Living with a colicky infant

Osteopathic Manual Therapy for Infant Colic: A Randomised Clinical Trial

BACKGROUND

Infant colic is a multifactorial syndrome for which various therapeutic strategies have been proposed. In this study, we evaluate the effectiveness of osteopathic manual therapy in treating symptoms related to infant colic.

METHOD

A prospective, randomised, blinded clinical trial was conducted of patients diagnosed with infant colic. The treatment group were given osteopathic manual therapy, and their parents received two sessions of counselling. The control group received no such therapy, but their parents attended the same counselling sessions. The non-parametric Mann-Whitney U test was applied to determine whether there were significant differences between the groups for the numerical variables considered. For the qualitative variables, Fisher's exact test was used. The threshold assumed for statistical significance was 0.05.

RESULTS

A total of 42 babies were assigned to each group. Those in the experimental group presented less severe infant colic with a trend towards statistical significance after the first session (p = 0.09). In sucking, excretion, eructation and gas there were no significant differences between the groups. Crying was a statistically significant dimension both after the first intervention (p = 0.03) and two weeks after (p = 0.04). Regurgitation values were significantly lower in the experimental group during the three weeks of follow-up (p = 0.05). Values for sleep were lower in the experimental group, but the differences were not statistically significant. In both groups, colic severity decreased over time, with no side effects.

CONCLUSIONS

Treatment with osteopathic manual therapy alleviates the symptoms of infant colic and could be recommended for this purpose from the onset of the condition.

Parental perceptions and experiences of infant crying: A systematic review and synthesis of qualitative research

BACKGROUND

Excessive infant crying is common and can have a huge impact on families and well-being. Systematically reviewing qualitative studies on infant crying can provide a greater understanding of parental perceptions and experiences.

AIM

This study sought to systematically review and thematically synthesize qualitative studies exploring parents/carers' views and experiences of infant crying.

DESIGN

A systematic review and synthesis of qualitative research.

DATA SOURCES

Electronic databases MEDLINE, EMBASE, PsycINFO and CINAHL were searched from the earliest date available to January 2022. We selected papers focussing on parents/carers' experiences, views, attitudes and beliefs about infant crying. We excluded papers focussing on health professionals' views and children older than 12 months.

REVIEW METHODS

Thematic synthesis was followed for the analysis of included studies and quality appraisal was conducted.

RESULTS

We synthesized 22 papers, reporting data from 376 participants in eight countries. Four analytical themes were developed: (1) Experiences and impact of crying; (2) parental management strategies; (3) the role of the health professional; (4) the role of infant feeding and maternal diet. Our findings suggest that infant crying has a substantial emotional impact on parents/carers that often impacts relationships. Parents/carers reported using a range of soothing techniques and coping strategies but were desperate to find effective treatment or cure. Support was often perceived as lacking. Excessive crying and beliefs about the role of maternal diet on breastmilk were reported to undermine parents' confidence in breastfeeding by making them feel their milk is insufficient or harmful, or through pressure from others to stop breastfeeding.

CONCLUSION

Parents/carers use a range of strategies to interpret and deal with the challenges of infant crying, but there is a need for more information and support.

IMPACT

Findings can be used to inform future research and interventions to support families experiencing excessive infant crying.

The Gastrointestinal Microbiome in Infant Colic: A Scoping Review

ABSTRACT

The significant crying of infantile colic adds stress to the infant and their family, yet it has no recognized etiology. Gastrointestinal health problems and dysfunction have been suspected in the etiology of colic. Disruptions to the microbiome colonization of the gastrointestinal system may lead to excess gas and inflammation that are associated with the crying of colic. Infants with colic have increased colonization with gas-producing bacteria, like Escherichia coli and Klebsiella, and they have lower colonization of anti-inflammatory bacteria, like Bifidobacterium and Lactobacillus. Colic is known to self-resolve around 3 months of age. However, few researchers have investigated how the microbiome may be changing at colic's natural resolution without the intervention of a probiotic. With a better understanding of what leads to colic's self-resolution, future researchers may be able to identify more effective therapies for colic prevention or treatment. This scoping review presents the collective evidence from 21 original, primary research articles on what is known about the gastrointestinal microbiome at colic onset and resolution.

Tools assessment and diagnosis to infant colic: a systematic review

BACKGROUND

Infant colic occurs between 10% and 40% of healthy born children in their first year of life. Its assessment is complex, and there are only a few instruments of appraisement and diagnosis.

METHODS

Scientific articles located through a systematic review using the Pubmed, Scopus, Cochrane, PEDro, Dialnet, IME and Dialnet databases. Two researchers obtained data independently from relevant studies previously identified. Risk of bias was assessed according to the methods recommended by the Cochrane Collaboration, with reporting following the preferred reported items for systematic reviews and meta-analyses guidelines and evaluating their methodological quality based on the EMPRO scale.

RESULTS

Four tools were obtained for valuation of infant colic. Parental diary of infant cry and fuss behaviour, Crying Pattern Questionnaire, Infant Colic Scale and, lastly, a validity of the Turkish version of the Infant Colic Scale.

CONCLUSIONS

Analysis of the existing tools involves the need to design and validate new assessment scales for this clinical frame.

The effect of inpatient treatment on the stress experienced by parents with an excessively crying infant / Die Auswirkungen eines Spitalaufenthaltes auf die Belastung von Eltern mit einem exzessiv schreienden Kind

Introduction

Up to 40% of families are faced with a fussy, inconsolable high need infant in the first three months postpartum. A major reason for parents to seek professional help is the trying aspect of the situation with these children. The supportive role of health professionals has the greatest potential to reduce the parent’s stress and burden. To our knowledge, there are no studies on inpatient treatment for families with such infants so far.

Aim

The aim of this study is to show how an inpatient setting may reduce the stress and burden of parents with an inconsolably crying infant.

Method

A grounded theory approach (Charmaz) was used to analyse semi-structured interviews of 13 parents from a total of 9 families.

Results

Two core categories emerged from the data: “To get out of hand” describes how parents lose the ability to control and direct family life. “To find one’s way into daily routine” describes how they once again gain confidence and develop coping strategies.

Conclusion

An inpatient treatment reduces the burden on families with inconsolably crying infants. The change in the environment is helpful. Guidance and support enhance the parents’ skill and ability to handling the infant. The stress on the parents can increase again upon hospital discharge. Therefore, improvement is needed in treatment planning and parental support at the conclusion of the hospital stay as well as upon hospital discharge.

Causal model structure analysis of emotional unrest in first time mothers faced with persistent infant crying 6-7 weeks postpartum

First time mothers faced with a continuously crying infant, who do not know how to stop their child from crying, are at risk of developing anxiety and other types of Emotional Unrest. Because continuous Emotional Unrest may lead to an emotional crisis, it is important for healthcare providers to understand causal factors associated with Emotional Unrest among first time mothers faced with a persistently crying infant 6-7 weeks postpartum.

METHODS

A cross-sectional survey was carried out on a study population of 217 first time mothers with infants aged 6-7 weeks. A self-administered questionnaire was used to measure Emotional Unrest, Neigh- borhood Social Organization, Effective Parenting Support, Understanding of Crying and the Effect of Infor- mation Available on Crying, Current Parenting Environment and Characteristics of the Mother and Child. Potential causal factors for Emotional Unrest were explored using structural equation modeling.

RESULTS

One hundred and thirty two (60.8%) of the mothers experienced persistent crying in the period 6-7 weeks after the birth of their child and 108 (49.7%) mothers experienced Emotional Unrest. Factor analysis revealed five important constructs to be causal factors of Emotional Unrest: Effective Parenting Support, Effective Assistance with Regard to Crying, Confused by Information, Neighborhood Social Organi- zation and Feelings of Fatigue and Anxiety. Structural equation modeling indicated that Effective Parenting Support, Effective Assistance with Regard to Crying, Confused by Information and Neighborhood Social Organization affect Feelings of Fatigue and Anxiety, which then leads to Emotional Unrest.

CONCLUSION

This study demonstrated that it will be necessary in future for health-care workers to pro- vide early intervention, such as accurate information about crying as well as concrete and appropriate response measures for dealing with crying. Furthermore, in motherhood/parenting classes and the dis- charge guidance conducted at birthing centers, it will be necessary to provide guidance on what kind of effective support and local area resources are available to parents following the birth of their child. [Asian Nursing Research 2009;3(1):1-14].

Information on infantile colic on the World Wide Web

INTRODUCTION

The purpose of this study was to explore and describe the type and quality of information on infantile colic that a parent might access on the World Wide Web.

METHODS

Two checklists were used to evaluate the quality indicators of 24 Web sites and the colic-specific content.

RESULTS

Fifteen health information Web sites met more of the quality parameters than the nine commercial sites. Eight Web sites included information about colic and infant abuse, with six being health information sites.

DISCUSSION

The colic-specific content on 24 Web sites reflected current issues and controversies; however, the completeness of the information in light of current evidence varied among the Web sites. Strategies to avoid complications of parental stress or infant abuse were not commonly found on the Web sites. Pediatric professionals must guide parents to reliable colic resources that also include emotional support and understanding of infant crying. A best evidence guideline for the United States would eliminate confusion and uncertainty about which colic therapies are safe and effective for parents and professionals.

Remembering the Chaos - But Life Went on and the Wound Healed. A Four Year Follow Up with Parents having had a Baby with Infantile Colic

Objective:

To elucidate parent´s experience of having had a baby with colic four years previously and of how the colic and care influenced the family in a long-term perspective.

Methodology and Participants:

A qualitative inductive follow-up study with 13 individual and one focus group interview including four parents. Altogether ten mothers and seven fathers representing 12 families, who had been interviewed when they were in the midst of the colicky period four years ago, were in the present study interviewed between December 2010 and May 2011. Parents’ narratives were analysed using content analysis.

Results:

Parent´s memories of the exhausting colic period were vivid, but when the colic had healed the family relationships also healed. Although it had taken longer time for some parents to attach to their child they now experienced a close relationship with their four year old child and felt confident in their role as parent. The colic scream was still unbearable and evoked negative feelings in the parents. Parents had decreased confidence in Child Health services and made suggestions for improvements in the health care approach. Most of all they wished for an effective treatment of infantile colic.

Conclusion:

The family relationships were healed and the colic left only few residual symptoms but parents still had decreased confidence in the Child Health Center. Consequently, there is a need to raise awareness to parents’ situation when having a child with infantile colic.

Out of the abyss of colic: a view through the fathers' eyes

PURPOSE

To elucidate the experience of fathers living with a colicky infant.

STUDY DESIGN AND METHODS

Interpretive phenomenology using in-depth interviews with 10 fathers of colicky infants. Reiterative interview reading, repeated meaning unit sorting, going back to the literature, and discussions gave way to emerging themes.

FINDINGS

The overall experience is one of "falling into and arising from the crying abyss together as a family." Four themes emerged: (a) falling in, (b) hitting bottom, (c) weaving strands to make a rope, and (d) climbing out.

CLINICAL IMPLICATIONS

From their stories, fathers provide insight useful to nurses assisting families of colicky infants through a very difficult time. Nurses should talk to fathers directly about the possibility of colic, and teach both parents what it is, how long it usually lasts, and what can be done about it. Anticipatory guidance as well as discussion about colic during newborn health visits can help parents to vocalize their feelings, and learn what actions to take when the stress of colic becomes overwhelming.

Qualitative case study methodology in nursing research: an integrative review

AIM

This paper is a report of an integrative review conducted to critically analyse the contemporary use of qualitative case study methodology in nursing research.

BACKGROUND

Increasing complexity in health care and increasing use of case study in nursing research support the need for current examination of this methodology.

DATA SOURCES

In 2007, a search for case study research (published 2005-2007) indexed in the CINAHL, MEDLINE, EMBASE, PsychINFO, Sociological Abstracts and SCOPUS databases was conducted. A sample of 42 case study research papers met the inclusion criteria.

METHODS

Whittemore and Knafl's integrative review method guided the analysis.

RESULTS

Confusion exists about the name, nature and use of case study. This methodology, including terminology and concepts, is often invisible in qualitative study titles and abstracts. Case study is an exclusive methodology and an adjunct to exploring particular aspects of phenomena under investigation in larger or mixed-methods studies. A high quality of case study exists in nursing research.

CONCLUSION

Judicious selection and diligent application of literature review methods promote the development of nursing science. Case study is becoming entrenched in the nursing research lexicon as a well-accepted methodology for studying phenomena in health and social care, and its growing use warrants continued appraisal to promote nursing knowledge development. Attention to all case study elements, process and publication is important in promoting authenticity, methodological quality and visibility.

Parental conceptions of self-mutilation among Finnish adolescents

The purpose of this paper is to describe self-mutilation from the viewpoint of parents of self-mutilating Finnish adolescents. Four parents of self-mutilating adolescents were interviewed in depth. Qualitative content analysis was applied. Four main categories emerged: the phenomenon of self-mutilation, factors contributing to self-mutilation, the purposes of self-mutilation and sequels of self-mutilation. Factors contributing to self-mutilation could be divided into those relating to the adolescent and those relating to the family, especially the mother. The purposes of self-mutilation were purposes relating to the adolescent and those relating to others, while sequels of self-mutilation could be divided into sequels for the adolescent and those for the parents. Sequels of self-mutilation for the adolescent could be further divided into sequels for the adolescent herself and for the relationship with significant others, including parents, siblings and peers, and sequels in relation to healthcare staff. While knowledge of self-mutilation is inadequate among parents, it evokes strong negative emotions when it occurs in their own family. Self-mutilation should be raised by healthcare professionals and discussed in health promotion or in parents' meetings at schools.

Descriptions of self-mutilation among Finnish adolescents: a qualitative descriptive inquiry

The purpose of this study was to describe self-mutilation from the perspectives of self-mutilating adolescents. A qualitative descriptive design was adopted. Self-mutilating adolescents were asked to write descriptions of their self-mutilation. Data analysis revealed three major categories: descriptions of the factors contributing to self-mutilation, descriptions of the act of self-mutilation, and descriptions of the sequels of self-mutilation. This study adds to our understanding of self-mutilation and the experiences of self-mutilating adolescents. In nursing practice and education, self-mutilation should be discussed based on existing knowledge to make nurses more familiar with it. Nurses should understand this phenomenon as a challenge for developing effective nursing practices.