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

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  1. Yard F van der Wala,
  2. D C van den Blastb,
  3. H Pauw-Plompc,
  4. G A de Jonged
  1. aMunicipal Wellness Service Amsterdam, Section of Epidemiology, Documentation and Wellness Promotion, PO Box 2200, 1000 CE Amsterdam, Netherlands, bDepartment of Pedagogics, University of Amsterdam, Wibautstraat iv, 1091 GM Amsterdam, Netherlands, cMunicipal Health Service Amsterdam, Department of Kid Health Care, dPrins Bernhardlaan l, 2341 KL Oegstgeest, Netherlands
  1. Dr van der Wal.

Abstract

OBJECTIVES To investigate the prevalence of baby crying and maternal soothing techniques in relation to ethnic origin and other sociodemographic variables.

DESIGN A questionnaire survey amidst mothers of ii–iii month old infants registered at 6 child wellness clinics in Amsterdam, holland.

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 abode for 1142 (63%) of these infants.

RESULTS Overall prevalences of "crying for three or more hours/24 60 minutes day", "crying a lot", and "difficult to comfort" were seven.6%, 14.0%, and 10.3%, respectively. Problematic infant crying was reported by 20.3% of the mothers. Of these infants, only fourteen% met all three inclusion criteria. Problematic crying occurred less frequently amidst girls, second and afterwards born children, Surinamese infants, and breast fed infants. Many mothers used soothing techniques that could touch their infant's health negatively. Shaking, slapping, and putting the infant to slumber in a prone position were more common among not-Dutch (specially Turkish) mothers than among Dutch mothers. Poorly educated mothers slapped their infant more ofttimes than highly educated mothers.

CONCLUSIONS Mothers' reports of infant crying and soothing varied sociodemographically. Much harm may exist prevented past counselling parents (especially immigrants) on how and how not to answer to infant crying. Health education should start before the child'southward nativity, because sure soothing techniques could be fatal, even when practised for the first fourth dimension.

  • Problematic infant crying was reported past 20.3% of mothers

  • Many mothers used soothing techniques that could affect their infant's health negatively

  • Undesirable soothing techniques were more prevalent among immigrant mothers

  • Much damage might be prevented past counselling parents (especially immigrants) on how and how not to reply to babe crying

  • infant crying
  • soothing
  • ethnic origin

Statistics from Altmetric.com

  • baby crying
  • soothing
  • indigenous origin

In many countries, excessive crying in infants is a common phenomenon and probably one of the virtually difficult problems parents take to face. This might elicit soothing techniques that can be injurious to wellness, such as putting the infant to sleep in a prone position. In kingdom of the netherlands, the prevalence of excessive infant crying is unknown. In other Western countries it varies from 3% to 30% in the kickoff four months of life, depending on the sampling pattern and the definition of excessive crying.ane-10 A frequently used definition is crying for three or more than hours/24 hour 24-hour interval.2 five six According to the most subjective definition, an infant cries excessively when the parents land that it cries a lot.11 Other definitions take accorded less importance to the actual amount of crying; other factors are stressed, such as unresponsiveness to soothing.12 In well-nigh studies, only one definition for excessive crying is used. To our noesis, no study to date includes these three definitions of problematic infant crying.

Cultural factors might influence the amount of baby crying—for example, differences in patterns of feeding and care.13 14 Some studies report effects of care giving styles on the amount of crying.xv-xviii From this perspective, excessive crying tin can be regarded as a response to the (Western) care giving mode. Cultural factors influence maternal soothing techniques also.19 20

Information about cultural differences concerning the amount of crying and soothing techniques is based mainly on cross cultural comparisons. Little is known nearly differences between ethnic groups living in a multicultural society. We examined the prevalence of reported baby crying (using 3 different definitions) likewise equally reported maternal soothing techniques in relation to ethnic origin and other sociodemographic variables.

Subjects and methods

We conducted a survey during the routine sociomedical examinations of infants aged 2–3 months in half dozen out of 21 child health clinics belonging to the Municipal Wellness Service of Amsterdam. The combined population of these six child wellness clinics is representative of all infants in Amsterdam with respect to sexual activity, ethnic origin, and maternal educational level.

DATA Drove

The study was conducted between January 1995 and December 1996. During this period, 2180 infants aged 2–3 months and their mothers were invited to visit the child health clinics at the addresses registered in the municipal population register. All residents of the city of Amsterdam are registered in the municipal population register. The nurses and physicians from the collaborating child health clinics filled out a questionnaire on sociodemographic characteristics and the kid's crying history. Interpreters were used if the mother did non speak Dutch: for non-Dutch speaking Turkish and Moroccan mothers a female interpreter was present during the sociomedical examination; for other indigenous groups the wellness centres chosen in the assistance of an interpreter by telephone. All Surinamese residents speak Dutch. A 2nd questionnaire on soothing techniques was given to the mother to be filled out at home and returned to the Municipal Health Service by prepaid mail. The questionnaire was bachelor in Dutch, Dutch–Turkish, Dutch–Moroccan or Dutch–English language, as appropriate. Although neither questionnaire included the proper noun of the subject, they were linked using a unique serial number.

QUESTIONNAIRE

Data on babe crying were nerveless past means of a retrospective questionnaire. This method is fast, convenient, and suitable for large scale use in measuring mother' perceptions of and responses to infant crying.4 Other methods frequently used to obtain information on the amount of infant crying are audiotape recordings and prospective diaries. Audiotape recordings are too expensive for use in large samples. Prospective diaries are unlikely to be completed in low socioeconomic groups and indigenous minorities.21Furthermore, the amount of crying reported by Western mothers in diaries and questionnaires is comparable.iv 22

Mothers were asked to report the total amount of crying in hours/24 60 minutes day, on average, in the previous week. Excessive crying was defined as crying for 3 or more hours/24 60 minutes day. Mothers were also asked whether their baby cries a lot, and whether their baby is easy or difficult to soothe. The interpretation of infant crying was left to the mothers themselves. Sociodemographic data included age and sex of the child, birth order, ethnic origin, educational level of the mother, and type of baby feeding. Ethnic origin was defined according to the female parent'south country of origin: holland, Surinam (former Dutch colony in S America), Morocco, Turkey, and other countries. The mother's educational level was divers every bit poor (main school or lower secondary schoolhouse) or high (higher secondary school or post-secondary education), based on the highest educational level accomplished.

The questionnaire on soothing techniques listed various responses to crying. The sensitive questions were hidden within a set of other, more neutral questions. Mothers were asked whether they had ever used each of the soothing techniques: for case, "Have you lot ever slapped your baby to make information technology stop crying?".

STATISTICAL ANALYSES

We used the statistical package SPSS/PC to analyse the information.23 Chi-squared tests were used to examine univariate associations between crying behaviours and diverse sociodemographic variables. Side by side, logistic regression was used to assess the relative importance of each of the sociodemographic variables on the prevalence of problematic infant crying. Logistic regression was likewise used to determine the relative effect of sociodemographic variables and crying behaviours on the prevalence of various soothing techniques. A regression was carried out for each individual soothing technique. The results of these analyses are expressed as adjusted odds ratios. The level of significance used was p < 0.05.

Results

RESPONSE RATES

A questionnaire on sociodemographic characteristics and crying behaviours was filled out for 1826 infants (84%). No information is available for the remaining infants. For 1142 (63%) of the 1826 infants, a questionnaire near soothing techniques was returned besides. The mothers who did not return the questionnaire were more than often of non-Dutch origin (p < 0.001) and more had a lower level of education (p < 0.001) and a first built-in child (p < 0.001). No differences in response rate were found for crying behaviour and other sociodemographic characteristics.

CRYING BEHAVIOUR

Table 1 presents the study sample according to sociodemographic characteristics and reported crying behaviour. Overall prevalences of "crying for three or more hours/24 60 minutes solar day", "crying a lot", and "difficult to comfort" were 7.half dozen%, 14.0%, and 10.3%, respectively (table 1). Problematic baby crying, according to at least 1 criterion, was reported by 20.3% of the mothers. Of these crying infants, only xiv% met all three inclusion criteria. Sex, parity, ethnic origin, and type of feeding were all related to crying behaviour (table 2). Perceived crying for three or more hours a day occurred less ofttimes in girls compared with boys, Surinamese infants compared with Dutch infants, and chest fed infants compared with formula or mixed fed infants. The same held true for infants whose mothers stated that their infant cries a lot. Furthermore, primiparous mothers stated more frequently that their infant cries a lot compared with multiparous mothers. Surinamese mothers reported less frequently that their infant was difficult to comfort compared with Dutch mothers.

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Tabular array 1

Report population (due north = 1826) according to sociodemographic factors and crying behaviour

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Table ii

Percentages, multivariate odds ratios (OR), and 95% conviction intervals (CI) for crying for iii or more hours per 24 hour twenty-four hour period, crying a lot, and inconsolable crying according to sociodemographic factors

SOOTHING TECHNIQUES

Mothers used diverse soothing techniques to calm their babies. In improver to harmless methods, mothers also used techniques that could impact the infant's health negatively (table iii). Most soothing methods were related to sociodemographic variables (table 4). Reported shaking, slapping, and putting the baby to slumber in a prone position were more than mutual among non-Dutch mothers than among Dutch mothers. This held truthful especially for Turkish mothers (OR = 6.36 for shaking; OR = vi.37 for slapping; and OR = 3.93 for prone sleeping position). Poorly educated mothers besides reported slapping their baby more oftentimes than highly educated mothers (OR = 4.08). Moroccan mothers rocked (0.56), held, and carried their babe less frequently than Dutch mothers in response to baby crying (OR = 0.24).

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Tabular array iii

Soothing techniques of mothers in response to infant crying (percentages)

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Table 4

Multivariate odds ratios of soothing techniques past sociodemographic factors and crying behaviour

Discussion

This report shows that the overall prevalence of reported problematic crying in babies aged ii–3 months differs according to the definition used: 7.6% for crying for three or more hours/24 hour solar day, 14.0% for crying a lot, and 10.3% for inconsolable crying. Problematic infant crying according to one or more criteria was reported by 20.3% of the mothers. Many mothers used soothing techniques that could affect the infant's health negatively. Mothers' reports of babe crying and soothing varied sociodemographically. Excessive crying was less common among girls, breast fed infants, and Surinamese infants. Soothing methods that can exist injurious to infants' wellness, such as slapping, shaking, and prone sleeping position, were more prevalent among non-Dutch mothers (especially Turkish) than amidst Dutch mothers.

Theoretically, a selective non-response among non-Dutch families might bias overall prevalences of crying babies. A selective high not-response among not-Dutch families is a common problem in surveys carried out in the multicultural cities of the Netherlands. However, in this study the non-response rate for the exact questionnaire was very low, probably as a result of the reputation of the child wellness clinics, as well as the experience of the nurses and physicians at these clinics in contacting and interviewing respondents. Apart from this, a previous survey in these half-dozen kid wellness centres showed that omnipresence rates vary piffling co-ordinate to ethnic grouping.24

A selective not-response was found for the mail service questionnaire on soothing techniques. As a result, overall prevalences might be biased. Furthermore, the results might be biased past differences in socially desirable responses. For instance, it is possible that Dutch mothers slap and shake their children more often than they reported. Information technology is also possible that "slapping" and "shaking" might have dissimilar meanings in different ethnic groups.

Of all problematic crying infants, just 14% met all three criteria. We observe it remarkable that only 39% of the infants who cry a lot are as well reported to cry for three or more hours/24 hour twenty-four hour period. Conversely, of the infants who cry for three or more hours/24 60 minutes day, 78% were also reported to cry a lot. Apparently, some parents cannot tolerate the least amount of crying, while others do non experience long crying periods every bit troublesome. Therefore, intervention efforts should be guided by parents' perceptions of baby crying, irrespective of the actual amount of crying.

EXCESSIVE CRYING By SOCIODEMOGRAPHIC CHARACTERISTICS

Dissimilar definitions of a crying infant pb to different conclusions most the sociodemographic factors associated with reported crying. For example, there was no association betwixt parity and crying for three or more hours/day. This is in agreement with other studies.2 4 25-27 However, crying a lot was reported to exist more common amid infants of primiparous mothers. Perhaps primiparous mothers experience the same corporeality of crying every bit more troublesome. Furthermore, primiparous mothers were more likely to seek referral for infant crying than mothers of later born infants.2 4

Reported excessive crying appeared to exist more than mutual in boys than in girls. Other studies reported no sexual practice differences in the prevalence of excessive crying1 28 29 or mean corporeality of crying.ii four 30 31 However, most of these studies were based on minor selective groups and information were sampled for purposes other than establishing sex differences in the amount of baby crying. One previous study found modestly increased crying in boys.32

Reported excessive crying was more than frequent among Dutch infants than amid Surinamese infants. We constitute only two other studies in Western multicultural societies dealing with ethnic differences in excessive infant crying. In an Australian study, excessive crying was reported more usually in infants with parents born in Lebanese republic, Asia, and South and Central America.33 A study in the U.s.a. among low birthweight infants showed that excessive crying was much less frequent amidst black infants than amongst white infants.27 This might reverberate ethnic differences in genetic predisposition, care giving exercise, or soothing techniques. Given that these studies were based on maternal reports, ethnic differences in maternal perceptions of crying might also be an caption.

Poorly educated mothers did non differ from highly educated mothers in their reports of excessive crying. This is in accordance with other studies.25 28 xxx In some studies, however, more baby crying was reported in higher socioeconomic groups10 29or lower socioeconomic groups.26 These inconsistent findings can be explained partly by different indicators of socioeconomic status in different studies. Socioeconomic health differences in children vary strongly depending on the indicator of socioeconomic status.34

Breast fed infants cried less than formula or mixed fed babies. This may not be related to the content of feeding. For instance, excessive infant crying is a common reason for mothers to switch from breastfeeding to bottle feeding. Furthermore, bottle fed infants might weep excessively because the child health clinic prescribes an insufficient amount of formula feeding,35 whereas breast fed babies can control the amount they feed. A Dutch report has shown that chest fed infants feed more frequently and/or were more frequently fed on demand than those who were canteen fed.36 These two factors are associated with a decrease in infant crying.sixteen 37

SOOTHING TECHNIQUES

There is bear witness that picking up and carrying,31 38 39 rocking,40 auditory stimula-tion,41 42 pacifiers,43 44and herbal tea45 are effective soothers. Whether these techniques reduce crying in the long run is not known. In improver, some soothers that have been shown to be highly effective in experimental research are not perceived every bit such by mothers.46

Some soothing methods must be strongly discouraged, considering of their possible injurious effect on the child'south health. The most dangerous techniques a parent can use are to smother, slap, or shake the baby to brand information technology tranquility. Nonetheless, these techniques were reported by 2%, three%, and five% of mothers, respectively. Among mothers of infants with problematic crying, these prevalences were two to three times higher. Excessive crying has been identified as a major cause of child abuse,47 which could be fatal in infants, because of their inability to escape impairment and their physical vulnerability to serious trauma.48

Some studies propose that ignoring a crying baby is constructive in reducing the amount of crying.49 50 Ignoring the infant's crying or leaving the infant lonely when crying is a common response in Western societies.31 51 In our study, 45% of mothers allow the baby cry on at least one occasion. Information technology is unclear how this behaviour affects the parent–child relationship. In a study dealing with the circumstances of 222 sudden unexpected deaths, five infants died in the night when the parents had let it continue to cry for the first time.52

Crying in breast fed infants can be a symptom of allergy to cow's milk products consumed by the mother.53 It is better to eliminate these products from the mother'due south diet than to terminate breastfeeding,54 which protects children from various diseases, especially infectious ones.55 Moreover, infants who had been switched to formula feeding were no more tranquility than infants who were exclusively breast fed.36

Swaddling (wrapping the baby in a blanket) appears to be soothing,56 merely some forms of wrapping increment the take a chance of a congenital dislocation of the hip.57

Laying infants prone to slumber increases the hazard of cot death,58 and then it is not acceptable to identify the baby in this position to stop it crying. In a series of 108 sudden unexpected deaths, six infants died during their slumber when they were put to sleep in a prone position for the commencement fourth dimension.59 In a serial of 222 other sudden unexpected deaths this was the example with 8 infants.52

Some mothers presume that baby crying is acquired past constipation, only the lack of prove means laxatives should be discouraged. Hypnotics and sedatives should not be used because of a possible relation to brain damage and cot decease.60

SOOTHING TECHNIQUES BY SOCIODEMOGRAPHIC CHARACTERISTICS

Primiparous mothers were shown to admonish their baby more often in response to crying than multiparous mothers. Similarly, Boukydis and Burgess61 noted that first time parents respond to crying with greater arousal and more irritation than multiparous parents.

It is notable that Turkish and Moroccan mothers relatively often admonished, slapped, and shook their infant in response to crying. Maybe penalization is a common child rearing exercise with immature children in those cultural groups. In a study of bed wetting in Amsterdam, relatively more Dutch parents praised their toddlers for a dry night, while relatively more immigrant parents punished their toddlers for a wet night.62

Many Turkish mothers placed their babe to sleep in the prone position in response to crying. This is probably ane reason why, in the Netherlands, Turkish infants are about twice as likely to endure cot death than Dutch infants.63 It is possible that the more frequent use of slapping and shaking among Turkish mothers too contributes to this higher take chances.64

IMPLICATIONS

Much harm may be prevented past counselling parents (specially immigrants) on how and how not to respond to infant crying. It is important to identify inappropriate parental responses and to advise alternatives. Furthermore, it is applied to inquire parents whether they detect differences in the effectiveness of their soothing methods, because constructive soothing strategies differ for each kid.65 Health education should start before the kid's nativity, because some soothing techniques can be fatal, even when practised for the first time, such as the decumbent sleeping position, assuasive the infant to continue to cry, smothering, and shaking.

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