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PubMed1996

Biodesensitization: biofeedback-controlled systematic desensitization of the stress response to infant crying.

Infant crying can be a source of parental stress both psychologically and physiologically and also may be an antecedent to physical child abuse or neglect. Biodesensitization is a new therapeutic technique that allows people to control the source of stress and develop self-control over their physiological responses to the stress-eliciting stimuli. Randomly assigned between three groups, 15 female participants were either given EEG biofeedback pretraining without stress, pretraining while listening to infant crying, or no stress management pretraining while listening to crying. After the pretraining manipulation all participants had biodesensitization training while listening to infant crying. Compared to control participants who were habituated to crying, stress management training significantly reduced the EEG cortical arousal as well as perceived arousal, and anxiety associated with listening to infant crying. The shift in participants' EEG power spectrum produced by infant crying was significantly correlated with perceived arousal and this relationship was strengthened after biofeedback training. In conjunction with other research, the experimental results suggest that stress management training may help ameliorate an aversive response to infant crying and possibly prevent child abuse as a response to physiological hyperreactivity.

Adult↗

PubMed1995

Role of infant crying in the early mother-infant dialogue.

This study examines the communicative role of crying by assessing the ability of infants to indicate different degrees of distress in different social circumstances. Behaviors of mother-infant pairs were observed in the home for 7-h periods when the infants were 2, 3, 4, and 5 wk old; and three weekly observations were made when the infants were 1 yr old. A Cry Responsiveness Index (CRI) was derived to quantify the degree to which a baby cried differentially during each observation. This statistic showed significant individual differences. The CRI scores were correlated with maternal measures during the early weeks and negatively correlated with "mother ignore" at one year. The CRI scores were unrelated to the total amount of crying. The results indicate that responsive infants have responsive mothers--or conversely, that responsive mothers have responsive infants. Thus, cry responsiveness is not a function of infant behavior alone but is inherently an expression of the dynamics of the mother-infant interactional system.

Adolescent↗

PubMed1989

Assessment of infant cry variability in high-risk infants.

Two studies were conducted to determine the relationship between variability in acoustic features of the infant cry and medical risk factors. In study 1, 3 groups of preterm infants (healthy, sick and CNS pathology) were compared with term infants at 40 weeks gestational age. The cry was analyzed by computer. The coefficient of variability of cry amplitude and the formant features of the cry differed among the groups of preterm infants. In study 2, 3 groups of term infants at low, moderate and high levels of hyperbilirubinemia were compared on the cry measures. More variability in the formant features of the cry was found in infants with higher levels of bilirubin. The correlation between the coefficient of variation in the cry formants and level of bilirubin was statistically significant. These two studies suggest that variability in the acoustic features of the cry relate to the medical status of the infant and may provide a measure of neurophysiological integrity.

Acoustics↗

PubMed2006

Age-related incidence curve of hospitalized Shaken Baby Syndrome cases: convergent evidence for crying as a trigger to shaking.

OBJECTIVE: To determine whether there is an age-specific incidence of hospitalized cases of Shaken Baby Syndrome (SBS) that has similar properties to the previously reported "normal crying curve," as a form of indirect evidence that crying is an important stimulus for SBS. DESIGN AND SETTING: The study analyzed cases of Shaken Baby Syndrome by age at hospitalization from hospital discharge data for California hospitals from October 1996 through December 2000. PATIENTS: All cases of children less than 18 months (78 weeks) of age for whom the diagnostic code for Shaken Baby Syndrome (995.55) in the International Classification of Disease, Ninth Edition, Clinical Modification was assigned. RESULTS: There were 273 hospitalizations for SBS. Like the "normal crying curve," the curve of age-specific incidence starts at 2-3 weeks, has a clear peak, and declines to baseline by about 36 weeks of age. In contrast to the normal crying curve that peaks at 5-6 weeks, the peak of SBS hospitalizations occurs at 10-13 weeks. CONCLUSIONS: The age-specific incidence curve of hospitalized SBS cases has a similar starting point and shape to the previously reported normal crying curve but the peak occurs about 4-6 weeks later. Of the likely predisposing causes, this pattern is only consistent with the properties of early crying. There are numerous explanations for the lag in the peaks between crying and SBS hospitalizations, including the possibility of repeat shakings prior to hospitalization. The importance of crying as a stimulus to SBS may provide an opportunity for preventive intervention.

Age Factors↗

PubMed2005

Excessive crying and gastro-oesophageal reflux disease in infants: misalignment of biology and culture.

Excessive crying is the most common problem presenting to the doctor in the first months of life in western industrialised societies, affecting up to 30% of infants. There has been an exponential increase in the diagnosis of gastro-oesophageal reflux disease (GORD) in babies who cry excessively over the past few decades, and many parents believe their crying infant "has reflux". This paper proposes that culturocentric assumptions have confused interpretation of research into GORD, and re-examines the findings of GORD research from the perspective of evolutionary biology. Evolutionary biologists argue that the human infant is an exterogestate foetus for at least the first six months of life, dependent on maternal co-regulation for optimal physiological function. However, infant-care practices in western industrialised societies shifted towards an emphasis on infant autonomy at the time of the Industrial Revolution. From the perspective of evolutionary biology, a misalignment between western culture and the biological expectations of the infant developed over two million years of evolution may result in excessive crying in less adapted babies. The key biocultural factors that impact on infant distress are feeding management, parental responsiveness, sensory nourishment and sleep management. When the concept of the human infant as an exterogestate foetus is integrated with the findings of GORD research, a hypothesis and its corollary emerge. This hypothesis proposes that infant GORD is a physiological manifestation of misalignment between biology and culture, and proposes, as a corollary, that if the impact of biocultural factors upon the physiology of otherwise well crying babies is not addressed in the first months of life, populations of infants who cry excessively may be predisposed to GORD after three to four months of age. If this hypothesis is correct, an integrated clinical approach to crying babies less than three to four months of age that considers feeding management (e.g., frequent feeds, breast- or bottle-feeding technique, referral to a lactation consultant, cow's milk allergy), parental responsiveness (e.g., prompt response to infant cues), sensory nourishment (e.g., sling or backpack, walks, massage) and sleep management (e.g., nocturnal co-sleeping) should, firstly, decrease crying when applied to infants less than three to four months of age, and secondly, decrease the incidence of GORD in these infants once they are older than three to four months of age. Thirdly, if this hypothesis is correct, combining the integrated approach with pharmaceutical intervention should improve outcomes in infants diagnosed with GORD.

Biological Evolution↗

PubMed1997

Differential response to intraoral sucrose, quinine and corn oil in crying human newborns.

Intraoral sucrose induces rapid and sustained calm in crying newborns and transiently increases mouthing and hand-mouth contact. To determine whether these effects are specific to sucrose and to explore which properties of orogustatory stimuli might contribute to this effect, 60 crying newborns were randomized to receive 250 ul of 24% sucrose solution, 0.25% quinine hydrochloride solution, or corn oil as well as water in a mixed parallel crossover design. Relative to water, sucrose persistently reduced crying, and transiently increased mouthing and hand-mouth contact as previously demonstrated. While quinine produces a "disgust" face in calm infants, in crying infants it transiently decreased crying and increased mouthing, but did not affect hand-mouth contact. Corn oil had no specific effect on crying, mouthing or hand-mouth contact. The results imply that crying newborns respond differentially to orogustatory stimuli, that taste "salience" rather than positive hedonic valence may account for initial crying reduction and increased mouthing, and that these behavioral effects are not induced by at least one lipid nutrient.

Behavior↗

PubMed1998

Links between maternal care and persistent infant crying in the early months.

A community sample was screened to select three groups of infants and their mothers according to how much the babies cried at 6 weeks of age, the peak age for infant crying. The three groups--of moderate (n = 55), evening (n = 38) and persistent criers (n = 67) and their mothers--were assessed by diary, observation and questionnaire measures of mother and infant characteristics and interactions at 6 weeks and 5 months of infant age. At 6 weeks, mothers of persistent criers spent more time interacting with and physically stimulating their babies. Below-optimum maternal sensitivity/affection was linked to moderately increased crying in the infants overall. However, most mothers of persistent criers showed optimum sensitivity and affection, while no significant links between maternal sensitivity/affection and infant crying were found in the persistent crying group. By 5 months, when infant crying declined, the range and size of differences between mothers of persistent criers and other mothers declined. Home observations and a standard play measure failed to show group differences in maternal sensitivity, affection and intrusiveness at this age. The findings show that persistent infant crying in the early months often occurs in spite of high quality maternal care, so that in most cases the crying is probably not due to inadequate parenting. The need to distinguish general community cases from those at social or medical risk is emphasized and the findings' implications for professionals are discussed.

Adult↗

PubMed1994

Judging pain in newborns: facial and cry determinants.

Explored the facial and cry characteristics that adults use when judging an infant's pain. Sixteen women viewed videotaped reactions of 36 newborns subjected to noninvasive thigh rubs and vitamin K injections in the course of routine care and rated discomfort. The group mean interrater reliability was high. Detailed descriptions of the infants' facial reactions and cry sounds permitted specification of the determinants of distress judgments. Several facial variables (a brow bulge, eyes squeezed shut, and deepened nasolabial fold constellation, and taut tongue) accounted for 49% of the variance in ratings of affective discomfort after controlling for ratings of discomfort during a noninvasive event. In a separate analysis not including facial activity, several cry variables (formant frequency, latency to cry) also accounted for variance (38%) in ratings. When the facial and cry variables were considered together, cry variables added little to the prediction of ratings in comparison to facial variables. Cry would seem to command attention, but facial activity, rather than cry, can account for the major variations in adults' judgments of neonatal pain.

Adolescent↗

PubMed1991

Infant crying patterns in the first year: normal community and clinical findings.

To provide information about persistent infant crying, crying durations and patterns were measured at four age points (1-3, 4-6, 7-9 and 10-12 months) in normal community (N = 400) and clinical (N = 68) samples. The findings provide a range of prevalence figures and descriptive statistics which may be useful for parents and professionals faced with infant crying. A large developmental shift in crying amount, and two age-related changes of crying pattern, were found. Clinical infants showed the same crying profiles as the general community infants, but were found to cry substantially more. Although mothers of first-borns were more likely to seek clinical referral, there were no birth-order differences in crying amount or pattern. The findings' implications for studies of infant temperament and development are indicated.

Age Factors↗

PubMed1994

The psychophysiology of crying.

Two conflicting views have emerged as to why people cry when they are sad. One suggests that crying serves homeostasis by facilitating recovery; the other suggests that crying produces an aversive high-arousal state that motivates behavior aimed at ending the tears. To test hypotheses drawn from these views, we showed a short film known to elicit sadness to 150 women. During this film, 33 subjects spontaneously cried and 117 did not. Subjects who cried exhibited more expressive behavior and reported feeling more sadness and pain than did subjects who did not cry. Crying also was associated with increases in somatic and autonomic nervous system activity. The increases in autonomic activity could not be accounted for solely by the increases in somatic activity. Crying is thus associated with an aversive state, including negative emotion and a complex mixture of sympathetic, parasympathetic, and somatic activation, and we speculate about the functional implications of these findings.

Adolescent↗

PubMed1996

Infant fussing and crying patterns in the first year in an urban community in Denmark.

Infant crying amounts and patterns in 590 1- to 12-month-old infants in an urban community in Denmark were studied using the Crying Patterns Questionnaire. The impact of the crying on parents and the primary health services was also assessed. The results showed that Danish mothers leave their infants to "cry out" substantially less than mothers in the UK and North America. Despite this difference, mean crying amounts, crying patterns and the incidence of persistent crying were similar to those reported in earlier western studies. The findings support the view that the infant crying peak in the first 3 months is due to normal maturational and developmental processes.

Age Factors↗

PubMed2005

Exposure to tobacco smoke and infant crying.

AIM: To examine the association of excessive infant crying with maternal smoking during and after pregnancy, paternal smoking, and smoking by other people in the living environment of the infant. METHODS: We collected data on infant crying and smoking in a Dutch national sample of 5845 infants aged 0-3 mo (response 62.8%). We defined excessive crying as crying over 3 h a day on more than 3 d of the preceding week. RESULTS: The prevalence rate of excessive crying was 4.0% (95% CI 3.5 to 4.5%). Excessive crying occurred more frequently among infants of fathers smoking 15 + cigarettes/d (odds ratio (OR) 1.99, 95% CI 1.38 to 2.86) and of mothers smoking 10 + cigarettes/d during pregnancy (OR 1.86, 95% CI 1.02 to 3.42). Infants whose parents were heavy current smokers or whose mothers had been so during pregnancy had a 69% higher prevalence of excessive crying than infants of non-smoking parents (rates: 6.3% and 3.7%, respectively; odds ratio 1.80; 95% CI 1.26 to 2.57). CONCLUSION: Parents stopping smoking may prevent excessive infant crying.

Breast Feeding↗

PubMed1998

Mothers' reports of infant crying and soothing in a multicultural population.

OBJECTIVES: To investigate the prevalence of infant crying and maternal soothing techniques in relation to ethnic origin and other sociodemographic variables. DESIGN: A questionnaire survey among mothers of 2-3 month old infants registered at six child health clinics in Amsterdam, the Netherlands. SUBJECTS: A questionnaire on sociodemographic characteristics and crying behaviour was completed for 1826 of 2180 (84%) infants invited with their parents to visit the child health clinics. A questionnaire on soothing techniques was also filled out at home for 1142 (63%) of these infants. RESULTS: Overall prevalences of "crying for three or more hours/24 hour day" "crying a lot", and "difficult to comfort" were 7.6%, 14.0%, and 10.3%, respectively. Problematic infant crying was reported by 20.3% of the mothers. Of these infants, only 14% met all three inclusion criteria. Problematic crying occurred less frequently among girls, second and later born children, Surinamese infants, and breast fed infants. Many mothers used soothing techniques that could affect their infant's health negatively. Shaking, slapping, and putting the baby to sleep in a prone position were more common among non-Dutch (especially Turkish) mothers than among Dutch mothers. Poorly educated mothers slapped their baby more often than highly educated mothers. CONCLUSIONS: Mothers' reports of infant crying and soothing varied sociodemographically. Much harm may be prevented by counselling parents (especially immigrants) on how and how not to respond to infant crying. Health education should start before the child's birth, because certain soothing techniques could be fatal, even when practised for the first time.

Chi-Square Distribution↗

PubMed1997

Severe pathological crying after left anterior choroidal artery infarct. Reversibility with paroxetine treatment.

BACKGROUND: There is increasing evidence that serotonergic neurotransmission may be damaged in poststroke pathological crying. A correlation between the clinical severity of pathological crying and the size of stroke-induced serotonergic pathway lesions is commonly accepted. We present a case of severe pathological crying after a limited left anterior choroidal artery territory infarction. CASE DESCRIPTION: A right-handed 55-year-old man who was a heavy smoker was admitted to the hospital after a right hemiplegia of sudden onset. Clinical examination revealed a right global hemiplegia including the face and a right hemihypoesthesia. Cerebral CT scan and MRI showed an infarct in the retrolenticular part of the posterior limb of the left internal capsule extending upward into the posterior paraventricular corona radiata region. Transesophageal echocardiography revealed an atrial septal aneurysm of 15-mm excursion without associated patent foramen ovale. From the first day of admission, the patient exhibited very frequent and intense fits of pathological crying. Their persistence led to initiation of treatment with the selective serotonin reuptake inhibitor paroxetine on day 30. Complete and immediate resolution of pathological crying occurred 24 hours after onset of therapy. Follow-up examination at day 90 confirmed the absence of relapse of pathological crying. CONCLUSIONS: We conclude that poststroke pathological crying in our patient may have been due to unilateral disruption of the capsular ascending projections of the serotonergic brain stem raphe nuclei. A small left-sided capsular lesion may have led to severe pathological crying. This disabling condition may be reversible with selective serotonin reuptake inhibitor therapy.

Cerebral Arteries↗

PubMed2006

Relation of prematurity and brain injury to crying behavior in infancy.

OBJECTIVES: The objective of this study was to assess crying behavior during infancy in very preterm infants with or without brain injury. METHODS: A total of 125 very low birth weight infants survived during January 2001 to July 2004 in Turku University Hospital, Finland. They were categorized according to the most pathologic brain finding either in ultrasound or MRI. Baby Day Diary was used to assess crying behavior at term, 6 weeks, and 5 months of corrected age. The behavior of a group of term control infants (n = 49) was assessed at 5 months. RESULTS: Severe brain injuries in very low birth weight infants did not affect the duration of fussing or crying. In very low birth weight infants, brain injuries did not affect the frequency of fussing or crying bouts or the development of circadian rhythm in crying behavior. At 5 months of corrected age, fussing bouts were more frequent in very low birth weight infants compared with term control infants (6.4 per day vs 4.5 per day), and very low birth weight infants were held more (169 minutes [97] vs 130 minutes [69], respectively). CONCLUSIONS: This prospective study using a validated cry diary showed that brain injuries that are related to prematurity do not have major effects on crying behavior or development of circadian rhythm. Prematurity does not increase the duration but increases the frequency of fussing and crying at 5 months of corrected age compared with term control infants. It also seems that prematurity and brain pathology may increase caregiving activity in the form of holding.

Age Factors↗

PubMed2002

Spectral analysis of prespeech sounds (spontaneous cries) in infants with unilateral cleft lip and palate (UCLP): a pilot study.

OBJECTIVE: The objectives of the present study were: (1) to analyze the cry features of infants with cleft lip and palate (UCLP) by means of spectral analysis, (2) to describe changes of the acoustic parameters from birth until 9 months of age, and (3) to compare these data with existing cry data of infants without cleft (control group). DESIGN: The study was designed on a interdisciplinary, prospective, and longitudinal basis. SETTING: Interdisciplinary study: (1) Institute of Anthropology at the Humboldt-University, Berlin; (2) Heidelberg University Hospital: Interdisciplinary Cleft Palate and Craniofacial Center. PATIENTS AND METHOD: The cry parameters of five patients with complete unilateral cleft lip, alveolar ridge, and hard and soft palate were analyzed from birth to 9 months of age. The patients were treated with the same protocol. At the age of 24 months, sensomotor development was assessed using the KIPHARD test. Perceptual judgment of speech, performed after 36 months of life, included nasal resonance, nasal emission of air, articulation disorders, and speech intelligibility. MAIN OUTCOME MEASURE: The cry parameters of fundamental frequency (F(0)), pitch period perturbation quotient (PPQ), and cry duration (Tsam) were analyzed. RESULTS: Contrary to the expectation that laryngeal parameters are not affected by vocal tract malformations, differences of cry parameters were found between the patients with UCLP and the non-cleft group. Particularly, the F(0) and its short-time variability (PPQ) were affected. CONCLUSIONS: The preliminary results of this study showed that F(0) and PPQ of spontaneous cries are influenced in patients with UCLP, and a cry analysis might become a noninvasive tool for early detection of an at-risk status for neuromuscular development and prediction of an at-risk status for later speech and language acquisition in infants with cleft lip and palate. Future research strategies are outlined.

Articulation Disorders↗

PubMed1979

Discrimination of infants' cry-signals.

A technique for clustering infants' cry-signals on the basis of perceptually discriminable acoustic characteristics is reported. A cry-sequence containing all pairwise combinations of 24 signals was constructed. These signals have been used previously in cry-recognition studies (e.g., Wasz-Hockert, et al., 1968) and consist of six each of pain, hunger, pleasure, and birth. 20 musically competent subjects were tested individually and instructed to compare each cry with the one immediately preceding it in the sequence. Forced-choice "similarity" scores were summed for every pair of cries. These "similarity scores" were data for both a manual and a computerized clustering method. There was absolute agreement between these two methods, and the clusters of cry-signals correspond very closely to the four original cry groups. This seems a valid technique for examining the acoustic similarity of infants' cry-signals.

Adolescent↗

PubMed2001

The effects of smiling or crying facial expressions on grip strength, measured with a hand dynamometer and the bi-digital O-ring test.

The effects of smiling or crying facial expressions on grip strength and the Bi-Digital O-Ring Test were evaluated in this study. Ten right-handed basketball players (age group 18-28) were included in the study. Grip strength was measured with a Riester hand dynamometer and the Bi-Digital O-Ring Test successively, after the players had looked at the drawing of a "crying face" for 5 seconds from a distance of 40 cm at the eye level. Immediately afterwards they were shown the drawing of a "smiling face" and were asked to grip with the same condition. Once all 10 players carried out this experiment, the order in which the drawings were shown was reversed. We then proceeded to measure the same variables, using the Bi-Digital O-Ring Test. The statistics obtained thereby were subjected to Pearsons correlation coefficient and paired t-test. Using a hand dynamometer and the Bi-Digital O-Ring Test, it was found that, in both tests, the "smiling face" drawing (first crying, then smiling face: with hand dynamometer, it increased from 8.34+/-0.97 kg to 9.18+/-0.9 kg; t=5.39,p=0.0001) increased the grip strength of the basketball players, and the "crying face" drawing (first smiling face, then crying face: with hand dynamometer it decreased from 9.35 +/- 0.90 kg to 8.51+/- 0.96 kg; t=9.81, p=0.0001) decreased the grip strength. Exposure to the smiling face drawing increased the grip strength, and exposure to the crying face decreased it, in every subject tested in this group. Similar effects were observed with the Bi-Digital O-Ring Test (first crying, then smiling: it increased from -2.80 +/- 1.13 to 2.20 +/- 1.32; t=33.54, p=0.0001; first smiling then crying: it decreased from 2.40 +/- 1.34 to -2.20 +/- 1.62; t = 15.06, p=0.0001).

Adolescent↗