ObjectiveTo study regulatory problems (RPs) of feeding, sleeping and excessive crying in infancy, and explore the influence of maternal mental health problems and parent–child relationship problems.Design and settingData were collected in the general child health surveillance delivered to infant families by community health nurses (CHNs). Information on CHNs’ assessments and conclusions were obtained on 2598 infants and merged with data from national registers. Descriptive statistics and logistic regression models were used to study RPs in early and late infancy, and the influences due to child, family and parent–child relationship problems.ResultsCombined RPs (C-RPs), defined as two or more simultaneous problems of feeding, sleeping or excessive crying, was identified in 2.9% and 8.6% of the population between age 2–6 and 8–11 months, respectively. Low maternal schooling and immigrant parents were associated with an increased risk of late C-RPs, but RPs in early infancy stand out as the main predictor of late C-RPs OR 3.4 (95% CI 1.8 to 6.6), and the effect of early maternal mental health problems and parent–child relationship problems seem to be mediated by early C-RPs.ConclusionsCombined problems of feeding, sleeping or excessive crying may exist throughout infancy independently of exposures to maternal mental health problems and parent–child relationship problems. The results indicate that infants with RPs exceeding age 2 months need special attention, in clinical as well as community settings. Suggested intervention includes specific guidance to the parents to help them understand and regulate their infant’s sensitivity and reactions.

BackgroundMental health problems are a major public health challenges, and strategies of early prevention are needed. Effective prevention depends on feasible and validated measures of screening and intervention. Previous research has demonstrated potentials for infant mental health screening by community health nurses (CHN) in existing service settings in Denmark. This study was conducted to describe the development of a service setting based measure to screen for infant mental health problems, to investigate problems identified by the measure and assess the validity and feasibility in existing public health settings.MethodsExperts within the field developed a short, feasible and comprehensive measure. A consecutive sample of 2973 infants from 11 municipalities around the city of Copenhagen was screened at 9–10 months. Face validity and feasibility were evaluated among CHNs. Data on child and family factors and the results of screening were included in descriptive analyses. Exploratory factor analysis (EFA) was used to assess content validity.ResultsThe measure identified problems of communication and interaction in 20.7% of the children, problems of eating in 20.1%, attention problems in 15.9% and problems of emotional regulation in 14.3%. Significant gender differences were seen. EFA demonstrated that among 27 items 11 items were clustering into five areas: Problems of eating, emotions, attention, language and communication and attachment, respectively. High face validity and feasibility was demonstrated, and the participation was 91%.ConclusionsThe new measure shows potentials for infant mental health screening. However, further exploration of construct validity and reliability is needed.

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Measures to identify infancy mental health problems are essential to guide interventions and reduce the risk of developmental psychopathology in early years. We investigated a new service-setting-based measure the Copenhagen Infant Mental Health Screening (CIMHS) within the general child health surveillance by community health nurses (CHN). The study population of 2973 infants was assessed by CIMHS at age 9-10 months. A subsample of 416 children was examined at age 1½ years, using parent interviews including the Child Behavior Checklist (CBCL 1½-5), Check List of Autism and Toddlers (CHAT), Infant-Toddler Symptom Checklist (ITSCL), and the Bayley Scales of Infant and Toddler Development (BSID) and observations of behavior, communication, and interaction. Child mental disorders were diagnosed according to ICD-10 and parent-child relationship disorders according to DC:0-3R. Statistical analyses included logistic regression analyses adjusted and weighted to adjust for sampling and bias. CIMHS problems of sleep, feeding and eating, emotions, attention, communication, and language were associated with an up to fivefold increased risk of child mental disorders across the diagnostic spectrum of ICD-10 diagnoses. Homo-type continuity was seen in problems of sleep and feeding and eating being associated with a threefold increased risk of disorders within the same area, OR 3.0 (95% CI 1.6-5.4) and OR 2.7 (95% CI 1.7-4.2), respectively. The sensitivity at high CIMHS problem scores was 32% and specificity 86%. In summary, CIMHS identify a broad range of infants' mental health problems that are amenable to guide intervention within the general child health surveillance.

Accumulating research document the needs of intervention towards mental health problems in early childhood. The general child health surveillance offers opportunities for early detection of mental health vulnerability, conditioned the availability of feasible and validated measures. The Copenhagen Infant Mental Health Questionnaire, CIMHQ, was developed to be feasible for community health nurses and comprehensive regarding the range of mental health problems seen in infancy. Previous testing of the CIMHQ has documented feasibility and face validity. The aim was to investigate the construct validity of the general population measure by using the Rasch measurement models, and to explore the differential functioning of the CIMHQ relative to a number of characteristics of the infants, local independence of items, and possible latent classes of infants. CIMHQ was tested in 2,973 infants from the general population, aged 9–10 months. The infants were assessed by community health nurses at home visits, in the period from March 2011 to December 2013. Rasch measurement models were used to investigate the construct validity of the CIMHQ. Analyses showed an overall construct valid scale of mental health problems, consisting of seven valid subscales of specific problems concerning eating, sleep, emotional reactions, attention, motor activity, communication, and language, respectively. The CIMHQ fitted a graphical loglinear Rasch model without differential item function. Analyses of local homogeneity identified two latent classes of infants. A simple model with almost no local dependency between items is proposed for infants with few problems, whereas a more complicated model characterizes infants with more problems. The measure CIMHQ differentiates between infants from the general population with few and more mental health problems, and between subgroups of problems that potentially can be targets of preventive intervention.