Anne Marie Kotzer

Reducing parenting stress in families with irritable infants.

Background: Caring for an infant with unexplained, persistent crying is one of the most stressful events for new parents. Infant irritability, also referred to as infantile colic, occurs in 10-25% of all infants and is the most common parental concern reported in the first year of life. Objective: The aim of this study was to evaluate the effectiveness of a home-based nursing intervention in reducing parenting stress in three groups of families with irritable infants, using data from a larger evaluation study. Methods: A two-site, randomized clinical trial was conducted with 121 infants and their parents. Infants were randomized to a treatment or a control group. A third group of infants (n = 43) was added as a posttest-only comparison. The level of parenting stress was measured by the Parenting Stress Index (PSI) at baseline, after the 4-week intervention, and at the 8-week follow-up visit. Results: A repeated measures analysis of variance (ANOVA) was used to compare the two groups across the three time points (baseline, immediately after the 4-week intervention, and at the 8-week follow-up visit). The results revealed a reduction in total parenting stress over time for both the treatment and control groups. Mothers in the treatment group reported reduced parenting stress on the parent-child dysfunctional interaction subscale (p = .04). Total parenting stress scores were found to be significantly higher for mothers in the posttest-only group (p = .009). Conclusion: Initial parenting stress levels were high in all participants. Parent feedback at the exit interview indicated that the nurse visits for data collection were also viewed as helpful in reducing the stress level associated with parenting these irritable infants. This home-based program was perceived as helpful in improving the interactions between parents and their irritable infants.

A longitudinal comparison of irritable and nonirritable infants.

Infantile colic is characterized by persistent crying, diminished soothability, and excessive activity or restlessness. The purpose of this study was to explore the processes underlying the persistent, recurrent irritability by investigating behavioral and interactional differences in irritable and nonirritable infants. In this two-group longitudinal study, 40 infants and their mothers were followed over the first 4 months of life. Statistically significant differences between the two groups were found, with the irritable infants demonstrating an increase in the amount and intensity of crying, more disruption in sleep-wake states, and less synchrony in mother-infant interaction.

Effectiveness of an Intervention for Colic

An intervention for infant irritability or colic was evaluated in a randomized clinical trial. A total of 121 full-term irritable infants (2 to 6 weeks old) were randomized to routine care or the home-based intervention program. A third group (n=43) of irritable infants were entered into a post-test-only group. Following the 4-week intervention, the treatment group infants cried 1.7 hours less per day than the infants in the control group (p=0.02). The findings support the emerging view of infant colic as a behavioral pattern that is responsive to environmental modification and structured cue-based care.

An intervention program for families with irritable infants.

Purpose:To describe and evaluate a home-based nursing intervention program, the REST routine, which incorporates the use of infant behavior assessment, pattern recognition, individualized infant schedules, specific management strategies, and parent education and support. Study Design and Method:A two-site clinical trial was conducted on 164 healthy full-term infants with excessive unexplained irritability or colic. Infants between the ages of 2 to 6 weeks were randomized to routine care or a home-based intervention program (n = 121). A third group (n = 43) of infants too old at entry for randomization (mean age = 10.4 weeks) were entered into a posttest-only group. Results:Infants in the REST routine treatment group cried 1.3 hours per day on average following the intervention program as compared to the control group crying 3 hours per day (p = .02). Infant irritability was resolved (<1 hour) in 62% of the treatment group while only in 29% of the control group at the time of the 8-week follow-up visit (p = .04). Clinical Implications:Families in both the treatment and control groups reported benefiting from a nurse visiting in their home to inquire about their infant and their well-being. Options for individualizing the program for those most in need of intensive home visiting and other delivery modes for the intervention are areas for further investigation

Development of a system for monitoring infant state behavior.

The concept of infant state refers to patterns of behavior that comprise the sleep-wake cycle. The infants ability to organize state behavior rhythmically is indicative of central nervous system maturation and predictive of later development. This article describes the development of a noninvasive, computerized infant monitoring system that can be used to categorize the infants sleep-wake behavior into states. Development of the system occurred in two phases: In the first phase of the study, reliability and validity of the infant monitoring system for recording continuous behavioral and physiological data were assessed. These results were then used in the second phase to develop a rule-based computer program to interpret the signal data stored on a micro-diskette and to characterize the infants state throughout the period of monitoring. The capability of computerized data collection and analysis of infant state behavior has expanded the application of this infant monitoring system. Its use as an investigative tool in clinical research is discussed.

Integrating clinical practice and research: A challenge for the pediatric nurse practitioner

Abstract Nurse practitioners can contribute greatly to nursing science by identifying problems for investigation and using research findings in their practice. This article describes two approaches available to pediatric nurse practitioners for becoming involved in research. the role is described of two nurse researchers based in a research center in facilitating selected studies in ambulatory pediatric health care. An alternative approach is discussed for nurse practitioners who are in practice settings. Guidelines for initiating, conducting, and using research in practice are provided. Seven phases of clinical research are offered to assist the beginning researcher.