WebMD Medical News
Laura J. Martin, MD
April 20, 2011 -- Babies who cry excessively and have difficulty sleeping and feeding may be at increased risk for behavioral problems during childhood, including attention deficit hyperactivity disorder (ADHD), a study shows.
Close to 20% of all babies show signs of “regulatory issues” such as persistent crying, sleeping issues, and feeding problems during the first year of life. Most of the time these symptoms are transient and infants adjust by the time they reach preschool.
But “those with persistent regulatory problems in families with other problems may require early interventions to minimize or prevent the long-term consequences of infant regulatory problems,” concludes study researcher Mirja Helen Hemmi of the University of Basel, Switzerland.
The new findings appear online in the Archives of Disease in Childhood.
Researchers analyzed 22 studies that looked at infant regulatory problems in 1,935 children. Ten of these studies looked at the consequences of excessive crying, four looked at sleeping problems, three concerned infant feeding issues, and five studies focused on babies with multiple regulatory issues.
Risk of behavioral problems was highest among infants who experienced problems in several categories. Most commonly, these problems were linked to ADHD and externalizing behavioral issues such as aggressive or destructive behavior and/or temper tantrums. ADHD is a behavioral disorder marked by impulsiveness, hyperactivity, and inattention.
Those who were at greatest risk for behavioral problems as children were also more likely to be from troubled families, including those with psychosocial problems and problems interacting with each other.
All babies cry, and it can be difficult to soothe them at times. Excessive crying refers to intense, unsoothable bouts of crying for no apparent reason in the first three months of life. Babies with sleeping difficulty have trouble settling in at bedtime and don’t sleep through the night without interruption. In the study, feeding issues were characterized as vomiting, food refusal, little appetite, and/or swallowing problems.
It used to be that fussy babies were called “colicky,” says Penny Glass, PhD, a developmental psychologist at the Children's National Medical Center in Washington, D.C. “Now what used to be accepted as colic is often diagnosed as mild reflux symptoms and treated,” she says. “A lot of babies who spend a lot of time being irritable respond quickly to these treatments.”
If you are concerned about your infant, talk to your pediatrician as it may be something that is easy to treat, such as mild reflux.
Be specific about your concerns, she says.
“Parents do the best when they write down notes before they go to the doctor rather than express their concerns off the top of their head,” she says. “Document the frequency, time of day, what you have tried, and whether or not it worked.”
Reach out to other parents who may have tips and advice, she says.
“Many babies are overstimulated and they cry more and don’t sleep as well or digest as well and may be distracted during feeds. So almost any parent feels that they must not be doing something right and need to do more and it can be a vicious cycle,” she says.
Family risk factors do have a role in this, Glass says.
“New parents often don’t have the kind of extended family support that is needed or that extra pair of hands to hold a fussy baby a little bit longer, and they may become more anxious about trying to get the baby to sleep at night,” she says. “When parents can be helped, everybody calms down.”
“Other factors can lead to fussy babies, including prenatal stress or stress during birth,” she says. Regardless of the cause, “help with early behavioral problems tends to have a positive effect on children and parents.”
So how do you know if your baby is just being a baby, or if he or she has regulatory issues and may be at-risk for behavioral problems in the future?
“If babies are fussy and cry for six or more hours a day and have difficulty feeding and sleeping, it can be stressful in the house,” says Atlanta-based pediatric nurse Jennifer Walker, RN, co-author (along with Laura Hunter) of The Moms on Call Guide to Basic Baby Care.
Some fussiness during the hours of 6 p.m. to 9 p.m. is expected, she says. “Babies have a need to get a certain amount of energy out every day.”
Find out what type of routine or schedule is normal for an infant at certain ages and stages, and see how your baby measures up.
For example, “anything goes during the first two weeks, but from two weeks to three months, you can expect a feeding every 2.5 to three hours and two 4.5- to five-hour stretches of sleep at night. After that the goal is a nine- to 12-hour stretch each night,” she says.
Sometimes some simple troubleshooting is all it takes to go from fussy to easy going.
For babies under 3 months of age, a swaddling makes a big difference in their ability to fall asleep, she says. “Keep feedings to about 30 minutes.”
“Babies cry for a lot of reasons, not just hunger, so feeding on command may not be a good option,” Walker says. “Most fussy babies will grow out of it, but we can fix their schedule and sleeping.”
SOURCES:Hemmi, M.H. Archives of Disease in Childhood.Penny Glass, PhD, developmental psychologist, Children's National Medical Center, Washington, D.C.Jennifer Walker, RN, pediatric nurse, Atlanta.
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