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2 5
2 0
15
10
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
Age in Months
Gray et al, 2004
12 weeks
Barr, Konner, Bakeman, & Adamson, 1991; Brazelton, 1962; St. James-Roberts, Bowyer, Varghese, & Sawdon, 1994
Brazelton, 1962
Brazelton, 1962
Definitions
Excessive crying: more than average amount of crying Colic: excessive crying plus sudden onset, more aversive acoustical qualities, physical signs, more inconsolability (Lester et al, 1990) Persistent crying: crying past cry curve months (past 4 months) FBN Fussy Baby: any baby from birth to one year whose parent feels is difficult for him/her to console, feed, or help sleep
Cry quality
Higher pitch, reaches peak quickly Like a pain cry
Physical signs
Late afternoon fist-shaking rage
Clenched fists Grimace/flushing Gas/distention
Inconsolable
Lester, Boukydis, Garcia-Coll, & Hole, 1990
End varies:
50% by 2 months 80% by 3 months 90% by 4 months
Weissbluth, 1998
Swaddling, Side positioning, Shushing, Swinging, Sucking Environmental dampening Infant massage / touch Chiropractic manipulation
MaternalInfant Distress
Reflux
Simethicone (Mylicon) Chamomile Gripe water Dill oil, Fennel oil Dicyclomine (Bentyl)
Temperament
Colic
Gastroesophageal Reflux
Lower esophageal sphincter (LES) is a muscle between the esophagus and the stomach LES matures at 6-7 weeks While immature, it does not close tightly, so feedings can go in a reverse direction, from stomach to esophagus
Mechanisms of Reflux
Maturation, length and angle of LES affect reflux Breathing (Inspiration and expiration) trigger contraction of different portions of LES Gastric distension (over feeding) and altered angle of LES (flexed position) can increase reflux
Regulatory Imbalance
Imbalance between excitatory (arousing) processes and inhibitory (calming) processes Imbalance impedes infants regulation of stable sleeping and waking states and smooth transitions between states. The underlying cause is not known.
Sucrose hypothesis: central self-soothing mechanism is not developed GO systems (sympathetic nervous system) develops before SLOW systems (parasympathetic) Transient immaturity or temperament Prenatally acquired constitutional factors
Lester, Boukydis,Garcia-Coll, Hole, & Peucker, 1992; Papouek & Papouek, 1984
Infant Sensitivities
Prematurity Drug exposure Sensitive sensory system
Psychosocial Distress
Perinatal Mood Disorder Birth trauma Limited family resources Parental conflict
Photo courtesy of Ruth Fremson/The New York Times, 2008 from: http://well.blogs.nytimes.com/2008/09/05/deliverymethod-affects-brain-response-to-babys-cry/#more-511
Proximal Caregiving
Babies communicate through movement and cries Mothers sense babies arousal through body signals and soothe before crying begins
Lester, 2006
Distal Caregiving
Cry now used to call for basic care Have longer crying bouts May have earlier consolidation of sleep
Age in Weeks
Maternal Depression
In mother
frequent crying appetite change sleep problems moderate to high anxiety panic attacks feeling unable to cope, worthless, despair, guilt sluggishness that interferes with childcare expression of little positive emotion with infant fear of harming child or self
In infant
poor eye contact unpredictable sleeping and/or eating patterns after 4 months constricted affect difficult to comfort or soothe developmental delays
Negative emotions
Wishing infancy away Its supposed to be bliss I just want it to be over. Progression of emotions Overwhelmed Angry Guilty
Do you ever get mad at her? feel like youre going to hurt her?
Family Impact
Disrupted lives Criticism and social isolation Search for diagnosis Maternal depression Parental conflict Parent-infant relationship distress Long & Johnson, 2001; Maxted et al., 2005; Wake et al., 2006
Family criticism: If only you would.. Parental guilt: Im not hurting her, I swear
Social isolation: I feel so alone and I cant take her any where
3% 13%
3%
0-3 months 4-6 months 7-9 months 57% 24% 10-12 months Did not report /missing
Worry Scale
Supportive interventions which embrace a biopsychosocial perspective and which focus on the baby, parents, and parent/baby/family relationships can build competence, decrease stress/risk, and support healthy development
Gilkerson, Gray, Mork, 2005; Papousek, 2007; Maldonado, & Garcia, 1996; Keefe, et al., 2006 ; Maxted, et al., 2005
Maternal Depression
PRIME-MD PHQ Responses
40 35
30
20 25
20
Negatives Positives
15
10 16 5
13
4 0 1 Administration 2
4.50
4.00
3.50 How distressed did you feel about your Fussy Baby issue?
Scale of 1 to 5
3.00
2.50
What was your distress level when your involvement with the FBN ended?
2.00 To what extent do you feel that the FBN helped you cope with your distress?
1.50
1.00
0.50