The Surviving Crying study: progress report for the first stage of research.

The term 'infant colic' has been used to refer both to 'prolonged' infant crying (a measure of crying) and to parents'concern thatexcessive'crying is a sign that something is wrong with their baby. There is growing evidence that the terms need to be distinguished, so that the traditional focus on the crying is balanced by an equal focus on the impact of the crying on parents. The Surviving Crying study is a first step towards developing and evaluating routine NHS services to support parents who are worried about their baby's excessive crying. This report summarises the study's overall aims and methods and describes the first stage, designed to develop this parental support package. The package comprises a website, printed materials for parents who do not use the internet and a CBT-based programme manual for delivering direct one-to-one or small-group support sessions to parents. Stage two of the study, designed to provide an initial evaluation of the package and its suitability for use in the NHS, is underway. An email address exists for practitioners and researchers who wish to be kept informed.

Cólico del lactante: cuidados basados en la evidencia / Infant colic: evidence-based care

El cólico del lactante (CL) se considera una identidad frecuente y de carácter multifactorial. Es uno de los procesos que más angustia causa a los padres y cuyo tratamiento todavía no está consensuado. Objetivo: determinar la evidencia científica disponible sobre la efectividad de las medidas de tratamiento del cólico del lactante. Método: revisión bibliográfica a través de búsqueda en las bases de datos: Cochrane Database Reviews, Medline y Cinahl, de ensayos clínicos, revisiones sistemáticas y metanálisis sobre intervenciones de tratamiento del CL, utilizando y combinando los términos “infant”, “colic”, “etiology” y “treatment”.Resultados y conclusiones: fueron seleccionados 20 artículos. Los tratamientos identificados se pueden agrupar en intervenciones farmacológicas, a través de terapias manuales, conductuales y dietéticas. El tratamiento mediante medicamentos no es eficaz en el CL. Las modalidades terapéuticas con eficacia constatada han sido la aplicación de glucosa y sacarosa para el alivio de los síntomas y el uso de probióticos, sobre todo Lactobacillus reuteri, que disminuye la incidencia de cólico. El uso de terapias manuales, como la osteopatía craneal y vertebral, mejora la sintomatología. El tratamiento conductual y el asesoramiento a los padres también se ha considerado eficaz en el tratamiento del CL. No obstante, es necesaria más investigación para consensuar la evidencia del tratamiento eficaz del cólico del lactante (AU)

Infant Colic (IC) is considered a frequent occurrence with several causes involved. This is one of the processes which cause higher anxiety in parents, and no consensus has been reached yet in terms of its treatment. Objective: to determine the available scientific evidence about the efficacy of treatment measures for Infant Colic. Methodology: bibliographic review through search in the following databases: Cochrane Database Reviews, Medline and Cinahl, including clinical trials, systematic reviews and meta-analysis about IC treatment intervention, by using and combining the terms “infant”, “colic”, “etiology” and “treatment”. Results and conclusions: twenty articles were selected. Those treatments identified may be grouped into pharmacological interventions, and manual, behavioural and dietetic therapies. Treatment using medication is not effective for IC. Those therapeutic methods with proven efficacy have been: administration of glucose and sucrose for symptom relief, and use of probiotics, particularly Lactobacillus reuteri, which reduces the incidence of colic. The use of manual therapies, such as cranial and vertebral osteopathy, improves the symptomatology. Behavioral treatment and counse ling for parents has also been considered effective in IC treatment. However, more research is required in order to reach a consensus in terms of the evidence for effective treatment of infant colic (AU)

Examination of the effect of BornFree ActiveFlow baby bottles on infant colic.

Despite its benign, natural course, colic is a significant problem in babies and imparts a psychological and physical burden to parents. This study has examined the relief of colic symptoms when using BornFree ActiveFlow baby bottles by comparing observed symptoms of 30 otherwise healthy newborns (ages 2-21 weeks) who had all been diagnosed as having colic symptoms. Twenty of the babies were switched to feeding with BornFree bottles (the experimental group), while the other 10 babies continued feeding with bottles by other manufacturers (the control group). A significant improvement was exhibited in the experimental group after 1 week of feeding with BornFree bottles, with a further significant improvement in the second week. Although they had different venting systems, the control group maintained the same level of colic symptoms as in the beginning of the study. We conclude that using BornFree baby bottles can effectively reduce colic symptoms in diagnosed babies.

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.

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.

Reducing parenting stress in families with irritable infants.

BACKGROUND: Caring for an infant with unexplained, persistent crying is one of the most stressful events for new parents. Infant irritability, also referred to as infantile colic, occurs in 10-25% of all infants and is the most common parental concern reported in the first year of life. OBJECTIVE: The aim of this study was to evaluate the effectiveness of a home-based nursing intervention in reducing parenting stress in three groups of families with irritable infants, using data from a larger evaluation study. METHODS: A two-site, randomized clinical trial was conducted with 121 infants and their parents. Infants were randomized to a treatment or a control group. A third group of infants (n = 43) was added as a posttest-only comparison. The level of parenting stress was measured by the Parenting Stress Index (PSI) at baseline, after the 4-week intervention, and at the 8-week follow-up visit. RESULTS: A repeated measures analysis of variance (ANOVA) was used to compare the two groups across the three time points (baseline, immediately after the 4-week intervention, and at the 8-week follow-up visit). The results revealed a reduction in total parenting stress over time for both the treatment and control groups. Mothers in the treatment group reported reduced parenting stress on the parent-child dysfunctional interaction subscale (p = .04). Total parenting stress scores were found to be significantly higher for mothers in the posttest-only group (p = .009). CONCLUSION: Initial parenting stress levels were high in all participants. Parent feedback at the exit interview indicated that the nurse visits for data collection were also viewed as helpful in reducing the stress level associated with parenting these irritable infants. This home-based program was perceived as helpful in improving the interactions between parents and their irritable infants.

Effectiveness of an intervention for colic.

An intervention for infant irritability or colic was evaluated in a randomized clinical trial. A total of 121 full-term irritable infants (2 to 6 weeks old) were randomized to routine care or the home-based intervention program. A third group (n=43) of irritable infants were entered into a post-test-only group. Following the 4-week intervention, the treatment group infants cried 1.7 hours less per day than the infants in the control group (p=0.02). The findings support the emerging view of infant colic as a behavioral pattern that is responsive to environmental modification and structured cue-based care.

Parental perceptions of the lasting effects of infant colic.

PURPOSE: To describe the experience of families with previously colicky infants. STUDY DESIGN: This qualitative, descriptive study explored parents' perspectives of the lasting effects of infant colic on their children's development and on their family relationships. METHODS: Through in-depth interviews, the parents had the opportunity to share what they remembered most about this experience. Participants volunteered by accessing the Infant Colic Study Web site advertised on numerous search engines. Forty-four participants, all of whom had an infant with colic at some time in the past, answered open-ended questions regarding their feelings about the colicky period and how their children developed later. Data were analyzed from a phenomenologic perspective. RESULTS: The majority of participants reported no later problems in their previously colicky children. Some did believe, however, that family relationships had been affected by the colic experience, and that communication and support had been impaired. Most described feelings about the colic experience that were negative. CLINICAL IMPLICATIONS: Continued support needs to be provided to families of colicky infants throughout their growth and development at a primary care level. Nurses need to recognize that the experience of infant colic may have residual effects on the entire family unit. These families need to be provided with the support and resources to enable them to successfully care for their children and to engage in nurturing relationships.

Feasibility of using kangaroo (skin-to-skin) care with colicky infants.

Infant colic affects about 20% of all infants and the cause remains elusive. Healthcare providers typically view infant colic as a minor inconvenience that is harmless to the thriving infant and will go away with time; however, parents view caring for a colicky infant as a crisis situation. The purpose of this feasibility study conducted via the internet was to examine the feasibility of implementing kangaroo care at the beginning of colicky episodes. Mothers of colicky infants began the study by completing the on-line Infant Colic Scale and recording in a baseline state-of-arousal diary for 3 days. Next, they implemented kangaroo care at the beginning of as many episodes of colic as possible for 2 weeks while recording in a second state-of-arousal diary. Then, they stopped kangaroo care for 2 days while continuing to record in the second state-of-arousal diary, and lastly they were asked how kangaroo care worked for them.Seventy-five parents of colicky infants consented to participate in this study; however, only five of them actually did. Three of these completed only the baseline state-of-arousal diary, and two completed all parts of the study. This dropout rate showed that conducting such an intervention via the internet is not a feasible approach. Because kangaroo care for infants with colic is a promising intervention and because there are no other effective treatments for most of these infants, another feasibility study is warranted using different methods. Then if results are promising, a larger clinical trial should be conducted.

Development and psychometric testing of the infant colic scale.

Novice researchers, when confronted with a clinical problem they want to study, are admonished by more experienced researchers to search the literature for an instrument that already has established reliability and validity, fits the problem of study, or that can be easily adapted. Sometimes, however, there is no such instrument available so the researcher has to develop a new instrument. The purpose of this article is to describe the steps required to develop and psychometrically test a new instrument. A new instrument, the Infant Colic Scale, is used as an example.

Infants with colic: their childhood characteristics.

The purpose of this study was to compare 40 six- to eight-year-old children, 20 with prospectively ascertained infantile colic and a matched sample of 20 without colic, on characteristics of emotional regulation and on parent stress. Children completed tests of cognitive ability, and mothers completed childhood behavioral questionnaires and a parenting stress assessment. Children with colic had maternal ratings suggestive of more difficulty with emotional regulation than their noncolic matches and displayed a more impulsive cognitive style. However, the mean scores of both groups were in the normal range.

Help in times of crying: nurses' approach to parents with colicky infants.

BACKGROUND: Colic, a condition that is well known to parents and nurses working in child health centres, is characterized by excessive crying. However, the criteria for defining colic are vague, there is no agreed definition and no effective treatment exists. Even though there is no cure for colic, nurses in child health centres have to deal with the condition as parents bring their crying infants to them. AIM: To develop an understanding of how nurses deal with infant colic/excessive crying, how the parents perceive nurses' contribution, and whether nursing makes a difference to the situation or not. ETHICAL ISSUES AND APPROVAL: The project was reviewed and approved by the Research Ethics Committee in Norway where the study was carried out. METHODS: The design is explorative, and data were collected through qualitative in-depth interviews with nurses and parents of crying infants. The analysis follows the guidelines of Kvale, which imply a phenomenological/hermeneutical mode of understanding. FINDINGS: The primary aim of nursing is to assist parents in their efforts to cope with the challenges of infant colic. Nurses and parents differ to some extent in how they define the problems and the needs of the families. In addition, both parents and nurses question the nurses' knowledge and ability to help in this situation. A relationship with the parents based on trust is fundamental to enable the nurses to achieve their goals, but such a relationship is not always developed. CONCLUSIONS: Even though nursing interventions do not cure infant colic, the amount of crying may be reduced and life made easier for the families if the parents are offered help in coping with the situation. Consequently, this should be the primary aim of nursing when approaching families with a colicky infant.

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