A support package for parents of excessively crying infants: development and feasibility study

App-based intervention for parents of children with crying, sleeping, and feeding problems: Usability, usefulness and implications for improvement

Background

There is a lack of evidence-based app guidance for parents of children with crying, sleeping, and feeding problems who are often highly burdened and not likely to seek professional help. A new psychoeducational app for parents providing scientifically sound information via text and videos, a diary function, selfcare strategies, a chat forum and a regional directory of specialized counseling centers may serve as a low-threshold intervention for this target group.

Objective

We investigated how parents perceived the app in terms of the following: (1) overall impression and usability, (2) feedback on specific app functions regarding usefulness and (3) possible future improvements.

Methods

Our clinical sample of N = 137 parents of children aged from 0 to 24 months was recruited from a cry baby outpatient clinic in Southern Germany between 2019 and 2022. A convergent parallel mixed methods design was used to collect and analyse cross-sectional data on app evaluation. After app use within the framework of a clinical trial, parents filled in an app evaluation questionnaire.

Results

Most participants used the app at least once a week (86, 62.8 %) over an average period of 19.06 days (SD = 15.00). Participants rated overall impression and usability as good, and the informational texts, expert videos and regional register of counseling centers as appealing and useful. The diary function and chat forum were found to be helpful in theory, but improvements in implementation were requested, such as a timer function for the diary entry. Regarding future functionality, parents posed several suggestions such as the option to contact counseling centers directly via app, and the inclusion of the profile of their partners.

Conclusions

Positive ratings of overall impression, usability, and specific app functions are important prerequisites for the app to be effective. App-based guidance for this target group should include easy-to-use information. The app is intended to serve as a secondary preventive low-threshold offer and to complement professional counseling.

Effectiveness of a starch thickened infant formula with reduced lactose content, probiotics and prebiotics on quality of life and clinical outcome in infants with regurgitation and/or colic

Background

Regurgitation and colic are quite common in young infants, leading to a reduced quality of life (QoL) and to parental distress. Their management is challenging and aims to effectively reassure and relieve symptoms. This study aimed to assess the effectiveness over 30 days of a starch thickened formula with a reduced lactose content, Limosilactobacillus reuteri (Lactobacillus reuteri) DSM 17938 and FOS/GOS.

Methods

A real-world prospective multicenter experimental study was conducted in a before-after design within subject. Full term infants 0-5 months with regurgitation or colic or both symptoms and without intercurrent illness were included after parental informed consent and received the studied formula. The primary endpoint was the improvement in QoL using the QUALIN infant's questionnaire. Secondary endpoints were the symptoms outcome and the formula tolerance.

Results

Of the 101 infants included (age: 6.2 ± 4.3  weeks), 33 had regurgitation, 34 colic and 34 had both. At D30, the QoL score was improved in 75% of infants in per protocol analysis (n = 68; +8.2 ± 13.7; p < 0.001), more in those with colic or both symptoms. Meanwhile, in intention to treat analysis (all p < 0.001), the daily number of regurgitations decreased by 61% and the weekly number of days with colic by 63% while the daily cumulative duration of crying decreased by 82 ± 106 mn. These improvements were observed within the first week by 89 and 76% of parents, respectively.

Conclusion

The study formula associated with reassurance is shown to be quickly effective in the management of infant's regurgitation or/and colic in routine clinical practice.

Clinical trial registration

https://clinicaltrials.gov/, identifier NCT04462640.

The dark side of fear expression: Infant crying as a trigger for maladaptive parental responses

While infant fearfulness, and its expression via crying, may have been adaptive in our evolutionary history, for modern parents, crying can be challenging to respond to. We discuss how and why prolonged crying can raise the risk for difficulties with adult care. Given that crying is the most-reported trigger for shaking, its potential to elicit maladaptive responses should not be overlooked.

'Putting all my eggs into the app': Self, relational and systemic surveillance of mothers' use of digital technologies during the transition to parenting

This paper builds on thematic findings from a larger study that explored how digital technologies (e.g. smartphones, apps, search engines) shape expectant and new mothers' early parenting practices. An overarching theme that arose across these mothers' experiences which deserved deeper exploration was relational digital surveillance. In the context of this paper, relational digital surveillance describes how mothers evaluate their sense of preparedness, goodness or suitability for motherhood as they transition into parenting in relation to: their own use of digital technologies when caring for their pregnant bodies (self-surveillance), partners' and family members' commentary and/or judgement regarding their use of digital technologies to support their parenting and decision-making (familial surveillance) in addition to service/health care providers' commentary and/or judgement concerning their technology use (systemic surveillance). Mothers' use of digital technologies in this study not only provided others (partners, family members, health care providers) with means to watch over their actions and bodies as they transitioned into motherhood but offered a new evaluative dimension for others to scrutinize their behaviour as a new mother. Such understandings of relational digital surveillance within the transition to parenting context raise critical questions concerning the promotion and commercialization of digital self-surveillance technologies among expectant/new parents given the ways these technologies can further push the boundaries of hegemonic mothering practices and contribute to feelings of inadequacy and self-doubt. Alternatively, these insights offer avenues where health care providers can intervene to facilitate activities that enhance digital health literacy skills and mitigate parents' exposure to platforms that amplify anxieties.

Infant colic, young children's temperament and sleep in a population based longitudinal cohort study

Background

Colic and sleep problems are common among infants, constitute challenges and distress for parents, and are often reasons for seeking help from health professionals. The literature debates whether infant colic and sleep problems are linked together or not. Further, limited evidence exists on how colic impacts on child temperament and sleep during early childhood. Thus, the purpose of this study was to increase our knowledge of the characteristics of infants with a history of colic compared to infants without, and to study how infant colic is associated with the development of child temperament and sleep over time.

Methods

The study is based on The Norwegian Mother, Father and Child Cohort Study (MoBa), a population-based cohort study conducted by the Norwegian Institute of Public Health. This sample contains 88,186 mothers and children. Data was retrieved from questionnaires distributed to mothers at recruitment (in pregnancy) and when the child was 6 months, 18 months, 3 years, and 5 years. Data was analysed using linear mixed models and GLM models for repeated measures.

Results

At 6 months, infants with reported colic are described as fussier, present more sleeping problems, are breastfed less, and the families visit the child health centre more often when compared to the non-colic group. Mothers of children with reported colic perceive their children’s temperament significantly more challenging from the age of 6 months to 5 years. Further, children with reported colic were more likely to sleep less than recommended (22%) and to have more frequent night awakenings (14%) than usual for their age (6 months to 5 years).

Conclusion

Infant colic often occurs together with other signs of regulatory problems which may amplify the load on the parents. Moderate differences in temperament and sleep-problems across time, between those with colic and those without, indicate that the diagnosis of colic is moderately associated with later behavioural difficulties. However, it is demanding for the parents, and important to be aware of and act upon symptoms of colic in the child health centres to reduce the parents’ load and prevent adverse long-term outcomes.

Distress in fathers of babies with infant colic

AIM

The aim of this case-control study was to compare parental stress, depression, anxiety and bonding problems between fathers and mothers of babies with infant colic and parents of control infants.

METHODS

Parents of 34 infants with infant colic and 67 control dyads were included. Parental feelings were assessed using validated questionnaires.

RESULTS

Fathers as well as mothers of infants with infant colic showed significantly higher mean scores compared with controls on stress (20.9 ± 5.8 and 25.5 ± 7.2 vs 16.4 ± 6.1 and 14.7 ± 7.0), depression (5.6 ± 4.0 and 9.1 ± 4.8 vs 2.9 ± 2.9 and 4.0 ± 3.1), anxiety (41.9 ± 9.2 and 46.0 ± 10.2 vs 32.4 ± 8.4 and 32.2 ± 9.3) and bonding problems (16.1 ± 8.1 and 13.7 ± 5.9 vs 8.7 ± 6.3 and 5.0 ± 4.4). In fathers, after adjustments for infant and parental confounders and maternal negative feelings, depression and anxiety were significantly increased in the infant colic group (difference of 2.7 (p = 0.017) and 8.6 (p = 0.002)).

CONCLUSION

In fathers of infants with infant colic, the experienced distress is strongly associated with maternal distress, except for depression and anxiety. Paediatricians should be aware of these paternal feelings as parental reassurance and support is one of the cornerstones in the treatment of infants with colic.

Prevalence of Functional Gastrointestinal Disorders in European Infants and Toddlers

OBJECTIVE

To assess the prevalence of functional gastrointestinal disorders (FGIDs) in young children in a cross-sectional, multicenter study in Belgium, Italy, and The Netherlands.

STUDY DESIGN

Children were enrolled if they were age 0-48 months, attending a general pediatrician (Belgium, Italy) or a well-baby clinic (The Netherlands) for routine follow-up. Separate questionnaires were developed for infants age 0-12 months and for toddlers age 13-48 months. Questionnaires evaluated the clinical history, symptoms, sociodemographic information on the family, and exposure to stressful life events. FGIDs were defined according to Rome IV criteria.

RESULTS

In total 2751 children were included: 1698 infants age 0-12 months and 1053 children age 13-48 months. The prevalence of any FGID in infants age 0-12 months and 13-48 months was 24.7% and 11.3%, respectively. The most common disorders were infant regurgitation (13.8%) in infants and functional constipation (9.6%) in toddlers. Multivariable regression analyses demonstrated that younger age (P = .030) and formula feeding (P = .045) were associated with the prevalence of any FGID among infants. Country (Italy) (P = .033) and parents subjected to domestic violence (P = .035) were associated with the prevalence of any FGID in toddlers age 13-48 months.

CONCLUSIONS

FGIDs are common in a community sample of Western European infants and toddlers. Regurgitation is most prevalent in infants and functional constipation is most common in toddlers. Younger age, formula feeding, and domestic violence to parents are associated with the prevalence of FGIDs.