02 Mar ‘Crying Babies’ At Increased Risk of Childhood Behavior Problems
MedicalResearch.com Interview with:
Ina S. Santos (on behalf of the co-authors)
Iná S. Santos, MD, PhD
Professora Titular Depto Medicina Social
Programa Pós-graduação Epidemiologia
Universidade Federal de Pelotas, Brasil
MedicalResearch: What is the background for this study? What are the main findings?
Response: Early regulatory problems (excessive crying, sleeping and feeding problems in infancy) have been considered early markers for similar processes of inadequate or under-controlled behavior in childhood and psychosocial problems in childhood are associated with psychological disorders later in life. The prevalence of excessive crying during the first 3 months of life in representative community-based samples from high-income countries has been reported to range between 14% and 29%.
There is no consensus regarding the definition of excessive crying. A frequently used definition is the excessive paroxysmal crying, that is most likely to occur about the same time every day (usually in the late afternoon or evenings) without any identifiable cause in an otherwise healthy baby aged 2 weeks to 4 months and lasting more than three hours per day, occurring in more than three days in any week for three weeks (rule of three) that is typically known as colic. Others give less emphasis to the amount of crying and give relevance to maternal or parental stress due to the child unresponsiveness to soothing or to the maternal perception of the intensity of crying.
Negative consequences of excessive crying on maternal and child health have been described: it is associated with early weaning from breast milk, frequent changes of formulae, and maternal mental symptoms, besides being the most common proximal risk factor for shaken baby syndrome.
In a study conducted in a middle-sized city located in Southern Brazil, 4231 children enrolled in the 2004 Pelotas Birth Cohort were followed-up from birth to four years of age. At the 3-month post-partum follow-up mothers were asked whether their infants cried more, less or as the same as others of the same age. Infants whose mothers perceived them as crying more than others of the same age were classified as “crying babies”. When the cohort reached four years old, all children were screened to assess their risk of presenting psychological problems. After taking into account a series of maternal and child characteristics (like, maternal age, maternal level of education, type of delivery, gestational age at birth, and child sex, among others) “crying babies” were at increased risk of presenting behavior problems in comparison to “non-crying babies”.
MedicalResearch: What should clinicians and patients take away from your report?
Response: Although excessive crying is usually a benign and self limiting neurodevelopmental phenomenon, with no need of additional investigations for a child with no signs of illness on a thorough history and examination, early detection and management of babies who cry a lot may play a role in the primary prevention of behavioral problems in childhood and in adult life.
Several methods have been tried to prevent or manage crying babies in the first months of life. Studies comparing parenting style showed that proximal care (prolonged holding, frequent breast feeding, rapid response to infant frets and cries, and bed-sharing with infants at night) or even moderate levels of physical contact from birth result in infants with less crying problems than more structured approaches of caring. Others however found no differences in amounts of crying and fussing independently of parenting style.
Considerable gaps and controversies still remain in regard to the effectiveness of available interventions, and further research into prevention and early intervention is required. Meanwhile, simple general rules like feeding a hungry baby, changing wet diapers, and comforting a baby who is cold and crying as a result of these, as well as parental attention, including eye contact, talking, touching, rocking, walking, and playing, may be effective in some infants and is never harmful.
MedicalResearch: What recommendations do you have for future research as a result of this study?
Response: A comprehensive literature review on the effect of behavioral interventions to reduce parental distress caused by excessive infant crying in the first 6 months of life showed that despite substantial investment in recent years in implementation and evaluation of first wave behavioral interventions for infant sleep in the first 6 months, these strategies have not shown to decrease infant crying, prevent sleep and behavioral problems in later childhood, or protect against postnatal depression, besides being subject to important methodological constraints. Well-planned interventions to be delivered to parents of “crying babies” are extremely needed. This is a research priority to optimize children’s mental health and development both in high- and in middle-income settings.
Excessive crying at 3 months of age and behavioural problems at 4 years age: a prospective cohort study
Iná S Santos, Alicia Matijasevich, Marcelo F Capilheira,Luciana Anselmi, Fernando C Barros
J Epidemiol Community Health jech-2014-204568Published Online First: 19 February 2015 doi:10.1136/jech-2014-204568
MedicalResearch.com Interview with: Ina S. Santos (on behalf of the co-authors) (2015). Excessively ‘Crying Babies’ At Increased Risk of Childhood Behavior Problems