Advanced

Infants with colic - Parents’ experiences in short and long perspectives and the effect of acupuncture treatment on crying, feeding, stooling and sleep

Landgren, Kajsa LU (2011) In Lund University, Faculty of Medicine, Doctoral Dissertation Series 2011:108.
Abstract (Swedish)
Popular Abstract in Swedish

Spädbarn med kolik – föräldrars upplevelse i ett kortare och ett längre perspektiv samt effekten av akupunktur på barnets skrik, ätande, avföringsmönster och sömn.



Spädbarnskolik definieras som ett tillstånd där ett för övrigt friskt barn skriker och gnäller mer än tre timmar per dag mer än tre dagar i veckan. Kolik drabbar ca 10 % av nyfödda barn i västvärlden. Både barnen och deras familjer lider och det är en risk att den viktiga anknytningen försenas. Orsakerna till kolik är sannolikt flera, och är inte fullt klarlagda. Hos ca 20 % av barnen med kolik avtar skrikandet om de inte exponeras för komjölksprotein. De läkemedel som finns har antingen ingen effekt eller allvarliga... (More)
Popular Abstract in Swedish

Spädbarn med kolik – föräldrars upplevelse i ett kortare och ett längre perspektiv samt effekten av akupunktur på barnets skrik, ätande, avföringsmönster och sömn.



Spädbarnskolik definieras som ett tillstånd där ett för övrigt friskt barn skriker och gnäller mer än tre timmar per dag mer än tre dagar i veckan. Kolik drabbar ca 10 % av nyfödda barn i västvärlden. Både barnen och deras familjer lider och det är en risk att den viktiga anknytningen försenas. Orsakerna till kolik är sannolikt flera, och är inte fullt klarlagda. Hos ca 20 % av barnen med kolik avtar skrikandet om de inte exponeras för komjölksprotein. De läkemedel som finns har antingen ingen effekt eller allvarliga biverkningar. Familjer med kolikbarn behöver mycket stöd från barnhälsovården under den ansträngande perioden.



Avhandlingens övergripande syfte var att belysa föräldrars upplevelse av att ha och av att ha haft ett spädbarn med kolik samt att utvärdera effekten av akupunktur på barnets skrik, mat-, avförings- och sömnmönster. Avhandlingen består av tre delstudier. För att nå en djup förståelse för föräldrarnas upplevelse av att ha ett spädbarn med kolik gjordes en kvalitativ studie där 23 mammor och pappor intervjuades medan de var mitt i kolikperioden. De utskrivna intervjuerna analyserades med en fenomenologisk hermeneutisk metod. Vid analysen framkom ett huvudtema, ”Koliken överskuggar allt” med tre underteman: ”Leva i ett inferno”, ”Saknad efter det vi drömt om” och ”Att överleva koliken”. Föräldrarnas upplevelse tolkades som en metafor: de utmattade och oroliga föräldrarna var som passagerare på en båt i storm där de tappat kontrollen. De led med sina barn och besättningen kunde inte hjälpa dem. För att ta sig och sitt barn till en säker hamn provade föräldrarna alla tänkbara strategier. De hjälptes åt för att klara sig igenom den stormiga resan och när havet ibland lugnade sig kände de hopp och kunde glädjas över sitt barn. Fyra år senare intervjuades 17 av föräldrarna igen (tio mammor och sju pappor). Tretton individuella intervjuer kombinerades med en fokusgruppsintervju med fyra föräldrar. Intervjuerna analyserades med innehållsanalys. Resultatet visade att föräldrarna tydligt mindes det kaos och den frustration de upplevde när de var mitt i kolikperioden. Värst var att inte bli trodd och att ingen förstod hur de hade det. När koliken gick över bleknade minnet och föräldrarna kunde ta till sig barnet. Föräldrarna var besvikna över bemötandet på BVC och önskade en utveckling av omhändertagandet.



För att utvärdera effekten av akupunktur vid spädbarnskolik utfördes en randomizerad kontrollerad studie med 81 spädbarn med kolik, 2-8 veckor gamla, som lottades till akupunktur- eller kontrollgrupp. Åttioett barn (43 i akupunkturgruppen och 38 i kontrollgruppen) genomförde ett strukturerat program som utgjordes av sex besök på en akupunkturmottagning. Vid besöken träffade föräldrarna en sjuksköterska som lyssnade på dem, svarade på frågor och gav standardiserade råd. Därefter bar sjuksköterskan, som inte visste vilken grupp barnet ingick i, barnet till ett annat rum där en akupunkturutbildad sjuksköterska behandlade alla barnen lika förutom att barnen i akupunkturgruppen dessutom fick akupunktur i form av en nål som stacks ca två mm djupt in i akupunkturpunkten LI4 på den ena handen under två sekunder. I en dagbok registrerade föräldrarna under de tre interventionsveckorna när barnet gnällde, skrek, hade en kolikattack, åt och bajsade. Dessutom fick föräldrarna svara på frågor om barnets sömn och hade möjlighet att beskriva förändringar i barnets beteende. Resultaten visar att akupunktur minskade tid och intensitet på skriket. Det var en skillnad (p=0.034) till akupunkturgruppens fördel, på tiden från inklusion tills barnet inte längre uppfyllde kriteriet för kolik. Mängden gnäll första och andra interventionsveckan (p=0.029 and 0.047) och av skrik under andra veckan (p=0.046) var lägre i akupunkturgruppen. Den totala mängden av gnäll, skrik och kolikskrik (TC) var lägre i akupunkturgruppen under den första (p=0.025) och den andra interventionsveckan (p=0.016). Den relativa skillnaden mellan baseline genom interventionsveckorna visade skillnader mellan grupperna den första veckan (p=0.028), för kolikskrik den andra veckan (p=0.041) och för TC under den andra veckan (p=0.024), allt till akupunkturgruppens fördel. Under den tredje interventionsveckan fanns inga skillnader mellan hur grupperna skrek.



Barnen hade en högre avföringsfrekvens än vad som tidigare rapporterats bland friska spädbarn. Akupunktur gav ingen förändring i barnets matmönster och bara en mindre effekt på avföringsfrekvensen. Föräldrarna till barn i akupunkturgruppen beskrev oftare att deras barn fått en normaliserad avföring, att barnen sov bättre och att koliken förbättrats jämfört med föräldrar i kontrollgruppen.



Sammanfattningsvis visar resultaten att kolik påverkar de flesta aspekter av familjelivet, att föräldrar känner sig maktlösa när de inte kan lindra sitt barns smärta men också att familjerelationerna läker och att minnet av kolikperioden bleknar. Fortsatt forskning behövs för att öka förståelsen för föräldrarnas situation så att bästa möjliga stöd och råd kan ges. Akupunktur minskade spädbarnens skrik och föräldrarna upplevde att barnens tarmfunktion normaliserades. Inga negativa effekter uppvisades. Akupunktur kan vara en behandling för att minska barns lidande och påfrestningar i familjelivet. Dock behövs det fortsatt forskning för att undersöka effekten av olika akupunkturpunkters effekt vid kolik och vilka behandlingsintervall som är optimala. (Less)
Abstract
Infantile colic, involving an otherwise healthy infant crying and fussing more than three hours per day and more than three days per week, is a common problem in Western countries. Both the infant and the parents suffer during the months of persistent crying and there is a risk that the establishing of the early relationship might be disturbed. Safe and effective treatment that provides relief in infantile colic is lacking.



The aim of this thesis was to elucidate parents’ experiences of having, and having had, a baby with infantile colic and to evaluate the effect of acupuncture treatment on crying, feeding, stooling and sleep patterns in infants with colic. Individual interviews were conducted with 23 parents (12... (More)
Infantile colic, involving an otherwise healthy infant crying and fussing more than three hours per day and more than three days per week, is a common problem in Western countries. Both the infant and the parents suffer during the months of persistent crying and there is a risk that the establishing of the early relationship might be disturbed. Safe and effective treatment that provides relief in infantile colic is lacking.



The aim of this thesis was to elucidate parents’ experiences of having, and having had, a baby with infantile colic and to evaluate the effect of acupuncture treatment on crying, feeding, stooling and sleep patterns in infants with colic. Individual interviews were conducted with 23 parents (12 mothers and 11 fathers) of infants with colic. The narratives were analysed using a phenomenological, hermeneutic method. The parents expressed that the colic overshadowed everything. Both fathers and mothers experienced they were living in an inferno and yearned for the scenario that they had dreamed of. They used various strategies to ease their child’s pain and thereby help them all get through the months of almost constant crying. The parents were disappointed when nothing they tried worked and when they did not receive help from the professionals. It was important for them to be able to share their burden. Four years later 17 of the parents were interviewed again, 13 of them individually and four in a focus group. These interviews were analysed with content analysis. The results showed that the parents vividly recalled the emotional and practical chaos they had lived in during the colic period and how relationships within the family had been strained. They had tried many recommended treatments but were frustrated when almost nothing helped. The lack of responsiveness from professionals and the experience that no one understood their situation was the worst part of the colic period. When the colic symptoms faded out relations healed and parents could enjoy the new family member. Parents’ confidence in the Child Health services was decreased and they suggested changes in treatment.



To evaluate the effect of minimal acupuncture treatment on crying, feeding, stooling and sleep patterns in infants with colic, a blinded, randomised, controlled trial comprising 81 infants aged 2–8 weeks and fulfilling the criteria for infantile colic was conducted. The infants went through a structured programme comprising six visits to an acupuncture clinic, twice a week, where parents could ask questions as well as receive verbal support from a nurse. Subsequently the infants were carried to a separate room; here, another nurse handled all the infants in a similar way with the exception for the infants who were allocated to receive acupuncture being given minimal, standardised acupuncture for two seconds in the acupuncture point, LI4 on the hand. Parents registered their infants’ fussing, crying, feeding and stooling in a diary on a daily basis. The results indicated that minimal acupuncture shortened the duration and reduced the intensity of crying in infants with colic. There was a difference (p=0.034), favouring the acupuncture group, in the time that passed from inclusion until the infant no longer met the criteria for colic. The duration of fussing in the first and second week (p=0.029 and 0.047) and of colicky crying in the second intervention week (p=0.046) was lower in the acupuncture group. The total duration of fussing, crying and colicky crying (TC) was lower in the acupuncture group during the first (p=0.025) and the second intervention week (p=0.016). The relative difference from baseline throughout the intervention weeks showed differences between groups for fussing in the first week (p=0.028), for colicky crying in the second week (p=0.041) and for TC in the second week (p=0.024), demonstrating favour towards the acupuncture group. During the third week there were no statistical differences in crying.



The infants had a higher stooling frequency than reported in healthy infants in previous reports. Minimal acupuncture showed no effect on feeding and only minor effect on stooling frequency. Parents in the acupuncture group more often described their infant to have normalised stooling, better sleep and improvement of colic compared to the control group.



The results indicate that infantile colic affects most aspects of family life. Mothers and fathers alike felt powerless and were overwhelmed by strong feelings when they could not ease their child’s pain. Acupuncture may constitute a valuable treatment for reducing the duration and intensity of crying in infants with colic and thereby preventing disturbances in families. To improve acupuncture treatment, research into different acupuncture points, needle techniques and intervals between treatments is required. In order to be able to support parents and infants when a child has infantile colic individualised but structured guidelines are needed. (Less)
Please use this url to cite or link to this publication:
author
supervisor
opponent
  • Professor Helseth, Sölvi, Högskolen i Oslo
organization
publishing date
type
Thesis
publication status
published
subject
keywords
Baby, Interviews, Infantile Colic, Crying, Content analysis, randomised, stooling, feeding, phenomenological hermeneutic, Parents’ experiences, Long term effects
in
Lund University, Faculty of Medicine, Doctoral Dissertation Series
volume
2011:108
pages
138 pages
publisher
Department of Health Sciences, Lund University
defense location
SSSH-salen, Health Sciences Center
defense date
2011-12-16 13:00
ISSN
1652-8220
ISBN
978-91-86871-58-1
language
English
LU publication?
yes
id
d8048bed-ed80-4aa4-9c28-2be04c1911bc (old id 2214251)
date added to LUP
2011-11-25 13:25:32
date last changed
2016-09-19 08:44:48
@phdthesis{d8048bed-ed80-4aa4-9c28-2be04c1911bc,
  abstract     = {Infantile colic, involving an otherwise healthy infant crying and fussing more than three hours per day and more than three days per week, is a common problem in Western countries. Both the infant and the parents suffer during the months of persistent crying and there is a risk that the establishing of the early relationship might be disturbed. Safe and effective treatment that provides relief in infantile colic is lacking.<br/><br>
<br/><br>
The aim of this thesis was to elucidate parents’ experiences of having, and having had, a baby with infantile colic and to evaluate the effect of acupuncture treatment on crying, feeding, stooling and sleep patterns in infants with colic. Individual interviews were conducted with 23 parents (12 mothers and 11 fathers) of infants with colic. The narratives were analysed using a phenomenological, hermeneutic method. The parents expressed that the colic overshadowed everything. Both fathers and mothers experienced they were living in an inferno and yearned for the scenario that they had dreamed of. They used various strategies to ease their child’s pain and thereby help them all get through the months of almost constant crying. The parents were disappointed when nothing they tried worked and when they did not receive help from the professionals. It was important for them to be able to share their burden. Four years later 17 of the parents were interviewed again, 13 of them individually and four in a focus group. These interviews were analysed with content analysis. The results showed that the parents vividly recalled the emotional and practical chaos they had lived in during the colic period and how relationships within the family had been strained. They had tried many recommended treatments but were frustrated when almost nothing helped. The lack of responsiveness from professionals and the experience that no one understood their situation was the worst part of the colic period. When the colic symptoms faded out relations healed and parents could enjoy the new family member. Parents’ confidence in the Child Health services was decreased and they suggested changes in treatment.<br/><br>
<br/><br>
To evaluate the effect of minimal acupuncture treatment on crying, feeding, stooling and sleep patterns in infants with colic, a blinded, randomised, controlled trial comprising 81 infants aged 2–8 weeks and fulfilling the criteria for infantile colic was conducted. The infants went through a structured programme comprising six visits to an acupuncture clinic, twice a week, where parents could ask questions as well as receive verbal support from a nurse. Subsequently the infants were carried to a separate room; here, another nurse handled all the infants in a similar way with the exception for the infants who were allocated to receive acupuncture being given minimal, standardised acupuncture for two seconds in the acupuncture point, LI4 on the hand. Parents registered their infants’ fussing, crying, feeding and stooling in a diary on a daily basis. The results indicated that minimal acupuncture shortened the duration and reduced the intensity of crying in infants with colic. There was a difference (p=0.034), favouring the acupuncture group, in the time that passed from inclusion until the infant no longer met the criteria for colic. The duration of fussing in the first and second week (p=0.029 and 0.047) and of colicky crying in the second intervention week (p=0.046) was lower in the acupuncture group. The total duration of fussing, crying and colicky crying (TC) was lower in the acupuncture group during the first (p=0.025) and the second intervention week (p=0.016). The relative difference from baseline throughout the intervention weeks showed differences between groups for fussing in the first week (p=0.028), for colicky crying in the second week (p=0.041) and for TC in the second week (p=0.024), demonstrating favour towards the acupuncture group. During the third week there were no statistical differences in crying.<br/><br>
<br/><br>
The infants had a higher stooling frequency than reported in healthy infants in previous reports. Minimal acupuncture showed no effect on feeding and only minor effect on stooling frequency. Parents in the acupuncture group more often described their infant to have normalised stooling, better sleep and improvement of colic compared to the control group. <br/><br>
<br/><br>
The results indicate that infantile colic affects most aspects of family life. Mothers and fathers alike felt powerless and were overwhelmed by strong feelings when they could not ease their child’s pain. Acupuncture may constitute a valuable treatment for reducing the duration and intensity of crying in infants with colic and thereby preventing disturbances in families. To improve acupuncture treatment, research into different acupuncture points, needle techniques and intervals between treatments is required. In order to be able to support parents and infants when a child has infantile colic individualised but structured guidelines are needed.},
  author       = {Landgren, Kajsa},
  isbn         = {978-91-86871-58-1},
  issn         = {1652-8220},
  keyword      = {Baby,Interviews,Infantile Colic,Crying,Content analysis,randomised,stooling,feeding,phenomenological hermeneutic,Parents’ experiences,Long term effects},
  language     = {eng},
  pages        = {138},
  publisher    = {Department of Health Sciences, Lund University},
  school       = {Lund University},
  series       = {Lund University, Faculty of Medicine, Doctoral Dissertation Series},
  title        = {Infants with colic - Parents’ experiences in short and long perspectives and the effect of acupuncture treatment on crying, feeding, stooling and sleep},
  volume       = {2011:108},
  year         = {2011},
}