The problems and management of excessive crying and fussing in infants

Excessive crying and fussing in young infants, often called "infantile colic", is a common and often serious problem for parents. It is also associated with infant sleep disturbance and possible disruptions in family life. As such, parents may undertake a variety of actions to stop excessive infant crying, some of which may be detrimental to infant health (e.g., physical shaking). Despite its potentially substantial negative health consequences, there remains no consensus regarding a definitive definition of excessive crying. Available definitions mostly focus on infant crying duration and its effect on parents. A number of different definitions, measurements, causes of crying, and settling management are presented in this article to help foster an understanding of this issue among nurses and to assist parents to cope effectively.     

A comprehensive definition of infant colic: parents' and nurses' perspectives

Colic is a term that is often used for crying in infancy. There is no unified definition, the aetiology is disputed and there is no effective method of treatment. Therefore, the crying infant constitutes a problem for parents and for nurses in child health clinics. The purpose of the study was to develop a clinically acceptable framework for describing colic. The design is exploratory, and data were collected through qualitative in-depth interviews with nurses and parents of crying babies. The infants identified by parents and nurses had periods of crying or fussing for more than 3 hours a day, the crying occurring on more than 3 days in any 1 week and lasting for more than 3 weeks. Three categories of crying emerged (intense crying, non-specific fussing and crying, feeding-related crying) that presumably differ in aetiology. An overall definition of colic is proposed that incorporates these categories. The proposed definition may function as a diagnostic tool for nurses when they encounter problems of infant crying. The definition provides nurses with clinical criteria that can guide data collection. More specific assessment and categorization of infant crying will be helpful for nurses in addressing problems of colic.     

父母应对婴儿哭闹的现状及其干预措施的研究进展

哭闹是婴儿表达自我需求、情绪和状态的主要方式。婴儿哭闹与父母应对行为彼此影响。本文围绕父母应对婴儿哭闹的现状(认知、信心、行为)及其影响因素、父母应对婴儿哭闹的评估方式、提升父母应对婴儿哭闹的干预措施进行综述,以期为婴儿家庭照护相关研究和实践提供借鉴。     

The crying infant

Infants with the chief complaint of crying can present a diagnostic dilemma to the health care provider. This article discusses the differential diagnosis and management of the crying infant.     

Neonatal facial coding system scores and spectral characteristics of infant crying during newborn circumcision

OBJECTIVE: To determine the relations between Neonatal Facial Coding System (NFCS) scores and measures of infant crying during newborn circumcision. METHODS: Video and audio recordings were made of infant facial activity and cry sounds, respectively, during the lysis phase of circumcisions of 44 healthy term males (<3 d of age). All infants received topical analgesia before circumcision. NFCS scores were determined by blinded assistant from video recordings of facial activity. Measures of infant crying were determined via spectrum analysis of audio recordings by a blinded, independent researcher. Pearson product-moment correlations were used to examine relationship between NFCS scores and measures of crying. Principal component factor analysis detected dimensions underlying related measures of crying. Factor scores from a factor analysis were used in stepwise linear regression to predict NFCS scores. RESULTS: Higher NFCS scores correlated with lower peak fundamental frequency of crying (P<0.01) and with higher amplitudes of crying at peak fundamental frequency and dominant frequency and in overall cry sample (P<0.01). The factor analysis showed 3 significant orthogonal dimensions underlying measures of crying: Power and Velocity (amplitude and rapidity), Pitch of Crying (frequency characteristics), and Infant Arousal (turbulence and intensity) accounting for 42.3%, 17.8%, and 14.6% of variance, respectively. A regression analysis showed all 3 factor scores accounted for significant and separate portions of variance (P<0.001). The best predictor of NFCS score was Power and Velocity (P<0.002), followed by Infant Arousal (P<0.002), and Pitch of Crying (P<0.007). DISCUSSION: These data provide some of the first known evidence linking specific measures of infant crying with an independent, validated measure of pain.     

Fathers' Experience of Childbirth and its Relation to Crying in His Infant

As part of a research project exploring ways through which we can understand the crying infant and its family, this study focuses on the experiences of fathers during labour and delivery of their infant. In a previous part of the project it was shown that fathers' negative experiences during the childbirth were correlated with the amount of crying in the infant during the first months after birth. The aim of the present study was to explore and interpret the experiences that fathers reported in an interview when the infant was between six months and one year of age. A hundred and nine fathers were interviewed. The interviews, which took place in the families' homes and with both parents present, were carried out in dialogue form with open-ended questions. The results reveal that complications during the delivery were significantly correlated with the amount of crying in the infant. Feelings of helplessness, of guilt and that staff behaviour had been negative were more common in the group of fathers who experienced the delivery as a negative event. ‘Locus of control’ seems to be the most relevant concept.     

Help in times of crying: nurses' approach to parents with colicky infants

BACKGROUND: Colic, a condition that is well known to parents and nurses working in child health centres, is characterized by excessive crying. However, the criteria for defining colic are vague, there is no agreed definition and no effective treatment exists. Even though there is no cure for colic, nurses in child health centres have to deal with the condition as parents bring their crying infants to them. AIM: To develop an understanding of how nurses deal with infant colic/excessive crying, how the parents perceive nurses' contribution, and whether nursing makes a difference to the situation or not. ETHICAL ISSUES AND APPROVAL: The project was reviewed and approved by the Research Ethics Committee in Norway where the study was carried out. METHODS: The design is explorative, and data were collected through qualitative in-depth interviews with nurses and parents of crying infants. The analysis follows the guidelines of Kvale, which imply a phenomenological/hermeneutical mode of understanding. FINDINGS: The primary aim of nursing is to assist parents in their efforts to cope with the challenges of infant colic. Nurses and parents differ to some extent in how they define the problems and the needs of the families. In addition, both parents and nurses question the nurses' knowledge and ability to help in this situation. A relationship with the parents based on trust is fundamental to enable the nurses to achieve their goals, but such a relationship is not always developed. CONCLUSIONS: Even though nursing interventions do not cure infant colic, the amount of crying may be reduced and life made easier for the families if the parents are offered help in coping with the situation. Consequently, this should be the primary aim of nursing when approaching families with a colicky infant.     

Infant crying during aircraft descent

The phenomenon of infant crying during aircraft descent is described, based on in-flight observations of 37 infant-mother pairs and mother interviews. The hallmark was crying during descent that was not alleviated by mothers' strategies that had been effective prior to descent. A significant relationship was found between bottle feeding and crying during descent; 18 (78%) of nonfeeding infants cried, compared with 4 (29%) of the bottle feeders. All infants with colds cried during descent, and descent crying always occurred more than 9 minutes after adults perceived the need to clear their ears. Only 4 of the 22 mothers (18%) with crying infants attributed the crying to ear pain, yet the findings support the explanation of otalgia due to inadequate middle ear ventilation. Developmental factors that put airborne infants at risk for otic barotrauma, educational implications, and directions for future research are discussed.     

Congenital Laryngeal Stridor

The supine position of the infant during bottle feeding results in forced feeding and causes the infant to strangle, gulp and swallow air. This produces crying, colic and chronic spitting. Positional otitis media requiring surgery also may develop in the infant fed in a supine position. An angled-neck nurser has been developed which allows the proper upright position of the infant during feeding. This nurser allows the infant to be held in a position comparable to that in breast feeding.     

Pain in infancy: neonatal reaction to a heel lance

A combined single subject and group design was used to investigate changes in heart rate and crying in response to a heel lance, non-invasive tactile stimulation and baseline periods in 10 male and 10 female infants, each in their second full day of life. Heart rate was measured with an electrocardiogram. Percentage of time crying was computed from observations of audiotapes. Results for individual subjects indicated that heart rate and percentage of crying were consistently increased by the heel lance but that there was often wide baseline variability in the two measures. Analysis of variance indicated that responses to heel lance were higher than responses to tactile stimulation which were in turn higher than responses to baseline for both heart rate and percentage of crying (P less than 0.01). No significant sex differences were found. It was suggested that the increases in heart rate and crying in the context of a tissue damaging stimulus indicated that the infants experienced pain and that pain in infants can be reliably measured in clinical settings.     

Infant Behaviors as Indicators of Established Acute Pain

ISSUES AND PURPOSE. Many infant pain assessment tools use infant behaviors indicative of increased arousal. These tools were developed and tested using clinical situations involving acute immediate pain responses. Are these behaviors valid, clinical indicators of acute established pain (non‐procedurally caused) pain? Can these tools be used to assess acute established infant pain? This article explores research findings to answer these questions. CONCLUSIONS. Findings suggest that behaviors indicative of increased arousal (e.g., crying, facial expressions that accompany crying) are nonspecific indicators of distress rather than independent indicators of established acute pain. Thus, the use of behaviors representing acute immediate pain responses to assess acute established pain, or the use of tools that incorporate these behaviors, can be misleading. PRACTICE IMPLICATIONS. Always use acute immediate pain behavioral responses (behaviors indicative of increased arousal) in conjunction with clinical data concerning “likelihood of pain“ and consolability.     

Infant crying and sleeping: helping parents to prevent and manage problems

This article summarizes the current understanding of infant crying and sleeping problems, together with the implications of this understanding for services and research, with a focus on the first months of infancy.     

Tobacco use triggers for mothers of infants: implications for pediatric nursing practice

PURPOSE: To extend current knowledge of tobacco use by exploring whether subsets of mothers of infants have unique triggers for smoking relapse during the early stages of becoming a mother. METHOD: Using data from a study of smoking relapse among mothers of infants (N = 133), comparative analyses were conducted for groups formed on the basis of their intention to be nonsmokers after delivery (yes/no) and their actual smoking behavior during the first 2 weeks of infant life (yes/no). FINDINGS: The identified groups of mothers were found to be significantly different from one another in several ways, including self-reports that their baby's crying episodes caused them to think about smoking and their level of self-confidence to not smoke as response to infant crying. CONCLUSIONS: Pediatric nurses in primary and acute care settings are in a unique position to support mothers for whom the challenge of handling infant cry episodes is a trigger for smoking behavior. Interventions that teach mothers how to cope with infant irritability are likely to support the smoking cessation efforts, and consequently, interrupt the intergenerational cycle of tobacco-related maternal and child health morbidities.     

Infantile colic

Infantile colic can be distressing to parents whose infant is inconsolable during crying episodes. Colic is often defined by the "rule of three": crying for more than three hours per day, for more than three days per week, and for longer than three weeks in an infant who is well-fed and otherwise healthy. The physician's role is to ensure that there is no organic cause for the crying, offer balanced advice on treatments, and provide support to the family. Colic is a diagnosis of exclusion that is made after performing a careful history and physical examination to rule out less common organic causes. Treatment is limited. Feeding changes usually are not advised. Medications available in the United States have not been proved effective in the treatment of colic, and most behavior interventions have not been proved to be more effective than placebo. Families may turn to untested resources for help, and the physician should offer sound advice about these treatments. Above all, parents need reassurance that their baby is healthy and that colic is self-limited with no long-term adverse effects. Physicians should watch for signs of continuing distress in the child and family, particularly in families whose resources are strained already.     

Rocking and pacifiers: Two comforting interventions for heelstick pain

The effects of behavioral interventions in reducing the stress of infant pain are not well documented. Two comfort interventions, rocking andpacifiers, were compared with routine care administered to 60 newborn infants randomly assigned to the three conditions following a neonatal screening heelstick. Heart rate, state of arousal, and crying were recorded continuously. Both pacifiers and rocking reduced crying, but pacifiers predominantly produced sleep states and rocking predominantly produced alert states. Pacifiers reduced heart rate levels significantly more than did rocking. Thus, newborns clearly benefit from both comforting methods. Several mechanisms are proposed to account for these findings.     

Adult attention to infants in a newborn nursery

Six 3-hour observations of adult attention to infants in a newborn nursery were conducted to describe the amount and type of attention received by the infants and to determine if individual differences among infants were related to this attention. Most infants spent the majority of the observation time between feedings in the nursery and received attention from an adult in the nursery an average of 5.5% of the time. More infant crying was associated with longer adult attention, although this effect was largely attributable to a small group of particularly irritable infants in which circumcised males were overrepresented. A number of infant characteristics, including age, sex, race, physical attractiveness, degree of prematurity, crying, and eye opening, were associated with the content of the interaction between nurses' aides and newborns. These observations are discussed with respect to hospital practices concerning care of newborns and the potential effects on newborns of rooming-in with their mothers.     

Use of music during physical therapy intervention for an infant with Erb's palsy: a single-subject design

Evidence supporting the use of music during pediatric physical therapy intervention is limited. The purpose of this single-subject design was to evaluate the effects of music on patient progress, the amount of crying during therapy, and parent satisfaction with physical therapy services. The subject was an infant girl with Erb's palsy who participated in this study from age 8 months to age 20 months. An A-B-A withdrawal single-subject design was used. The patient's progress was assessed by using the T.I.M.E. The amount of crying was documented in the Crying Log. A parent satisfaction questionnaire was administered three times over the course of the study. The subject's progress in the music intervention period increased on three of five primary subtests of the T.I.M.E. The amount of crying decreased and parent satisfaction increased when music was played during therapy. Music may be used by pediatric physical therapists to decrease the patient's crying, increase parent satisfaction, and possibly to increase the child's rate of progress. Further research conducted with a group of infants and toddlers may help generalize these findings to a wider patient population.     

Kangaroo Care (Skin Contact) Reduces Crying Response to Pain in Preterm Neonates: Pilot Results

Crying commonly occurs in response to heel stick and adversely affects the infant's physiologic stability. Minimal crying in response to pain is desired. “Kangaroo Care,” skin contact between mother and infant, reduces pain and may reduce crying in response to pain. The purpose of this pilot study was to test Kangaroo Care's effect on the preterm infant's audible and inaudible crying response to heel stick. Inaudible crying has not been previously studied. A prospective randomized cross-over study with 10 preterm infants 2-9 days old (30-32 weeks' postmenstrual age) was conducted. Infants were randomly assigned to two sequences (sequence A: day 1 heel stick in Kangaroo Care [after 30 min of prone skin contact upright between maternal breasts] and day 2 heel stick in incubator [inclined, nested and prone]; or sequence B: opposite of sequence A) was conducted. Videotapes of baseline, heel warming, heel stick, and recovery phases were scored for audible and inaudible crying times. Audible and inaudible crying times for each subject in each phase were summed and analyzed by repeated-measures analysis of variance. Subject characteristics did not differ between those in the two sequences. Crying time differed between the study phases on both days (p ≤ .001). When in Kangaroo Care compared with the incubator, crying time was less during the heel stick (p = .001) and recovery (p = .01) phases, regardless of sequence. Because Kangaroo Care reduced crying in response to heel stick in medically stable preterm infants, a definitive study is merited before making recommendations.     

Explaining infant feeding style of low-income black women

Unstructured interviews were conducted with 10 low-income black women to explore infant feeding style. Formula-feeding with early introduction of cereal in the bottle was the most common pattern used by mothers in the first 3 months. By 6 months, formula-fed infants had a complex diet of a variety of foods. Half the women intended to breast-feed, but only one exclusively breast-fed. Beliefs about healthy infants and crying influenced feeding. There was a lack of knowledge about and support for breast-feeding in these women's environment. Support and advice about infant feeding from the health care system were uneven.