Research Study

WHEN BABIES ARE HELD MOST OF THE TIME: DO THEY CRY LESS AND HAVE LESS COLIC?

An invitation to take part in a research study About 1 in 6 babies cry regularly for long periods, without apparent reason, in the first 3 months after they are born. The crying ‘peaks’ in the evening, but often occurs at other times of day. Because it can’t be soothed by the usual strategies, the crying can be very stressful for parents.

We have been studying the reasons for this crying for several years. Some people believe that it is due to indigestion, so that it often gets called ‘colic’. But, most babies who cry in this way seem to have normal digestion and put on weight satisfactorily. Nor is the crying due to neglectful parental care – our studies have found that the crying often occurs in spite of highly responsive care.

Anecdotally, it is said that babies raised by ‘traditional’ methods of care – for instance in Africa – cry much less than Western babies and do not show ‘colic’. In reality, we do not know whether this is true. So far, no study has used standard, scientifically precise, methods to measure babies’ crying in the same way across different cultures and approaches to baby-care at this age. That is what we are planning to do in this study.

The study will involve babies and their parents in and around London, as well as in Copenhagen and Africa. In the UK, we plan to include two groups:

• a ‘conventional Western care’ group;
• a group where parents look after their baby in a more ‘proximal’ way, that is, where babies are held (rather than put down in cots), and are breast-fed frequently on demand. We have called this ‘proximal care’ to distinguish it from ‘distal care’.

If the anecdotal evidence is correct, babies cared for in this way should have very little ‘colic’.

The aim of this letter is to make contact with parents who would like to adopt a ‘proximal care’ approach to looking after their babies. We hope that you will consider taking part. To be in this group, you would need to meet 3 stipulations:

1. To be in physical contact (holding or carrying) with your baby at least 80% of daylight hours during the first 5 weeks after your baby is born. The holding can be shared – it does not have to be just one person doing it.
2. To breast-feed on demand as often as you think your baby needs it, rather than 3 or 4-hourly, in the first 5 weeks.
3. To respond quickly to your baby’s frets and cries, rather than delaying or leaving your baby to cry.

What will happen if you agree to take part:

1. When your baby is about a week old, we will telephone you to check whether you still want to take part in the study. If so, we will send you a ‘behaviour diary’ which records where your baby spends his/her time and how much he/she cries. This will need to be filled in for 4 days by whoever looks after your baby. It is not difficult – many parents have kept it for us – and we will help if you have any queries. But, it does mean jotting on a chart when crying, sleeping and feeding happen.
2. When your baby is approaching 5 weeks old (the infant crying ‘peak’), we will ask you to fill the diary in again. Depending on where you live, we may also telephone to ask to visit you at home – not all families are asked to do this and it is optional.If you agree, we will make 3 measures in the normal environment of your home:First we will observe your baby’s behaviour (including fretting and crying) and record specific aspects of care, like feeding intervals, which are believed to vary across different cultures. Second, we will give your baby a standard baby test (called the NAPI) designed to measure temperament. We believe that the amounts babies cry may reflect their temperaments and this test will allow us to examine whether this is true across cultures. Thirdly, we will measure your baby’s temperature throughout the visit, using a small sensor under your baby’s armpit. Babies’ temperatures tend to dip in the evening and we want to examine whether this is related to the amount that they cry. This home visit can be spread over 2 days.
3. When your baby is 12 weeks, we will ask you to keep the diary again for 2 days, to check how much your baby is crying at this age. We will ask your permission to take details from your medical records about any complications during pregnancy or your baby’s birth. We do not expect these to affect babies’ crying, but we want to check to make sure.

All the information we collect will be kept completely confidential. We will be collecting the same information in other cultures (in Copenhagen, Denmark and in the Aka tribe in Central Africa). When all the data are collected, we will send you a summary of the findings as a whole. As a small thank-you, we will send you a copy of the video of your baby’s NAPI test.

Why have I been chosen?

All the babies and mothers we include in the study will be normal and healthy. We are approaching women who have contacted childbirth and baby-care organisations, because we hope that many of them will wish to use ‘proximal care’.

Do I have to take part?

No, not at all. It is up to you to decide whether or not to take part. If you decide to do so, you will be given this information sheet to keep and be asked to sign a consent form. If you decide to take part you are still free to withdraw at any time and without giving a reason. If you wish, we will leave the room at any time during the home visit. A decision not to take part, or to withdraw at any time, will not affect the standard of care you receive.

If you are interested in learning more, please fill in and return to us the ‘Expression of Interest’ form.
Or, telephone or e-mail us at the addresses given below.

The Infant Crying Research Team:
Ian St James-Roberts, Jenny Goodwin, Catherine Aicken, Emese Csipke, Tanya Abramsky & Tamara Boake:
Please telephone Tamara on 020 7612 6930 or email her at t.boake@ioe.ac.uk if you need any further information.

This study is supported by The Wellcome Trust and has been approved by the Hammersmith, Queen Charlotte’s and Chelsea Hospitals Research Ethics Committee (project no. 2001/6226).