A neurobiological model for cry-fuss problems in the first three to four months of life
Section snippets
Background
One of the most common problems parents bring to paediatricians, general practitioners, child health nurses, midwives, psychologists and Emergency Departments in the first weeks and months of life is the baby who cries and fusses. One in five new parents report that their baby has problem crying [1]. Infant cry-fuss behaviour is a complex problem, emerging out of multiple dynamically interacting and co-evolving factors, including genetics, temperament, an individual baby’s unique level of
Cry-fuss problems emerge out of disrupted maternal-infant neurobehavioural synchrony
Biologically programmed, or innate, patterns of synchrony operate between the neuroendocrine systems of mother and infant, increasingly elucidated by functional MRI imaging of the brain and neurohormonal assay. These morphological and neurohormonal changes correlate with mother–infant neurobehaviours, for example, during birth, infant care, or feeds. Due to the highly social nature of our species, maternal–infant neuroendocrine and neurobehavioural synchrony may be either supported or impeded
The infant’s nervous system
Neuroscience increasingly elucidates the neurocorrelates of mother–infant interaction and the neuronal circuitries of depression, anxiety and fear [14]. We hypothesise that when an infant’s amygdala, which are mature at birth, are activated by a perceived need or threat either internally or in the environment, the hypothalamic–pituitary–adrenal (HPA) neurohormonal circuitry upregulates, triggering sympathetic nervous system (SNS) activity and adrenaline release, with associated cardiovascular,
Neurohormonal mechanisms which underlie clinical intervention
The translation of a metanarrative review of the heterogenous and interdisciplinary evidence concerning cry-fuss problems in the first months of life into a systematic, five-domain clinical intervention (“The Possums Approach”) is detailed elsewhere [31], [73], [77], [78]. This intervention aims for early identification and management of problems that disrupt maternal–infant neurobehavioural synchronies. Regardless of feeding method, our intervention systematically addresses relevant factors in
Discussion
This neurobiological explanatory model for infant cry-fuss problems in the first few months of life (“The Possums Model”) has been developed from a synthesis of the evidence across multiple disciplines. The model proposes first, that crying in the first three to four neurodevelopmentally sensitive months signals activation of the HPA axis and adrenergic neuronal circuitry in response to perceptions of discomfort or threat. Second, this neurobiological model proposes that susceptible infants are
Conclusion
Despite the self-limiting nature of the condition for most, unsettled behaviour in the first few months of life requires early, integrated intervention. Our synthesis of the heterogenous evidence across multiple disciplines elucidates the underlying neurobiological mechanisms of infant crying, and the underlying neurobiological mechanisms of a five domain interdisciplinary clinical intervention. This shared explanatory framework aims to facilitate collaboration between researchers from
Conflict of interest statement
Pamela Douglas and Peter Hill declare that they have no conflict of interest to report.
Competing interests
None declared.
Funding
No specific funding.
Author’s contributions
PSD conceived of the study. PSH participated in conceptualization and critique of concept. PSD drafted the manuscript. PSH critically reviewed and edited the manuscript. Both authors approve the final version.
Acknowledgements
We thank Professor Debra Creedy, Griffith University, and Associate Professor Yvette Miller, Queensland University of Technology, for reading this paper in an early draft and offering critique.
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2019, MidwiferyCitation Excerpt :There are several reasons why this may occur, including possible residual pain in the infant from procedures such as forceps, or medications used during labour (Taylor et al., 2000; Ransjo-Arvidson et al., 2001; Brown and Jordan, 2013). High cortisol levels circulating during labour might also overstimulate an infant's hypothalamic–pituitary–adrenocortical axis, leaving them in a state of arousal, and potentially altering their stress response (Douglas and Hill, 2013). However, how maternal psychological experience of childbirth might indirectly affect her infant's behaviour has yet to be fully considered.
Practice-based interpretation of ultrasound studies leads the way to more effective clinical support and less pharmaceutical and surgical intervention for breastfeeding infants
2018, MidwiferyCitation Excerpt :Secondly, a neurotypical baby who has repeated experiences of frustration at the breast due to an inability to maintain positional stability and transfer milk comfortably may develop a conditioned hyperarousal of the sympathetic nervous system and hypothalamic-pituitary-adrenal axis (referred to here as conditioned SNS hyperarousal), either when presented with the breast or as the feed progresses. This mechanism is elucidated in the neurobiological model of infant cry-fuss problems (Douglas and Hill, 2013). Conditioned SNS hyperarousal due to positional instability is evident in fussiness with latching, repeated pulling off the breast, back-arching, and crying, and may be referred to as ‘aversive feeding behaviour’, ‘breast refusal’ or ‘oral aversion’.
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Present Address: School of Population Health, The University of Queensland Herston, Queensland 4029, Australia.