A Randomized, Controlled Trial of a Behavioral Intervention to Reduce Crying among Infants

The Journal of the American Board of Family Medicine

Adam J. Zolotor²  Jonna M. McRury¹ 

[1] Department of Pediatrics, University of Toledo, Toledo, OH (JMM);Departments of Family Medicine and Pediatrics, University of North Carolina, and the Injury Prevention Research Center, Chapel Hill, NC (AJZ)

关键词: Clinical Trial;    Crying;    Infant;   

DOI  :  10.3122/jabfm.2010.03.090142

学科分类：过敏症与临床免疫学

来源: The American Board of Family Medicine

【 摘 要 】

Objective: To evaluate the efficacy of videotaped instruction of a behavioral intervention to reduce crying among newborns.

Methods: Mothers of healthy, full-term newborns were recruited from the postpartum unit of a large community hospital for a prospective, randomized, controlled trial of an intervention to reduce infant crying. Mothers participating in the intervention viewed a videotape with instructions involving swaddling, side positioning, white noise, jiggling, and sucking. Mothers in the control group viewed a videotape with instructions for normal newborn care. Intervention was assessed by mean hours per day of infant total crying (fussing, crying, and unsoothable crying) and sleeping as recorded in a diary 3 days a week during the 1st, 4th, 6th, 8th, and 12th weeks of age; the Parenting Stress Index was also used during the 6th and 12th weeks.

Results: Fifty-one mother-infant pairs were recruited; 35 completed the study (18 intervention and 17 controls). Sixteen were lost to follow-up. There were no statistically significant differences between the groups in the hours of mean daily total crying or sleeping during the 1st, 4th, 6th, 8th, or 12th weeks of age. For example, during the 6th week of age mean daily total crying was 1.9 hours for infants in the control group versus 2.2 hours for infants in the intervention group (P = .4); sleep was 14.5 hours for infants in the control group versus 14.4 hours for infants in the intervention group (P = .8). During the 12th week mean daily total crying was 1.2 hours for infants in the control group versus 1.8 hours for infants in the intervention group (P = .8) and sleep was 14.1 hours for infants in the control group versus 14.0 hours for infants in the intervention group (P = 1.0). There was no difference between the groups in the Parenting Stress Index during the 6th week of age.

Conclusion: The behavioral intervention, when provided via videotape, does not seem to be efficacious in decreasing total crying among normal infants.

• Clinical Trial
• Crying
• Infant

The persistent crying of infants during the first 3 months of life is one of the most frequent complaints made by caregivers and one of the most common reasons for both breastfeeding cessation and visits to medical care providers.^1–3 Persistent crying can be associated with maternal physical and psychological symptoms or marital tension and affect the maternal-infant bonding process.^4,5 Infant crying and the caregiver's inability to console the infant has been identified as a common inciting event for shaken baby syndrome.^6–9 Infants who cry persistently may sleep less than other infants,^10,11 which contributes to these problems. Although persistent crying is a self-limiting condition,^12,13 caregiver fatigue and frustration, impaired bonding, and child abuse are compelling reasons to develop and evaluate interventions.

Recent reviews of the literature describe several treatments that have been shown to be effective in randomized controlled trials.^14,15 Most reviews recommend a trial of a hypoallergenic diet, especially for infants who had other associated symptoms.^14–16 Lactobacillus reuteri, fennel seed oil, herbal tea, and an herbal preparation have all been shown to decrease daily crying in randomized controlled trials.^17–20 None of these trials reported adverse events, but the short-term and long-term safety is not known. Behavioral interventions, such as decreasing stimulation and providing parent support, have been taught to parents with mixed results on the amount of crying,^21–25 although an educational intervention has shown an increased knowledge about infant crying.²⁶ There seems to be no consensus on treatment and further research is generally recommended.^14,15

One method for calming infants, referred to as The Happiest Baby (THB) method, is based on the hypothesis that actions mimicking conditions in the womb will trigger a calming reflex.²⁷ This method uses swaddling as a basis for the intervention, and proceeds to incorporate side/stomach positioning, shushing (producing a loud and constant sound near the infant's ear), swinging/jiggling, and sucking as needed. This method has some similarities to behavior exhibited by the !Kung San, whose infants have been found to have a shorter duration of crying than those in western societies.²⁸

We hypothesized that infants of mothers who viewed a videotape teaching the THB method would fuss and cry less and sleep more during the 4th to 8th weeks of age than those whose mothers viewed a control tape. We also hypothesized that mothers viewing the intervention video would experience less stress, as indicated by a lower Parenting Stress Index (PSI).

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