Preliminary evaluation of a primary care intervention for cry-fuss behaviours in the first 3−4 months of life (‘The Possums Approach’): effects on cry-fuss behaviours and maternal mood
Pamela S. Douglas A E , Yvette Miller B , Anne Bucetti B , Peter S. Hill C and Debra K. Creedy D
+ Author Affiliations
- Author Affiliations
A Discipline of General Practice, The University of Queensland, Herston, Brisbane, Qld 4029, Australia.
B Queensland Centre for Mothers and Babies, The University of Queensland, St Lucia, Brisbane, Qld 4067, Australia.
C School of Population Health, The University of Queensland, Herston, Brisbane, Qld 4029, Australia.
D Centre for Health Practice Innovation, Griffith University, Nathan, Brisbane, Qld 4111, Australia.
E Corresponding author. Email: pameladouglas@uq.edu.au
Australian Journal of Primary Health 21(1) 38-45 https://doi.org/10.1071/PY13011
Submitted: 22 January 2013 Accepted: 18 July 2013 Published: 2 September 2013
Abstract
Problem crying in the first few months of life is both common and complex, arising out of multiple interacting and co-evolving factors. Parents whose babies cry and fuss a lot receive conflicting advice as they seek help from multiple health providers and emergency departments, and may be admitted into tertiary residential services. Conflicting advice is costly, and arises out of discipline-specific interpretations of evidence. An integrated, interdisciplinary primary care intervention (‘The Possums Approach’) for cry-fuss problems in the first months of life was developed from available peer-reviewed evidence. This study reports on preliminary evaluation of delivery of the intervention. A total of 20 mothers who had crying babies under 16 weeks of age (average age 6.15 weeks) completed questionnaires, including the Crying Patterns Questionnaire and the Edinburgh Postnatal Depression Scale, before and 3−4 weeks after their first consultation with trained primary care practitioners. Preliminary evaluation is promising. The Crying Patterns Questionnaire showed a significant decrease in crying and fussing duration, by 1 h in the evening (P = 0.001) and 30 min at night (P = 0.009). The median total amount of crying and fussing in a 24-h period was reduced from 6.12 to 3 h. The Edinburgh Postnatal Depression Scale showed a significant improvement in depressive symptoms, with the median score decreasing from 11 to 6 (P = 0.005). These findings are corroborated by an analysis of results for the subset of 16 participants whose babies were under 12 weeks of age (average age 4.71 weeks). These preliminary results demonstrate significantly decreased infant crying in the evening and during the night and improved maternal mood, validating an innovative interdisciplinary clinical intervention for cry-fuss problems in the first few months of life. This intervention, delivered by trained health professionals, has the potential to mitigate the costly problem of health professionals giving discipline-specific and conflicting advice post-birth.
References
Alvarez M, St James-Roberts I (1996) Infant fussing and crying patterns in the first year in an urban community in Denmark. Acta Paediatrica (Oslo, Norway) 85, 463–466.| Infant fussing and crying patterns in the first year in an urban community in Denmark.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK28zht1Omsg%3D%3D&md5=b58314c49da6e46f22b53d251dfc0487CAS |
Ammaniti M, Lucarelli L, Cimino S, D’Olimpio F, Chatoor I (2010) Maternal psychopathology and child risk factors in infantile anorexia. The International Journal of Eating Disorders 43, 233–240.
Barr RG (1993) Normality: a clinically useless concept. The case of infant crying and colic. Journal of Developmental and Behavioral Pediatrics 14, 264–270.
| Normality: a clinically useless concept. The case of infant crying and colic.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK2c%2FhtlGhtQ%3D%3D&md5=7f7df6d038ecc7f5ef3eb444d6600904CAS | 8408670PubMed |
Bernaix LW, Beaman ML, Schmidt CA, Harris JK, Miller LM (2010) Success of an educational intervention on maternal/newborn nurses’ breastfeeding knowledge and attitudes. Journal of Obstetric, Gynecologic, and Neonatal Nursing 39, 658–666.
| Success of an educational intervention on maternal/newborn nurses’ breastfeeding knowledge and attitudes.Crossref | GoogleScholarGoogle Scholar | 21039848PubMed |
Blair PS, Heron J, Fleming PJ (2010) Relationship between bed-sharing and breastfeeding: longitudinal, population-based analysis. Pediatrics 126, e1119–e1126.
| Relationship between bed-sharing and breastfeeding: longitudinal, population-based analysis.Crossref | GoogleScholarGoogle Scholar | 20956410PubMed |
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 |
Brown A, Jordan S (2013) Impact of birth complications on breastfeeding duration: an internet survey. Journal of Advanced Nursing 69, 828–839.
| Impact of birth complications on breastfeeding duration: an internet survey.Crossref | GoogleScholarGoogle Scholar | 22765355PubMed |
Brown M, Heine RG, Jordan B (2009) Health and well-being in school-age children following persistent crying in infancy. Journal of Paediatrics and Child Health 45, 254–262.
| Health and well-being in school-age children following persistent crying in infancy.Crossref | GoogleScholarGoogle Scholar | 19493116PubMed |
Bryanton J, Beck C (2010) Postnatal parental education for optimizing infant general health and parent-infant relationships. Cochrane Database of Systematic Reviews CD004068
Colson SD, Meek JH, Hawdon JM (2008) Optimal positions for the release of primitive neonatal reflexes stimulating breastfeeding. Early Human Development 84, 441–449.
| Optimal positions for the release of primitive neonatal reflexes stimulating breastfeeding.Crossref | GoogleScholarGoogle Scholar | 18243594PubMed |
Cox JL, Holden JM, Sagovsky R (1987) Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale. The British Journal of Psychiatry 150, 782–786.
| Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaL1c%2FgtFahtw%3D%3D&md5=90c24b5d05d905b1a47c05b79c9d51b6CAS | 3651732PubMed |
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 |
de Lauzon-Guillain B, Wijndaele K, Clark M, Acerini CL, Hughes IA, Dunger DB, Wells JC, Ong KK (2012) Breastfeeding and infant temperament at age three months. PLoS ONE 7, e29326
| Breastfeeding and infant temperament at age three months.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BC38Xht12mtLw%3D&md5=b8731482c5508275c38f516675c3f0a9CAS |
Dewey KG, Nommsen-Rivers LA, Heinig MJ, Cohen RJ (2003) Risk factors for suboptimal infant breastfeeding behavior, delayed onset of lactation, and excess neonatal weight loss. Pediatrics 112, 607–619.
| Risk factors for suboptimal infant breastfeeding behavior, delayed onset of lactation, and excess neonatal weight loss.Crossref | GoogleScholarGoogle Scholar | 12949292PubMed |
Dørheim SK, Bondevik GT, Eberhard-Gran M, Bjorvatn B (2009) Sleep and depression in postpartum women: a population-based study. Sleep 32, 847–855.
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 (2013) Diagnosing gastro-oesophageal reflux disease or lactose intolerance in babies who cry a lot in the first few months overlooks feeding problems. Journal of Paediatrics and Child Health 49, E252–E256.
| Diagnosing gastro-oesophageal reflux disease or lactose intolerance in babies who cry a lot in the first few months overlooks feeding problems.Crossref | GoogleScholarGoogle Scholar | 23495859PubMed |
Douglas P, Hill P (2011a) Managing infants who cry excessively in the first few months of life. BMJ (Clinical Research Ed.) 343, d7772
| Managing infants who cry excessively in the first few months of life.Crossref | GoogleScholarGoogle Scholar |
Douglas PS, Hill PS (2011b) The crying baby: what approach? Current Opinion in Pediatrics 23, 523–529.
| The crying baby: what approach?Crossref | GoogleScholarGoogle Scholar | 21799411PubMed |
Douglas P, Hill PS (2013) Behavioural sleep interventions in the first six months of life do not improve outcomes for mothers or infants: a systematic review. Journal of Developmental and Behavioral Pediatrics In press
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 P Shirley B 2013
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 |
Douglas PS, Mares RE, Hill PS (2012) Interdisciplinary perspectives on the management of the unsettled baby: key strategies for improved outcomes. Australian Journal of Primary Health 18, 332–338.
| Interdisciplinary perspectives on the management of the unsettled baby: key strategies for improved outcomes.Crossref | GoogleScholarGoogle Scholar | 22951297PubMed |
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 |
Goyal D, Gay CL, Lee K (2009) Fragmented maternal sleep is more strongly correlated with depressive symptoms than infant temperament at three months postpartum. Archives of Women’s Mental Health 12, 229–237.
| Fragmented maternal sleep is more strongly correlated with depressive symptoms than infant temperament at three months postpartum.Crossref | GoogleScholarGoogle Scholar | 19396527PubMed |
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 |
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 |
Kendall-Tackett K, Cong Z, Hale TW (2011) The effect of feeding method on sleep duration, maternal well-being, and postpartum depression. Clinical Lactation 2, 22–26.
| The effect of feeding method on sleep duration, maternal well-being, and postpartum depression.Crossref | GoogleScholarGoogle Scholar |
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 |
Kurth E, Spichiger E, Cignacco E, Kennedy HP, Glanzmann R, Schmid M, Staehelin K, Schindler C, Stutz EZ (2010) Predictors of crying problems in the early postpartum period. Journal of Obstetric, Gynecologic, and Neonatal Nursing 39, 250–262.
| Predictors of crying problems in the early postpartum period.Crossref | GoogleScholarGoogle Scholar | 20576068PubMed |
Li R, Fein SB, Chen J, Grummer-Strawn LM (2008) Why mothers stop breastfeeding: mothers’ self-reported reasons for stopping during the first year. Pediatrics 122, S69–S76.
| Why mothers stop breastfeeding: mothers’ self-reported reasons for stopping during the first year.Crossref | GoogleScholarGoogle Scholar | 18829834PubMed |
Matricciani LA, Olds TS, Blunden SL, Rigney G, Williams MT (2012) Never enough sleep: a brief history of sleep recommendations for children. Pediatrics 129, 548–556.
| Never enough sleep: a brief history of sleep recommendations for children.Crossref | GoogleScholarGoogle Scholar | 22331340PubMed |
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 47, 818–823.
| 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 Revews CD005255
Miller LJ, LaRusso EM (2011) Preventing postpartum depression. The Psychiatric Clinics of North America 34, 53–65.
| Preventing postpartum depression.Crossref | GoogleScholarGoogle Scholar | 21333839PubMed |
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=e035c32b5e3084ddc64ad2fb44693419CAS | 11124777PubMed |
Odom EC, Li R, Scanlon KS, Perrine CG, Grummer-Strawn L (2013) Reasons for earlier than desired cessation of breastfeeding. Pediatrics 131, e726–e732.
| Reasons for earlier than desired cessation of breastfeeding.Crossref | GoogleScholarGoogle Scholar | 23420922PubMed |
Patton MQ (2011) Developmental evaluation: applying complexity concepts to enhance innovation and use. New York: The Guildford Press.
Price AM, Wake M, Ukoumunne OC, Hiscock H (2012) Outcomes at six years of age for children with infant sleep problems: longitudinal community-based study. Sleep Medicine 13, 991–998.
| Outcomes at six years of age for children with infant sleep problems: longitudinal community-based study.Crossref | GoogleScholarGoogle Scholar | 22748447PubMed |
Reijneveld SA, Brugman E, Hirasing RA (2001) Excessive infant crying: the impact of varying definitions. Pediatrics 108, 893–897.
| Excessive infant crying: the impact of varying definitions.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3MrjsVKjsA%3D%3D&md5=7fb77dcd6097ef4b294e4919845cb556CAS | 11581441PubMed |
Reijneveld SA, van der Wal M, Brugman E, Hira Sing R, Verloove-Vanhorick S (2004) Infant crying and abuse. Lancet 364, 1340–1342.
| Infant crying and abuse.Crossref | GoogleScholarGoogle Scholar | 15474137PubMed |
Renfrew M, Pokhrel S, Quigley M, McCormick F, Fox-Rushby J, Dodds R, Duffy S, Trueman P, Williams A (2012) Preventing disease and saving resources: the potential contribution of increasing breastfeeding rates in the UK. London: Unicef UK.
Reyna BA, Pickler RH (2009) Mother-infant synchrony. Journal of Obstetric, Gynecologic, and Neonatal Nursing 38, 470–477.
| Mother-infant synchrony.Crossref | GoogleScholarGoogle Scholar | 19614883PubMed |
Sakalidis VS, Williams TM, Hepworth AR, Garbin CP, Hartmann PE, Paech MJ, Al-Tamimi Y, Geddes DT (2013) A comparison of early sucking dynamics during breastfeeding after cesarean section and vaginal birth. Breastfeeding Medicine 8, 79–85.
| A comparison of early sucking dynamics during breastfeeding after cesarean section and vaginal birth.Crossref | GoogleScholarGoogle Scholar | 22845858PubMed |
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=bec67ea97dc23c0fe41083849c000c40CAS |
Shonkoff JP, Boyce WT, McEwen BS (2009) Neuroscience, molecular biology, and the childhood roots of health disparities. Journal of the American Medical Association 301, 2252–2259.
| Neuroscience, molecular biology, and the childhood roots of health disparities.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BD1MXnt1OjsL8%3D&md5=c5e6daa347bde341c5ad1c89587937eaCAS | 19491187PubMed |
Sirvinskiene G, Zemaitene N, Zaborskis A, Markuniene E, Jusiene R (2012) Infant difficult behaviors in the context of perinatal biomedical conditions and early child environment. BMC Pediatrics 12, 44
| Infant difficult behaviors in the context of perinatal biomedical conditions and early child environment.Crossref | GoogleScholarGoogle Scholar | 22494700PubMed |
Smart J, Hiscock H (2007) Early infant crying and sleeping problems: A pilot study of impact on parental well-being and parent-endorsed strategies for management. Journal of Paediatrics and Child Health 43, 284–290.
| Early infant crying and sleeping problems: A pilot study of impact on parental well-being and parent-endorsed strategies for management.Crossref | GoogleScholarGoogle Scholar | 17444831PubMed |
Smillie CM (2012) How infants learn to feed: a neurobehavioral model. In Watson CG, editor. Supporting sucking skills. New York: Jones and Bartlett Learning. pp. 83–104.
St James-Roberts I, Hurry J, Bowyer J (1993) Objective confirmation of crying durations in infants referred for excessive crying. Archives of Disease in Childhood 68, 82–84.
| Objective confirmation of crying durations in infants referred for excessive crying.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK3s7msl2gug%3D%3D&md5=e73076070719a78810cb31929384ade2CAS | 8435015PubMed |
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 sleep 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 sleep problems.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3Mvhsl2hsQ%3D%3D&md5=0b3e29c8a5d87d2716e4f867e4e237deCAS | 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 |
Stremler R, Hodnett E, Kenton L, Lee K, Weiss S, Weston J, Willan A (2013) Effect of behavioural-educational intervention on sleep for primiparous women and their infants in early postpartum: multisite randomised controlled trial. BMJ (Clinical Research Ed.) 346, f1164
| Effect of behavioural-educational intervention on sleep for primiparous women and their infants in early postpartum: multisite randomised controlled trial.Crossref | GoogleScholarGoogle Scholar |
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 |
Symon 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.
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 (Oslo, Norway) 98, 1344–1348.
| Infantile colic, prolonged crying and maternal postnatal depression.Crossref | GoogleScholarGoogle Scholar |
Wake M, Morton-Allen E, Poulakis Z, Hiscock H, Gallagher S (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 |
Wolke D, Gray P, Meyer R (1994) Validity of the Crying Patterns Questionnaire in a sample of excessively crying babies. Journal of Reproductive and Infant Psychology 12, 105–114.
| Validity of the Crying Patterns Questionnaire in a sample of excessively crying babies.Crossref | GoogleScholarGoogle Scholar |
Wolke D, Samara M, Alvarez Wolke M (2011) Meta-analysis of fuss/cry durations and colic prevalence across countries. Proceedings of the 11th International Infant Cry Research Workshop; June 2011; Zeist, The Netherlands.
