Promoting Maternal Child Health by Teaching Parents to Calm Fussy Infants

BACKGROUND/PURPOSE

The Children with Special Needs Program (CSNP) Public Health Nurses at Boulder County Public Health identified frequent problems related to parents unable to calm a fussy infant. Parents of children with special health care needs are at increased risk for problems, including sleep deprivation and fatigue, poor attachment and bonding, postpartum depression, all potentially leading to child abuse and neglect.

Observations of CSNP staff were:

• Many first?time parents have little to no knowledge about normal growth and development or parenting techniques.
• Parents unable to calm their babies feel discouraged and incompetent.
• A rising number of pre?natally drug?exposed infants demonstrate increased fussiness, irritability, crying behavior.
• An unusually high proportion of multiple births (5.6% of all county births in 2005), for which risk of sleep deprivation and parental stress are particularly high.
• A number of WIC parents complaining of exhaustion due to significant sleep deprivation secondary to atypical newborn sleep patterns.

Among findings in recent research are:

• Infants who cry persistently in an uncontrollable manner without any obvious cause after 12 weeks of age are at greater risk for low and poorer fine motor skills by the time they reach 5 years of age.
• The inability to calm a crying baby may provoke and exacerbate postpartum depression.
• Untreated postpartum depression is associated with disturbed mother?infant relationship and psychiatric morbidity in children later in life.
• In one study 63% of Shaken Baby Syndrome cases, the infant was crying for 30 minutes prior to the incident.

OBJECTIVES

Utilizing techniques from the Happiest Baby on the Block CSNP public health nurses will educate 90% of parents receiving Nursing Consultation through the Children with Special Needs Program to calm their crying infants.

METHODS

The CSNP public health nurses at Boulder County Public Health researched for a program that would support positive parenting techniques from infancy and provide a primary child abuse prevention tool. “Happiest Baby on the Block” came to their attention as a program that would support the above mentioned goals.

OUTCOMES/RESULTS

This program has exceeded our expectations, and has contributed positively to the goals described above:

1. For the first 42 families for whom the CSNP public health nurses have applied these techniques, there was significant improvement in the parent’s ability to calm a crying infant in 41 families (98%). The only infant who was unable to be calmed was diagnosed with an acute illness.
2. We found that parents who are less sleep?deprived are better able to cope and to integrate information provided on a home visit.
3. By the end of 2004, all four local hospitals were showing HB as part of postpartum education to new mothers.

Here are a few annotated outcomes:

• A stay?at?home father who had anger management issues and chronic depression, and who was raised in foster homes, was able to successfully calm his crying infant, when needed, without negative repercussions.
• Parents who had gone over two months being severely sleep?deprived due to their infant with special health care needs were able to increase the infant’s sleep time by two hours each night, eventually increasing to five hours.
• An infant with in?utero drug exposure to methamphetamine was able to significantly decrease crying and focus when fed.
• A methadone?addicted baby with abnormal day/night sleeping habits was able to reestablish normal sleeping and eating patterns.
• A number of infants suffering from gastroesophageal reflux were able to successfully increase feeding time without screaming, arching backwards, or diverting gaze.
• Each training that the public health nurses provided was followed by accolades from the trainees, as they were able to put these new skills to work with immediate and dramatic results with their clients.

PUBLIC HEALTH IMPLICATIONS

The HB techniques are relatively easy to learn if taught correctly. The vast majority of families for whom the HB techniques were applied experienced immediate reductions in crying and fussiness. This not only promoted healthy parent?infant attachment, but also established greater rapport between families who might otherwise be resistant to outside assistance from the public health nurses. Reducing stress upon the infant?parent relationship with a positive parenting intervention is a wonderful primary child abuse prevention program.