Posted by: Indonesian Children | September 12, 2009

Sleep, Colic, and Excessively Crying Infants

source : journal pediatric


Crying in early infancy has a tendency to increase after birth.13 When the amount of crying is at its maximum, a proportion of infants cry more than is tolerated by the caregivers. Infants who cry >3 hours a day for 3 days or more a week are referred to as colicky infants.4 No organic cause can be demonstrated in the vast majority of these infants, and they recover from the crying period without any obvious consequences.5

Crying episodes tend to cluster in the evenings, especially at the age of high amounts of crying.2 Simultaneously, the development of sleep goes through rapid changes. At the age from 2 weeks to 3 months, infant’s sleep-wake rhythm changes from regular 4-hour cycles to a well-defined day-night rhythm. The longest awake period tends to occur during evening hours6,7 at the time when infants also cry the most.3 During the same time period, the structure of sleep changes. Neonatal sleep characteristics such as sleep onset with rapid eye movement (REM) periods rapidly subside after the age of 4 to 5 weeks, and the variable length of REM and non–rapid eye movement (NREM) sleep cycle length stabilizes at 4 months of age.8 During the night, the REM and NREM ratio decreases by increasing age.9 The coincidence of these phenomena suggests that excessive crying in infancy may be associated with disturbances in the developing sleep structure or sleep-wake rhythm.

An association between colic and later sleep problems originally received support from questionnaire studies in which mothers who reported sleep problems also recalled more colic in their children retrospectively,10,11 and mothers who reported more colic reported more sleep problems prospectively in their children at 3 years of age.12 These results are confronted by our later prospective study of colicky infants using daily diaries to document the amount of crying. It did not show any differences in the duration of night sleep, amount of night awakenings, duration of night awakenings, or day time sleep at either 8 or 12 months of age.13 This finding has been confirmed by a recent study by Canivet et al.14

Diary-based studies during colic have suggested that the total daily sleep time is shorter in colicky infants compared with control subjects. St James Roberts et al15 reported that the total daily sleep time was 77 minutes shorter in the group of excessively crying infants compared with control subjects at 6 weeks of age. When the 24-hour day was split into 6-hour quartiles, the difference was observed only during daytime (between 6 AM and noon). Prudhomme et al16 showed that 2-month-old colicky infants slept 2 hours less per day than control infants. In a study by Papousek and von Hofacker,17 excessively crying infants slept 93 minutes per day less than control subjects at the age of 3.6 months. In our earlier study, the diary data at 5 weeks of age showed 108 minutes less sleep a day in the group of excessively crying infants compared with the control subjects. There was less reported sleep during each quartile of the day, but the difference was statistically significant only during evening hours and nighttime. However, this difference was not observed in later overnight sleep polygraphy recordings of the same infants in a sleep laboratory at 2 or 7 months of age.

Wolff proposed that crying is 1 of 5 behavioral states in infancy. According to his observations, fussing is a state of transition. Excessive proportion of fussing and crying may be taken off from either awake or sleep states. The diary-based studies have suggested that excessive fussing or crying is at least partly taken “off” from sleep time and therefore will be reflected also in the development of infants’ sleep-wake rhythm. However, excessive fussing and crying could also be a consequence of sleep deprivation, which may lead to difficulty in behavioral control.

Excessively crying infants may have characteristics that disturb the sleep structure. Cow milk allergy as a distressing factor has been described to cause a disruption of sleep and an increase in the proportion of undetermined NREM sleep in infants.20 Because REM sleep is easily disturbed in infants, a REM sleep disturbance would also be expecte





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