Neonatal scleroderma is a rare condition in newborns that causes the skin and tissue underneath to become hard and tight. Early signs of neonatal scleroderma often include skin that feels cold, waxy, or difficult to pinch, and the hardening may spread over hours to days. It is seen most often in premature babies or very sick full-term newborns, usually in the first days or weeks of life. Not everyone will have the same experience, but severe neonatal scleroderma can make feeding, breathing, and movement harder and can be life-threatening. Treatment for neonatal scleroderma focuses on intensive supportive care and on treating the underlying illness, because the outlook depends a lot on how sick the baby is overall.
How many people live with Neonatal scleroderma?
Because neonatal scleroderma is so rare and is usually described only in newborn case reports, there is no reliable recent estimate for how many babies are affected worldwide or in the United States. Most published reports are single cases or very small hospital series, so a global or U.S. total cannot be stated with confidence.
Overview
Neonatal sclerodermaSymptoms
Neonatal scleroderma causes very tight, hard skin in newborns, often over the trunk and limbs. Babies may have trouble moving, feeding, or breathing, and growth can be poor.
Outlook and prognosis
Outlook depends on how much skin hardening affects feeding, breathing, and temperature control, and on the baby's overall health. Neonatal scleroderma can improve in some babies, but it is more serious in premature or medically fragile newborns.
Causes and risk factors
Neonatal scleroderma is usually linked to prematurity, low birth weight, infection, dehydration, and poor blood flow or low oxygen after birth. It is not usually inherited, though severe illness and cold stress can raise risk.
Genetic influences
For neonatal scleroderma, genetics do not seem to be a main driver in most cases. Most babies have no clear inherited cause, but genetic testing may be considered if features are unusual or there is a family history.
Diagnosis
Diagnosis of Neonatal scleroderma usually starts with the baby's skin changes and exam findings. Doctors may use blood tests, imaging, and sometimes a skin biopsy to confirm it and rule out other causes.
Treatment and drugs
Treatment for neonatal scleroderma focuses on supportive hospital care. Babies may need warmth, careful fluids and feeding, and help with breathing. Doctors also treat any infection or other trigger, because recovery often depends on managing these problems promptly.
Symptoms
In the first days of life, a baby with neonatal scleroderma may feel unusually stiff when you pick them up or change a diaper. The skin may be firm and tight rather than soft, and this can affect how the baby moves, feeds, and breathes. Loved ones often notice the changes first. These are often among the early features of neonatal scleroderma and need urgent medical attention.
The skin can feel unusually hard, thick, or bound down instead of soft and stretchy. It may look shiny or waxy, and large areas of the body can be affected.
When the skin is very tight, bending the arms, legs, fingers, or neck can be difficult. A baby may seem stiff during diaper changes, dressing, or cuddling.
Tight skin around the mouth, jaw, or chest can make sucking and swallowing harder. Some babies tire quickly with feeds or have trouble taking enough milk, which can slow weight gain.
If the chest wall is less flexible, breathing may become fast, shallow, or more effortful. Neonatal scleroderma with breathing difficulty is an emergency because newborns can get tired quickly.
How people usually first notice Neonatal scleroderma?
Neonatal scleroderma is usually first noticed in the first days or weeks of life, when a baby’s skin looks unusually hard, tight, shiny, or thick rather than soft and flexible. The first signs of neonatal scleroderma often include swelling and stiffness of the skin on the legs, buttocks, or trunk, and families or doctors may also notice that the baby moves less easily or has trouble feeding because the skin and underlying tissues feel firm. Because several newborn skin conditions can look similar at first, doctors pay close attention to when the skin changes started, how quickly they spread, and whether the baby seems otherwise well or medically fragile.
Types of Neonatal scleroderma
Neonatal scleroderma is not usually divided into clear, widely accepted subtypes in the way some other conditions are. Symptoms don’t always look the same for everyone, and severity can vary from one newborn to another. In practice, doctors describe how extensive the skin hardening is, how quickly it develops, and whether other signs of illness are present, rather than using formal types of neonatal scleroderma.
Can I slow down the onset of symptoms?
No. For neonatal scleroderma, there is no good evidence that lifestyle changes or routine medical treatment can meaningfully delay when symptoms start, and this condition usually appears in very sick newborns rather than developing slowly in a way families can control. Careful pregnancy care and fast treatment of problems such as infection, low body temperature, dehydration, or poor blood flow may support a baby's overall health and may lower some risks, but they have not been shown to prevent neonatal scleroderma or reliably push symptoms back. The most helpful step is getting urgent medical care if a newborn's skin becomes unusually hard or tight, because early treatment may help doctors manage complications even though it cannot promise a different timeline.
What genetics can tell you about symptoms
Genetics can sometimes help explain why a baby is born with very tight or thickened skin, but "neonatal scleroderma" is a descriptive term rather than one single genetic condition. In some infants, an underlying gene change that affects connective tissue can influence which features appear, such as how widespread the skin changes are, whether joints are stiff, and how early symptoms begin, but in others no clear genetic cause is found. Even when a gene change is identified, it usually cannot predict every symptom or exactly how severe the condition will be.
Causes and risk factors
Neonatal scleroderma usually develops in newborns who are already medically fragile, not from a single clear cause. Risk factors for neonatal scleroderma include prematurity, low birth weight, infection, low oxygen, and poor blood flow or shock. Cold stress and dehydration can also add to the risk. It’s rarely just one factor—it’s the mix that matters. No strong inherited cause is known, and parent lifestyle does not directly cause it, but factors that raise the chance of prematurity or severe newborn illness can indirectly increase risk.
What are the most common causes or risk factors?
The exact cause of neonatal scleroderma is not fully understood, but it is most often seen in newborns who are very sick, especially babies born early or at a low birth weight. The main risk factors are serious infection, low oxygen, poor blood flow, dehydration, trouble staying warm, and other major medical problems around birth. There is no well-established inherited cause, so it is generally not thought of as a genetic condition.
Environmental and biological risk factors
Neonatal scleroderma is a rare condition in which a newborn’s skin and the tissue underneath become unusually firm, most often when a baby is already very unwell. The main risk factors for neonatal scleroderma are severe biological stress and cold-related environmental stress in the first days of life. Doctors often group risks into internal (biological) and external (environmental).
Babies born premature or very small often have less body fat, less stable temperature control, and more fragile circulation. These biological stresses can make neonatal scleroderma more likely during serious illness.
Sepsis and other major infections can trigger widespread inflammation and reduce blood flow to the skin and fat. This is one of the strongest biological risk factors linked with neonatal scleroderma.
Shock, very low blood pressure, or low oxygen levels can keep skin and deeper tissues from getting enough blood supply. When that happens, tissue hardening becomes more likely.
Exposure to low temperatures or difficulty staying warm can affect blood flow and the way newborn fat behaves. This environmental factor matters most in babies who are already fragile or critically ill.
Genetic risk factors
For most babies described as having Neonatal scleroderma, doctors cannot point to one proven inherited gene change. Current evidence suggests Neonatal scleroderma itself is usually sporadic, meaning it appears without a clear family pattern. Some inherited disorders can cause tight, thick, or hard skin at birth and may be mistaken for it, which can make the genetic causes of Neonatal scleroderma hard to sort out. This sheds light on why outcomes differ, even when risks look alike.
No proven gene: Researchers have not identified one gene change that clearly causes most cases of Neonatal scleroderma. Many babies with this diagnosis have no known family history and no predictable inheritance pattern.
Inherited look-alikes: Rare inherited conditions can cause very tight or hard skin in a newborn and may look similar to Neonatal scleroderma. In these cases, the underlying problem is a different genetic disorder rather than Neonatal scleroderma itself.
Family history: If close relatives have unusual skin hardening, severe joint stiffness, or certain inherited connective tissue disorders, doctors may look more closely for a genetic explanation. This does not prove a baby will develop Neonatal scleroderma, but it can affect which tests are most useful.
New gene changes: Some genetic conditions happen because of a new gene change in the baby, even when no one else in the family is affected. This is one reason genetic evaluation may be considered when the early signs of Neonatal scleroderma are present at birth.
Lifestyle risk factors
Neonatal scleroderma is not caused by lifestyle habits, but day-to-day care can influence skin comfort, movement, feeding, and the chance of complications. In practice, how lifestyle affects neonatal scleroderma is mainly about caregiver routines that protect fragile skin and support growth. The most important areas are nutrition, gentle handling, skin care, mobility, and close follow-up with the care team.
Poor feeding can make it harder for an infant with neonatal scleroderma to maintain weight and hydration. Careful, regular feeding plans can support growth and may reduce stress from prolonged or tiring feeds.
Inadequate fluid intake can worsen dryness and make already tight skin less comfortable. Keeping hydration appropriate for the infant’s age and medical plan can support circulation and overall stability.
Harsh soaps, frequent friction, or delayed moisturizing can increase irritation and skin breakdown in neonatal scleroderma. Gentle cleansing and clinician-approved emollients may help protect the skin barrier and improve comfort.
Too little movement can contribute to stiffness and reduced joint range when skin is tight. Gentle repositioning and prescribed stretching or physical therapy can help preserve mobility and limit contractures.
Risk prevention
There is no sure way to prevent neonatal scleroderma itself, and it is not caused by something a parent did or did not do. For many families, prevention means lowering the risk of complications, protecting movement and growth, and catching problems early. Different people need different prevention strategies—there’s no single formula.
Early follow-up with a pediatrician and skin specialist can help confirm what type of neonatal scleroderma is present and how closely it needs to be watched. This can make it easier to act on the early symptoms of neonatal scleroderma before tight skin starts to affect feeding, comfort, or movement.
Regular stretching and guided physical therapy may help keep joints from becoming stiff as the skin tightens. For many living with neonatal scleroderma, this can support easier dressing, carrying, and day-to-day movement as they grow.
Gentle skin care, careful moisturizing, and avoiding irritation can help protect skin that is tight, fragile, or easily damaged. Preventing cracks and sores may also lower the chance of infection.
Keeping the baby comfortably warm and avoiding cold stress may help if skin tightening affects blood flow in the hands, feet, or other areas. Alongside medical care, everyday habits also matter.
Can you prevent Neonatal scleroderma?
There is no sure way to prevent neonatal scleroderma, and in many babies it is not something parents could have stopped. Because it is more likely in babies who are born too early or are very sick, good pregnancy care, lowering the chance of early birth when possible, and quick treatment of infections or other serious newborn problems may help reduce the risk, but they cannot fully prevent it.
Transmission
Neonatal scleroderma is not contagious, so it cannot be passed from one baby to another or from a baby to caregivers through touch, breathing, or everyday contact. In practical terms, many living with concern about this diagnosis can be reassured that the condition itself is not infectious at all.
When families ask how neonatal scleroderma is inherited, the key point is that it is generally not considered an inherited disorder passed from parent to child. Instead, it usually develops in newborns who are already medically fragile, often alongside other serious health problems, so any underlying infection would be a separate issue from the skin hardening itself.
When to test your genes
Genetic testing is not routine for neonatal scleroderma, because diagnosis is usually based on the skin findings and overall clinical picture rather than a single known gene. It may be worth considering if skin hardening starts very early, runs in the family, or comes with unusual features that suggest an inherited connective tissue disorder.
Diagnosis
Neonatal scleroderma is usually recognized when a newborn’s skin becomes unusually hard, tight, or woody over a short period of time, sometimes making movement, feeding, or breathing seem more difficult. Doctors often diagnose it by combining the baby’s appearance and exam findings with tests that help confirm the cause and rule out other conditions that can also make the skin look thick or swollen. Getting a diagnosis is often a turning point toward answers and support.
Doctors look closely at where the skin is firm, how quickly the changes appeared, and whether the hardening affects movement or chest expansion. The diagnosis of neonatal scleroderma often begins with these visible and touch-based findings, especially in a sick or premature newborn.
The care team asks about prematurity, low birth weight, recent infection, feeding problems, and any complications around birth. A detailed family and health history can help separate neonatal scleroderma from inherited skin disorders that may look similar early on.
Blood work may be used to check for infection, inflammation, dehydration, or problems with salts, sugar, and organ function. These tests do not diagnose neonatal scleroderma by themselves, but they help rule out common causes of a very ill newborn with skin changes.
In some cases, doctors take a small skin sample to look at the deeper layers under a microscope. This can help confirm abnormal thickening in the skin and fatty tissue and distinguish neonatal scleroderma from other newborn skin conditions.
How is Neonatal scleroderma diagnosed?
Neonatal scleroderma is usually diagnosed based on the baby’s symptoms and a careful exam, especially skin that becomes firm, tight, and hard soon after birth. Doctors may also check the baby’s overall condition and use blood tests or other basic tests to look for related illness and rule out other causes of hard skin, such as infection or swelling. A small skin sample is only rarely needed if the diagnosis is unclear, and genetic testing is not usually part of making the diagnosis.
Stages of Neonatal scleroderma
Neonatal scleroderma does not have defined progression stages. That is because it is not usually described as a condition that moves through clear step-by-step phases over time; instead, doctors focus on which skin and body changes are present, how severe they are, and whether they stay limited or affect deeper tissues. Doctors usually start with a conversation about when the skin changes began, what they look and feel like, and whether there are feeding, breathing, or growth concerns. Monitoring often includes physical exams and, in some cases, blood tests or imaging to check for related problems, especially if the early symptoms of neonatal scleroderma suggest more than skin involvement.
Outlook and prognosis
The outlook for neonatal scleroderma is guarded and depends largely on how premature or ill the infant is and whether there is an underlying problem such as sepsis, dehydration, hypothermia, or metabolic instability. Mild or localized skin hardening may improve with aggressive supportive care and treatment of the trigger, but widespread disease in very sick newborns is associated with a much poorer prognosis. Mortality has historically been high, especially in premature or low-birth-weight infants with diffuse skin involvement and severe infection, although outcomes may be better today with modern neonatal intensive care. Babies who survive the acute phase can recover as the skin softens over time, and long-term problems are more often related to the underlying illness than to the skin changes themselves. Early recognition, prompt treatment of infection or shock, and intensive supportive management are the main factors that improve survival.
Long-term effects
For babies who live with neonatal scleroderma, the long-term picture depends a lot on how much of the skin and deeper tissue are affected early on. Some infants recover with little lasting change, while others can have ongoing skin tightness and related health problems as they grow. It’s important to remember that long-term does not always mean progressive, but severe early disease can leave lasting effects.
Lasting hardening or thickening of the skin can limit how easily the skin stretches as a child grows. This may lead to areas that stay stiff, shiny, or less flexible over time.
Tight skin around the arms, legs, hands, or feet can reduce normal joint movement. Over time, daily routines may become harder because bending, reaching, or grasping is more limited.
When skin and underlying tissue stay tight, normal growth of the affected area may be uneven. Some children may develop smaller or less mobile hands, feet, or limbs compared with expected growth.
If neonatal scleroderma affects the face, mouth area, or overall energy needs in early life, feeding can remain difficult for some infants. Poor feeding in the newborn period can contribute to slower weight gain and growth.
How is it to live with Neonatal scleroderma?
Living with neonatal scleroderma usually means a newborn needs close medical care from the very start, because the skin can become unusually hard and tight, which may limit movement and sometimes make feeding, comfort, and temperature regulation harder. For families, daily life often shifts quickly toward hospital visits, careful skin and general health monitoring, and the emotional strain of caring for a very fragile baby. The experience can be overwhelming, but support from neonatal and dermatology teams can help families understand what is happening and focus on comfort, monitoring, and the baby’s overall stability.
Treatment and drugs
Neonatal scleroderma is treated mainly with hospital-based supportive care, because it often happens in very sick newborns and can affect feeding, breathing, and body temperature. Treatment usually focuses on the problem driving it, such as infection, dehydration, low oxygen, or poor circulation, while the baby may also need warmth, fluids, nutrition support, and sometimes breathing support. Doctors sometimes recommend a combination of lifestyle changes and drugs, but in neonatal scleroderma that usually means careful intensive care rather than a single medicine that directly reverses the skin hardening. If an infection is suspected, antibiotics are often started quickly, and the care team will monitor the baby closely for changes in blood sugar, oxygen levels, and organ function. Because neonatal scleroderma can be life-threatening, early treatment in a neonatal intensive care unit gives the best chance for stabilization and recovery.
Can you cure Neonatal scleroderma?
No, there is not a specific cure for neonatal scleroderma. Treatment focuses on supporting the baby and treating any underlying problem, such as infection or poor blood flow, while helping with breathing, feeding, warmth, and the hardening of the skin. Some babies do improve with care, but recovery depends a lot on how severe the condition is and what is causing it.
Non-drug treatment
In neonatal scleroderma, non-drug care usually focuses on keeping a baby stable, comfortable, and well nourished while protecting the skin and watching for breathing or feeding problems. Managing this condition often means hospital-based supportive care, especially early on, because symptoms and severity can vary a lot from one newborn to another. For many families, how neonatal scleroderma is treated without medication depends on which body systems are affected and how quickly the skin changes appeared.
Keeping the baby warm is a key part of care because hard, tight skin can make it harder to maintain body temperature. Warm incubators, careful room temperature control, and frequent checks help lower stress on the body.
Some babies with neonatal scleroderma have trouble feeding well because they tire easily or cannot coordinate sucking and swallowing. Extra feeding support may include paced feeds, feeding by tube, and close tracking of weight and hydration.
Tight skin and overall illness can make breathing more difficult, especially in very sick newborns. Non-drug treatments may include oxygen, gentle respiratory support, or mechanical ventilation when needed.
Gentle skin care helps reduce injury when the skin feels firm, shiny, or fragile. Soft handling, careful repositioning, and protecting pressure areas can lower the risk of skin breakdown.
Your genes may have an impact on how drugs work for you
For people living with neonatal scleroderma, there is no clear, well-established evidence that inherited gene differences strongly change how the usual treatments work. In real life, doctors are more likely to choose and adjust care based on what is causing the skin hardening, how severe it is, and how well the baby is feeding, breathing, and growing, rather than on genetic testing. As research grows, this may become clearer, but right now genes are not a routine guide for medication decisions in this condition.
Pharmacological treatments
Treatment for neonatal scleroderma is not based on one standard medicine, because this rare condition can have different causes and severity. In many newborns, doctors focus on intensive supportive care and treat problems that can happen alongside the skin hardening, such as infection, pain, feeding trouble, or poor circulation. Sometimes medicines are taken short-term (acute treatment), while others are used long-term (maintenance therapy). Because early symptoms of neonatal scleroderma can overlap with serious newborn illness, treatment is usually individualized in a neonatal unit.
Ampicillin and gentamicin are often used first if doctors are worried about a blood infection or sepsis happening at the same time. These drugs do not treat the skin changes directly, but they can be lifesaving when infection is part of the picture.
Vancomycin, cefotaxime, or meropenem may be used if a newborn is very unwell or if hospital-acquired infection is a concern. The exact choice depends on culture results, local resistance patterns, and how sick the baby is.
Acetaminophen may be used for discomfort, and opioids such as morphine can be needed in intensive care when pain is more severe. Dosing is carefully adjusted because newborns are especially sensitive to side effects.
Dopamine, dobutamine, or epinephrine may be given if neonatal scleroderma is part of a critical illness with low blood pressure or poor circulation. These medicines support the heart and blood flow rather than treating the skin itself.
Genetic influences
Neonatal scleroderma is not usually thought to be caused by a single inherited gene change. Genetics is only one piece of the puzzle, but most cases do not show a clear family pattern. Doctors more often look for medical problems around birth or severe illness in the newborn than for a known genetic trigger. Rarely, very similar skin hardening in a newborn can be part of a broader inherited disorder that affects connective tissue or the immune system. Because neonatal scleroderma is rare, the genetic causes of neonatal scleroderma are not well defined. If there are other unusual findings or a strong family history, the care team may suggest seeing a genetics specialist to decide whether testing could be useful.
Is Neonatal scleroderma genetic?
For neonatal scleroderma, genetics do not seem to be a main driver in most cases. Most babies have no clear inherited cause, but genetic testing may be considered if features are unusual or there is a family history.
Having a genetic risk is not necessarily a diagnosis
Changes in genes are a normal part of human biology and are widely found in the general population. Most of these variants do not directly affect health and are simply part of natural human diversity. For many genes, carrying a variant associated with a condition suggests a possible link rather than a definite diagnosis, especially when several genes and environmental factors are involved. In some situations, though, a single well-characterized variant in a specific gene can be enough to confirm the diagnosis.
Pharmacogenetics—how genetics influence drug effects
When a newborn has skin hardening that may be called neonatal scleroderma, the exact cause matters a lot because treatment can differ between an inflammatory illness and a rare inherited condition that looks similar. Genetic testing can sometimes help doctors sort this out, which may prevent a baby from getting medicines that are unlikely to help and instead guide supportive care, monitoring, and follow-up. Not every difference in response is genetic, but in neonatal scleroderma, genes are more often helpful for diagnosis than for choosing one specific drug. If inflammation seems to be driving the problem, specialists may use medicines such as corticosteroids or other immune-lowering treatments, but those decisions are usually based on symptoms, organ involvement, and how the baby is doing day to day. Because newborns process medicines differently from older children and adults, doses need very close supervision, and family history can add useful clues when an inherited disorder is suspected. In short, how genetics affect treatment for neonatal scleroderma is mainly by helping confirm what condition the baby actually has, rather than through routine pharmacogenetic testing to predict drug response.
Interactions with other conditions
Neonatal scleroderma often appears in babies who are already medically fragile, so it may occur alongside serious problems such as infection, dehydration, breathing trouble, or heart disease. Another important aspect is how it may link with other diseases. When the skin becomes very firm and tight, it can make feeding, movement, and sometimes breathing more difficult, which may add to the strain from those other illnesses. In practice, this means doctors usually look closely for the underlying cause rather than treating the skin changes on their own. For families asking about the early symptoms of neonatal scleroderma, the skin changes may be only one part of a bigger picture that includes poor feeding, low activity, or signs of a severe newborn illness. Because neonatal scleroderma tends to happen in very sick newborns, care usually involves close monitoring and treatment of any related infection, fluid imbalance, or organ problem at the same time.
How genes can cause diseases
Humans have more than 20,000 genes, each carrying out one or a few specific functions in the body. One gene instructs the body to digest lactose from milk, another tells the body how to build strong bones and another prevents the body's cells from beginning to multiply uncontrollably and developing into cancer. As all of these genes combined are the building instructions for our body, a defect in one of these genes can have severe health consequences.
Through decades of genetic research, we know the genetic code of any healthy/functional human gene. We have also identified that in certain positions on a gene, some individuals may have a different genetic letter from the one you have. We call these hotspots "Genetic Variations" or "Variants" in short. In many cases, studies have been able to show that having the genetic letter "G" in the position makes you healthy, but having the letter "A" in the same position disrupts the gene function and causes a disease. Genopedia allows you to view these variants in genes and summarizes all that we know from scientific research, which genetic letters (Genotype) have good or bad consequences on your health or on your traits.
What other conditions can cause similar symptoms to Neonatal scleroderma?
Other problems that can look similar include a rare condition where the fat under a newborn's skin becomes hard and lumpy, called subcutaneous fat necrosis, and another rare skin problem called scleredema, where the skin becomes puffy and thick. Severe infection, poor blood flow, or major fluid buildup can also make a baby's skin look tight, hard, cold, or discolored, so doctors often check for these first. Because these conditions can look alike at first, the baby's overall health and the exact feel and pattern of the skin changes help tell them apart.
History
Long before modern newborn intensive care, doctors were already writing about babies who developed unusually hard, tight skin soon after birth. What is now called neonatal scleroderma was described in older medical texts under different names, and early reports often focused on what families and doctors could see at the bedside: skin that felt firm or waxy, trouble feeding, and a newborn who seemed too weak or cold.
In the 1800s and early 1900s, neonatal scleroderma was usually recognized only after symptoms had become severe. At that time, many newborn illnesses looked similar, so this condition was sometimes grouped together with other causes of skin thickening or swelling in infants. Not every early description was complete, yet those reports gradually helped doctors separate neonatal scleroderma from other newborn skin conditions and understand that the pattern of hardening could matter.
As medical care improved, especially in hospitals caring for premature and very sick newborns, doctors began to notice that neonatal scleroderma was most often seen in infants who were already medically fragile. This changed how the condition was viewed. Rather than treating it as only a skin problem, clinicians increasingly understood it as a sign of serious illness in the whole body.
Later research helped clarify the early symptoms of neonatal scleroderma and the settings in which it was most likely to appear. For many families, this may have looked like a newborn whose skin became stiff over hours or days, making normal movement, feeding, or warmth harder to maintain. Over time, better temperature control, infection treatment, nutrition, and intensive newborn care made the condition less common in places with advanced medical support.
Today, the history of neonatal scleroderma is also a reminder of how much newborn medicine has changed. Older reports often carried a very poor outlook because the babies affected were usually extremely ill and treatment options were limited. With modern care, doctors are better able to recognize the condition early, look for the underlying illness driving it, and support infants more effectively than in the past.