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ORIGINAL ARTICLE

Infant colic and feeding difficulties
C Miller-Loncar, R Bigsby, P High, M Wallach, B Lester
............................................................................................................................... Arch Dis Child 2004;89:908–912. doi: 10.1136/adc.2003.033233

See end of article for authors’ affiliations ....................... Correspondenceto: Assistant Professor Cynthia Miller-Loncar, Women & Infants Hospital, Infant Development Center, 111 Plain Street, Providence, RI 02905, USA; cynthia_loncar@ brown.edu Accepted 5 January 2004 .......................

Aims: To examine the relation between colic and feeding difficulties and their impact on parental functioning for a primarily clinic referred sample. Methods: Forty three infants(and their mothers) were enrolled between 6 and 8 weeks of age. Infants were divided into two groups, colic (n = 19) and comparison (n = 24), based on a modified Wessel rule of three criteria for colic. Families were assessed at two visits; one occurred in the laboratory and one occurred in a paediatric radiology office. Outcome measures included the clinical assessment of infant oral motorskills, behavioural observation of mother-infant feeding interactions, maternal questionnaires on infant crying, sleeping and feeding behaviours, and the occurrence of gastro-oesophageal reflux (GOR) in the infants using abdominal ultrasound. Results: Infants in the colic group displayed more difficulties with feeding; including disorganised feeding behaviours, less rhythmic nutritive and non-nutritivesucking, more discomfort following feedings, and lower responsiveness during feeding interactions. Infants in the colic group also had more evidence of GOR based on the number of reflux episodes on abdominal ultrasound as well as maternal report of reflux. Mothers in the colic group reported higher levels of parenting stress. Conclusions: Results provide the first systematic evidence of feedingproblems in a subgroup of infants with colic. Data also illustrate the impact of these difficulties on parental and infant functioning. The association between feeding difficulties and colic suggests the potential for ongoing regulatory problems in infants presenting with clinically significant colic symptoms.

lthough excessive crying has been shown to subside for many infants from communitysamples within the first three months of life, these same studies identify a subgroup of infants with persistent colic symptoms.1 2 This suggests the need for research on clinic referred samples to assess more severe presentations of colic. Colic presents as a heterogeneous disorder with many potential causes. Feeding problems are one area that may co-occur in infants with cry problems.3–7 To date,studies have focused on factors such as formula composition8–10 or the feeding method (breast versus bottle)11 with a reliance on retrospective parental report measures.12 Information on the association between functional measures of feeding as they relate to the infant’s ability to modulate crying, such as the organisation of oral motor skills and behaviours during feeding interactions, islimited.13 Feeding and crying difficulties also may impact parental functioning through a disruption in early social exchanges, resulting in increased parental stress and depression and less optimal parent-infant interactions.14 15 Studies examining crying and feeding difficulties note that infants with these problems are perceived as more vulnerable by their parents16 and may display later behaviourproblems at preschool and early school ages.17 18 The present study examines the relation between colic and infant feeding difficulties and their impact on parental functioning for a primarily clinic referred sample. The purpose of this study was to test the hypothesis that infants with colic would have more feeding problems, including disorganised oral motor skills, gastro-oesophageal reflux (GOR),...
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