Impact of babyface schema on time perception: Insights from neutral and crying facial expressions.

Facial expressions in infants have been noted to create a spatial attention bias when compared with adult faces. Yet, there is limited understanding of how adults perceive the timing of infant facial expressions. To investigate this, we used both infant and adult facial expressions in a temporal bisection task. In Experiment 1, we compared duration judgments of neutral infant and adult faces. The results revealed that participants felt that neutral infant faces lasted for a shorter time than neutral adult faces, independent of participant sex. Experiment 2 employed sad (crying) facial expressions. Here, the female participants perceived that the infants' faces were displayed for a longer duration than the adults' faces, whereas this distinction was not evident among the male participants. These findings highlight the influence of the babyface schema on time perception, nuanced by emotional context and sex-based individual variances.

White blood cells, TNF-α, and interleukin-6 in subjects with infantile colic treated with Lacticaseibacillus rhamnosus GG (ATCC 53103): a randomised prospective study.

Recent metanalysis reported that certain probiotic strains, such as Limosilactobacillus reuteri and Lacticaseibacillus rhamnosus (LGG), seem effective for treatment of infantile colic of exclusively breastfed infants; some reports have also linked probiotics to have an immunological effect, however further investigation are needed to fully understand the exact mechanism. The objective of this study was to assay white blood cells, tumour necrosis factor (TNF)-α and interleukin (IL)-6 values in peripheral blood in subjects treated in a randomised, double-blind, placebo-controlled trial for infantile colic with LGG. Fifty-eight infants were enrolled and followed for a study period of 28 days. Parent were asked to record daily crying time using a structured cry diary. Peripheral white blood cells was assessed and RNA (mRNA) expression of TNF-α and IL-6 was measured using TaqMan real-time PCR-maternal amplification. Infants with colic treated with LGG showed a reduction in daily crying duration after 28 days of treatment and a reduction in values of IL-6 ( P < 0.005) and TNF-α ( P < 0.05); we observe also a significantly decreasing of IL-6 in the placebo group while decrease of TNF-α was not significant in this group. A significant decreased values of monocytes ( P < 0.05) was observed in infants treated with LGG. Our data therefore showed, in addition to crying time reduction, a significant decrease of TNF-α and a significant reduction of monocytes cells in colicky infants treated with LGG, compared to placebo group. This observation supports the hypothesis that probiotics may have anti-inflammatory properties. Further studies are needed to better understand the influence of probiotic on immunity cells.

I Kept Crying.

In this narrative medicine essay, a second-year pediatric resident bears the scars from the terror that descended the moment of her son's birth at 31 weeks' gestation, terror relived even after he has come home healthy.

Effects of probiotics on gastrointestinal symptoms, anthropometric measurements, and breastfeeding duration in infants with colic: a randomized control trial.

BACKGROUND: Infantile colic has a multifactorial etiology. Recent studies have suggested that probiotics may be effective in its management. OBJECTIVE: This study was carried out to evaluate the effect of the Actiregularis strain (5×106 cfu\ml) included in maternal nutrition on gastrointestinal problems, growth development, and breastfeeding outcomes in infantile colic. DESIGN AND SETTING: The study was a randomized controlled trial conducted in the neonatal outpatient clinic of a training and research hospital in Turkey. METHODS: A probiotic drink containing the Actiregularis (5×106 cfu\ml) strain was added to the diet of mothers in the probiotics group once daily for 15 consecutive days. Data were collected for each infant's 0th (birth), 1st, 4th, and 6th months. RESULTS: Infants whose mothers were administered Actiregularis for 15 days had decreased crying intensity (P = 0.000). When the difference in breastfeeding rates between the groups was significant at the 4th and 6th months (P = 0.044; P = 0.035). There was no difference in anthropometric values except the babies' weights at the 6th month. (P < 0.001). CONCLUSION: Infants treated with Actiregularis, which was added to their mothers' diet for 15 days, showed a decrease in the frequency of crying, and the difference in breastfeeding rates between the groups was significant at the 4th and 6th months. There was no difference in anthropometric values except the babies' weights at the 6th month. CLINICAL TRIALS REGISTRATION: NCT04374955 (https://clinicaltrials.gov/ct2/show/).

The infant-doctor relationship: an examination of infants' distress reactions in the presence of a doctor.

Fear of doctors is a common source of distress among infants; however, the underlying sources of this distress are unknown. To investigate the doctor-infant relationship, the behaviors of 61 healthy infants (176-617 days old) were observed in a simulated examination room. Their behaviors and electrocardiograms were recorded. Two groups of infants were analyzed: those who cried and those who did not. When an experimenter dressed in the doctor's attire entered the room, all 9 infants who were crying (14.8% of all infants) stopped crying, all infants gazed at the experimenter, and their mean heart rate (HR) decreased. After the auscultation started, 29.5% of all infants cried, and the HRs of infants who cried were higher than those of infants who did not cry. During the auscultation, 80.0% of infants who cried averted from the experimenter, while 34.4% of infants who did not cry. Within 5 s of gazing at the stethoscope, the number of infants who cried increased from 3 to 12, and their mean HR also increased. Our findings suggest that the fear of doctors is not due to the appearance of doctors but rather to specific actions performed by doctors, such as auscultation. Infants may regard a doctor's appearance as a source of interest. Furthermore, a stethoscope is a possible trigger for infants' crying. These behavioral observations suggest the potential for patient-centered care for infants.

Abusive head trauma and crying infant-Public awareness of newborn and infant trauma.

AIM: Crying seems to be a common trigger for abusive head trauma (AHT), which is the leading cause of fatalities from physical abuse in infants. Our objective was to evaluate knowledge of AHT, crying infants and correct behavioural measures in a general population. METHODS: An online questionnaire (LimeSurvey) was created to assess the risk of shaking. The online survey contained a total of 41 questions, including a demonstration of a previously recorded video in which an infant doll is shaken. RESULTS: A total of 319 people, 245 of them (76.8%) with own children, participated in the study. Almost all respondents (98.4%) were aware of serious injuries due to shaking, even to the point of death (98.1%). Most participants (97.5%) had heard the term 'shaking trauma' prior but did not receive any professional information, neither before nor after birth (85.2% or 86%), or during follow-up examinations (88.5%). The majority of the participants (95%) considered that useful coping strategies in infant crying were inappropriate. CONCLUSION: The consequences of shaking an infant were common knowledge in a normal population, whereas there was a knowledge gap regarding the management of excessive crying infants. Prevention programmes should mainly focus on male caregivers during postnatal care.

Effect of lactase supplementation on infant colic: Systematic review of randomized controlled trials.

To systematically review evidence on the efficacy and safety of using a lactase supplementation for managing infant colic. The MEDLINE, EMBASE, and Cochrane Library databases were searched (up to September 2023) for randomized controlled trials (RCTs) comparing oral lactase supplementation with placebo or no intervention in infants younger than 6 months old with infant colic. The risk of bias was assessed using the revised version of the Cochrane risk-of-bias tool. Outcomes measured were selected according to a standardized core outcome set. Five RCTs involving a total of 391 infants were identified. Three RCTs reported reduced crying duration, but one showed effect only in a compliant group (40.4%, p = 0.0052). A meta-analysis of two RCTs found no difference in crying duration and fussing time during 1 week of lactase treatment compared with placebo (mean difference [MD] -17.66 min/day, 95% confidence interval [CI], -60.8 to 25.5; I2 = 68% and MD 2.75, 95% CI, -58.2 to 57.2; I2 = 80%, respectively). Other outcomes were assessed only in individual studies or not reported. The risk of bias was low in only one RCT, high in three, and raised some concerns in one. While individual trials have shown some promise, the overall evidence for the efficacy of lactase supplementation in treating infant colic remain inconclusive. Further well-designed RCTs are necessary to determine the effects of lactase on managing infant colic.

Effect of pacifier and pacifier with dextrose in reducing pain during orogastric tube insertion in newborns: a randomized controlled trial.

OBJECTIVE: This study aimed to assess the efficacy of pacifier use, with and without 25% dextrose, in reducing pain during orogastric tube insertion in newborns. STUDY DESIGN: In a randomized controlled trial involving 60 newborns at a public hospital from April to December 2019, participants were divided into three groups: pacifier (n = 20), pacifier with 25% dextrose (n = 20), and control (n = 20). A pacifier, with and without dextrose, was used for the experimental groups, while the control group performed a routine procedure. Neonatal infant pain scale, crying duration, heart rate (HR), and oxygen saturation (SpO2) were evaluated. RESULTS: Results indicated that the control group experienced significantly higher pain levels, elevated HRs, decreased SpO2, and prolonged crying. Conversely, the pacifier with 25% dextrose group showed a notable reduction in crying duration. CONCLUSION: A pacifier, with and without 25% dextrose, effectively reduces pain and improves physiological and behavioral parameters during orogastric tube insertion. CLINICAL TRIAL NUMBER: NCT05462964 CLINICAL TRIAL REGISTRATION: The protocol for this randomized controlled experimental trial is registered on ClinicalTrials.gov. The clinical trial registration number is https://clinicaltrials.gov ; NCT05462964.

'In the shower crying but we came back in the following day and did it all again'. Distress and resilience in care home staff during the COVID-19 pandemic- A qualitative interview study.

BACKGROUND: Care homes (long-term care facilities) were profoundly impacted early in the COVID-19 pandemic, both in terms of resident mortality and restrictions for infection control. This study investigated the impact on the emotional well-being of care home staff of challenges faced at this time, and the strategies used to manage them. METHODS: Semi-structured interviews conducted October 2020-June 2021 with care home staff and health service staff working with them explored the impact of the early waves of the COVID-19 pandemic (March 2020-June 2021). Interview data were analysed using reflexive thematic analysis. RESULTS: Interview participants were 16 care home staff and 10 health service staff. Analysis generated four key themes: 1)Anxiety and distress, 2)Overwhelming workload, 3)Pulling through; and 4)Resilience in a time of crisis. Care home staff experienced Anxiety and distress due to uncertainty of what to expect; witnessing illness and deaths of residents; concerns regarding their own health, and sometimes feeling their work was under-recognised. They also experienced an Overwhelming workload due to infection control measures, caring for sick residents and reduction in external healthcare support. Our theme of Pulling through reflects the peer support and problem-solving strategies with which care home staff managed the impact of the pandemic, along with a sense of responsibility and meaning towards their work. An overarching theme of Resilience in a time of crisis drew on the other three themes and describes how many staff managed, maintained, and often increased their work despite the challenges of the pandemic. Participants also described increasing emotional fatigue as the pandemic continued. CONCLUSIONS: This paper builds on literature on the emotional impact of the pandemic on care home staff, also exploring ways that staff responded to this impact. These findings can help inform planning for future crises including disease outbreaks, and raise important questions for further work to develop pandemic preparedness in care homes and beyond. They also raise wider questions about the current cultural status of care work, which may have exposed care home staff to greater risk of distress, and which contrasts with the professionalism and responsibility shown by staff in response to pandemic challenges.

Use of psychoacoustic spectrum warping, decision template fusion, and neighborhood component analysis in newborn cry diagnostic systems.

Dealing with newborns' health is a delicate matter since they cannot express needs, and crying does not reflect their condition. Although newborn cries have been studied for various purposes, there is no prior research on distinguishing a certain pathology from other pathologies so far. Here, an unsophisticated framework is proposed for the study of septic newborns amid a collective of other pathologies. The cry was analyzed with music inspired and speech processing inspired features. Furthermore, neighborhood component analysis (NCA) feature selection was employed with two goals: (i) Exploring how the elements of each feature set contributed to classification outcome; (ii) investigating to what extent the feature space could be compacted. The attained results showed success of both experiments introduced in this study, with 88.66% for the decision template fusion (DTF) technique and a consistent enhancement in comparison to all feature sets in terms of accuracy and 86.22% for the NCA feature selection method by drastically downsizing the feature space from 86 elements to only 6 elements. The achieved results showed great potential for identifying a certain pathology from other pathologies that may have similar effects on the cry patterns as well as proving the success of the proposed framework.

Prepartum and postpartum mothers' and fathers' feelings of frustration in response to infant crying.

In this cross-sectional study performed in Canada, we evaluated the frustration levels of prepartum and postpartum mother and father couple-pairs. Our goal was to determine if there were differences in frustration levels between mothers and fathers while listening to prolonged infant crying, and further, how frustration levels might differ between prepartum and postpartum samples. Using two discrete groups, prepartum (Sample 1; N = 48) and postpartum (Sample 2; N = 44) mother and father couple-pairs completed 600 s of listening to audio-recorded infant cry sounds. Participants continuously reported their subjective frustration using a computerized Continuous Visual Analog Scale (CVAS). There was no significant difference in frustration responses between mothers and fathers across both prepartum and postpartum samples. Postpartum mothers and fathers experienced greater frustration than their prepartum counterparts, and frustration increased faster in postpartum couples compared to prepartum couples. Informing first-time parents of the universal experiences of frustration to prolonged crying bouts that are characteristic of their infant's early weeks of life may lead to greater understanding towards their infant, and perhaps decreased instances of harmful responses.

En este estudio transeccional, evaluamos los niveles de frustración de las parejas de mamás y papás antes y después del parto. Nuestro propósito fue determinar si hay diferencias entre mamás y papás en cuanto a los niveles de frustración mientras escuchan el prolongado llanto del infante, y cómo los niveles de frustración pudieran diferir entre grupos­muestra antes y después del parto. Usando dos grupos discretos, antes del parto (grupo­muestra 1; N = 48) y después del parto (grupo­muestra 2; N = 44), las parejas de mamás y papás completaron 600 segundos escuchando sonidos grabados en audio de llanto de infante. Los participantes continuamente reportaron su frustración subjetiva usando una escala análoga visual continua computarizada (CVAS). No hubo diferencia significativa en las respuestas de frustración entre mamás y papás a lo largo de los grupos­muestra tanto antes del parto como después del parto. Las mamás y papás en el grupo­muestra después del parto experimentaron mayor frustración que sus homólogos en el grupo­muestra antes del parto, y la frustración aumentó más rápido en las parejas del grupo­muestra después del parto tal como se les comparó con las parejas del grupo­muestra antes del parto. Estos resultados sugieren que las parejas primíparas posterior al parto están más propensas a experimentar considerables cantidades de frustración como respuesta al llanto del infante después que el bebé ha nacido. Informarles a los progenitores primerizos acerca de las experiencias generales de la frustración a los prolongados ataques de llanto que son característicos de las primeras semanas de vida de su infante pudiera llevar a una mayor comprensión hacia su infante y quizás disminuir las instancias de respuestas dañinas.

Dans cette étude transversale nous avons évalué les niveaux de frustration des couples­paires mère et père avant et après la naissance. Notre but était de déterminer s'il existe des différences entres les mères et les pères dans leurs niveaux de frustration en entendant des pleurs de bébé prolongés et de quelle manière les niveaux pourraient différer entre les échantillons avant la naissance et après la naissance. En utilisant deux groupes discrets, avant la naissance (Echantillon 1; N = 48) et après la naissance (Echantillon 2; N = 44) les couples­paires mère et père ont écouté 600 seconds d'enregistrements de pleurs de bébés. Les participants ont fait état de leur frustration subjective en utilisant une échelle analogique visuelle continue informatisée (CVAS). Il s'est avéré n'y avoir aucune différence importante dans les réactions de frustration entre les mères et les pères au travers des échantillons à la fois avant l'accouchement et après l'accouchement. Ces résultats suggèrent que les coupes postpartum primipares sont plus à même de faire l'expérience de niveaux élevés de frustration en réaction aux pleurs du bébé une fois le bébé arrivé. Informer les parents qui sont parents pour la première fois des expériences universelles de frustration aux crises de pleurs prolongées qui caractérisent les premières semaines de la vie des bébés peut mener à une plus grande compréhension de leur bébé et peut­être à une baisse des case d réactions néfastes.

Oral Sucrose in Infants Undergoing Flexible Nasolaryngoscopy: A Blinded Randomized Pilot Study.

INTRODUCTION: Flexible nasolaryngoscopy (FNL) is a common, uncomfortable procedure performed to assess the upper airway in infants. Oral sucrose is used during various painful procedures in infants but has not been used during FNL. Our objective was to understand the impact of oral sucrose on discomfort in infants undergoing FNL. METHODS: Infants (<12-months-old) undergoing FNL in the otolaryngology clinic were randomized to treatment (0.5 mL 24% oral sucrose) or standard management (no sucrose). Sucrose was administered <2 min prior to FNL performed by a single endoscopist. Outcome measures included: EVENDOL pain scale and cry duration and visit duration. Infant discomfort was measured by a second observer who was blinded to treatment group. RESULTS: Forty-seven infants were included, 23 were treated with sucrose and 24 with standard management. The median (IQR) age was 3.0 (2-5.7) months. There were no significant differences in age, weight, or sex across groups. The median (IQR) duration of FNL was 35.2 (26.5-58.4) and 36.4 (28.9-51.8) seconds for treatment and standard management groups, respectively. Mean (SD) EVENDOL scores were significantly lower in the sucrose group [4.9 (2.0)] than standard group (6.7 [2.1]) (p = 0.003). Mean cry duration after FNL was significantly shorter in the sucrose group (29.9 [20.4] seconds) than the standard group (52.7.0 [40.6] seconds) (p = 0.02). Median (IQR) visit duration did not differ across groups (1.1 [0.9-1.3] vs. 1.1 [0.7-1.4] h [p = 0.15]). CONCLUSION: Oral sucrose given before FNL reduced EVENDOL scores and cry duration after FNL and did not prolong clinic visits in this randomized pilot study. LEVEL OF EVIDENCE: 2 Laryngoscope, 134:3826-3831, 2024.

Infant carrying: Associations with parental reflective functioning, parental bonding and parental responses to infant crying.

Infant carrying may have beneficial effects on the parent-infant relationship but only limited research has been conducted in this area. Therefore, the main aim of the current study was to investigate whether infant carrying is associated with parental reflective functioning, parental bonding, and parental (emotional) and behavioral responses to infant crying, key elements within the parent-infant relationship, promoting infant development. Parents reporting high levels (N = 389) of infant carrying (six times a week or daily) and parents reporting low levels (N = 128) of infant carrying (less than once a week or not at all) who participated in an online survey about the developing parent-infant relationship in Germany were included in the present study. Standardized questionnaires were used to assess parental reflective functioning, parental bonding impairments, and emotional responses to infant crying. Further insensitive (non-responsive and hostile) behaviors in response to infant crying were assessed. Parents with high levels of infant carrying showed better parental reflective functioning, lower parental bonding problems, less negative emotions, and less insensitive behaviors in response to infant crying.

Cargar al infante pudiera tener efectos beneficiosos para la relación progenitor­infante, pero sólo una limitada investigación se ha llevado a cabo en esta área. Por tanto, el objetivo principal del presente estudio fue investigar si cargar al infante se asocia con que el funcionamiento con reflexión del progenitor, los lazos de afectividad del progenitor, así como las respuestas de comportamiento (emocional) del progenitor al llanto del infante, elementos claves dentro de la relación progenitor­infante, promueven el desarrollo del infante. Se incluyó en el presente estudio a los progenitores que reportaron altos niveles (N=389) de llanto del infante (seis veces por semana o diariamente) y a los progenitores que reportaron bajos niveles (N=128) del llanto del infante (menos de una vez por semana o nunca), quienes participaron en una encuesta electrónica acerca de la relación progenitor­infante en desarrollo, en Alemania. Se usaron cuestionarios estandarizados para evaluar el funcionamiento con reflexión del progenitor, los impedimentos de lazos afectivos del progenitor, así como las respuestas emocionales al llanto del infante. Se evaluaron además comportamientos insensibles (sin respuesta afectiva y hostil) como respuesta al llanto del infante. Los progenitores con altos niveles de cargar al infante demostraron un mejor funcionamiento con reflexión del progenitor, más bajos problemas en cuanto a lazos de afectividad del progenitor, menos emociones negativas y menos comportamientos insensibles como respuesta al llanto del infante.

Porter un bébé peut avoir des effets bénéfiques sur la relation parent­bébé mais il n'existe que peu de recherches sur ce domaine. C'est pour cette raison que le but principal de cette étude était d'investiguer si le fait de porter un bébé est lié avec une fonction réflexive parentale, le lien parental et les réactions parentales (émotionnelles) et comportementales aux pleurs du bébé, des éléments clef au sein de la relation parent­bébé, promouvant le développement du bébé. Les parents faisant état de niveaux élevés (N=389) de portage du bébé (six fois par semaine ou tous les jours) et les parents faisant état de niveaux bas (N=128) de portage du bébé (moins d'une semaine ou pas du tout) qui ont participé à un questionnaire en ligne sur la relation parent­bébé se développant en Allemagne ont été inclus dans cette étude. Des questionnaires standardisés ont été utilisés afin d'évaluer la fonction réflexive parentale, les troubles du lien parental, et les réactions émotionnelles aux pleurs du bébé. D'autres comportement insensibles (non­réactifs et hostile) en réaction aux pleurs du bébé ont été évalués. Les parents avec des niveaux élevés de portage du bébé ont fait preuve d'une meilleure fonction réflexive parentale, de moins de problèmes de lien parental, de moins d'émotions négatives, et de moins de comportements insensibles en réaction aux pleurs du bébé.

The effectiveness of the therapeutic toys on the comfort level and vital signs of the neonates during intravenous cannula insertion (Comfiestudy): A randomized controlled trial.

PURPOSE: This study was planned to determine the effect of the therapeutic toy used during IV cannula insertion on the comfort level, crying time and vital signs of neonates. METHODS: The sample (n = 38) was randomized to the Control and the Comfie Groups. Vital signs were measured before, during, and after the IV cannula insertion. Comfort levels and the duration of crying were measured during the insertion. RESULTS: Neonates in the Comfie Group had lower pulse and higher saturation levels during the insertion, and they had lower respiration rates and pulse but higher oxygen saturation levels at the post 1st-5th minute. They were more comfortable than the neonates in the control group. DISCUSSION: The result of this research reveals that therapeutic toys applied during the IV cannula insertion in neonates increase the comfort level and stabilize the vital signs. APPLICATION TO PRACTICE: The use of toys during IV cannula insertion could be an effective nonpharmacological method to improve outcomes.

When crying turns to hitting: Examining maternal responses to negative affect.

Physical aggression in toddlerhood is empirically linked to anger and often conceptualized as a byproduct of frustration and related negative affect. Further, parenting is the major environmental construct implicated in the development of aggressive behaviors. Given parents' role as "external regulators," parents' responses to their toddlers' negative affect may serve to escalate or de-escalate their toddlers' affective experience, thereby impacting the likelihood of subsequent aggression. In the present study, we examined whether parents' negative affect, harsh, soothing, and distracting responses to their toddlers' negative affect mediated the relation between toddlers' negative affect and their aggressive behavior in brief conflict episodes. During a laboratory visit, a community sample of 69 mother-toddler dyads was observed in a structured interaction task. We found that child negative affect is associated with subsequent aggressive behavior by way of maternal harsh responses to negative affect. Negative emotional expression, soothing, and distraction neither facilitated or hindered children's escalation from negative affect to aggression. Our findings support a dyadic intervention in which patterns of coercive parent-child interactions are targets for prevention and intervention of toddler aggression.

An Uncommon Cause of Nocturnal Crying and Discomfort: A Case of a 15-month-old Girl With Spondylodiscitis.

Nocturnal crying in toddlers has a broad spectrum of causes, including psychosocial and somatic causes, whereby the majority are self-limiting and do not need referral to specialist medical care. Although uncommon, atypical presentations of nocturnal crying-such as spondylodiscitis-require referral to specialist medical care, especially when combined with discomfort. In this case report, we present a case of a 15-month-old girl with an atypical presentation of nocturnal crying in combination with back pain.

Evaluation of measurement errors in the Patient-Oriented Eczema Measure (POEM) outcome.

BACKGROUND: The Patient-Oriented Eczema Measure (POEM) is the recommended core outcome instrument for atopic dermatitis (AD) symptoms. POEM is reported by recalling the presence/absence of seven symptoms in the last 7 days. OBJECTIVE: To evaluate measurement errors in POEM recordings due to imperfect recall. METHODS: Using data from a clinical trial of 247 AD patients aged 12-65 years, we analysed the reported POEM score (r-POEM) and the POEM derived from the corresponding daily scores for the same seven symptoms without weekly recall (d-POEM). We quantified recall error by comparing the r-POEM and d-POEM for 777 patient-weeks collected from 207 patients, and estimated two components of recall error: (1) recall bias due to systematic errors in measurements and (2) recall noise due to random errors in measurements, using a bespoke statistical model. RESULTS: POEM scores have a relatively low recall bias, but a high recall noise. Recall bias was estimated at 1.2 points lower for the r-POEM on average than the d-POEM, with a recall noise of 5.7 points. For example, a patient with a recall-free POEM of 11 (moderate) could report their POEM score anywhere from 5 to 14 (with 95% probability) because of recall error. Model estimates suggested that patients tend to recall itch and dryness more often than experienced (positive bias of less than 1 day), but less often for the other symptoms (bleeding, cracking, flaking, oozing/weeping and sleep disturbance; negative bias ranging 1-4 days). CONCLUSIONS: In this clinical trial data set, we found that patients tended to slightly underestimate their symptoms when reporting POEM, with significant variation in how well they were able to recall the frequency of their symptoms every time they reported POEM. A large recall noise should be taken into consideration when interpreting POEM scores.