Infantile colic, prolonged crying and maternal postnatal depression

Aim:  To study if infant crying is associated with maternal postnatal depression.
Methods:  Data from 1015 mothers and their children participating in a prospective European multicentre study were analysed. Infantile colic and prolonged crying were defined as excessive crying as reported by the mothers 2 and 6 months after delivery, and at the same time the mothers completed the Edinburgh Postnatal Depression Scale (EPDS).
Results:  In cross-sectional analyses, infant crying was associated with high EPDS scores both 2 (OR: 4.4; 95% CI: 2.4–8.2) and 6 months postpartum (OR: 10.8; 95% CI: 4.3–26.9). More than one-third of the others of infants with prolonged crying had high EPDS scores 6 months postpartum. Longitudinal analyses showed that mothers of infants with colic had increased odds of having high EPDS scores 6 months after delivery even if crying had resolved (OR: 3.7; 95% CI: 1.4–10.1).
Conclusion: Both infantile colic and prolonged crying were associated with high maternal depression scores. Most noteworthy, infantile colic at 2 months of age was associated with high maternal depression scores
4 months later.     

Infant colic and feeding difficulties

Aims: To examine the relation between colic and feeding difficulties and their impact on parental functioning for a primarily clinic referred sample. Methods: Forty three infants (and their mothers) were enrolled between 6 and 8 weeks of age. Infants were divided into two groups, colic (n = 19) and comparison (n = 24), based on a modified Wessel rule of three criteria for colic. Families were assessed at two visits; one occurred in the laboratory and one occurred in a paediatric radiology office. Outcome measures included the clinical assessment of infant oral motor skills, behavioural observation of mother-infant feeding interactions, maternal questionnaires on infant crying, sleeping and feeding behaviours, and the occurrence of gastro-oesophageal reflux (GOR) in the infants using abdominal ultrasound. Results: Infants in the colic group displayed more difficulties with feeding; including disorganised feeding behaviours, less rhythmic nutritive and non-nutritive sucking, more discomfort following feedings, and lower responsiveness during feeding interactions. Infants in the colic group also had more evidence of GOR based on the number of reflux episodes on abdominal ultrasound as well as maternal report of reflux. Mothers in the colic group reported higher levels of parenting stress. Conclusions: Results provide the first systematic evidence of feeding problems in a subgroup of infants with colic. Data also illustrate the impact of these difficulties on parental and infant functioning. The association between feeding difficulties and colic suggests the potential for ongoing regulatory problems in infants presenting with clinically significant colic symptoms.     

Infant crying: nature, physiologic consequences, and select interventions

This article describes the nature of infant crying, the physiologic events and changes associated with it, and appropriate nursing interventions for infant crying. A cry is a series of four movements that basically resembles a Valsalva maneuver. Documented immediate and long-term sequelae of crying include increased heart rate and blood pressure, reduced oxygen level, elevated cerebral blood pressure, initiation of the stress response, depleted energy reserves and oxygen, interrupted mother-infant interaction, brain injury, and cardiac dysfunction. Caregivers are encouraged to answer infant cries swiftly, consistently, and comprehensively. Kangaroo care is an efficient method for preventing, minimizing, and halting crying. Other interventions for crying include swaddled holding, a pacifier, sugar water, a sweet-tasting nonsucrose solution, heartbeat sounds, distraction by lullabies or mother's voice, rhythmic movement, and reduction of external stimuli.     

Infant colic and feeding difficulties.

AIMS: To examine the relation between colic and feeding difficulties and their impact on parental functioning for a primarily clinic referred sample. METHODS: Forty three infants (and their mothers) were enrolled between 6 and 8 weeks of age. Infants were divided into two groups, colic (n = 19) and comparison (n = 24), based on a modified Wessel rule of three criteria for colic. Families were assessed at two visits; one occurred in the laboratory and one occurred in a paediatric radiology office. Outcome measures included the clinical assessment of infant oral motor skills, behavioural observation of mother-infant feeding interactions, maternal questionnaires on infant crying, sleeping and feeding behaviours, and the occurrence of gastro-oesophageal reflux (GOR) in the infants using abdominal ultrasound. RESULTS: Infants in the colic group displayed more difficulties with feeding; including disorganised feeding behaviours, less rhythmic nutritive and non-nutritive sucking, more discomfort following feedings, and lower responsiveness during feeding interactions. Infants in the colic group also had more evidence of GOR based on the number of reflux episodes on abdominal ultrasound as well as maternal report of reflux. Mothers in the colic group reported higher levels of parenting stress. CONCLUSIONS: Results provide the first systematic evidence of feeding problems in a subgroup of infants with colic. Data also illustrate the impact of these difficulties on parental and infant functioning. The association between feeding difficulties and colic suggests the potential for ongoing regulatory problems in infants presenting with clinically significant colic symptoms.     

Extent of fussing and colic type crying preceding atopic disease

In a prospective follow up of 116 high risk infants, a 24 hour behavioural chart on seven consecutive days was analysed at seven and 12 weeks of age. Of children who manifested atopic disease at 2 years, 44/116 (38%), had shown significantly more fussing during the seventh, and colic type cry during the twelfth week than those who remained healthy (72/116, 62%).     

Bases for maternal perceptions of infant crying and colic behaviour

According to the commonest definition, infant colic is distinguished by crying which is 'paroxysmal'-that is, intense and different in type from normal fussing and crying. To test this, maternal reports of the distress type of 67 infants whose fuss/crying usually exceeded three hours a day ('persistent criers') were scrutinised using 24 hour audiorecordings of the infants' distressed vocalisation. 'Moderate criers' (n = 55) and 'evening criers' (n = 38) were also assessed. Most of the distress in all three groups was fussing. In the audiorecordings the persistent criers showed a higher crying: fussing ratio than the moderate criers, but intense crying was rare. A third of the persistent criers were reported by their mothers to have occasional, distinct colic bouts of 'intense, unsoothable crying and other behaviour, perhaps due to stomach or bowel pain.' In the audiorecordings these periods were longer, but not paroxysmal in onset or more intense than the crying of persistent criers not judged to have colic. The audible features of the crying may be less important than its unpredictable, prolonged, hard to soothe, and unexplained nature.     

Prolonged and unsoothable crying bouts in infants with and without colic

ABSTRACT.: The authors sought to determine which features of early distress were "excessive" and specific to the first months of life as described by diary recordings. In a short-term, longitudinal, controlled study, total daily amount, frequency, and bout duration of fussing, crying, and unsoothable crying were derived from validated diaries kept by parents of infants with and without diary-defined colic at 6 weeks and 5 months recruited from primary pediatrics practices. By definition, infants with colic demonstrated more distress at 6 weeks, but they also had a much greater reduction in distress by 5 months and more distress during the fifth month. However, bout frequencies and bout durations showed different patterns. Bout duration was longer for the colic group only at 6 weeks; the difference completely disappeared by 5 months. Bout frequency was higher for the colic group at 6 weeks and 5 months, but the reduction across ages was similar in infants with and without colic. These patterns were true for all distress modalities (fussing, crying, and unsoothable crying). Unsoothable crying was present in significant amounts only at 6 weeks but virtually disappeared by 5 months. The authors conclude that prolonged distress bouts and unsoothable crying are specific to the first few months and more common, though not unique, in infants with colic. This implies that our understanding of colic may depend more on why these infants cry longer once started than what makes infants cry. These features of parental experience may be important in preventive efforts to reduce negative impacts of early increased crying such as shaken baby syndrome.     

Extent of fussing and colic type crying preceding atopic disease.

In a prospective follow up of 116 high risk infants, a 24 hour behavioural chart on seven consecutive days was analysed at seven and 12 weeks of age. Of children who manifested atopic disease at 2 years, 44/116 (38%), had shown significantly more fussing during the seventh, and colic type cry during the twelfth week than those who remained healthy (72/116, 62%).     

Bases for maternal perceptions of infant crying and colic behaviour.

According to the commonest definition, infant colic is distinguished by crying which is ''paroxysmal''-that is, intense and different in type from normal fussing and crying. To test this, maternal reports of the distress type of 67 infants whose fuss/crying usually exceeded three hours a day (''persistent criers'') were scrutinised using 24 hour audiorecordings of the infants'' distressed vocalisation. ''Moderate criers'' (n = 55) and ''evening criers'' (n = 38) were also assessed. Most of the distress in all three groups was fussing. In the audiorecordings the persistent criers showed a higher crying: fussing ratio than the moderate criers, but intense crying was rare. A third of the persistent criers were reported by their mothers to have occasional, distinct colic bouts of ''intense, unsoothable crying and other behaviour, perhaps due to stomach or bowel pain.'' In the audiorecordings these periods were longer, but not paroxysmal in onset or more intense than the crying of persistent criers not judged to have colic. The audible features of the crying may be less important than its unpredictable, prolonged, hard to soothe, and unexplained nature.     

Infant colic syndrome--maternal fantasies of aggression and infanticide

This study examined the impact of infant colic on the emotional state of the mother. Subjects were 23 pairs of mothers and their colicky infants. Structured interviews were conducted with mothers to elicit details around the colic episode and included (1) the emotional state experienced by the mother, (2) the quality and content of the mother's fantasies in response to her infant, and (3) the emotional impact on the parents. Explicit aggressive thoughts and fantasies were revealed by 16 (70%) of the mothers while six (26%) admitted thoughts of infanticide during their infant's colic episodes, a finding notable because previously this has not been documented in medical literature. All mothers experienced physical and psychological symptoms in response to their infant's colic. More than 90% of the mothers with a colicky infant experienced significant marital tension and disruption in their social contacts. The findings suggest that physician receptivity and skill in uncovering the physical and psychological impact of colic on parents is essential for the physical and emotional well-being of the family. Active support and counseling by physicians is critical to diminish any potential for abuse and infanticide in these infants.     

Infant colic: Is there anything new?

Coping with a colicky infant presents a challenge under the best of circumstances. However, when parents are stressed by life events that compromise their coping mechanisms, they may be unable to interpret and respond appropriately to their infants' cues. Their self-esteem, marital relationship, and attachment to their infant may be at risk. Health care providers can facilitate parents' understanding of colicky behavior, provide suggestions for relief of the infant's symptoms, and offer emotional support to parents. Consequently parents may be able to develop confidence in their caretaking capabilities and have positive family interactions.     

Editorial: For crying out loud: Infant signaling and parental responsiveness

Crying represents a powerful signal for human newborns. How parents should respond has been a matter of debate, with some urging prompt responding and others expressing concern about spoiling. Despite the fervor of the debate, few longitudinal observational studies have addressed the question. A new study in this issue by Bilgin and Wolke provides important data about ignoring crying in early infancy and its predictive correlates. The results of their investigation are discussed in the context of attachment and behavioral theories.     

Infant fussing and crying patterns in the first year in an urban community in Denmark

Infant crying amounts and patterns in 590 1- to 12-month-old infants in an urban community in Denmark were studied using the Crying Patterns Questionnaire. The impact of the crying on parents and the primary health services was also assessed. The results showed that Danish mothers leave their infants to "cry out" substantially less than mothers in the UK and North America. Despite this difference, mean crying amounts, crying patterns and the incidence of persistent crying were similar to those reported in earlier western studies. The findings support the view that the infant crying peak in the first 3 months is due to normal maturational and developmental processes.