Newborn predictors of infant irritability.

OBJECTIVE: To identify newborn infant behaviors that may predict infant irritability, commonly referred to as colic. DESIGN: A prospective, correlational design, with data collection occurring the first 4 days of life and again at 1 month of age. SETTING: This study was conducted in a private hospital in a large metropolitan city in the Midwest. PARTICIPANTS: Sixty infants who were at low risk and full term and whose weight was appropriate for gestational age were recruited during their postpartum hospital stay. Infants with congenital anomalies, signs of illness, or high-risk factors were excluded from the study. MAIN OUTCOME MEASURES: During infants' 1-4-day hospital stays, their crying was assessed and reported by the nurses, and a Neonatal Behavioral Assessment Scale was completed on each infant. At 1 month of age, irritability was measured using the Fussiness Rating Scale. RESULTS: Only two components of the Neonatal Behavioral Assessment Scale were related to development of colic or infant irritability at 1 month of age. These were the cluster of variables representing motor activity and the Neonatal Behavioral Assessment Scale supplemental item measuring the persistence necessary on the part of the examiner to get the infant to attend to stimuli presented. The infants who were classified by parents as irritable at 1 month of age were more active and more attentive to stimuli in the first few days of life. CONCLUSIONS: Of interest was that the newborn nursery nurses cry ratings were not related to the later development of colic in these infants. Active infants who are sensitive to stimuli may be predisposed to infant irritability; however, further work is needed to understand the relationships of these infant characteristics to the human interactions and physical environments they encounter

A longitudinal comparison of irritable and nonirritable infants.

Infantile colic is characterized by persistent crying, diminished soothability, and excessive activity or restlessness. The purpose of this study was to explore the processes underlying the persistent, recurrent irritability by investigating behavioral and interactional differences in irritable and nonirritable infants. In this two-group longitudinal study, 40 infants and their mothers were followed over the first 4 months of life. Statistically significant differences between the two groups were found, with the irritable infants demonstrating an increase in the amount and intensity of crying, more disruption in sleep-wake states, and less synchrony in mother-infant interaction.

Acoustic analysis of cries from "normal" and "irritable" infants.

Infant irritability or colic is characterized by recurrent episodes of persistent, unexplained crying. The lack of a precise definition of the type and amount of cry that distinguishes an infant as colicky has hampered research and intervention efforts. The primary aims of this study are to describe the acoustic characteristics of cries of irritable infants and compare these to those of normal infants. Tape recorded cries of 11 irritable and 11 non-irritable infants were compared. The average age for infants of both groups was 8 weeks. The cries of irritable infants were higher in jitter, shimmer, proportion of noise, and tenseness than were the cries of control infants. Findings suggest that colic or infant irritability is more than just excessive crying. Acoustic characteristics of the cries of irritable infants reveal an increase in stress-arousal that supports the thesis of a state regulation disorder. Characterizing the nature and origin of the cries of irritable infants is essential to an understanding that will eventually guide appropriate diagnosis and management of these infants.

Development of a system for monitoring infant state behavior.

The concept of infant state refers to patterns of behavior that comprise the sleep-wake cycle. The infant's ability to organize state behavior rhythmically is indicative of central nervous system maturation and predictive of later development. This article describes the development of a noninvasive, computerized infant monitoring system that can be used to categorize the infant's sleep-wake behavior into states. Development of the system occurred in two phases: In the first phase of the study, reliability and validity of the infant monitoring system for recording continuous behavioral and physiological data were assessed. These results were then used in the second phase to develop a rule-based computer program to interpret the signal data stored on a micro-diskette and to characterize the infant's state throughout the period of monitoring. The capability of computerized data collection and analysis of infant state behavior has expanded the application of this infant monitoring system. Its use as an investigative tool in clinical research is discussed.

Irritable infant syndrome: theoretical perspectives and practice implications.

Conceptually weak and unsubstantiated theories attempting to explain the origins of infant colic have led to inconsistent and ineffective approaches to the management of the infant with persistent crying. A new theoretical perspective that views excessive crying as a developmental behavioral disorder is presented. The clinical implications of this model for nurses working with families of irritable infants are discussed.

The impact of infant rooming-in on maternal sleep at night.

Two opposing issues in postpartum rooming-in are the benefits of continuous interaction and the threat of maternal sleep disruption. A two-group comparison study was designed to investigate differences in sleep patterns for a group of mothers who roomed-in with their infants at night as compared with a group who was separated from their infants at night. The data collected from the mothers in the study indicated that mothers did not sleep longer or better when their infants were returned to the nursery during the night.

Comparison of neonatal nighttime sleep-wake patterns in nursery versus rooming-in environments.

A two-group design was used to compare the state behavior of newborns who roomed-in with their mothers at night with those who were cared for by the traditional nursery-at-night method. Twenty-one full-term, low-risk newborns comprised the study sample. Data were collected using a sleep monitor bassinet for two consecutive nights after delivery. Comparison of the nursery environment with the mother's postpartum room at night revealed greater light and sound levels in the nursery setting. Regarding caregiving practices, rooming-in infants received more contact with the caregiver and care that was more often related to their state behavior. Infants in the mother's room had significantly, p less than .001, more quiet sleep (33% vs. 25.4%), less indeterminate (4.8% vs. 11.2%), and less crying (0.6% vs. 7.5%) states than infants who remained in the nursery.

The views of school principals and teachers on the role of the school nurse with handicapped students.

As part of recent program evaluation activities for the University of Colorado School Nurse Achievement Program, a questionnaire was distributed to a sample of school principals and teachers to obtain their views on the role of the school nurse with handicapped students. Generally, the respondents perceived this aspect of the school nurse's role as encompassing a variety of valuable activities; they tended to feel that certain activities (eg, writing the health component of the IEPs) should be carried out by school nurses more than they actually are; and they reported a myriad of unsolved problems and needs of handicapped students, many that could be dealt with by school nursing services if resources were available. Although the data were obtained from only a small and select group of principals and teachers, they help reveal how other school personnel view this increasingly important component of the school nurse's role and may provide some direction for future continuing education programs for school nurses as well as information-dissemination efforts for other school personnel.