Ah, the bliss of bringing baby home from the hospital — until that baby begins to cry inconsolably for hours and fuss through feedings. A diagnosis of colic has brought many new parents to their knees, but new research from Brown University finds that infants who take part in “integrated care” — an unusual model being pioneered at Brown — stop crying sooner than those who see only their regular pediatrician for standard scheduled visits.
For two years, researchers at the Infant Behavior, Cry and Sleep Clinic at Women & Infants Hospital of Rhode Island followed 61 families whose babies had problems with colic, excessive crying and poor sleep.
All the families kept their scheduled pediatric visits, but half were also given regular appointments at the infant behavior clinic, where they received integrated care in three sessions over 10-week periods. In this case, integrated care refers to tag-team intervention that includes a developmental pediatrician, a mental health clinician, social workers and clinical and developmental psychologists, who collaborate to troubleshoot both the baby’s distress and the impact that colic has on the parents and their relationship with their newborn.
The families filled out a behavior diary for their babies, recording in 15-minute blocks throughout the day what their baby was doing — eating, sleeping or crying — according to the study, which was published in the Infant Mental Health Journal.
Researchers used that data — along with information about levels of maternal depression and paternal involvement — to develop a care plan for each baby who came to the clinic. They offered strategies for helping babies sleep better: if babies cried after feedings, researchers would consider whether reflux was a possibility. For catnappers who couldn’t seem to consolidate their sleep, researchers might suggest stricter schedules to help encourage a more defined sleep/wake cycle.
In general, they made many of the same suggestions that pediatricians might, but they had considerably more time to ponder each infant’s individual situation and brainstorm solutions. And parents walked away with individualized treatment recommendations to address problems in the areas of sleep, feeding, infant schedules and family mental health.
As a result, babies who came to the clinic had a faster rate of decline in crying. “That’s important because in a lot of colic research, most babies are not crying by 12 to 16 weeks of age anyway,” says lead author Amy Salisbury, a clinical nurse specialist in child and family psychiatry at Women & Infants Hospital. “They all end up not crying much eventually. So the longer families deal with these issues, the more stress there is. The patterns for how parents deal with their infants and stress have already been established.”
Colic as a diagnosis is in itself controversial. Salisbury has heard some medical residents say there’s no such thing. But parents of distraught infants believe otherwise. “A lot of people say their pediatrics said, He’s just fussy, don’t treat it, it will go away,” says Salisbury. “For most babies it will go away. But what do you do for those three months? The stress parents deal with in the interim is quite high.”
While well-baby visits might be as brief as 15 minutes, appointments at the behavior clinic can last up to an hour. Any frustrated new parent can attest to how valuable an hour focused on helping baby feel better would be. As a result, Salisbury suggests it would be helpful if pediatricians incorporated behavior and sleep specialists into routine care. “That is our hope for the future,” she says. “It would be much more cost-effective.”
Not to mention a boon to new parents’ mental health.