Fussy Infant Research Articles

Parental Administration of Chemical Agents: A Cause of Apparent Life-Threatening Events

Nine infants with apparent life-threatening events that occurred as a result of poisoning by a caretaker are described. These episodes were characterized by apnea plus some combination of color change, choking or gagging, and abnormal muscle tone. Five of the infants responded to vigorous stimulation, and four required cardiopulmonary resuscitation. Most poisonings (seven infants) were detected by a urine drug screen. Medications detected included acetaminophen, amphetamine, benzodiazepines (two infants), cocaine, codeine, meperidine (two infants), Methadone, phenobarbital, and phenothiazines (three infants). Four infants received two or more drugs. Most perpetrators of the poisonings were mothers (seven) and five of the parents admitted administering the various agents. Reasons for the poisonings included an apparent attempt to harm an infant, the need to sedate a fussy infant, or a gross misunderstanding of the potential risk of various agents to infants. Because no history of drug administration was elicited at the time of hospital admission, six infants might have been discharged with a diagnosis of apnea of infancy had not an attempt been made to investigate the possibility of poisoning. These cases suggest that poisoning by a caretaker should be added to the differential diagnosis of any infant brought to medical attention because of an apparent life-threatening event and that urine drug screening should be considered in the evaluation.

Temperament and Increased Weight Gain in Infants

The role of temperamental characteristics in accelerated and decelerated weight gain in normal infants has not been investigated previously except for differences in activity. The present study drew a random sample of 200 normal infants from a largely middle-class private practice. It found 24 infants who gained 30 or more percentile points in weight for length determinations between 6 and 12 months of age and 25 who lost 20 percentile points or more. These growth data were compared with contemporaneous findings on the Infant Temperament Questionnaire. Those gaining the most had significantly more difficult temperament ratings (p less than 0.05) and were perceived by their mothers as "more difficult than average" (p less than 0.001). Infants with the most decelerated growth were not temperamentally different from the general sample. Negative mood rather than low activity was the specific characteristic distinguishing the infants gaining the most (p = 0.006). Clinical experience would suggest that fussy infants are fed more to quiet them.

GALEN ON A CRYING AND FUSSY INFANT

Claudius Galenus, one of the greatest figures in medical history, was born at Pergamos in Asia Minor A.D. 131 and lived to be about 70 years old. He studied medicine at Alexandria, and in 162 settled in Rome, where in 169 he became personal physician to the Emperor Marcus Aurelius. Among his voluminous writings, none is superior to his book entitled Hygiene (De Sanitate Tuenda). The quotation below taken from Dr. Robert M. Green's superb translation of Galen's Hygiene will show his practical approach in soothing a crying and fussy infant. For no animal likes excess of anything, but always wants moderation. But moderation is not the same to all, for all moderation is relative to the individual. Therefore whoever undertakes the bringing up of infants must be able to guess accurately what is moderate and comfortable and provide this before increasing distress throws the body and mind into excess of activity, and if ever the increasing distress escapes his notice, to try to provide immediately the thing desired or to remove the annoyance either by rocking in the arms or by modulation of the voice, which sagacious nurses are accustomed to employ. Once, when a baby had cried and fussed and tossed all day, and the nurse was completely at a loss, I discovered the cause of the trouble. For when he did not quiet down by having the nipple put in his mouth or by the nurse holding him in case he wanted to move his bowels or urinate, and was not consoled even when by taking him in her arms she tried to make him lie down, I inspected his bed and his coverings and his soiled clothing, and the baby himself dirty and unwashed, and ordered her to wash and wipe him, change his bed, and give him completely clean clothing.

New knowledge in early child development. Its importance for pediatricians.

Until quite recently, most pediatric teaching on early child development has centered around the ages and stages observations of Gesell and his colleagues and the psychoanalytic theories of early emotional development. In 1964, Bloom's review of longitudinal studies refocused attention on the importance of the first five years of life for the social and cognitive development of the child 1 and in the past few years, knowledge about early child development has been increasing at a rapid rate. The following is a review of some recent studies which have important implications for the practice of pediatrics. Social Development The identification by Thomas et al of significant behavioral characteristics of infants and children that are unrelated to parental child rearing practices is of major importance. 2 Fussy infants with irregular patterns of eating, sleeping, and elimination, intense negative reactions to new situations, and slow adaptability were found to be particularly difficult