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The infant with acute, unexplained, excessive crying.

This study describes 56 infants who presented to the Emergency Department of The Children's Hospital of Denver during a 1-year period with an episode of excessive, prolonged crying, without fever and without a cause that was apparent to the parents. The final diagnoses included a broad array of conditions, of which 61% were considered serious. The history provided clues to the final diagnosis in 20% of cases. Physical examination revealed the final diagnosis in 41% and provided clues to the diagnosis in another 13%. Accurate diagnosis requires a thorough physical examination, which should include careful skin inspection underneath all clothing, palpation of all large bones, fluorescein staining of the cornea, eversion of eyelids, rectal examination, retinal examination, and thorough neurologic examination. "Screening" laboratory tests, except for urinalysis and urine culture, were of little help. This study indicates that for those patients in whom the physical examination is not diagnostic, the persistence of excessive crying after the initial examination predicts the presence of a serious cause. Those infants who cease crying before or during the initial assessment are unlikely to have a serious cause. Recommendations for a stepwise assessment are offered.

Child, Preschool↗

Perceptions of vulnerability 3 1/2 years after problems of feeding and crying behavior in early infancy.

The long-term consequences for infants with problems of feeding and crying behavior remain unknown. The purpose of this research was to determine whether such children are later perceived by their parents as vulnerable and more often have behavior problems and have different personalities than children without problems in infancy. The implications of managing such problems by changing milk formulas is explored. Mothers of 379 infants were enrolled in the postpartum period. Information about problems of feeding and crying behavior was obtained at 4 months. Thirty-six percent of the infants had problems and the formula had been changed for 17%. At 3 1/2 years, 320 (84%) mothers completed a questionnaire. Children who had had problems were more often perceived as vulnerable (relative risk [RR] 1.86; 95% confidence interval [CI] 1.09, 3.19) and more often had behavior problems (RR 1.78; 95% CI 1.03, 3.07). There were no differences in personality. Children whose problems had been managed by changing milk formulas were more often perceived as vulnerable (RR 2.18; 95% CI 1.05, 4.53). Although allergies were reported significantly more often for those children who had had problems, there were no differences in the prevalence of asthma or eczema. Problems of feeding and crying behavior in early infancy and the way they are managed may have long-term implications for the child.

Child Behavior Disorders↗

[The patterns of anxiety and crying among normal Danish infants with and without colic].

On the basis of a descriptive, prospective investigation, the patterns of fussing and crying in normal Danish infants aged from 2-3 to 14 weeks are described. A total of 102 infants were included in the investigation and 85% completed the investigation. The parents carried out daily registration of the periods of fussing and crying. The great majority of the infants were very placid. The mean duration of fussing for the entire group was half an hour per week during the third week of life. This increased to 2 1/2 hours per week at the sixth week of life and then decreased gradually to 0 hours per week from the 12th week of life. The material was subdivided into quartiles. Infants in the first and second quartiles showed practically no fussing. Infants in the third quartile were fussy at the commencement of the period and became gradually more placid from the fifth week of life. Infants in the fourth quartile were fussy during the first 9-10 weeks of life, after which the fussing gradually diminished. In infants in the third and fourth quartiles, fussing was most marked in the evenings. Two pairs of parents considered that their infants had colic. Ten infants were defined as having infantile colic. In these infants, the patterns of fussing and crying showed a common pattern and this was significantly different from the remainder of the group. The basic variables for the 25% most placid infants and the ten infants presumed to have colic are compared.

Anxiety↗

Effects of marijuana use during pregnancy on newborn cry.

The effects of maternal marijuana use on the newborn cry were studied in Jamaica, where it was possible to rule out confounding factors such as the use of other substances and demographic variables that have clouded previous studies and where higher dosages may make the effects more visible. The acoustic characteristics of the cries of 20 infants of marijuana users and 20 controls were analyzed. The cries of the infants of marijuana users were shorter, had a higher percentage of dysphonation, a higher and more variable fundamental frequency, and a lower first formant than controls. There was also a dose response relation between the first formant and marijuana use. We suggest that heavy marijuana use affects the neurophysiological integrity of the infant.

Acoustics↗

A 45,XX,-5,-14,+t(5q;14q)mat cri du chat child.

A two-year-old girl has the following features of the cri du chat syndrome: microcephaly, hypertelorism, downward slanting of the palpebral fissures, psychomotor retardation and a cat-like cry. She is only of five patients having the cat cry syndrome with 45 chromosomes. Her karyotype is 45,XX, -5, -14, +t(5; 14)(5qter leads to 5p11: : 14q11 leads to 14qter) with the translocation inherited from her mother and maternal grandmother, each of whom is the carrier of a balanced translocation 46,XX,t(5;14)(p11q11). Normal plasma activity for hexosaminidase B suggests the locus for this enzyme is not located in the delected segment of 5 p.

Chromosome Deletion↗

Reducing nocturnal awakening and crying episodes in infants and young children: a comparison between scheduled awakenings and systematic ignoring.

Infants and toddlers (N = 33) exhibiting spontaneous awakening and crying episodes during the night were randomly assigned to one of three groups: scheduled awakenings, systematic ignoring or control. Scheduled awakenings consisted of a parent arousing and feeding or consoling the child 15 to 60 minutes before typical spontaneous awakenings. Once spontaneous awakenings were precluded, scheduled awakenings by parents were gradually eliminated. Systematic ignoring consisted of allowing the child to "cry it out" without parental attention except to ensure physical well-being of their child. Children in the scheduled awakening group and the systematic ignoring group awoke and cried less frequently than children in the control group during 8 weeks of treatment and during two follow-up checks, 3 and 6 weeks after treatment. Systematic ignoring was found to be more effective than the scheduled awakenings condition during 1 week of treatment; otherwise effects of the two conditions were similar. Implications of the use of these treatment procedures are discussed.

Child, Preschool↗

[Development of a baby's cry].

The work is dedicated to studying of development of babies cries forms (systems of acoustic characteristics) during first half-year of life. The main cry functions in the system of baby's interaction with mother is being considered and the acoustic parameters to which mother reacts determining the cause of cry are being revealed.

Acoustics↗

Colic: excessive crying in newborns.

The pediatrician is commonly called upon to evaluate and manage the crying newborn. While most of these infants have colic, organic causes of crying must be carefully considered. The role of crying in precipitating child abuse also requires special vigilance on the physician's part. Colicky babies respond most effectively to physical contact and gentle motion. Other approaches, such as changing formulas or drugs, are unnecessary and potentially dangerous. Preventive measures for colic are addressed in steps one through four of the article "The Prevention of Sleep Problems" in this volume.

Child Abuse↗

Child abusers' responses to infant smiles and cries.

14 child abusers and a matched group of non-abusers watched videotapes of crying and smiling infants. Their psychophysiological responses were monitored throughout the session. After each videotape, the subjects described their emotional responses on a mood adjective checklist. The crying infant elicited heart-rate acceleration and increases in skin conductance and diastolic blood pressure from both groups, although the abusers experienced greater increases in heart rate and reported more aversion and less sympathy. Like other parents tested in this paradigm, the nonabusers responded to the smiling infant with no change in or declines in physiological activation. The abusers, however, responded to the smile and cry stimuli similarly.

Affect↗

[Prenatal detection of crying cat syndrome due to balanced translocation in one parent].

Prenatal detection of "Cri du chat" syndrome, as the consequence of balanced translocation 46,XY,t (5, 15) (p 13, p11) of the father, is described. A phenotipically normal child, with the same type of translocation possesed by his father was born in this family, as well as a child with "Cri du chat" syndrome. Four pregnancies were termed by spontaneous abortion. In the seventh pregnancy amniocenthesis was performed. On the basis of cell culture of amniotic fluid the diagnosis of "Cri du chat" syndrome was established. The diagnosis was confirmed by culture of peripheral blood of prematurely born foetus. Tissue cultures of some fetal organs were performed in order to find the origin of amniotic cells whose culture served for screening cytogenetic analysis.

Amniocentesis↗

[Pathological crying and unilateral pontine infarction].

A 64-year-old man presented with pathologic crying and right hemiplegia due to a unilateral pontine infarct from probable branch disease of the basilar artery. The circumscribed nature of the lesion was supported by MRI and short-latency evoked potentials. The weeping spells ceased after a few days of imipramine in low doses. Pathologic laughing and crying can be viewed as a limbic-motor disconnection syndrome, in which the faciovocal motor system is released from forebrain afferents carrying information of emotional content. The inclusion of pathologic laughing and crying in the syndrome pseudobulbar palsy is inaccurate and misleading, since each is related to distinct functional and anatomic systems intrinsic to the human brainstem.

Antidepressive Agents, Tricyclic↗

Excessive crying in infants with regulatory disorders.

The authors point out a correlation between regulatory disorders in infants and the problem of excessive crying. The literature describes other behavioral problems involving excessive crying in very young children, but with little emphasis on this association. The recognition and diagnosis of regulatory disorders in infants who cry excessively can help practitioners design appropriate treatment interventions. Understanding these conditions can also help parents tailor their caretaking style, so that they provide appropriate soothing and stimulation to their child. In so doing, they will be better able to develop and preserve a satisfactory parent-child relationship, as well as to maintain their own sense of competence and self-esteem as parents.

Child Development↗

Prenatal maternal reactivity to infant cries predicts postnatal perceptions of infant temperament and marriage appraisal.

In a sample of 60 primiparous women, cardiac response and ratings of subjective aversiveness to recordings of unfamiliar infant cries were studied at 32 weeks' gestation. Regression analyses were used to examine relations between cardiac acceleration and subjective aversiveness and 3 groups of postnatal dependent variables: perception of infant temperament, the mother's emotional state, and her appraisal of her marriage. Mothers who prenatally rated the cry recordings as more aversive postnatally described their 3-month-old infants as more fussy/difficult and unpredictable. With statistical control for prenatal variation on the emotional state and marital outcome measures, cardiac acceleration predicted later marital quality. Women who showed greater cardiac acceleration to the cries described their postnatal marital relationships more negatively.

Adult↗

The bedtime pass: an approach to bedtime crying and leaving the room.

OBJECTIVE: To evaluate a novel intervention for bedtime problems. DESIGN: We used an ABAB withdrawal-type experimental design. SETTING: The intervention was prescribed in an outpatient primary health care context and evaluated in the home setting. PARTICIPANTS: Two normally developing boys aged 3 and 10 years were the primary participants. Twenty parents and 23 practicing pediatricians rated the acceptability of the intervention. INTERVENTION: A bedtime pass, exchangeable for 1 excused departure from the bedroom after bedtime. MAIN OUTCOME MEASURES: For both primary participants, instances of crying and/or coming out from the bedroom after bedtime; for the 20 parents and 23 pediatricians, comparative ratings of acceptability for the pass and 2 other commonly used approaches to bedtime problems (ignoring crying and letting children sleep with their parents). RESULTS: Crying and coming out from the bedroom reduced to zero rates in both children. Pediatricians rated using the pass as significantly more acceptable than letting children sleep with parents and equivalent to ignoring. Parents rated the pass as more acceptable than either alternative. CONCLUSION: The bedtime pass provides pediatricians with a readily usable, potentially effective, and highly acceptable novel intervention for bedtime problems, one of the most common complaints in outpatient pediatrics.

Adult↗

Cloning and sequencing of cDNA coding for Cry j I, a major allergen of Japanese cedar pollen.

cDNA clones coding for Cry j I, a major allergen of the Japanese cedar (Cryptomeria japonica) pollen, have been isolated. Two of the clones were sequenced and found to code for a putative 21-residue signal peptide and a 353-residue mature protein with a derived molecular weight of 38.5 KDa. Five possible N-linked glycosylation sites were found in the sequence. Comparison of the nucleotide sequences of the two clones revealed sixteen nucleotide differences and these led to five amino acid exchanges in the mature allergen, indicating that an isoform of the Cry j I molecule exists. The deduced amino acid sequence of the Cry j I shows 46-48% identities with those of the Amb a I family and Amb a II, the major allergens of short ragweed. These findings should facilitate study of the structure-function relationship between the allergen and the immunocompetent cells.

Allergens↗

Modulation of Cry IV A toxin protein expression by glucose in Bacillus thuringiensis israelensis.

Bacillus thuringiensis subsp. israelensis (Bti) produces Cry IV A protoxin protein as part of the insecticidal crystal toxin during sporulation. This study was conducted with the objective of identifying environmental signals which regulate toxin synthesis by Bti. Glucose was found to repress Cry IV A toxin induction at the mRNA level. The repressive effect of glucose was dependent on a phosphorylation step since protein kinase inhibitor calphostin c relieved the 130-kD protoxin synthesis at both the mRNA and protein level. Phosphorylation of HPr, the phosphocarrier protein of the phosphotransferase system, occurred during glucose repression of Cry IV A toxin synthesis in Bti cells was seen by Western blotting with anti-phosphoserine antibody and rabbit anti-HPr serum. Phosphorylation of HPr in vivo as well as in the in vitro assay was inhibited by calphostin c, a specific inhibitor of serine/threonine kinase. Calphostin c had no effect on sporulation efficiency of Bti cells.

Animals↗

Maximal airway pressures during crying in healthy preterm and term neonates.

Respiratory muscle strength can be assessed by measurement of maximal inspiratory (PIMAX) and maximal expiratory pressure (P(EMAX)) during crying. There are, however, relatively few data on P(IMAX) and P(EMAX) in infancy, particularly from those born preterm. Our aim was to investigate which factors influenced P(IMAX) and P(EMAX) in preterm and term infants. Forty infants, median gestational age 37 weeks (range 26-43) and birthweight 2.579 kg (range 0.956-5.180) were studied at a postconceptional age (PCA) of 38 weeks (range 32-44). None had respiratory problems. A facemask was placed firmly over the infant's mouth and nose and the infant studied during spontaneous crying. A pneumotachograph fitted snugly into the facemask and from a sideport airway pressure changes were measured. During crying, the distal end of the pneumotachograph was occluded for five breaths and at least three separate occlusions were made. The highest P(EMAX) value sustained for at least 1 s and the highest peak inspiratory pressure P(IMAX) were recorded. The mean P(IMAX) and P(EMAX) were higher in the term compared to the preterm infants (70 cmH2O +/-S.D. 19 versus 58 cmH2O +/-S.D. 17 P(IMAX) and 53 cmH2O +/-S.D. 13 versus 44 cmH2O +/-S.D. 19 P(EMAX), P< 0.05). Both P(IMAX) and P(EMAX) related significantly with postconceptional age, gestational age and weight, but not postnatal age. Stepwise regression analysis demonstrated P(IMAX) related independently with PCA and P(EMAX) with weight. These results suggest respiratory muscle strength is influenced by maturation at birth.

Airway Resistance↗