the phenomena of early infant crying and colic · 3/2/2009 · the phenomena of early infant...

1

The Phenomena of Early The Phenomena of Early Infant Crying and ColicInfant Crying and Colic

Ronald G. Barr, MDCM, FRCPCRoss Trust Seminar

Infant crying: causes, challenges and long-term outcomes

Centre for Community Child HealthRoyal Children’s Hospital

Melbourne, AustraliaMarch 2, 2009

The Phenomena of Early The Phenomena of Early Infant Crying and ColicInfant Crying and Colic

Or, why I hope my next child has colic!Or, why I hope my next child has colic!

Ronald G. Barr, MDCM, FRCPCRoss Trust Seminar

Infant crying: causes, challenges and long-term outcomes

Centre for Community Child HealthRoyal Children’s Hospital

Melbourne, AustraliaMarch 2, 2009

Infants cryingInfants crying: : ““photographs made by the photographs made by the instantaneous processinstantaneous process””

Darwin, The Expression of Emotion in Animals and Man, 1872 The The ““ArgumentArgument””

Clinical crying problems are:a. Costlyb. Not explained by “pathology” in the infant or

the caregiverc. Should be reconceptualized as a

manifestation of normal behavioral development

The Argument The Argument (cont(cont’’d)d)

The phenomena of early infant crying may be adaptive (from the point of view of evolutionary behavioral ecology).

This understanding of early increased infant crying (and colic) as “normal” has some implications for clinical approaches to early infant crying problems.

The The ““CostCost”” of Early Infant Cryingof Early Infant Crying

2

Crying concerns in the health Crying concerns in the health care systemcare system

Early increased cryingis used as anadvertisement for theQuebec telephone call-inservice.It accounts for about30% of all calls.

© Ronald G. Barr, MDCM, FRCPC 2009

Maternal Emotional Distress and Maternal Emotional Distress and ““ColicColic””Miller, Barr et al (1993) Pediatrics 92: 551Miller, Barr et al (1993) Pediatrics 92: 551--558558

Mothers who had infantswith colic (modifiedWessel’s criteria) hadelevated levels ofemotional distress,despite equivalentdistress levels in 3rdtrimester

The The ““costcost”” of cryingof cryingSleep and St. James-Roberts, 1998

• Cost of health professional time for cry and sleep complaints in the first 3 months (salary only): $CDN 46.08/baby

• Annual cost for NHS: $CDN 35,304,652• Equivalents:

a. 775 full time nursesb. 4238 hip fracturesc. 270 patients with HIV treated for life


What is colic?What is colic?Defining featuresDefining features

(Gormally & Barr, 1997)

1. Age-dependent crying patterns (peak during 2nd month).These are due to changes in the amounts of crying that cluster during the evening.

2. Associated behaviors (prolonged cry bouts, unsoothability, “pain facies”)

3. “Paroxysmal” (unpredictable)


WesselWessel’’s s ““Rule of 3Rule of 3’’ss””An infant has colic when s/he cries:

> 3 hours/day> 3 days/week> 3 weeks


Assumption:Assumption:Colic is an abnormality,Colic is an abnormality,or or ““something wrongsomething wrong””

with the infantwith the infant

3

The Argument Against The Argument Against PathologyPathology

• Non-pathological mechanisms can account for all primary features of colic

• Good outcome


““ColicColic”” is not explained by is not explained by pathology in the infant or in pathology in the infant or in

the caregiverthe caregiver

The Lamp PostThe Lamp Post

Anthropology

PsychobiologyNonlinear dynamic systems (catastrophe)

Clinical



((GormallyGormally & Barr, 1997)& Barr, 1997)

1.1. AgeAge--dependent crying patterns dependent crying patterns (peak during 2nd month).(peak during 2nd month).




The The ““crying curvecrying curve””((BrazeltonBrazelton, 1962), 1962)

Large differences

from infant to infant


““Peak PatternPeak Pattern”” of Early of Early Crying BehaviorCrying Behavior

Hunziker & Barr, Pediatrics 1986

4


!Kung San Gathering!Kung San Gathering(Photos by Marjorie (Photos by Marjorie ShostakShostak))

!Kung San Mother & Infant!Kung San Mother & Infant(Photo by Marjorie (Photo by Marjorie ShostakShostak))


!Kung San Mother & Infant!Kung San Mother & Infant(Photo by Marjorie (Photo by Marjorie ShostakShostak))


Western Western CaregivingCaregiving StylesStyles


CaregivingCaregiving ContextsContexts !Kung San Western Contact Constant Intermittent

Carry Constant Response to cry

Feeding “Continuous” “Pulse”

Posture Upright Supine

Responsivity Universal Occ. Non-response


Hourly Hourly Cry/Fret DurationCry/Fret Duration in !Kung in !Kung San Infants in Early MonthsSan Infants in Early Months

Barr, Barr, KonnerKonner et al DMCN 1991et al DMCN 1991

Large infant to infant

differences

5


Hourly Cry/Fret Hourly Cry/Fret FrequencyFrequency in !Kung San, in !Kung San, Dutch, and USA InfantsDutch, and USA Infants

Hourly Cry/Fret Hourly Cry/Fret DurationDuration in !Kung in !Kung San vs. Dutch InfantsSan vs. Dutch Infants


AgeAge--related Crying Patterns in related Crying Patterns in Preterm InfantsPreterm Infants

(Barr, Chen, Hopkins et al DMCN)


NN--shaped curves in other shaped curves in other biological functionsbiological functions

Age-related changes in headhead--turning to turning to rattle soundsrattle sounds.

Less “turning towards” and more “no turns” at 2 months.

Field, Muir et al, Child Dev, 1980


NN--shaped curve in caloric intakeshaped curve in caloric intake


““Distress CurvesDistress Curves”” have been found have been found in all nonin all non--human mammalian (i.e. human mammalian (i.e.

breast feeding) species breast feeding) species investigated.investigated.

• Guinea pig pups (Pettyjohn, 1979)

• Infant rat pups (Hofer et al, 1999)

• Chimpanzees (Bard, 2000)

• Free-living Rhesus macaques (Barr et al, 2005)

6


Parental Responses to Infant Parental Responses to Infant Chimp DistressChimp Distress

(Bard K, In Barr et al ((Bard K, In Barr et al (edseds) 2000)) 2000)


Evidence that the Evidence that the ““Crying CurveCrying Curve””is a Behavioral Universal of Infancyis a Behavioral Universal of Infancy

There is a similar pattern and timing in:1. All samples of Western infants2. Cultures with radically different caregiving styles3. Prematures4. A wide variety of human infant biological & behavioral functions5. Non-human species



(Gormally & Barr, 1997)

1. Age-dependent crying patterns (peak during 2nd month).

2. Associated behaviors (prolonged cry Associated behaviors (prolonged cry bouts, bouts, unsoothabilityunsoothability, , ““pain pain faciesfacies””))



UnsoothableUnsoothable Crying BoutsCrying Boutsin London, Copenhagen, and with a in London, Copenhagen, and with a ““proximalproximal””

form of careform of careInfants with Bouts of Unsoothable Crying

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

10 days 5 weeks 12 weeks

Age of Infants

Perc

enta

ge o

f Inf

ants

London CommunityCopenhagen CommunityProximal Care

St James-Roberts, I., Alvarez, M., Csipke, E., Abramsky, T., Goodwin, J., Sorgenfrei, E. Infant crying and sleeping in London, Copenhagen, and when parents adopt a 'proximal' form of care. Pediatrics,2006.


Uniqueness of Uniqueness of UnsoothableUnsoothableCrying Bouts to Early CryingCrying Bouts to Early Crying

0

10

20

30

40

Min

utes

/day

(mea

n +

1 SD

)

Age

Daily Unsoothable Cry

Non-colic

Colic

6 Weeks 5 Months

By 5 months, the mean amount of

unsoothable crying is 1-3 minutes/day

in all infants.

Barr, Paterson et al, JDBP, 2005


The early cry is a The early cry is a gradedgradedsignal, not a typological signal, not a typological

sign or signalsign or signal

Gustafson: Can we hear the causes of

infant crying?

“He sounds just like a porpoise”

In Barr, Hopkins, Green: Crying as a Sign, a Symptom and a Signal, London: MacKeith Press, 2000

7


““If you were a good mother, If you were a good mother, you wouldyou would…”…”

• Listen carefully to the cry and learn to read what the cause of the crying is so that you address the needs of your baby…

• Learn the right way to soothe your infant so that s/he can be calmed and not cry…


One is crying following a painOne is crying following a painstimulus, one crying before a feed.stimulus, one crying before a feed.

Can you tell which is which?Can you tell which is which?



((GormallyGormally & Barr, 1997)& Barr, 1997)

1. Age-dependent crying patterns (peak during 2nd month).These are due to changes in the amounts of crying that cluster during the evening.


3. 3. ““ParoxysmalParoxysmal”” (unpredictable)(unpredictable)

““ClassicClassic”” colic: Paroxysmalcolic: Paroxysmal

• Unpredictable• Begins and ends apparently

unrelated to anything in the environment

• May begin or end “suddenly”

Basic Phenomenon in Basic Phenomenon in ““Well behavedWell behaved””Chaotic Systems: the Lorenz AttractorChaotic Systems: the Lorenz Attractor

NonNon--linear phase transitionslinear phase transitions

GAS

LIQUID

SOLID

Temperature

8

NonNon--linear Phase Transitions in linear Phase Transitions in Behavioral SystemsBehavioral Systems

NonNon--linear Phase Transitions in linear Phase Transitions in Behavioral SystemsBehavioral Systems

Concept of Infant Behavioral Concept of Infant Behavioral StatesStates (Wolff, 1987)(Wolff, 1987)

Infant behavioral states as a linear continuum of “arousal”

Infant behavioral states as distinct, nonlinear, and discontinuous, organizations of behavior.

The The ““ShapeShape”” of Nonof Non--linear linear TransitionsTransitions

““ExplainingExplaining”” Prolonged Crying Bouts, Prolonged Crying Bouts, Resistance to Soothing and Resistance to Soothing and Paroxysmal Crying BoutsParoxysmal Crying Bouts

X1 = soothing attempt while in stable state.

X2 = soothing attempt while in transitional state

Summary re: Summary re: ““ParoxysmalParoxysmal””Crying BoutsCrying Bouts

No pathologic or abnormal mechanism need be postulated to explain unpredictable, paroxysmal, “unexplained” nature of crying bouts.

They are most likely to be classical state transitions in infants functioning as “well-behaved” non-linearly organized behavioral systems.

9

““Colic:Colic:”” a a reconceptualizationreconceptualizationRather than thinking of colic as distinctdistinct,

qualitatively differentdifferent, and due to underlying pathophysiologypathophysiology or pathopsychologypathopsychology…

Perhaps we should think of it as continuouscontinuouswith normal behavior, qualitatively similarsimilar, and due to infants acting as as they shouldthey should, or were designed to, act.


““ColicColic”” has a good outcomehas a good outcome


Outcome of Outcome of ““coliccolic”” in Infantsin Infants(Lehtonen, Gormally and Barr, 2000)

• Wt. Gain delay Transient• Allergy None• Crying Much reduced• Behavior disturbance None• Temperament difficult None• Sleep problems None• Negative reactivity None


There are 3 curves, not 1There are 3 curves, not 1

1 2 3 4 5

Wessel’s criteria



1 2 3 4 5

Wessel’s criteria

Persistent mother-infant distress

syndrome (Papousek et al)

#1

#2



1 2 3 4 5

Wessel’s criteria

“Difficult”infant

#3

10


Clifford et al: Clifford et al: SequelaeSequelae of of Infant ColicInfant Colic

Arch Arch PediatrPediatr AdolescAdolesc Med (2002) 156:1183Med (2002) 156:1183--11881188• Diaries at 6 weeks and 3 months of age• Modified Wessel’s criteria• Of those with colic at 6 weeks:

a. 86.3% did not have colic at 3 months: 13.7% still did (“persistent” colic)

• At 3 months, 6.4% had colic:a. Of these, 50% did not have colic at 6

weeks (in other words, 50% with colic at 3 months “developed” it)



1 2 3 4 5

Wessel’s criteria

Persistent mother-infant distress

syndrome

“Difficult”infant

6.4%6.4%


Although early increased Although early increased crying (crying (‘‘coliccolic’’) has no long ) has no long term negative outcomes, term negative outcomes,

persistent or repeated elevated persistent or repeated elevated crying crying afterafter 33--4 months 4 months doesdoeshave longhave long--term predictability term predictability

to later poorer outcomesto later poorer outcomes


LongtermLongterm Effects of Effects of ““PostPost””Curve Crying Curve Crying

• Papousek, Wurmser, von Hofacker: Clinical perspectives on unexplained early crying: challenges and risks for infant mental infant mental healthhealth and parentparent--infant relationshipsinfant relationships. In Barr, St. James-Roberts, Keefe MR (eds) New evidence on unexplained early infant crying: its origins, nature and management, 2001 (289-316)

• Wolke, Rizzo, Woods: Persistent infant crying and hyperactivityhyperactivityproblems in middle childhood. Pediatrics 2002: 109(6):1054-1060.

• Rao MR, Brenner RA, Schisterman EF, Vik T, Mills JL: Long term cognitive developmentcognitive development in children with prolonged crying. Arch DisChild 2004:89:989-992.

• Wake M, Morton-Allen E, Poulakis Z, Hiscock H, Gallagher S, Oberklaid F: Prevalence, stability and outcomes of crycry--fussfuss and sleep problemssleep problems in the first 2 years of life: prospective community-based study. Pediatrics 2006: 117:836-842.


Typical Assumption:Typical Assumption:Colic is an abnormality,Colic is an abnormality,

or or ““something wrongsomething wrong”” with the with the infant infant

The Argument Against The Argument Against PathologyPathology

Non-pathological mechanisms for primary features:

a. Crying curveb. Unsoothable crying boutsc. Paroxysmal crying

Good outcomea. For infants with classical colic (first 3-4

months)b. Less good for infants with “post-curve”

persistent elevated crying

11


Current EvidenceCurrent Evidence--based based Assumption:Assumption:

Colic and early increased Colic and early increased crying are crying are normalnormal,,

and there is and there is nothing wrongnothing wrongwith the infant with the infant

© Ronald G. Barr, MDCM, FRCPC 2009The Period of PURPLE Crying is a registered trademark and all content is copyright protected. All rights reserved, Ronald G. Barr, MDCM and the National Center on Shaken Baby Syndrome (2004-2008)

In SummaryIn Summary“Colic” is a manifestation of normal behavioral development

“Colic” is the upper end of a continuumof crying behavior in normal infants (like height: some infants are taller and some are shorter)

“Colic” is not an indication of disease in the infant.


The Phenomena of Early The Phenomena of Early Increased Crying May Be Increased Crying May Be

AdaptiveAdaptive


The Phenomena of Early The Phenomena of Early Increased Crying May Be Increased Crying May Be

Adaptive:Adaptive:1.1. They contribute to survivalThey contribute to survival

2. They have the properties of an 2. They have the properties of an ““honest signalhonest signal””


How Crying Signals May Have How Crying Signals May Have Functioned in our Evolutionary Past Functioned in our Evolutionary Past

(after (after BowlbyBowlby))


Cry as a Stimulus for Milk Cry as a Stimulus for Milk Letdown Letdown (after Lind et al)(after Lind et al)

12


CryCry--Feed Relationship Among Feed Relationship Among !Kung San !Kung San ((KonnerKonner))

Probability of nursing following cry/fret in !Kung San infants, from direct observations

Months of age

Percentage


Crying promotes motherCrying promotes mother--infant attachment and infant attachment and

““bondingbonding””

Thanks to Pilyoung Kim and colleagues (James Swain, Gary Evans)


The limbicThe limbic--hypothalamichypothalamic--midbrain circuits called midbrain circuits called ‘‘Maternal CircuitsMaternal Circuits’’ overlap with the overlap with the mesocorticolimbicmesocorticolimbic dopaminargicdopaminargic reward pathwaysreward pathways..

Swain et al. (2007)© Ronald G. Barr, MDCM, FRCPC 2009

Febo, Numan, Ferris, 2005

Rodent mothers have greater activations in the reward circuits while nursing.


10 sec

Rest

Rest

Rest

Rest

Rest

OwnBabyCry

OtherBabyCry

OwnBabyNoise

OtherBabyNoise

30 sec 30 sec 30 sec 30 sec

Mothers were exposed to Mothers were exposed to cries cries andand picturespictures of their of their own and othersown and others’’ babies.babies.

Own baby Other baby© Ronald G. Barr, MDCM, FRCPC 2009

Insula DLPFC

AmygdalaPeriaqueductal Gray Precuneus

Substantia nigra

Breastfeeding mothers had greater activations in the Breastfeeding mothers had greater activations in the mesocorticolimbicmesocorticolimbic reward circuitreward circuit in response to in response to own own baby crybaby cry at at 22‐‐4 weeks4 weeks postpartum. postpartum.

p<.05, corrected

Also, hypothalamus, VTA, OFC, Putamen

13


Thalamus

Visual CortexSubstantia nigra Head of Caudate

DL Prefrontal Cortex

Insula

Precuneus

p<.05, corrected

Breastfeeding mothers had greater activations in the mesocorticolimbic reward circuit in response to own baby cry at 3‐4 months postpartum.


Thalamus InsulaPosterior Cingulate

Amygdala

Breastfeeding mothers had greater activations in the Breastfeeding mothers had greater activations in the mesocorticolimbicmesocorticolimbic reward circuitreward circuit in response to in response to own own baby picturesbaby pictures at at 22‐‐4 weeks4 weeks postpartum.postpartum.

p<.05, corrected

Substantia Nigra

Also, OFC, VTA, Putamen, fusiform gyrus, precuneus


CaudateAnterior Cingulate Prefrontal Corex

DifferencesDifferences in brain responses to in brain responses to own baby picture own baby picture among two groups decrease at 3among two groups decrease at 3‐‐4 months4 months postpartum postpartum became became smallersmaller. .

p<.05, corrected© Ronald G. Barr, MDCM, FRCPC 2009

Crying Levels and Crying Levels and ““AffectiveAffective””Caregiver Responses Caregiver Responses ((AceboAcebo & & ThomanThoman))

Higher levels of crying are associated with increased levels of positive interaction

Even the highest levels of crying are associated with more positive interaction than the lowest levels of crying

““ModelingModeling”” Adaptive Value of Cry Adaptive Value of Cry Functions: CryFunctions: Cry--FeedFeed 11stst PathwayPathway

““ModelingModeling”” Adaptive Value of Cry Adaptive Value of Cry Functions: CryFunctions: Cry--AttachmentAttachment

14


Summary: the Summary: the ““goodgood””• Early crying may be

advantageous for survival

Soltis J (2004) “The signal functions of early infant crying” Beh & Brain

Sciences, 27(4): 443-458

Barr RG (2004) “Infant crying as a behavioral state rather than a signal”

BBS 27(4), 460


Some clinical implications Some clinical implications of the normality of early of the normality of early

increased cryingincreased crying


1 2 3 4 5

Crying started to increase

Stopped breast-feeding; start Similac

Change to soy

Vitamins

Goat’s milk—success!

For the parent: Scott the For the parent: Scott the High CrierHigh Crier----MarilynMarilyn’’s Storys Story

Months of age © Ronald G. Barr, MDCM, FRCPC 2009

Clinical ImplicationsClinical Implications• If you do not take the curve into account,

therapeutic interventions can be misinterpreted as effective when they are not effective, or ineffective when they are effective


Clinical ImplicationsClinical Implications

1 2 3 4 5

Wessel’s criteria

“False positive” effective

“False negative”ineffective


Clinical ImplicationsClinical Implications• If you do not take the curve into account,

therapeutic interventions can be misinterpreted as effective when the are not effective, or ineffective when they are effective

• ALL infants experience the curve, and “organic causes” only move the infant “up” within the range of crying

15


Clinical ImplicationsClinical Implications

1 2 3 4 5

Wessel’s criteria


New York New York TimesTimes

July 8, 1944

“…who admitted that he had killed his 31/2 week old daughter because she cried too much…”


The ShakingThe Shaking

• Weak Neck Muscles

• Normal Large Head to Body ratio

• Violent,sustainedshaking


Intracranial Intracranial ““CascadeCascade”” from Shakingfrom Shaking


Mechanical Stresses During Mechanical Stresses During Shaking & Eye LesionsShaking & Eye Lesions


Outcomes of Hospitalized Outcomes of Hospitalized CasesCases

• 20-35% die• Of the survivors, 65-80% have

significant long term neurological and developmental abnormalities

16


Why is crying in Why is crying in normalnormal infants infants relevant to Shaken Baby relevant to Shaken Baby

Syndrome?Syndrome?


Questionnaire Study of Soothing Methods in Holland

van der Wal et al, Arch Dis Child, 1998

Techniques used to soothe infants:

1. Smother 2%2. Slap 3%3. Shake 5%


Runyan.Runyan.TheThe challenges of assessing the challenges of assessing the incidence of inflicted traumatic brain injury: A incidence of inflicted traumatic brain injury: A

world perspective.world perspective.Amer J Prev Med 2008;34 (4S)

“The impact of these private acts must be further studied as there may be other long-lasting and serious intracranial impacts that have not been characterized.”


The The ““crying curvecrying curve””(Brazelton, 1962) Hypothesis:Hypothesis: IF crying was a

significant stimulus for sbs, THEN the pattern of age-

related incidence of sbs should be similar to the age-related

properties of the crying curve


AgeAge--specific incidence of specific incidence of hospitalizedhospitalized cases of SBScases of SBS

(Barr, Trent et al Child Abuse & Neglect 2006)

0

5

10

15

20

25

30

35

40

45

50

0 8 16 24 32 40 48 56 64 72 80

Age (weeks)

No.

of c

ases


AgeAge--specific Incidence ofspecific Incidence ofPubliclyPublicly--reportedreported Cases of SBSCases of SBS

(Lee, Barr et al JDBP 2007)

0

20

40

60

80

100

120

0-4 5-8 9-12 13-16 17-20 21-24 25-28 29-32 33-36 37-40 41-44 45-48 49-52 53-56 57-60 61-64 65-68 69-72 73-76 77-80

Baby's Age (weeks)

No.

of C

ases

Crying Stimuli (n=166) All Stimuli (n=591)

17


Curves of Early Crying and Curves of Early Crying and SBS IncidenceSBS Incidence

1 2 3 4 5Months of Age

Lag

Ons

et

Cry Curve

SBS Curve


Sheets L et al.:Sheets L et al.:Sentinel injuries Sentinel injuries precede abusive precede abusive

head trauma in head trauma in infantsinfants

Presented Presented HelferHelfer Society, Society, Sept 2008, Tucson, AZSept 2008, Tucson, AZ

Used with permission from L. Sheets


Pathways to ShakingPathways to Shaking

Crying

Threshold

Frustration ……….Anger

Shaking


The Pathways to Prevention:The Pathways to Prevention:AppropriatenessAppropriateness

of Adviceof Advice

Crying

Threshold


Shaking

AppropriateAccurateAdvice


The Pathways to Shaking:The Pathways to Shaking:Wrong Advice?Wrong Advice?

Crying

Threshold


Shaking

InaccurateInappropriate

WrongAdvice

••Must not result in Must not result in more harm than goodmore harm than good


The Period of PURPLE The Period of PURPLE CryingCrying

PP Peak of CryingPeak of CryingUU UnexpectedUnexpectedR R Resists SoothingResists SoothingPP PainPain--like Facelike FaceLL Long LastingLong Lasting

EE EveningEvening

18


Five Things We Think We KnowFive Things We Think We Know• The “crying curve” (and “colic”) is a behavioral

universal of infancy• Unsoothable bouts are unsoothable!• Post-curve, persistent or repeated elevated

crying after 3-4 months is an important, but different, phenomenon, and has long-term predictability to later outcomes;

• The early cry is a graded signal, not a typological sign or signal

• The most important negative clinical consequence of “colic” for the infant is shaken baby syndrome or infant abuse


Both Jack and I Both Jack and I thank youthank you


How Do How Do ““Increasing Increasing Carry, Comfort, Walk Carry, Comfort, Walk

and Talk and Talk ResponsesResponses”” Work?Work?

Fuss Cry

F C

Increasing contact reduces distress Inconsolable Cry

But it does not reduce inconsolable crying

50% less

CrossCross--species species CaregivingCaregiving and and BreastmilkBreastmilk CompositionComposition

Blurton-Jones


Infants with ColicInfants with Colicin London, Copenhagen, and with a in London, Copenhagen, and with a

““proximalproximal”” form of careform of careInfants with "Colic"

0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

10 days 5 weeks 12 weeks

Age of Infants

Perc

enta

ge o

f Inf

ants

London CommunityCopenhagen CommunityProximal Care

*

* denotes χ2 test where p < 0.001

St James-Roberts, I., Alvarez, M., Csipke, E., Abramsky, T., Goodwin, J., Sorgenfrei, E. Infant crying and sleeping in London,Copenhagen, and when parents adopt a 'proximal' form of care. Pediatrics, 2006.

A counter-example or an explainable

variant?


ReconceptualizationReconceptualization of of ““Colic:Colic:””Colic is a manifestation of normal Colic is a manifestation of normal

behavioralbehavioral developmentdevelopmentAll of the features of the crying definitive of

excessive crying (or “colic”) can be understood as manifestations of the upper end of a spectrum of crying behavior that is typical of normally normally developing infantsdeveloping infants rather than a distinct crying pattern indicative of underlying disease in the infant or psychopathology in the caregiver(s).

19


Moderate Retinal Hemorrhage in Moderate Retinal Hemorrhage in Shaken Baby SyndromeShaken Baby Syndrome

Courtesy Alex Levin, MDCourtesy Alex Levin, MD

Guinea Pig Distress as a Function of Guinea Pig Distress as a Function of ““PlacePlace”” & Mother Presence & Mother Presence ((PettijohnPettijohn 1979)1979)

Levels of Levels of Description Description of Cryingof Crying

Barr (1990) Human Nature 1: 355-389

A proposed taxonomy for describing crying phenomena, in which “cycles,” “events” and “bouts” are related hierarchically in terms of the cry cycles and how they are related to each other

Events

Cycles

Bouts

Coded State Changes between Coded State Changes between CryingCrying and and AlertAlert

!Kung San Hunters!Kung San Hunters(Courtesy Marjorie (Courtesy Marjorie ShostakShostak))


NN--shaped curves in habituation to shaped curves in habituation to visual stimulivisual stimuli

20


Is there an Is there an ““early crying peakearly crying peak”” in freein free--ranging Rhesus macaques?ranging Rhesus macaques?

(Barr, Warfield, Catherine SRCD Apr 9, 2005)(Barr, Warfield, Catherine SRCD Apr 9, 2005)

0

5

10

15

20

25

30

35

0-6 7-12 13-18 19-24 25-30 31-36 37-42Age (Weeks)

Rat

e Di

stre

ss V

ocal

izat

ions

(dv/

hr) Mean

Median

Time Spent in Time Spent in ““CryingCrying”” or or ““AlertAlert””

States or States or ““In In transitiontransition””

Frequency histograms of % negative vocalizations in 10-second blocks, prior to (upper graph) and following (lower graph) taste administrations.

Negative Vocalizations:

CryingCrying = 100%

AlertAlert = 0%

TransitionTransition = 10-90%

Barr, Beek & Calinoiu, 1999


Methodological Caveat for Methodological Caveat for Measuring CurvesMeasuring Curves

Principle:You must make enough measurements at the right times to capture the properties of the phenomenon you are measuring.


Is there a "curve"?

0

20

40

60

80

100

120

140

160

180

w1 w2 w3 w4 w5 w6 w7 w8 w9w10

w11w12

Recording Week

Min

utes

/day

Dis

tress

Brazelton

Green diamonds includes St J-R (1999)

Symposium organized by M.

Alvarez, Stockholm

“6 weeks of age” is week 7 of life

the phenomena of early infant crying and colic · 3/2/2009 · the phenomena of early infant...

Documents