Excessive Infant Research Articles

Maternal vitamin B-12 and folate status during pregnancy and excessive infant crying

BackgroundThe etiology of excessive infant crying is largely unknown. We hypothesize that excessive infant crying may have an early nutritional origin during fetal development. AimsThis study is the first to explore whether (1) maternal vitamin B-12 and folate status during pregnancy are associated with excessive infant crying, and (2) whether and how maternal psychological well-being during pregnancy affects these associations. Study designWomen were approached around the 12th pregnancy week to complete a questionnaire (n=8266) and to donate a blood sample (n=4389); vitamin B-12 and folate concentrations were determined in serum. Infant crying behavior was measured through a postpartum questionnaire (±3months; n=5218). SubjectsPregnant women living in Amsterdam and their newborn child. Outcome measuresExcessive infant crying, defined as crying ≥3h/day on average in the past week. ResultsMultiple logistic regression analysis was performed for 2921 (vitamin B-12) and 2622 (folate) women.Vitamin B-12 concentration (categorized into quintiles) was associated with excessive infant crying after adjustment for maternal age, parity, ethnicity, education, maternal smoking and psychological problems (OR[95%CI]: Q1=3.31[1.48–7.41]; Q2=2.50[1.08–5.77]; Q3=2.59[1.12–6.00]; Q4=2.77[1.20–6.40]; Q5 = reference). Stratified analysis suggested a stronger association among women with high levels of psychological problems during pregnancy. Folate concentration was not associated with excessive infant crying. ConclusionsFirst evidence is provided for an early nutritional origin in excessive infant crying. A low maternal vitamin B-12 status during pregnancy could, in theory, affect infant crying behavior through two potential mechanisms: the methionine–homocysteine metabolism and/or the maturation of the sleep–wake rhythm.

Säuglingsschreien und mütterliche Müdigkeit in den ersten 12 Wochen nach der Geburt (Postnatal Infant Crying and Maternal Tiredness: Examining their evolution and interaction in the first 12 weeks postpartum)

A new mother lazing in childbed is a blessing for her family” is an old Swiss proverb. Maternal rest and recuperation after birth was a common concern in the past and was frequently supported by the extended family. However, mothers today barely enjoy restful days after birth; instead they enter directly into the challenge of combining baby- and selfcare. They often struggle to soothe a crying baby, while coping with their own exhaustion, which can adversely affect family health. Surveys on maternal health consistently report tiredness and fatigue as the most frequent complaint postpartum, affecting 46%-87% of new mothers [1, 2]. Inconsolable infant crying is the most cited reason why parents consult health professionals [3]. To date little is known on how mothers confront and handle these challenges after birth. Routine postnatal care lacks effective strategies to alleviate the burden of infant crying and maternal tiredness which can adversely affect family health in the earliest stage. Following the traditional division between neonatal and maternal healthcare, research has usually focussed on conditions affecting either the mother or the neonate, but little attention has been given to the interplay of infant crying and maternal tiredness. While maternal tiredness after birth can be seen as normal reaction to the efforts of gestation and birth [4], maternal fatigue is more severe than tiredness, and can be defined as imbalance of activity and rest [5]. Whereas tiredness is naturally relieved in the circadian rhythm by periods of sleep, fatigue persists through the circadian rhythm, cannot be relieved through a single period of sleep, and is accompanied with a negative feeling [6]. Fatigue hampers the well-being of the affected person and is known as risk factor for the development of postpartum depression [7] and for a slightly less optimal development of the infants’ fine motor and coordinative skills [8]. Postnatal infant crying is currently regarded as a normal part of a child’s neuro-behavioural development following a typical curve which peaks during the sixth week postpartum at nearly 3 hours crying per day, and declines to below 1 hour per day by 12 weeks of age, with large inter-individual variation [9, 10]. Excessive crying is usually defined by ‘Wessel’s rule of three’. It lasts more than 3 hours on more than 3 days per week, and recurs for more than 3 weeks [3, 11]. Such crying behaviour is a known risk factor for the development of maternal postpartum depression, dysfunctional parent-child relation and, in extreme cases, for shaken baby syndrome or other forms of child abuse [12-14]. Our interest in the present research project was not limited to the pathologic forms of maternal fatigue and excessive crying, but embraced the entire continuum from physiologic maternal tiredness to fatigue, and from normal to excessive infant crying. If healthcare is to address the prominent concerns of parents caring for a neonate, we need a deeper understanding of how infant crying and…

Mothers' perception of excessive crying in infancy in south eastern Nigeria.

Excessive infant crying, though usually benign, can be very troublesome to parents with unwanted consequences on the child. Previous reports had shown cultural and racial differences in it's perception by mothers. We undertook this study to determine the prevalence of excessive crying in our area of practice and also determine associated factors. This was a cross sectional, questionnaire based descriptive study on mothers' perception of their infants' crying. Subjects were mother/infant pairs attending the well baby clinics at the Institute of Child Health, University of Nigeria Teaching Hospital, Enugu, Mother of Christ Specialist Hospital, Enugu and the Ebonyi State University Teaching Hospital, Abakaliki. Four hundred and eighty mother/infant pairs participated in the study. Seven point nine percent of the mothers reported excessive crying in their infants. There was no significant diurnal variation in the rate of excessive crying among these infants. Educated mothers (P = 0.008) reported excessive crying less frequently than the uneducated ones. Other maternal and infants demographic factors did not have any influence on mothers' perception of excessive crying in their infants. Excessive crying among infants is more commonly perceived by uneducated mothers. This group should be identified and counselled about excessive crying to prevent untoward consequences.

Paternal Depressive Symptoms During Pregnancy Are Related to Excessive Infant Crying

Excessive infant crying, or infantile colic, is a common and often stress-inducing problem for parents that can ultimately result in child abuse. From previous research it is known that maternal depression is related to excessive crying, but so far little is known about the influence of paternal depression. In a prospective, population-based study, we obtained information on both maternal and paternal depressive symptoms at 20 weeks of pregnancy by using the Brief Symptom Inventory. Parental depressive symptoms were related to excessive crying in 4426 two-month-old infants. The definition of excessive crying was based on the widely used Wessel's criteria (ie, crying >3 hours for >3 days in the past week). After adjustment for depressive symptoms of the mother and relevant confounders, we found a 1.29 (95% confidence interval: 1.09-1.52) higher risk of excessive infant crying per SD of paternal depressive symptoms. Our findings indicate that paternal depressive symptoms during pregnancy might be a risk factor for excessive infant crying. This finding could be related to genetic transmission, interaction of a father with lasting depressive symptoms with the infant, or related indirectly through contextual stressors such as marital, familial, or economic distress.

Frühkindliche Regulationsstörungen

Eltern-Säuglings-/Kleinkind-Beratung und -Psychotherapie bei frühkindlichen Regulationsstörungen haben ein 3-faches Ziel: die kindlichen Verhaltensprobleme zu beheben, überforderte Eltern zu entlasten und belastete Eltern-Kind-Interaktionen/-Beziehungen zu entspannen und in entwicklungsangemessene Bahnen zu lenken. Kinderärzten kommt dabei als primären Ansprechpartnern und vertrauten Beratern der Eltern oder bei Bedarf als Vermittler an entsprechende Spezialambulanzen eine wichtige Aufgabe zu. Am Beispiel des exzessiven Schreiens informiert der Artikel im Überblick über ein Spektrum von Beratungs- und Behandlungsmethoden und deren Wirksamkeit. Neben pädiatrisch-somatischen Aspekten der Therapie werden Möglichkeiten des Kinderarztes in den Bereichen Entwicklungsberatung, Interaktionsanleitung und integrierter Behandlungsangebote dargestellt.

Stress and Emotional Problems During Pregnancy and Excessive Infant Crying

There is evidence that stress and emotional problems during pregnancy are related to adverse health outcomes of the child at birth and in later life. The aim of this study was to determine the association between stress and emotional problems during pregnancy and excessive infant crying. From an initial sample of 8266 pregnant women, a follow-up sample of 4976 women and their 3- to 6-month-old babies was examined. Depressive symptoms, pregnancy related anxiety, parenting stress, and job strain during pregnancy were all univariately and multivariately associated with excessive infant crying (adjusted odds ratios between 1.69 and 2.23). Women with three or four of these antenatal risks were more likely to have an infant who cries excessively than women with no antenatal risks (adjusted odds ratio of 4.89). In conclusion, stress and emotional problems during pregnancy increase the chances of having an excessively crying baby. Women with multiple antenatal risk factors are at particular risk.

O-267: Older maternal age and pregnancy risks

To evaluate the risks of pregnancy complications and adverse outcomes with increasing maternal age. Population-based, historical cohort study. The study population included 8,079,996 live births of singletons of ≥20 weeks among women ages 30-54 years from the 1995-2000 Birth Cohort Linked Birth/Infant Death Data Set. Nine outcomes were modeled by maternal age, by age and race (white vs black), and by age and parity (nulliparas vs multiparas) using Mantel-Haenzel adjusted odds ratio (AOR) and 95% confidence intervals (CI). The outcomes included diabetes (pregestational or gestational), chronic hypertension (pregestational or before 20 weeks gestation), pregnancy hypertension, tocolysis, premature rupture of membranes (PROM), excessive bleeding at delivery, cesarean delivery, early preterm birth (<32 weeks), and infant mortality. The risks for all nine outcomes paralleled increasing maternal age, as shown below. The highest risk among the oldest women, overall and within parity and racial groups, was for chronic hypertension (AORs of 3.70-4.89), followed by diabetes (AORs of 2.19-3.12). By parity, the next highest risks (AORs of 2.0 or greater) were for cesarean delivery, excessive bleeding, and early preterm birth among nulliparas, and pregnancy hypertension among multiparas. By race, the next highest risks were for excessive bleeding, cesarean delivery, and infant death among white women, and cesarean delivery among black women. The risks were consistently higher for black vs white women within each age group, although the difference decreased with advancing age for PROM, early preterm birth, and infant mortality, as shown below.Tabled 1Tabled 1 Increasing maternal age is associated with significantly elevated risks for pregnancy complications and adverse outcomes, which vary by parity and racial group. Women undergoing infertility treatment should be counseled regarding the increased risks associated with pregnancy at older ages.

Childhood Functional Gastrointestinal Disorders: Neonate/Toddler

Recognizing the importance of childhood functional gastrointestinal disorders in understanding adult functional gastrointestinal disorders, and encouraging clinical and research interest, the Rome Coordinating Committee added a pediatric working team to Rome II in 1999. For Rome III, there was an increase from 1 to 2 pediatric working teams. This report summarizes the current consensus concerning functional disorders in infants and toddlers. Another report covers disorders diagnosed more often in school-aged children and adolescents. The symptoms from functional gastrointestinal disorders in children younger than 5 years depend on maturational factors in anatomy, gastrointestinal physiology, and intellectual and affective functioning. There has been little or no change for infant regurgitation, infant rumination syndrome, or infant dyschezia. Cyclic vomiting syndrome may be diagnosed after 2 rather than 3 episodes. The description of infant colic has been expanded, although there was consensus that infant colic does not reflect gastrointestinal malfunction. The greatest change was in functional constipation. Functional constipation and functional fecal retention in the 1999 report were merged into a single entity: functional constipation. Data-driven changes in diagnostic criteria for functional constipation appear to be less rigid and more inclusive than previous criteria.

Son Preference and Its Consequences (A Review)

Son preference is one of the oldest issues in most of the societies with special reference to sons being getting preferential treatment over daughters in South Asia and developing countries. Women usually didn\'t get proper regard in their husbands\' families until and unless they had a son in most of the societies. Numerous factors affecting son preference were socio-economic set-up of the society, cultural beliefs, literacy, lesser opportunities for women jobs, cultural restrictions on women, family size, males\' dominance and their validity as earning heads of the households and intact/shared relations with the family as compared to daughters who would otherwise leave their families soon after getting married. Daughter\'s birth in Bangladesh, India and Pakistan was considered as an economic liability because of the dowry system and the higher incurring cost on their weddings. Son preference was found to be stronger in areas where daughters were more expensive to marry owing to the dowry system. Cultural preference for sons was evident from that fact that in Hindu\'s traditions, only sons could pray for and release the souls of their dead parents and only males could perform birth, death and marriage rituals. Although, son preference was stronger, some 98% of the women in Bangladesh wanted to have at least one daughter realizing the importance of women in a house for household activities and perpetuation of generation. A common perception of son\'s preference on daughter was the ascribed ability of sons; to contribute more to family income, provide adequate support to parents in old age; carry on family name and impose minimal financial burdens on their parents. Women\'s employment problems and male inheritance also favored son preference in Taiwan. Excessive infant mortality in females was due to discrimination against females in the allocation of food and health care within the household. Aside from male\'s attitude towards son preference, women their-self in most of the south Asian countries preferred sons to daughters. In addition, women were having few opportunities to generate income and invest household resources in female children as compared to males, thereby further widening the chances for son preference. Preferential son treatment may lead to larger family size and higher fertility if there is increased incidence of female births. Emphasis on women education and employment, giving them due status in the society and creating awareness among the people to treat son and daughter alike would be better options to eliminate frustration, reduce fertility rate and limit family size. Gender & Behaviour Vol.3 2005: 269-280

Cradling in the prevention of excessive crying and colic symptoms in infants.

To evaluate lying in a cradle in the prevention of excessive infant crying or colic symptoms, and to investigate potential protective or risk factors for the phenomenon, 220 newborns were randomized to sleep either in a bed or cot (control group, N = 108) or in a cradle (cradle group, N = 112). During three months, the parents filled in diaries on the sleeping place most used and the amount of crying of their infants. Three infants in the cradle group and one control fulfilled the criteria of colic. The percentages of extremely weepy infants (25.7% vs 24.4 %) and the intensity of crying did not differ between the groups. Medication for colic symptoms was used equally frequently in both groups. A high educational (OR 3.18, 95% CI 1.01; 10.04) and socioeconomic (OR 3.76, 95% CI 1.34; 10.52) level of the family and having a sibling with a history of colic (OR 6.46, 95% CI 1.17; 35.73) were predictors for the infant being weepy. Absence of nursing problems and having no sibling with a history of colic seemed to be related with a low amount of crying. Excessive infant crying was less common in families with unemployed fathers compared to those in which the father had an occupation (p = 0.018). Cradling seems not to prevent excessive crying or colic symptoms in infants. Breast-feeding guidance during rooming-in period and presence of father or another adult supporter at home might be preventive means against excessive crying.

Exposure to tobacco smoke and infant crying

To examine the association of excessive infant crying with maternal smoking during and after pregnancy, paternal smoking, and smoking by other people in the living environment of the infant. We collected data on infant crying and smoking in a Dutch national sample of 5845 infants aged 0-3 mo (response 62.8%). We defined excessive crying as crying over 3 h a day on more than 3 d of the preceding week. The prevalence rate of excessive crying was 4.0% (95% CI 3.5 to 4.5%). Excessive crying occurred more frequently among infants of fathers smoking 15 + cigarettes/d (odds ratio (OR) 1.99, 95% CI 1.38 to 2.86) and of mothers smoking 10 + cigarettes/d during pregnancy (OR 1.86, 95% CI 1.02 to 3.42). Infants whose parents were heavy current smokers or whose mothers had been so during pregnancy had a 69% higher prevalence of excessive crying than infants of non-smoking parents (rates: 6.3% and 3.7%, respectively; odds ratio 1.80; 95% CI 1.26 to 2.57). Parents stopping smoking may prevent excessive infant crying.

Colic and the early crying curve: A developmental account

The hypothesis that excessive early infant crying evolved to reduce the risk of withdrawal of parental care is disputed on the grounds that excessive infant crying is irritating and imposes fitness losses rather than gains. Alternative explanations for the early crying curve that take into account development on the part of the infant and the emerging infant-caregiver bond are proposed.

The signal functions of early infant crying

In this article I evaluate recent attempts to illuminate the human infant cry from an evolutionary perspective. Infants are born into an uncertain parenting environment, which can range from indulgent care of offspring to infanticide. Infant cries are in large part adaptations that maintain proximity to and elicit care from caregivers. Although there is not strong evidence for acoustically distinct cry types, infant cries may function as a graded signal. During pain-induced autonomic nervous system arousal, for example, neural input to the vocal cords increases cry pitch. Caregivers may use this acoustic information, together with other cues, to guide caregiving behavior. Serious pathology, on the other hand, results in chronically and severely abnormal cry acoustics. Such abnormal crying may be a proximate cause of adaptive infant maltreatment, in circumstances in which parents cut their losses and reduce or withdraw investment from infants with low survival chances. An increase in the amount of crying during the first few months of life is a human universal, and excessive crying, or colic, represents the upper end of this normal increase. Potential signal functions of excessive crying include manipulation of parents to acquire additional resources, honest signaling of need, and honest signaling of vigor. Current evidence does not strongly support any one of these hypotheses, but the evidence is most consistent with the hypothesis that excessive early infant crying is a signal of vigor that evolved to reduce the risk of a reduction or withdrawal of parental care.

Is excessive infant crying an honest signal of vigor, one extreme of a continuum, or a strategy to manipulate parents?

An evolutionary account of excessive crying in young infants – colic – has been elusive. A study of mothers with new infants suggests that more crying is associated with more negative emotions towards the infant, and perceptions of poorer infant health. These results undermine the hypothesis that excessive crying is an honest signal of vigor.

Primary care services promoting optimal child development from birth to age 3 years: review of the literature.

To examine the evidence base for primary health care services promoting the optimal development of typically developing children aged birth to 3 years. Peer-reviewed publications addressing clinical evaluations of primary care services from the MEDLINE and PsychINFO databases. Criteria for selection were as follows: (1) publication between 1979 and 1999; (2) evaluation of efficacy or effectiveness of education, intervention, and care coordination services or validation of assessment approaches; (3) services applicable to an office practice setting; (4) target population including children aged birth to 3 years; and (5) publication in English. A total of 312 publications were abstracted and reviewed by both of us; 47 were selected for inclusion. Assessments of parental concerns and psychosocial risk factors using validated approaches seem to be more accurate in identifying developmental problems than clinicians' appraisals. In general, study results support the efficacy of (1) primary care educational efforts toward promoting optimal parent-child interaction, parents' understanding of child temperament, book-sharing activities, and approaches to healthy sleep habits and (2) office interventions such as counseling for the management of excessive infant crying and sleep problems. The literature suggests that many primary care activities promoting the optimal development of children are efficacious. Evaluations of developmental assessment and services in primary care should be expanded in depth and breadth. The implications for clinical practice, training, and health care policy are discussed.

Excessive infant crying: the impact of varying definitions.

To assess the impact of varying definitions of excessive crying and infantile colic on prevalence estimates and to assess to what extent these definitions comprise the same children. Parents of 3345 infants aged 1, 3, and 6 months (response: 96.5%) were interviewed on the crying behavior of their infant in a Dutch cross-sectional national population-based study. We computed the prevalence of excessive crying according to 10 published definitions regarding parent-reported duration of infant crying and the parents' experience. We measured concordance between pairs of definitions by Cohen's kappa (agreement adjusted for chance agreement). Overall prevalence rates of excessive crying varied strongly between definitions, from 1.5% to 11.9%. They were always highest in 1-month-old infants. Concordance between definitions was only excellent (kappa > 0.75) if they were closely related, such as crying for >3 hours/day for >3 days/week for the preceding 2 or 3 weeks. Concordance between less closely related definitions was much weaker. Concordance between definitions that were based on duration and on parental experience was mostly poor (kappa: 0.17-0.53 for infants aged 1 and 3 months). Different definitions of excessive crying lead to the inclusion of very dissimilar groups of infants. We recommend presenting study results using clearly described definitions, preferably concerning both duration of crying and parental distress. This may improve the comparability of studies on the cause and treatment of excessive infant crying. The impact of the method of data collection on this comparability needs additional study.colic, preventive child health care, prevention, infancy.

Excessive infant crying: often not confined to the first 3 months of age.

Excessive crying/fussing in infancy may account for serious problems in mother-infant interactions but is believed to be self-limiting around the age of 3 months. A random digit dialling telephone survey weighted by sex, age, and population density and yielding 662 children aged 9 to <36 months was used to estimate prevalence and the proportion of cases where this problem extends beyond the third month postpartum. Excessive infant crying/fussing during the first 3 months of age was found in 21.0% (95% CI 17.9-24.1) and persisted for longer in 39.6% (95% CI 31.5-47.7) of these. Professionals consulting parents on crying problems should take into account its possible persistence for longer periods of time.

Risk factors for infant mortality in Down's syndrome: a nationwide study.

The aim of this study was to assess risk factors for the excessive infant mortality rates (IMR) of infants with Down's syndrome (DS). The study population included all 847 Jewish DS births in Israel during 1979-83 and 1987-91. Cases were identified through the National DS Registry. Data were abstracted from hospitalisation records. Ninety-one per cent of the DS diagnoses were confirmed by a cytogenetic analysis. The DS IMR were 24.3 times higher than in the general population. Major risk factors affecting DS IMRs were health status, time period of birth and residential arrangement of the infant. Other known risk factors for infant mortality, such as young maternal age, high birth order and low birthweight, had a weaker impact on IMR in the DS population. Our results imply that the current better survival of infants with DS is a function of the changing attitude towards this population. The study identifies a potential for further reduction in the mortality rates of DS infants, provided there is willingness to adopt a more active and supportive treatment and further changes in ethical codes of the public.

Excessive infant crying and later behaviour problems: Findings of the bavarian longitudinal study (BLS)

The current study aimed to replicate and extend Rojahn et al. [Rojahn, J., Aman, M. G., Matson, J. L., & Mayville, E. (2003). The aberrant behavior checklist and the behavior problems inventory: Convergent and divergent validity. Research in Developmental Disabilities, 24, 391–404] by examining the convergent validity of the behavior problems inventory (BPI) and the aberrant behavior checklist (ABC) for individuals presenting with multiple complex behavior problems. Data were collected from 69 children and adults with severe intellectual disabilities and challenging behavior living in residential establishments. MANCOVA analyses showed that individuals with elevated BPI stereotyped behavior subscale scores had higher scores on ABC lethargy and stereotypy subscales, while those with elevated BPI aggressive/destructive behavior subscale scores obtained higher scores on ABC irritability, stereotypy and hyperactivity subscales. Multiple regression analyses showed a corresponding pattern of results in the prediction of ABC subscale scores by BPI subscale scores. Exploratory factor analysis of the BPI data suggested a six-factor solution with an aggressive/destructive behavior factor, four factors relating to stereotypy, and one related to stereotypy and self-injury. These results, discussed with reference to Rojahn et al. [Rojahn, J., Aman, M. G., Matson, J. L., & Mayville, E. (2003). The aberrant behavior checklist and the behavior problems inventory: Convergent and divergent validity. Research in Developmental Disabilities, 24, 391–404], support the existence of relationships between specific subscales of the two instruments in addition to an overall association between total scores related to general severity of behavioral disturbance.

Intuitive parenting and excessive infant crying: Regulatory processes and interactional failures

Substance use disorder (SUD) is associated with major socioeconomic consequences but its etiology is only partly known. The disease predisposition may be established early in life and prenatal stress may play a role. We aimed to examine whether prenatal maternal bereavement, as the indicator of prenatal stress, was associated with an increased risk of SUD in offspring.This population-based cohort study included all children born in Denmark (N = 1 686 416) and Sweden (N = 2 563 659) from 1973 to 1997. The exposure was maternal bereavement by the death of a close relative 1 year before or during pregnancy. Children were followed from 10 years of age until their death, migration, onset of substance abuse, or December 31st, 2007. The main outcome is hospitalization due to substance use disorder (SUD).A total of 100 363 children (2.45%) were born to mothers who had experienced bereavement 1 year before or during pregnancy. Overall, these exposed children had a similar risk of hospitalization due to SUD (IRR = 1.02, 95% CI: 0.98–1.07), compared to unexposed children. Children born to mothers who lost a spouse during pregnancy had a two-fold risk (IRR = 2.19, 95% CI: 1.74–2.76) and similar elevated risks were observed in children whose mothers lost a spouse during the first 10 years after child birth.Our data do not support a programming role of prenatal stress following maternal bereavement on SUD later in life. The increased risk in relation to spousal bereavement may mostly be explained by postpartum changes in familial environment.