Reducing parenting stress in families with irritable infants

Effects of a Mobile-Based Intervention for Parents of Children With Crying, Sleeping, and Feeding Problems: Randomized Controlled Trial

BACKGROUND

Excessive crying, sleeping, and feeding problems in early childhood are major stressors that can result in parents feeling socially isolated and having low self-efficacy. Affected children are a risk group for being maltreated and developing emotional and behavioral problems. Thus, the development of an innovative and interactive psychoeducational app for parents of children with crying, sleeping, and feeding problems may provide low-threshold access to scientifically based information and reduce negative outcomes in parents and children.

OBJECTIVE

We aimed to investigate whether following the use of a newly developed psychoeducational app, the parents of children with crying, sleeping, or feeding problems experienced less parenting stress; gained more knowledge about crying, sleeping, and feeding problems; and perceived themselves as more self-effective and as better socially supported and whether their children's symptoms decreased more than those of the parents who did not use the app.

METHODS

Our clinical sample consisted of 136 parents of children (aged 0-24 months) who contacted a cry baby outpatient clinic in Bavaria (Southern Germany) for an initial consultation. Using a randomized controlled design, families were randomly allocated to either an intervention group (IG; 73/136, 53.7%) or a waitlist control group (WCG; 63/136, 46.3%) during the usual waiting time until consultation. The IG was given a psychoeducational app that included evidence-based information via text and videos, a child behavior diary function, a parent chat forum and experience report, tips on relaxation, an emergency plan, and a regional directory of specialized counseling centers. Outcome variables were assessed using validated questionnaires at baseline test and posttest. Both groups were compared at posttest regarding changes in parenting stress (primary outcome) and secondary outcomes, namely knowledge about crying, sleeping, and feeding problems; perceived self-efficacy; perceived social support; and child symptoms.

RESULTS

The mean individual study duration was 23.41 (SD 10.42) days. The IG reported significantly lower levels of parenting stress (mean 83.18, SD 19.94) after app use compared with the WCG (mean 87.46, SD 16.67; P=.03; Cohen d=0.23). Furthermore, parents in the IG reported a higher level of knowledge about crying, sleeping, and feeding (mean 62.91, SD 4.30) than those in the WCG (mean 61.15, SD 4.46; P<.001; Cohen d=0.38). No differences at posttest were found between groups in terms of parental efficacy (P=.34; Cohen d=0.05), perceived social support (P=.66; Cohen d=0.04), and child symptoms (P=.35; Cohen d=0.10).

CONCLUSIONS

This study provides initial evidence of the efficacy of a psychoeducational app for parents with child crying, sleeping, and feeding problems. By reducing parental stress and increasing knowledge of children's symptoms, the app has the potential to serve as an effective secondary preventive measure. Additional large-scale studies are needed to investigate long-term benefits.

TRIAL REGISTRATION

German Clinical Trials Register DRKS00019001; https://drks.de/search/en/trial/DRKS00019001.

Ecological Momentary Assessment of Heavy Episodic Drinking in the Early Postpartum Period: A Feasibility Study

Background

Postpartum mothers are at heightened risk for heavy episodic drinking (HED). Research with this population is critical to developing acceptable and effective tailored interventions, but new mothers who use alcohol are often reluctant to engage in research due to stigma and fear of child removal. This study examined feasibility of recruitment and ecological momentary assessment (EMA) in early postpartum mothers with histories of HED.

Methods

Participants were recruited via Facebook and Reddit and completed 14 days of EMA surveys. Baseline characteristics, recruitment feasibility, and EMA feasibility and acceptability were examined. Participants attended focus groups to further inform quantitative data.

Results

Reddit yielded a larger proportion of eligible individuals than Facebook, and 86% of the final enroled sample was recruited via Reddit. The average compliance rate of 75% is in line with other studies of similar populations. Half the sample reported alcohol use, and 78% reported the urge to drink at least once, supporting feasibility of EMA for collecting alcohol use data. Participants reported low burden and high acceptability of the study on both quantitative and qualitative measures. Baseline low maternal self-efficacy was associated with greater EMA compliance, and first-time mothers reported lower EMA burden compared to veteran mothers. College graduates, and participants with lower drinking refusal self-efficacy and greater alcohol severity were more likely to report alcohol use on EMA.

Conclusions

Future studies should consider Reddit as a recruitment strategy. Findings generally support feasibility and acceptability of EMA to assess HED in postpartum mothers.

Treatment of infant colic with craniosacral therapy. A randomized controlled trial

OBJECTIVE

To evaluate the number of craniosacral therapy sessions that can be helpful to obtain a resolution of the symptoms of infantile colic and to observe if there are any differences in the evolution obtained by the groups that received a different number of Craniosacral Therapy sessions at 24 days of treatment, compared with the control group which did not received any treatment.

METHODS

Fifty-eight infants with colic were randomized into two groups of which 29 babies in the control group received no treatment and those in the experimental group received 1-3 sessions of craniosacral therapy (CST) until symptoms were resolved. Evaluations were performed until day 24 of the study. In this study crying hours served as primary outcome. The secondary outcome were the hours of sleep and the severity, measured by an Infantile Colic Severity Questionnaire (ICSQ).

RESULTS

Significant statistical differences were observed in favor of experimental group compared to the control group on day 24 in crying hours (mean difference = 2.94, at 95 %CI = 2.30-3.58; p < 0.001) primary outcome, and also in hours of sleep (mean difference = 2.80; at 95 %CI = - 3.85 to - 1.73; p < 0.001) and colic severity (mean difference = 17.24; at 95 %CI = 14.42-20.05; p < 0.001) secondary outcomes. Also, the differences between the groups ≤ 2 CST sessions (n = 19), 3 CST sessions (n = 10) and control (n = 25) were statistically significant on day 24 of the treatment for crying, sleep and colic severity outcomes (p < 0.001).

CONCLUSION

Babies with infantile colic may obtain a complete resolution of symptoms on day 24 by receiving 2 or 3 CST sessions compared to the control group, which did not receive any treatment.

Probiotics and gastrointestinal diseases

During the past decades, scientists have discovered the intimate role of the gut microbiome in human health, and since then, several papers have been published to investigate if the use of biotics (probiotics, prebiotics, synbiotics, and postbiotics) may have a beneficial impact on human health both in treatment and prevention. We now ask ourselves whether we have reached the finish line or just a new starting point, as the evidence supporting the use of biotics in several conditions still needs a lot of work. Many questions remain unanswered today because the evidence differs depending on the indication, used strain, and amount and duration of administration. Herein we will summarize the evidence on probiotics in some gastrointestinal diseases such as infantile colic, functional abdominal pain disorders, celiac disease, acute gastroenteritis, inflammatory bowel disease, and Helicobacter pylori infection.

The effect of behavioral therapy based counseling with anxious mothers on their infants' colic: a randomized controlled clinical trial

Background

Given the possible effect of maternal anxiety on the severity of colic pain in infants, this study aimed to investigate the effects of behavioral therapy counseling on infantile colic (primary outcome), maternal anxiety, and mother-infant attachment (secondary outcomes) in anxious mothers with colicky infants.

Method

This randomized controlled clinical trial was conducted on 46 anxious mothers of 2–6-weeks-old exclusively breastfed colicky infants who had a score of 112 and above according to the Postpartum Specific Anxiety Scale (PSAS), reffered to the pediatric clinics of Al-Zahra, Taleghani and Children Hospitals of Tabriz, Iran. The participants were randomly assigned to the intervention (n = 23) and control (n = 23) groups using randomized block design. Mothers in the intervention group attended 8 systematic desensitization counseling sessions (2–3 sessions per week). Those in the control group received routine care. The researcher completed the Postpartum Specific Anxiety Scale (PSAS), Mother-Infant Attachment Questionnaire (MIAQ), and Infant Colic Scale (ICS) by interviewing the participants before and two weeks after the intervention.

Results

There was no significant difference between the intervention and control groups in the socio-demographic profile of participants. After the intervention, the mean postpartum anxiety score of women in the intervention group was significantly lower than that of those in the control group (Mean Difference (MD) = 22.5, 95% Confidence Interval (CI) = 2.3 to 42.7; p = 0.029). The mean infant colic score of the infants of mothers in the intervention group was insignificantly lower than that of those in the control group (MD = -2.9, 95% CI = -8.3 to 2.4; p = 0.271). In addition, no significant difference was observed between the two groups in terms of their mean mother-infant attachment scores (MD = -0.04, 95% CI = -3.1 to 0.3; p = 0.976).

Conclusion

Behavioral therapy counseling effectively reduced postpartum anxiety in women with colicky infants; however, this reduction did not lead to a significant decrease in the infants’ colic pain. Therefore, health care providers are recommended to use this counseling method in combination with other effective counseling approaches to promote mental health of these mothers.

Trial Registration

IRCT Registration Number: IRCT20111219008459N14, registered on 08/10/2020. https://irct.ir/user/trial/45949/view

Can a parental sleep intervention in an individual setting improve the maternal and paternal sense of competence and parent-child interaction in parents of young sleep-disturbed children? findings from a single-arm pilot intervention study

BACKGROUND

In early childhood sleep and regulatory problems, parental factors are often impaired but essential to overcoming them. This study aims to examine, in parents of young sleep-disturbed children, whether mothers' and fathers' sense of parenting competence were increased and dysfunctional parent-child interactions reduced with a parental sleep intervention, whether these changes were sustained over a 12-month follow-up period and if children's symptomatic parameters could be related factors.

METHODS

A total of 57 families with sleep-disturbed children aged 6 months to 4 years entered this single-arm pilot study. Each parent pair participated in six weekly individual face-to-face sessions of a multimodal cognitive-behavioral sleep intervention. The Parenting Sense of Competence Scale, Parental Stress Index Short Form, Child's Sleep Diary and Child's Questionnaire on Crying, Eating and Sleeping were obtained pre-, post-, 3, 6 and 12 months after the intervention.

RESULTS

Maternal sense of competence and dysfunctional mother-child interaction improved significantly up to 6 months after the intervention. Factors related to lower maternal competence were the child's more frequent nightly food intake and more crying due to defiance; factors related to dysfunctional mother-child interaction were more frequent crying episodes, more crying due to defiance and more eating difficulties; factors related to increased maternal competence were less duration of child's night waking, less bed-sharing and lower frequency of crying episodes; factors related to increased paternal competence were less child's nightly food intake and fewer episodes of unexplained and unsoothable crying; and factors related to improved father-child interaction were less frequent child's night waking and fewer unexplained and unsoothable crying episodes.

CONCLUSION

For parents of sleep-disturbed young children, an intervention that addresses the child's sleep could be promising to increase the parental sense of competence and reduce dysfunctional parent-child interactions, especially for mothers. Child symptomatic parameters may change, together with the parental sense of competence and parent-child interaction of both parents, after the intervention. Mothers with children with more severe symptomatology perceive their parenting competence as lower on average and their mother-child interaction as more dysfunctional. Future research with a larger sample and a randomized controlled design is needed.

TRIAL REGISTRATION

The study was retrospectively registered at the German Clinical Trials Register (ID: DRKS00028578; registration date: 21.03.2022).

Is the Predisposition to Have More Children Beneficial among Parents with Only One Child? Evidence from Spanish Parents

The fertility deficit in many European countries is related to a low rate of second births. Understanding the factors associated with the predisposition of one-child parents to have more children could contribute to the search for solutions to this social problem. Although previous evidence highlights the role of employment and social factors, psychological factors have been poorly investigated. This study examines the relationship between different psychosocial factors (rumination, personality, life satisfaction, perfectionism, social support, parental stress, guilt linked to work–family conflict, age and child temperament) and parents’ predisposition to have more children. The sample consisted of 96 one-child Spanish parents whose child was in early childhood education (59.3% women; M_age = 37.41). The results show that one-child parents with the predisposition to have more children, compared to those without a predisposition to have more children, showed higher levels of life satisfaction, extroversion and adaptive perfectionism but lower levels of rumination and parental stress. The social implications of these findings and how they may affect parenting today are discussed.

Use of Limosilactobacillus reuteri DSM 17938 in paediatric gastrointestinal disorders: an updated review

Strains of lactobacilli are the most widely used probiotics and can be found in a large variety of food products and food supplements throughout the world. In this study, the evidence on Limosilactobacillus reuteri DSM 17938 (LR DSM 17938) has been reviewed. This species secretes reuterin and other substances singularly or in microvesicles, inhibiting pathogen growth and interacting with the intestinal microbiota and mucosa, restoring homeostasis. The use of LR DSM 17938 has been exploited in several pathological conditions. Preclinical research has shown that this probiotic can ameliorate dysbiosis and, by interacting with intestinal mucosal cells, can raise the pain threshold and promote gastrointestinal motility. These aspects are amongst the significant components in functional gastrointestinal disorders, such as colic and regurgitation in infants, functional abdominal pain and functional constipation in children and adolescents. This strain can decrease the duration of acute diarrhoea and hospitalization for acute gastroenteritis but does not seem to prevent nosocomial diarrhoea and antibiotic-associated diarrhoea. Because of its ability to survive in the gastric environment, it has been tested in Helicobacter pylori infection, showing a significant decrease of antibiotic-associated side effects and a tendency to increase the eradication rate. Finally, all these studies have shown the excellent safety of LR DSM 17938 even at higher dosages. In conclusion data from various clinical trials here reviewed can guide the clinician to find the correct dose, frequency of administration, and therapy duration.

Adaptive Text Messaging for Postpartum Risky Drinking: Conceptual Model and Protocol for an Ecological Momentary Assessment Study (Preprint)

Background

Risky drinking is prevalent among women of childbearing age. Although many women reduce their drinking during pregnancy, more than half return to prepregnancy levels during the early postpartum period. Risky drinking in new mothers may be associated with negative child and maternal health outcomes; however, new mothers are unlikely to seek treatment for risky drinking because of stigma and fear of child protective service involvement. SMS text messaging is a promising approach for reaching non–treatment-seeking new mothers at risk because of risky drinking. SMS text messaging interventions (TMIs) are empirically supported for alcohol use, but a tailored intervention for new mothers does not exist. This study aims to fill this gap by developing a just-in-time adaptive TMI for postpartum risky drinking.

Objective

The objectives of this paper are to present a preliminary conceptual model of postpartum risky drinking and describe the protocol for conducting an ecological momentary assessment (EMA) study with new mothers to inform the refinement of the conceptual model and development of the TMI.

Methods

This paper presents a preliminary conceptual model of postpartum risky drinking based on the motivational model of alcohol use, social cognitive theory, and temporal self-regulation theory. The model proposes three primary intervention targets: motivation, self-efficacy, and self-regulation. Theoretical and empirical literature in support of the conceptual model is described. The paper also describes procedures for a study that will collect EMA data from 30 participants recruited via social media and the perinatal Central Intake system of New Jersey. Following the baseline assessment, EMA surveys will be sent 5 times per day for 14 days. The assessment instruments and data analysis procedures are described.

Results

Recruitment is scheduled to begin in January 2022 and is anticipated to conclude in March 2022. Study results are estimated to be published in July 2022.

Conclusions

The study findings will enhance our understanding of daily and momentary fluctuations in risk and protective factors for risky drinking during the early postpartum period. The findings will be used to refine the conceptual model and inform the development of the TMI. The next steps for this work include the development of intervention components via an iterative participatory design process and testing of the resulting intervention in a pilot microrandomized trial.

International Registered Report Identifier (IRRID)

PRR1-10.2196/36849

Prevalence and perinatal risk factors of parent-reported colic, abdominal pain and other pain or discomforts in infants until 3 months of age - A prospective cohort study in PreventADALL

AIMS AND OBJECTIVES

To estimate the prevalence and perinatal risk factors associated with parent reported colic, abdominal pain and pain or other discomforts in infants until 3 months of age.

BACKGROUND

Infant colic is a common concern for parents and clinicians. The prevalence varies in different studies and its symptoms overlap with other conditions like abdominal pain and discomfort. Diagnosis criteria are challenging, pathogenesis unclear and risk factors are conflicting.

DESIGN

This was a prospective cohort study.

METHODS

The 1852 mother-child pairs from the PreventADALL prospective birth-cohort answering the 3 months questionnaire were included. Information on perinatal risk factors was collected from the inclusion visit and questionnaires during pregnancy at 18 and 34 weeks, as well as birth charts. STROBE checklist was followed.

RESULTS

The reported prevalence of colic was 3% (59/1852), abdominal pain 22% (415/1852) and pain or other discomfort 6% (119/1852), with a total of 26% (478/1852) infants. Mothers on sick leave in pregnancy and reporting any allergic diseases had a significantly higher odds of reporting infant colic, abdominal pain and pain or other discomforts. Mothers with higher perceived stress in pregnancy exhibited a trend towards higher odds for reporting infant pain. Mothers coming from Sweden were less likely to report infant abdominal pain compared to mothers from Norway.

CONCLUSIONS

The prevalence of abdominal pain and pain or other discomforts was higher than the prevalence of colic. Perinatal risk factors connected to maternal health were associated with all three symptoms.

RELEVANCE TO CLINICAL PRACTICE

Colic and abdominal pain are stressful, symptoms overlap and risk factors for both can be identified in pregnancy. Our study suggests that it is difficult for parents to distinguish among infant colic, abdominal pain and other pain or discomfort and some report two or all three symptoms. Identifying the perinatal risk factors associated with infant pain may help target and support parents.

Development and validation of the infant crying and parent well-being screening tool

This article describes the development and validation of the infant crying and parent well-being (ICPW) screening tool, developed to provide an effective and efficient way of identifying families struggling with infant crying and soothing. Construct validity for the ICPW was assessed using survey data from 290 parents of infants. Scores on the ICPW were associated with parental depression, parenting stress, and low co-parent confidence. Parents with positive ICPW screens-indicating additional support is needed-were more likely to have high or clinical levels of parenting stress than parents with negative screens. Inconsolable and excessive infant crying negatively impacts the well-being of parents, and most importantly, is the primary trigger for infant abuse. The ICPW is a unique, efficient tool that allows providers to screen for families who may need additional support around infant crying and soothing.

Helping Families of Infants With Persistent Crying and Sleep Problems in a Day-Clinic

Excessive crying and sleep problems affect up to 30% of infants and often coexist. Although usually benign and self-limiting, persistent crying, and sleep problems exceeding 6 months of age need attention as they may impair the mental health of the infant and its family. The source and the impact of these persistent regulatory problems is often not restricted to the infant, but extends to the parents and the parent-infant relationship. Clinical practice needs interdisciplinary and multi-method interventions focusing beyond regulatory problems of the infant but also on parental self-regulation and parent's co-regulatory responses toward the infant. Treating clinicians may encounter limitations of home-visits, outpatient, and pediatric residential settings when working with families in distress. We describe an infant mental health day-clinic treatment, drawing attention to this viable future direction. It offers a therapeutic climate based on forming a triangle of co-regulation between clinician, parent and infant to first help the parent and the infant settle down. This stress reduction restores parent-infant connectedness and parental learning and reflecting capacity. Clinicians then use established therapeutic modalities to support parental self- and co-regulatory skills which is important for the development of self-regulation in the infant. Experience with this treatment program suggests that a day-clinic setting facilitates interdisciplinary and integrative multi-method intervention, infant and parental stress reduction and integration of parental self- and co-regulatory skills in daily family life, improving overall outcomes. This perspective warrants further investigation.

Parent training programmes for managing infantile colic

BACKGROUND

Infantile colic has an effect on both infants and their parents, who become exhausted and concerned as they attempt to comfort their child. Common approaches have focused upon physical treatments to reduce symptoms, with inconclusive evidence as to their effectiveness. An alternative approach seeks to provide training, support and psychological interventions for parents. This approach is known as parent training programmes. Programmes can include soothing techniques, advice on feeding or normalisation material in any form. The teaching format can vary including face-to-face courses, online learning, printed materials, home visits and remote support and counselling. Here, we aim to collate the evidence on the effectiveness of these interventions and examine their effectiveness at reducing infantile colic symptoms and parental anxiety levels, and their safety.

OBJECTIVES

1. To evaluate the effectiveness and safety of parent training programmes for managing colic in infants under four months of age. 2. To identify the educational content and attributes of such published programmes.

SEARCH METHODS

In June 2019 we searched CENTRAL, MEDLINE, Embase, 13 other databases and two trials registers. We also handsearched conference abstracts, inspected the references of included studies and contacted leaders in the field for more trials.

SELECTION CRITERIA

Randomised controlled trials (RCTs) and quasi-RCTs investigating the effectiveness of any form of parental training programmes, alone or in combination, versus another intervention(s) or control, on infantile colic.

DATA COLLECTION AND ANALYSIS

Two authors independently selected studies for inclusion, extracted data, and assessed the risk of bias within the included studies. We used Review Manager 5 to analyse the data. We assessed the certainty of the evidence using GRADE methodology.

MAIN RESULTS

Our search found 6064 records from which we selected 20 for full-text review. From these, we identified seven studies with 1187 participants that met our inclusion criteria. All of the studies included infants under the age of four months suffering from infantile colic. Four studies were conducted in the USA, one in Canada, one in the Netherlands and one in Iran. Four studies stated their funding sources, which included national research institutes, foundations and nutritional companies. Five studies assessed parent training versus a control group that received reassurance or routine care; and of these, one study was three-armed and also examined the effectiveness of using a specialised baby seat. One study examined parent training programmes against a milk-exclusion diet and one study assessed a parent training programme versus the same parent training programme plus swaddling. The duration of the interventions varied, with the shortest being six days and the longest being three months. Generally, most studies had low participant numbers and were at high risk of bias, prone to selection bias, performance bias, and the placebo effect. We could not complete the planned qualitative analysis (objective 2) due to lack of data in study reports and no further information being supplied by authors on request. Instead, we completed a descriptive content analysis with the limited information available. The parent training interventions were found to focus on one or a combination of the following: soothing techniques for crying infants (six studies); general care advice, including sleep (four studies); feeding advice (two studies); stress reduction and empathic programme for parents (two studies); and positive play interaction advice (one study). One study taught 'kangaroo care', a specific form of skin-to-skin cuddling. The control groups consisted of reassurance (two studies), advice to rock the infant in the crib (one study), or no intervention (two studies). Parent training versus control We conducted a meta-analysis using data from three studies (157 infants) that assessed the primary outcome of 'crying time at completion of study period'. Parent training was more effective than control: mean difference (MD) -113.58 m/d, 95% confidence interval (CI) -144.19 m/d to -82.96 m/d; low-certainty evidence (downgraded due to imprecision and some concerns with risk of bias). Parent training versus specialised baby seat One study (38 participants) found no difference in mean crying time at completion between the parent training group and the specialised baby seat group, but did not report specific figures. Parent training versus a milk-exclusion/soy milk formula One study (20 participants) comparing parent training with a milk-exclusion/soy milk formula found crying time at completion of the study to be 2.03 hours versus 1.08 hours, respectively. Parent training versus parent training plus swaddling One study (398 participants) comparing parental training with the same intervention plus training on how to swaddle an infant did not report separate data for each group. No adverse effects were reported, but these were not explicitly reported in any study.

AUTHORS' CONCLUSIONS

There is limited evidence on the effectiveness and safety of parent training programmes for managing infantile colic. Despite a single meta-analysis showing that parent training may reduce crying times for infants, compared to control, the certainty of the evidence was low. Evidence for other comparisons was sparse. We were unable to identify comprehensively the educational content and attributes of the included programmes due to a lack of information in study reports. Further RCTs are needed: they should define interventions clearly to ensure replicability, address all appropriate outcome measures, and minimise risk of bias in order to assess definitively the role of parent training programmes in managing infantile colic.

Involvement of prolactin in newborn infant irritability following maternal perinatal anxiety symptoms

BACKGROUND

Newborn irritability could be an unique and special status and/or adverse neurobehavioral outcomes which was independent of serious disease. To determine whether maternal perinatal anxiety symptoms was associated with newborn irritability, and whether the alteration of serum prolactin in newborns were involved in newborn irritability.

METHODS

205 pregnant women were recruited: normal group (n = 100), and anxiety group (n = 105), which was randomly divided to Newborn Behavioral Observations (NBO)+anxiety group(n = 65) and control+anxiety group(n = 40). Newborn Irritability was assessed by Neonatal Behavioral Assessment Scale(NBAS). Serum prolactin, cortisol and 5-HT in mothers and infants were measured.

RESULTS

1. The scores of irritability items in the newborns of anxiety group were higher than that of the normal group (p < 0.05). 2. Lower serum PRL, 5-HT and higher serum cortisol were found in the newborns of anxiety group compared with that of the control group both postpartum 2d and 15 (p < 0.05). 3. The level of serum PRL in newborn infants were significantly and negatively correlated to the scores of irritability items (p < 0.05). 4. After 7 rounds of NBO interventions, the anxiety scores of mothers and the scores of irritability items of newborns in the NBO intervention group were all lower than those of the control group (p < 0.05) .

LIMITATIONS

In future experiments, we should explore the effect of PRL in the breast milk on newborn infant serum PRL.

CONCLUSIONS

Prolactin could be a potential mediator in newborn irritability following maternal perinatal anxiety symptoms.

The effect of chiropractic treatment on infantile colic: study protocol for a single-blind randomized controlled trial

Background

Infantile colic is a common condition during early childhood affecting around one of six newborns. The condition is characterized by inconsolable crying and fussing in otherwise healthy and thriving infants. The most used definition is excessive crying for at least three hours a day for at least three days for at least three weeks. The cause of colic is still unknown although many hypotheses and thereby many different treatment modalities have been investigated. Chiropractic care is used increasingly in treatment of infants, including for infantile colic, although the evidence worldwide is sparse. A randomized, controlled trial was designed to evaluate the effect of chiropractic treatment on infantile colic. This paper describes the protocol as well as results from a pilot study examining the acceptability and feasibility of the intervention.

Method

The study is designed as a single-blind randomized, controlled trial. The invited families are residents on the Island of Funen and information about the project is distributed from the maternity wards and health visitors. Children at the age of 2-14 weeks with unexplained excessive crying are screened for eligibility and recruited by the primary investigator through home visits. Eligible children are then randomized to chiropractic treatment or control. All children attend in the chiropractor clinic two times a week for two weeks. The parents are unaware of their child's allocation during the project period. The primary outcome measure is change in daily hours of crying based on the parental diaries.The study intends to include 200 children, and the intervention has, during a pilot study, been found acceptable and feasible among families with newborns.

Discussion

In a single-blind randomized controlled design we will evaluate the effectiveness of chiropractic treatment on infantile colic. The study will contribute to determine the effect of chiropractic treatment on infantile colic in an area where limited evidence exists. Furthermore, the study aims to explore if subgroups of children with suspected musculoskeletal problems will benefit more from the intervention than others. If they obtain better results, this could imply the need for stratified care.

Trial registration

Clinicaltrials.gov and Identifier: NCT02595515 (registered 2 November 2015).

Fathers make a difference: positive relationships with mother and baby in relation to infant colic

BACKGROUND

Maternal psychological factors like depression, anxiety and stress have been associated with infant fussiness or colic. However, little research exists on whether positive factors such as social support and the happiness of the mother-partner relationship are associated with lower rates of infant fussiness or colic.

OBJECTIVES

We investigated the association between infant colic and three types of maternal support: general maternal social support (during pregnancy and post partum), the happiness of the mother-partner relationship (during pregnancy and post partum) and partner involvement in caring for the newborn.

METHODS

Participants were 3006 women in the First Baby Study, a prospective study of the effect of mode of first delivery on subsequent childbearing. Women were interviewed by telephone during pregnancy and 1 month after first childbirth and asked about social support and if their baby had a variety of problems since birth, including 'Colic - crying or fussiness three or more hours a day'. Multivariable logistic regression models were used to model the association between maternal support and infant colic, controlling for confounders, including maternal race or ethnicity, insurance, marital status, smoking, mode of delivery, maternal post-partum depression, breastfeeding, other neonatal illnesses and newborn gestational age.

RESULTS

Infant colic was reported by 11.6% of new mothers. High general maternal social support (in comparison with low), measured during pregnancy, was associated with lower reported infant colic (adjusted odds ratio (AOR), 0.55, 95% confidence interval (CI), 0.40-0.75) and measured post partum (AOR, 0.51, 95% CI, 0.39-0.67); high relationship happiness (in comparison with low), measured during pregnancy (AOR, 0.71, 95% CI, 0.54-0.93), and measured post partum (AOR, 0.22, 95% CI, 0.12-0.40); and high partner involvement with newborn care (in comparison with low) (AOR, 0.60, 95% CI, 0.44-0.81).

CONCLUSION

Higher levels of maternal social support during pregnancy and post partum are associated with lower rates of maternal reported infant colic.

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.

Maternal and infant factors associated with reasons for introducing solid foods

The current UK Department of Health advice is to introduce solid foods to infants at around 6 months of age, when the infant is showing signs of developmental readiness for solid foods. However, many mothers introduce solid foods before this time, and for a wide variety of reasons, some of which may not promote healthy outcomes. The aim of the current study was to examine infant and maternal characteristics associated with different reasons for introducing solid foods. Seven hundred fifty-six mothers with an infant aged 6-12 months old completed a questionnaire describing their main reason for introducing solid foods alongside demographic questions, infant weight, gender, breast/formula feeding and timing of introduction to solid foods. The majority of mothers introduced solid foods for reasons explicitly stated in the Department of Health advice as not signs of readiness for solid foods. These reasons centred on perceived infant lack of sleep, hunger or unsettled behaviour. Maternal age, education and parity, infant weight and gender and breast/formula feeding choices were all associated with reasons for introduction. A particular association was found between breastfeeding and perceiving the infant to be hungrier or needing more than milk could offer. Male infants were perceived as hungry and needing more energy than female infants. Notably, signs of readiness may be misinterpreted with some stating this reason for infants weaned prior to 16 weeks. The findings are important for those working to support and educate new parents with the introduction of solid foods in understanding the factors that might influence them.

Infant teething information on the world wide web: taking a byte out of the search

INTRODUCTION

The purpose of this study was to describe and evaluate the quality of infant teething information on selected popular parenting Web sites.

METHODS

Two checklists were used to evaluate the quality of the 16 parenting sites and infant teething-specific content included on each site.

FINDINGS

Three of the 16 parenting sites did not contain teething-specific articles. Teething-specific content found on 13 of the 16 sites supported a connection between the process of teething and nonspecific symptoms with a perception that management is required. Popular management strategies included chewing on chilled objects, gingival massage, and the use of over-the-counter medications. Information about possible adverse effects of administering medications for infant teething was not found on the majority of sites. Eleven of the 16 sites advised parents to contact their primary care provider if they were uncertain about management for infant teething or whether the symptoms were related to illness.

IMPLICATIONS

Although infant teething has an evidence base from which parents and professionals can make safe decisions about symptoms and treatment, translating the evidence into professional practice and health-related information on the Internet remains a challenge. Parents and pediatric health providers would benefit greatly from the development of clinical practice guidelines summarizing our present-day understanding of teething symptoms and the limited evidence supporting the use of over-the-counter medications.

Reporting outcome measures in trials of infant colic

OBJECTIVES

Infant colic (IC), with an estimated prevalence of 5% to 25%, has a high impact on health care costs. Furthermore, reported negative sequelae are disturbed parent-infant interaction, increased susceptibility to abdominal pain, and even child abuse. Its etiology remains unknown, leading to a wide variety in interventions. We hypothesize that definitions and outcome measures in studies on IC will be heterogeneous as well. Our objective is to systematically assess how definitions and outcome measures are reported in randomized controlled trials (RCTs) of IC.

METHODS

CENTRAL, Embase, and MEDLINE/PubMed were searched from inception to December 2012. English-language systematic reviews (SRs) and RCTs concerning IC in children ages 0 to 9 months were included. Bibliographies of included SRs were searched for additional articles. Quality was assessed using the Delphi list.

RESULTS

A total of 1702 studies were found; 55 articles were included (16 SRs, 39 RCTs). In 39 trials, we found 20 different definitions for IC, 11 different definitions for improvement, 28 different interventions, and 19 different outcomes. Fifty-one percent of the trials were of good methodological quality. All of the trials used parental diaries; only 31% stated that their instrument was validated.

CONCLUSIONS

Too many different definitions and outcome measures for IC are used in RCTs. Only a minority of the trials reported parental perception as primary outcome. Uniform definitions, outcomes, and validated instruments are needed to make a comparison between intervention studies possible.

The excessively crying infant: etiology and treatment

Excessive crying, often described as infantile colic, is the cause of 10% to 20% of all early pediatrician visits of infants aged 2 weeks to 3 months. Although usually benign and self-limiting, excessive crying is associated with parental exhaustion and stress. However, an underlying organic cause is found in less than 5% of these infants. In the majority of cases, treatment consists not of "curing the colic," although usually it is possible to reduce crying, but of helping the parents to get through this challenging period in their baby's development. The aims of this review are to discuss definition, etiology, and evaluate different treatment regimes in infants who cry excessively.

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.

Theory! The missing link in understanding the performance of neonate/infant home-visiting programs to prevent child maltreatment: a systematic review

CONTEXT

Home-visiting programs have been offered for more than sixty years to at-risk families of newborns and infants. But despite decades of experience with program delivery, more than sixty published controlled trials, and more than thirty published literature reviews, there is still uncertainty surrounding the performance of these programs. Our particular interest was the performance of home visiting in reducing child maltreatment.

METHODS

We developed a program logic framework to assist in understanding the neonate/infant home-visiting literature, identified through a systematic literature review. We tested whether success could be explained by the logic model using descriptive synthesis and statistical analysis.

FINDINGS

Having a stated objective of reducing child maltreatment-a theory or mechanism of change underpinning the home-visiting program consistent with the target population and their needs and program components that can deliver against the nominated theory of change-considerably increased the chance of success. We found that only seven of fifty-three programs demonstrated such consistency, all of which had a statistically significant positive outcome, whereas of the fifteen that had no match, none was successful. Programs with a partial match had an intermediate success rate. The relationship between program success and full, partial or no match was statistically significant.

CONCLUSIONS

Employing a theory-driven approach provides a new way of understanding the disparate performance of neonate/infant home-visiting programs. Employing a similar theory-driven approach could also prove useful in the review of other programs that embody a diverse set of characteristics and may apply to diverse populations and settings. A program logic framework provides a rigorous approach to deriving policy-relevant meaning from effectiveness evidence of complex programs. For neonate/infant home-visiting programs, it means that in developing these programs, attention to consistency of objectives, theory of change, target population, and program components is critical.

Baby lost and found: mothers' experiences of infants who cry persistently

INTRODUCTION

The purpose of this study was to describe mothers' experiences of parenting an irritable infant. Although "colic" is regarded as a "self-limiting" condition that usually disappears by 3 to 4 months of age, the entire family is affected by the infant's crying; no definitive cause or cure has been identified.

SAMPLE AND SETTING

Twelve middle-class married mothers (mean age=27.6 years) of irritable infants were interviewed. The women responded to open-ended questions, beginning with a description of the "typical day" with the infant. All interviews were tape recorded, transcribed verbatim, and entered into the AtlasTi qualitative analysis program. Grounded theory methods were used to analyze the data. Transcripts were read repeatedly to verify coding and emerging concepts.

RESULTS

The basic social psychological problem was the loss of the perceived baby and competence as a mother. The psychosocial process was the search for the baby and sense of self as mother. Processes involved cycles of hope and despair and trial and error as mothers became more isolated.

DISCUSSION

Implications for practitioners include support and listening to mothers during this difficult period.

Acupuncture reduces crying in infants with infantile colic: a randomised, controlled, blind clinical study

OBJECTIVE

To investigate whether acupuncture reduces the duration and intensity of crying in infants with colic. Patients and methods 90 otherwise healthy infants, 2-8 weeks old, with infantile colic were randomised in this controlled blind study. 81 completed a structured programme consisting of six visits during 3 weeks to an acupuncture clinic in Sweden. Parents blinded to the allocation of their children met a blinded nurse. The infant was subsequently given to another nurse in a separate room, who handled all infants similarly except that infants allocated to receive acupuncture were given minimal, standardised acupuncture for 2 s in LI4.

RESULTS

There was a difference (p=0.034) favouring the acupuncture group in the time which passed from inclusion until the infant no longer met the criteria for colic. The duration of fussing was lower in the acupuncture group the first (74 vs 129 min; p=0.029) and second week (71 vs 102 min; p=0.047) as well as the duration of colicky crying in the second intervention week (9 vs 13 min; p=0.046) was lower in the acupuncture group. The total duration of fussing, crying and colicky crying (TC) was lower in the acupuncture group during the first (193 vs 225 min; p=0.025) and the second intervention week (164 vs 188 min; p=0.016). The relative difference from baseline throughout the intervention weeks showed differences between groups for fussing in the first week (22 vs 6 min; p=0.028), for colicky crying in the second week (92 vs 73 min; p=0.041) and for TC in the second week (44 vs 29 min; p=0.024), demonstrating favour towards the acupuncture group.

CONCLUSIONS

Minimal acupuncture shortened the duration and reduced the intensity of crying in infants with colic. Further research using different acupuncture points, needle techniques and intervals between treatments is required.

Lactobacillus reuteri DSM 17938 in infantile colic: a randomized, double-blind, placebo-controlled trial

OBJECTIVE

To test the efficacy of Lactobacillus reuteri on infantile colic and to evaluate its relationship to the gut microbiota.

STUDY DESIGN

Fifty exclusively breastfed colicky infants, diagnosed according to modified Wessel's criteria, were randomly assigned to receive either L reuteri DSM 17 938 (10(8) colony-forming units) or placebo daily for 21 days. Parental questionnaires monitored daily crying time and adverse effects. Stool samples were collected for microbiologic analysis.

RESULTS

Forty-six infants (L reuteri group: 25; placebo group: 21) completed the trial. Daily crying times in minutes/day (median [interquartile range]) were 370 (120) vs 300 (150) (P=.127) on day 0 and 35.0 (85) vs 90.0 (148) (P=.022) on day 21, in the L reuteri and placebo groups, respectively. Responders (50% reduction in crying time from baseline) were significantly higher in the L reuteri group versus placebo group on days 7 (20 vs 8; P=.006), 14 (24 vs 13; P=.007), and 21 (24 vs 15; P=.036). During the study, there was a significant increase in fecal lactobacilli (P=.002) and a reduction in fecal Escherichia coli and ammonia in the L reuteri group only (P=.001). There were no differences in weight gain, stooling frequency, or incidence of constipation or regurgitation between groups, and no adverse events related to the supplementation were observed.

CONCLUSION

L. reuteri DSM 17 938 at a dose of 10(8) colony-forming units per day in early breastfed infants improved symptoms of infantile colic and was well tolerated and safe. Gut microbiota changes induced by the probiotic could be involved in the observed clinical improvement.

Parents' experience of living with a baby with infantile colic--a phenomenological hermeneutic study

BACKGROUND

About 10% of newborn babies have infantile colic which means that they cry more than 3 hours per day. The baby's crying risks disturbing the early parent-child interaction.

OBJECTIVE

This study aimed to illuminate the meaning of being a parent of a baby with infantile colic.

DESIGN

An inductive qualitative interview study.

PARTICIPANTS AND SETTINGS

Twenty-three parents (12 mothers and 11 fathers) seeking help for infantile colic at a Child Health Clinic in south Sweden, having verified in a diary their babies' crying to more than 3 hours/day, were individually interviewed between March 2006 and April 2007. Parents were selected to ensure variation in age and gender and if they were first-time parents.

METHOD

Parent's narratives were analysed using a phenomenological hermeneutic method.

FINDINGS

The main theme found was 'Colic overshadows everything'. Tired and worried parents experienced living in an inferno. Both fathers and mothers suffered with their babies, felt powerless and overwhelmed by strong feelings and neglected their other needs. To get through this period, parents used various strategies to ease their baby's pain. Parents forced themselves not to lose control, to keep a stiff upper lip and generally to bear up. Sharing the burden was important. In spite of the suffering, they also felt hope, happiness and gratitude that they had a healthy baby. The results were reflected upon in relation to systems theory, attachment theory and a theory of interpersonal aspects of nursing.

CONCLUSION

It is an important task for professionals to empower parents and help them to endure the colic period and to gain higher self-esteem as parents. By listening to the parents' stories they can better understand their situation, offer support and increase self-efficacy.

Infant temperament and parental stress in 3-month-old infants after surgery for complex congenital heart disease

OBJECTIVE

This study aimed to identify and compare differences in temperament and maternal stress between infants with complex congenital heart disease and healthy controls at 3 months of age.

METHODS

Study sample was drawn from an existing longitudinal study examining growth in infants with congenital heart disease when compared with healthy controls. Infant temperament and parental stress were measured in 129 mother-infant dyads. Inclusion criteria for infants with congenital heart disease were > or = 36-week postmenstrual age, > or = 2500 g at birth, surgery in first 6 weeks of life, and no major congenital anomalies or genetic syndromes. The Early Infancy Temperament Questionnaire and Parent Stress Index were the assessment tools used.

RESULTS

Infants with single ventricular (SV) physiology were more negative in mood (F = 7.14, p < .001) and less distractible (F = 5.00, p < .008) than the biventricular physiology or Control (C) infant groups. The demands of care for infants with congenital heart disease were a source of stress when compared with Control infants (p < .05). Five of 6 subscales of the Child Domain were significant sources of stress in the SV group compared with biventricle and Control groups. Negative mood and difficulty to soothe were predictors for Child Domain and Total Life Stress in SV infants.

CONCLUSION

The demands of parenting an irritable infant with SV physiology put these mothers at risk for high levels of stress. Results suggest the need for predischarge anticipatory guidance for parents to better understand and respond to the behavioral style of their infants, in particular, infants with SV physiology.

Furthering the understanding of parent-child relationships: a nursing scholarship review series. Part 4: parent-child relationships at risk

PURPOSE

The purpose of this integrative review is to synthesize nursing scholarship on parent-child relationships considered fragile because of parent-child's chronic condition or occurrence within a risky context.

CONCLUSIONS

Most reviewed studies demonstrated negative effects of risk conditions on parent-child relationships and documented importance of child, parent, and contextual variables. Studies were predominately single investigations. Varying theoretical perspectives complicated interpretation. Mainly White, middle-class, and small samples limited generalizability. Important areas for further research were identified.

PRACTICE IMPLICATIONS

Nurse researchers identified factors that may interfere with the parent-child relationship. Nurses are in a position to support families under these circumstances.

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.

Health care interventions for excessive crying in infants: regularity with and without swaddling

This article describes two health care interventions developed to support parents whose infant cries excessively. Intervention 1 consists of advice to caregivers to bring about regularity and uniformity in daily infant care and to reduce external stimuli. Intervention 2 is the same advice accompanied by instructions to swaddle during sleep. Nurses can teach parents these interventions easily. The goal is to help infants to establish a stable sleep-wake rhythm, for overtiredness to disappear and excessive crying to stop. The approach is based on offering predictability, which helps to develop infant self-regulating ability. If the intervention succeeds, which is often the case, the baby cries less, drinks adequately, is able to fall asleep on their own and to sleep sufficiently, and therefore is no longer overtired. Parental stress is reduced, which could translate into an improvement in family health and quality of interaction between the parents and the child.

Self-medication for infants with colic in Lagos, Nigeria

BACKGROUND

Infantile colic is a self-limiting condition that is distributed worldwide. It is often misdiagnosed as an organic disease for which an infant is admitted to the hospital. Many studies have described the aetiopathogenesis, pharmacologic and non-pharmacologic management of colic but none has evaluated self-medication for infants with colic. The aim of this study was therefore to determine the knowledge of Nigerian mothers about colic, their home-based management, extent of self-medication for the infants with colic and the types of medicines involved.

METHODS

It is a prospective study conducted at the vaccination clinics of 20 primary health care centres, each from different Local Government Areas in Lagos, Nigeria. Eight hundred mothers that brought their infants for vaccination between April and September, 2006 were interviewed with open-and close-ended questionnaire.

RESULTS

Six hundred and eighty three (85.4%) mothers claimed they had a good knowledge of colic. Incessant and excessive cry was the main clinical feature of colic identified by 430(62.9%) mothers. Three hundred and seventy eight (67.7%) infants were treated by self-medication, 157 (28.1%) sought medical intervention and 17 (3.1%) were treated at a traditional birth attendant home. Herbal medicines constituted 51.8% of the self-medicated medicines, of which 48 (26.2%) were "Ororo Ogiri". Nospamin (49.5%) and Gripe water (43.0%) were the two frequently prescribed and self-medicated medicines for infants with colic.

CONCLUSION

Nigerian mothers are deficient in their knowledge of colic. Self-medication was the most frequently used home-based intervention. Health education would appear necessary to improve parental management of this self-limiting condition.

Management of infantile colic: a review

Infantile colic is an easily identified childhood entity that has no clear treatment guidelines. The management of infantile colic varies among physicians, and families are often frustrated by the medical community's inability to prescribe a cure for colic. This article reviews the current concepts for management options of infantile colic.

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.

Longitudinal study on the predictors of parental stress in mothers and fathers of toddlers

AIM

Longitudinal study on the predictors of parental stress in mothers and fathers of toddlers.

BACKGROUND

To study whether anxiety, depression, or marital problems increase the parenting stress in parents of toddlers.

METHODS

At early pregnancy, 2 - 3 months, and 2 - 3 years after delivery, 214 low-risk couples filled in questionnaires on their marital relationship, social support, child's temperament, and self-evaluated competence in routine care-taking. In hierarchical regression analyses, they were used as predictors of parental stress.

RESULTS

Those mothers who in early pregnancy had adequate social support, adaptive social strategies, and high self-esteem, and who had given birth vaginally, enjoyed breastfeeding, and whose spouse supported breastfeeding reported less stress 2 - 3 years later. Pregnancy-related anxiety, depression, general anxiety, neuroticism, and vulnerability in early pregnancy, as well as child's temperament and low self-estimated competence in routine care-taking measured at both 2 - 3 months and 2 - 3 years after childbirth predicted parental stress. Depression and living alone in early pregnancy, and the child-related variables (temperament and care-taking, measured both at 2 - 3 months and 2 - 3 years after childbirth) predicted high parenting stress in fathers of toddlers.

CONCLUSIONS

Parental stress in toddlers' parents was predicted both by the temperament of the child, and by the parents' depression, self-esteem, and anxiety, as well as by lack of support and low self-evaluated competence in routine care-taking.

Mothers' reflections about infant irritability and postpartum tobacco use

BACKGROUND

Recent research has shown that most women who stop or substantially reduce cigarette smoking during pregnancy return to previous levels of tobacco use soon after delivery. The determinants of postpartum tobacco use have not been adequately identified. To address this gap, the present study examined one potential contributor to postpartum smoking, namely, unexplained infant crying and fussiness. The purpose of this study was to describe mothers' reflections about perceived infant irritability and postpartum tobacco use.

METHODS

A qualitative descriptive approach was applied to the responses of low-income women who participated in a mixed methods study of smoking relapse among mothers of infants. The subset of mothers for the present study (n = 86) was composed of women who intended to be nonsmokers after delivery. Thematic content analysis was conducted of the texts from their interviews.

RESULTS

Four major themes were identified with respect to perceptions of infant irritability and postpartum tobacco use: not knowing what to do, seeking renewal, seeking relief, and evaluating self.

CONCLUSIONS

The reflections of the study participants suggest that the challenges of handling infant irritability often trigger thoughts of smoking or smoking behavior. Health practitioners may strengthen cessation interventions by using strategies to help mothers cope with this experience, which is unique to the first few months after delivery.

Primary care from infancy to adolescence

The use of complementary and alternative medical (CAM) therapies is increasing among well children and adolescents and in those children who have special health care needs. Integrative pediatrics, a holistic practice that includes an examined integration of CAM and conventional therapies, is ideally suited for primary care. This article describes how to integrate evidence-based CAM therapies for colic, atopy, ADHD, eating disorders, and other conditions commonly seen in primary care practice.

Identifying risk factors for postpartum tobacco use

PURPOSE

To identify factors associated with becoming a mother that may contribute to postpartum smoking-related outcomes.

DESIGN

Cross-sectional, correlational.

METHODS

Postpartum women (N=133) who were clients in a nutrition supplement program for low-income families responded to questionnaires about smoking and early motherhood experiences. Inferential statistical tests included hierarchical multiple and logistic regression.

FINDINGS

After controlling for factors known to be associated with smoking outcomes for the general population, factors associated with becoming a mother significantly contributed to the amount of explained variance in both postpartum self-efficacy to refrain from smoking and smoking within 2 weeks after delivery.

CONCLUSIONS

Study findings indicated that prenatal intentions about postpartum tobacco use and maternal response to infant cry episodes were areas for risk assessment that might lead to effective smoking cessation interventions uniquely tailored to women who experience becoming a mother.

A Validity and Reliability Study Investigating the Turkish Version of the Infant Colic Scale

The Infant Colic Scale is used to diagnose colic and to determine factors that cause colic. This study aimed to establish the validity and reliability of the Infant Colic Scale for the Turkish population. The research sample included mothers (N = 110) of 132 infants with colic registered at three public health clinics in the Denizli province. Language validity, content validity, and construct validity were examined. On the basis of the Infant Colic Scale's internal consistency reliability analysis, three items were removed. Factor analysis resulted in five subscales. The Cronbach's alpha coefficients were .55 to .89 for the subscales, and .73 for the total scale. The scale's test-retest reliability was .65. The Infant Colic Scale was found to be a valid and reliable measurement tool for the Turkish population.