Original articles
Infants with “Colic”—mothers' perspectives on the crying problem

https://doi.org/10.1016/S0022-3999(99)00084-7Get rights and content

Abstract

Objectives: This study was designed to evaluate relationships between infant crying behavior and fussing behavior and the mother's causal attributions of the crying, her emotional responses to the crying, as well as her later perception of infant temperament. Methods: Twenty mothers who presented their 3–9-week-old infants in pediatric practices because of excessive crying (“colic complaint group”) and 20 mothers who visited for public preventive screening (“control group”) were compared. Mothers kept a “baby diary.” A highly structured interview with the mothers was conducted. When the babies were 4 months old, mothers completed a temperament questionnaire. The colic complaint group was subdivided using the Wessel criteria. Results: Infants from the colic complaint group who did not meet these criteria did not differ from control subjects in any of the parameters derived from the diaries. However, the mothers of this group described significantly heightened negative affect and cognitions of being rejected in response to the crying. In contrast, mothers of infants who conformed to Wessel's definition, and thereby far exceeded the other subjects in crying duration, did not differ from control mothers in respect of the aforementioned feelings and cognitions. Mothers' “negative affect and feelings of being rejected” were associated with the perception of high negative emotionality 4 months later. Conclusion: In regard to the colic problem, attention must be paid not only to the characteristics of the child, but also to aspects of maternal perception and processing of the crying problem.

Introduction

Excessive crying behavior is one of the most common complaints brought to pediatricians in the first 3 months of life [1]. If an infant cries often, and if this crying is not explainable to the caregiver or if soothing efforts ordinarily fail, then parents often seek medical advice. If the pediatric examination of the infant does not reveal any organic cause of the crying, and if the infant is well-nourished and developed, the parental complaint will be labeled as “3-month colic” [2].

A widely accepted definition of colic (the criteria of Wessel [3]) includes a cutoff point on crying duration: it defines colic as fussing or crying lasting for more than 3 hours per day and occurring on more than 3 days in any 1 week for 3 weeks or longer.

The etiology of the phenomenon is not known and it is very doubtful that infantile “colic” with respect to cause is a homogeneous entity 2, 4, 5, 6. Furthermore, colic crying can hardly be differentiated qualitatively from “normal” crying [2]. The development of crying follows a universal course: beginning at about 2 weeks, the amount of crying increases. It peaks at around 6 weeks of age and thereafter declines continously until it reaches a basal level in the third month. Prolonged crying episodes tend to cluster in the late afternoon and evening hours 2, 7, 8, 9. Intra- and interindividual variability in crying behavior is high.

Wolke [10] differentiated three common but partially conflicting opinions on colic:

  • 1.

    Colic as the upper end of the normal crying distribution.

  • 2.

    Colic as a clinical syndrome.

  • 3.

    Colic as behavior that cannot be tolerated by the caregiver.

Until now, colic research has revealed only weak support for the second position 5, 11, whereas the first and third ones are compatible with models that center on the poorness of fit between parental and infant characteristics 12, 13, 14, 15. For example, Papous̆ek and Papous̆ek [12] hypothesized a disposition on the part of the infant; that is, a “difficult temperament” concerning heightened negative emotionality/irritability and poor soothability. On the part of the caregiver it depends on personal and psychosocial resources as to whether supporting interactional behavior can be shown, and thus compensate for the child's problems.

If this supporting parental behavior is lacking, excessive crying may become worse. Finally, in a vicious circle, serious impairment of the parent–infant relationship may result. Colic is therefore hypothesized to be a major risk for the infant's development 12, 16.

We can summarize as follows: infant colic is a frequent cause of parents consulting pediatricians. However, there is insufficient agreement on the definition of colic, and knowledge about the genesis of the problem as well as the long-term effects is deficient. It is probable that parental and infant characteristics in varying degrees and combinations are responsible for the development of the syndrome.

Demos [17] has pointed out that, on the part of the caregiver, his or her subjective perspective on the crying problem (i.e., causal attributions, cognitions, and emotional reactions) may play a very important role with regard to parental consulting behavior as well as developmental consequences of the problem. So far, not much attention has been devoted to studying these issues.

In this study, the mother–infant dyad with colic complaint is described with regard to the amount of crying behavior (using the Wessel criteria) and further aspects of early state organization. For this purpose, the “colic complaint group” will be compared to mother–infant pairs without a colic problem. Second, we address the question of whether—depending on the amount of infant crying behavior—specific causal attributions, thoughts, and feelings concerning infant crying can be found in the “colic complaint group” mothers. Finally, we investigate whether mothers—depending on the existence and degree of the colic problem and on their causal attributions, cognitions, and affective reactions to the crying—describe their infants as difficult in temperament at the age 4 months; that is, at a time when the colic problem has passed.

Section snippets

Subjects

The sample consisted of 40 mothers of 3–9-week-old infants. Twenty of these mothers brought their child to pediatric practices because of excessive crying, or indicated crying as a problem in public preventive screening (U3). Index group subjects were recruited from nine pediatric practices in the area of Gießen/Friedberg (western Germany), and control subjects were recruited from the same pediatric practices when they attended for preventive screening. To control for potential influences of

Description of the subgroups

The “colic complaint group” and the “control group” were matched carefully. After subdivision into the Wessel and non-Wessel colic groups (WC and NWC), there were still no statistically significant differences between the three groups in the control variables (see Table 1).

Significant group differences were found for the typical “colic” problem concerning soothing interventions: 66.6% (n = 6) of the mothers of NWC infants and 63.7% (n = 7) of WC infants, but only 15% (n = 3) of the control

Discussion

A primary aim of this study was a description of mother–infant pairs with colic complaints as compared to other mother–infant dyads with respect to infant crying behavior and several other characteristics of the infant's state organization. For this purpose, the “colic complaint” group was subdivided into two subgroups according to the Wessel criteria on crying duration.

Consistent with the findings presented by Barr et al. [5] in a comparable but larger sample of 38 colic infants and their

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