Co-morbidity of crying and feeding problems with sleeping problems in infancy: Concurrent and predictive associations

Exploring the Longitudinal Relationship Between Short Sleep Duration, Temperament and Attention Deficit Hyperactivity Disorder Symptoms in a Biethnic Population of Children Aged Between 6 and 61 Months: A Born in Bradford Study

OBJECTIVE

Examine the association between sleep duration, temperament and symptoms of Attention Deficit Hyperactivity Disorder (ADHD) in a biethnic child-population from The Born in Bradford cohort.

METHOD

Parent-report sleep duration categorized children as: early short, late short, consistently short or consistently normal sleepers between 6 and 36 months. Temperament was measured using the Infant Characteristics Questionnaire at 6 months. The Strengths and Difficulties Questionnaire assessed symptoms of ADHD at 37, 54, and 61 months.

RESULTS

Normal sleepers before 18 months had significantly fewer ADHD symptoms at 37 months compared with consistently short sleepers. Fussiness at 6 months was significantly positively associated with ADHD symptoms at 37 and 54 months; but does not appear to mediate the relationship between sleep duration and ADHD symptoms.

CONCLUSION

Awareness of the relationship between short sleep duration and fussiness in infancy and later ADHD symptomatology may support earlier identification of arising difficulties in children.

Feeding Problems Including Avoidant Restrictive Food Intake Disorder in Young Children With Autism Spectrum Disorder in a Multiethnic Population

We examined feeding problems, including Avoidant Restrictive Food Intake Disorder (ARFID), in preschool children with Autism Spectrum Disorder (ASD). Data were collected from a prospective longitudinal study of 46 children with ASD in a multiethnic, low resource area in Gothenburg, Sweden. Feeding problems were found in 76% of the children with ASD, and in 28%, the criteria for ARFID were met. The study highlights early onset age, the heterogeneity of feeding problems, and the need for multidisciplinary assessments in ASD as well as in feeding problems, and also the need for further elaboration of feeding disorder classifications in children.

Temporal Patterns of Infant Regulatory Behaviors in Relation to Maternal Mood and Soothing Strategies

This study investigates the temporal patterning of infant self-regulatory behaviors (crying/fussing, sleeping) in relation to both infant (age, sex, regulatory problems) and maternal variables (soothing behaviors, mood). Self-regulatory and soothing behaviors were assessed in 121 mother-infant dyads (4-44 weeks) by the Baby's Day Diary at 5 min intervals over 3 days. Further infant characteristics and maternal mood were assessed by questionnaires (DASS, CES-D, STAI) and the Diagnostic Interview for the Assessment of Regulatory Problems in Infancy and Toddlerhood. Data were analyzed using generalized additive mixed models. Negative maternal mood was associated with a deviant course of crying/fussing during the day. Body contact was associated with reduced variability in the 24 h course of sleep. Mother-infant transactional processes-above and beyond known relationships with overall levels of crying/fussing and sleeping-might play out on the temporal dimension of infant regulatory behaviors.

Infant regulatory problems, parenting quality and childhood attention problems

BACKGROUND AND AIMS

To determine the combined impact of infant multiple/persistent regulatory problems (RPs), parenting quality and maternal mental health on childhood attention problems.

STUDY DESIGN

A prospective, population-based cohort study including 16 paediatric hospitals in Southern Bavaria (Germany).

SUBJECTS

1459 infants were followed from birth to 8 years of age.

OUTCOME MEASURES

RPs were assessed at 5 and 20 months using interviews by trained paediatricians; parenting quality was assessed between birth and 5 months using parent interviews and nurses' observations; maternal mental health was assessed at birth and 5 months using standardized parents' interviews; childhood data on attention problems were collected at 8 years, using parent reports and expert behaviour observation ratings.

RESULTS

After correction for gestational age, sex, and socioeconomic status, early RPs (β = 0.079) and low parenting quality (β = 0.175) predicted later attention problems (R² = 0.272). Their impact was additive, such that infants with both multiple/persistent RPs and poor parenting quality showed the highest attention problems 8 years later. However, the impact of RPs on attention was strongest for preterm children. Maternal mental health was a significant moderator of the relationship between parenting quality and attention problems. With adequate maternal mental health, good parenting quality was related to lower attention problems, yet with mental health problems present, the effect of good parenting on attention problems diminished.

CONCLUSIONS

Guidance and support for parents of infants with multiple/persistent crying, sleeping or feeding problems may be essential to prevent the development of childhood attention problems, especially when maternal mental health problems are present.

Regulatory Problems in Very Preterm and Full-Term Infants Over the First 18 Months

OBJECTIVE

This study is an investigation of differences in regulatory problems (RPs; crying, sleeping, feeding) expressed by infants born very preterm (VP; <32 wk gestation) or with very low birth weight (VLBW; <1500 g) and infants born at full term (FT) during the first 18 months of life. It investigates the prevalence of single and multiple RPs, their persistence and how early in infancy RPs still found at 18 months of age can be predicted.

METHOD

This prospective longitudinal study of 73 VP/VLBW and 105 FT infants utilized a standard interview of mothers to assess regulatory problems among the infants at term, 3, 6, and 18 months of age.

RESULTS

Few differences were found between VP/VLBW and FT infants in the first 6 months. At 18 months, VP/VLBW infants had more single sleeping (RR = 2.2, CI = 1.3-3.7), feeding (RR = 1.4, CI = 1.03-1.8), and multiple RPs (RR = 1.7, CI = 1.02-2.8) than FT infants. In VP/VLBW infants, RPs as early as 3 months and in FT infants RPs as early as 6 months predicted RPs at 18 months. Those infants who had persistent RPs in the first 6 months of life were more likely to still have RPs at 18 months.

CONCLUSION

VP/VLBW children are at slightly increased risk for RPs at term and in the second year of life. Clinicians should be aware that RPs that persist across the first 6 months point to increased risk of continuing RPs into toddlerhood in both VP/VLBW and FT infants.

Maternal anxiety versus depressive disorders: specific relations to infants' crying, feeding and sleeping problems

BACKGROUND

Maternal depression has been associated with excessive infant crying, feeding and sleeping problems, but the specificity of maternal depression, as compared with maternal anxiety remains unclear and manifest disorders prior to pregnancy have been widely neglected. In this prospective longitudinal study, the specific associations of maternal anxiety and depressive disorders prior to, during and after pregnancy and infants' crying, feeding and sleeping problems were investigated in the context of maternal parity.

METHODS

In the Maternal Anxiety in Relation to Infant Development (MARI) Study, n = 306 primiparous and multiparous women were repeatedly interviewed from early pregnancy until 16 months post partum with the Composite International Diagnostic Interview for Women (CIDI-V) to assess DSM-IV anxiety and depressive disorders. Information on excessive infant crying, feeding and sleeping problems was obtained from n = 286 mothers during postpartum period via questionnaire and interview (Baby-DIPS).

RESULTS

Findings from this study revealed syndrome-specific risk constellations for maternal anxiety and depressive disorders as early as prior to pregnancy: Excessive infant crying (10.1%) was specifically associated with maternal anxiety disorders, especially in infants of younger and lower educated first-time mothers. Feeding problems (36.4%) were predicted by maternal anxiety (and comorbid depressive) disorders in primiparous mothers and infants with lower birth weight. Infant sleeping problems (12.2%) were related to maternal depressive (and comorbid anxiety) disorders irrespective of maternal parity.

CONCLUSIONS

Primiparous mothers with anxiety disorders may be more prone to anxious misinterpretations of crying and feeding situations leading to an escalation of mother-infant interactions. The relation between maternal depressive and infant sleeping problems may be better explained by a transmission of unsettled maternal sleep to the fetus during pregnancy or a lack of daily structure and bedtime routine with the infant. Maternal disorders prior to pregnancy require more attention in research and clinical practice.

Video Evidence That London Infants Can Resettle Themselves Back to Sleep After Waking in the Night, as well as Sleep for Long Periods, by 3 Months of Age

OBJECTIVE

Most infants become settled at night by 3 months of age, whereas infants not settled by 5 months are likely to have long-term sleep-waking problems. We assessed whether normal infant development in the first 3 months involves increasing sleep-period length or the ability to resettle autonomously after waking in the night.

METHODS

One hundred one infants were assessed at 5 weeks and 3 months of age using nighttime infrared video recordings and parental questionnaires.

RESULTS

The clearest development was in sleep length; 45% of infants slept continuously for ≥5 hours at night at 3 months compared with 10% at 5 weeks. In addition, around a quarter of infants woke and resettled themselves back to sleep in the night at each age. Autonomous resettling at 5 weeks predicted prolonged sleeping at 3 months suggesting it may be a developmental precursor. Infants reported by parents to sleep for a period of 5 hours or more included infants who resettled themselves and those with long sleeps. Three-month olds fed solely breast milk were as likely to self-resettle or have long sleep bouts as infants fed formula or mixed breast and formula milk.

CONCLUSIONS

Infants are capable of resettling themselves back to sleep in the first 3 months of age; both autonomous resettling and prolonged sleeping are involved in "sleeping through the night" at an early age. Findings indicate the need for physiological studies of how arousal, waking, and resettling develop into sustained sleeping and of how environmental factors support these endogenous and behavioral processes.

Arizona Twin Project: a focus on early resilience

The Arizona Twin Project is an ongoing longitudinal study designed to elucidate the genetic and environmental influences underlying the development of early competence and resilience to common mental and physical health problems during infancy and childhood. Participants are a sample of 600 twins (25% Hispanic) recruited from birth records in the state of Arizona, United States. Primary caregivers were interviewed on twins' development and early social environments when twins were 12 and 30 months of age. Measures include indices of prenatal and obstetrical risk coded from hospital medical records, as well as primary caregiver-report questionnaires assessing multiple indicators of environmental risk and resilience (e.g., parental warmth and control, family and social support), twins' developmental maturity, temperament, health, behavior problems, and competencies. Preliminary findings highlight the importance of the early environment for infant and toddler health and well-being, both directly and as a moderator of genetic influences. Future directions include a third longitudinal assessment in middle childhood examining daily bidirectional relations between sleep, health behaviors, stress, and mood.

Continuity and change in infants' sleep from 8 to 14 months: a longitudinal actigraphy study

In this report changes and stability in sleep-wake characteristics, at the latter part of infancy, were examined. The sample comprised of 34 healthy infants whose sleep was assessed by means of actigraphy at 8, 10, 12 and 14 months. The results indicated that while sleep schedules did not change significantly from 8 to 14 months, sleep consolidation continued across time. Age 12 months stands out in that sleep disruption was unrelated to whether or not the child was a frequent nightwaker before and/or after the 1st birthday. The findings demonstrate the importance of investigating sleep longitudinally using multiple time scales.

Predictors of crying, feeding and sleeping problems: a prospective study

BACKGROUND

Infant regulatory problems, that is, excessive crying, feeding and/or sleeping difficulties, are precursors of adverse development. However, the aetiology of regulatory problems is still unclear. The aim of this study was to investigate pre-, peri- and post-natal neurophysiological and psychosocial predictors of single and multiple regulatory problems at 5 months of age.

METHODS

This prospective longitudinal study included all children born at neonatal risk in a geographically defined area in southern Germany. The data of n = 5093 singleton infants (83.6%) were analysed using crude and multivariate logistic regression analyses. As outcome measures we used single and multiple regulatory problems, that is, crying, feeding and/or sleeping difficulties at 5 months of age, which were assessed via a standardized interview with the parents by study paediatricians as part of a neurodevelopmental examination.

RESULTS

In total, 30.7% of the sample suffered from single or multiple regulatory problems at 5 months. Breastfeeding increased the odds of single sleeping problems 5.12-fold, but decreased the odds of single feeding problems [odds ratio (OR) 0.51; 95% confidence interval (CI) 0.35-0.74]. Very preterm birth was predictive of single feeding (OR 1.79; 95% CI 1.25-2.55) and multiple regulatory problems (OR 2.03; 95% CI 1.19-3.46), and foetal abnormalities increased the odds of single feeding and multiple regulatory problems from 1.53- to 1.64-fold. Family adversity and psychosocial stress factors were associated with single crying and multiple regulatory problems.

CONCLUSIONS

Pre-, peri- and post-natal neurophysiological and psychosocial factors are predictive of single and multiple regulatory problems. The results may be useful in terms of early recognition of at risk groups for regulatory problems.

Preventing obesity during infancy: a pilot study

More than 20% of US children between ages 2 and 5 years are overweight suggesting efforts to prevent obesity must begin earlier. This study tested the independent and combined effects of two behavioral interventions delivered to parents, designed to promote healthy infant growth in the first year. Mother-newborn dyads intending to breastfeed were recruited from a maternity ward. With a 2 × 2 design, 160 dyads were randomized into one of four treatment cells to receive both, one, or no interventions delivered at two nurse home visits. The first intervention ("Soothe/Sleep") instructed parents on discriminating between hunger and other sources of infant distress. Soothing strategies were taught to minimize feeding for non-hunger-related fussiness and to prolong sleep duration, particularly at night. The second intervention ("Introduction of Solids") taught parents about hunger and satiety cues, the timing for the introduction of solid foods, and how to overcome infants' initial rejection of healthy foods through repeated exposure. A total of 110 mother-infant dyads completed the year-long study. At 1 year, infants who received both interventions had lower weight-for-length percentiles (P = 0.009). Participants receiving both interventions had a mean weight-for-length in the 33rd percentile; in contrast, those in other study groups were higher first intervention only--50th percentile; second intervention only--56th percentile; control group--50th percentile).This suggests that multicomponent behavioral interventions may have potential for long-term obesity prevention (ClinicalTrials.gov number, NCT00359242).

Why are they having infant colic? A nested case-control study

We aimed to analyse infant (birth characteristics, feeding type, faecal enzyme activities) and environmental (maternal smoking, nutrition and psychological status, mother-child bonding, family structure, support for the mother, familial atopy) risk factors for infant colic and to follow infants with respect to physical growth, sleeping status up to 8 months of age in a nested case-control study. 660 mothers who delivered at Dr Zekai Tahir Burak Maternity Hospital, were enrolled within 3-72 h post delivery. Each infant with inconsolable persistent crying and four matched infants with no crying episodes were invited by phone to Hacettepe University Ihsan Doğramacı Children's Hospital at 30-45 days post partum. At 40-55 days, we examined the infants and gave mothers a questionnaire, including crying characteristics of the infants; 47 infants were diagnosed with colic and 142 as non-colic. When the infants were 7-8 months old, another interview was done. The colic group had higher proportions of less-educated (≤ 8 years) and smoking mothers, extended family and families with domestic violence than the non-colic group. The colic group of mothers had significantly higher rates of 'impaired bonding' in the Postpartum Bonding Questionnaire, higher scores on the Edinburgh Postnatal Depression Scale, higher scores for hostility subscales of the Brief Symptom Inventory and a more irregular sleep pattern than the non-colic group. No differences were revealed for faecal enzyme activities. At 7-8 months, the colic group was shorter than the non-colic group. Colic was associated with various perinatal factors (maternal education, smoking habits, cheese consumption, hostility scores and domestic violence) and having colic in infancy negatively affected the sleeping pattern and the height of the infant.

A prospective study on the persistence of infant crying, sleeping and feeding problems and preschool behaviour

AIM

To determine the persistence of regulatory problems (RP), i.e. excessive crying (>3 months of age), feeding and sleeping difficulties from infancy to preschool age, and to evaluate whether RP at 5 months are predictive of preschool adaptive behaviour and social skills.

METHOD

A prospective population study of newborns admitted to neonatal care. RP at 5, 20 and 56 months of age were obtained via parent interviews and neurological examination and preschool adaptive behaviour and social skills by parent ratings. Logistic and linear regression analyses were conducted and controlled for psychosocial and neurological factors.

RESULTS

More than half of the sample had RP at least at one measurement point. In about 8% of infants, RP persisted across the preschool years. Multiple RP and feeding problems increased the odds of eating problems at 20 and 56 months. Persistent RP and feeding problems were predictive of deficits in preschool adaptive behaviour and social skills. In addition, sex differences were found.

CONCLUSIONS

Multiple RP and feeding problems had the highest stability. Persistent RP were predictive of adverse social and adaptive behaviour. Understanding of the aetiology may help to prevent persistent RP.

Crying and feeding problems in infancy and cognitive outcome in preschool children born at risk: a prospective population study

OBJECTIVE

To investigate whether regulatory problems, i.e., crying and feeding problems in infants older than 3 months of age, predict cognitive outcome in preschool children born at risk even when controlled for confounding factors.

METHODS

A prospective longitudinal study of children born in a geographically defined area in Germany. N = 4427 children of 6705 eligible survivors (66%) participated at all 4 assessment points (neonatal, 5, 20, and 56 months of age). Excessive crying and feeding problems were assessed at 5 months. Mental development was measured with the Griffiths Scale at 20 months, and cognitive assessments were conducted at 56 months. Neonatal complications, neurological, and psychosocial factors were controlled as confounders in structural equation modeling and analyses of variance.

RESULTS

One in 5 infants suffered from single crying or feeding problems, and 2% had multiple regulatory problems, i.e., combined crying and feeding problems at 5 months. In girls, regulatory problems were directly predictive of lower cognition at 56 months, even when controlled for confounders, whereas in boys, the influence on cognition at 56 months was mediated by delayed mental development at 20 months. Both in boys and girls, shortened gestational age, neonatal neurological complications, and poor parent-infant relationship were predictive of regulatory problems at 5 months and lower cognition at 56 months.

CONCLUSION

Excessive crying and feeding problems in infancy have a small but significant adverse effect on cognitive development.

Maternal smoking during pregnancy and neonatal behavior: a large-scale community study

OBJECTIVE

To investigate the influence of prospectively measured smoking during pregnancy on aspects of neonatal behavior in a large community sample.

METHODS

Participants were mothers and infants from the Providence, Rhode Island, cohort of the National Collaborative Perinatal Project enrolled between 1960 and 1966. Mothers with pregnancy/medical complications and infants with medical complications and/or born premature or of low birth weight were excluded. The final sample included 962 mother-infant pairs, 23% of whom were black. Maternal smoking was measured prospectively at each prenatal visit. Neonatal behavior was assessed by using the Graham-Rosenblith Behavioral Examination of the Neonate. Items from the examination were reduced to 3 subscales: irritability, muscle tone, and response to respiratory challenge.

RESULTS

Sixty-two percent of the sample reported smoking during pregnancy, with 24% of smokers reporting smoking 1 pack per day or more. We found a significant influence of maternal smoking exposure (none, moderate/less than 1 pack per day, heavy/1 pack per day or more) on irritability and muscle tone in the neonate, with exposed infants showing greater irritability and hypertonicity. Effects remained significant after controlling for significant covariates: maternal socioeconomic status, age, and race and infant birth weight and age. Posthoc tests suggested particular effects of heavy smoking on increased infant irritability and both moderate and heavy smoking exposure on increased muscle tone.

CONCLUSIONS

In a large community sample, exposure to maternal smoking was associated with increased irritability and hypertonicity in neonates. Exposure to maternal smoking did not influence neonatal response to respiratory challenge. This study is the largest-scale investigation to date of the effects of maternal smoking (heavy and moderate) on examiner-assessed neonatal behavior. Given the associations between both maternal smoking and infant irritability and later behavioral dysregulation, results have important implications for early identification and intervention with at-risk offspring.

Opportunities for the primary prevention of obesity during infancy

Many parents, grandparents, and clinicians have associated a baby’s ability to eat and gain weight as a sign of good health, and clinicians typically only call significant attention to infant growth if a baby is failing to thrive or showing severe excesses in growth. Recent evidence, however, has suggested that pediatric healthcare providers should pay closer attention to growth patterns during infancy. Both higher weight and upward crossing of major percentile lines on the weight-for-age growth chart during infancy have long term health consequences, and are associated with overweight and obesity later in life. Clinicians should utilize the numerous available opportunities to discuss healthy growth and growth charts during health maintenance visits in the first two years after birth. Further, providers should instruct parents on strategies to promote healthy behaviors that can have long lasting obesity preventive effects.

Infant crying and sleeping: helping parents to prevent and manage problems

This article summarizes the current understanding of infant crying and sleeping problems, together with the implications of this understanding for services and research, with a focus on the first months of infancy.

Infant crying and sleeping in London, Copenhagen and when parents adopt a "proximal" form of care

OBJECTIVE

Western parents are given conflicting advice about whether to introduce a "scheduled" approach to infant care or to follow their infants' demands. Attempts to address this issue using randomized, controlled trials have been unsuccessful. This comparative study collected evidence about methods of parenting and associated infant crying and sleeping in 2 communities with substantially different approaches to infant care (London, United Kingdom, and Copenhagen, Denmark) and in a "proximal care" group, where parents planned to hold their infants > or =80% of the time between 8 am and 8 pm, breastfeed frequently, and respond rapidly to infant cries.

METHODS

Validated behavior diaries were used to measure parental behavior and infant crying and night waking longitudinally at 8 to 14 days, 5 to 6 weeks, and 10 to 14 weeks of age. Feeding and sleeping practices were measured by questionnaire.

RESULTS

Proximal care parents held infants for 15 to 16 hours per 24 hours and coslept with them through the night more often than other groups. London parents had 50% less physical contact with their infants than proximal care parents, including less contact when the infants were crying and when awake and settled. London parents also abandoned breastfeeding earlier than other groups. Copenhagen parents fell in between the other groups in measures of contact and care. These differences in caregiving were associated with substantial differences in several aspects of infant crying and settled behavior at night. London infants cried 50% more overall than infants in both other groups at 2 and 5 weeks of age. However, bouts of unsoothable crying occurred in all 3 of the groups, and the groups did not differ in unsoothable bouts or in colicky crying at 5 weeks of age. Proximal care infants woke and cried at night most often at 12 weeks. Compared with proximal care infants, Copenhagen infants cried as little per 24 hours, but woke and cried at night less often at 12 weeks of age.

CONCLUSIONS

"Infant-demand" care and conventional Western care, as practiced by London parents, are associated with different benefits and costs. As used by proximal care and Copenhagen parents, infant demand parenting is associated with less overall crying per 24 hours. However, the proximal form of infant-demand parenting is associated with more frequent night waking and crying at 12 weeks of age. Copenhagen infants cry as little per 24 hours as proximal care infants but are settled at night like London infants at 12 weeks of age. Colicky crying bouts at 5 weeks of age are unaffected by care. The findings have implications for public health care policy. First, they add to evidence that bouts of unsoothable crying, which are common in early infancy, are not much affected by variations in parenting, providing reassurance that this aspect of infant crying is not parents' fault. Second, the findings provide information that professionals can give to parents to help them to make choices about infant care. Third, the findings support some experts' concerns that many English parents are adopting methods of care that lead to increased crying in their infants. There is a need for informed debate among professionals, policy makers, and parents about the social and cultural bases for the marked differences between London and Copenhagen parents' approach to care.

Age-related incidence curve of hospitalized Shaken Baby Syndrome cases: convergent evidence for crying as a trigger to shaking

OBJECTIVE

To determine whether there is an age-specific incidence of hospitalized cases of Shaken Baby Syndrome (SBS) that has similar properties to the previously reported "normal crying curve," as a form of indirect evidence that crying is an important stimulus for SBS.

DESIGN AND SETTING

The study analyzed cases of Shaken Baby Syndrome by age at hospitalization from hospital discharge data for California hospitals from October 1996 through December 2000.

PATIENTS

All cases of children less than 18 months (78 weeks) of age for whom the diagnostic code for Shaken Baby Syndrome (995.55) in the International Classification of Disease, Ninth Edition, Clinical Modification was assigned.

RESULTS

There were 273 hospitalizations for SBS. Like the "normal crying curve," the curve of age-specific incidence starts at 2-3 weeks, has a clear peak, and declines to baseline by about 36 weeks of age. In contrast to the normal crying curve that peaks at 5-6 weeks, the peak of SBS hospitalizations occurs at 10-13 weeks.

CONCLUSIONS

The age-specific incidence curve of hospitalized SBS cases has a similar starting point and shape to the previously reported normal crying curve but the peak occurs about 4-6 weeks later. Of the likely predisposing causes, this pattern is only consistent with the properties of early crying. There are numerous explanations for the lag in the peaks between crying and SBS hospitalizations, including the possibility of repeat shakings prior to hospitalization. The importance of crying as a stimulus to SBS may provide an opportunity for preventive intervention.

Changes in sleep problems, parents distress and impact of sleep problems from infancy to preschool age for referred and unreferred children

This article compares and describes changes in sleep problems in 3- to 5-year-old Icelandic children referred and unreferred for sleep problems in infancy and explores changes in parents' distress and the impact of children's sleep problems on families over time. The sample consisted of a clinical group (n = 31) that had been referred to a sleep-disorder clinic in infancy, and a comparative group (n = 150) of age-matched unreferred community children. Self-report scales assessed infant/child sleep pattern, the impact of the sleep problem on family life and parents' distress. Results showed that about half the children in the community group have had a sleep problem in infancy. Nightwakings improved in both the referred and unreferred group over time but remained more frequent in the unreferred group. The referred group had significantly more settling problems in infancy than the other group but settling improved markedly over time. Parents of referred children were more fatigued compared with others despite improvement of children's sleep problems over time. Mothers of referred children were however, less likely to perceive the sleep problem as troublesome for family life than the others. It is concluded that parents of referred children are more fatigued than parents of unreferred children and nightwakings are more likely to persist in children who had sleep problems in infancy than in those with no such problems.

Persistent infant crying and hyperactivity problems in middle childhood

OBJECTIVE

To investigate whether persistent infant crying is associated with an increased risk for externalizing behavior problems in childhood.

METHODS

Sixty-four infants who were referred for persistent crying in infancy (PC; mean age: 3.8 +/- 1.3 months) were reassessed at 8 to 10 years of age and compared with 64 classroom controls (CC). The major outcome measure was pervasive hyperactivity or conduct problems defined as parent, child, and teacher ratings that across informants were within the borderline/clinical range according to the Strengths and Difficulties Questionnaire (SDQ). Ratings of other behavior problems, parent ratings of temperament, and teacher assessment of academic achievement were also obtained.

RESULTS

Ten (18.9%) of 53 PC had pervasive hyperactivity problems (child, parent, and teacher reported) compared with 1 (18.9%) of 62 CC (odds ratio: 14.19 [1.75-114.96]). Parents (29 [45.3%] of 64 vs 11 [17.2%] of 64; 4.00 [1.77-9.01]) and children (30 [46.9%] of 64 vs 17 [26.6%] of 64; 2.44 [1.16-5.12]) but not the teachers reported more conduct problems. Parents of PC rated the temperament of their children to be more negative in emotionality (PC mean: 3.0 +/- 1.0; CC: 2.4 +/- 1.0; effect size: 0.6) and difficult-demanding (PC mean: 5.2 +/- 1.3; CC: 6.3 +/- 0.9; effect size: 1.0). Academic achievement was reported by teachers to be significantly lower for PC than CC, in particular for those children with pervasive hyperactivity problems.

CONCLUSIONS

Infants who are referred for PC problems and associated sleeping or feeding problems are at increased risk for hyperactivity problems and academic difficulties in childhood.

Infants with colic have a normal sleep structure at 2 and 7 months of age

OBJECTIVE

To compare nighttime sleep structure between infants with colic and a control group.

STUDY DESIGN

Sleep and cry times of 15 infants with colic and 16 infants in a control group were recorded with the use of a daily diary at the ages of 5 weeks and 6 months. The diary was kept at home for a 1-week period. Overnight polygraphic sleep recordings in a sleep laboratory were performed when the infants were 2 months of age and were repeated for 11 infants with colic and 14 infants in a control group at 7 months of age.

RESULTS

Daily sleep time was shorter in infants with colic compared with the control group at 5 weeks of age (P =.001). Polygraphic data showed a similar sleep structure between the study groups at 2 and 7 months of age. Infants with colic had somewhat more obstructive apneas during rapid eye movement sleep at the age of 2 months (P =.04), and they had fewer awakenings at the age of 7 months than the control group (P =.003).

CONCLUSION

Infants with colic had normal sleep polygraphic finding at 2 and 7 months of age including sleep structure, movements, and breathing. Despite the shorter reported daily sleep times, the polygraphic data did not suggest infantile colic to be associated with a sleep disorder.

Ergebnisse der Bayerischen Entwicklungsstudie

Zusammenfassung. Die Bayerische Entwicklungsstudie untersuchte die Entwicklung von Kindern, die innerhalb der ersten zehn Lebenstage in eine Kinderklinik in Südbayern aufgenomen wurden zu fünf Zeitpunkten während der ersten neun Lebensjahre. Dazu gehörten sehr Frühgeborene < 32 Tragzeitwochen, neonatale Risikokinder > 31 Tragzeitwochen und reifgeborene Kontrollkinder. Sehr Frühgeborene hatten mehr als zehnmal häufiger kognitive Defizite als reifgeborene Kontrollen und besondere Probleme bei der ganzheitlichen Informationsverarbeitung. Oft waren mehrere Funktionsbereiche gleichzeitig betroffen (IQ, Lesen, Schreiben, Rechnen, Sprache). Es traten häufiger Aufmerksamkeitsprobleme auf und 22% der sehr Frühgeborenen besuchten eine Sonderschule. Auch die größeren Hoch-Risikokinder hatten häufiger kognitive Probleme. Dieses Defizit wurde jedoch ab dem dritten Lebensjahr besser durch soziale als durch biologische Faktoren erklärt. Im Gegensatz dazu waren protektive Faktoren für die Entwicklung der sehr Frühgeborenen geringe neonatale Komplikationen, geringere Intensität der Versorgung und frühes Kopfaufholwachstum. Die Probleme sehr früher Geburt sind langfristig und bei anhaltenden Defiziten wahrscheinlich hirnorganischer Natur. Interventionen zur Vermeidung sekundärer Schäden sollten vor der Entlassung aus der Klinik einsetzen. Größere Frühgeborene (> 31 Tragzeitwochen) profitieren am meisten von psycho-pädagogischen Maßnahmen in der frühen Kindheit.

An epidemiologic longitudinal study of sleeping problems and feeding experience of preterm and term children in southern Finland: comparison with a southern German population sample

OBJECTIVE

To determine the influence of breast-feeding on the prevalence and persistence of sleeping problems in southern Finland (SF) and southern Germany (SG).

DESIGN

Prospective binational population study of infants admitted to special care units (SCUs) in geographically defined areas in SF and SG.

SUBJECTS

In SF, the number of SCU infants was 1057 (very preterm, 47; preterm, 258; term, 752); 485 term infants were control subjects. In SG, the number of SCU infants was 4427 (very preterm, 284; preterm, 1419; term, 2724).

MAIN OUTCOME MEASURE

Parent reports of child sleeping problems at 5, 20, and 56 months of age.

RESULTS

Night waking at 5 months of age was less frequent for SCU very preterm (25.5%), preterm (40.6%), and term infants (48%) than for term control subjects (56.7% to 59.9%) in SF. No differences in sleeping behavior according to gestation were found at 20 and 56 months. Sleeping problems were greater in SF infants (25.5% to 48%) than in SG infants (15.1% to 19.1%) at 5 months of age and were explained by a higher rate of breast-feeding in SF. Breast-feeding had no long-term effects on night waking or on co-sleeping in SF. In contrast, breast-fed infants continued to wake more often in SG.

CONCLUSIONS

Breast-feeding rather than gestational age is strongly related to night waking. More support for dealing with night waking might prevent early termination of breast-feeding.

Links between infant crying and sleep-waking at six weeks of age

Infant crying, and parental concern about unexplained crying, peak when infants are around 6 weeks of age. Diary measures of amounts of time infants spent crying, sleeping, waking-settled and feeding at 6 weeks were obtained in three samples: a group of moderate criers (N = 45), a group with an evening crying peak (N = 33) and a group whose fuss/crying exceeded 3 h per day (persistent criers, N = 54). Substantial negative correlations between amounts of fuss/crying and sleeping, but few associations between fuss/crying and waking or feeding, were found. The persistent criers slept an average of 77 min per 24 h less than the moderate criers. The clearest group differences were in the daytime and all three groups showed evidence of a diurnal organisation in their behaviour. Persistent crying at 6 weeks is associated with a sleeping deficit.