Infantile colic and parental experiences

Early Development and Parenting, Vol. 3 (Z), 63-69 (1994)

Infantile Colic and Parental Experiences Gunilla Bohlin* Berit Hagekull Lene Lindberg Department of Clinical Psychology, Uppsala University, Sweden

The study comprised two groups of 33 parents each, one whose infants were identified by parents as colicky during their first 3 months and one with non-colicky infants. Parents filled out a questionnaire with one set of questions about parental experiences when infants were 3 months old and a set of parallel questions concerning current experiences (infant age 8-11 months). The results showed that the %month situation was more negatively described with regard to both infant behaviour and parental experiences by the parents of colicky infants. For the current situation (8-11 months), there were no significant group differences, meaning that no long-lasting effects could be demonstrated. However, in the colic group amount of q i n g and difficulty in comforting during the colic period were significantly related to current parental satisfaction, which suggests that these aspects of infant behaviour and experienced parental competence are of importance also in a longer perspective.

I

Key words: Infantile colic, crying, parental experiences.

be argued that the salient aspect of the problem is parental experiences of problems in dealing with infant crying. Such a perspective is adopted in the present study. In view of the lack of conceptual clarity surrounding infantile colic, it is perhaps not surprising that prevalence figures have varied considerably, between 10% and 40% (Hide and Guyer, 1982; Lindberg et al., 1991; St%hlberg, 1984; Wessel ef al., 1954),or that efforts at isolating causal factors have given inconclusive findings (see overviewsby Geertsma and Hyams, 1989; Hewson et al., 1987; Pinyerd and Zipf, 1989). Similarly, efforts at finding effective treatments have so far not been very successful (see Pinyerd and Zipf, 1989). Although the period of infant colic is known to be relatively short, usually ending when the infant is between 3 and 4 months old (e.g. Taylor, 1957), *Requests for reprints: Dr Gunilla Bohlin, Department of there is a growing concern about the effects that Clinical Psychology, Uppsala University, Box 1225, 5-75142 persistent crying may have on parent-child interaction (Sloman et al., 1990; St James-Roberts, Uppsala, Sweden.

Although infantile colic has been described and defined in various ways, there seems to be general acceptance of persistent crying as being its main presenting problem (Carey, 1984; Hewson et al., 1987). Definitions in terms of hours of crying per day have been suggested (Illingworth,1954; Wessel et al., 1954), and recent presentations of normative data (e.g. St James-Roberts and Ham, 1991) may provide a basis for forming a consensus about such a definition. Definitions in terms of quantity of crying have, however, been questioned because of the difficulty in getting objective measures of crying time and the arbitrariness in setting a particular cutoff such as 3 hours a day, as well as the risk of missing more significant aspects such as crying pattern (Geertsma and Hyams, 1989; St JamesRoberts, 1991). From a clinical perspective it could

CCC 1057-3593/94/020063-07 0 1994 by John Wiley & Sons, Ltd.

Received 1 January 1992 Accepted 15 April 1993

64 1989; Pinyerd and Zipf, 1989).The first few months constitute the starting point for the developing relationship between infants and parents, and disturbances during this period may initiate vicious circles in the continuing adaptive process between the two partners. Such a process was exemplified by Van den Boom (1989), who described negative effects of early infant irritability on maternal sensitivity. Little seems to be known, however, about the sequelae of colic symptoms (Pinyerd and Zipf, 1989). The aim of the present study was to explore possible long-lasting effects of early colic symptoms, as experienced and identified by parents, by comparing a colic and a noncolic group with regard to parental reports on infant crying, sleeping and feeding as well as on parental behaviour and experiences. The parental report concerned both the retrospective situation when the infant was 3 months of age and the situation several months later when infants in the colic group were no longer identified as colicky by their parents.

METHOD Subjects The study comprised 70 families belonging to the 86.5% responders in a questionnaire study about consisted of all infant feeding. The sample (N=660) families with a Swedish surname in the commune of Uppsala, Sweden, with an infant born during 4 consecutive months 1986-1987 (Lindberg e f al., 1991).The 567 responding families had infants aged between 30 and 60 weeks, Of the infants 53% were male and 47% female, 45% were the first child and 55% had siblings. On the basis of answers to questions about colic, a group of 35 infants fulfilling the following criteria was found: daily colic symptoms (as defined by parents) which had started during the first month and lasted at least to the infant’s third month, no suspected food allergy, no other feeding problem, and no long-lasting disease. Thus, the colic group was defined by a parental report of daily ‘colic symptoms’ (not specified) during the first three months. A non-colic group of 35 families was selected through matching for infant sex, age, and birth order status (firstborn vs laterborn). The 70 families were asked by mail to participate in a follow-up study on colic problems by answering a second questionnaire (see below). This questionnaire was returned by 33 families in the colic group

G. Bohlin, B . Hagekull and L. Lindberg and by all families in the non-colic group. The questionnaires of the 33 no-problem families which were matched to the 33 responding colic families were used in the study. Each group consisted of 17 female and 16 male infants, aged between 8 and 11 months at the time of inquiry (M=9.42; SD=1.09). In each group 16 infants were firstborn and 17 had siblings. Parental age in the two groups was similar: mean maternal age in the colic group was 29.4 years (SD=4.4) and in the non-colic group it was 29.7 years (SD=5.3); mean paternal age in the colic group was 31.5 years (SD-4.8) and in the non-colic group fathers’ mean age was 31.9 years (SD=5.6). The occupational level of mothers and fathers was also similar in the colic and non-colic groups with about half the groups having blue-collar or lower white-collar occupations, about 30% having higher white-collar occupations, and the remaining being students, unemployed or unclassifiable.

Questionnaire The first five questions were directed only to the colic group and concerned amount of crying during the peak of colic (response alternatives: 4 hr), and severity of colic symptoms (1: slight-5: very severe). Information about type of medication and effects of medication and of help (1:no effect-5: very good effect) received at the child healthcare centre (CHC) was also asked for. The rest of the questionnaire was directed to both groups and contained items about crying, sleeping and feeding of the infant as well as questions concerning parental role satisfaction. The questions were repeated twice. First, the parents were asked to describe the situation when the child was 3 months old. Thereafter, they were asked to describe the current situation, when the infant was 8-11 months of age. Response options included different verbally defined five-step scales, time estimates, frequencies, and yeslno alternatives. In the cry section, information was requested about amount of crying (response alternatives as above) and uncertainty about reasons for crying as well as difficulty in comforting (response scales 1: almost never-5: almost always). Parental distress reactions (feeling worried, stressed, irritated, helpless, sad) were rated from not at all (1) to very much (5). In the statistical analyses these were combined into one measure with a homogeneity coefficient (alpha; McKennell, 1970) of 0.81. Finally, routines for comforting the child were requested in a checklist with yeslno options.

Infantile Colic and Parental Experiences Questions about the infant's sleeping habits dealt with time awake at night (1: c 15min; 2: 15-30 min; 3: 30-60 min; 4: 1-2 hr; 5: > 2 hr) and amount of daytime sleep (1: 2hr). Data on regularity of sleeping hours were obtained on a scale from very irregular (1)to very regular (5). Parental distress reactions to the child's sleep habits (feeling stressed, irritated, helpless, tied down, tired) were rated and statistically analysed in the same way as reactions to crying (alpha=0.89). This section also contained a checklist about routines needed for putting the infant to sleep (yeslno answers). Two items concerned infant feeding: number of meals per 24 hours and regularity of eating (1:very irregular-5: very regular). The final section concerned general parental role satisfaction operationalized in ratings of seven items: feelings of excitement, strain, being tied down, insecurity, satisfaction with routines, and with the situation in general, and experiencing the situation as terrific. The response scales had as endpoints not at all (1)and very much (5). The parental role satisfaction measure was the mean of these ratings (reversing the ratings for negative feelings) with an alpha coefficient of 0.86 for the 3-month data and 0.72 for the 8-11-month data. Finally, there was one item with the same response scale, asking specifically about feelings of satisfaction and enjoyment when being with the infant.

RESULTS Parental Description of Colic The amount of crying per day during the most intense period of colic was reported to be more than 4hr for 36.6% of the infants, 2-4hr by 45.5%, 90-120 min by 9.1%, 30-90 min by 6.1% and less than 30 min by 3.0%. Colic symptoms were rated as fairly difficult on the five-point rating scale (M=3.5, SD=l.O). Twenty-seven of the infants had received medication to relieve symptoms, but the effect was judged as having been modest (M=2.9, SD= 1.3).These 27 families had also obtained advice from CHC nurses, which, however, had been of relatively little help as judged by the parents (M=2.5, SD=1.3).

Parity Differences Within the Colic Group To evaluate the importance of parity for the parental perceptions of colic and associated infant

65 behaviours and parental adjustment, the reports from parents in the colic group with firsborn infants were compared with reports of parents of laterbom infants concerning colic variables, %month variables and 8-11-month variables. The only sigruhcant difference was for the effect of prescribed medication, where parents of laterbom infants had experienced a better effect (t(24)=2.35, ~ ~ 0 . 0 5 ) .

Comparison of the Colic and Non-Colic Groups Two-way analyses of variance (using repeated measures on the time factor) were performed for the infant behaviour and parental experience variables. Results are presented in Table 1and Figures 1 and 2. The pattern is similar for most of the variables; both infant behaviour and parental experiences at infant age 3 months were in the colic group retrospectively described as more negative than in the non-colic group. Descriptions of the current situation did not differ between groups. Statistically, thispattern was shown in sigruhcant groups x time interactions. As can be seen in Table 1, such a pattern was found for all variables except for amount of daytime sleep Table 1. Results from two-way analyses of variance with groups (colic and non-colic) and time periods (3months and 8-11 months) as factors df

Infant behaviour Amount of crying Uncertain cause of crying Difficult to comfort Amount of daytime sleep Time awake at night Regularity of sleep Number of mealslday Regularity of eating Parental experiences Parental distress to crying Parental distress to sleep habits Parental enjoyment of infant Parental role satisfaction

1/64

Groups F

Time F

Groups xtime F

7.70**37.92***20.25***

1/64 0.84 7.85** 5.26' 1/64 21.59** 37.73***34.31*** 1/64

1.00

0.21

0.46

1/50 14.93** 22.14*** 9.27** 1/64 6.31* 27.77***13.61*** 1/62 3.87

34.66*** 1.06

1/64 10.03** 35.69*** 7.37**

1/63 11.31** 29.83***30.23*** 1/63 6.07* 13.07** 11.37**

1/64 2.05

13.65*** 5.81*

1/64 7.85** 32.67***16.60***

*p