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Australian Journal of Primary Health Australian Journal of Primary Health Society
The issues influencing community health services and primary health care
RESEARCH ARTICLE

Interdisciplinary perspectives on the management of the unsettled baby: key strategies for improved outcomes

Pamela S. Douglas A D , Renata E. Mares B and Peter S. Hill C
+ Author Affiliations
- Author Affiliations

A Discipline of General Practice, The University of Queensland, Herston, Qld 4029, Australia.

B School of Public Health, University of Western Cape, Private Bag X17, Bellville, Republic of South Africa.

C School of Population Health, The University of Queensland, Herston, Qld 4027, Australia.

D Corresponding author. Email: pameladouglas@uq.edu.au

Australian Journal of Primary Health 18(4) 332-338 https://doi.org/10.1071/PY11073
Submitted: 9 July 2011  Accepted: 1 December 2011   Published: 23 December 2011

Abstract

The objectives of this study were to analyse the perspectives of key informants with clinical expertise in the care of unsettled babies in the first few months of life and their families, concerning changes required to improve outcomes. The research used a purposive selection strategy and thematic analysis of key informant interviews of 24 health professionals from 11 disciplines. Informants were selected for extensive experience in the management of unsettled babies and their families.Participants corroborated existing evidence that post-birth care in Australia is fragmented. All held the view that, first, early primary care intervention for unsettled infants and their families, and second, improved cross-professional communication, are vital if the burden of this problem to the infant, family and health system are to be minimised. There was consensus, third, that significant gaps exist in health professionals’ knowledge base and management behaviours.The development of education resources, best practice guidelines, shared assessment frameworks for primary care practitioners and strategies for improved cross-professional communication are necessary to improve the health outcomes and decrease the burden of this common yet complex post-birth problem.

Additional keywords: crying baby, excessive crying, infant, infant feeding, post-birth.


References

Ammaniti M, Lucarelli L, Cimino S, D’Olympio F, Chatoor I (2010) Maternal psychopathology and child risk factors in infantile anorexia. The International Journal of Eating Disorders 43, 233–240.

Bandyopadhyay M, Small R, Watson LF (2010) Life with a new baby: how do immigrant and Australian-born women’s experiences compare? Australian and New Zealand Journal of Public Health 34, 412–421.
Life with a new baby: how do immigrant and Australian-born women’s experiences compare?Crossref | GoogleScholarGoogle Scholar | 20649783PubMed |

Barnes M, Courtney M, Pratt J, Walsh A (2003) Contemporary child health nursing practice: services provided and challenges faced in metropolitan and outer Brisbane areas. Collegian (Royal College of Nursing, Australia) 10, 14–19.
Contemporary child health nursing practice: services provided and challenges faced in metropolitan and outer Brisbane areas.Crossref | GoogleScholarGoogle Scholar |

Barrett J, Fleming AS (2011) Annual research review: all mothers are not created equal: neural and psychobiological perspectives on mothering and the importance of individual differences. Journal of Child Psychology and Psychiatry, and Allied Disciplines 52, 368–397.
Annual research review: all mothers are not created equal: neural and psychobiological perspectives on mothering and the importance of individual differences.Crossref | GoogleScholarGoogle Scholar | 20925656PubMed |

Baxter J, Eyles J (1997) Evaluating qualitative research in social geography: establishing ‘rigour’ in interview analysis. Transactions of the Institute of British Geographers 22, 505–525.
Evaluating qualitative research in social geography: establishing ‘rigour’ in interview analysis.Crossref | GoogleScholarGoogle Scholar |

Brodribb W, Fallon A, Jackson C, Hegney D (2008) Breastfeeding and Australian GP registrars – their knowledge and attitudes. Journal of Human Lactation 24, 422–430.
Breastfeeding and Australian GP registrars – their knowledge and attitudes.Crossref | GoogleScholarGoogle Scholar | 18974291PubMed |

Cantrill RM, Creedy DK, Cooke M (2003) An Australian study of midwives’ breast-feeding knowledge. Midwifery 19, 310–317.
An Australian study of midwives’ breast-feeding knowledge.Crossref | GoogleScholarGoogle Scholar | 14623510PubMed |

Commonwealth of Australia (2009a) ‘Improving maternity services in Australia: the report of the maternity services review.’ (Commonwealth of Australia: Canberra.)

Commonwealth of Australia (2009b) ‘Australian national breastfeeding strategy 2010–2015.’ (Commonwealth of Australia: Canberra.)

Davies WH, Satter E, Berlin KS, Sato AF, Silverman AH, Fischer EA, Arvedson JC, Rudolph CD (2006) Reconceptualizing feeding and feeding disorders in interpersonal context: the case for a relational disorder. Journal of Family Psychology 20, 409–417.
Reconceptualizing feeding and feeding disorders in interpersonal context: the case for a relational disorder.Crossref | GoogleScholarGoogle Scholar | 16937997PubMed |

DeSantis A, Coster W, Bigsby R, Lester B (2004) Colic and fussing in infancy, and sensory processing at 3 to 8 years of age. Infant Mental Health Journal 25, 522–539.
Colic and fussing in infancy, and sensory processing at 3 to 8 years of age.Crossref | GoogleScholarGoogle Scholar |

Douglas PS (2005) Excessive crying and gastro-oesophageal reflux disease in infants: misalignment of biology and culture. Medical Hypotheses 64, 887–898.
Excessive crying and gastro-oesophageal reflux disease in infants: misalignment of biology and culture.Crossref | GoogleScholarGoogle Scholar | 15780481PubMed |

Douglas PS, Hill PS (2011) The crying baby: what approach? Current Opinion in Pediatrics 23, 523–529.
The crying baby: what approach?Crossref | GoogleScholarGoogle Scholar | 21799411PubMed |

Douglas PS, Hiscock H (2010) The unsettled baby: crying out for an integrated, multidisciplinary primary care intervention. The Medical Journal of Australia 193, 533–536.

Douglas PS, Hill PS, Brodribb W (2011) The unsettled baby: how complexity science helps. Archives of Disease in Childhood 96, 793–797.
The unsettled baby: how complexity science helps.Crossref | GoogleScholarGoogle Scholar | 21297170PubMed |

Downe S, Finlayson K, Fleming A (2010) Creating a collaborative culture in maternity care. Journal of Midwifery & Women’s Health 55, 250–254.
Creating a collaborative culture in maternity care.Crossref | GoogleScholarGoogle Scholar |

Eronen R, Calabretto H, Pincombe J (2011) Improving the professional support for parents of young infants. Australian Journal of Primary Health 17, 186–194.
Improving the professional support for parents of young infants.Crossref | GoogleScholarGoogle Scholar | 21645476PubMed |

Evans K, Evans R, Simmer K (1995) Effect of the method of breastfeeding on breast engorgement, mastitis and infantile colic. Acta Paediatrica 84, 849–852.
Effect of the method of breastfeeding on breast engorgement, mastitis and infantile colic.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK28%2FltV2rsw%3D%3D&md5=8400e8a76e9b055bcc36b8bf0443f219CAS | 7488804PubMed |

Feldman-Winter L, Barone L, Milcarek B, Hunter K, Meek J, Morton J, Williams T, Naylor A, Lawrence RA (2010) Residency curriculum improves breastfeeding care. Pediatrics 126, 289–297.
Residency curriculum improves breastfeeding care.Crossref | GoogleScholarGoogle Scholar | 20603262PubMed |

Flowers K (2008) An exploration of child health nursing practice in pharmacy baby clinics. Paediatric and Child Health Nursing 11, 18–25.

Golski CA, Rome ES, Martin RJ, Frank SH, Worley S, Sun Z, Hibbs AM (2010) Pediatric specialists’ beliefs about gastroesophageal reflux disease in premature infants. Pediatrics 125, 96–104.
Pediatric specialists’ beliefs about gastroesophageal reflux disease in premature infants.Crossref | GoogleScholarGoogle Scholar | 20008431PubMed |

Gunn J, Lumley J, Young D (1996) Visits to medical practitioners in the first 6 months of life. Journal of Paediatrics and Child Health 32, 162–166.
Visits to medical practitioners in the first 6 months of life.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK2s%2FhtlGmtQ%3D%3D&md5=16d6a3db4be85765ded79f560966d23dCAS | 9156528PubMed |

Hansen EC (2006) Research design and rigor. In ‘Successful qualitative health research: a practical introduction’. (Eds J Adams, J Gunn) (Allen & Unwin: Crows Nest, NSW.)

Hemmi MH, Wolke D, Schneider S (2011) Associations between problems with crying, sleeping and/or feeding in infancy and long-term behavioural outcomes in childhood: a meta analysis. Archives of Disease in Childhood 96, 622–629.
Associations between problems with crying, sleeping and/or feeding in infancy and long-term behavioural outcomes in childhood: a meta analysis.Crossref | GoogleScholarGoogle Scholar | 21508059PubMed |

Hill PD, Aldag JC, Chatterton RT, Zinaman M (2005) Primary and secondary mediators’ influence on milk output in lactating mothers of preterm and term infants. Journal of Human Lactation 21, 138–150.
Primary and secondary mediators’ influence on milk output in lactating mothers of preterm and term infants.Crossref | GoogleScholarGoogle Scholar | 15886340PubMed |

Hirst C (2005) ‘Re-birthing: report of the review of maternity services in Queensland.’ (Queensland Government: Brisbane)

Howard CR, Lanphear N, Lanphear BP, Eberly S, Lawrence RA (2006) Parental responses to infant crying and colic: the effect on breastfeeding duration. Breastfeeding Medicine 1, 146–155.
Parental responses to infant crying and colic: the effect on breastfeeding duration.Crossref | GoogleScholarGoogle Scholar | 17661591PubMed |

Kent JC, Mitoulas LR, Cregan MD, Ramsay DT, Doherty DA, Hartmann PE (2006) Volume and frequency of breastfeedings and fat content of breast milk throughout the day. Pediatrics 117, e387–e395.
Volume and frequency of breastfeedings and fat content of breast milk throughout the day.Crossref | GoogleScholarGoogle Scholar | 16510619PubMed |

Martin CM, Kasperski J (2010) Developing interdisciplinary maternity services policy in Canada. Evaluation of a consensus workshop. Journal of Evaluation in Clinical Practice 16, 238–245.
Developing interdisciplinary maternity services policy in Canada. Evaluation of a consensus workshop.Crossref | GoogleScholarGoogle Scholar | 20367842PubMed |

McCallum SM, Rowe HJ, Gurrin LC, Quinlivan JA, Rosenthal DA, Fisher JRW (2011) Unsettled infant behaviour and health service use: a cross-sectional community survey in Melbourne, Australia. Journal of Paediatrics and Child Health
Unsettled infant behaviour and health service use: a cross-sectional community survey in Melbourne, Australia.Crossref | GoogleScholarGoogle Scholar | 21679331PubMed |

McCormick FM, Tosh K, McGuire W (2010) Ad libitum or demand/semi-demand feeding versus scheduled interval feeding for preterm infants. Cochrane Database of Systematic Reviews CD005255

McMahon C, Barnett B, Kowalenko N, Tennant C, Don N (2001) Postnatal depression, anxiety and unsettled infant behaviour. The Australian and New Zealand Journal of Psychiatry 35, 581–588.
Postnatal depression, anxiety and unsettled infant behaviour.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3Mrgt1yguw%3D%3D&md5=8eaab678d83e23b46cdef8053f7a0756CAS | 11551272PubMed |

Miller-Loncar C, Bigsby R, High P, Wallach M, Lester B (2004) Infant colic and feeding difficulties. Archives of Disease in Childhood 89, 908–912.
Infant colic and feeding difficulties.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD2cvnt1aqug%3D%3D&md5=eb572e3af3b203d58cb1ab05b5ec73f9CAS | 15383432PubMed |

Moore ER, Anderson GC, Bergman N (2007) Early skin-to-skin contact for mothers and their healthy newborn infants. Cochrane Database of Systematic Reviews CD003519
Early skin-to-skin contact for mothers and their healthy newborn infants.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD2svhvFersQ%3D%3D&md5=4758fc7b38a4df50006f4ef6953714aaCAS |

Morris S, St James-Roberts I, Sleep J, Gilham P (2001) Economic evaluation of strategies for managing crying and sleeping problems. Archives of Disease in Childhood 84, 15–19.
Economic evaluation of strategies for managing crying and sleeping problems.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3M3itlOkug%3D%3D&md5=535bf4f9fc83eabe192fa6f16d6de86dCAS | 11124777PubMed |

National Health and Medical Research Council (2010) ‘National guidance on collaborative maternity care.’ (National Health and medical Research Council: Canberra)

RACGP (2009) ‘Response to government discussion paper titled “Towards a national primary health care strategy”.’ (Royal Australian College of General Practitioners: Melbourne)

Reijneveld SA, van der Wal M, Brugman E, Sing RAH, Verllove-Vanhorick SP (2004) Infant crying and abuse. Lancet 364, 1340–1342.
Infant crying and abuse.Crossref | GoogleScholarGoogle Scholar | 15474137PubMed |

Schmid G, Schreier A, Meyer R, Wolke D (2010) A prospective study on the persistence of infant crying, sleeping and feeding problems and preschool behaviour. Acta Paediatrica 99, 286–290.

Schmid G, Schreier A, Meyer R, Wolke D (2011) Predictors of crying, feeding and sleeping problems: a prospective study. Child: Care, Health and Development 37, 493–502.
Predictors of crying, feeding and sleeping problems: a prospective study.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BC3MrnvVKgtg%3D%3D&md5=01be1cfd15401975768f0b5337f6b6e1CAS |

Sherman PM, Hassall E, Fagundes-Neto U, Gold BD, Kato S, Koletzko S, Orenstein S, Rudolph C, Vakil N, Vandenplas Y (2009) A global, evidence-based consensus on the definition of gastroesophageal reflux disease in the pediatric population. The American Journal of Gastroenterology 104, 1278–1295.
A global, evidence-based consensus on the definition of gastroesophageal reflux disease in the pediatric population.Crossref | GoogleScholarGoogle Scholar | 19352345PubMed |

St James-Roberts I, Sleep J, Morris S, Owen C, Gillham P (2001) Use of a behavioural programme in the first 3 months to prevent infant crying and sleeping problems. Journal of Paediatrics and Child Health 37, 289–297.
Use of a behavioural programme in the first 3 months to prevent infant crying and sleeping problems.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3Mvhsl2hsQ%3D%3D&md5=a418ae02456079239a000a65d50ae79bCAS | 11468047PubMed |

St James-Roberts I, Alvarez M, Csipke E, Abramsky T, Goodwin J, Sorgenfrei E (2006) Infant crying and sleeping in London, Copenhagen and when parents adopt a “proximal” form of care. Pediatrics 117, e1146–e1155.
Infant crying and sleeping in London, Copenhagen and when parents adopt a “proximal” form of care.Crossref | GoogleScholarGoogle Scholar | 16740816PubMed |

Swain JE, Lorberbaum JP, Kose S, Strathearn L (2007) Brain basis of early parent–infant interactions: psychology, physiology, and in vivo functional neuroimaging studies. Journal of Child Psychology and Psychiatry, and Allied Disciplines 48, 262–287.
Brain basis of early parent–infant interactions: psychology, physiology, and in vivo functional neuroimaging studies.Crossref | GoogleScholarGoogle Scholar | 17355399PubMed |

Sweeney JK, Heriza CB, Blanchard Y, Dusing SC (2010) Neonatal physical therapy. Part II: Practice frameworks and evidence-based practice guidelines. Pediatric Physical Therapy 22, 2–16.
Neonatal physical therapy. Part II: Practice frameworks and evidence-based practice guidelines.Crossref | GoogleScholarGoogle Scholar | 20142700PubMed |

Symond BG, Marley JE, Martin AJ, Norman ER (2005) Effect of a consultation teaching behaviour modification on sleep performance in infants: a randomised controlled trial. The Medical Journal of Australia 182, 215–218.

Underdown A, Barlow J, Chung V, Stewart-Brown S (2006) Massage intervention for promoting mental and physical health in infants aged under six months. Cochrane Database of Systematic Reviews CD005038
Massage intervention for promoting mental and physical health in infants aged under six months.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD28nhvFWntg%3D%3D&md5=8d26abb206c16fc063c7b2f8178b22eaCAS |

van der Pol RJ, Smits MJ, van Wijk MP, Omari TI, Tabbers MM, Benninga MA (2011) Efficacy of proton-pump inhibitors in children with gastroesophageal reflux disease: a systematic review. Pediatrics 127, 925–935.
Efficacy of proton-pump inhibitors in children with gastroesophageal reflux disease: a systematic review.Crossref | GoogleScholarGoogle Scholar | 21464183PubMed |

van Sleuwen BE, Engelberts AC, Boere-Boonekamp MM, Kuis W, Schulpen TWJ, L’Hoir MP (2007) Swaddling: a systematic review. Pediatrics 120, e1097–e1106.
Swaddling: a systematic review.Crossref | GoogleScholarGoogle Scholar | 17908730PubMed |

Vandenplas Y, Brueton M, Dupont C, Hill D, Isolauri E, Koletzko S, Oranje AP, Staiano A (2007) Guidelines for the diagnosis and management of cow’s milk protein allergy in infants. Archives of Disease in Childhood 92, 902–908.
Guidelines for the diagnosis and management of cow’s milk protein allergy in infants.Crossref | GoogleScholarGoogle Scholar | 17895338PubMed |

Vik T, Grote V, Escribano J, Socha J, Verduci E, Fritsch M, Carlier C, von Kries R, Koletzko B, for the European Childhood Obesity Trial Study Group (2009) Infantile colic, prolonged crying and maternal postnatal depression. Acta Paediatrica 98, 1344–1348.
Infantile colic, prolonged crying and maternal postnatal depression.Crossref | GoogleScholarGoogle Scholar | 19432839PubMed |

Wake M, Morton-Allen E, Poulakis Z, Hiscock H, Gallagher S, Oberklaid F (2006) Prevalence, stability, and outcomes of cry-fuss and sleep problems in the first 2 years of life: prospective community-based study. Pediatrics 117, 836–842.
Prevalence, stability, and outcomes of cry-fuss and sleep problems in the first 2 years of life: prospective community-based study.Crossref | GoogleScholarGoogle Scholar | 16510665PubMed |

Whittemore R, Chase SK, Mandle CL (2001) Validity in qualitative research. Qualitative Health Research 11, 522–537.
Validity in qualitative research.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3MvnslOhtA%3D%3D&md5=9d68f539fa0e6e92485803912a2c6003CAS | 11521609PubMed |

Wolke D, Samara M, Alvarez Wolke M (2011) Meta-analysis of fuss/cry durations and colic prevalence across countries. In ‘Proceedings of the 11th international infant cry research workshop’. 18–10 June 2011; Zeist, The Netherlands.