020) and second (November 2020) national lockdowns, we sent online questionnaires to a large sample of mothers of young children (aged 6 – 48 months) who were taking part in an ongoing longitudinal study. From this, we quickly gained subjective reports of how the pandemic had changed the world of mothers with young children. For example, one mother explains the severe impact of the pandemic on her mental health:

“Although my anxiety levels and stress levels are through the roof as a result of this pandemic, it is not the bug that has caused this…it is the impact of being stuck at home, having had all support networks ripped away…The impact of the pandemic on our mental health is horrific, and the damage is going to last for years.”

Maternal mental health during the COVID-19 pandemic

Additionally, we gained an index of pandemic-related stress by compiling ten questionnaire items into a ‘COVID-19 Stress Scale’. These included questions about negative feelings relating specifically to the pandemic such as levels of stress, worry, anxiety and depression. Interestingly, mothers’ pandemic-specific COVID-19 stress score was significantly higher in April than in November, suggesting that overall pandemic-related stress declined from the first to the second national lockdown. Mothers also completed a well-validated depression questionnaire ⁵, which provided us with a more global measure of their depressive symptoms. In contrast to existing during-pandemic research, we observed no significant increase in maternal depressive symptoms across the pandemic.

What about the impact on early childhood temperament?

Maternal reports of infant and early childhood temperament (using gold-standard early childhood temperament questionnaires ^6,7 indicated a significant increase in effortful control (the effective use of strategies to regulate emotions and behaviour) across the pandemic, and no significant change in ratings of negative affect (negative emotionality) or surgency (positive affect/extraversion). We also observed longitudinal and concurrent associations between maternal depressive symptoms and child temperament across the pandemic. Since we found no associations relating to COVID-19-specific stress, and no discernible negative effect of the presence of pandemic on child temperament in pre- to during-pandemic analyses, we have no evidence to suggest that these associations are a consequence of the pandemic. Instead, it is possible that these effects would typically be expected at this point in development, although further research is needed to confirm this.

An important consideration

It is key to note that potential pandemic effects on both child temperament and maternal well-being might be crucially moderated by the age of children sampled by individual studies. For example, studies focusing on mothers during pregnancy or the early post-partum period may be capturing an elevation of pregnancy-related stressors or depressive symptoms as a result of negative pandemic-related changes, such as difficulty in accessing healthcare and social support. In contrast, studies surveying mothers of school-aged children are likely capturing an entirely different set of challenges during the pandemic, such as the pressures of school closures, home-schooling and financial difficulties from reduced work hours. In our study, we captured the experiences of mothers with young children (under 4 years of age) and, in doing so, have contributed to the shared effort of gathering knowledge about the differential impact of the COVID-19 pandemic on diverse groups within the population.

So, what does this all mean?

In a time where we are all adapting to a new world in which there are many negative consequences of the COVID-19 pandemic, we are pleased to report no distinct impact of the pandemic on maternal depressive symptoms and the typical development of temperament across infancy and early childhood. Of course, these findings relate primarily to the initial stages of the pandemic, and an important caveat is that our sample consisted of primarily White British mothers living in an affluent part of the UK.

We strongly encourage further longitudinal during-pandemic studies that can help to establish whether the resilience of temperament development found in our study also applies in more disadvantaged and at-risk populations of mothers and children, both throughout the UK and across the globe.

This blog post is based on the authors’ recent longitudinal research on maternal depressive symptoms and early childhood temperament during the pandemic: Fiske, A., Scerif, G., & Holmboe, K. (2021, July 2). Maternal depressive symptoms and early childhood temperament before and during the COVID-19 pandemic in the United Kingdom. https://doi.org/10.31234/osf.io/quket. See also our project on the Open Science Framework website for further information and open access to data associated with this study [https://osf.io/zg97d/].

References

1. Hessami, K., Romanelli, C., Chiurazzi, M. & Cozzolino, M. COVID-19 pandemic and maternal mental health: a systematic review and meta-analysis. Journal of Maternal-Fetal and Neonatal Medicine (2020) doi:10.1080/14767058.2020.1843155.
2. Shapiro, A. F., Jolley, S. N., Hildebrandt, U. & Spieker, S. J. The effects of early postpartum depression on infant temperament. Early Child Dev. Care 190, 1918–1930 (2018).
3. Spry, E. A. et al. Maternal and paternal depression and anxiety and offspring infant negative affectivity: A systematic review and meta-analysis. Dev. Rev. 58, 100934 (2020).
4. Rigato, S., Charalambous, S., Stets, M. & Holmboe, K. Maternal depressive symptoms and infant temperament in the first year of life predict child behaviour at 3 years of age. (2020) doi:https://doi.org/10.31234/osf.io/j2de8.
5. Beck, A. ., Steer, R. . & Brown, G. Beck Depression Inventory- II. (APA PsycTests, 1996). doi:https://doi.org/10.1037/t00742-000.
6. Putnam, S. P., Helbig, A. L., Gartstein, M. A., Rothbart, M. K. & Leerkes, E. Development and assessment of short and very short forms of the Infant Behavior Questionnaire-Revised. J. Pers. Assess. 96, 445–458 (2014).
7. Putnam, S. P., Gartstein, M. A. & Rothbart, M. K. Measurement of fine-grained aspects of toddler temperament: The Early Childhood Behavior Questionnaire. Infant Behav. Dev. 29, 386–401 (2006).

If you have expertise in covid-related issues in countries outside the United States and would like to write a post for the ICIS Baby Blog, please let us know!

About the Author

by Ashley Ruba

COVID-19 completely changed our social lives. Between physical distancing, cancelled family gatherings, and continual mask-wearing, we have seen far less of one another. While these social changes have been undeniably difficult for everyone, caregivers have been especially concerned about how these changes might impact their infants. In many conversations over the past year, I have been asked the same question: how will mask-wearing impact infants’ emotional development?

How do infants learn about others’ emotions?

Infants’ environments are full of emotions. Caregivers, siblings, and others display their emotions in many different ways across many different situations. From the moment they are born, infants are bathed in this rich emotional information.

A few months after birth, infants begin to notice subtle differences in how people display emotions (Ruba & Repacholi, 2020). Four-month-olds can see the difference between a smile and a frown, and they can hear the difference between laughter and crying. Shortly thereafter, infants learn that different types of emotion cues tend to pair together. Seven-month-olds expect a smiling face to pair with laughter, and a frowning face to pair with sounds of crying. Infants also start to notice that certain emotion cues tend to occur in different types of situations. Caregivers may predictably smile and laugh during playtime, frown and raise their voice when mediating a sibling disagreement, and scrunch their noses when changing a particularly dirty diaper. Infants are remarkable learners, and even 10-month-olds have begun to determine when, how, and why people display emotions (Ruba et al., 2019).

By their first birthday, infants are able to adjust their behavior in response to other people’s emotional cues. If an adult frowns or scrunches their nose at a new toy, 12-month-olds tend to avoid the toy. However, if an adult smiles at the toy, infants tend to play! In this case, infants have learned that an adult’s smile usually indicates that new things are safe and approachable, while a frown indicates the opposite. Through a year of observing and interacting with people, infants have learned how to use other’s emotion cues to navigate their world (Ruba & Pollak, 2020a).

Learning about emotions during COVID-19

 So, what about infants born in the past year? Will infants be able to learn about emotions—including expressions like smiles and frowns—if they cannot see people’s full faces?

In answering this question, we must keep a few things in mind. First, infants (especially newborns) spend much of their time at home with one to three caregivers. Infants’ early experiences with faces are limited to these few individuals (Smith et al., 2018), who are likely not wearing masks constantly inside their homes.

Second, and more importantly, emotions are not just displayed on the face. Emotions are communicated in many ways, including tone of voice, body posture, and physical touch. Infants can use all of these cues to figure out how another person is feeling, even if that person is wearing a mask. In fact, infants may be better at responding to emotions from tone of voice than from the face alone (Vaish & Striano, 2004). This is especially true for newborns, who have rather poor vision, but excellent hearing. While many people (including infant researchers) tend to focus on facial expressions of emotion, faces are not the only clue—or even the most important clue—to figuring out how another person is feeling (Barrett et al., 2019).

Finally, children can still determine how another person is feeling, even if that person is wearing a mask. In a recent study, Dr. Seth Pollak and I asked 7- to 12-year-old children to guess what emotion a person was displaying, based on a picture (Ruba & Pollak, 2020b). The pictures were people displaying stereotypical emotions while wearing masks, sunglasses, or no face covering. As you might expect, children’s emotion perception was better for uncovered faces compared to faces wearing masks and sunglasses; however, children still performed better than random guessing for all faces. Importantly, children’s emotion perception for masked faces did not differ from their emotion perception for faces with sunglasses. Since children regularly see people wearing sunglasses, with no obvious detriment to their emotional development, it is likely that mask-wearing would not dramatically impair emotional development either (for a similar study, see also Carbon, 2020). It is important to note that this study examined older children rather than young infants, and to date, no studies have assessed infants’ emotional development during this period of mask wearing. No doubt, infancy researchers will conduct these studies over the next few years.

Helping infants learn about emotions

 Although infants can still learn about emotions from people wearing masks, caregivers can take additional steps to facilitate their infants’ emotional development. Most importantly, caregivers should talk about emotions with their infants, early and often. Labeling your emotions clearly communicates how you feel, which is particularly important while wearing a face mask. In addition, labeling emotions (“You’re so happy!”), asking questions about emotions (e.g., “Do you feel happy?”), and elaborating on emotions (e.g., “You feel happy because grandma is here.”) facilitates infants’ emotional development (Tompkins et al., 2018). Even if your child is too young to talk, hearing these labels helps infants learn about emotions (Ruba et al., 2020). And even if you are wearing a mask, infants can still recognize familiar spoken words (Singh et al., 2021)!

Understandably, many concerns have been raised about the impact of COVID-19 on infant development. And while it will be several years before science has carefully examined these impacts, caregivers can take comfort in current research on infant emotion learning.

If you have expertise in covid-related issues in countries outside the United States and would like to write a post for the ICIS Baby Blog, please let us know!

About the Author

by Suzanne Curtin, Janet Werker, & Henny Yeung

This blog post is an adaptation of an op-ed that appeared in the Globe and Mail on Feb. 23rd, 2021.

Facemasks are an essential public health tool against the spread of COVID-19(1), but now that vaccine distribution in many rich countries is proceeding at record rates, there are renewed debates about what role facemasks will have in guarding against future resurgences of this virus and its variants. As children (and perhaps, eventually, infants) become vaccinated, there will be correspondingly new questions about the role that facemasks have in those public spaces where infants and children gather, like childcares, playgrounds, and schools. Many have thus asked how degraded auditory speech and the accompanying loss of visible facial cues from wearing masks could influence speech and language development. In ideal listening conditions, such as a controlled lab environment, there is brand new evidence from Singh, Tan, & Quinn that infants can recognize spoken words produced by a speaker wearing a mask(2). However, the muffling of speech that can occur from wearing a mask (or two, in the case of double-masking) in normal listening environments creates exactly the conditions where visible speech would be incredibly helpful – particularly if there is also background noise like in a busy classroom or daycare. Some researchers have advocated the use of clear masks, but little research has been done on whether – and what kinds of – clear masks help, with Singh et al.’s research suggesting clear masks could even distort visible speech 2 for infants.

As infancy researchers, we know that infants are attracted to faces from birth, and are sensitive to the correspondence between the sound and sight of a talking face. Indeed, work from ICIS members has shown that babies and toddlers can and do use visible information in talking faces to assist their processing and learning of spoken language. Other work from researchers working at older ages has also shown that the ability to use visual speech continues to grow across childhood and into adolescence. However, while children throughout the 4 to 14 year age range can use their immature visual speech abilities to aid perception when the auditory signal is obscured or when listening in noisy environments, a reliance on visual speech is much larger in older than younger children, and it is only in adulthood that visual cues significantly improve speech processing even in quiet environments. Even though children use visual speech information, it may not be as important for language comprehension as it is for adults.

So how concerned should we be that an increased use of facemasks compared to pre-COVID times might impact infant and child language development, and eventual school-based learning? While we need to be vigilant, there are perhaps several reasons not to be overly concerned. First, mask-wearing is not common at home, and so infants and children likely have considerable opportunity to hear language while watching talking faces. A critical research question is just how much access to this visual speech component is needed to provide sufficient exposure for language development. For now, we do think it is important to encourage face-to-face interactions in the home for parents and other home caregivers, which not only provides access to visible talking faces, but critically, also supports the kind of rich conversational interactions that we know are essential for healthy language development.

Second, it is also not known whether access to visual speech outside the home is equally important for all learners and across all environments. For spoken language, for example, access to visual speech may be crucial in only some circumstances, like in noisy environments; only for some children, like those learning in a second language at a certain age; or only in some tasks, such as when teachers are trying to teach children to map sounds onto letters. Masked faces might also pose a significant challenge for other populations, such as deaf or hard of hearing infants and children who are learning a signed language, where a great deal of critical linguistic information is conveyed through lip movements and facial expressions. Finding the answers to these questions can help parents and educators figure out alternative strategies for these settings and/or for these learners.

Third, we need to better understand how much speech information is conveyed from the parts of the face that remain unobscured by masks. While the bulk of speech is certainly conveyed by the movements of the mouth and lower face, there is also information in eye movements, head nods, and the like, which undoubtedly contribute to language understanding. The brains of infants and young children are more plastic than those of adults. Thus, young children may be able to learn – more rapidly than adults – to use the information that is available even in masked faces to facilitate understanding of what is being said. While we wait for research addressing these questions, we can take comfort from recent studies that show children – and even toddlers – can learn language in carefully selected interactive online book reading and video chat sessions, providing another avenue of access to visual speech information.

Although it is unclear how prevalent facemasks will be in public spaces over the next few years, we do think that facemasks will be more present than in pre-COVID times, particularly in global regions where vaccinations are not efficiently and equitably distributed(3). Indeed, this is not a new phenomenon:

Face coverings—whether for religious and cultural reasons, or as protection against disease or pollution—are common in public spaces within many societies, and children growing up in these societies are successful too in learning spoken language. So, until masks are no longer required, let us remember that the development of children’s use of visual speech spans many years, and there is not currently any evidence that reduced exposure to faces has any dramatic impact on speech and language development. As we wait for evidence-based best practices about mask use and language development, we should all do our best to ensure that we communicate and interact with our infants and children at home, not simply because home is where we remove our masks, but rather because decades of research has shown that language development is optimal when infants have a rich language environment, hearing lots of speech with a variety of words and sentences in socially-guided conversational interactions.

Footnotes 

1. https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus-infection/prevention-risks/about-non-medical-masks-face-coverings.html
2. Singh, L., Tan, A., & Quinn, P. C. (2021). Infants recognize words spoken through opaque masks but not through clear masks. Developmental Science, (May). https://doi.org/10.1111/desc.13117
3. https://www.washingtonpost.com/opinions/global-opinions/rich-countries-me-first-vaccine-hoarding-is-leaving-behind-low-income-nations/2021/01/23/3830e7d4-5c23-11eb-a976-bad6431e03e2_story.html

If you have expertise in covid-related issues in countries outside the United States and would like to write a post for the ICIS Baby Blog, please let us know!

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by Nina Fefferman & Vanessa LoBue

Now that the COVID-19 global pandemic is into its second year, we are finally seeing some relief in parts of the world with the approval of various vaccinations that prevent symptoms of the virus. In the United States, the three vaccines approved for current use have been shown to greatly reduce the probability of catching COVID-19 (with efficacy for preventing lab-confirmed illness ranging from 94%-95% for the two-dose Pfizer or Moderna shots to about 70% of moderate to severe illness for the single-dose Johnson and Johnson shot) (Katella, 2021). Much more importantly, all three vaccinations have been shown to almost completely prevent severe illness, hospitalization, and death.

However, these vaccinations are not yet approved for infants and small children. In fact, until this week, Pfizer’s vaccine had only approved for individuals aged 16 and up, and has just been approved by the FDA for ages 12 and up. The Moderna and Johnson & Johnson’s vaccines start at the ripe old age of 18. Although all three of these companies have already begun clinical trials in children, it’s too early to know when they will be approved and available for our younger populations. This has led several researchers, pediatricians, and parents alike to wonder when they can truly relax and feel that families with younger children are safe.

Why do we need clinical trials for children?

One question a lot of people are asking is why do we need clinical trials for children if we already have them for adults? The short answer is that children’s immune systems are immature and continue to develop throughout childhood and into the teenage years. As children’s immune systems change, they can react to vaccinations differently than adults’ immune systems. This means that not only can adult vaccinations leave children vulnerable to a specific illness, but children can also experience different side effects than adults do, which might be dangerous in some cases (Fatima, & Syed, 2018). For some diseases, we can safely provide effective vaccines to infants who are only a few months old (such as Hepatitis B, Rotavirus, or Pertussis), but vaccines given so early in life often require subsequent doses to ensure ongoing protection. Thus, it is incredibly important for vaccine trials to specifically target different age groups before they are approved for infants and young children.

Vaccines for school-aged children

It isn’t news to anyone that to prevent the spread of COVID-19, schools were closed and went to remote instruction last March. Some have returned to in-person instruction, others have adopted hybrid models with the option of both some in-person and some remote instruction, while other schools have been enduring 100% remote instruction for over a year now. Closing schools has been a costly burden on parents, students, and their surrounding communities.

Fortunately, the Phase 3 clinical trial for Pfizer studying vaccines in children aged 12-15 has just yielded excellent early results and is expected to be expanded by mid-summer. Moderna is also running advanced trials for children aged 12-17. Pfizer and Moderna have also begun trials for children as young as 6 months, but those trials are much earlier along and do not yet have any sort of timeline for FDA approval. Such a timeline depends not only on continuing to see no health problems in children receiving the vaccines, but also on the rate at which diagnosed infection in both vaccinated and unvaccinated children is identified. Indeed, early childhood vaccine schedules have to balance when children can be effectively protected, how often they need additional doses to retain that protection, the probability of exposure to the disease, and the likely severity of the health outcome if they were to be exposed. This means that paradoxically, better controlling community transmission of COVID-19 in children actually slows down the testing and approval process for emergency vaccine authorization from the FDA. But while children are less likely to experience severe disease than adults for the original strain of COVID-19, there can still be serious outcomes from illness that vaccines could ideally prevent (American Academy of Pediatrics, 2020).

With this week’s approval of Pfizer vaccines for 12- to 15-year-olds, many older children may be able to be fully immunized by this summer. For younger children, it’s reasonable to hope that tests might be concluded and analyzed by this fall or by the end of this year, and for infants perhaps by the spring of 2022. But the younger the child, the more speculative the timeline.

Vaccines for toddlers

Although it is important to vaccinate children who can pass the virus on to other children and adults in schools, as soon as children begin crawling and walking on their own, they become risky carriers of the virus. Toddlers are already being included in some trials that just began in March of 2021 (Moderna and Pfizer), but it is likely to be awhile before any vaccines are approved for this young age group. As with any group, it will be important to make sure that there are no unforeseen side effects (there have been none reported so far), and that children’s immune systems respond to the vaccine in a way that leads to meaningful protection against illness.

Vaccines for infants

For infants, most of the potential risks of exposure come from family members, peers, and caretakers at early childhood daycares. These risks can be minimized by ensuring that all eligible family members and caregivers are fully vaccinated. The original strain of COVID-19 is unlikely to cause serious illness in toddlers or infants (Ng, Bandi, & Tang, 2020), but more recent strains are infecting younger age groups, so taking precautions against exposure is still a good idea, even with infants, until a vaccine is approved for our youngest age groups. While results from clinical trials are the best way to ensure that the vaccines will not cause unanticipated side effects in infants, the main risks would come from failure to achieve full immune protection.

For both toddlers and infants, if vaccines are simply not effective in individuals with immature immune systems, they will not be approved. If, however, they are effective, but the protection wanes over time, we can expect a recommended vaccination schedule of boosters throughout childhood, which is already standard practice for many other vaccines. Parents should try to adhere as closely as possible to the recommended schedule, both to ensure consistent protection for their own children and to prevent their children from becoming sources of exposure to others.

For more information on Moderna’s clinical trials with children: https://clinicaltrials.gov/ct2/show/study/NCT04796896

For more information on Pfizer’s clinical trials with children: https://clinicaltrials.gov/ct2/show/study/NCT04816643

References

American Academy of Pediatrics (April 8, 2021). Children and COVID-19: State-Level Data Report, https://services.aap.org/en/pages/2019-novel-coronavirus-covid-19-infections/children-and-covid-19-state-level-data-report/

Fatima, K., & Syed, N. I. (2018). Dengvaxia controversy: impact on vaccine hesitancy. Journal of global health, 8(2).

Katella, K. (April 13, 2021). Comparing the COVID-19 Vaccines: How are they different? Yale Medicine, https://www.yalemedicine.org/news/covid-19-vaccine-comparison

Ng, K. F., Bandi, S., Bird, P. W., & Tang, J. W. T. (2020). COVID-19 in neonates and infants: progression and recovery. The Pediatric infectious disease journal, 39(7), e140-e142.

If you have expertise in covid-related issues in countries outside the United States and would like to write a post for the ICIS Baby Blog, please let us know!

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