A support package for parents of excessively crying infants: development and feasibility study

Abstract

Background Around 20% of 1- to 4-month-old infants cry for long periods without an apparent reason. Traditionally, this was attributed to gastrointestinal disorder (‘colic’), but evidence shows that just 5% of infants cry a lot because of organic disturbances; in most cases, the crying is attributable to normal developmental processes. This has led to a focus on the impact of the crying on parents. Parental vulnerabilities influence how parents evaluate and respond to the crying and predict adverse outcomes. By developing evidence-based services that support parents, this study was designed to take the first steps towards national health services that enhance the coping and well-being of parents whose babies excessively cry. Related aims were to improve these infants’ outcomes and how NHS money is spent. Objectives To develop a novel intervention package to support parents of excessively crying infants and to examine the feasibility of delivering and evaluating it in the NHS. Design Stage 1 of this study aimed to (1) complete a literature review to identify example support materials, (2) obtain parents’ guidance on the support needed when a baby cries excessively, together with their evaluation of the example materials, and (3) develop a support package based on the results. Stage 2 aimed to (1) recruit 60 parents whose babies were currently excessively crying, (2) assess parents’ and NHS professionals’ willingness to complete a study of the support package, (3) measure the use and evaluation of the package components, (4) estimate the package component costs and (5) provide evidence on the feasibility and methods for a large-scale trial. Setting Primary health care. Participants Stage 1: 20 parents of previously excessively crying infants and 55 health visitors (HVs) or specialist community public health nurses (SCPHNs). Stage 2: 57 parents of currently excessively crying infants and 124 HVs/SCPHNs. Interventions The support package included a website, a printed booklet and a programme of cognitive–behavioural therapy-based sessions delivered to parents by a qualified practitioner. Main outcome measures (1) Demographic data, (2) figures for parents’ use of the package components and continuation in the study, (3) parents’ and HVs’/SCPHNs’ ratings of the package components and suitability for NHS use, (4) questionnaire measures of parental well-being and infant health and (5) costs. Results Most parents (95%) accessed the website or printed materials and half (51%) attended the practitioner sessions. All 52 parents and 85% of HVs/SCPHNs providing data would support the inclusion of the package in the NHS. It was associated with reduced parental frustration, anxiety, depression, reported infant crying and contacts with health professionals and increased knowledge about crying. Methods for a full trial and figures for the cost of excessive infant crying for the NHS and each package element were identified. Limitations No control group was included. Most of the recruited parents were white, well educated and in stable relationships. Conclusions Parents and HVs/SCPHNs recognise the need for NHS provisions that support parents of excessively crying babies and consider the materials developed to meet that need. A full-scale randomised controlled trial is feasible and desirable. Trial registration Current Controlled Trials ISRCTN84975637. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 56. See the NIHR Journals Library website for further project information.

Distress in fathers of babies with infant colic

“…29 In another study, assisting parents who sought help because of excessive infant crying with a support package not only led to reductions in reported crying, but was also associated with substantial reductions in parental frustration, anxiety, depression and contact with professionals. 30 Our findings suggest that we might want to intervene differently for mothers and fathers with an excessively crying infant. Integrated care which reduces negative feelings of stress and bonding in mothers might also have positive effects on these feelings in fathers.…”

“…In one study, family‐based treatment reduced the amount of crying faster than did standard paediatric care 29 . In another study, assisting parents who sought help because of excessive infant crying with a support package not only led to reductions in reported crying, but was also associated with substantial reductions in parental frustration, anxiety, depression and contact with professionals 30 …”

Infant colic, young children’s temperament and sleep in a population based longitudinal cohort study

“…There is evidence that interventions targeting overall parenting are effective in helping children with regulatory problems and their parents [ 5 , 12 ]. Reported effects are reduced parental frustration anxiety, reported amount of infant crying, more contact with health professionals and increased knowledge about crying [ 30 ]. As described, the differences between the groups in this study are significant, but also moderate to small over time.…”

“…The gastrointestinal causes of colic are often referred to as developmental lactose intolerance, altered gut microorganism, immaturity of the gut, increased motilin receptors, or cow milk hypersensitivity [ 32 ]. Yet, research has shown that gastrointestinal disturbances only apply to a minority (5%) of infants who cry excessively during the first months of life [ 5 , 30 ]. Still, it is important to be aware that the term colic is used as a collective term for excessive infant crying and fussing.…”

Excessive Crying in Children With Cerebral Palsy and Communication Deficits

“…27 Excessive crying in infants is a challenge. 29 Identifying the cause of Excessive Crying in Children with Cerebral Palsy and Communication De cits [ECCCPCD], either because of their age or global developmental delay/profound intellectual retardation, is more challenging. It is di cult to distinguish discomfort, pain, and distress in such children.…”