Unsettled infant behaviour and health service use: a cross-sectional community survey in Melbourne, Australia

Aims: To investigate factors associated with health service use by women and their infants in Victoria, Australia. Methods: Cross‐sectional screening survey of 875 women with 4‐month‐old infants attending immunisation clinics in five local government areas in Melbourne between May 2007 and August 2008. The self‐report instrument assessed socio‐demographic characteristics, unsettled infant behaviour, maternal mood (Edinburgh Postnatal Depression Scale) and, the outcome, health service use during the first 4 months post‐partum. Results: Mothers and their infants used on average 2.8 different health services in the first 4 months post‐partum (range 0–8). After adjustment for other factors, high health service use (defined as >3 different services) was more common in mothers whose infants were unsettled with persistent crying, resistance to soothing and poor sleep. A one‐point increase on the unsettled infant behaviour measure was associated with an 8% (2–14%) increase in the use of >3 services, 9% (3–16%) in use of emergency departments, 7% (2–13%) in use of telephone helplines and 9% (3–14%) of parenting services. Poorer maternal mental health was also implicated with a one‐point increase on the Edinburgh Postnatal Depression Scale associated with a 4% (0.4–8%) increase in the likelihood of using more than three services. Conclusions: Unsettled infant behaviour is associated with increased use of multiple health services. The high use of emergency departments by families with unsettled infants found in this study suggests that enhancement of primary health‐care capacity might be required.