Infantile colic--less common than previously estimated?

A two-part population-based study investigating the occurrence of infantile colic was undertaken, in which 92% of mothers with newborn healthy infants were reached. In the prospective part 152 mothers ("diary group") registered crying and fussing in their infants during 12 weeks. In the retrospective part 224 mothers ("interview group") were contacted by telephone at an infant age of 5-7 months. The colic occurrence was determined according to four different definitions; the rate varied from 3.3 to 17.1%. The classical "Wessel-type" colic was present in 9.3%. Colic defined as "crying seen as a problem by parent" was present in 12.1% of the "interview group", but in only 3.3% of the "diary group". Some earlier studies may have overestimated colic occurrence. Another possibility is an actual decline. The contributive part of preventive measures is discussed.     

Distress crying in neonates: Species and peer specificity.

Two experiments replicated the results of a series of earlier studies by A. Sagi and M. L. Hoffman (see record 1976-12035-001) and M. L. Simner (see record 1971-28677-001). 70 newborn infants participated. Calm infants cried in response to the tape-recorded crying of other infants. In addition, results show the following: (a) Crying infants continued to cry in response to the crying of another infant. (b) Crying infants who heard their own cry almost completely stopped crying. (c) Calm infants who heard their own cry made practically no response. (d) Calm infants simply ignored the cries of a chimpanzee and older child. It is concluded that these behaviors are peer and species specific. (27 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Women's responses to young infants' cries.

Women's caregiving and perceptual responses to young infants' cries were assessed as a function of parity and cry cause. Ss cared for a crying infant manikin in a simulated baby-sitting situation. Mothers and nonmothers were quite similar in basic features of their caregiving behaviors, suggesting that the effects of parity may be to fine-tune skills that many women bring to the task of caring for young infants. The specific cause of the cry (hunger or pain) was associated with few differences in caregiving behavior, even though a subsequent perceptual task showed that Ss reliably discriminated the two cries. Further analyses of the perceptual data indicated that cry sounds communicate information about the general distress level of the infant better than information about specific causes. Thus, although the sound of the cry may inform caregivers about overall distress level, caregiving behaviors appear to be determined by additional factors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Adult perception of emotion intensity in human infant cries: effects of infant age and cry acoustics

The relation between adult perception of emotion intensity in the cries of 1- and 6-month-old infants and the acoustic characteristics of the cries was examined. In the first study, adults who were inexperienced in child care rated 40 cries on 3 emotion intensity scales: anger, fear, and distress. The cries of 6-month-olds were rated as being significantly more intense. Different acoustic variables accounted for emotion intensity ratings for the 2 infant ages. Peak amplitude and noisiness of the cry predicted adult judgments of intensity ratings of 1-month-olds' cries; a measure of amplitude ratio (in 2 frequency bands) was the best predictor of intensity ratings of 6-month-olds' cries. In the second study, parents of infants rated the same cries on the same scales. They also rated the older infants' cries as being more intense. The 2 adult groups did not differ on their ratings, and a regression equation derived from one adult group predicted the other adult group's rating of the same infant age better than it predicted its own ratings for the other infant age. Infant age, and its associated acoustic features, seems to be a more important determinant of adults' perception of emotion intensity than are such adult characteristics as gender or infant-care experience.     

Adults' perceptions of experimental modifications of durations of pauses and expiratory sounds in infant crying.

Durations of all pauses and expiratory sounds in a 10-sec bout of infant crying were digitally increased and decreased by 50% to create cries that varied in the duration of pauses and expiratory sounds. Ratings by 40 men and women showed a general monotonic effect of pause duration so that cries with increasingly shorter pauses were perceived to be more arousing, informative, and aversive. The monotonic effect for pause duration was enhanced in an interaction with expiration duration for perceptions of urgency. Results provide the 1st known experimental evidence of how variations in the temporal structure of infant crying differentially affect adults' perceptions and support views of the cry of the young infant as a graded signal. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Gastroesophageal reflux in children

BACKGROUND: Gastroesophageal reflux is common in small children. It is important to recognise that its natural history and management differ from reflux in adults. OBJECTIVE: This article will summarise the clinical presentation, pathophysiology, appropriate investigations and therapy of reflux in small children. DISCUSSION: A small amount of regurgitation is common in infancy, and is only pathological if it results in harm. In children, reflux-induced injury can result from either acid exposure, nutrient loss or respiratory complications. Recognised presentations include heartburn, oesophagitis, infant irritability, dysphagia, haematemesis, stricture, growth failure, aspiration, apnoea and pneumonia. Excessive crying and irritable behaviour in infancy can be due to a variety of causes, but there is a fashionable tendency to assume that gastroesophageal reflux is a major factor. Regurgitation can be a symptom of other conditions such as infection or metabolic disturbance. It is important to carefully evaluate any infant with distressed behaviour to exclude a significant medical cause. Prolonged oesophageal pH monitoring is a very useful means of linking episodes of reflux with putative symptoms. The severity of gastroesophageal reflux tends to improve with age in infants and this should be considered when advising appropriate therapy, especially fundoplication.     

Temperament ratings at 2 weeks, 2 months, and 1 year: Differential stablity of activity and emotionality.

To determine the usefulness of a temperament perspective in the study of young infants, the mothers of 36 newborns completed the Rothbart (1978) Infant Behavior Questionnaire (IBQ) approximately at 2 weeks and at 2 months after their infants were born and, again, when their infants reached 1 year of age. Moreover, both mothers and infants were observed at home in interaction at 1 month. IBQ activity level, responsivity, and irritability exhibited stability from 2 weeks to 2 months and from 2 months to 12 months. However, only irritability was stable from 2 weeks to 12 months. Although stability of their rank ordering was apparent, IBQ ratings generally increased by the end of 1 year. Observed infant alertness and crying at 1 month were significantly related to IBQ irritability at the first two times of measurement. In contrast, maternal behaviors were associated with later IBQ estimates. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Links between maternal care and persistent infant crying in the early months

A community sample was screened to select three groups of infants and their mothers according to how much the babies cried at 6 weeks of age, the peak age for infant crying. The three groups--of moderate (n = 55), evening (n = 38) and persistent criers (n = 67) and their mothers--were assessed by diary, observation and questionnaire measures of mother and infant characteristics and interactions at 6 weeks and 5 months of infant age. At 6 weeks, mothers of persistent criers spent more time interacting with and physically stimulating their babies. Below-optimum maternal sensitivity/affection was linked to moderately increased crying in the infants overall. However, most mothers of persistent criers showed optimum sensitivity and affection, while no significant links between maternal sensitivity/affection and infant crying were found in the persistent crying group. By 5 months, when infant crying declined, the range and size of differences between mothers of persistent criers and other mothers declined. Home observations and a standard play measure failed to show group differences in maternal sensitivity, affection and intrusiveness at this age. The findings show that persistent infant crying in the early months often occurs in spite of high quality maternal care, so that in most cases the crying is probably not due to inadequate parenting. The need to distinguish general community cases from those at social or medical risk is emphasized and the findings' implications for professionals are discussed.     

Production of emotional facial expressions in European American, Japanese, and Chinese infants

European American, Japanese, and Chinese 11-month-olds participated in emotion-inducing laboratory procedures. Facial responses were scored with BabyFACS, an anatomically based coding system. Overall, Chinese infants were less expressive than European American and Japanese infants. On measures of smiling and crying, Chinese infants scored lower than European American infants, whereas Japanese infants were similar to the European American infants or fell between the two other groups. Results suggest that differences in expressivity between European American and Chinese infants are more robust than those between European American and Japanese infants and that Chinese and Japanese infants can differ significantly. Cross-cultural differences were also found for some specific brow, cheek, and midface facial actions (e.g., brows lowered). These are discussed in terms of current controversies about infant affective facial expressions.     

Intolerance to protein hydrolysate infant formulas: an underrecognized cause of gastrointestinal symptoms in infants

The purpose of this study was to determine the effectiveness of an amino acid-based infant formula in infants with continued symptoms suggestive of formula protein intolerance while they were receiving casein hydrolysate formula (CHF). Twenty-eight infants, 22 to 173 days of age, were enrolled; each had received CHF for an average of 40 days (10 to 173 days) and continued to have bloody stools, vomiting, diarrhea, irritability, or failure to gain weight, or a combination of these symptoms. Sigmoidoscopy with rectal biopsy was performed in all infants. The infants then received an amino acid-based infant formula, Neocate, for 2 weeks. After 2 weeks of treatment, 25 of the infants demonstrated resolution of their symptoms and underwent challenge with CHF. Of the 25 who were challenged, eight tolerated the CHF and the remainder had recurrence of their symptoms. The histologic features in these infants varied from eosinophilic infiltration to normal. We conclude that not all infants with apparent formula protein-induced colitis respond to CHF and that these infants may have resolution of their symptoms when fed an amino acid-based infant formula.     

The crying infant

The crying infant is a common presenting complaint and a difficult diagnostic dilemma that may represent the primary manifestation of a serious or even life-threatening condition. Although many children experience an exacerbation of the normal crying tendencies or minor ailments typical of the early months of life, a significant number of infants have underlying pathologic conditions requiring immediate intervention. This article briefly reviews current and past research on this phenomenon and presents differential diagnoses and recommendations for the evaluation and management of the acute crying episode.     

Rudiments of infant temperament: Newborn to 9 months.

Assessed temperament for 110 newborn twins drawn from 23 male–male twin pairs, 21 female–female pairs, and 11 opposite-sex pairs, using a comprehensive neonatal examination that focused on irritability, resistance to soothing, activity, and reinforcement value. The same Ss were later assessed at 9 mo in a structured laboratory setting. Summary ratings of emotional activity were compiled for each S, representing the preponderant reaction of the S in both settings. Individual differences were markedly evident, ranging from wailing distress to smiling and contentment. The neonatal variables correlated significantly with emotional tone at 9 mo, and a further analysis revealed a generalized multiple correlation between the neonatal variables and the 9-mo measures of temperament. When extreme groups on emotional tone were selected at 9 mo (crying and distress vs smiling and contentment), the groups were significantly discriminated by their neonatal scores, with 70% of the Ss being correctly assigned to the appropriate extreme group. Overall, the irritable, difficult-to-soothe neonate was likely to be fussier and more distressed in the laboratory assessment than the more tractable neonate. The results affirm a significant predictive linkage between neonatal behaviors and later measures of temperament and thus give credence to the premise of some stability in infant temperament. (21 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A comparison of symptoms used by mothers and nurses to identify an infant with colic

In this survey research a comparison was made between symptoms used by mothers and nurses which led them to think the baby might be "colicky." Two questionnaires, one for mothers and one for nurses, were used to collect the data. The mothers most frequently selected passes gas rectally, clenches fists, draws-up legs, cries late afternoon and evening, holds body straight, and wants to be held. The nurses selected mother states baby is inconsolable, cries more than 4 hours in 24, draws up legs and wants to feed but won't. Parents believed the colic to be related to a variety of factors; these included baby's eating behaviour, maternal anxiety, baby's and mother's diets, and baby's stress. Ten parents reported pain and screaming as symptoms of colic.     

The mother's psychophysiological reactions to contrasting affective expressions by her own and an unfamiliar infant.

Investigated mothers' autonomic reactions to their own infants' emotional states. 17 mothers of 5-mo-olds viewed 2 landscape scenes and 4 types of videotaped segments depicting their own baby and an unfamiliar baby smiling or crying. Each episode was presented for 3 consecutive 10-sec trials, and order of stimulation was varied systematically. Initial presentations of Ss' own infants evoked cardiac acceleration and large skin conductance responses (SCRs), whereas cardiac deceleration and smaller SCRs were evoked by the unfamiliar infant crying. Episodes displaying the strange infant smiling and landscapes yielded nonsignificant trends toward cardiac deceleration and still smaller SCRs. Results indicate that mothers react with excitement to images of their own child and with patterns characteristic of environmental intake or orientation when viewing unfamiliar infants. Because parent–child relations are considered transactional, physiological indices of maternal responsiveness to infant behaviors are useful as potential predictors of developmental outcome. Hence, it is concluded that the findings that mothers display differential physiological reactions to their own and unfamiliar infants are especially promising. (25 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Similarities and differences in infant-mother and infant-father interaction in the strange situation: A component process analysis.

This study examined similarities and differences in infant–mother and infant–father interaction. Previously published data (Belsky, Garduque, & Hrncir, 1984) on infants observed in the Strange Situation with their mothers (N?=?60) and fathers (N?=?50) at 12 and 13 months were reanalyzed using a component process approach to investigate (a) whether the organization of social interactive behavior is relationally based, (b) the factor-analytic structure of social interaction with the two caregivers, (c) the predictive power of crying and social interactive behavior with each caregiver to subsequent behavior with a stranger, and (d) the relative cross-caregiver consistency of crying versus social interaction. Results indicated (a) that the organization of infant social interaction depends on the interactive partner and on the affective context, (b) that infant behavior with the father is more predictive of infant–stranger interaction than is infant–mother interaction, and (c) that crying is more consistent than social interaction across caregivers. Results are interpreted as being consistent with a view of attachment relationships as relationally based and as evidence for the usefulness of the finer-grained analysis provided by the component process approach. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Verapamil-induced "primary" polydipsia

An 11-month-old male infant with recurrent supraventricular tachycardia (SVT) was treated with oral verapamil. Shortly thereafter he developed marked changes in behavior including lethargy, intensely increased thirst and urination, and irritability when denied fluids. "Primary" polydipsia was diagnosed following an evaluation which showed no evidence of adrenal insufficiency, diabetes insipidus, diabetes mellitus, hypercalcemia, hyperosmolality, or renal disease. The symptoms resolved 1 week after verapamil was discontinued.     

Fathers' and mothers' responses to the faces and cries of normal and premature infants.

32 White, middle-class couples with 5-mo-old infants were shown videotapes depicting infants who were, in turn quiescent, crying, and quiescent. Half of the parents viewed a normal (full-term) newborn, while half viewed a premature infant. Sound tracks were dubbed so that half of the normal and half of the premature infants "emitted" the cry of a normal infant, while the other half emitted the cry of a premature infant. Physiological (heart rate, diastolic blood pressure, and skin conductance) and self-report measures (a mood adjective checklist and an infant temperament measure) were gathered. The cry of the premature infant elicited greater autonomic arousal and was perceived as more aversive than the cry of the normal infant. The effect was especially pronounced when the premature cry was paired with the face of a premature infant. There were few sex differences. Results are discussed with reference to demographic evidence indicating that prematurely born children are "at risk" for child abuse. (30 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Excessive infant crying: a controlled study of mothers helping mothers

OBJECTIVE: To determine the efficacy of behavioral management counseling in the treatment of persistent, excessive infant crying (> 3 hours per day). DESIGN: Two treatments, one no treatment control group. Infants were group-matched according to baseline fuss/cry levels, sociodemographic, and infant variables. Treatments were carried out sequentially by the same counselors. SETTING: Telephone counseling by volunteers (mothers) of CRY-SIS, a national support group for the parents of crying infants. PATIENTS AND INTERVENTIONS: Sequential sample of 27 mother-infant pairs receiving treatment 1 (Tr1, empathy: talking through the problem), 21 receiving treatment 2 (Tr2, behavioral management: specific care taking suggestions) and 44 receiving no treatment (C, controls). Infants were between 1 to 5 months of age. MEASUREMENTS AND RESULTS: Mother-infant pairs had a pretreatment baseline assessment and a posttreatment follow-up (3 months after baseline) using 1-week diaries. Total fuss/cry duration reduced significantly more in the behavioral management group (by 51%) than the empathy group (37%) or the control group (35%). This was mainly due to significantly reduced evening fussing/crying in Tr2 (67%) compared with Tr1 (45%) and C (42%). No differences in total number of fuss/cry bouts/day were found. However, the number of fuss/cry bouts reduced significantly more in the evening in Tr2 (by 55%) compared with Tr1 (27%) and C (32%). Behavioral management mothers evaluated the same counselors as more sympathetic, knowledgeable, and understanding. Tr2 was also perceived by mothers to have helped them more in reducing the crying problem, coping with the infant, and improving the relationship with their infant than Tr1. No effects of treatment on infant difficult temperament were found. CONCLUSIONS: Behavioral management was more effective in reducing fussing/crying than spending time with the mother talking through the problem or just waiting for spontaneous remission. Treatment by suitably but briefly trained lay counselors is an inexpensive and successful treatment option.     

Mothers' emotional reactions to crying pose risk for subsequent attachment insecurity.

Links between maternal emotional reactions to crying (anger and anxiety) and infant attachment security were examined in 119 mother-infant dyads. Mothers rated the intensity of their emotional responses to videotapes of crying infants prenatally. Maternal sensitivity was observed during infant exposure to emotion eliciting tasks at six and 16 months postpartum and mothers' self-reported on their responses to their infant's negative emotions at 16 months. Infant attachment security was assessed using the Strange Situation at 16 months postpartum. Results indicated that observed sensitivity was associated with fewer avoidant and resistant behaviors and prenatal maternal anger and anxiety in response to infant crying predicted the developing attachment system independent of observed sensitivity, but in different ways. Maternal anxiety in response to crying was positively associated with resistant behaviors as a direct effect. Maternal anger in response to crying was associated with avoidant behaviors indirectly through mothers' self-reported punitive and minimizing responses to infant distress at 16 months. Theoretical, applied, and methodological implications are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Effects of nicotine deprivation and irritability on physical aggression in male smokers.

Thirty-five continuing male smokers were randomly assigned to either a deprived or a nondeprived condition. On the basis of self-reported irritability, participants were then assigned to 1 of 4 groups: deprived–high irritable, deprived–low irritable, nondeprived–high irritable, and nondeprived–low irritable. Aggression was measured with a modified version of the Taylor aggression paradigm. Self-reported smoking urge was assessed throughout the reaction time competition. Results indicated that the deprived—high irritable group displayed the highest levels of aggressive behavior. Positive associations between urge ratings and aggression indexes were detected only in the deprived—high irritable group. Results support the existence of an interactive effect of nicotine deprivation and trait irritability on physical aggression and highlight the role of smoking urge as an important factor in the deprivation-aggression link. (PsycINFO Database Record (c) 2010 APA, all rights reserved)