Instruction on Infant Crying May Lower Caregiver Depression

Jenni Laidman

January 06, 2014

Teaching caregivers about normal infant sleeping and crying patterns and providing them with information on infant settling techniques improved maternal depression scores, according to a study published online January 6 in Pediatrics. The information also improved daytime sleep problems among infants who fed at least a dozen times a day.

Harriet Hiscock, MBBS, MD, from the Centre for Community Child Health, The Royal Children’s Hospital, Parkville, Australia; Murdoch Childrens Research Institute, The Royal Children’s Hospital, Melbourne; and the Department of Paediatrics, University of Melbourne, Australia, and colleagues conducted a randomized controlled trial , to determine the effect of an intervention program targeting infant sleep and crying problems. They enrolled 770 families of 781 infants born at 32 weeks' gestation or later in 42 well-child centers in Melbourne.

The intervention began at 4 weeks, when 385 families with 388 infants were given a booklet and a DVD that covered normal sleep and crying patterns, techniques for settling infants, information on possible medical causes of crying, and parent self-care advice. At 8 weeks, the information was reinforced in a telephone conversation, and again at 13 weeks in a parent group. Caregiver-reported infant sleeping and crying and caregiver depression symptoms were compared with reports from a control group of 385 families with 393 infants who were provided standard well-infant care.

Although caregivers saw some benefit in infants behavior in the treatment group, there were no overall differences in reports of infant sleeping, crying, or feeding problems at either 4 or 6 months in either cohort. However, infants classified as frequent feeders at baseline (those feeding >11 times in 24 hours) had reduced odds of daytime sleep problems at 4 months (odds ratio [OR] 0.13; 95% confidence interval [CI], 0.03 - 0.54) and 73% lower odds of daytime crying problems (OR, 0.27; 95% CI, 0.08 - 0.86). Nighttime sleep problems were similar in frequent feeders in both the treatment and control cohorts.

There were no differences in caregiver depression at 4 months, but at 6 months, caregivers in the intervention group were less likely to score higher than 9 on the Edinburgh Postnatal Depression Scale, with 7.9% scoring higher than 9 in the intervention group vs 12.9% in the control cohort (adjusted odds ratio [AOR], 0.57; 95% CI, 0.34 - 0.94; P = .03). The researchers adjusted for infant age, sex, rating in the Socio-Economic Indexes for Areas, parent education, parenting doubt surrounding infant sleep measured at baseline, parenting self-efficacy, and parental rating of self as a tense person.

Intervention caregivers had fewer doubts about their ability to manage infant sleep at both 4 months and 6 months (P < .02 for both periods), and at 6 months, caregivers in the intervention group were also less likely to spend 20 minutes or more attending infant wakings (41% vs 51%; AOR, 0.66; 95% CI, 0.46 - 0.95; P = .03). The intervention group was also less likely to change infant formula, with 13% of the intervention group changing formula compared with 23% in the control group (AOR, 0.41; 95% CI, 0.21 - 0.82; P = .01).

Those who received the booklet and other training also reported less difficulty setting limits (adjusted mean difference, −1.22; 95% CI, −2.03 to −0.41; P = .003) and less excessive concern about sudden infant death (adjusted mean difference, −0.38; 95% CI, −0.67 to −0.08; P = .01). At 4 months, those in the intervention group sought help more often from health professionals, but there was no difference at 6 months.

This study was supported by the Victorian Department of Education and Early Childhood Development and the Scobie and Claire Mackinnon Trust. Dr. Hiscock is supported by a National Health and Medical Research Council Career Development Award, one coauthor by Deakin Population Health SRC, and one coauthor by a National Health and Medical Research Council Early Career Fellowship. Murdoch Childrens Research Institute research is supported by the Victorian Government’s Operational Infrastructure Support Program. The authors have disclosed no other relevant financial relationships.

Pediatrics. Published online January 6, 2014. Abstract


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