Poor Treatment of Infant Crying a Risk Factor for Child Abuse

New Orleans—In the session “Translating Infant Crying for Parents,” Dr. Ronald G. Barr, of the University of British Columbia, Vancouver, corrected misunderstandings about the most common causes of excessive infant crying and provided evidence-based advice on how to counsel parents with the goal of preventing infant abuse.
 
The typical assumption that colic is an abnormality is incorrect. The current evidence-based assumption is that colic and early increased crying are normal. When evaluating an infant with unsoothable crying bouts, it is important to remember that there are 3 curves, not 1. The 3 curves can be identified as Wessel’s criteria, “difficult infant,” and persistent mother-infant distress syndrome (or atypical crying curve). Prognosis is good for typical crying curves but less good for an atypical crying curve.
 
Colic is not an indication of disease in the infant. The likelihood of an organic etiology is about 5%; however, this is likely an overestimation. Dr. Barr said, “In most infants with an organic cause, there are symptoms or signs of disease.”
 
The problem for parents and practitioners is that neither can distinguish between crying following pain and crying before a feed. Dr. Barr asked his audience to please not propagate the myth that you can tell by looking at the infant or by the sound of the cry, which is hunger or pain.
 
When counseling parents, Dr. Barr said to ask 3 key questions to determine risk of abuse:
•Is the frustration too great?
•Are there signs of depression of lack of self-confidence?
•Are parents able to be attracted to their infant despite the crying?
 
It is important to address ways of soothing noting that evidence shows soothing will not work all the time and to provide principles of soothing with real-life examples of “failed soothing.” And tell parents, “It’s OK to be frustrated. It’s what you do when you’re frustrated that’s important.”