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Parsons CE, Skewes JC. The dark side of fear expression: Infant crying as a trigger for maladaptive parental responses. Behav Brain Sci 2023; 46:e75. [PMID: 37154372 DOI: 10.1017/s0140525x22001881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
While infant fearfulness, and its expression via crying, may have been adaptive in our evolutionary history, for modern parents, crying can be challenging to respond to. We discuss how and why prolonged crying can raise the risk for difficulties with adult care. Given that crying is the most-reported trigger for shaking, its potential to elicit maladaptive responses should not be overlooked.
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Affiliation(s)
- Christine E Parsons
- Interacting Minds Centre (IMC), Aarhus University, Aarhus C 8000, Denmark ; https://pure.au.dk/portal/en/persons/christine-parsons(8828f773-0764-4eb0-959d-3357956aec4f).html ; https://pure.au.dk/portal/en/persons/joshua-skewes(22c8a4e5-1104-4c4e-9c17-b84a9233e905).html
| | - Joshua C Skewes
- Interacting Minds Centre (IMC), Aarhus University, Aarhus C 8000, Denmark ; https://pure.au.dk/portal/en/persons/christine-parsons(8828f773-0764-4eb0-959d-3357956aec4f).html ; https://pure.au.dk/portal/en/persons/joshua-skewes(22c8a4e5-1104-4c4e-9c17-b84a9233e905).html
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Yu J, Wei Z, Wells JC, Fewtrell M. Effects of relaxation therapy on maternal psychological status and infant growth following late preterm and early-term delivery: a randomized controlled trial. Am J Clin Nutr 2023; 117:340-349. [PMID: 36811573 DOI: 10.1016/j.ajcnut.2022.12.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 11/30/2022] [Accepted: 12/08/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Maternal stress is one modifiable variable that could influence mother-infant signaling and negatively affect breastfeeding and infant growth. OBJECTIVES This study aimed to test the hypothesis that relaxation therapy would reduce maternal stress and improve infant growth, behavior, and breastfeeding outcomes after late preterm (LP) and early-term (ET) delivery. METHODS A single-blind randomized controlled trial was conducted in healthy Chinese primiparous mother-infant pairs after LP or ET delivery (34+0-37+6 gestation weeks). Mothers were randomly assigned to the intervention group (IG, listening to relaxation meditation at least once a day) or control group (CG, normal care). Primary outcomes-changes in maternal stress (perceived stress scale), anxiety (Beck Anxiety Inventory), and infant weight and length standard deviation score-were assessed at 1 wk and 8 wks postpartum. Secondary outcomes-breast milk energy and macronutrient composition, maternal breastfeeding attitudes, infant behaviors (3-d diary), and 24-hour milk intake-were assessed at 8 wks. RESULTS In total, 96 mother-infant pairs were recruited. There was a significantly greater reduction in maternal perceived stress (Perceived Stress Scale score) (mean difference [MD] = 2.65; 95% CI: 0.8, 4.5) and significantly greater infant weight standard deviation score gain (MD = 0.51; 95% CI: 0.2, 0.9) from 1 wk to 8 wks in the IG than those in the CG. Exploratory analyses showed a significant interaction between intervention and sex, with greater effects on weight gain in female infants. Mothers of female infants used the intervention more frequently with significantly higher milk energy observed at 8 wks. CONCLUSIONS The relaxation meditation tape is a simple, effective practical tool that could easily be used in clinical settings to support breastfeeding mothers after LP and ET delivery. The findings need confirmation in larger groups and in other populations.
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Affiliation(s)
- Jinyue Yu
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Zhuang Wei
- Department of Child Healthcare, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, China
| | - Jonathan Ck Wells
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Mary Fewtrell
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, United Kingdom.
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Vermillet AQ, Tølbøll K, Litsis Mizan S, C Skewes J, Parsons CE. Crying in the first 12 months of life: A systematic review and meta-analysis of cross-country parent-reported data and modeling of the "cry curve". Child Dev 2022; 93:1201-1222. [PMID: 35438798 PMCID: PMC9541248 DOI: 10.1111/cdev.13760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Crying is an ubiquitous communicative signal in infancy. This meta-analysis synthesizes data on parent-reported infant cry durations from 17 countries and 57 studies until infant age 12 months (N = 7580, 54% female from k = 44; majority White samples, where reported, k = 18), from studies before the end Sept. 2020. Most studies were conducted in the United States, the United Kingdom, and Canada (k = 32), and at the traditional cry "peak" (age 5-6 weeks), where the pooled estimate for cry and fuss duration was 126 mins (SD = 61), with high heterogeneity. Formal modeling of the meta-analytic data suggests that the duration of crying remains substantial in the first year of life, after an initial decline.
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Affiliation(s)
- Arnault-Quentin Vermillet
- Interacting Minds Center, Aarhus University, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Katrine Tølbøll
- Department for Linguistics, Cognitive Science, and Semiotics, Aarhus University, Aarhus, Denmark
| | - Samouil Litsis Mizan
- Department for Linguistics, Cognitive Science, and Semiotics, Aarhus University, Aarhus, Denmark
| | - Joshua C Skewes
- Interacting Minds Center, Aarhus University, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Christine E Parsons
- Department for Linguistics, Cognitive Science, and Semiotics, Aarhus University, Aarhus, Denmark
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Sommermeyer H, Bernatek M, Pszczola M, Krauss H, Piatek J. Supporting the diagnosis of infantile colic by a point of care measurement of fecal calprotectin. Front Pediatr 2022; 10:978545. [PMID: 36245729 PMCID: PMC9559995 DOI: 10.3389/fped.2022.978545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 09/02/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Infantile colic (IC) is a condition characterized by extensive crying which affects about 20% of all infants during their first months of life. Most pediatricians diagnose IC only based on their clinical experience. AIM Investigating if a measurement of fecal calprotectin can support the diagnosis of IC. METHODS The crying behavior of newborns was assessed using the Wessel's criteria. Fecal calprotectin levels were measured in non-colicky and colicky babies using a standard test that can be used at the time and place of patient care (point of care (PoC) measurement). RESULTS Colicky babies were found to have significantly elevated fecal calprotectin levels. Calprotectin levels were not influenced by gender, type of feeding, gestation age or birth weight. However, significantly elevated fecal calprotectin levels were found in cesarean section born babies. Fecal calprotectin ≥100 μg/g correlated with a colicky status of an infant while those <100 μg/g indicated a non-colicky status the error margin was 11.2 and 13.2%, respectively. Combining data of fecal calprotectin with information about the type of delivery made it possible to determine the colicky status in vaginally-born infants with fecal calprotectin ≥100 μg/g with an accuracy of 97.8%. As elevated fecal calprotectin levels in cesarean-born infants can be caused by IC, but also by the disturbed gut microbiota commonly found in these babies, the accuracy of diagnosing the colicky status of a cesarean-born infant with calprotectin levels ≥100 μg/g was less accurate (accuracy rate of 76.5%). CONCLUSION Data from the study suggest that measuring fecal calprotectin should be considered by pediatricians to support the diagnosis of IC.The study was registered at ClinicalTrials.gov under NCT04666324.
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Affiliation(s)
| | | | - Marcin Pszczola
- Department of Genetic and Animal Breeding, Faculty of Veterinary Medicine and Animal Science, Poznan University of Life Sciences, Poznan, Poland
| | - Hanna Krauss
- Department of Health Sciences, Calisia University, Kalisz, Poland
| | - Jacek Piatek
- Department of Health Sciences, Calisia University, Kalisz, Poland
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Ölmestig TK, Siersma V, Birkmose AR, Kragstrup J, Ertmann RK. Infant crying problems related to maternal depressive and anxiety symptoms during pregnancy: a prospective cohort study. BMC Pregnancy Childbirth 2021; 21:777. [PMID: 34789174 PMCID: PMC8597256 DOI: 10.1186/s12884-021-04252-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 10/25/2021] [Indexed: 12/24/2022] Open
Abstract
Background Infant crying may cause concerns among new parents and is a frequent reason for seeking help from their general practitioner (GP). The etiology of crying problems in infancy is not fully understood, but recent studies have found associations with maternal mental factors. It is well-established that postpartum depression is related to infant crying problems while the influence of maternal mental problems in pregnancy on infant crying is less investigated. We aimed to explore whether maternal depressive symptoms or maternal anxiety during pregnancy were related to crying problems by the newborn child. Methods In this prospective cohort study, 1290 pregnant women and their newborn children were followed throughout pregnancy until 8 weeks postpartum. Depressive symptoms and anxiety symptoms were assessed three times during pregnancy and again 8 weeks postpartum with the Major Depressive Inventory (MDI) and the Anxiety Symptoms Scale (ASS). Eight weeks postpartum the mothers were also asked whether their child cried in a way they found problematic. Multivariable regression was used to assess the association between depressive and anxiety symptoms during pregnancy and crying problems, and to adjust for potential confounders. Results We found statistically significant associations between high scores of depressive symptoms and anxiety symptoms in pregnancy and infant crying problems. Previously reported strong associations postpartum between depressive symptoms, anxiety symptoms and infant crying problems were also observed in the present data. Conclusion These results indicate that mental problems during pregnancy are associated with having a child with crying problems after birth. If more focus is given to maternal mental problems during pregnancy, the healthcare system might be able to detect and help these women, which would be beneficial for both mother and child.
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Affiliation(s)
- Tabitha Krogh Ölmestig
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1353 Copenhagen K, Denmark.
| | - Volkert Siersma
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1353 Copenhagen K, Denmark
| | - Anna Rubach Birkmose
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1353 Copenhagen K, Denmark
| | - Jakob Kragstrup
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1353 Copenhagen K, Denmark
| | - Ruth Kirk Ertmann
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1353 Copenhagen K, Denmark
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An evaluation of Neuroprotective Developmental Care (NDC/Possums Programs) in the First 12 Months of Life. Matern Child Health J 2021; 26:110-123. [PMID: 34622364 DOI: 10.1007/s10995-021-03230-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Transitioning to motherhood is an important life event. Stress often arises due to feeding concerns, infant crying, and sleep problems. Neuroprotective Developmental Care (NDC) also known as the Possums programs provides an evidence-based, consistent and holistic approach to maternal and infant wellbeing. OBJECTIVES To understand maternal characteristics at point of services access and an exploratory evaluation of effectiveness of NDC/Possums services. METHODS All mothers accessing NDC/Possums services via clinical services or self-paced online modules were invited to participate in a baseline survey. Follow up occurred when infants were 6 and 12 months of age. Participants who completed the 6-month survey were compared against their own baseline surveys. Those who completed the survey at 12-months were compared against their own baseline surveys. A pseudo-control group who had completed the baseline survey with infants 12 months of age was also compared to those who had accessed NDC/Possums services prior to 12 months of age (termed 'intervention' group). RESULTS Crying time, mothers' perceptions of infant sleep problems, mothers' own sleep, mothers' Acceptance and Action Questionnaire (AAQ) scores and the mothers' Edinburgh Postnatal Depression Scale (EPDS) scores showed statistically significant improvements from baseline to 12-month old follow-up. Significant differences were also found between the pseudo-control group and 'intervention' groups. CONCLUSIONS FOR PRACTICE This results indicate that accessing NDC/Possums services is efficacious in addressing infant's crying, the mother's perceptions of their baby's sleep problems, the mother's own sleep satisfaction, the mother's experiential avoidance, and the mother's risk of postnatal depression. NDC is relevant to public health, clinical service delivery and education for health professionals.
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Bilgin A, Wolke D. Parental use of 'cry it out' in infants: no adverse effects on attachment and behavioural development at 18 months. J Child Psychol Psychiatry 2020; 61:1184-1193. [PMID: 32155677 DOI: 10.1111/jcpp.13223] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 01/16/2020] [Accepted: 01/22/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Leaving infant to cry it out has been the subject of discussion among researchers and parents. Nevertheless, there is paucity of empirical research investigating the association between leaving infant to cry it out and consequent crying duration and frequency, mother-infant attachment and behavioural development. METHODS The sample with complete longitudinal data comprised 178 infants and their caretakers. Parental use of 'leaving infant to cry out' and cry duration were assessed with maternal report at term, 3, 6 and 18 months, and frequency of crying was assessed at term, 3 and 18 months of age. Attachment was measured at 18 months using the strange situation procedure. Behavioural development of the infant was assessed with two observational measures and a parent-report questionnaire at 18 months. RESULTS The use of 'leaving infant to crying' was rare at term and increased over the next 18 months. 'Leaving infants to cry it out' at term was associated with a decrease in crying frequency at 3 months. Furthermore, leaving infants to cry it out a few times at term and often at 3 months was associated with shorter fuss/cry duration at 18 months of age. No adverse impacts of leaving infants to cry it out in the first 6 months on infant-mother attachment and behavioural development at 18 months were found. CONCLUSIONS Contemporary practice of some parents in the United Kingdom to occasionally or often 'leaving infant to cry it out' during the first 6 months was not associated with adverse behavioural development and attachment at 18 months. Increased use of 'leaving to cry it out' with age may indicate differential responding by parents related to infant self-regulation.
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Affiliation(s)
- Ayten Bilgin
- Department of Psychology, University of Warwick, Coventry, UK
| | - Dieter Wolke
- Department of Psychology, University of Warwick, Coventry, UK.,Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
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Yu J, Wells J, Wei Z, Fewtrell M. Effects of relaxation therapy on maternal psychological state, infant growth and gut microbiome: protocol for a randomised controlled trial investigating mother-infant signalling during lactation following late preterm and early term delivery. Int Breastfeed J 2019; 14:50. [PMID: 31889973 PMCID: PMC6916017 DOI: 10.1186/s13006-019-0246-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 11/27/2019] [Indexed: 12/16/2022] Open
Abstract
Background Breastfeeding is of great importance for infant health both short and long term, especially for those born preterm. Apart from the socio-economic and cultural factors which may influence a mother's decision on breastfeeding, lactation performance is also influenced by maternal physiological and psychological condition, as well as infant behavioural factors. The aim of this project is to investigate physiological, psychological and anthropological aspects of 'signalling' between mother and infant during lactation in a stressful situation, following late preterm delivery, using an experimental approach. Method A single blind parallel randomised controlled trial will be conducted in Chinese primiparous mothers who deliver a infant (34 0/7-37 6/7) weeks and plan to exclusively breastfeed. Mothers will be recruited from four local community clinics attached to Beijing Children Hospital. Two home visits will be arranged at one week and eight weeks postpartum. Participants will be randomly assigned to either intervention arm or control (no intervention) before the first home visit. Mothers from the intervention group will be asked to listen to an audio recording with relaxation meditation daily during breastfeeding. Maternal stress and anxiety will be measured at one week and eight week postpartum using Chinese version of Cohen's Perceived Stress Scale (PSS) and Beck Anxiety Inventory (BAI). Infant weight and length gain (as SD scores) from one to eight week will be measured using anthropometry. Milk volume will be measured using 48-h test-weighing method. Breast milk samples and mother and infant's stool samples will be collected to measure macronutrient and microbiome content. Anthropometric measurements (weight, length and head circumference) will be performed during all home visits. Discussion Primary outcomes of this study will be the effect of the intervention on maternal psychological state, and infant growth. Other outcomes will include the effect of the intervention on milk production, infant behaviours, and the microbiome composition in breastmilk and maternal and infant's gut. Results of this study will provide greater understanding about maternal-infant factors which influence the success of breastfeeding, and which may then be useful targets for future interventions. Trial registration ClinicalTrials.gov identifier: NCT03674632. Registered 14 September 2018.
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Affiliation(s)
- Jinyue Yu
- Institute of Child Health, University College London, London, UK
| | - Jonathan Wells
- Institute of Child Health, University College London, London, UK
| | - Zhuang Wei
- Child Care Centre, Beijing Children’s Hospital, Beijing, China
| | - Mary Fewtrell
- Institute of Child Health, University College London, London, UK
- Child Care Centre, Beijing Children’s Hospital, Beijing, China
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Gastrointestinal Symptoms in Infants of Mothers With a Psychiatric History and the Role of Depression and Bonding. J Pediatr Gastroenterol Nutr 2019; 69:662-667. [PMID: 31517718 DOI: 10.1097/mpg.0000000000002484] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Gastroesophageal reflux (GER), excessive crying, and constipation are common gastrointestinal symptoms in infancy of multifactorial origin in which psychosocial stress factors play an important role. The aims of this observational study were to investigate the presence of gastrointestinal symptoms in infants of mothers with or without a history of a psychiatric disorder, their association with maternal depressive symptoms, and the possible mediating role of bonding. METHODS One hundred one mothers with a history of a psychiatric disorder and 60 control mothers were included. Infant gastrointestinal symptoms, maternal depressive symptoms, and mother-infant bonding were assessed using validated questionnaires and diagnostic criteria at 1.5 months postpartum. RESULTS The mean total score on the Infant Gastroesophageal Reflux Questionnaire Revised reported in infants of mothers with psychiatric disorder (13.4 standard deviation 5.4) was significantly higher than that in infants of control mothers (10.8 standard deviation 5.4; P = .003). No significant differences were found in the presence of excessive crying (modified Wessel criteria and subjective experience) and constipation (ROME IV criteria) between both groups. Infant GER was associated with maternal depressive symptoms (P = 0.027) and bonding problems (P = <0.001). Constipation was related to maternal depressive symptoms (P = 0.045), and excessive crying (Wessel and subjective criteria) was associated with bonding problems (P = 0.022 and P = 0.002, respectively). The effect of maternal depressive symptomatology on infant GER symptoms and excessive crying was mediated by bonding problems. CONCLUSION Maternal psychiatric history is associated with infant gastrointestinal symptoms, in which mother-infant bonding is a mediating factor.
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St James-Roberts I, Garratt R, Powell C, Bamber D, Long J, Brown J, Morris S, Dyson S, Morris T, Bhupendra Jaicim N. A support package for parents of excessively crying infants: development and feasibility study. Health Technol Assess 2019; 23:1-144. [PMID: 31597591 DOI: 10.3310/hta23560] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Around 20% of 1- to 4-month-old infants cry for long periods without an apparent reason. Traditionally, this was attributed to gastrointestinal disorder ('colic'), but evidence shows that just 5% of infants cry a lot because of organic disturbances; in most cases, the crying is attributable to normal developmental processes. This has led to a focus on the impact of the crying on parents. Parental vulnerabilities influence how parents evaluate and respond to the crying and predict adverse outcomes. By developing evidence-based services that support parents, this study was designed to take the first steps towards national health services that enhance the coping and well-being of parents whose babies excessively cry. Related aims were to improve these infants' outcomes and how NHS money is spent. OBJECTIVES To develop a novel intervention package to support parents of excessively crying infants and to examine the feasibility of delivering and evaluating it in the NHS. DESIGN Stage 1 of this study aimed to (1) complete a literature review to identify example support materials, (2) obtain parents' guidance on the support needed when a baby cries excessively, together with their evaluation of the example materials, and (3) develop a support package based on the results. Stage 2 aimed to (1) recruit 60 parents whose babies were currently excessively crying, (2) assess parents' and NHS professionals' willingness to complete a study of the support package, (3) measure the use and evaluation of the package components, (4) estimate the package component costs and (5) provide evidence on the feasibility and methods for a large-scale trial. SETTING Primary health care. PARTICIPANTS Stage 1: 20 parents of previously excessively crying infants and 55 health visitors (HVs) or specialist community public health nurses (SCPHNs). Stage 2: 57 parents of currently excessively crying infants and 124 HVs/SCPHNs. INTERVENTIONS The support package included a website, a printed booklet and a programme of cognitive-behavioural therapy-based sessions delivered to parents by a qualified practitioner. MAIN OUTCOME MEASURES (1) Demographic data, (2) figures for parents' use of the package components and continuation in the study, (3) parents' and HVs'/SCPHNs' ratings of the package components and suitability for NHS use, (4) questionnaire measures of parental well-being and infant health and (5) costs. RESULTS Most parents (95%) accessed the website or printed materials and half (51%) attended the practitioner sessions. All 52 parents and 85% of HVs/SCPHNs providing data would support the inclusion of the package in the NHS. It was associated with reduced parental frustration, anxiety, depression, reported infant crying and contacts with health professionals and increased knowledge about crying. Methods for a full trial and figures for the cost of excessive infant crying for the NHS and each package element were identified. LIMITATIONS No control group was included. Most of the recruited parents were white, well educated and in stable relationships. CONCLUSIONS Parents and HVs/SCPHNs recognise the need for NHS provisions that support parents of excessively crying babies and consider the materials developed to meet that need. A full-scale randomised controlled trial is feasible and desirable. TRIAL REGISTRATION Current Controlled Trials ISRCTN84975637. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 56. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Ian St James-Roberts
- Thomas Coram Research Unit, University College London Institute of Education, University College London, London, UK
| | - Rosemary Garratt
- The Leicester School of Nursing and Midwifery Research Centre, De Montfort University, Leicester, UK
| | - Charlotte Powell
- The Leicester School of Nursing and Midwifery Research Centre, De Montfort University, Leicester, UK
| | - Deborah Bamber
- The Leicester School of Nursing and Midwifery Research Centre, De Montfort University, Leicester, UK
| | - Jaqui Long
- The Leicester School of Nursing and Midwifery Research Centre, De Montfort University, Leicester, UK
| | - Jayne Brown
- The Leicester School of Nursing and Midwifery Research Centre, De Montfort University, Leicester, UK
| | - Stephen Morris
- Department of Applied Health Research, University College London, London, UK
| | - Sue Dyson
- School of Health and Education, Middlesex University, London, UK
| | - Tom Morris
- Leicester Clinical Trials Unit, University of Leicester, Leicester, UK
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Mohr C, Gross-Hemmi MH, Meyer AH, Wilhelm FH, Schneider S. Temporal Patterns of Infant Regulatory Behaviors in Relation to Maternal Mood and Soothing Strategies. Child Psychiatry Hum Dev 2019; 50:566-579. [PMID: 30710313 DOI: 10.1007/s10578-018-00862-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This study investigates the temporal patterning of infant self-regulatory behaviors (crying/fussing, sleeping) in relation to both infant (age, sex, regulatory problems) and maternal variables (soothing behaviors, mood). Self-regulatory and soothing behaviors were assessed in 121 mother-infant dyads (4-44 weeks) by the Baby's Day Diary at 5 min intervals over 3 days. Further infant characteristics and maternal mood were assessed by questionnaires (DASS, CES-D, STAI) and the Diagnostic Interview for the Assessment of Regulatory Problems in Infancy and Toddlerhood. Data were analyzed using generalized additive mixed models. Negative maternal mood was associated with a deviant course of crying/fussing during the day. Body contact was associated with reduced variability in the 24 h course of sleep. Mother-infant transactional processes-above and beyond known relationships with overall levels of crying/fussing and sleeping-might play out on the temporal dimension of infant regulatory behaviors.
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Affiliation(s)
- Cornelia Mohr
- Clinical Child and Adolescent Psychology, Ruhr-Universität Bochum, Massenbergstraße 9 -11, 44787, Bochum, Germany.
| | - Mirja H Gross-Hemmi
- Swiss Etiological Study of Adjustment and Mental Health, Institute of Psychology, University of Basel, Basel, Switzerland
| | - Andrea Hans Meyer
- Division of Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Basel, Switzerland
| | - Frank H Wilhelm
- Division of Clinical Psychology, Psychotherapy, and Health Psychology, Department of Psychology, University of Salzburg, Salzburg, Austria
| | - Silvia Schneider
- Clinical Child and Adolescent Psychology, Ruhr-Universität Bochum, Massenbergstraße 9 -11, 44787, Bochum, Germany
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Probiotics in pregnancy: protocol of a double-blind randomized controlled pilot trial for pregnant women with depression and anxiety (PIP pilot trial). Trials 2019; 20:440. [PMID: 31315657 PMCID: PMC6637581 DOI: 10.1186/s13063-019-3389-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Accepted: 05/02/2019] [Indexed: 12/28/2022] Open
Abstract
Background Maternal prenatal depressive or anxiety symptoms are associated with adverse maternal and infant health outcomes. With prevalence rates of maternal prenatal depression and anxiety ranging between 10 and 20%, attempts to identify effective interventions to reduce symptoms are priority. There are indications that probiotics can reduce symptoms of maternal depression or anxiety. Probiotics ingested by the mother may thus offer a promising and accessible intervention to complement existing treatments. Methods The Probiotics in Pregnancy (PIP) pilot trial is a double-blind, placebo-controlled, randomized pilot trial. While one group orally consumes a probiotic mixture (Ecologic® Barrier; 2,5 × 109 colony forming units/g; 2 g; daily), the other group consumes a placebo, from between 26 and 30 weeks gestation until delivery. Subjects are randomly allocated (1:1) to the intervention or placebo group. Forty healthy pregnant women with symptoms of depression or anxiety and uncomplicated pregnancies at randomization will be included. The primary aim is to determine the feasibility and acceptability of a probiotic trial to reduce symptoms of maternal depression or anxiety in pregnancy. The secondary aim is to exploratorily compare the potential effect of probiotics, compared to placebo, on depressive and/or anxiety symptoms, maternal stress (i.e. reported/hair cortisol), maternal vaginal and intestinal microbiota, and by possibly affecting maternal mood and microbiota, maternal bonding to offspring, infant microbiota and infant crying. Discussion Results of this pilot trial will help determine whether or not to proceed with a full trial after the pilot trial, and if so, whether revisions should be made to the study protocol and procedures before conducting a full randomized controlled trial. Additionally, they are expected to provide insights into whether changes in psychological, behavioral and biological parameters can be attributed to the probiotic intervention. Trial registration Netherlands Trial Register, NTR6219. Registered on 28 February 2017. Electronic supplementary material The online version of this article (10.1186/s13063-019-3389-1) contains supplementary material, which is available to authorized users.
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Miller JE, Hanson HA, Hiew M, Lo Tiap Kwong DS, Mok Z, Tee YH. Maternal Report of Outcomes of Chiropractic Care for Infants. J Manipulative Physiol Ther 2019; 42:167-176. [PMID: 31029467 DOI: 10.1016/j.jmpt.2018.10.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Revised: 09/11/2018] [Accepted: 10/21/2018] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate the report by mothers of their infants' condition before and after a trial of care provided by registered chiropractic clinicians in addition to ratings of satisfaction, cost of care, and reports of any adverse events or side effects. A second purpose was to report the demographic profile of infants who presented for care to 16 chiropractic clinics in the United Kingdom. METHODS This observational study prospectively collected reports by mothers of their infants' demographic profiles and outcomes across several domains of infant behavior and their own mental state using the United Kingdom Infant Questionnaire. Participating registered chiropractors were recruited through the Royal College of Chiropractors annual meeting in January 2016, and 15 clinics and the Anglo-European College of Chiropractic University College teaching clinic volunteered to participate. RESULTS In all, 2001 mothers completed intake questionnaires and 1092 completed follow-up forms. Statistically significant (P < .05) improvements were reported across all aspects of infant behavior studied, including feeding problems, sleep issues, excessive crying, problems with supine sleep position, infant pain, restricted cervical range of motion, and time performing prone positioning. Maternal ratings of depression, anxiety, and satisfaction with motherhood also demonstrated statistically significant improvement (P < .05). In total, 82% (n = 797) reported definite improvement of their infants on a global impression of change scale. As well, 95% (n = 475) reported feeling that the care was cost-effective, and 90.9% (n = 712) rated their satisfaction 8 or higher on an 11-point scale. Minor self-limiting side effects were reported (5.8%, n = 42/727) but no adverse events. CONCLUSION In this study, mothers reported that chiropractic care for their infants was effective, safe, and cost-effective. Although the observational design makes it impossible to determine efficacy, the study's findings indicate that, on average, the changes observed by mothers were positive and may be clinically relevant.
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Affiliation(s)
- Joyce E Miller
- Outpatient Teaching Clinic, AECC University College, Bournemouth, Dorset, UK.
| | | | - Mandy Hiew
- AECC University College Teaching Clinic, Bournemouth, Dorset, UK
| | | | - Zicheng Mok
- AECC University College Teaching Clinic, Bournemouth, Dorset, UK
| | - Yun-Han Tee
- AECC University College Teaching Clinic, Bournemouth, Dorset, UK
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Abstract
Infant colic is a commonly reported phenomenon of excessive crying in infancy with an enigmatic and distressing character. Despite its frequent occurrence, little agreement has been reached on the definition, pathogenesis or the optimal management strategy for infant colic. This Review aims to delineate the definitional entanglement with the Rome IV criteria, which were published in 2016, as the leading, most recent diagnostic criteria. Moreover, neurogenic, gastrointestinal, microbial and psychosocial factors that might contribute to the pathophysiology of infant colic are explored. This Review underlines that a comprehensive medical history and physical examination in the absence of alarm symptoms serve as guidance for the clinician to a positive diagnosis. It also highlights that an important aspect of the management of infant colic is parental education and reassurance. Management strategies, including behavioural, dietary, pharmacological and alternative interventions, are also discussed. Owing to a lack of large, high-quality randomized controlled trials, none of these therapies are strongly recommended. Finally, the behavioural and somatic sequelae of infant colic into childhood are summarized.
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Development of materials to support parents whose babies cry excessively: findings and health service implications. Prim Health Care Res Dev 2018; 19:320-332. [PMID: 29317013 DOI: 10.1017/s1463423617000779] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
AimTo develop evidence-based materials which provide information and support for parents who are concerned about their baby's excessive crying. As well as meeting these parents' needs, the aim was to develop a package of materials suitable for use by the UK National Health Service (NHS). BACKGROUND Parents report that around 20% of infants in Western countries cry excessively without an apparent reason during the first four months of age. Traditionally, research has focused on the crying and its causes. However, evidence is growing that how parents evaluate and respond to the crying needs to receive equal attention. This focus encompasses parental resources, vulnerabilities, well-being and mental health. At present, the UK NHS lacks a set of routine provisions to support parents who are concerned about their baby's excessive crying. The rationales, methods and findings from a study developing materials for this purpose are reported. METHOD Following a literature review, 20 parents whose babies previously cried excessively took part in focus groups or interviews. They provided reports on their experiences and the supports they would have liked when their baby was crying excessively. In addition, they identified their preferred delivery methods and devices for accessing information and rated four example support packages identified by the literature review.FindingsDuring the period their baby cried excessively, most parents visited a health service professional and most considered these direct contacts to have provided helpful information and support. Websites were similarly popular. Telephones and tablets were the preferred means of accessing online information. Groups to meet other parents were considered an important additional resource by all the parents. Three package elements - a Surviving Crying website, a printed version of the website and a programme of Cognitive Behaviour Therapy-based support sessions delivered to parents by a qualified practitioner, were developed for further evaluation.
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Associations Between Feeding Problems and Maternal Sensitivity Across Infancy: Differences in Very Preterm and Full-Term Infants. J Dev Behav Pediatr 2017; 38:538-544. [PMID: 28692577 DOI: 10.1097/dbp.0000000000000466] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine the influence of maternal sensitivity on infant feeding problems in very preterm/very low birth weight (VP/VLBW) and full-term (FT) infants. METHODS Longitudinal study of 178 infants (73 VP/VLBW and 105 FT). Feeding problems and maternal sensitivity were assessed at term, 3 and 18 months. A cross-lagged path model was tested to assess the longitudinal associations. RESULTS The direction of the association between maternal sensitivity and feeding problems differed among VP/VLBW and FT infants. In VP/VLBW infants, higher feeding problems at term and 3 months were associated with less maternal sensitivity at 3 months (β = -.27, p < .05) and at 18 months (β = -.36, p < .05), respectively. In FT infants, a reciprocal relationship of feeding problems and maternal sensitivity over time was found. Feeding problems at 3 months were associated with decreased maternal sensitivity at 18 months (β = -.32, p < .05), whereas decreased maternal sensitivity at 3 months was related to increased feeding problems at 18 months (β = -.25, p < .05). CONCLUSION Feeding problems are frequent in VP/VLBW infants and subsequently are associated with poorer maternal sensitivity. In FT infants, poorer levels of maternal sensitivity were both predicted by feeding problems but also were associated with more feeding problems over time.
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Shukri NHM, Wells J, Mukhtar F, Lee MHS, Fewtrell M. Study protocol: An investigation of mother-infant signalling during breastfeeding using a randomised trial to test the effectiveness of breastfeeding relaxation therapy on maternal psychological state, breast milk production and infant behaviour and growth. Int Breastfeed J 2017; 12:33. [PMID: 28725257 PMCID: PMC5512827 DOI: 10.1186/s13006-017-0124-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 07/03/2017] [Indexed: 11/21/2022] Open
Abstract
Background The physiological and psychological signalling between mother and infant during lactation is one of the prominent mother-infant factors that may influence breastfeeding outcomes. The infant can ‘signal’ his needs through vocalisation, and the mother can respond by allowing or restricting nipple access, which might alter the breast milk composition or volume. This may lead to parent-offspring conflict during the lactation period. Challenging infant behaviour has also been associated with maternal psychological distress, which might affect breastfeeding performance. Most attempts to improve breastfeeding rates focus on providing additional support, yet many aspects of the breastfeeding process are poorly understood. Thus, our objective is to investigate mother-infant signalling during breastfeeding by manipulating maternal psychological state using a relaxation therapy intervention. The study will test the hypothesis that mothers who listen to the therapy will be more relaxed/less stressed and this will favourably alter breast milk composition and/or affect milk volume and hence influence infant outcomes. Methods A randomised controlled trial will be conducted in first-time breastfeeding mothers and their new-born infants. Pregnant mothers will be recruited at antenatal clinics in Selangor, Malaysia, and four home visits will be carried out at 2, 6, 12 and 14 weeks postnatally. Participants will be randomised into a control and an intervention group in the early post-partum period. Mothers from the intervention group will be asked to listen daily to an audio recording with relaxation therapy during breastfeeding. Maternal psychological state, breastfeeding practices and infant behaviour will be assessed using validated questionnaires. Milk volume will be measured using stable isotopes. Breast milk samples will be collected to measure macronutrient content and hormone levels. Anthropometric measurements (weight, length and head circumference) will be performed during all home visits, including body composition at week 14. Discussion The main outcomes will be the effect of the intervention on maternal psychological state, milk production, cortisol levels, and infant behaviour and growth. Secondary outcomes will be associations between breast milk composition and infant appetite and growth. This study aims to provide a greater understanding of maternal-infant factors which influence breastfeeding outcomes and which may be useful targets for future interventions. Trial registration ClinicalTrials.gov identifier: NCT01971216.
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Affiliation(s)
- N H M Shukri
- UCL Great Ormond Street Institute of Child Health, University College London, WC1N 1EH, London, UK.,Faculty of Medicine & Health Sciences, Universiti Putra Malaysia, Seri Kembangan, Malaysia.,Department of Nutrition & Dietetics, Faculty of Medicine & Health Sciences, Universiti Putra Malaysia, 43400 UPM, Serdang, Malaysia
| | - J Wells
- UCL Great Ormond Street Institute of Child Health, University College London, WC1N 1EH, London, UK
| | - F Mukhtar
- Faculty of Medicine & Health Sciences, Universiti Putra Malaysia, Seri Kembangan, Malaysia.,Department of Psychiatry, Faculty of Medicine & Health Sciences, Universiti Putra Malaysia, 43400 UPM, Serdang, Malaysia
| | - M H S Lee
- Faculty of Medicine & Health Sciences, Universiti Putra Malaysia, Seri Kembangan, Malaysia.,Department of Nutrition & Dietetics, Faculty of Medicine & Health Sciences, Universiti Putra Malaysia, 43400 UPM, Serdang, Malaysia
| | - M Fewtrell
- UCL Great Ormond Street Institute of Child Health, University College London, WC1N 1EH, London, UK
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Wolke D, Bilgin A, Samara M. Systematic Review and Meta-Analysis: Fussing and Crying Durations and Prevalence of Colic in Infants. J Pediatr 2017; 185:55-61.e4. [PMID: 28385295 DOI: 10.1016/j.jpeds.2017.02.020] [Citation(s) in RCA: 110] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 01/06/2017] [Accepted: 02/07/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To determine the mean duration of fussing and crying and prevalence of colic using modified Wessel criteria in infants in the first 3 months of life. STUDY DESIGN A systematic literature search was performed using the databases Medline, PsycINFO, and Embase. The major outcome measure was mean total fuss/cry duration during 24 hours at ages 1-2 weeks (11 samples), 3-4 weeks (6 samples), 5-6 weeks (28 samples), 8-9 weeks (9 samples), and 10-12 weeks (12 samples). RESULTS Of 5687 articles reviewed, 28 diary studies (33 samples) were suitable for inclusion in meta-analysis; these studies included 8690 infants. No statistical evidence for a universal crying peak at 6 weeks of age across studies was found. Rather, the mean fuss/cry duration across studies was stable at 117-133 minutes (SDs: 66-70) in the first 6 weeks and dropped to a mean of 68 minutes (SD: 46.2) by 10-12 weeks of age. Colic was much more frequent in the first 6 weeks (17%-25%) compared with 11% by 8-9 weeks of age and 0.6% by 10-12 weeks of age, according to modified Wessel criteria and lowest in Denmark and Japan. CONCLUSIONS The duration of fussing/crying drops significantly after 8-9 weeks of age, with colic as defined by modified Wessel criteria being rare in infants older than 9 weeks. Colic or excessive fuss/cry may be more accurately identified by defining fuss/cry above the 90th percentile in the chart provided based on the review.
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Affiliation(s)
- Dieter Wolke
- Department of Psychology, University of Warwick, Coventry, United Kingdom; Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, United Kingdom.
| | - Ayten Bilgin
- Department of Psychology, University of Warwick, Coventry, United Kingdom
| | - Muthanna Samara
- Department of Psychology, Kingston University London, Kingston upon Thames, London, United Kingdom
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Development of comorbid crying, sleeping, feeding problems across infancy: Neurodevelopmental vulnerability and parenting. Early Hum Dev 2017; 109:37-43. [PMID: 28433797 DOI: 10.1016/j.earlhumdev.2017.04.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 03/31/2017] [Accepted: 04/04/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND Regulatory problems (excessive crying, feeding, and sleeping difficulties), specifically their comorbidity, are early warning signs of future problems. Insensitive parenting and neurodevelopmental vulnerabilities have been suggested as factors explaining development or maintenance of regulatory problems. Nevertheless, none of the previous studies investigated these factors within the same sample across infancy, taking into account the reciprocal influences between maternal sensitivity and regulatory problems. AIM To investigate the prospective association between very preterm birth, comorbid regulatory problems and maternal sensitivity. SUBJECTS 178 participants including 73 very preterm/very low birth weight and 105 full-term infants and their caretakers. STUDY DESIGN A prospective study from birth to 18months. MEASURES Regulatory problems were measured at term, 3months and 18months with a structured parental interview. Maternal sensitivity was measured with a nurse observation at term; and a researcher observation of play tasks at 3months and at 18months. RESULTS Very preterm birth was associated with regulatory problems at term (β=0.19, SE=0.10, p<0.05) and at 18months (β=0.21, SE=0.10, p<0.05), while it had no association to maternal sensitivity across infancy. There were no cross-lagged reciprocal effects between maternal sensitivity and regulatory problems across infancy. Maternal sensitivity at term had a negative association to regulatory problems at 3months (β=-0.26, SE=0.12, p<0.05), but not from 3 to 18months. CONCLUSIONS Neurodevelopmental vulnerabilities provided more consistent prediction of regulatory problems in comparison to sensitive parenting.
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Popp L, Fuths S, Seehagen S, Bolten M, Gross-Hemmi M, Wolke D, Schneider S. Inter-rater reliability and acceptance of the structured diagnostic interview for regulatory problems in infancy. Child Adolesc Psychiatry Ment Health 2016; 10:21. [PMID: 27382412 PMCID: PMC4932761 DOI: 10.1186/s13034-016-0107-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 06/10/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Regulatory problems such as excessive crying, sleeping-and feeding difficulties in infancy are some of the earliest precursors of later mental health difficulties emerging throughout the lifespan. In the present study, the inter-rater reliability and acceptance of a structured computer-assisted diagnostic interview for regulatory problems (Baby-DIPS) was investigated. METHODS Using a community sample, 132 mothers of infants aged between 3 and 18 months (mean age = 10 months) were interviewed with the Baby-DIPS regarding current and former (combined = lifetime) regulatory problems. Severity of the symptoms was also rated. The interviews were conducted face-to-face at a psychology department at the university (51.5 %), the mother's home (23.5 %), or via telephone (25.0 %). Inter-rater reliability was assessed with Cohen's kappa (k). A sample of 48 mothers and their interviewers filled in acceptance questionnaires after the interview. RESULTS Good to excellent inter-rater reliability on the levels of current and lifetime regulatory problems (k = 0.77-0.98) were found. High inter-rater agreement was also found for ratings of severity (ICC = 0.86-0.97). Participants and interviewers' overall acceptance ratings of the computer-assisted interview were favourable. Acceptance scores did not differ between interviews that revealed one or more clinically relevant regulatory problem(s) compared to those that revealed no regulatory problems. CONCLUSIONS The Baby-DIPS was found to be a reliable instrument for the assessment of current and lifetime problems in crying and sleeping behaviours. The computer-assisted version of the Baby-DIPS was well accepted by interviewers and mothers. The Baby-DIPS appears to be well-suited for research and clinical use to identify infant regulatory problems.
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Affiliation(s)
- Lukka Popp
- Clinical Child and Adolescent Psychology, Ruhr-Universität Bochum, Massenbergstraße 9-13, 44787 Bochum, Germany
| | - Sabrina Fuths
- Clinical Child and Adolescent Psychology, Ruhr-Universität Bochum, Massenbergstraße 9-13, 44787 Bochum, Germany
| | - Sabine Seehagen
- School of Psychology, University of Waikato, Private Bag 3105, Hamilton, 3240 New Zealand
| | - Margarete Bolten
- Department of Developmental Psychopathology, Child and Adolescents Psychiatric Clinic, University Basel, Schanzenstrasse 13, 4056 Basel, Switzerland
| | - Mirja Gross-Hemmi
- Department of Developmental Psychopathology, Child and Adolescents Psychiatric Clinic, University Basel, Schanzenstrasse 13, 4056 Basel, Switzerland
| | - Dieter Wolke
- Department of Psychology and Health Sciences Research Institute, Warwick Medical School, University of Warwick, Coventry, CV47AL UK
| | - Silvia Schneider
- Clinical Child and Adolescent Psychology, Ruhr-Universität Bochum, Massenbergstraße 9-13, 44787 Bochum, Germany
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Salisbury A, Minard K, Hunsley M, Thoman EB. Audio recording of infant crying: Comparison with maternal cry logs. INTERNATIONAL JOURNAL OF BEHAVIORAL DEVELOPMENT 2016. [DOI: 10.1080/016502501316934897] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This study investigated the accuracy of mothers’ reports of their babies’ crying. The crying of babies, 5-16 weeks old, was recorded by means of a wire-less, miniature microphone contained within a terry cloth belt worn by the baby. Crying was transmitted to a voice-activated recorder with a range of 500 feet. Thirteen 24-hour recordings were obtained from seven infants while, at the same time, the mothers kept a Cry Log of their baby’s crying. The number of minutes of crying and the number of bouts of crying obtained from the two procedures were highly correlated, although the amount of crying reported by the mothers was less than that obtained from the recorder. The mothers reported fewer bouts of crying. The results suggest that maternal cry reports are valuable for obtaining relative amounts of crying of infants within a group, as well as information on mothers’ perceptions of their infants’ crying, whereas audio recordings offer a more precise method for obtaining the amount and temporal patterning of infant crying.
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Holsti L, Barr RG. The Importance of Electronic Diary Studies for Occupational Therapy Research. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2016. [DOI: 10.1177/153944920602600206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Diary research methods are being used to assess many health-related conditions in both adult and pediatric populations. However, electronic diary data collection, ecological momentary assessment techniques, and multilevel statistical modeling are little used methodologies in occupational therapy research. It is important to add these methodologies to occupational therapy research; they offer prospective, flexible, and timely methods of evaluating the effects of conditions and diseases on occupational performance in many populations and across a variety of settings.
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Werner EA, Gustafsson HC(F, Lee S, Feng T, Jiang N, Desai P, Monk C. PREPP: postpartum depression prevention through the mother-infant dyad. Arch Womens Ment Health 2016; 19:229-42. [PMID: 26231973 PMCID: PMC4738166 DOI: 10.1007/s00737-015-0549-5] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 07/05/2015] [Indexed: 10/23/2022]
Abstract
Most interventions to prevent postpartum depression (PPD) focus on the mother rather than the mother-infant dyad. As strong relationships between infant sleep and cry behavior and maternal postpartum mood have been demonstrated by previous research, interventions targeted at the dyad may reduce symptoms of PPD. The goal of the current study was to examine the effectiveness of Practical Resources for Effective Postpartum Parenting (PREPP). PREPP is a new PPD prevention protocol that aims to treat women at risk for PPD by promoting maternally mediated behavioral changes in their infants, while also including mother-focused skills. Results of this randomized control trial (RCT) (n = 54) indicate that this novel, brief intervention was well tolerated and effective in reducing maternal symptoms of anxiety and depression, particularly at 6 weeks postpartum. Additionally, this study found that infants of mothers enrolled in PREPP had fewer bouts of fussing and crying at 6 weeks postpartum than those infants whose mothers were in the Enhanced TAU group. These preliminary results indicate that PREPP has the potential to reduce the incidence of PPD in women at risk and to directly impact the developing mother-child relationship, the mother's view of her child, and child outcomes.
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Affiliation(s)
| | | | - Seonjoo Lee
- Columbia University Medical Center,New York State Psychiatric Institute
| | - Tianshu Feng
- Columbia University Medical Center,New York State Psychiatric Institute
| | | | | | - Catherine Monk
- Columbia University Medical Center,New York State Psychiatric Institute
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Benninga MA, Faure C, Hyman PE, St James Roberts I, Schechter NL, Nurko S. Childhood Functional Gastrointestinal Disorders: Neonate/Toddler. Gastroenterology 2016; 150:S0016-5085(16)00182-7. [PMID: 27144631 DOI: 10.1053/j.gastro.2016.02.016] [Citation(s) in RCA: 309] [Impact Index Per Article: 38.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 02/09/2016] [Indexed: 02/08/2023]
Abstract
In 2006, a consensus concerning functional gastrointestinal intestinal disorders (FGIDs) in infants and toddlers was described. At that time little evidence regarding epidemiology, pathophysiology, diagnostic work-up, treatment strategies and follow-up was available. Consequently the criteria for the clinical entities were more experience than evidence based. In the past decade, new insights have been gained in the different FGIDs in these age groups. Based on those, further revisions have been made to the criteria. The description of infant colic has been expanded to include criteria for the general pediatrician and specific criteria for researchers. The greatest change was the addition of a paragraph regarding the neurobiology of pain in infants and toddlers, including the understanding of the neurodevelopment of nociception and of the wide array of factors that may impact the pain experience.
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Affiliation(s)
- Marc A Benninga
- Pediatric Gastroenterology, Emma Children's Hospital / Academic Medical Center, Amsterdam, The Netherlands.
| | - Christophe Faure
- Pediatric Gastroenterology, Sainte-Justine Hospital, Montreal, Qc, Canada
| | - Paul E Hyman
- Pediatric Gastroenterology, Children's Hospital, New Orleans, USA
| | - Ian St James Roberts
- Thomas Coram Research Unit, UCL Institute of Education, University College London, UK
| | - Neil L Schechter
- Pediatric pain center, Boston Children's Hospital, Boston Ma, USA
| | - Samuel Nurko
- Center for Motility and Functional Gastrointestinal Disorders, Boston Children's Hospital, Boston Ma, USA
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Santos IS, Matijasevich A, Capilheira MF, Anselmi L, Barros FC. Excessive crying at 3 months of age and behavioural problems at 4 years age: a prospective cohort study. J Epidemiol Community Health 2015; 69:654-9. [PMID: 25700531 PMCID: PMC4484259 DOI: 10.1136/jech-2014-204568] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Accepted: 02/03/2015] [Indexed: 11/07/2022]
Abstract
Background Excessive crying in early infancy has been associated with behavioural problems among preschool children from high income countries but studies in low income and middle income countries are scarce. Methods The 2004 Pelotas Birth Cohort is a population-based study planned to enrol all live births occurring in Pelotas that year and comprises 4231 children who so far have been followed up at 3, 12, 24, 48 and 72 months of age. Several familial, maternal and child characteristics were gathered in every follow-up. At the 3-month follow-up, infants whose mothers perceived them as crying more than others of the same age were classified as ‘crying babies’. Child behavioural problems were assessed through the Child Behavior Checklist (CBCL) applied to the mother at the 48-month follow-up. Crude and adjusted ORs with 95% CIs were calculated by logistic regression. Results Prevalence of excessive crying at 3 months was 11.9% (10.9% to 13.0%). Among children with excessive crying at 3 months the proportion in the clinical range for CBCL total, internalising and externalising problems at 4 years of age was 31.2%, 12.9% and 37.5%, respectively, against 20.6%, 6.8% and 29.6%, respectively, among non-crying babies. After controlling for confounders crying babies presented increased risk of being in clinical range of CBCL total (OR=1.34; 1.03 to 1.74), internalising (OR=1.55; 1.09 to 2.21) and externalising problems (OR=1.29; 1.01 to 1.64) than infants without excessive crying. Conclusions Excessive crying in early infancy may represent one important risk factor for developing behavioural problems in later phases of early childhood.
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Affiliation(s)
- Iná S Santos
- Post-graduate Program in Epidemiology, Department of Social Medicine, Faculty of Medicine, Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | - Alicia Matijasevich
- Post-graduate Program in Epidemiology, Department of Social Medicine, Faculty of Medicine, Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brazil Department of Preventive Medicine, School of Medicine, University of São Paulo, São Paulo, São Paulo, Brazil
| | - Marcelo F Capilheira
- Post-graduate Program in Epidemiology, Department of Social Medicine, Faculty of Medicine, Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | - Luciana Anselmi
- Post-graduate Program in Epidemiology, Department of Social Medicine, Faculty of Medicine, Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | - Fernando C Barros
- Post-graduate Program in Health and Behavior, Catholic University of Pelotas, Pelotas, Rio Grande do Sul, Brazil
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Douglas PS, Miller Y, Bucetti A, Hill PS, Creedy DK. Preliminary evaluation of a primary care intervention for cry-fuss behaviours in the first 3-4 months of life (‘The Possums Approach’): effects on cry-fuss behaviours and maternal mood. Aust J Prim Health 2015; 21:38-45. [DOI: 10.1071/py13011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Accepted: 07/18/2013] [Indexed: 11/23/2022]
Abstract
Problem crying in the first few months of life is both common and complex, arising out of multiple interacting and co-evolving factors. Parents whose babies cry and fuss a lot receive conflicting advice as they seek help from multiple health providers and emergency departments, and may be admitted into tertiary residential services. Conflicting advice is costly, and arises out of discipline-specific interpretations of evidence. An integrated, interdisciplinary primary care intervention (‘The Possums Approach’) for cry-fuss problems in the first months of life was developed from available peer-reviewed evidence. This study reports on preliminary evaluation of delivery of the intervention. A total of 20 mothers who had crying babies under 16 weeks of age (average age 6.15 weeks) completed questionnaires, including the Crying Patterns Questionnaire and the Edinburgh Postnatal Depression Scale, before and 3−4 weeks after their first consultation with trained primary care practitioners. Preliminary evaluation is promising. The Crying Patterns Questionnaire showed a significant decrease in crying and fussing duration, by 1 h in the evening (P = 0.001) and 30 min at night (P = 0.009). The median total amount of crying and fussing in a 24-h period was reduced from 6.12 to 3 h. The Edinburgh Postnatal Depression Scale showed a significant improvement in depressive symptoms, with the median score decreasing from 11 to 6 (P = 0.005). These findings are corroborated by an analysis of results for the subset of 16 participants whose babies were under 12 weeks of age (average age 4.71 weeks). These preliminary results demonstrate significantly decreased infant crying in the evening and during the night and improved maternal mood, validating an innovative interdisciplinary clinical intervention for cry-fuss problems in the first few months of life. This intervention, delivered by trained health professionals, has the potential to mitigate the costly problem of health professionals giving discipline-specific and conflicting advice post-birth.
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Barr RG, Fairbrother N, Pauwels J, Green J, Chen M, Brant R. Maternal frustration, emotional and behavioural responses to prolonged infant crying. Infant Behav Dev 2014; 37:652-64. [DOI: 10.1016/j.infbeh.2014.08.012] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Revised: 06/12/2014] [Accepted: 08/26/2014] [Indexed: 10/24/2022]
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Litmanovitz I, Bar-Yoseph F, Lifshitz Y, Davidson K, Eliakim A, Regev RH, Nemet D. Reduced crying in term infants fed high beta-palmitate formula: a double-blind randomized clinical trial. BMC Pediatr 2014; 14:152. [PMID: 24942975 PMCID: PMC4081465 DOI: 10.1186/1471-2431-14-152] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2013] [Accepted: 06/12/2014] [Indexed: 11/18/2022] Open
Abstract
Background Beta-palmitate (sn-2 palmitate) mimics human milk fat, enabling easier digestion. Therefore, we hypothesized that infants consuming high beta-palmitate formula would have more frequent, softer stools and reduced crying compared to infants consuming low beta-palmitate formula. Methods Formula-fed infants were randomly assigned to receive either (1) formula with high beta-palmitate (HBP, n = 21) or (2) regular formula with a standard vegetable oil mix (LBP, n = 21). A matched group of breastfed infants served as a reference (BF, n = 21). Crying and stool characteristics data were recorded by the parents for 3 days before the 6- and 12-week visits. Results We found no significant differences in the stool frequency or consistency between the two formula groups. The percentage of crying infants in the LBP group was significantly higher than that in the HBP and BF groups during the evening at 6 weeks (88.2% vs. 56.3% and 55.6%, p < 0.05) and during the afternoon at 12 weeks (91.7% vs. 50.0% and 40%, p < 0.05). The infants fed HBP had significantly shorter crying durations when compared with infants fed LBP formula (14.90 ± 3.85 vs.63.96 ± 21.76 min/day, respectively; p = 0.047). Conclusions Our study indicates that consumption of a high beta-palmitate formula affects infant crying patterns during the first weeks of life. Comparable to breastfeeding, it reduced crying duration and frequency, primarily during the afternoon and evening hours, thereby improving the well-being of formula-fed infants and their parents. Trial registration NCT00874068. Registration date March 31, 2009
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Affiliation(s)
- Ita Litmanovitz
- Neonatal Department Meir Medical center, (Tchernichovsky 59), Kfar Saba (4428164), Israel.
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Bar-Yoseph F, Lifshitz Y, Cohen T. Review of sn-2 palmitate oil implications for infant health. Prostaglandins Leukot Essent Fatty Acids 2013; 89:139-43. [PMID: 23541258 DOI: 10.1016/j.plefa.2013.03.002] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Human milk provides the optimal balanced nutrition for the growing infant in the first months after birth. The human mammary gland has evolved with unusual pathways, resulting in a specific positioning of fatty acids at the outer sn-1 and sn-3, and center sn-2 of the triacylglyceride, which is different from the triglycerides in other human tissues and plasma. The development of structured triglycerides enables mimicking the composition as well as structure of human milk fat in infant formulas. Studies conducted two decades ago, together with very recent studies, have provided increasing evidence that this unusual positioning of 16:0 in human milk triglycerides has a significant role for infant health in different directions, such as fat and calcium absorption, bone health, intestinal flora and infant comfort. This review aims to unravel the relevance of human milk triglyceride sn-2 16:0 for intestinal health and inflammatory pathways and for other post-absorption effects.
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Radesky JS, Zuckerman B, Silverstein M, Rivara FP, Barr M, Taylor JA, Lengua LJ, Barr RG. Inconsolable infant crying and maternal postpartum depressive symptoms. Pediatrics 2013; 131:e1857-64. [PMID: 23650295 DOI: 10.1542/peds.2012-3316] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To quantify the extent to which maternal report of inconsolable infant crying, rather than colic (defined by Wessel's criteria of daily duration of fussing and crying >3 hours), is associated with maternal postpartum depressive symptoms. METHODS Participants were 587 mothers who were recruited shortly before or after delivery and followed longitudinally. At 5 to 6 weeks postpartum, mothers recorded the duration and mode (fussing, crying, or inconsolable crying) of their infant's distress by using the Baby's Day Diary. The Edinburgh Postnatal Depression Scale (EPDS) was administered at enrollment and at 8 weeks postpartum. Using regression models that included baseline EPDS scores and multiple confounders, we examined associations of colic and inconsolable crying with later maternal EPDS scores at 8 weeks postpartum. RESULTS Sixty mothers (10%) met the EPDS threshold for "possible depression" (score ≥9) at 8 weeks postpartum. For mothers reporting >20 minutes of inconsolable crying per day, the adjusted odds ratio for an EPDS score ≥9 was 4.0 (95% confidence interval: 2.0-8.1), whereas the adjusted odds ratio for possible depression in mothers whose infants had colic was 2.0 (95% confidence interval: 1.1-3.7). These associations persisted after adjusting for baseline depression symptoms. CONCLUSIONS Maternal report of inconsolable infant crying may have a stronger association with postpartum depressive symptoms than infant colic. Asking a mother about her ability to soothe her infant may be more relevant for potential intervention than questions about crying and fussing duration alone.
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Empirische Grundlagen des Fragebogens zum Schreien, Füttern und Schlafen (SFS). Prax Kinderpsychol Kinderpsychiatr 2013; 62:327-47. [DOI: 10.13109/prkk.2013.62.5.327] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Miller JE, Newell D, Bolton JE. Efficacy of Chiropractic Manual Therapy on Infant Colic: A Pragmatic Single-Blind, Randomized Controlled Trial. J Manipulative Physiol Ther 2012; 35:600-7. [DOI: 10.1016/j.jmpt.2012.09.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2012] [Revised: 06/30/2012] [Accepted: 07/04/2012] [Indexed: 10/27/2022]
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Fujiwara T, Yamada F, Okuyama M, Kamimaki I, Shikoro N, Barr RG. Effectiveness of educational materials designed to change knowledge and behavior about crying and shaken baby syndrome: a replication of a randomized controlled trial in Japan. CHILD ABUSE & NEGLECT 2012; 36:613-620. [PMID: 22954642 DOI: 10.1016/j.chiabu.2012.07.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2012] [Revised: 06/21/2012] [Accepted: 07/04/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVES Infant crying is particularly frustrating to caregivers in the first few months of life and the most common trigger for shaking and abuse. The effectiveness of the Period of PURPLE Crying prevention materials (DVD and booklet) designed to increase knowledge and change behaviors related to crying and the dangers of shaking was reported in North America. The aim of this study was to replicate the effectiveness of the PURPLE materials with mothers of newborns in Japan. METHODS In a randomized controlled trial, 201 parents received either PURPLE materials or analogous control materials on infant safety via mail within 2 weeks of birth. At 6 weeks, mothers completed a 4-day behavioral diary. At 2 months, participants completed a predefined 20-min structured telephone survey by an independent firm to assess knowledge and behavior. RESULTS Scores on crying knowledge scales (out of 100) were significantly higher in the intervention than control groups (56.1 vs. 53.1; difference=3.0, 95% confidence interval [CI]: 1.0-4.9, p<0.005). Percentage of sharing of advice to walk away if frustrated by crying was significantly higher in the intervention than control groups (22.4% vs. 4.1%; difference=18%, 95% CI: 7.4-29.1). Walking away during unsoothable crying was significantly higher in the intervention group than controls (0.085 vs. 0.017 events per day, rate ratio=4.8, 95% CI: 1.1-21.2) by diary. Self-talk behavior scale (out of 100) tended to significance in the intervention group (16.6 vs. 8.9, difference=7.7, 95% CI: -1.0 to 16.4, p<0.1). CONCLUSIONS Crying knowledge, sharing of walk away information with others and walk away behavior when crying was unsoothable were higher for those who received intervention than control materials. The Period of PURPLE Crying materials may be useful in Japan as well as in North America for informing caregivers about the properties of infant crying and changing some behaviors related to infant crying and shaking. (UMIN Clinical Trials Registry register no. UMIN000001711.).
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Affiliation(s)
- Takeo Fujiwara
- Department of Social Medicine, National Research Institute for Child Health and Development, Tokyo, Japan
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Guyer C, Huber R, Fontijn J, Bucher HU, Nicolai H, Werner H, Molinari L, Latal B, Jenni OG. Cycled light exposure reduces fussing and crying in very preterm infants. Pediatrics 2012; 130:e145-51. [PMID: 22689866 DOI: 10.1542/peds.2011-2671] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To examine whether cycled lighting (CL) conditions during neonatal care in very preterm infants (<32 weeks' gestational age [GA]) decrease crying and fussing behavior, improve the consolidation of sleep, and influence activity behavior at 5 and 11 weeks' postterm corrected age (CA) compared with preterm infants cared for in dim lighting (DL) conditions. METHODS Thirty-seven preterm infants were randomly assigned to CL (7 am-7 pm lights on, 7 pm-7 am lights off [n = 17; mean GA: 30.6 ± 0.95 weeks; 9 girls]) or DL (lights off whenever the child is asleep [n = 20; GA: 29.5 ± 2.1 weeks; 8 girls]) conditions. Sleeping, crying, and activity behavior was recorded by using parental diaries and actigraphy at 5 and 11 weeks' CA. RESULTS A significant reduction of fussing (59.4 minutes/24 hours [± 25.8 minutes]) and crying (31.2 minutes/24 hours [± 14.4 minutes]) behavior and a trend to higher motor activity during daytime was found in CL-exposed infants at 5 and 11 weeks' CA compared with infants cared for in DL conditions. No significant difference between groups was observed for sleep behavior at 5 and 11 weeks' CA. Infants in CL conditions showed a trend to improved daily weight gain (average: 3.6 g/d) during neonatal care compared with DL conditions. CONCLUSIONS CL conditions in neonatal care have beneficial effects on infant's fussing and crying behavior and growth in the first weeks of life. This study supports the introduction of CL care in clinical neonatal practice.
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Affiliation(s)
- Caroline Guyer
- Child Development Center, Department of Pediatrics, University Children's Hospital, Zurich, Switzerland
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Bolten MI, Fink NS, Stadler C. Maternal self-efficacy reduces the impact of prenatal stress on infant's crying behavior. J Pediatr 2012; 161:104-9. [PMID: 22289357 DOI: 10.1016/j.jpeds.2011.12.044] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2011] [Revised: 12/06/2011] [Accepted: 12/28/2011] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine whether prenatal stress is associated with behavioral and emotional regulation problems (crying/fussing) in infants, after controlling for confounding factors. Furthermore, the study investigated the stress-buffering effect of maternal self-efficacy. STUDY DESIGN Data were collected in 120 pregnant women (29 ± 3.2 weeks gestation) and their infants at 6 weeks of age. Expecting mothers completed a structured interview and self-report questionnaires on prenatal stress and self-efficacy. Crying/fussing data were obtained with a validated parental diary. RESULTS After controlling for confounding variables, multiple regression analyses show that prenatal stress and self-efficacy accounted for 20% of the variance of infant's fussing and crying behavior. Results suggest a mediating role of self-efficacy. Babies of mothers reporting high levels of prenatal stress cried less when their mother had high levels of self-efficacy compared with mothers with low self-efficacy. In addition, mothers of infants with excessive crying reported more symptoms of stress, depression, and anxiety in pregnancy. CONCLUSION To foster the development of well-adapted parent-infant relationships and potentially to reduce infant crying in the early postpartum phase, health care professionals need special education about the effects of prenatal stress and interventions that promote self-efficacy.
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Affiliation(s)
- Margarete I Bolten
- Department of Developmental Psychopathology, Child and Adolescents Psychiatric Clinic, University of Basel, Basel, Switzerland.
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Fewtrell MS, Kennedy K, Nicholl R, Khakoo A, Lucas A. Infant feeding bottle design, growth and behaviour: results from a randomised trial. BMC Res Notes 2012; 5:150. [PMID: 22424116 PMCID: PMC3328286 DOI: 10.1186/1756-0500-5-150] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Accepted: 03/16/2012] [Indexed: 12/02/2022] Open
Abstract
Background Whether the design of an anti-vacuum infant feeding bottle influences infant milk intake, growth or behavior is unknown, and was the subject of this randomized trial. Methods Results Conclusion Bottle design may have short-term effects on infant behaviour which merit further investigation. No significant effects were seen on milk intake or growth; confidence in these findings is limited by the small sample size and this needs confirmation in a larger study. Trial registration Clinical Trials.gov NCT00325208.
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Affiliation(s)
- M S Fewtrell
- MRC Childhood Nutrition Research Centre, UCL Institute of Child Health, London, UK.
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Salisbury AL, High P, Twomey JE, Dickstein S, Chapman H, Liu J, Lester B. A randomized control trial of integrated care for families managing infant colic. Infant Ment Health J 2012; 33:110-122. [PMID: 28520096 DOI: 10.1002/imhj.20340] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
This article presents a randomized clinical trial examining the effectiveness of a unique model of integrated care for the treatment of infant colic. Families seeking help for infant colic were randomized to either the family-centered treatment (TX; n = 31) or standard pediatric care (SC; n = 31). All parents completed 3 days of Infant Behavior Diaries (Barr et al., 1998) and the Colic Symptom Checklist (Lester, 1997), Beck Depression Inventory (Beck & Steer, 1984), and Parenting Stress Index 3rd ed.-SF (Abidin, 1995). TX families were seen three times by a pediatrician and a mental health clinician within 1, 2, and 6 weeks of baseline data. TX families received individualized treatment plans addressing problem areas of sleep, feeding, routine, and family mental health. SC families were seen only by their own healthcare provider. All families were visited at home by a research assistant to retrieve data at 2, 6, and 10 weeks after baseline. Family-based treatment accelerated the rate of reduction of infant crying faster than did standard pediatric care. Infants in the TX group had more hours of sleep at 2 weeks posttreatment and spent less time feeding at 2, 6, and 10 weeks posttreatment than did SC infants. Results indicate that individualized family-based treatment reduces infant colic more rapidly than does standard pediatric care.
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Affiliation(s)
- Amy L Salisbury
- Women & Infants Hospital, Brown Center for the Study of Children at Risk and Warren Alpert Medical School, Brown University
| | - Pamela High
- Warren Alpert Medical School, Brown University and Rhode Island Hospital/Hasbro Children's Hospital
| | - Jean E Twomey
- Women & Infants Hospital, Brown Center for the Study of Children at Risk and Warren Alpert Medical School, Brown University
| | - Susan Dickstein
- Warren Alpert Medical School, Brown University and Bradley Hospital
| | - Heather Chapman
- Warren Alpert Medical School, Brown University and Rhode Island Hospital/Hasbro Children's Hospital
| | - Jing Liu
- Women & Infants Hospital, Brown Center for the Study of Children at Risk and Warren Alpert Medical School, Brown University
| | - Barry Lester
- Women & Infants Hospital, Brown Center for the Study of Children at Risk and Warren Alpert Medical School, Brown University
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Infant distress at five weeks of age and caregiver frustration. J Pediatr 2011; 159:425-430.e1-2. [PMID: 21429518 DOI: 10.1016/j.jpeds.2011.02.010] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2010] [Revised: 01/13/2011] [Accepted: 02/04/2011] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To investigate the differential association of three modes (fussing, crying, unsoothable crying) and three properties (duration/day, frequency/day, maximum bout length) of infant distress with daily caregiver frustration. STUDY DESIGN Replicated cross-sectional studies were completed in Vancouver, British Columbia (n = 1065) and Seattle, Washington (n = 1857). Infant fussing, crying, and unsoothable crying and caregiver frustration were measured daily for 4 days at 5 weeks of age by the Baby's Day Diary. Generalized estimating equation models were used to predict caregiver frustration from nine measurements of distress. RESULTS In Vancouver, measurements of distress significantly associated with caregiver frustration in decreasing order of magnitude were as follow: (1) maximum bout length of unsoothable crying; (2) duration/day of crying; and (3) frequency of unsoothable crying and duration/day of fussing. In Seattle, associated measurements of distress were: (1) maximum bout length of unsoothable crying; (2) maximum bout length and duration/day of crying, frequency of unsoothable crying, and duration/day of fussing; and (3) frequency/day of crying. CONCLUSIONS Daily caregiver frustration is associated differentially with different modes and properties of infant distress. Specifically, maximum bout length of unsoothable crying was most strongly related in both sites. Additionally, frequency/day of unsoothable crying and duration/day of crying and of fussing were significantly associated at both sites.
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Hemmi MH, Schneider S, Müller S, Meyer AH, Wilhelm FH. Analyzing temporal patterns of infant sleep and negative affective behavior: a comparison between different statistical models. Infant Behav Dev 2011; 34:541-51. [PMID: 21820742 DOI: 10.1016/j.infbeh.2011.06.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2010] [Revised: 05/30/2011] [Accepted: 06/23/2011] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Variability in infant sleep and negative affective behavior (NAB) is a developmental phenomenon that has long been of interest to researchers and clinicians. However, analyses and delineation of such temporal patterns were often limited to basic statistical approaches, which may prevent adequate identification of meaningful variation within these patterns. Modern statistical procedures such as additive models may detect specific patterns of temporal variation in infant behavior more effectively. METHOD Hundred and twenty-one mothers were asked to record different behaviors of their 4-44 weeks old healthy infants by diaries for three days consecutively. Circadian patterns as well as individual trajectories and day-to-day variability of infant sleep and NAB were modeled with generalized linear models (GLMs) including a linear and quadratic polynomial for time, a GLM with a polynomial of the 8th order, a GLM with a harmonic function, a generalized linear mixed model (GLMM) with a polynomial of the 8th order, a generalized additive model, and a generalized additive mixed model (GAMM). RESULTS The semi-parametric model GAMM was found to fit the data of infant sleep better than any other parametric model used. GLMM with a polynomial of the 8th order and GAMM modeled temporal patterns of infant NAB equally well, although the GLMM exhibited a slightly better model fit while GAMM was easier to interpret. Besides the well-known evening clustering in infant NAB we found a significant second peak in NAB around midday that was not affected by the constant decline in the amounts of NAB across the 3-day study period. CONCLUSION Using advanced statistical procedures (GAMM and GLMM) even small variations and phenomena in infant behavior can be reliably detected. Future studies investigating variability and temporal patterns in infant variables may benefit from these statistical approaches.
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Affiliation(s)
- Mirja H Hemmi
- Swiss Etiological Study of Adjustment and Mental Health, Institute of Psychology, University of Basel, Switzerland.
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Kaley F, Reid V, Flynn E. The psychology of infant colic: A review of current research. Infant Ment Health J 2011; 32:526-541. [DOI: 10.1002/imhj.20308] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Kvitvaer BG, Miller J, Newell D. Improving our understanding of the colicky infant: a prospective observational study. J Clin Nurs 2011; 21:63-9. [PMID: 21507093 DOI: 10.1111/j.1365-2702.2010.03680.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM To investigate characteristics differentially associated with infants suffering from colicky-crying vs. other infants. BACKGROUND The crying baby is the most common presentation in every clinician's office in the first 16 weeks of life. As little agreement exists in the literature, attempts to establish differential diagnosis, aetiology, incidence, risk factors and natural progression in addition to appropriate intervention guidelines are urgently needed. DESIGN Prospective observational study. SUBJECTS Infants ≤ 12 months, 159 colicky and 27 non-colicky infants (n = 186) from whom complete data sets were collected. METHODS Parents of infants presented to the clinic completed questionnaires of their infant's characteristics. The data were analysed using logistic regression. RESULTS Symptoms supporting the diagnosis of colicky-crying infants included 'child flexes/curls legs', 'child has difficulty/discomfort on bowel movement', 'child is more irritable postfeeding', 'child is more irritable when put into cot', 'child appears in pain', 'child wants frequent cuddling', 'family allergy/asthma' and 'child changes from happy to crying in an instant'. A nomogram illustrated if a mother suggests colic as a diagnosis and the infant has the symptoms supporting the diagnosis, then the chances of being a colicky infant rise from the initial prevalence 85% to approximately 98%. If the symptoms are not present, the chances of being a colicky infant drop from 85% to around 3%. CONCLUSION Because the literature lacks consensus regarding a gold standard for the diagnosis of the colicky-crying infant, these findings may offer help to the health care practitioner when faced with an excessively crying infant. RELEVANCE TO CLINICAL PRACTICE It has been hypothesised that there may be multiple reasons for excessive crying in an infant. It is necessary to differentiate between the types of crying infants that present to the clinician to determine the best course of action.
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Affiliation(s)
- Bente G Kvitvaer
- Anglo-European College of Chiropractic, Bournemouth University, Bournemouth, Dorset, UK
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Abstract
OBJECTIVE Infants who cry a lot, or are unsettled in the night, are common sources of concern for parents and costly problems for health services. The two types of problems have been linked together and attributed to a general disturbance of infant regulation. Yet the infant behaviours involved present differently, at separate ages and times of day. To clarify causation, this study aims to assess whether prolonged crying at 5-6 weeks (the peak age for crying) predicts which infants are unsettled in the night at 12 weeks of age (when most infants become settled at night). METHODS Data from two longitudinal studies are analysed. Infant crying data were obtained from validated behaviour diaries; sleep-waking data from standard parental questionnaires. RESULTS A significant, weak relationship was found between crying at 5-6 weeks and 12-week night waking and signalling in one study, but not the other. Most infants who met the definition for prolonged crying/colic at 5-6 weeks were settled during the night at 12 weeks of age; they were not more likely than other infants to be unsettled. CONCLUSIONS Most infants who cry a lot at 5-6 weeks of age 'sleep through the night' at 12 weeks of age. This adds to evidence that the two types of problematic behaviour have different causes, and that infant sleep-waking problems usually involve maintenance of signalling behaviours rather than a generalised disturbance.
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Affiliation(s)
- Ian St James-Roberts
- Thomas Coram Research Unit, Institute of Education, University of London, 27-28 Woburn Square, London, UK.
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Paul IM, Savage JS, Anzman SL, Beiler JS, Marini ME, Stokes JL, Birch LL. Preventing obesity during infancy: a pilot study. Obesity (Silver Spring) 2011; 19:353-61. [PMID: 20725058 PMCID: PMC3477360 DOI: 10.1038/oby.2010.182] [Citation(s) in RCA: 150] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
More than 20% of US children between ages 2 and 5 years are overweight suggesting efforts to prevent obesity must begin earlier. This study tested the independent and combined effects of two behavioral interventions delivered to parents, designed to promote healthy infant growth in the first year. Mother-newborn dyads intending to breastfeed were recruited from a maternity ward. With a 2 × 2 design, 160 dyads were randomized into one of four treatment cells to receive both, one, or no interventions delivered at two nurse home visits. The first intervention ("Soothe/Sleep") instructed parents on discriminating between hunger and other sources of infant distress. Soothing strategies were taught to minimize feeding for non-hunger-related fussiness and to prolong sleep duration, particularly at night. The second intervention ("Introduction of Solids") taught parents about hunger and satiety cues, the timing for the introduction of solid foods, and how to overcome infants' initial rejection of healthy foods through repeated exposure. A total of 110 mother-infant dyads completed the year-long study. At 1 year, infants who received both interventions had lower weight-for-length percentiles (P = 0.009). Participants receiving both interventions had a mean weight-for-length in the 33rd percentile; in contrast, those in other study groups were higher first intervention only--50th percentile; second intervention only--56th percentile; control group--50th percentile).This suggests that multicomponent behavioral interventions may have potential for long-term obesity prevention (ClinicalTrials.gov number, NCT00359242).
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Affiliation(s)
- Ian M Paul
- Department of Pediatrics, Penn State College of Medicine, Hershey, Pennsylvania, USA.
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Abstract
OBJECTIVES To assess (1) preference of parental use of an electronic diary (e-diary) over a paper diary to record continuous infant and caregiver behaviors over 7 days; (2) whether e-diary recordings would differ in systematic ways from those obtained by paper diaries, and (3) frequency of diary entries when parents provide entries when convenient. METHODS Mothers of normal newborns were randomized at 5 weeks infant age to a paper diary first (n = 34) or e-diary first (n = 35) group. With 3 days between, mothers completed 7-day recordings on both the paper Baby's Day Diary and an analogous personal digital assistant e-diary for infant (sleep, awake alert, feeding, fussing, crying, inconsolable crying) and caregiver (carrying/holding, moving) behaviors, and completed post diary ease-of-use ratings and poststudy preference ratings. RESULTS Mothers found e-diaries less bothersome but similarly disruptive and enjoyable to paper diaries. At study end, more found e-diaries easier to use, less bothersome and more efficient. E-diary behaviors were consistently more frequent, but rarely different in duration, then paper diary behaviors. Time-stamped e-diary entries (1) generally declined across weeks, (2) were higher if e-diaries were used first, and (3) settled at a modal 2 to 3 entries/day by the second week. CONCLUSIONS For behavioral recording of infant and caregiver behaviors, mothers generally expressed more approval for e-diaries than paper diaries, but neither was considered onerous. E-diaries consistently report more frequent but similar durations of behaviors. If recording when convenient, daily diary entries trend toward 2 to 3 entries a day. The e-diary results provide convergent evidence that paper diary recordings of common infant and caregiver behavior durations provide good estimates of durations, but that behavioral frequencies may be underestimated.
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McGlaughlin A, Grayson A. Crying in the first year of infancy: Patterns and prevalence. J Reprod Infant Psychol 2010. [DOI: 10.1080/02646830020032300] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Affiliation(s)
- A. McGlaughlin
- a Division of Psychology, Department of Social Sciences , The Nottingham Trent University , UK
| | - A. Grayson
- b Centre for Human Development and Learning, School of Education , The Open University , UK
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Barr RG, Barr M, Fujiwara T, Conway J, Catherine N, Brant R. Do educational materials change knowledge and behaviour about crying and shaken baby syndrome? A randomized controlled trial. CMAJ 2009; 180:727-33. [PMID: 19255065 PMCID: PMC2659818 DOI: 10.1503/cmaj.081419] [Citation(s) in RCA: 116] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Shaken baby syndrome often occurs after shaking in response to crying bouts. We questioned whether the use of the educational materials from the Period of PURPLE Crying program would change maternal knowledge and behaviour related to shaking. METHODS We performed a randomized controlled trial in which 1279 mothers received materials from the Period of PURPLE Crying program or control materials during a home visit by a nurse by 2 weeks after the birth of their child. At 5 weeks, the mothers completed a diary to record their behaviour and their infants' behaviour. Two months after giving birth, the mothers completed a telephone survey to assess their knowledge and behaviour. RESULTS The mean score (range 0-100 points) for knowledge about infant crying was greater among mothers who received the PURPLE materials (63.8 points) than among mothers who received the control materials (58.4 points) (difference 5.4 points, 95% confidence interval [CI] 4.1 to 6.5 points). The mean scores were similar for both groups for shaking knowledge and reported maternal responses to crying, inconsolable crying and self-talk responses. Compared with mothers who received control materials, mothers who received the PURPLE materials reported sharing information about walking away if frustrated more often (51.5% v. 38.5%, difference 13.0%, 95% CI 6.9% to 19.2%), the dangers of shaking (49.3% v. 36.4%, difference 12.9%, 95% CI 6.8% to 19.0%), and infant crying (67.6% v. 60.0%, difference 7.6%, 95% CI 1.7% to 13.5%). Walking away during inconsolable crying was significantly higher among mothers who received the PURPLE materials than among those who received control materials (0.067 v. 0.039 events per day, rate ratio 1.7, 95% CI 1.1 to 2.6). INTERPRETATION The receipt of the Period of PURPLE Crying materials led to higher maternal scores for knowledge about infant crying and for some behaviours considered to be important for the prevention of shaking.
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Affiliation(s)
- Ronald G Barr
- Centre for Community Child Health Research, Child and Family Research Institute, University of British Columbia, Vancouver, BC
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Barr RG, Rivara FP, Barr M, Cummings P, Taylor J, Lengua LJ, Meredith-Benitz E. Effectiveness of educational materials designed to change knowledge and behaviors regarding crying and shaken-baby syndrome in mothers of newborns: a randomized, controlled trial. Pediatrics 2009; 123:972-80. [PMID: 19255028 DOI: 10.1542/peds.2008-0908] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Infant crying is an important precipitant for shaken-infant syndrome. OBJECTIVE. To determine if parent education materials (The Period of PURPLE Crying [PURPLE]) change maternal knowledge and behavior relevant to infant shaking. METHODS This study was a randomized, controlled trial conducted in prenatal classes, maternity wards, and pediatric practices. There were 1374 mothers of newborns randomly assigned to the PURPLE intervention and 1364 mothers to the control group. Primary outcomes were measured by telephone 2 months after delivery. These included 2 knowledge scales about crying and the dangers of shaking; 3 scales about behavioral responses to crying generally and to unsoothable crying, and caregiver self-talk in response to unsoothable crying; and 3 questions concerning the behaviors of sharing of information with others about crying, walking away if frustrated, and the dangers of shaking. RESULTS The mean infant crying knowledge score was greater in the intervention group (69.5) compared with controls (63.3). Mean shaking knowledge was greater for intervention subjects (84.8) compared with controls (83.5). For reported maternal behavioral responses to crying generally, responses to unsoothable crying, and for self-talk responses, mean scores for intervention mothers were similar to those for controls. For the behaviors of information sharing, more intervention mothers reported sharing information about walking away if frustrated and the dangers of shaking, but there was little difference in sharing information about infant crying. Intervention mothers also reported increased infant distress. CONCLUSIONS Use of the PURPLE education materials seem to lead to higher scores in knowledge about early infant crying and the dangers of shaking, and in sharing of information behaviors considered to be important for the prevention of shaking.
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Affiliation(s)
- Ronald G Barr
- MDCM, FRCPC, Centre for Community Child Health Research, 4480 Oak St, L408, Vancouver, British Columbia, Canada.
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Kennedy E, Majnemer A, Farmer JP, Barr RG, Platt RW. Motor development of infants with positional plagiocephaly. Phys Occup Ther Pediatr 2009; 29:222-35. [PMID: 19842852 DOI: 10.1080/01942630903011016] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Concurrent with recommendations to place infants to sleep in supine, there has been a dramatic increase in the number of infants with positional plagiocephaly (PP). Recent evidence suggests that infants who have decreased exposure to prone position may have a higher incidence of PP and may be at risk for a delay in the acquisition of certain motor skills. The purpose of this study was to compare motor development between infants with PP and matched peers without PP. We also examined differences in infant positioning practices when asleep and awake between the two groups. Twenty-seven infants with PP, 3 to 8 months of age, were matched by age, gender, and race to infants without PP. Motor performance was evaluated using the Alberta Infant Motor Scale (AIMS) and the Peabody Developmental Motor Scales (PDMS). Parents completed a diary that recorded infant positioning over a 3-day period. Mean AIMS percentile score for infants with PP was 31.1 +/- 21.6 as compared with 42.7 +/- 20.2 in infants without PP (p = .06). Better performance on the AIMS was positively correlated with the amount of time in prone position when awake, for both groups of children (PP r = .52, no PP r = .44, p < .05). Therapists should be aware of a risk of a motor delay when evaluating infants with PP. It is also important for parents to be informed about the importance of supervised prone playtime to enhance the development of early motor skills.
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Affiliation(s)
- Eileen Kennedy
- Department of Physical Therapy, Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada
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Bonichini S, Axia G, St. James-Roberts I, DeCian S. Infant crying and maternal holding in the first 2 months of age: an Italian diary study. INFANT AND CHILD DEVELOPMENT 2008. [DOI: 10.1002/icd.565] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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