Fallon Cook

Preventing Early Infant Sleep and Crying Problems and Postnatal Depression: A Randomized Trial

OBJECTIVE: To evaluate a prevention program for infant sleep and cry problems and postnatal depression. METHODS: Randomized controlled trial with 781 infants born at 32 weeks or later in 42 well-child centers, Melbourne, Australia. Follow-up occurred at infant age 4 and 6 months. The intervention including supplying information about normal infant sleep and cry patterns, settling techniques, medical causes of crying and parent self-care, delivered via booklet and DVD (at infant age 4 weeks), telephone consultation (8 weeks), and parent group (13 weeks) versus well-child care. Outcomes included caregiver-reported infant night sleep problem (primary outcome), infant daytime sleep, cry and feeding problems, crying and sleep duration, caregiver depression symptoms, attendance at night wakings, and formula changes. RESULTS: Infant outcomes were similar between groups. Relative to control caregivers, intervention caregivers at 6 months were less likely to score >9 on the Edinburgh Postnatal Depression Scale (7.9%, vs 12.9%, adjusted odds ratio [OR] 0.57, 95% confidence interval [CI] 0.34 to 0.94), spend >20 minutes attending infant wakings (41% vs 51%, adjusted OR 0.66, 95% CI 0.46 to 0.95), or change formula (13% vs 23%, P < .05). Infant frequent feeders (>11 feeds/24 hours) in the intervention group were less likely to have daytime sleep (OR 0.13, 95% CI 0.03 to 0.54) or cry problems (OR 0.27, 95% CI 0.08 to 0.86) at 4 months. CONCLUSIONS: An education program reduces postnatal depression symptoms, as well as sleep and cry problems in infants who are frequent feeders. The program may be best targeted to frequent feeders.

Dissociative Tendencies and Memory Performance on Directed-Forgetting Tasks

The current article presents two studies that aimed to replicate DePrince and Freyds (2001, 2004) studies demonstrating that high and low dissociators differentially recall neutral and trauma words under conditions of varying cognitive load. We did not find this effect. This lack of replication was apparent for both free recall and word recognition memory and in both studies. In effect, we found little evidence to support betrayal trauma theory, yet observed increased memory fallibility, as demonstrated by lower general recall and (in one study) commission errors, in high dissociators.

Changes in long term neural connectivity following psychological trauma

OBJECTIVE Neural connectivity differences between adults reporting childhood, adulthood or no history of trauma were examined. METHODS A total of 39 participants completed the Post-traumatic Stress Diagnostic Scale (PDS; Foa EB. Post-traumatic Stress Diagnostic Scale (PDS) Manual. Minneapolis, MN: National Computer Systems, 1995), a Word Memory Task (WMT; [McNally RJ, Metzger LJ, Lasko NB, Clancy SA, Pitman RK. Directed forgetting of trauma cues in adult survivors of childhood sexual abuse with and without post-traumatic stress disorder. J Abnorm Psychol 1998;107:596-601]) and EEG analysis. Intelligence was not assessed during the study. RESULTS As predicted, those with childhood trauma had significantly higher EEG coherence than those with either adulthood trauma or no past trauma. CONCLUSIONS Significant differences were observed over frontal, central, temporal and parietal areas. Evidence was found suggesting that childhood psychological trauma may have a lasting impact on neuronal connectivity. SIGNIFICANCE This is the first study to demonstrate the suspected long term effect of trauma over central, temporal and parietal areas. Long term neural correlates of childhood and adult trauma appear to suggest information processing differences--differences that may, eventually, lead to better interventions following trauma.

Baby Business: a randomised controlled trial of a universal parenting program that aims to prevent early infant sleep and cry problems and associated parental depression

BackgroundInfant crying and sleep problems (e.g. frequent night waking, difficulties settling to sleep) each affect up to 30% of infants and often co-exist. They are costly to manage and associated with adverse outcomes including postnatal depression symptoms, early weaning from breast milk, and later child behaviour problems. Preventing such problems could improve these adverse outcomes and reduce costs to families and the health care system. Anticipatory guidance-i.e. providing parents with information about normal infant sleep and cry patterns, ways to encourage self-settling in infants, and ways to develop feeding and settling routines before the onset of problems-could prevent such problems. This paper outlines the protocol for our study which aims to test an anticipatory guidance approach.Methods/Design750 families from four Local Government Areas in Melbourne, Australia have been randomised to receive the Baby Business program (intervention group) or usual care (control group) offered by health services. The Baby Business program provides parents with information about infant sleep and crying via a DVD and booklet (mailed soon after birth), telephone consultation (at infant age 6-8 weeks) and parent group session (at infant age 12 weeks). All English speaking parents of healthy newborn infants born at > 32 weeks gestation and referred by their maternal and child health nurse at their first post partum home visit (day 7-10 postpartum), are eligible. The primary outcome is parent report of infant night time sleep as a problem at four months of age and secondary outcomes include parent report of infant daytime sleep or crying as a problem, mean duration of infant sleep and crying/24 hours, parental depression symptoms, parent sleep quality and quantity and health service use. Data will be collected at two weeks (baseline), four months and six months of age. An economic evaluation using a cost-consequences approach will, from a societal perspective, compare costs and health outcomes between the intervention and control groups.DiscussionTo our knowledge this is the first randomised controlled trial of a program which aims to prevent both infant sleeping and crying problems and associated postnatal depression symptoms. If effective, it could offer an important public health prevention approach to these common, distressing problems.Trial registration numberISRCTN: ISRCTN63834603

Language outcomes at 7 years: early predictors and co-occurring difficulties

The ability of early factors to predict low language abilities at 7 years is explored together with the degree and nature of co-occurring difficulties present. OBJECTIVE: To examine at 7 years the language abilities of children, the salience of early life factors and language scores as predictors of language outcome, and co-occurring difficulties METHODS: A longitudinal cohort study of 1910 infants recruited at age 8 to 10 months. Exposures included early life factors (sex, prematurity, birth weight/order, twin birth, socioeconomic status, non–English speaking background,family history of speech/language difficulties); maternal factors (mental health, vocabulary, education, and age); and child language ability at 2 and 4 years. Outcomes were 7-year standardized receptive or expressive language scores (low language: ≥1.25 SD below the mean), and co-occurring difficulties (autism, literacy, social, emotional, and behavioral adjustment, and health-related quality of life). RESULTS: Almost 19% of children (22/1204;18.9%) met criteria for low language at 7 years. Early life factors explained 9-13% of variation in language scores, increasing to 39-58% when child language scores at ages 2 and 4 were included. Early life factors moderately discriminated between children with and without low language (area under the curve: 0.68–0.72), strengthening to good discrimination with language scores at ages 2 and 4 (area under the curve: 0.85–0.94). Low language at age 7 was associated with concurrent difficulties in literacy, social-emotional and behavioral difficulties, and limitations in school and psychosocial functioning. CONCLUSIONS: Child language ability at 4 years more accurately predicted low language at 7 than a range of early child, family, and environmental factors. Low language at 7 years was associated with a higher prevalence of co-occurring difficulties.

Cohort Profile: The Early Language in Victoria Study (ELVS)

Cohort Profile: The Early Language in Victoria Study (ELVS) Sheena Reilly,* Fallon Cook, Edith L. Bavin, Lesley Bretherton, Petrea Cahir, Patricia Eadie, Lisa Gold, Fiona Mensah, Sandra Papadopoullos and Melissa Wake Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia, Murdoch Children’s Research Institute, Parkville, Victoria, Australia, Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia, The Royal Children’s Hospital, Parkville, Victoria, Australia, Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, Victoria, Australia, Melbourne Graduate School of Education, The University of Melbourne, Parkville, Victoria, Australia, School of Health and Social Development, Deakin University, Burwood, Victoria, Australia, Centre for Community Child Health, The Royal Children’s Hospital, Parkville, Victoria, Australia and Department of Paediatrics and The Liggins Institute, The University of Auckland, Auckland, New Zealand

Depression and anger in fathers of unsettled infants: A community cohort study

To examine the relationship between unsettled infant behaviour and fathers’ depressive symptoms, cognitions surrounding infant sleep (anger, doubt), and personal sleep, in a community cohort.

Health service use and costs for infant behaviour problems and maternal stress.

We aim to describe health service (HS) use in the first 6 months post‐partum and to examine the associations between service costs, infant behaviour and maternal depressive symptoms.

Behavioral Outcomes of Infant Colic in Toddlerhood: A Longitudinal Study

Objective To assess whether infants with colic that resolved before 6 months of age have poorer medium‐term outcomes than infants without colic. Study design Comparative study of 2 prospective, community‐based cohorts of children aged 2‐3 years in Melbourne, Australia: children from the Baby Biotics study, with previously diagnosed Wessel criteria of colic without problem crying at 6 months (True Colic Cohort), vs children from the Baby Business trial, without problem crying at 1, 4, and 6 months (No Colic Cohort). Caregiver report of child internalizing and externalizing behaviors (primary outcome), temperament, regulatory (crying/sleeping/feeding) problems, and family functioning at child age 2‐3 years was collected. We conducted regression analyses of mean differences/ORs adjusted for child sex, age, social disadvantage, parental education, and maternal mental health. Results In total, 74% of the original Baby Biotics (n = 124) sample and 75% of the Baby Business (n = 503) sample completed questionnaires. In adjusted analyses, there were no significant differences between the True Colic Cohort (n = 99) and No Colic Cohort (n = 182) in internalizing behavior problems (adjusted mean difference 0.73; 95% CI –3.96 to 5.43, P = .76) or externalizing behavior problems (adjusted mean difference –1.53; 95% CI –6.02 to 2.97, P = .51). There were no statistically significant differences between groups in temperament, parental perception of regulatory problems, or family functioning. Conclusions Infants with colic whose crying self‐resolves do not experience adverse effects regarding child behavior, regulatory abilities, temperament, or family functioning in the medium term. Parents and clinicians can be reassured that infant crying as the result of colic, and related stress, is short‐lived and will likely resolve.

Prevalence, comorbidity and factors associated with sleeping, crying and feeding problems at 1 month of age: A community-based survey: Sleeping, crying and feeding at 1 month

To examine, in a community cohort of healthy one‐month‐old infants, (i) the prevalence of early infant sleeping, crying and feeding problems; (ii) the extent to which they co‐exist; and (iii) infant and mother characteristics associated with each problem alone and with comorbid problems.