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Behavior Problems in Infants

During early infancy, common issues include crying and night waking. During the second half of infancy, additional issues include repetitive rocking movements, fears, and clinging behaviors. More problematic behaviors, include colic and protracted nighttime struggles.

Crying and fussy periods

The majority of healthy babies experience daily periods of crying for which there is no explanation. By 6 weeks, the duration of daily crying peaks to 3 hours.

Parents should be encouraged to respond to their infant's cry, be assured that a young infant cannot be "spoiled," and understand that most babies need cuddling during both fussy and nonfussy times. Teaching the baby to become a "self_calmer" (eg, helping the infant to find his thumb) may be helpful. When parents find that their routine fails to soothe the baby.

Night waking

The newborn sleeps 16 to 17 hours in a 24_hour period, divided equally between day and night. Parents should expect two to four wakings per night.

By 3 months, three-quarters of infants at this age experience.

By 6 months of age, the majority of children are sleeping through the night.

Some infants, particularly those with complicated perinatal courses and those who have colic, may experience a delay in sleeping through the night. Some infants who are breast fed may not sleep through the night until weaning occurs.

Between 9 and 12 months, with the acquisition of object permanence, even infants who have been "good sleepers" may begin to signal during the night. Separation anxiety may also contribute.

 

Repetitive movements

Neonates often display rhythmic mouthing and sucking, reflex smiling, and myoclonic twitches. Ninety percent of healthy babies display thumb and finger sucking, lip sucking and biting or toe sucking. Body rocking, head rolling, or head banging are noted in 10-20% of normal infants. Bruxism, the grinding of teeth together, is observed in 50% of normal infants.

Such behaviors should be regarded as normal and transient developmental phenomenon. Underlying acute illness (eg, otitis media) or a chronic disorder (eg, sensory impairment, autism, seizures, or mental retardation) can 

For healthy infants with normal examinations, parents may be reassured that such behaviors typically are self_limited and not dangerous. Head banging infrequently causes contusions, and thumb sucking rarely

Fears and clinging behaviors

Stranger and separation anxieties emerge as the infant begins to distinguish the familiar from the

Frequent daytime feedings, which may lead to nighttime feedings, should be excluded. A detailed sleep history, unrealistic early bedtimes, late or prolonged naps, or insufficient limit setting should be excluded.

Physical examination should rule out the possibility of otitis media, neurological impairment, or other

Colic

Colicky babies demonstrate paroxysmal crying for more than 3 hours per day, at least several days a week. Ten percent of babies have colic. Crying begins soon after hospital discharge, peaks between 6 and 8 weeks, and gradually wanes.

Possible etiologies for colic include neuromaturational immaturity or hypersensitivity, gastrointestinal tract immaturity, and difficult temperament.

The history should include pre and perinatal history (eg, maternal drug or alcohol abuse, infections during pregnancy), past medical history (eg, head trauma, medications), social history (eg, child abuse or neglect), and family history (eg, inherited metabolic disorders, allergies). Review of 

Overfeeding, underfeeding, or a maladaptive feeding technique should be ruled out. Assessment should determine the vigorousness of the babies suck, feeding schedule, formula preparation methods, duration of feedings. What cues are used to start or end a feeding? Is the baby getting enough? Burping techniques, type of nipple used, and the angle at which the infant is held should be assessed.

Physical examination

Plotting of height, weight, and head circumference on growth charts usually demonstrates a healthy, vigorous infant.

Signs of organic disorders include unusual facial appearance (fetal alcohol syndrome), retinal hemorrhages (shaken baby syndrome), a tense or bulging fontanel (central nervous system infection, trauma, or hydrocephalus), or goiter.

An "olive" of pyloric stenosis, an asymmetrical abdomen (intussusception or volvulus), hernia, testicular torsion, enlargement of the kidneys, rectal fissure, foreign body in the eye or hair wrapped around a digit should be sought.

The tympanic membranes should be examined to rule out otitis media. The skin must be inspected carefully for atopic dermatitis, which may accompany the rare case of food allergy.

The feeding process should be observed. Laboratory tests should be reserved for instances in which the history or physical examination suggests a specific diagnosis.

Treatment of colic

Parental evaluation of the infant should determine whether that the infant is hungry, desires to suck, wants to be held, wants stimulation, or is tired and wants to sleep. Should no response calm the

Feeding techniques. Overfeeding and swallowing of excess air should be avoided. The parent should be advised to feed the baby in a semi_upright position, burp every ½ to 1 oz, make sure the nipple hole

Dietary manipulation does not usually offer any lasting improvement. On rare occasions, however, colic will improve by switching to an elemental non_cow milk, non_soy formula; removing lactose from

Simethicone ( Mylicon drops) is intended to improve the infant's ability to burp or pass flatus. It is of

Reassurance of parents of a colicky infant should include an explanation that the vast majority of