Colicky Babies And Postpartum Depression

A compelling connection exists between colicky babies and postpartum depression, according to a study conducted by a Brown Medical School professor and Rhode Island Department of Health family health experts.

The study is the first to establish a link between colic and depression using a large sample of demographically diverse women. Results will be presented in May at the Pediatric Academic Societies’ 2006 Annual Meeting in San Francisco. The meeting is the largest academic pediatric gathering in the world.

Pamela High, M.D., served as lead. High is a clinical professor of pediatrics at Brown Medical School and director of developmental-behavioral pediatrics at Hasbro Children’s Hospital. She is also head of the Infant Behavior, Cry and Sleep Program run by the Brown Center for the Study of Children at Risk, which is supported by Women & Infants Hospital of Rhode Island.

The research team also included staff from the Rhode Island Department of Health’s Division of Family Health, who provided data and analytical support. They are Hannah Kim, senior epidemiologist; Samara Viner-Brown, chief of data and evaluation and director of the Pregnancy Risk Assessment Monitoring System, or PRAMS; and Rachel Cain, PRAMS coordinator.

High warned that the work does not show a direct cause-and-effect relationship between a fussy baby and a depressed mom. “We can’t say that inconsolability causes depression or that depression causes inconsolability,” High said. “However, we did find a link between the two. And this won’t surprise anyone who knows a mother coping with a fussy baby.”

High directs the Infant Behavior, Cry and Sleep Program – known locally as the Colic Clinic – in Providence. High and other Colic Clinic staff have helped hundreds of families having trouble with their infants’ crying. After conducting an exam and taking a medical history, clinic staffers help new mothers and fathers console their babies, pinpoint the cause of the crying, and take care of their own needs.

A 2005 Brown Medical School study of 93 mothers seen at the Colic Clinic showed that 45 percent reported moderate to severe depressive symptoms. Barry Lester, head of the Brown Center for the Study of Children at Risk, led the study.

“At the clinic, it is not unusual to see mothers who are very tired and sometimes very anxious and depressed,” High said. “Moms are trying hard to understand their child’s needs and meet those needs. Sometimes they feel inadequate when they can’t console their baby.”

The study is based on responses to the Rhode Island PRAMS, an ongoing, confidential survey of women who have recently given birth. The state is one of 32 participating in PRAMS, which is funded by the federal Centers for Disease Control and Prevention and aims to improve the health of new mothers and their babies. Each month, women are randomly chosen to receive the survey, which covers topics such as prenatal care, smoking, and nutrition and breast-feeding.

High is a member of the Rhode Island PRAMS steering committee. The committee was able to choose a few state-specific questions that would be added to the standard survey. The survey already asked about depression. Wondering if there was a connection to colic, High suggested another: “How inconsolable is your baby?”

The new question appeared on Rhode Island’s first PRAMS survey, administered in 2002, and again in 2003. A total of 4,214 new mothers got the questionnaire and 2,927 responded. The majority of mothers were white, married, had household incomes of more than $40,000 per year and had health insurance. Most of their babies were between two and four months of age.

The results: 19 percent of mothers reported moderate to severe symptoms of postpartum depression, and 8 percent reported that their babies were difficult to console. Responses showed a strong connection between the two. Mothers reporting depression were more than twice as likely to report infant inconsolability, and women with inconsolable babies were more than two times as likely to report depression. Even when other variables were controlled – such as age, race and income – the two were closely related.

“Depression and inconsolability are strong predictors of one another,” High said. “One in three women with fussy infants acknowledged that they were depressed.”

Researchers say the study sends a clear message to pediatricians: If you are treating a colicky baby, check on the moms, too. Ask them how they are feeling and if they have support from family and friends. When appropriate, refer women to mental health providers.

“This study is a terrific example of the use of survey data to further our understanding of maternal and child health issues and develop recommendations for improving public health practices,” Viner-Brown said. “It also shows the benefits of partnerships between state governments, universities and hospitals.”

New study links colic, maternal depression to family problems

Some families with new babies face excessive infant crying, or colic. And some new mothers go through maternal post-partum depression (PPD) following childbirth. Neither situation is considered healthy, but a recent study published in the Infant Mental Health Journal has found that the combined impact of colic and PPD can have a highly toxic outcome. Researchers have linked colicky babies and maternal depression to decrease in overall family functioning.

“We found that severe depressive symptoms in the mothers were related to fussy, or difficult infant temperament, more parenting stress, lower parental self-esteem and more family-functioning problems,” says senior author Barry Lester, PhD with the Bradley Hasbro Children’s Research Center (BHCRC) and Brown Medical School.

Dr. Lester founded the Colic Clinic at the Infant Development Center at Women and Infant’s Hospital in Providence, RI, and is the foremost colic researcher in the country. His new book Why is My Baby Crying? was published last month by Harper-Collins and is touted as ‘the parent’s survival guide for coping with crying problems and colic’.

“Colic is ultimately defined by the parental threshold for infant crying,” says Lester and his co-authors, “so one possibility is that cry-related problems like colic act as a catalyst for dysfunction in already stressed families.”

Examples of family dysfunction might include poor communication, confusion over roles, difficulty in solving family problems, poor family interaction and a lack of emotional responsiveness.

Other studies have shown that depression can alter the way a mother perceives and responds to her baby’s cry signals. In light of this, the authors conclude that the co-occurrence of infant colic and maternal depression might be especially risky for infant development outcomes such as behavior skills or forming relationships.

“Forty-four percent of the women showing up at the Colic Clinic are depressed which is pretty devastating and now we have evidence to show that it’s harmful to the whole family,” says Lester.

Maternal postpartum depression (PPD) has been described as the most common unrecognized postpartum complication and occurs in 15 to 20 percent of women following childbirth. According to the American Psychiatric Association, PPD symptoms include loss of pleasure or interest in usual activities coupled with sleep or appetite changes, loss of energy and/or recurrent thoughts of death for at least 2 weeks.

The authors hope the study will prompt pediatricians to ask more questions about parental and family well-being during an infant’s regular check-up.

“By recognizing the potential risk that crying and maternal depression presents, pediatric healthcare providers have an opportunity to refer treatment that could potentially prevent future problems within the family,” the authors conclude.

New review confirms Colief’s efficacy in the reduction of colic related crying time

For the parents of a baby with colic, the periods of unbroken crying can drive them to the brink of despair. Being a new parent is difficult enough but the inability to console a baby who appears distressed and in pain can prove too much and lead to a total loss of parental confidence. Now a new review published in the GP’s magazine the Prescriber [1], offers fresh hope to suffering parents.

The review by Dr Dipak Kanabar, consultant paediatric gastroenterologist at Guys Hospital, compared 6 alternative approaches to the treatment of colic symptoms in babies. Findings showed that while other options offered some relief, only preincubation of baby milk with a lactase enzyme such as Colief Infant Drops dramatically reduced the crying time in colicky babies.

Although there is no single cause for colic, undigested lactose in food as a result of Transient Lactase Deficiency has been identified as a causative factor in many babies suffering from colic. Undigested lactose leads to bacteriological and metabolic changes in the gut, which in turn cause pain and distress.

The review published in Prescriber confirms the findings of a double blind, placebo controlled study carried out at the Department of Paediatrics at Guys Hospital in 2001 [2], which showed that pre-treatment of feeds with lactase typically reduces crying time in responders of 45% or more.