Infantile colic: natural history and treatment.
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Animals↗
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Results for “Infant Behavior”
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Epidural anesthesia in labor. Benefits versus risks.
Epidural anesthesia is used for relief of labor pain by 29% of women having hospital deliveries in the United States, a number that has doubled within the past 10 years. Although epidurals provide objective pain relief that is exponentially better than the other pain relief methods, there are many purported complications and side effects. This article reviews how epidurals work, summarizes the literature regarding complications, and presents some of the ethical dilemmas inherent in the use of this technology for labor.
Anesthesia, Epidural↗
Are postoperative pain instruments useful for specific groups of vulnerable infants?
Based on the authors' review of the literature on pediatric postoperative pain assessment with special attention to groups of vulnerable infants, this article (1) reports on type of surgery and its relationship to postoperative pain intensity; (2) reviews the characteristics of existing postoperative pain instruments for neonates, infants, and toddlers; (3) discusses timing, duration, and who should assess postoperative pain; (4) reviews the specific literature on pain assessment in critically ill infants, including the extremely low birth weight and the cognitively and/or neurologically impaired infant, and (5) discusses the role of parents in postoperative pain assessment. Postoperative pain instruments are useful for specific groups of vulnerable infants, but it is important that in addition to the valuable scoring of pain, common sense is used and factors such as developmental stage, temperament and personality, number of previous painful experiences, anxiety, and environmental factors are taken into account.
Child, Preschool↗
Infant crying and abuse.
Child abuse and neglect are important causes of child morbidity and death. We assessed potentially detrimental parental actions induced by infant crying in 3259 infants aged 1-6 months, in the Netherlands. In infants aged 6 months, 5.6% (95% CI 4.2-7.0) of parents reported having smothered, slapped, or shaken their baby at least once because of its crying. The risks of detrimental actions were highest for parents from non-industrialised countries, those with either no job or a job with short working hours, and those who judged their infant's crying to be excessive. Clinicians should be aware of the risks of abuse in children known to cry a lot and should target interventions at parents to help them cope with this crying.
Child Abuse↗
If only you hadn't, I would not have hit you: infant crying and abuse.
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Child Abuse↗
Understanding a young child's pain.
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Child, Preschool↗
An early marker for neurological deficits after perinatal brain lesions.
BACKGROUND: In normal awake infants, fidgety movements are seen from the age of 6 weeks to 20 weeks. The aim of the study was to test the predictive value of absent or abnormal spontaneous movements in young infants for the later development of neurological deficits. METHODS: In a collaborative study involving five hospitals we collected data on the normal and abnormal quality of fidgety movements of 130 infants and compared it with assessments of neurological development done longitudinally until the age of 2 years. On the basis of ultrasound scans infants were classified as at low-risk or at high-risk of neurological deficits. Infants were videoed for 1 h every week from birth to discharge and then for 15 min every 3 to 4 weeks; quality of general movements was assessed. Repeated neurological assessments were also done until 24 months of corrected age. FINDINGS: 67 (96%) of 70 infants with normal fidgety movements had a normal neurological outcome. Abnormal quality or total absence of fidgety movements was followed by neurological abnormalities in 57 (95%) of the 60 infants (49 had cerebral palsy and eight had developmental retardation or minor neurological signs). Specificity and sensitivity of fidgety movement assessment were higher (96% and 95%, respectively) than of ultrasound imaging of the infants' brain (83% and 80%, respectively). INTERPRETATION: Our technique of assessing spontaneous motor activity can identify and distinguish between those infants who require early intervention for neurological abnormalities and those who do not. Our technique is simple, non-intrusive, reliable, quick, and can be done on very young infants.
Biomarkers↗
Infant discrimination of rapid auditory cues predicts later language impairment.
The etiology and mechanisms of specific language impairment (SLI) in children are unknown. Differences in basic auditory processing abilities have been suggested to underlie their language deficits. Studies suggest that the neuropathology, such as atypical patterns of cerebral lateralization and cortical cellular anomalies, implicated in such impairments likely occur early in life. Such anomalies may play a part in the rapid processing deficits seen in this disorder. However, prospective, longitudinal studies in infant populations that are critical to examining these hypotheses have not been done. In the study described, performance on brief, rapidly-presented, successive auditory processing and perceptual-cognitive tasks were assessed in two groups of infants: normal control infants with no family history of language disorders and infants from families with a positive family history for language impairment. Initial assessments were obtained when infants were 6-9 months of age (M=7.5 months) and the sample was then followed through age 36 months. At the first visit, infants' processing of rapid auditory cues as well as global processing speed and memory were assessed. Significant differences in mean thresholds were seen in infants born into families with a history of SLI as compared with controls. Examination of relations between infant processing abilities and emerging language through 24 months-of-age revealed that threshold for rapid auditory processing at 7.5 months was the single best predictor of language outcome. At age 3, rapid auditory processing threshold and being male, together predicted 39-41% of the variance in language outcome. Thus, early deficits in rapid auditory processing abilities both precede and predict subsequent language delays. These findings support an essential role for basic nonlinguistic, central auditory processes, particularly rapid spectrotemporal processing, in early language development. Further, these findings provide a temporal diagnostic window during which future language impairments may be addressed.
Apgar Score↗
A randomized trial of oral iron on tests of short-term memory and attention span in young pregnant women.
Recent studies suggest that infant behavior and psychological test performance are impaired by iron deficiency and may be improved by iron. Comparable studies have not been performed in older populations. Young women early in pregnancy whose nutritional intake may be impaired by poverty constitute a high-risk population. Women aged 14-24 years coming for prenatal care at or before 16 weeks gestation whose hematocrits were greater than or equal to 31% were randomized in a double-blind trial to receive vitamins supplemented with iron (experimental group) or vitamins alone (controls). Hematologic status and tests of short-term memory and attention span were assessed at entry and conclusion of the one-month treatment period. The experimental group showed significant improvement on the most sensitive measure of short-term memory and three subtests. On comparison of the change between initial and final scores, the experimental group showed significant or borderline greater improvement than controls on three tests. These results indicated a beneficial effect of iron therapy on psychometric test-score performance.
Adolescent↗
Development of emotional sweating in preterms measured by skin conductance changes.
Skin conductance shows the emotional state, as reflected in changes in the sympathetic nervous system. Skin conductance changes (number and amplitude of the waves, as well as mean skin conductance level) were measured in connection with heel prick from 29 weeks gestational age. The purposes of this study were to examine the development of emotional sweating in preterm infants, and to correlate the changes in emotional sweating with the changes in behavioural state. Fifty infants' behavioural state and skin conductance changes were measured for 2 min before, 2 min during, and 2 min after heel prick. Half of the infants were between 29 and 31 weeks gestational age. They were divided into three sub-groups; 0-10, 11-20 and 21-30 days postnatal age. The other half of the infants were between 32 and 34 weeks gestational age and they were divided into three similar sub-groups. They changed their behavioural state 114 times. Infants from 29 weeks gestational age and more than 10 days old showed emotional sweating as measured by the number and amplitude of the waves that were lowest in sleep and highest during crying (p<0.05). The mean skin conductance level mirrored the behavioural state from 34 weeks gestational age (p<0.05).To conclude, skin conductance changes increased with the level of behavioural state from 29 weeks gestational age and more than 10 days postnatal age.
Birth Weight↗
Skin conductance and behaviour during sensory stimulation of preterm and term infants.
AIM: To investigate the responses to painful and tactile stimulation in preterm and term infants in terms of changes in the plantar skin conductance activity (SCA) and behavioural state. Plantar SCA reflects activity in the sympathetic nervous system. DESIGN: The plantar SCA and behavioural state in response to nociceptive (the heel prick for blood samples, or immunization) and tactile (routine nursery handling) simulation was recorded in four different groups of infants (n=71): Preterm and term neonatal infants (defined here as up to 1 week old), and preterm and term infants in the postneonatal period. RESULTS: The preterm infants had significant increases in all skin conductance variables during both tactile and nociceptive stimulation (p<0.02), except for wave amplitude when newborns were heel pricked. The term infants displayed a more varied picture, but both the number and amplitude of the waves increased significantly during both procedures in the newborn groups, while the postneonatal groups only showed significant increases in wave amplitude during nociceptive stimulation (p<0.05). Tactile stimulation of the preterm newborn infants produced significantly higher increases in SCA than nociceptive stimulation (p<0.01), while the behavioural state was highest during nociceptive stimulation (p<0.05). A gradual change in this relation was seen with advancing total age. CONCLUSION: Non-painful sensory stimulation of infants, especially the newborn and preterm ones, can produce equal or higher levels of physiological stress activation than painful stimulation. Repeated nociceptive stimulation probably sensitises the infants to pain.
Female↗
The qualitative assessment of general movements in preterm, term and young infants--review of the methodology.
We describe the state of the art of Prechtl's method for the qualitative assessment of general movements as a diagnostic tool for early detection of brain dysfunction. After discussing the optimal technique for video recording general movements in preterm, term and young infants, attention is focused on the proper analysis of this spontaneous motor pattern. Recently, a group of active researchers in the field reached consensus on the various qualities of normal and abnormal general movements. These definitions are reported here in full. Since it is a newly introduced method careful investigation into its reliability is required. Various groups of investigators have obtained data which demonstrate the robust character of the method (interscorer agreement: 78-98%). Finally, we discuss the validity of this early assessment method on the basis of the reports published so far. While the method's sensitivity is similar in all age groups studied (preterm, term, first month, second month, and third month age epochs), and averages 94.5%, the specificity of the method is age-dependent. It is low during the early ages, increases gradually and reaches 82 to 100% at 3 months post-term. This phenomenon is explained by spontaneous recovery of early dysfunction. In contrast, consistent abnormalities of general movements are linked to neurological deficits found at the 2 year follow-up.
Brain Diseases↗
Posture, spontaneous movements, and behavioural state organisation in infants affected by brain malformations.
Posture, quantity of spontaneous movement patterns, quality of general movements (GMs), and behavioural state organisation were studied in nine infants affected by documented brain malformations. A single 1 h video recording of five infants and two or more serial video recordings of another four infants were performed after birth. The graphic representation of single movement patterns (actogram) and of behavioural states of one video recording was performed in eight out of nine infants. The quality of GMs was assessed according to Prechtl's method in all video recordings. All nine infants showed a less variable posture than normal newborn infants and an unusual resting posture was detected in seven infants. Poor behavioural state organisation without sleep cycles was common to the nine infants and excessive wakefulness was observed in six infants. As for the quantity of single movement patterns, six infants lacked one or two movement patterns normally present in healthy newborn infants. An abnormal quality of GMs was noted in all nine infants and distinct motor abnormalities were observed in single infants. A monotonous and sometimes stereotyped sequence of different body parts involved in the movement (i.e. poor repertoire GMs) was common to all infants. In the four infants of whom two or more video recordings were available, initial poor repertoire GMs were followed by a further deterioration in movement quality. No relationship was found between the quantity of defective brain tissue, lack of a specific part of the brain, type and severity of GM and posture abnormalities.
Brain↗
Crying, fussing and colic behaviour in breast- and bottle-fed infants.
Persistent infant crying and "colic" have been linked in some studies to feeding, but this association has not been tested in a planned longitudinal study comparing breast- with formula fed babies. We used validated maternal diaries of infant behaviours, kept for three days at both two and six weeks of infant age, in a comparative study of 97 breast- or formula fed babies. The total duration of overall crying rose significantly between 2 and 6 weeks in breast-fed infants and fell in those fed formula. At 6 weeks, breast-fed infants cried an average of almost 40 minutes more per day than formula fed infants; and 31% cried for more than three hours per day, compared with only 12% of the formula fed group. At six weeks, breast-fed infants also slept almost 80 minutes less per day than the formula fed babies. While six weeks is the established peak age for infant crying, those fed formula peaked much earlier and at 2 weeks intense crying/colic behaviour occurred in 43% of formula fed babies and just 16% of those fed by breast. These findings link the timing of the infant crying peak to the mode of feeding. Our data indicate that any regimen designed to reduce crying should commence in the neonatal period in formula fed infants.
Aging↗
Orientation responses to biological odours in the human newborn. Initial pattern and postnatal plasticity.
The initial pattern and development of odour preference was studied in infants simultaneously exposed to amniotic fluid (AF) and maternal lacteal secretion (L). Five groups of varying age (range: 1-5 days) and breast-feeding experience (range: 0-32 feeds) were studied. Before postnatal day 3, no evidence of differentiation of AF and L was apparent. After 3 days and 7-12 breast-feeding episodes, a significant preference for L arised. The initial stage (days 1-3) may reflect fetal acquisition of AF odour and sensory/motivational equivalence of AF and L odours. The second stage (days 4-5) may reflect the infants' perception of change in milk quality and increasing experience with milk. This sequential development attests to a high plasticity in the initial stage of human olfactory development.
Age Factors↗
Psychometric testing of an infant risk assessment for prenatal drug exposure.
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Case-Control Studies↗
Enabling parents to "read" their baby.
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Adult↗
The effect of prenatal cocaine exposure on neurobehavioral outcome: a meta-analysis.
A meta-analysis was performed of the research published from 1985 to 1998 examining the effect of in utero exposure to cocaine on infant neurobehavioral outcome. The initial search for articles to include in the meta-analysis identified 18 studies with potentially meta-analytic variables. Of the studies originally retrieved, 13 failed to meet all of the inclusion criteria and were excluded from the meta-analysis. A total of 14 meta-analyses were performed comparing cocaine-exposed infants to nonexposed infants on NBAS cluster scales at birth and at 3-4 weeks of age. While the meta-analytic combination of studies produced a large enough sample size to drive statistical significance in a small majority of the tests of difference between the cocaine-exposed and nonexposed infants both at birth and soon after, the magnitude of all effects was small. The largest reliable differences appeared for the motor performance and abnormal reflexes clusters. Both also demonstrated a slight trend for increasing standard differences from birth to measures obtained at 3-4 weeks. The orientation and autonomic regulation clusters produced small, significant effects at both time periods, but the trend was for reduced effect sizes over time. All other effects appear truly negligible.
Cocaine-Related Disorders↗