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Douglas PS. Pre-emptive Intervention for Autism Spectrum Disorder: Theoretical Foundations and Clinical Translation. Front Integr Neurosci 2019; 13:66. [PMID: 31798425 PMCID: PMC6877903 DOI: 10.3389/fnint.2019.00066] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Accepted: 11/04/2019] [Indexed: 12/28/2022] Open
Abstract
Autism spectrum disorders (ASD) are an emergent public health problem, placing significant burden upon the individual, family and health system. ASD are polygenetic spectrum disorders of neural connectome development, in which one or more feedback loops amplify small genetic, structural, or functional variations in the very early development of motor and sensory-motor pathways. These perturbations trigger a 'butterfly effect' of unpredictable cascades of structural and functional imbalances in the global neuronal workspace, resulting in atypical behaviors, social communication, and cognition long-term. The first 100 days post-term are critically neuroplastic and comprise an injury-sensitive developmental window, characterized by a neural biomarker, the persistence of the cortical subplate, and a behavioral biomarker, the crying diathesis. By the time potential diagnostic signs are identified, from 6 months of age, ASD neuropathy is already entrenched. The International Society for Autism Research Special Interest Group has called for pre-emptive intervention, based upon rigorous theoretical frames, and real world translation and evaluation. This paper responds to that call. It synthesizes heterogenous evidence concerning ASD etiologies from both psychosocial and biological research literatures with complexity science and evolutionary biology, to propose a theoretical framework for pre-emptive intervention. This paper hypothesizes that environmental factors resulting from a mismatch between environment of evolutionary adaptedness and culture initiate or perpetuate early motor and sensory-motor lesions, triggering a butterfly effect of multi-directional cascades of atypical developmental in the complex adaptive system of the parent and ASD-susceptible infant. Chronic sympathetic nervous system/hypothalamic-pituitary-adrenal axis hyperarousal and disrupted parent-infant biobehavioral synchrony are the key biologic and behavioral mechanisms perpetuating these atypical developmental cascades. A clinical translation of this evidence is proposed, for application antenatally and in the first 6 months of life, as pre-emptive intervention for ASD.
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Affiliation(s)
- Pamela S Douglas
- Transforming Maternity Care Collaborative, Griffith University, Brisbane, QLD, Australia.,Discipline of General Practice, The University of Queensland, Brisbane, QLD, Australia
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Abstract
Marriage is a risky undertaking that people enter with incomplete information about their partner and their future life circumstances. A large literature has shown how new information gained from unforeseen but long-lasting or permanent changes in life circumstances may trigger a divorce. We extend this literature by considering how information gained from a temporary change in life circumstances-in our case, a couple having a child with infantile colic-may affect divorce behavior. Although persistent life changes are known to induce divorce, we argue that a temporary stressful situation allows couples more quickly to discern the quality of their relationship, in some cases leading them to divorce sooner than they otherwise would have. We formalize this argument in a model of Bayesian updating and test it using data from Denmark. We find that the incidence of infantile colic shortens the time to divorce or disruption among couples who would have split up anyway.
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Affiliation(s)
- Peter Fallesen
- Swedish Institute for Social Research, Stockholm University, SE-106 91, Stockholm, Sweden.
- Rockwool Foundation Research Unit, Copenhagen, Denmark.
| | - Richard Breen
- Nuffield College, Oxford University, Oxford, United Kingdom
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Milidou I, Lindhard MS, Søndergaard C, Olsen J, Henriksen TB. Developmental Coordination Disorder in Children with a History of Infantile Colic. J Pediatr 2015; 167:725-30.e1-2. [PMID: 26164380 DOI: 10.1016/j.jpeds.2015.06.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Revised: 04/15/2015] [Accepted: 06/03/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To investigate whether children with a history of infantile colic showed impaired motor development at age 7 years compared with unaffected peers. STUDY DESIGN We studied 27,940 children from the Danish National Birth Cohort (1997-2002), including 1879 (6.8%) with a history of infantile colic. Infantile colic was defined according to the modified Wessel criteria as crying for more than 3 hours per day and more than 3 days per week. We compared the parental Developmental Coordination Disorder Questionnaire 2007 (DCDQ'07) scores in children with and without infantile colic after adjustment for intrauterine exposures, feeding type, parity, maternal age, socioeconomic status, Apgar score, gestational age, and birth weight. RESULTS Children with a history of infantile colic had an elevated risk of scoring above the predefined cutoff limit of possible or suspected developmental coordination disorder (OR, 1.3; 95% CI, 1.0-1.7; P = .034). The mean total DCDQ'07 score was -0.4 point (95% CI, -0.8 to 0) lower in children with a history of infantile colic. Moreover, they were at higher risk for a low total score (OR for a 10-point decrease, 1.1; 95% CI, 1.0-1.1; P = .006) and a low general coordination score (OR, 1.3; 95% CI, 1.1-1.5, P = .000) in the DCDQ'07. All associations appeared to be stronger among boys, but no statistically significant effect measure modification between infantile colic and sex was found. CONCLUSION We found no evidence of a strong association between infantile colic and developmental coordination disorder in this large Danish cohort.
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Affiliation(s)
- Ioanna Milidou
- Perinatal Epidemiology Research Unit, Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark.
| | | | | | - Jørn Olsen
- Department of Epidemiology, School of Public Health, Aarhus University, Aarhus, Denmark
| | - Tine Brink Henriksen
- Perinatal Epidemiology Research Unit, Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark; Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark
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Streit U, Nantke S, Jansen F, Wolf K, Gallasch M, Kohlmann T. [The influence of an improvement of body contact on regulatory disorders in infancy]. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2014; 42:301-13. [PMID: 25163993 DOI: 10.1024/1422-4917/a000306] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE This study concerns the influence of an improvement of body contact on regulatory disorders in infancy. Two interventions were examined: 1. parent counseling on the subject of body contact; 2. practical training of body contact in connection with exposure. Both methods were supplemented by a video-based parent training. METHODS 20 infants with regulatory disorder were assigned to each treatment. Body and eye contact were examined by means of video ratings before and after treatment. In addition, we measured the daily amount of crying, sleeping, feeding, being fussy, and quiet play by means of an infant behavior diary. RESULTS Both interventions resulted in an improvement of body contact, though only in the group with practical training was this improvement stable after 3 months. Taking all 40 participating infants together, we found significant improvements for "fussiness," "sleep duration," "awake, quiet or playing," and a marginal significant intervention effect for the duration of crying. Both interventions showed that children who had markedly improved in body contact also improved with regard to the regulation problem. Finally, the practical training of body contact was superior to pure counseling respective to the fussiness of the infants and to their gaze contact. CONCLUSIONS Body contact can be improved through specific therapeutic interventions. Video-based parent training in combination with interventions aiming at an improvement of body contact have a positive effect on the regulation problem.
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Affiliation(s)
| | | | | | - Karina Wolf
- Begabungspsychologische Beratungsstelle der Ludwig-Maximilians-Universität, München
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Phillips J, Sharpe L, Nemeth D. Maternal psychopathology and outcomes of a residential mother-infant intervention for unsettled infant behaviour. Aust N Z J Psychiatry 2010; 44:280-9. [PMID: 20180728 DOI: 10.3109/00048670903487225] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Residential mother-infant intervention programmes for unsettled infant behaviour have been shown to be associated with positive child and maternal outcomes. Despite evidence of elevated rates of maternal psychopathology among residential unit populations, little is known about whether psychological disorders interfere with the effectiveness of such interventions. METHOD Two cohorts (n = 104 and 147, respectively) were recruited from a residential mother-infant intervention programme for unsettled infant behaviour. In study 1, mothers completed self-report questionnaires measuring depression, anxiety and parenting stress at three time points (admission, 1 month after discharge and 3 months after discharge). In study 2, mothers were interviewed using a structured clinical interview for depressive and anxiety disorders. In both studies, nurses recorded infant behaviours over the duration of the 5 day admission using 24 h behaviour charts. RESULTS Study 1 showed the intervention to be associated with significant improvements in child behaviours and in levels of maternal depression, anxiety and parenting stress. These improvements were evident for women who scored above the Edinburgh Postnatal Depression Scale threshold for major depression during the admission, as well as for women in the normal range. Study 2 confirmed that the intervention was associated with significant improvements in infant behaviours. Infants of mothers with a depressive or anxiety disorder were less unsettled on admission, but improvements over the course of the admission were comparable for infants of women who had, or had not, experienced an anxiety or depressive disorder during the admission. CONCLUSIONS These results show positive infant and maternal outcomes associated with a residential mother-infant intervention for unsettled infant behaviour, regardless of the women's psychiatric status on admission. This suggests that women with depression or anxiety disorders who also report unsettled infant behaviour, will benefit from referral to residential programmes.
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Affiliation(s)
- Jane Phillips
- Karitane, PO Box 241, Villawood, NSW 2163, Australia.
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Rao MR, Brenner RA, Schisterman EF, Vik T, Mills JL. Long term cognitive development in children with prolonged crying. Arch Dis Child 2004; 89:989-92. [PMID: 15499048 PMCID: PMC1719720 DOI: 10.1136/adc.2003.039198] [Citation(s) in RCA: 85] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Long term studies of cognitive development and colic have not differentiated between typical colic and prolonged crying. OBJECTIVE To evaluate whether colic and excessive crying that persists beyond 3 months is associated with adverse cognitive development. DESIGN Prospective cohort study. A sample of 561 women was enrolled in the second trimester of pregnancy. Colic and prolonged crying were based on crying behaviour assessed at 6 and 13 weeks. Children's intelligence, motor abilities, and behaviour were measured at 5 years (n = 327). Known risk factors for cognitive impairment were ascertained prenatally, after birth, at 6 and 13 weeks, at 6, 9, and 13 months, and at 5 years of age. RESULTS Children with prolonged crying (but not those with colic only) had an adjusted mean IQ that was 9 points lower than the control group. Their performance and verbal IQ scores were 9.2 and 6.7 points lower than the control group, respectively. The prolonged crying group also had significantly poorer fine motor abilities compared with the control group. Colic had no effect on cognitive development. CONCLUSIONS Excessive, uncontrolled crying that persists beyond 3 months of age in infants without other signs of neurological damage may be a marker for cognitive deficits during childhood. Such infants need to be examined and followed up more intensively.
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Affiliation(s)
- M R Rao
- Epidemiology Branch, Division of Epidemiology, Statistics and Prevention Research, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA.
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Abstract
Infantile colic is a common complaint for which mothers bring their babies to pediatricians. Though the condition has been a cause of controversy and a subject of extensive research, no consensus is yet reached on its definition, etio-pathogenesis and management. This article reviews the existing literature on present subject.
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Affiliation(s)
- Pankaj Garg
- Shanti Manglick Hospital, Agra, Uttar Pradesh, India.
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DeSantis A, Coster W, Bigsby R, Lester B. Colic and fussing in infancy, and sensory processing at 3 to 8 years of age. Infant Ment Health J 2004. [DOI: 10.1002/imhj.20025] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Abstract
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.
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Affiliation(s)
- Dieter Wolke
- University of Hertfordshire, Department of Psychology, Wolke Research Group, Hatfield Campus, Hatfield/Herts, United Kingdom.
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Affiliation(s)
- M M Garrison
- Child Health Institute and Department of Pediatrics, University of Washington, Seattle, WA
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Abstract
AIM To describe how fetal growth and gestational age affect infantile colic, while considering other potential risk factors. STUDY DESIGN A population based follow up study of 2035 healthy singleton infants without any disability born to Danish mothers. Information was collected by self administered questionnaires at 16 and 30 weeks of gestation, at delivery, and 8 months post partum. Infantile colic is defined according to Wessel's criteria, but symptoms are restricted to crying for more than three hours a day, for more than three days a week, and for more than three weeks. RESULTS The cumulated incidence of infantile colic was 10.9%. Low birth weight babies (< 2500 g) had more than twice the risk (odds ratio = 2.7, 95% confidence interval 1.2 to 6.1) of infantile colic when controlled for gestational age, maternal height, and smoking. CONCLUSION Low birth weight may be associated with infantile colic, and further research will be aimed to focus on fetal growth and infantile colic.
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Affiliation(s)
- C Søndergaard
- The Danish Epidemiologic Science Centre, Department of Epidemiology and Social Medicine, University of Aarhus, Denmark.
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Wiberg JM, Nordsteen J, Nilsson N. The short-term effect of spinal manipulation in the treatment of infantile colic: a randomized controlled clinical trial with a blinded observer. J Manipulative Physiol Ther 1999; 22:517-22. [PMID: 10543581 DOI: 10.1016/s0161-4754(99)70003-5] [Citation(s) in RCA: 70] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To determine whether there is a short-term effect of spinal manipulation in the treatment of infantile colic. DESIGN A randomized controlled trial. SETTING A private chiropractic practice and the National Health Service's health visitor nurses in the suburb Ballerup (Copenhagen, Denmark). SUBJECTS Infants seen by the health visitor nurses, who fulfilled the diagnostic criteria for infantile colic. INTERVENTION One group received spinal manipulation for 2 weeks, the other was treated with the drug dimethicone for 2 weeks. OUTCOME MEASURE Changes in daily hours of crying as registered in a colic diary. RESULTS By trial days 4 to 7, hours of crying were reduced by 1 hour in the dimethicone group compared with 2.4 hours in the manipulation group (P = .04). On days 8 through 11, crying was reduced by 1 hour for the dimethicone group, whereas crying in the manipulation group was reduced by 2.7 hours (P = .004). From trial day 5 onward the manipulation group did significantly better that the dimethicone group. CONCLUSION Spinal manipulation is effective in relieving infantile colic.
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Affiliation(s)
- J M Wiberg
- Center for Biomechanics, Odense University, Denmark
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Abstract
Offspring provide mothers with stimuli that impel their own nurturance. In rats, distal sensory stimuli from pups--sight, sound, odor--contribute to contact-seeking, whereas tactile stimuli from pups to dam's snout and ventrum elicit essential maternal behavioral reflexes involved in retrieval, licking, and the quiescent, upright nursing posture (kyphosis). Brain sites involved with maternal behavior--assessed by lesions, immunocytochemical visualization of gene activity, and neurophysiological mapping--include the midbrain central gray, medial preoptic nucleus, limbic system, and somatosensory cortex; these may change with experience. Human mothers inadvertently learn to identify their own baby rapidly after birth and can do so via a single sensory modality. Subsequently maternal responsiveness and gratification are impaired by inappropriate, insufficient, or nonreciprocal interactions such as occurs when the baby cries excessively, is blind, deaf, or autistic. Thus, maternal behavior characterized by elicited responses and emotional reactions to stimuli from offspring may be evolutionarily conserved.
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Affiliation(s)
- J M Stern
- Department of Psychology, Rutgers State University of New Jersey, New Brunswick 08903, USA
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Abstract
This descriptive, retrospective study compared the temperament styles of 25 4- to 8-month-old infants who had colic with the temperament styles of 30 infants of similar age without colic. Infant temperament style was characterized by the mother's ratings of her infant's behavioral style. The degree of bother that the mother experienced in relationship to her infant's temperament also was examined. Results indicated that mothers of infants with colic rated their infants' temperaments differently than mothers of infants without colic in the temperament dimensions of activity and mood. Mothers of infants with colic were more bothered by the infants' temperament dimension of mood than were mothers of infants without colic. More infants in the colic group were characterized as difficult than were infants in the noncolic group. Individual temperament characteristics should be considered in the differential diagnosis of primary excessive crying (colic) during the newborn and infant periods.
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Affiliation(s)
- D Jacobson
- College of Nursing, Arizona State University, Tempe, 85287-2602, USA
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Abstract
This study examines the communicative role of crying by assessing the ability of infants to indicate different degrees of distress in different social circumstances. Behaviors of mother-infant pairs were observed in the home for 7-h periods when the infants were 2, 3, 4, and 5 wk old; and three weekly observations were made when the infants were 1 yr old. A Cry Responsiveness Index (CRI) was derived to quantify the degree to which a baby cried differentially during each observation. This statistic showed significant individual differences. The CRI scores were correlated with maternal measures during the early weeks and negatively correlated with "mother ignore" at one year. The CRI scores were unrelated to the total amount of crying. The results indicate that responsive infants have responsive mothers--or conversely, that responsive mothers have responsive infants. Thus, cry responsiveness is not a function of infant behavior alone but is inherently an expression of the dynamics of the mother-infant interactional system.
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Affiliation(s)
- C Acebo
- Biobehavioral Sciences Graduate Degree Program, University of Connecticut, Storrs 06269-4154, USA
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Woolridge MW, Phil D, Baum JD. Recent advances in breast feeding. ACTA PAEDIATRICA JAPONICA : OVERSEAS EDITION 1993; 35:1-12. [PMID: 8460537 DOI: 10.1111/j.1442-200x.1993.tb02996.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Increasingly, epidemiological studies are showing the benefits of exclusive breast-feeding to infants in industrialized countries, as they have previously for those in developing countries. In this review we have focused on several recent developments, in particular on the interplay between infant behaviour and maternal physiology in regulating breast milk supply. This will illustrate that many past and current clinical problems concerning breast-feeding are likely to be of iatrogenic origin, the products of imposing arbitrary rules for breast-feeding management. In order for the protective benefits to be fully realized it is necessary to ensure that breast-feeding is free from prescriptive practices. We will illustrate the key role played by the infants' control of appetite in the hope of encouraging clinicians to empower infants to exercise more control over the feeding process.
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Affiliation(s)
- M W Woolridge
- Institute of Child Health, University of Bristol, Royal Hospital for Sick Children, St Michael's Hill, United Kingdom
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Pinyerd BJ. Infant colic and maternal mental health: nursing research and practice concerns. ISSUES IN COMPREHENSIVE PEDIATRIC NURSING 1992; 15:155-67. [PMID: 1308232 DOI: 10.3109/01460869209078249] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
This study compared the mental health of 12 mothers who had infants with colic to 12 mothers of infants without colic. Colic was defined as infant fussing/crying of at least 2 hours/day for at least 5 out of 7 days, infant cry high-pitched and pain-sounding, and maternal report of infant inconsolability. Mental health was operationalized as scores on the Profile of Mood States and the Symptom Checklist-90R. Mothers of infants with colic had multidimensional psychological distress; they reported more bodily dysfunction, fears, disordered thinking, depression, anxiety, fatigue, hostility, impulsive thoughts and actions; and they had stronger feelings of personal inadequacy or inferiority. Implications for nursing research and practice are discussed in the context of study findings.
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