Neonatal mortality remains a major health challenge across the world, which involves neonatal sepsis and other related factors of prematurity. Though many strides have been done in reducing NMR, there is a need for more appropriate interventions and strategies directed towards addressing the rise in the escalation of AMR. Combating AMR will be critical in improving neonatal survival rates while giving each newborn a healthier start into life globally.

The newborn period is the key period for infant health, and the first 28 days of life are critically important-both for survival and as a base to set lifetime health and development. Neonatal deaths globally have witnessed a significant decline over the past couple of decades. The neonatal mortality count has significantly reduced dropping from a high of 5 million in 1990 to as low as 2.3 million as of 2022. However, this decline notwithstanding, neonatal mortality is still staggeringly high across low-and middle-income nations.

Neonatal mortality rates are 22 per 1000 live births in India. Neonatal sepsis and prematurity are the main causes of neonatal deaths in these tragic events. Recognizing the gravity of the issue the Indian government started the Indian Newborn Action Plan (INAP) in 2014. The goal is to take NMR down to the single digits by 2030. This initiative has brought in several key interventions, including antenatal care (vaccines, micronutrient supplementation), skilled birth attendance, clean birth practices, and neonatal resuscitation techniques. More promisingly, postnatal interventions, including early initiation of breastfeeding and skin-to-skin contact, have been proven to work well in improving newborn survival rates.

Despite these improvements, one of the biggest concerns in neonatal care today is the growing problem of antimicrobial resistance (AMR) which seriously threatens efforts to reduce neonatal mortality.

What is Antimicrobial Resistance?

Antimicrobial resistance occurs when microorganisms such as bacteria, viruses and fungi evolve over time and become resistant to commonly used antibiotics and other medications. This resistance makes infections more difficult to treat, increasing the risk of mortality and complicating treatment options. The World Health Organization has classified AMR as one of the most urgent global health threats since it not only causes death and disability but also places immense pressure on healthcare systems, significantly raising the economic burden.

The sources of AMR are many, including poor hygiene and infection control in healthcare settings, overuse and misuse of antibiotics. Contributing factors to this rapidly growing problem are antibiotic prescriptions for patient needs that do not require them and failure to complete antibiotic courses, as prescribed.

AMR and Newborn Health

For neonates, the risk is much more vital for AMR. Neonates are particularly prone to developing infections due to their rather weak immune systems. Neonatal sepsis, severe bacterial infection, is one of the leading causes of neonate deaths and it often manifests complications when it is because of drug-resistant pathogens.

According to Dr. Apoorva Taduri, Consultant Neonatologist, "Neonatal sepsis accounts for a significant proportion of neonatal deaths, and AMR is making it worse. MDR pathogens cause around 30% of neonatal sepsis mortality globally.

Maternal health and care are also factors influencing AMR in neonates. Over-prescription of antibiotics during pregnancy increases the risk of neonatal sepsis and the development of multi-drug-resistant pathogens in newborns. This calls for prudent use of antibiotics during pregnancy and at the time of delivery. In fact, studies indicate that indiscriminate use of antibiotics in mothers has a direct impact on neonatal health, which may eventually lead to resistant infections in newborns.

One of the major issues is that the drug-resistant bacteria are causing an increasing number of healthcare-associated infections in the neonatal care settings, which include NICUs. Infections by such bacteria prove to be challenging to treat; they require more advanced, expensive interventions, and the period of risk of mortality and morbidity is extended.

Counteracting AMR in Neonatal Care

To combat AMR and reduce neonatal mortality a multifaceted approach is necessary. Dr. Taduri emphasizes the continuation of the strategies outlined by the Indian Newborn Action Plan (INAP), specifically in reducing neonatal sepsis and improving infection control. However, to combat AMR more must be done to ensure proper use of antibiotics in both maternal and neonatal care settings.

Key strategies for reducing AMR in neonatal care are:

1. Improving Infection Prevention Practice: This implies, therefore, that more efforts would be made regarding stricter hospital hygiene standards, strict equipment sterilization after its usage and even maintaining adequate hand hygiene. Enhanced infection control practices greatly impact minimizing AMR pathogens distribution.

2. Antibiotic Stewardship- Teaching the healthcare providers how not to use antibiotics is a crucial thing in preventing overuse prescription. Antibiotic stewardship programs are designed to promote use of antibiotics only when truly required; appropriate drug, dose and length of treatment should be taken.

3. Improved access to WASH: Access to clean water and sanitation is a fundamental aspect of preventing infections in mothers and newborns. WASH interventions such as clean birthing practices, can reduce the risk of neonatal sepsis due to unsanitary conditions.

4. Maternal Health Strengthening: Proper maternal care, such as proper vaccination, antenatal steroids, and supplementation of micronutrients, can reduce the risk of prematurity and neonatal infection. Prevention of infection in mothers is the first step towards prevention of infection in newborns.

5. Early Diagnosis and Treatment: Early identification and treatment of neonatal infections are very important. This includes proper screening for sepsis and the use of appropriate antibiotics based on the local resistance patterns. It also involves ensuring that infants receive adequate neonatal care, such as those provided in Special Newborn Care Units (SNCUs).

The rise of antimicrobial resistance is a global health challenge that requires urgent action. Combating AMR requires a coordinated effort from governments, healthcare systems and communities worldwide. In neonatal care, addressing AMR is essential to further reducing neonatal mortality rates and ensuring that every newborn has the opportunity to thrive.

As Dr. Taduri concludes, "While we have made substantial progress in reducing neonatal mortality, the emerging risk of antimicrobial resistance creates a major challenge for our efforts. Combating AMR requires a global collective effort, with priorities on infection prevention, responsible use of antibiotics, and enhancement of healthcare practices to ensure a healthier future for all newborns."

Dr Apoorva Taduri is a Consultant Neonatologist at Fernandez Hospital

The US is facing a long-term decline in the birth rates. As per experts, this raises a concern in terms of what this means for country's future, especially with regard to health of its population, economy, and caregiving systems.

A Slight Rise in 2024

As per the new data released by the US Centers for Disease Control and Prevention (CDC), more than 3.6 million babies were born in 2024. This is just a 1% increase from the previous year, which had been the lowest record in births. While this uptick may seem encouraging, it is not enough to reverse the troubling trend.

The US fertility rate remains around 1.6 births per woman. This is significantly below the 2.1 births that is required to sustain the population growth without immigration.

As per the demographers, this continuous drop began during the Great Recession in 2007. It has continued steadily since.

Shift In Teen Births

One of the biggest shifts is the steep decline in teen births. In 1991, about 62 of every 1,000 teenage girl had a child. This number has now fell to just under 13 by 2024. This is a historic low that reflects a positive shift, better education, access to contraception, and changing attitudes about early parenthood.

Similar trend is seen among women in their 20s, as the rates their too have dropped. In 2007, about 106 of every 1,000 women aged 20 to 24 gave birth. By 2024, the number has dropped to around 57. For women aged 25 to 29, the rate fell from 118 in every 1,000 women in 2007, to 91 in 2024.

Though there has been a slight rise in births among women in their 30s, experts say that it is not enough to offset the overall decline.

Are Births Being Delayed?

“One of the big questions is all these births that haven’t occurred—are they just being delayed?” asked Ken Johnson, a demographer at the University of New Hampshire. “Or are a lot of these births going to be forgone entirely?”

The answer has significant public health implications. A shrinking younger population could lead to fewer caregivers for an aging society, higher burdens on healthcare systems, and a smaller workforce contributing to national health programs like Medicare.

Why Are Fewer Americans Having Kids?

As per experts, while people still want children, there is a lingering financial burden and social barriers too that get in a way. High student loans, debt, and the rising coast of child care, unstable housing, along with limited access to paid parental leave are all major concerns.

“People don’t have kids when they don’t feel good about their own futures,” said Karen Benjamin Guzzo, a family demographer at the University of North Carolina.

Can Policies Help?

Some political leaders are proposing measures to encourage parenthood. Former President Trump, for instance, has suggested “baby bonuses” and scholarships for married couples or parents. However, Johnson believes that without stronger, systemic support, the U.S. birth rate is unlikely to bounce back to replacement level.

Immigration may help slow the effects of falling birth rates. Many immigrants move to the U.S. with plans to start families, Johnson noted. “They bring the potential for babies in the future.”

Not so long ago, childhood was seen as a joyful chapter of life rich with play, discovery, and endless imagination but now, a dangerous shift is underway. More and more number of children and teens are fighting severe emotional struggles that were once considered rare in youth. From depression and anxiety to more serious, more intricate mood disorders, the emotional well-being of the next generation is in shambles.

A study appearing recently in JAMA Pediatrics put a spotlight on a frightening trend: a sharp and consistent rise in mood disorders in children and teenagers over the last six years. Over 1 in 10 kids—10.6%—suffered from anxiety in 2022, compared to 7.1% in 2016. Depression also increased, hitting 4.6% of children in 2022, up from 3.2% in 2016. These statistics are not abstract; they reflect an escalating emotional crisis among our children, one that requires immediate and thoughtful action from parents, medical professionals, educators, and policymakers.

These aren't one-time occurrences. They're indicators of a broader crisis that is occurring in schools, homes, and communities—one which was fueled by the pandemic but was well under way before that. As the stressors of childhood change and escalate, so does the psychological load on our children.

But whereas scraped knees or the flu are tangible and obvious, mood disorders can be intangible, misunderstood, or dismissed altogether. And if left unidentified or unaddressed, the impact can trail a child into adolescence and adulthood, impacting everything from grades to relationships, self-worth, and health outcomes.

Not Just a Post-Pandemic Phenomenon

Although the COVID-19 pandemic shed international light on mental health conditions, scientists explain that the increased prevalence of mood disorders among adolescents is not exclusively a pandemic phenomenon. "Our results highlight the urgent need to address youth mental health, which continued to decline even as we exited the pandemic," says Marie Heffernan, assistant professor of pediatrics at Northwestern University Feinberg School of Medicine.

The research, conducted on the National Survey of Children's Health, shows a bittersweet pattern: although a few physical medical issues such as asthma and migraine are reducing in numbers, mental and emotional ailments are increasing. This contrast serves to emphasize that children's emotional health must command just as much clinical attention as does their bodily well-being.

What Are Mood Disorders?

Mood disorders, or affective disorders, are mental illnesses that encompass major depression, bipolar disorder, and dysthymia. They are marked by disturbances in an individual's emotional state that exceed the normal ups and downs of childhood or adolescence. The emotional changes are persistent, intense, and hard to control, and they tend to interfere with a child's functioning at home, school, and in social relationships.

Some of the most frequently diagnosed mood disorders in children and adolescents are:

Major Depressive Disorder: Ongoing sadness or irritability for two weeks or more.

Persistent Depressive Disorder (Dysthymia): Ongoing low-grade depression for one year or more.

Bipolar Disorder: Intermittent periods of elevated and depressed mood.

Disruptive Mood Dysregulation Disorder (DMDD): Intense irritability and persistent outbursts of temper.

Substance-Induced Mood Disorder: Mood disturbances due to medication, drugs, or toxins.

Mood Disorders Caused by Medical Illnesses: Mood shifts brought on by chronic disease or injury.

How to Identify the Warning Signs

In contrast to adults, children and adolescents tend to convey emotional distress through physical complaints or behavioral problems instead of talking about sadness or anxiety. This can make it more difficult to identify mood disorders. The Children's Hospital of Philadelphia states that symptoms can be:

• Severe or persistent sadness, irritability, or anger
• Substantial changes in sleep, appetite, or energy
• Withdrawal from friends or family, or withdrawal from social events
• No interest or pleasure in activities that they used to enjoy
• Difficulty with schoolwork without an identifiable cause
• Excessive physical complaints such as headaches or stomachaches

More often than not, these symptoms are confused with "phases" or attributed to stress or personality traits. That diagnostic delay can result in escalating symptoms or the emergence of comorbid conditions such as substance abuse or conduct disorders.

Why Are Today's Kids More Vulnerable Emotionally?

Experts cite several overlapping reasons for the explosion of mood disorders in young people:

Heightened Academic and Social Stress: Children today are under enormous pressure to succeed—academically, athletically, and socially—with little time left for emotional regulation.

Social Media and Online Exposure: Ongoing exposure to filtered realities, cyberbullying, and online validation cycles can exacerbate feelings of inadequacy and anxiety.

Family Life and Stress: Domestic instability, economic struggles, or family conflict can have a significant effect on a child's emotional resilience.

Deficiencies in Mental Health Infrastructure in Schools: Most schools do not have adequate psychological support staff or school programs emphasizing emotional well-being.

Stigma and Lack of Awareness: Mental health, in most communities, is still stigmatized, and its underreporting and underdiagnosis follow accordingly.

Managing Mood Disorders with Early Intervention

Mood disorders in children can be treated—if caught early. Treatments include:

• Cognitive Behavioral Therapy (CBT) to assist in coping with detrimental thought patterns in children
• Medication, as needed and very closely monitored
• Family Therapy to treat systemic stressors
• School-Based Support Services, including counseling and emotional wellness programs

Experts have said that continued concern and resources are justified at a national level to explain and treat the array of possible reasons for increasing anxiety and depression.

What Can Parents and Schools Do?

The awareness is the beginning, parents need to notice not only the changes in behaviour, but also emotional and physical signals that indicate distress. Schools, in return, require improved mental health education for teachers and more accessible support systems for pupils.

Promoting open dialogue about mental health, safe emotional release, and decreasing stigma can help children get through their feelings. As has been proven through research, numerous children benefit immensely from early, long-term intervention—and go on to live strong, healthy lives.

The emotional well-being of our children is not a specialty concern—it's a global public health imperative. With anxiety and depression levels steadily increasing, the time to take action is now. Being able to provide children with the proper resources, attention, and support systems can influence not only their emotional well-being in the short term but their capacity to thrive in the future.

The Talk. If you are an adult, a parent, or in your early adulthood, you must have heard about "The Talk". This conversation, as important as it is to have, could also be anxiety inducing.

What Exactly Is "The Talk"?

The question that may loom over parents is when is it the right age to have "The Talk"? But, before we get to that, let us discuss what "The Talk" is?

By "The Talk", people mean to drop the bomb, or address the elephant in the room. This conversation involves talking to your kids about puberty that will bring about many changes in their bodies, their minds, how they fell, and much more.

"The Talk" is not just one conversation that can happen only once in your life. It is an on-going discourse. However, having "the Talk" at least once, sets the foundation for kids and tells them that they can reach out to their parents whenever they wish to.

As per the CS Mott Children's Hospital National Poll on Children's Health, about 41% of parents reported that they approached talking with their child about puberty only when prompted by child. Only 36% of parents think it is best to have this conversation before the age of 10. So, what is the right age?

If experts are to be believed, it is best to bring this conversation up before your child brings it to you.

However, it is an anxiety-inducing process. But why is this important to talk?

“It’s easy to assume a child is too young for conversations about puberty, but many parents are surprised to find their tween already showing signs,” said Sarah Clark, Mott Poll Co-Director.

Early discussions, she explains, allow parents to present the information in an age-appropriate way, easing confusion and anxiety. If parents don’t begin the conversation, kids may seek answers from classmates, social media, or television.

Different Approaches, Different Comfort Levels

The poll revealed a wide range of parental approaches:

Proactive Parents: About half said they start conversations before questions arise.

Reactive Approach: Two in five wait until their child brings it up.

Avoidance: Around 5% avoid the topic altogether.

Many parents feel uneasy: one in five worry about embarrassment, and one in six fear saying the wrong thing. Some children resist as well—25% of parents with 10- to 12-year-olds say their child doesn’t want to talk about puberty, and a third of parents with 7- to 9-year-olds feel their child is too young to understand.

Parental History Shapes Comfort

Parents' past experiences with “The Talk” also play a role. Fewer than one in three received adequate information from their own parents. More than a third never had the conversation at all.

“Whether they realize it or not, parents may bring their own childhood experiences into how they handle this now,” Clark noted.

Navigating Topics of Sex and Reproduction

Another common challenge: knowing whether to include discussions about sex and reproduction, and if so, how much to share. Clark advises starting with the basics—physical and emotional changes—then layering in more detail over time.

Confidence in spotting puberty varies. About half of parents say they can recognize signs of puberty, and 60% of parents with 10- to 12-year-olds say they’ve already seen them. Among parents of younger children (ages 7–9), 17% have noticed early signs, while nearly a third remain unsure what to look for.