DOES SLEEPTIGHT WORK? A BEHAVIORAL ANALYSIS OF THE EFFECTIVENESS OF SLEEPTIGHT FOR THE MANAGEMENT OF INFANT COLIC

We evaluated the effectiveness of SleepTight in the management of infant colic. SleepTight is a device that vibrates the infant's crib to simulate the action of a car traveling at 55 mph. A multiple baseline design across 6 infants was used. Data were collected on infant crying, parental use of SleepTight, and parental satisfaction. The application of SleepTight was associated with reduction in crying in 4 of the 6 infants. These outcome data notwithstanding, consideration of reported nonrecording of severe episodes and mixed reports of satisfaction suggests that SleepTight may not be a viable means of managing infant colic.     

Infantile colic and parental experiences

The study comprised two groups of 33 parents each, one whose infants were identified by parents as colicky during their first 3 months and one with non-colicky infants. Parents filled out a questionnaire with one set of questions about parental experiences when infants were 3 months old and a set of parallel questions concerning current experiences (infant age 8-11 months). The results showed that the 3-month situation was more negatively described with regard to both infant behaviour and parental experiences by the parents of colicky infants. For the current situation (8-11 months), there were no significant group differences, meaning that no long-lasting effects could be demonstrated. However, in the colic group amount of crying and difficulty in comforting during the colic period were significantly related to current parental satisfaction, which suggests that these aspects of infant behaviour and experienced parental competence are of importance also in a longer perspective.     

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.     

A randomized control trial of integrated care for families managing infant colic

This article presents a randomized clinical trial examining the effectiveness of a unique model of integrated care for the treatment of infant colic. Families seeking help for infant colic were randomized to either the family‐centered treatment (TX; n = 31) or standard pediatric care (SC; n = 31). All parents completed 3 days of Infant Behavior Diaries (Barr et al., 1998) and the Colic Symptom Checklist (Lester, 1997 ), Beck Depression Inventory (Beck & Steer, 1984 ), and Parenting Stress Index 3rd ed.‐SF (Abidin, 1995 ). TX families were seen three times by a pediatrician and a mental health clinician within 1, 2, and 6 weeks of baseline data. TX families received individualized treatment plans addressing problem areas of sleep, feeding, routine, and family mental health. SC families were seen only by their own healthcare provider. All families were visited at home by a research assistant to retrieve data at 2, 6, and 10 weeks after baseline. Family‐based treatment accelerated the rate of reduction of infant crying faster than did standard pediatric care. Infants in the TX group had more hours of sleep at 2 weeks posttreatment and spent less time feeding at 2, 6, and 10 weeks posttreatment than did SC infants. Results indicate that individualized family‐based treatment reduces infant colic more rapidly than does standard pediatric care.     

Infants with colic: A study of maternal stress and anxiety

The purpose of this article is to broaden our understanding of colic and to explore the effects of infant colic both on the mother's stress level and on her anxiety about separation from her infant. A “colic” group of 20 mother-infant dyads was compared with a second, control “noncolic” group of equal size. Significant group differences in the amount of time the infants cried, fussed, and were in a quiet/awake state were found. Although no difference in maternal trait anxiety was found, mothers in the colic group reported higher levels of stress associated with their infants' crying behavior. This stress was inversely related to the amount of time the infants slept during a 24-hour period. Mothers in the colic group also expressed significantly greater anxiety about separating from their infants for short periods of time; but the lack of freedom was significantly less of a problem for them than it was for mothers in the noncolic group. We conclude that mothers of difficult infants are more anxious about being separated from their infants, but do not appear to feel “trapped” by their extra maternal duties.     

Clinical,developmental and social aspects of infant crying and colic

Persistent unexplained infant crying in the first few months is a common source of distress for parents and is costly for the health services. The aim was to assess the merits of developmental and social conceptualizations of this phenomenon, compared to the clinical approach as represented by the concept of colic. From a community sample of 530 infants, 67 who met the ‘rule of threes’ definition of colic by fussing and crying for 3 or more hours per day at 4-5 weeks of age were chosen. To avoid confusion, these infants were called ‘persistent criers’. Groups of ‘evening criers’ (N = 38) and ‘moderate cries’ (N = 55) were also selected. These 160 infants were assessed by researcher measures of their consolability and by maternal diary measures of their amounts of fussing, crying and colic behaviour when 5-6 weeks old. The persistent and evening criers cried more than the moderate criers. However, irritable, ‘fussy’ behaviour was the predominant form of distress for all three groups of infants. Colic bouts–defined as ‘bouts of intense, unsoothable crying and other behaviour, perhaps due to stomach or bowel pain’–were rare even among the persistent criers and only 7% of these infants were found to be inconsolable. The results support growing evidence that normal infant developmental processes are central to this phenomenon. In addition, social interactions between infants and parents, and parental subjective variables, appear to be involved. Colic was distinguished as a rare and separate form of distress by the infants' mothers. Further evidence needs to determine whether colic is a distinct clinical phenomenon or an extreme degree of normal distress interpreted within a western cultural framework.     

Crying as social behavior

Twenty mother-infant pairs were observed once a week for 7-hour periods when the infants were 2, 3, 4, and 5 weeks old. The occurrence of crying and its relationship to patterning of maternal behaviors was studied in two social contexts: while the mother was holding the infant and while she was not holding the infant. There were significant individual differences in the amount of crying in each of these contexts. The amount of crying in the two contexts was not correlated. Six variables describing forms of maternal attention throughout the 7-hour day were selected, and profiles were formed from measures of these variables. These profiles were found to vary systematically as a function of the amount of crying while the mother was holding the infant. In this context, only physical stimulation increased linearly with increased crying, whereas other forms of attention showed a U-shaped function in relation to increased crying. No relationship was found between crying while the mother was not holding the baby and patterns of interaction. We conclude that the structuring of a mother-infant relationship is reflected in the amount of crying that occurs while mother and infant are in close physical contact. The results also provide evidence that the social context for an infant's crying must be taken into account if the full adaptive value of crying is to be understood.     

Colic: What's maternal mental health got to do with it?

Families can benefit when pediatric and mental health professionals have a greater appreciation of psychological and relational issues that arise in the course of caring for an infant with colic. The Infant Behavior, Cry, and Sleep Clinic is a multidisciplinary, clinical intervention for parents who identify infant crying as adversely affecting infant, parental, and/or family functioning. Pairing pediatric and mental health expertise provides parents with strategies to manage infant colic within a context that recognizes parental mental health needs. Clinical case material illustrates varying responses and degrees of psychological distress in mothers whose infants have colic. Treatment approaches to colic that take into account maternal mental health needs may contribute to more optimal infant, maternal, and family outcomes.     

Infant crying,risk status and social support in families of preterm and term infants

Infant crying influences the caregiver and the broader caregiving environment. In this study, cry acoustics were recorded and acoustically analyzed from a sample of fullterm and preterm infants at 40 weeks gestational age, along with the medical risk and socioeconomic status (SES) of the family. Following factor analysis of the cry acoustics, cry factors, along with medical risk and SES were used to predict patterns of social support in the informal (family, friends) and formal (health care providers) social support networks at 44 weeks gestational age. One cry factor, temporal patterning, indicative of the influence of respiratory factors on the infant's cry, predicted a significant amount of variance in the amount of support from the informal network, beyond that predicted from medical risk and SES. Medical risk alone predicted the amount of contact with the formal network, and SES predicted satisfaction with help from the formal network. There were different patterns of relationship between cry acoustics and social support for families with term and preterm infants, indicating that caregivers may interpret and respond to different information in the acoustics of their infants' cries. These findings have implications for understanding how infant crying and behavior influence the caregiving environment and for the clinical management of early cry problems in families with infants differing in risk status. © 1998 John Wiley & Sons, Ltd.     

Maternal correlates of infant temperament ratings and of infant-mother attachment: A longitudinal study

This study examined longitudinally correlates of mothers' ratings of their infant's temperament and of the infant-mother attachment relationship. Measures included Carey's Revised Infant Temperament Questionnaire, child-rearing attitudes, psychophysiological responses to an unfamiliar infant's crying pre- and postdelivery, psychophysiological responses to the mother's own infant's crying, and assessments of infant-mother attachment. The results indicated that maternal ratings of infant temperament at 4 months were significantly related not only to concurrent cry responsiveness but also to cry responsiveness and child-rearing attitudes predelivery, as well as to the quality of attachment at 1 year. It is suggested that a differential response pattern of mothers of “easy” and of “difficult” infants, which affects the developing infant-mother bond, may in part originate in maternal dispositions existing prior to parenthood.     

Increasing parenting self-efficacy: The Fussy Baby Network® intervention

High levels of infant crying place families at risk for disrupted relationships, parenting stress, and even for child maltreatment. We conducted an evaluation of the Fussy Baby Network^® (FBN), a program supporting families struggling with infant crying and related concerns. The study contrasted 29 families who sought help from FBN with 27 families with excessively crying infants who did not seek services. Researchers measured parenting self-efficacy, depression, and stress in each group before and after the intervention. Results from hierarchical multiple regression analysis indicated greater improvements over time in parenting self-efficacy for parents receiving FBN services. Furthermore, the greater improvements in parenting self-efficacy in the intervention group were not directly attributable to reductions in infant crying. These findings provide preliminary evidence that the FBN approach may be effective at boosting the confidence of parents struggling with caring for their infants. Future research with larger samples with baseline equivalence and stronger research designs should explore this intervention further. This study also suggests that interventions for families with excessively crying infants should move beyond the focus of reducing infant crying to a broader strategy of supporting parents and strengthening relationships between parents and their infants to build parenting capacity.     

The effect of situation familiarity on the establishment of co-references between mother and infant

The purpose of this study was to determine whether the familiarity or the novelty of play objects available during mother-infant interaction has an effect on the mother's ability to capture and maintain the infant's attention. Twelve mother-infant dyads with 5- and 9-month-old infants were filmed during two 5-minute sessions with familiar or unfamiliar toys. Changes in the infant's visual orientation preceded by a maternal behaviour within a 3-sec interval were studied. In the familiar toy situation, the infants focused more frequently on the maternal referent than with the unfamiliar toys. The mother's verbal and non-verbal interventions were more effective at initiating and maintaining co-reference, because the infant was more frequently in an receptive state. Conversely, when the toys were unfamiliar, the baby was often the initiator. Unfamiliar objects, which appear more attractive, may compete with the mother's attempts to gain the child's attention.     

Mother's attachment representations of their premature infant at 6 and 18 months after birth

The effects of premature birth on attachment have generally been examined from the infant's perspective. There is a lack of data concerning parental attachment representations toward a premature child. Because of the psychological stress engendered in parents confronted with a premature birth, we hypothesized that their attachment representations would be altered during the first months after the hospital discharge. Fifty families with a premature infant (25–33 gestation weeks) and a control group of 30 families with a full‐term infant participated to the study. Perinatal risks were evaluated during hospitalization. To assess mothers' representations of their infant, the Working Model of the Child Interview (WMCI, Zeanah & Benoit, 1995 & Benoit, Zeanah, Parker, Nicholson, & Coolbear, 1997) were administered when their children were 6 and 18 months old. The severity of the perinatal risks was found to have an impact on the mothers' attachment representations. At six months, only 20% of the mothers of a prematurely born infant (30% at 18 months) had secure attachment representations, vs. 53% for the control group (57% at 18 months). Furthermore, mothers of low‐risk premature infants more often had disengaged representations, whereas distorted representations were more frequent in the high‐risk group of premature children. These findings suggest that the parental response to a premature birth is linked to the severity of postnatal risks. The fact that secure attachment representations are affected in mothers of low‐risk infants just as much as they are in mothers of high‐risk infants points to the need to conduct further studies aimed at evaluating whether preventive intervention for both low‐risk and high‐risk premature will be helpful.     

Psychobiological Aspects of Infant Crying

This study addresses the relationship between the amount of infant crying and maternal responsiveness to the infant's facial communicative cues during distress and non-distress situations. From an evolutionary perspective, the interpretation of infant crying as a communicative signal is preferred over its distance-regulating function. This view implies a relation between the amount of infant crying and parameters describing interactional regulation. Maternal responsiveness is operationalized by (a) the contingent reactions in a latency time span which define the intuitive character of parental behaviours (200–800 ms) and by (b) an event-based coding system of maternal inappropriate behaviour. Infant states (crying, fussing, sleeping and waking hours) were assessed by means of diaries kept by the mothers. In two samples (N=10, N=13, respectively), married, middle-class mothers were videotaped in free play situations with their healthy, firstborn children in their family homes. Results show that there is a strong intersituational consistency of maternal behaviour, but context-sensitive components of maternal behaviour could also be found. The contingency of maternal reactions during the free play situation can be regarded as a predictor of the duration of the infant's crying measured by a maternal diary. The whole pattern of the results confirms the regulatory function of infant crying in the context of early caregiver–child interactions.     

Family dynamics as predictors of infant disposition

In this longitudinal study of mothers, their families, and their infants, both discriminant and regression analyses showed that prenatal reports of family dynamics predicted infant disposition at 8 months with considerable accuracy. The most important predictive component was organization and consistency within the family unit as well as the dependability of other family members. Possible mechanisms by which family dynamics might affect the infant's developing disposition are discussed.     

Read your baby: A follow-up intervention program for parents with NICU infants

An intervention model designed to provide education and support to parents of sick or preterm infants throughout their first year of life is described. The intervention focused on helping parents communicate more skillfully with their infant and encouraging parents to maximize their infant's participation in the family system. Seventeen medium-risk infants received intervention; another seventeen served as controls. Independent evaluations of all families at 12 months adjusted age revealed that intervention babies were significantly advanced on Bayley Scales of Infant Development and Mastery Motivation tasks and that their mothers viewed them as easier to care for and less irritable.     

Greek women's attitudes toward pregnancy,labor, and infant: Their significance for intervention

Greek women's needs, attitudes, and experiences during the months immediately prior to and subsequent to the birth of their infants were evaluated. Themes considered were women's feelings and attitudes toward pregnancy, labor and the expected infant; breast feeding; emotional and practical needs; experiences from perinatal care and relationships with medical care personnel and with the family; perceptions of physical and emotional stress; and their relationships with infant and partner. Findings showed, among others, that women emphasized a desire for more personal care — more time, continuity of care, information about their pregnancy, and less distance from the doctor. Moreover, they expressed their need for emotional support. Anxiety was found to be a central feature of women's feelings during labor and delivery. The same anxiety was related to efforts to deal with infant crying, attempts to console the infant, and concern for picking the baby up. Understanding maternal attitudes provides guidelines for designing an intervention program that would integrate emotional and cognitive factors.     

Young adults’ reactions to infant crying

An infant's optimal development is determined to a great extent by the adequate and sensitive responses of the caregiver. The adequacy and sensitivity of a reaction to an infant in distress (i.e. crying) will partly depend on the causal attributions of the crying and on the individual's sympathy for the infant. Being female, prior caring experiences, and multiparity have shown to be linked to more sympathetic, tolerant and less hostile emotional responses to crying. However, little is known about other factors explaining inexperienced future caregivers’ reactions to infant crying. The present paper's goal is to shed more light on the subject by looking at how personality factors, caregiving interest, sex, promptness of the reaction, and gender identity are related to emotional reactions and causal attributions to crying in a population of young adults without children.     

Perceptions of infant boys' behavior and mental health: Relation to infant attachment

Two studies were conducted to determine the impact of infants' attachment classifications and behaviors on naive adults' impressions of their behavior and mental health. In Study 1, three groups of 44 adults viewed a videotape of episode 8 of the Strange Situation for either an avoidant, a resistant, or a secure male infant. After viewing the videotape, they made judgments about aspects of the infant's mental health. Adults viewed the resistant baby as less socially competent and more negative in affect than the other two babies and the secure baby as the least independent of the three babies. Parents rated babies as more intelligent than did nonparents. In Study 2, 15 parents were matched on race and gender with 15 nonparents. All adults viewed a videotape of the reunions of two secure, two avoidant, and two resistant male infants. Avoidant babies were viewed as more socially competent and independent than secure babies and the C2 baby was viewed as the least intelligent, least independent, least socially competent, and most affectively negative of the infants. Results are interpreted as underscoring the need to educate parents and paraprofessionals about the importance of infant distress and physical contact with parents.