Search

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., (© 2024 Michigan Association for Infant Mental Health.)

Purpose: To investigate the observation that perpetrators of abusive head trauma engage in repeated shakings because shaking "works" to quiet the infant., Methods: Sixty first-time parent couples individually cared for a programmable model infant in two consecutive 7-min trials. After six minutes of consolable followed by inconsolable crying, parents selected one of three soothing techniques. For trial one, parents were randomized to a "Successful" or "Failed" Soothing Condition. Whether the soothing technique was repeated after trial two was determined by the study investigators. Parents rated their frustration after each trial., Results: As hypothesized, parents were more likely to repeat a soothing technique that "worked" in trial one. Compared to fathers, mothers reported more frustration when soothing failed., Conclusions: That caregivers were more likely to repeat a successful soothing technique converges with perpetrator confessions that crying cessation after shaking may be a reason why shaking is used repeatedly in response to crying., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Background: Unwanted intrusive thoughts of intentionally harming one's infant (intrusive harm thoughts) are common distressing experiences among postpartum mothers and fathers., Aim: To understand infant crying as a stimulus for intrusive harm thoughts and associated emotional responses in prepartum and postpartum mothers and fathers in response to infant cry., Method: Following completion of self-report measures of negative mood and anger, prepartum (n = 48) and postpartum (n = 44) samples of mother and father pairs completed 10 minutes of listening to audio-recorded infant crying. Post-test questionnaires assessed harm thoughts, negative emotions, urges to comfort and flee, and thoughts of shaking as a soothing or coping strategy., Results: One quarter of prepartum and 44% of postpartum parents reported intrusive infant-related harm thoughts following crying. Mothers and fathers did not differ in the likelihood of reporting harm thoughts, nor in the number of thoughts reported. Women reported more internalizing emotions compared with men. Hostile emotions were stronger among postpartum parents, and parents reporting harm thoughts. All parents reported strong urges to comfort the infant. Urges to flee were stronger among parents who reported harm thoughts. The likelihood of using infant shaking as a soothing or coping strategy was minimally endorsed, albeit more strongly by fathers and parents who also reported harm thoughts., Conclusions: In response to crying, harm thoughts are common and are associated with hostile emotions, urges to flee, and increased thoughts of using infant shaking. Reassuringly, the number of participants considering infant shaking as a strategy for soothing or for coping with a crying infant was low.

Crying is the principal means by which newborn infants shape parental behavior to meet their needs. While this mechanism can be highly effective, infant crying can also be an aversive stimulus that leads to parental frustration and even abuse. Fathers have recently become more involved in direct caregiving activities in modern, developed nations, and fathers are more likely than mothers to physically abuse infants. In this study, we attempt to explain variation in the neural response to infant crying among human fathers, with the hope of identifying factors that are associated with a more or less sensitive response. We imaged brain function in 39 first-time fathers of newborn infants as they listened to both their own and a standardized unknown infant cry stimulus, as well as auditory control stimuli, and evaluated whether these neural responses were correlated with measured characteristics of fathers and infants that were hypothesized to modulate these responses. Fathers also provided subjective ratings of each cry stimulus on multiple dimensions. Fathers showed widespread activation to both own and unknown infant cries in neural systems involved in empathy and approach motivation. There was no significant difference in the neural response to the own vs. unknown infant cry, and many fathers were unable to distinguish between the two cries. Comparison of these results with previous studies in mothers revealed a high degree of similarity between first-time fathers and first-time mothers in the pattern of neural activation to newborn infant cries. Further comparisons suggested that younger infant age was associated with stronger paternal neural responses, perhaps due to hormonal or novelty effects. In our sample, older fathers found infant cries less aversive and had an attenuated response to infant crying in both the dorsal anterior cingulate cortex (dACC) and the anterior insula, suggesting that compared with younger fathers, older fathers may be better able to avoid the distress associated with empathic over-arousal in response to infant cries. A principal components analysis revealed that fathers with more negative emotional reactions to the unknown infant cry showed decreased activation in the thalamus and caudate nucleus, regions expected to promote positive parental behaviors, as well as increased activation in the hypothalamus and dorsal ACC, again suggesting that empathic over-arousal might result in negative emotional reactions to infant crying. In sum, our findings suggest that infant age, paternal age and paternal emotional reactions to infant crying all modulate the neural response of fathers to infant crying. By identifying neural correlates of variation in paternal subjective reactions to infant crying, these findings help lay the groundwork for evaluating the effectiveness of interventions designed to increase paternal sensitivity and compassion., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Ninety-eight mothers of healthy firstborn infants 0 to 6 months old were randomly assigned to listen to 10-min of infant crying or infant cooing while continuously rating subjective feelings of frustration. Participants completed pre-test measures of depressed mood, empathy, and trait anger and post-test measures of infant-related harm thoughts, negative and positive emotions, and urge to comfort and to flee. Twenty-three (23.5 %) participants endorsed unwanted thoughts of active harm (e.g., throwing, yelling at, shaking the infant). Women in the cry condition were more likely than women in the coo condition to report thoughts of harm. Women in the cry condition who endorsed thoughts of harm reported higher frustration levels over the 10 min of crying, higher levels of post-test negative emotions, and stronger urges to flee the infant but not stronger urges to comfort the infant. Trait anger and personal distress empathy predicted the occurrence of unwanted thoughts of infant harm, whereas negative mood did not. Unwanted, intrusive, infant-related thoughts of harm may be triggered by prolonged infant crying, are predicted by personal distress empathy and a tendency to experience anger, and are associated with higher frustration, negative emotions, and the urge to escape the infant.

Objective: The primary aim of this study was to determine whether there was any change in visits of 0- to 5-month old infants to the medical emergency room (MER) of a metropolitan pediatric hospital after province-wide implementation of a public health prevention program that teaches new parents about the properties of early crying in normal infants., Methods: Free-text descriptions of Presenting Complaint and Final Diagnosis on electronic MER clinic visit files were used to classify infants as cases of infant crying not due to disease. Annual crying case visits as a percent of MER visits were analyzed pre- and post-introduction of the prevention program., Results: Before the program, crying case visits represented 724 of 20,394 MER visits (3.5%). The age-specific pattern of MER visits for crying peaked at 6 weeks and was similar to the previously reported age-specific pattern of amounts of crying in the community. After program implementation, crying cases were reduced by 29.5% (p < .001). The most significant reductions were for crying visits in the first to third months of life., Conclusion: The findings imply that improved parental knowledge of the characteristics of normal crying secondary to a public health program may reduce MER use for crying complaints in the early months of life.

The devastating and for the most part irremediable consequences for an infant, his or her family, and society in cases of abusive head trauma have spurred research into ways of preventing it. In the last four or five decades, increasing interest in infant crying and its clinical manifestation of colic has led to a reconceptualization of crying in early infancy, such that most of the characteristics of colic can be understood as manifestations of the crying typical of normal infants. This includes an early increase and then decrease in the amount of crying, the unexpected and unpredictable appearance of prolonged crying bouts, and the presence of inconsolable crying that occurs in the early months of life. When these concepts are merged with anecdotal clinical experiences, perpetrator confessions and epidemiological evidence of abusive head trauma, it is clear that these crying characteristics--and caregiver responses--are the predominant, and potentially modifiable, risk factors for abusive head trauma. This unfortunate but understandable relationship between early crying, shaking and abuse has opened windows of opportunity for primary, universal prevention efforts that are appropriate for--and support--all parents and may be able to prevent at least some of these tragic cases.

Prolonged inconsolable crying bouts in the first months of life are frustrating to parents and may lead to abuse. There is no empirical description of frustration trajectories during prolonged crying, nor of their emotional predictors or emotional and behavioural sequelae. Frustration responses and their relationships were explored in an analogue cry listening paradigm. Without knowing how long it would last, 111 postpartum mothers were randomized to listen to a 10-min audiotape of infant crying or cooing while continuously recording frustration on a visual analogue 'slider' scale. The listening bout was preceded by questionnaires on negative mood, trait anger and empathy and followed by questionnaires on the reality of the cry sound, positive and negative emotions, soothing strategies, coping strategies and urges to comfort and flee. Individual frustration trajectories were modelled parametrically and characterized by frustration maximum, rate of rise, inflections and harmonicity parameters. As hypothesized, the modal response was of gradually increasing frustration throughout. However, there were marked individual differences in frustration trajectories. Negative mood, trait anger and empathy did not predict modal or modelled individual trajectories. However, frustration responses were significantly related to post-listening emotions and behavioural ratings. In particular, prolonged crying generated highly ambivalent positive and negative emotional responses. In summary, maternal frustration generally increased as the crying bout progressed; however, frustration trajectories were highly individual and emotional responses were highly ambivalent in terms of positive and negative emotions generated. Some emotional and behavioural responses were associated with specific trajectory parameters of frustration responses., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Objective: To quantify the extent to which maternal report of inconsolable infant crying, rather than colic (defined by Wessel's criteria of daily duration of fussing and crying >3 hours), is associated with maternal postpartum depressive symptoms., Methods: Participants were 587 mothers who were recruited shortly before or after delivery and followed longitudinally. At 5 to 6 weeks postpartum, mothers recorded the duration and mode (fussing, crying, or inconsolable crying) of their infant's distress by using the Baby's Day Diary. The Edinburgh Postnatal Depression Scale (EPDS) was administered at enrollment and at 8 weeks postpartum. Using regression models that included baseline EPDS scores and multiple confounders, we examined associations of colic and inconsolable crying with later maternal EPDS scores at 8 weeks postpartum., Results: Sixty mothers (10%) met the EPDS threshold for "possible depression" (score ≥9) at 8 weeks postpartum. For mothers reporting >20 minutes of inconsolable crying per day, the adjusted odds ratio for an EPDS score ≥9 was 4.0 (95% confidence interval: 2.0-8.1), whereas the adjusted odds ratio for possible depression in mothers whose infants had colic was 2.0 (95% confidence interval: 1.1-3.7). These associations persisted after adjusting for baseline depression symptoms., Conclusions: Maternal report of inconsolable infant crying may have a stronger association with postpartum depressive symptoms than infant colic. Asking a mother about her ability to soothe her infant may be more relevant for potential intervention than questions about crying and fussing duration alone.

Objectives: Infant crying is particularly frustrating to caregivers in the first few months of life and the most common trigger for shaking and abuse. The effectiveness of the Period of PURPLE Crying prevention materials (DVD and booklet) designed to increase knowledge and change behaviors related to crying and the dangers of shaking was reported in North America. The aim of this study was to replicate the effectiveness of the PURPLE materials with mothers of newborns in Japan., Methods: In a randomized controlled trial, 201 parents received either PURPLE materials or analogous control materials on infant safety via mail within 2 weeks of birth. At 6 weeks, mothers completed a 4-day behavioral diary. At 2 months, participants completed a predefined 20-min structured telephone survey by an independent firm to assess knowledge and behavior., Results: Scores on crying knowledge scales (out of 100) were significantly higher in the intervention than control groups (56.1 vs. 53.1; difference=3.0, 95% confidence interval [CI]: 1.0-4.9, p<0.005). Percentage of sharing of advice to walk away if frustrated by crying was significantly higher in the intervention than control groups (22.4% vs. 4.1%; difference=18%, 95% CI: 7.4-29.1). Walking away during unsoothable crying was significantly higher in the intervention group than controls (0.085 vs. 0.017 events per day, rate ratio=4.8, 95% CI: 1.1-21.2) by diary. Self-talk behavior scale (out of 100) tended to significance in the intervention group (16.6 vs. 8.9, difference=7.7, 95% CI: -1.0 to 16.4, p<0.1)., Conclusions: Crying knowledge, sharing of walk away information with others and walk away behavior when crying was unsoothable were higher for those who received intervention than control materials. The Period of PURPLE Crying materials may be useful in Japan as well as in North America for informing caregivers about the properties of infant crying and changing some behaviors related to infant crying and shaking. (UMIN Clinical Trials Registry register no. UMIN000001711.)., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Objective: To investigate the differential association of three modes (fussing, crying, unsoothable crying) and three properties (duration/day, frequency/day, maximum bout length) of infant distress with daily caregiver frustration., Study Design: Replicated cross-sectional studies were completed in Vancouver, British Columbia (n = 1065) and Seattle, Washington (n = 1857). Infant fussing, crying, and unsoothable crying and caregiver frustration were measured daily for 4 days at 5 weeks of age by the Baby's Day Diary. Generalized estimating equation models were used to predict caregiver frustration from nine measurements of distress., Results: In Vancouver, measurements of distress significantly associated with caregiver frustration in decreasing order of magnitude were as follow: (1) maximum bout length of unsoothable crying; (2) duration/day of crying; and (3) frequency of unsoothable crying and duration/day of fussing. In Seattle, associated measurements of distress were: (1) maximum bout length of unsoothable crying; (2) maximum bout length and duration/day of crying, frequency of unsoothable crying, and duration/day of fussing; and (3) frequency/day of crying., Conclusions: Daily caregiver frustration is associated differentially with different modes and properties of infant distress. Specifically, maximum bout length of unsoothable crying was most strongly related in both sites. Additionally, frequency/day of unsoothable crying and duration/day of crying and of fussing were significantly associated at both sites., (Copyright © 2011 Mosby, Inc. All rights reserved.)

Background: Shaken baby syndrome often occurs after shaking in response to crying bouts. We questioned whether the use of the educational materials from the Period of PURPLE Crying program would change maternal knowledge and behaviour related to shaking., Methods: We performed a randomized controlled trial in which 1279 mothers received materials from the Period of PURPLE Crying program or control materials during a home visit by a nurse by 2 weeks after the birth of their child. At 5 weeks, the mothers completed a diary to record their behaviour and their infants' behaviour. Two months after giving birth, the mothers completed a telephone survey to assess their knowledge and behaviour., Results: The mean score (range 0-100 points) for knowledge about infant crying was greater among mothers who received the PURPLE materials (63.8 points) than among mothers who received the control materials (58.4 points) (difference 5.4 points, 95% confidence interval [CI] 4.1 to 6.5 points). The mean scores were similar for both groups for shaking knowledge and reported maternal responses to crying, inconsolable crying and self-talk responses. Compared with mothers who received control materials, mothers who received the PURPLE materials reported sharing information about walking away if frustrated more often (51.5% v. 38.5%, difference 13.0%, 95% CI 6.9% to 19.2%), the dangers of shaking (49.3% v. 36.4%, difference 12.9%, 95% CI 6.8% to 19.0%), and infant crying (67.6% v. 60.0%, difference 7.6%, 95% CI 1.7% to 13.5%). Walking away during inconsolable crying was significantly higher among mothers who received the PURPLE materials than among those who received control materials (0.067 v. 0.039 events per day, rate ratio 1.7, 95% CI 1.1 to 2.6)., Interpretation: The receipt of the Period of PURPLE Crying materials led to higher maternal scores for knowledge about infant crying and for some behaviours considered to be important for the prevention of shaking.

Background: Infant crying is an important precipitant for shaken-infant syndrome. OBJECTIVE. To determine if parent education materials (The Period of PURPLE Crying [PURPLE]) change maternal knowledge and behavior relevant to infant shaking., Methods: This study was a randomized, controlled trial conducted in prenatal classes, maternity wards, and pediatric practices. There were 1374 mothers of newborns randomly assigned to the PURPLE intervention and 1364 mothers to the control group. Primary outcomes were measured by telephone 2 months after delivery. These included 2 knowledge scales about crying and the dangers of shaking; 3 scales about behavioral responses to crying generally and to unsoothable crying, and caregiver self-talk in response to unsoothable crying; and 3 questions concerning the behaviors of sharing of information with others about crying, walking away if frustrated, and the dangers of shaking., Results: The mean infant crying knowledge score was greater in the intervention group (69.5) compared with controls (63.3). Mean shaking knowledge was greater for intervention subjects (84.8) compared with controls (83.5). For reported maternal behavioral responses to crying generally, responses to unsoothable crying, and for self-talk responses, mean scores for intervention mothers were similar to those for controls. For the behaviors of information sharing, more intervention mothers reported sharing information about walking away if frustrated and the dangers of shaking, but there was little difference in sharing information about infant crying. Intervention mothers also reported increased infant distress., Conclusions: Use of the PURPLE education materials seem to lead to higher scores in knowledge about early infant crying and the dangers of shaking, and in sharing of information behaviors considered to be important for the prevention of shaking.

The objective of this study is to determine whether advice in parenting magazines reflects current evidence-based understanding of early infant crying and colic, where (1) "colic" is the upper end of a spectrum of crying behavior reflective of normal infant development, and (2) physical abuse--in particular, shaken baby syndrome (SBS)--is a serious medical consequence of early crying. All available issues of 11 popular Canadian parenting magazines published between January 2000 and December 2004 were hand-searched and systematically reviewed. Fifty-one articles were found with information on: (1) causes of, (2) responses to, and/or (3) mention of SBS or abuse as a consequence of crying and/or colic. There were 105 specific causes suggested, but almost no agreement concerning the causes of crying and colic. Similarly, there were 231 specific responses to crying and colic mentioned, but little agreement among the suggested responses. For both crying and colic together, the consequence of abuse was mentioned only 7 times, and SBS only twice. Making the advice literature a truly helpful vehicle for parents concerning normal behavioral development and its consequences for their new infant seems to be a significant challenge. Arguably, this is an important shared responsibility of physicians, researchers, and journalists.

Objective: : This study aims to determine whether the age-specific incidences (1) of publicly reported cases of shaken baby syndrome (SBS) and (2) of publicly reported cases of SBS with crying as the stimulus have similar properties to the previously reported normal crying curve., Methods: : The study reports cases of SBS by age of the child at the time of the inflicted trauma from the data set of the National Center on Shaken Baby Syndrome using cases entered between January 1, 2003 and August 31, 2004., Results: : There were 591 cases of infants up to 1.5 years of age who had been reported to have been shaken or shaken and physically abused. Of these, crying was reported as the stimulus in 166 cases. In both samples, the curves of age-specific incidence started at 2-3 weeks, reached a clear peak at about 9-12 weeks of age, and declined to lower more stable levels by about 29-32 weeks of age, similar to the normal crying curve. These curves have similar onsets and shapes and a slightly later peak compared to the normal crying curve., Conclusions: : The findings provide convergent indirect evidence that crying, especially in the first 4 months of age, is an important stimulus for SBS.

Objective: To determine whether there is an age-specific incidence of hospitalized cases of Shaken Baby Syndrome (SBS) that has similar properties to the previously reported "normal crying curve," as a form of indirect evidence that crying is an important stimulus for SBS., Design and Setting: The study analyzed cases of Shaken Baby Syndrome by age at hospitalization from hospital discharge data for California hospitals from October 1996 through December 2000., Patients: All cases of children less than 18 months (78 weeks) of age for whom the diagnostic code for Shaken Baby Syndrome (995.55) in the International Classification of Disease, Ninth Edition, Clinical Modification was assigned., Results: There were 273 hospitalizations for SBS. Like the "normal crying curve," the curve of age-specific incidence starts at 2-3 weeks, has a clear peak, and declines to baseline by about 36 weeks of age. In contrast to the normal crying curve that peaks at 5-6 weeks, the peak of SBS hospitalizations occurs at 10-13 weeks., Conclusions: The age-specific incidence curve of hospitalized SBS cases has a similar starting point and shape to the previously reported normal crying curve but the peak occurs about 4-6 weeks later. Of the likely predisposing causes, this pattern is only consistent with the properties of early crying. There are numerous explanations for the lag in the peaks between crying and SBS hospitalizations, including the possibility of repeat shakings prior to hospitalization. The importance of crying as a stimulus to SBS may provide an opportunity for preventive intervention.

ABSTRACT.: The authors sought to determine which features of early distress were "excessive" and specific to the first months of life as described by diary recordings. In a short-term, longitudinal, controlled study, total daily amount, frequency, and bout duration of fussing, crying, and unsoothable crying were derived from validated diaries kept by parents of infants with and without diary-defined colic at 6 weeks and 5 months recruited from primary pediatrics practices. By definition, infants with colic demonstrated more distress at 6 weeks, but they also had a much greater reduction in distress by 5 months and more distress during the fifth month. However, bout frequencies and bout durations showed different patterns. Bout duration was longer for the colic group only at 6 weeks; the difference completely disappeared by 5 months. Bout frequency was higher for the colic group at 6 weeks and 5 months, but the reduction across ages was similar in infants with and without colic. These patterns were true for all distress modalities (fussing, crying, and unsoothable crying). Unsoothable crying was present in significant amounts only at 6 weeks but virtually disappeared by 5 months. The authors conclude that prolonged distress bouts and unsoothable crying are specific to the first few months and more common, though not unique, in infants with colic. This implies that our understanding of colic may depend more on why these infants cry longer once started than what makes infants cry. These features of parental experience may be important in preventive efforts to reduce negative impacts of early increased crying such as shaken baby syndrome.

Objectives: Infant crying is particularly frustrating to caregivers in the first few months of life and the most common trigger for shaking and abuse. The effectiveness of the "Period of PURPLE Crying" prevention materials (DVD and booklet) designed to increase knowledge and change behaviors related to crying and the dangers of shaking was reported in North America. The aim of this study was to replicate the effectiveness of the "PURPLE" materials with mothers of newborns in Japan. Methods: In a randomized controlled trial, 201 parents received either "PURPLE" materials or analogous control materials on infant safety via mail within 2 weeks of birth. At 6 weeks, mothers completed a 4-day behavioral diary. At 2 months, participants completed a predefined 20-min structured telephone survey by an independent firm to assess knowledge and behavior. Results: Scores on crying knowledge scales (out of 100) were significantly higher in the intervention than control groups (56.1 vs. 53.1; difference = 3.0, 95% confidence interval [CI]: 1.0-4.9, p less than 0.005). Percentage of sharing of advice to walk away if frustrated by crying was significantly higher in the intervention than control groups (22.4% vs. 4.1%; difference = 18%, 95% CI: 7.4-29.1). Walking away during unsoothable crying was significantly higher in the intervention group than controls (0.085 vs. 0.017 events per day, rate ratio = 4.8, 95% CI: 1.1-21.2) by diary. Self-talk behavior scale (out of 100) tended to significance in the intervention group (16.6 vs. 8.9, difference = 7.7, 95% CI: -1.0 to 16.4, p less than 0.1). Conclusions: Crying knowledge, sharing of walk away information with others and walk away behavior when crying was unsoothable were higher for those who received intervention than control materials. The "Period of PURPLE Crying" materials may be useful in Japan as well as in North America for informing caregivers about the properties of infant crying and changing some behaviors related to infant crying and shaking. (UMIN Clinical Trials Registry register no. UMIN000001711.) (Contains 5 tables and 1 figure.)

Objective: To determine whether there is an age-specific incidence of hospitalized cases of Shaken Baby Syndrome (SBS) that has similar properties to the previously reported ''normal crying curve,'' as a form of indirect evidence that crying is an important stimulus for SBS. Design and setting: The study analyzed cases of Shaken Baby Syndrome by age at hospitalization from hospital discharge data for California hospitals from October 1996 through December 2000. Patients: All cases of children less than 18 months (78 weeks) of age for whom the diagnostic code for Shaken Baby Syndrome (995.55) in the International Classification of Disease, Ninth Edition, Clinical Modification was assigned. Results: There were 273 hospitalizations for SBS. Like the ''normal crying curve,'' the curve of age-specific incidence starts at 2-3 weeks, has a clear peak, and declines to baseline by about 36 weeks of age. In contrast to the normal crying curve that peaks at 5-6 weeks, the peak of SBS hospitalizations occurs at 10-13 weeks. Conclusions: The age-specific incidence curve of hospitalized SBS cases has a similar starting point and shape to the previously reported normal crying curve but the peak occurs about 4-6 weeks later. Of the likely predisposing causes, this pattern is only consistent with the properties of early crying. There are numerous explanations for the lag in the peaks between crying and SBS hospitalizations, including the possibility of repeat shakings prior to hospitalization. The importance of crying as a stimulus to SBS may provide an opportunity for preventive intervention.

Examined behavioral/physiological responses of 2-month-olds during physical examinations. Found that colic infants cried twice as much, cried more intensely, and were more inconsolable than control infants. Heart rate, vagal tone, and cortisol measures showed no appreciable difference. At home, colic infants displayed a blunted rhythm in cortisol production and slept about 2 hours less than control infants. (Author/KB)

Conducted spectrum analysis of standard and vociferous cries from infants with Wessel's colic, non-Wessel's colic, and comparison infants. Vociferous cries had longer duration, higher fundamental frequency, and greater percentage of dysphonation than standard cries. After feedings, problematic criers had greater percentage of dysphonation in vociferous cries than comparison infants, and Wessel's colic infants had higher dominant frequencies than others. (Author/KB)

Abstract Background Infant colic, characterised by excessive crying/fussing for no apparent cause, affects up to 20% of infants under three months of age and is a great burden to families, health professionals and the health system. One promising approach to improving its management is the use of oral probiotics. The Baby Biotics trial aims to determine whether the probiotic Lactobacillus reuteri DSM 17938 is effective in reducing crying in infants less than three months old ( Methods/Design Design: Double-blind, placebo-controlled randomised trial in Melbourne, Australia. Participants: 160 breast and formula fed infants less than three months old who present either to clinical or community services and meet Wessel’s criteria of crying and/or fussing. Intervention: Oral once-daily Lactobacillus reuteri (1x108 cfu) versus placebo for one month. Primary outcome: Infant crying/fussing time per 24 hours at one month. Secondary outcomes: i) number of episodes of infant crying/fussing per 24 hours and ii) infant sleep duration per 24 hours (at 7, 14, 21, 28 days and 6 months); iii) maternal mental health scores, iv) family functioning scores, v) parent quality adjusted life years scores, and vi) intervention cost-effectiveness (at one and six months); and vii) infant faecal microbiota diversity, viii) infant faecal calprotectin levels and ix) Eschericia coli load (at one month only). Analysis: Primary and secondary outcomes for the intervention versus control groups will be compared with t tests and non-parametric tests for continuous data and chi squared tests for dichotomous data. Regression models will be used to adjust for potential confounding factors. Intention-to-treat analysis will be applied. Discussion An effective, practical and acceptable intervention for infant colic would represent a major clinical advance. Because our trial includes breast and formula-fed babies, our results should generalise to most babies with colic. If cost-effective, the intervention’s simplicity is such that it could be widely taken up as a new standard of care in the primary and secondary care sectors. Trial Registration Current Controlled Trials ISRCTN95287767

Abstract Low incidence rates and economic recession have hampered interpretation of educational prevention efforts to reduce abusive head trauma (AHT). Our objective was to determine whether the British Columbia experience implementing a province-wide prevention program reduced AHT hospitalization rates. A 3-dose primary, universal education program (the Period of PURPLE Crying ) was implemented through maternal and public health units and assessed by retrospective-prospective surveillance. With parents of all newborn infants born between January 2009 and December 2016 (n = 354,477), nurses discussed crying and shaking while delivering a booklet and DVD during maternity admission (dose 1). Public health nurses reinforced Talking Points by telephone and/or home visits post-discharge (dose 2) and community education was instituted annually (dose 3). During admission, program delivery occurred for 90% of mothers. Fathers were present 74.4% of the time. By 2–4 months, 70.9% of mothers and 50.5% of fathers watched the DVD and/or read the booklet. AHT admissions decreased for <12-month-olds from 10.6 (95% CI: 8.3–13.5) to 7.1 (95% CI: 4.8–10.5) or, for <24-month-olds, from 6.7 (95% CI: 5.4–8.3) to 4.4 (95% CI: 3.1–6.2) cases per 100,000 person-years. Relative risk of admission was 0.67 (95% CI: 0.42–1.07, P = 0.090) and 0.65 (95% CI: 0.43-0.99, P = 0.048) respectively. We conclude that the intervention was associated with a 35% reduction in infant AHT admissions that was significant for <24-month-olds. The results are encouraging that, despite a low initial incidence and economic recession, reductions in AHT may be achievable with a system-wide implementation of a comprehensive parental education prevention program. [ABSTRACT FROM AUTHOR]

Background: Shaken baby syndrome often occurs after shaking in response to crying bouts. We questioned whether the use of the educational materials from the Period of PURPLE Crying program would change maternal knowledge and behaviour related to shaking. Methods: We performed a randomized controlled trial in which 1279 mothers received materials from the Period of PURPLE Crying program or control materials during a home visit by a nurse by 2 weeks after the birth of their child. At 5 weeks, the mothers completed a diary to record their behaviour and their infants' behaviour. Two months after giving birth, the mothers completed a telephone survey to assess their knowledge and behaviour. Results: The mean score (range 0-100 points) for knowledge about infant crying was greater among mothers who received the PURPLE materials (63.8 points) than among mothers who received the control materials (58.4 points) (difference 5.4 points, 95% confidence interval [CI] 4.1 to 6.5 points). The mean scores were similar for both groups for shaking knowledge and reported maternal responses to crying, inconsolable crying and self-talk responses. Compared with mothers who received control materials, mothers who received the PURPLE materials reported sharing information about walking away if frustrated more often (51.5% v. 38.5%, difference 13.0%, 95% CI 6.9% to 19.2%), the dangers of shaking (49.3% v. 36.4%, difference 12.9%, 95% CI 6.8% to 19.0%), and infant crying (67.6% v. 60.0%, difference 7.6%, 95% CI 1.7% to 13.5%). Walking away during inconsolable crying was significantly higher among mothers who received the PURPLE materials than among those who received control materials (0.067 v. 0.039 events per day, rate ratio 1.7, 95% CI 1.1 to 2.6). Interpretation: The receipt of the Period of PURPLE Crying materials led to higher maternal scores for knowledge about infant crying and for some behaviours considered to be important for the prevention of shaking. (Clinical- Trials.gov trial register no. NCT00175422.) [ABSTRACT FROM AUTHOR]

Abstract. In industrialized societies, the unique pattern of crying in the first three months is "unexplained" but thought to be due to different biobehavioral factors from later crying behavior. To increase the range of the feeding and caretaking behaviors hypothesized to be relevant determinants of early crying? home observations and diary records were analyzed from samples of two subcultures of American middle-class women (La Leche League and "standard care" mothers; each n = 16) differing primarily in such practices. Both during and after the early crying stage, frequently fed infants cried or fretted less often (8.1 v 15.8 episodes per hour at 2 months of age; 10.7 v 16.6 episodes per hour at 4 months of age), and fewer of them exhibited rhythmic crying behavior (four v 11 at 2 months; eight v 13 at 4 months) during observations. However, only during the early crying period at 2 months were interval between feedings and maternal response latency shown to be independent determinants of cry/fret frequency (overall r[sup 2] = .35, P = .01), each factor accounting for approximately half of the explained individual variance. Furthermore, feeding interval was the only variable associated with rhythmic crying behavior at 2 months of age (r[sup 2] = .20; P = .01). In similar analyses at 4 months, there were no significant relationships with later crying or fretting. The results suggest that, in the presence of variation in feeding practice greater than that which is typical for our society, feeding interval may be a significant factor in early (but not later) crying behavior; furthermore, this effect is independent of and additive to the soothing effect of short response latency. Pediatrics 1988;81:529-536; cry, infant, feeding. [ABSTRACT FROM AUTHOR]

‘Colic’ is an ill-defined but common complaint typically thought to be a sign of an underlying disease process or a clinical entity distinct from the crying t hat characterizes normal in rants. In this paper, an alternative hypothesis is suggested. The general argument is that colic represents the upper end of the spectrum of the crying activity of normal infants. However, it is not the case that all aspects of crying will be increased: rather, that the ‘excessive’ crying in colic is due specifically to prolonged bouts of otherwise normal crying. The results of three studies in normal infants are presented to support this argument. Together, the results support the concept that the crying typical of normal infants reflects a biological predisposition to cry, which is nevertheless affected by sufficiently large changes in the caretaking environment, and that these caretaking changes preferentially affect bout length. If so, then the key to ‘colic’ may be in understanding how biology and behavior interact to produce, not just crying, but prolonged crying bouts. [ABSTRACT FROM AUTHOR]

Recent research concerning the phenomenology of crying in normal and clinical contexts has clarified a number of defining dimensions of the behaviour. Four of the most prominent are developmental changes in both form and function of crying, especially those which take place between two and four months of age; categorical as compared to non-categorical descriptions of crying phenomenology; crying as a behavioural state and its relationships to other state behaviours of infants; and the differential impact of crying in clinical and non-clinical settings. These dimensions are recurrent themes in current research on crying as a signal and must be considered In any comprehensive account of the role and meaning of early infant crying. [ABSTRACT FROM AUTHOR]

Comments on infant crying and infantile colic in the context of a family affair. Predisposition for otherwise normal infants to increase the amount of crying; Mystery and phenomenon of infantile colic; Difficulty of getting a clean definitional handle on the elusive phenomenon.

Introduces articles related to infant crying published in the November 1995 issue of the journal "Early Development and Parenting."

A proximal mechanism is proposed whereby early crying helps maintain ideal levels of brain activation during the first three postnatal months. The proposal is consonant with both animal and human infant literatures, and new data are presented in its support. [ABSTRACT FROM AUTHOR]

I argue that in the first three months, crying is primarily a be- havioral state rather than a signal and that its properties include prolonged and unsoothable crying bouts as part of normal development. However, these normal properties trigger Shaken Baby Syndrome, a form of child abuse that does not easily fit an adaptive infanticide analysis. [ABSTRACT FROM AUTHOR]