Our aim was to establish whether there is an interconnection between the compositional development of the gut microbiota and the amount of fussing and crying in early infancy.
Behavioral patterns of 89 infants during the 7th and 12th week of life were recorded in parental diaries. Total distress was defined as the sum of daily amounts of crying and fussing. Infants' gut microbiota profiles were investigated by several molecular assays during the first six months of life.
The median (range) duration of total distress among the infants was 106 (0–478) minutes a day during the 7th and 58 (0–448) minutes a day during the 12th week. The proportion of Bifidobacterium counts to total bacterial counts was inversely associated with the amount of crying and fussing during the first 3 months of life (p = 0.03), although the number of Bifidobacterium breve was positively associated with total distress (p = 0.02). The frequency of Lactobacillus spp. at the age of 3 weeks was inversely associated with total infant distress during the 7th week of life (p = 0.02).
Bifidobacterium and Lactobacillus appear to protect against crying and fussing. Identification of specific strains with optimal protective properties would benefit at-risk infants.
In a prospective follow up of 116 high risk infants, a 24 hour
behavioural chart on seven consecutive days was analysed at seven and
12 weeks of age. Of children who manifested atopic disease at 2 years,
44/116 (38%), had shown significantly more fussing during the seventh,
and colic type cry during the twelfth week than those who remained
healthy (72/116, 62%).
Parents commonly seek clinicians' help for infant crying that they judge to be excessive. To date there is no independent evidence whether such babies actually cry more than average. To assess this, maternal diary and 24 hour audiotape recordings of the crying periods of 16 infants referred for excessive crying were compared with equivalent measures of a normative sample. The overall amounts of crying measured by the two methods were similar. The referred infants cried substantially more over 24 hours and in the afternoon and evening. The difference approached significance in the morning but was insignificant at night time. Some qualifications to the findings are indicated.
The mother of a 3-month old girl presented her daughter for chiropractic care with a medical diagnosis of gastroesophageal reflux disease. Her complaints included frequently interrupted sleep, excessive intestinal gas, frequent vomiting, excessive crying, difficulty breastfeeding, plagiocephaly and torticollis. Previous medical care consisted of Prilosec prescription medication. Notable improvement in the patient’s symptoms was observed within four visits and total resolution of symptoms within three months of care. This case study suggests that patients with complaints associated with both musculoskeletal and non-musculoskeletal origin may benefit from chiropractic care.
GERD; chiropractic; pediatric
Infants who cry a lot, or are unsettled in the night, are common sources of concern for parents and costly problems for health services. The two types of problems have been linked together and attributed to a general disturbance of infant regulation. Yet the infant behaviours involved present differently, at separate ages and times of day. To clarify causation, this study aims to assess whether prolonged crying at 5–6 weeks (the peak age for crying) predicts which infants are unsettled in the night at 12 weeks of age (when most infants become settled at night).
Data from two longitudinal studies are analysed. Infant crying data were obtained from validated behaviour diaries; sleep-waking data from standard parental questionnaires.
A significant, weak relationship was found between crying at 5–6 weeks and 12-week night waking and signalling in one study, but not the other. Most infants who met the definition for prolonged crying/colic at 5–6 weeks were settled during the night at 12 weeks of age; they were not more likely than other infants to be unsettled.
Most infants who cry a lot at 5–6 weeks of age ‘sleep through the night’ at 12 weeks of age. This adds to evidence that the two types of problematic behaviour have different causes, and that infant sleep-waking problems usually involve maintenance of signalling behaviours rather than a generalised disturbance.
Shaken baby syndrome often occurs after shaking in response to crying bouts. We questioned whether the use of the educational materials from the Period of PURPLE Crying program would change maternal knowledge and behaviour related to shaking.
We performed a randomized controlled trial in which 1279 mothers received materials from the Period of PURPLE Crying program or control materials during a home visit by a nurse by 2 weeks after the birth of their child. At 5 weeks, the mothers completed a diary to record their behaviour and their infants' behaviour. Two months after giving birth, the mothers completed a telephone survey to assess their knowledge and behaviour.
The mean score (range 0–100 points) for knowledge about infant crying was greater among mothers who received the PURPLE materials (63.8 points) than among mothers who received the control materials (58.4 points) (difference 5.4 points, 95% confidence interval [CI] 4.1 to 6.5 points). The mean scores were similar for both groups for shaking knowledge and reported maternal responses to crying, inconsolable crying and self-talk responses. Compared with mothers who received control materials, mothers who received the PURPLE materials reported sharing information about walking away if frustrated more often (51.5% v. 38.5%, difference 13.0%, 95% CI 6.9% to 19.2%), the dangers of shaking (49.3% v. 36.4%, difference 12.9%, 95% CI 6.8% to 19.0%), and infant crying (67.6% v. 60.0%, difference 7.6%, 95% CI 1.7% to 13.5%). Walking away during inconsolable crying was significantly higher among mothers who received the PURPLE materials than among those who received control materials (0.067 v. 0.039 events per day, rate ratio 1.7, 95% CI 1.1 to 2.6).
The receipt of the Period of PURPLE Crying materials led to higher maternal scores for knowledge about infant crying and for some behaviours considered to be important for the prevention of shaking. (ClinicalTrials.gov trial register no. NCT00175422.)
According to the commonest definition, infant colic is distinguished by crying which is 'paroxysmal'-that is, intense and different in type from normal fussing and crying. To test this, maternal reports of the distress type of 67 infants whose fuss/crying usually exceeded three hours a day ('persistent criers') were scrutinised using 24 hour audiorecordings of the infants' distressed vocalisation. 'Moderate criers' (n = 55) and 'evening criers' (n = 38) were also assessed. Most of the distress in all three groups was fussing. In the audiorecordings the persistent criers showed a higher crying: fussing ratio than the moderate criers, but intense crying was rare. A third of the persistent criers were reported by their mothers to have occasional, distinct colic bouts of 'intense, unsoothable crying and other behaviour, perhaps due to stomach or bowel pain.' In the audiorecordings these periods were longer, but not paroxysmal in onset or more intense than the crying of persistent criers not judged to have colic. The audible features of the crying may be less important than its unpredictable, prolonged, hard to soothe, and unexplained nature.
The purpose of this study, in a sample of preschool children (ages 3 to 5 years; N=47), was to evaluate the feasibility of scheduled analgesic dosing following outpatient tonsillectomy in order to optimize pain management.
Parents were instructed to give their child acetaminophen with hydrocodone (167mg/5ml) every 4 hours around-the-clock for the first 3 days following surgery. Parents recorded ratings of their child’s pain with/without swallowing using the Faces, Legs, Activity, Cry, and Consolability (FLACC) behavioral pain scale, pain relief ratings, and severity of analgesic side effects in a home diary. Audiotaped interviews were conducted with parents to document descriptions of their experiences in managing their child’s pain at home.
Mean FLACC scores with/without swallowing were less than 2 at each measurement time and pain relief scores increased over time. Total analgesic dose decreased and the number of missed doses increased over the first 3 days after surgery. Moderate-to-severe daytime sedation, nausea, vomiting, and constipation were reported by parents.
Study results suggest that acetaminophen with hydrocodone is effective in relieving preschool children’s pain following tonsillectomy, and that parental adherence to a scheduled analgesic regimen decreases over time. Time-contingent dosing was associated with moderate to severe side effects, and should be addressed in discharge teaching with parents. Findings provide insight into parents’ perspective of pain management at home following tonsillectomy and methods for relieving their child’s pain.
tonsillectomy pain; pediatric pain; postoperative pain management; acetaminophen with hydrocodone
The TGF-β/BMP signaling cascades control a wide range of developmental and physiological functions in vertebrates and invertebrates. In Drosophila melanogaster, members of this pathway can be divided into a Bone Morphogenic Protein (BMP) and an Activin-ß (Act-ß) branch, where Decapentaplegic (Dpp), a member of the BMP family has been most intensively studied. They differ in ligands, receptors and transmitting proteins, but also share some components, such as the Co-Smad Medea (Med). The essential role of Med is to form a complex with one of the two activating Smads, mothers against decapentaplegic (Mad) or dSmad, and to translocate together to the nucleus where they can function as transcriptional regulators of downstream target genes. This signaling cascade underlies different mechanisms of negative regulation, which can be exerted by inhibitory Smads, such as daughters against decapentaplegic (dad), but also by the Ski-Sno family. In this work we identified and functionally analyzed a new member of the Ski/Sno-family, fussel (fuss), the Drosophila homolog of the human functional suppressing element 15 (fussel-15). fuss codes for two differentially spliced transcripts with a neuronal expression pattern. The proteins are characterized by a Ski-Sno and a SAND homology domain. Overexpression studies and genetic interaction experiments clearly reveal an interaction of fuss with members of the BMP pathway, leading to a strong repression of BMP-signaling. The protein interacts directly with Medea and seems to reprogram the Smad pathway through its influence upon the formation of functional Mad/Medea complexes. This leads amongst others to a repression of downstream target genes of the Dpp pathway, such as optomotor blind (omb). Taken together we could show that fuss exerts a pivotal role as an antagonist of BMP signaling in Drosophila melanogaster.
Sleep-wake behaviors and temperament were examined longitudinally for trait stability and relationship to behavioral state regulation from infancy to early childhood. Subjects were 120 low-risk, full-term infants from a middle class sample. At 6 weeks, parents completed 3 consecutive days of the Baby’s Day Diary which measures sleep, wake, fuss, feed and cry states and the Infant Characteristics Questionnaire. At 16 months, parents assessed sleep behaviors with the Sleep Habits Inventory and temperament with the Toddler Symptom Checklist. At 24 months, parents repeated 3 days of the Baby’s Day Diary. Structural Equation Modeling was used to examine cross-age hypotheses for sleep-wake and temperament associations. From early infancy to toddlerhood, sleep-wake behaviors and irritable temperament were notably stable but independent in this cohort.
Sleep; wake; infant; toddler; temperament; continuity; fuss; diary method; longitudinal
AIM: To assess the incidence of infantile colic and its association with variable predictors in infants born in a community maternity hospital, Tehran, Iran.
METHODS: In this prospective cohort study, mothers who gave birth to live newborns between February 21 and March 20, 2003 at the hospital were invited to join to the study. For every infant-mother dyad data were collected on infant gender, type of delivery, gestational age at birth, birth weight, birth order, and mother’s reproductive history. Then mothers were given a diary to document the duration of crying/fussiness behaviors of their infants for the next 12 wk. We scheduled home visits at the time the infants were 3 mo of age to collect the completed diaries and obtain additional information on infants’ nutritional sources and identify if medications were used for colic relief. Cases of colic were identified by applying Wessel criteria to recorded data. Chi-square and Mann-whitney U tests were used to compare proportions for non-parametric and parametric variables, respectively.
RESULTS: From 413 infants, follow-up was completed for 321 infants. In total, 65 infants (20.24%) satisfied the Wessel criteria for infantile colic. No statistical significance was found between colicky and non-colicky infants according to gender, gestational age at birth, birth weight, type of delivery, and, infant’s feeding pattern. However, firstborn infants had higher rate for developing colic (P = 0.03).
CONCLUSION: Colic incidence was 20% in this population of Iranian infants. Except for birth order status, no other variable was significantly associated with infantile colic.
Infantile colic; Incidence; Iran; Risk factors
Pathological laughing and crying is a disorder of emotional expression seen in a number of neurological diseases. The aetiology is poorly understood, but clinical descriptions suggest a disorder of emotion regulation. The goals of this study were: (i) to characterize the subjective, behavioural and physiological emotional reactions that occur during episodes of pathological laughing and crying; (ii) to compare responses during these episodes to those that occur when emotions are elicited under standard conditions (watching sad and amusing emotional films, being startled); and (iii) to examine the ability of patients with this disorder to regulate their emotions under standardized conditions. Twenty-one patients with pathological laughing and crying due to amyotrophic lateral sclerosis and 14 with amyotrophic lateral sclerosis but no pathological laughing and crying were studied. Emotional measures included self-reported emotional experience, video recordings of facial reactivity and peripheral physiological responses (skin conductance, heart rate and somatic activity). Nineteen of the 21 patients with histories of pathological laughing and crying had at least one episode in the laboratory that they agreed constituted pathological laughing or crying (a total of 56 episodes were documented). Compared with viewing sad and amusing films, the episodes were associated with greater facial and physiological activation. Contrary to many clinical descriptions, episodes were often induced by contextually appropriate stimuli and associated with strong experiences of emotion that were consistent with the display. When instructed to regulate their facial responses to emotion-eliciting films, patients with pathological laughing and crying showed impairments compared with patients who did not have a history of this disorder. These findings support the idea that pathological laughing and crying represents activation of all channels of emotional responding (i.e. behavioural, physiological and subjective). Furthermore, they support previously advanced theories that, rather than being associated with general emotional hyperreactivity, this disorder may be due to dysfunction in frontal neural systems that support voluntary regulation of emotion.
behavioural neurology; pseudobulbar affect; affective neuroscience; amyotrophic lateral sclerosis
Few convincing treatment options have been identified for the excessively crying infant. One explanation may be a lack of identification of patient subgroups. This study used a clinically plausible categorization protocol to subgroup infants and compared changes in symptoms between these subgroups during treatment.
An observational cohort design was employed. All infants presenting with excessive infant crying between July 2007 and March 2008 were categorized into three subgroups, (A) infant colic, (B) irritable infant syndrome of musculoskeletal origin (IISMO) and (C) inefficient feeding crying infants with disordered sleep (IFCIDS) based on history and physical findings. Mothers completed questionnaires which rated their own and their child’s characteristics prior to and at the end, of a course of manual therapy. Independent associations between infant subgroups and changes in continuous outcomes (crying, stress, sleep, and consolability) were assessed. Multivariable analysis of covariance was used to identify and control for potential confounders.
A total of 158 infants were enrolled. There was no significant difference in demographic profile between groups or any significant difference in infant crying or level of maternal stress at the start. Only the putative subgroups were significantly associated with differences in outcomes. In general, colic babies improved the most in consolability and crying.
Babies with excessive crying should not be viewed as a homogenous group. Treatment outcomes may be improved by targeting appropriate subgroups prior to treatment.
Subgroups; infant colic; excessive crying of infancy; Sous-groupes; colique du nourrisson; pleurs excessifs du nourrisson
With an increase in the prevalence of overweight being seen as early as infancy, it is essential that the factors which account for early excess weight gain be identified. In this study, maternal and infant characteristics were examined to determine their relation to the frequency of infants being fed. A cohort of 67 low-educated Mexican mothers who formula-fed their infants were recruited at a WIC Center and home-visited when their infants were 6-months-old. Mothers were surveyed with regard to their feeding attitudes and perception of their infant’s temperament, and kept a 24-hour diary of their infant’s behavior. Nearly 30% of the 6-month-old infants were at or above the 85th percentile of weight-for length. A regression analysis revealed only one factor, the number of infant crying episodes, as predictive of infant feeding (Beta = .246, p<.07), with the correlation even stronger (r =.35 (p<.01). As crying appeared to elicit feeding among these mothers, pediatricians, nurses, and WIC educators should consider discussing alternate strategies for quieting infants with the mothers they counsel.
Infant feeding; temperament; Mexican mothers
Both the oxytocin receptor (OXTR) gene and depressive symptoms have been associated with parenting behaviour. The OXTR GG genotype has been suggested to be related to more sensitive parenting, whereas depressive symptoms may affect sensitivity negatively. We examined the role of OXTR and the influence of depressive symptoms in explaining differences in physiological reactivity to infant crying. Heart rate responses of 40 healthy females without children (age 19–47 years, randomly selected half of twin pairs) were measured during the presentation of three episodes of infant cry sounds. Participants with the presumably more efficient variant of the oxytonergic system gene (OXTR GG) had more pronounced physiological reactivity to repeated cry sounds, except when they showed more symptoms of depression. Results were replicated in the second half of the twin sample. This is the first study to suggest effects of OXTR genotype on physiological reactivity to infant crying. Depressive symptoms may however suppress the effect of the OXTR GG genotype.
oxytocin receptor gene; depression; physiological reactivity; infant crying; parenting
OBJECTIVES—To investigate the prevalence of infant
crying and maternal soothing techniques in relation to ethnic origin
and other sociodemographic variables.
DESIGN—A questionnaire survey among mothers of
2-3 month old infants registered at six child health clinics in
Amsterdam, the Netherlands.
SUBJECTS—A questionnaire on sociodemographic
characteristics and crying behaviour was completed for 1826 of 2180 (84%) infants invited with their parents to visit the child health
clinics. A questionnaire on soothing techniques was also filled out at
home for 1142 (63%) of these infants.
RESULTS—Overall prevalences of "crying for
three or more hours/24 hour day", "crying a lot", and
"difficult to comfort" were 7.6%, 14.0%, and 10.3%,
respectively. Problematic infant crying was reported by 20.3% of the
mothers. Of these infants, only 14% met all three inclusion criteria.
Problematic crying occurred less frequently among girls, second and
later born children, Surinamese infants, and breast fed infants. Many
mothers used soothing techniques that could affect their infant's
health negatively. Shaking, slapping, and putting the baby to sleep in
a prone position were more common among non-Dutch (especially Turkish)
mothers than among Dutch mothers. Poorly educated mothers slapped their
baby more often than highly educated mothers.
CONCLUSIONS—Mothers' reports of infant crying and
soothing varied sociodemographically. Much harm may be prevented by
counselling parents (especially immigrants) on how and how not to
respond to infant crying. Health education should start before the
child's birth, because certain soothing techniques could be fatal,
even when practised for the first time.
Background: Infants with neonatal cerebral insults are susceptible to excessive crying as a result of difficulties with self-regulation.
Aims: To compare the effectiveness of swaddling versus massage therapy in the management of excessive crying of infants with cerebral insults.
Methods: Randomised three-week parallel comparison of the efficacy of two intervention methods. Infants with symptoms of troublesome crying and their parents were randomly assigned to a swaddling intervention group (n = 13) or a massage intervention group (n = 12).
Results: The amount of total daily crying decreased significantly in the swaddling group, but did not decrease significantly in the massage group. Infant behavioural profiles and maternal anxiety levels improved significantly in the swaddling group post-intervention. Parents in the swaddling group were more satisfied with the effectiveness of the intervention in reducing crying than parents in the massage group.
Conclusion: Results indicate that swaddling may be more effective than massage intervention in reducing crying in infants with cerebral injuries.
When preterm infants experience heel stick, crying commonly occurs and has adverse physical effects. A reduction in crying is desired. Kangaroo Care, skin contact between mother and infant, reduces pain as measured by the Premature Infant Pain Profile, and may reduce crying time. The purpose of the pilot was to test Kangaroo Care's effect on the preterm infant's crying response to heel-stick.
A prospective cross-over study with 10 prematures 2-9 days old (30-32 weeks postmenstrual age) was conducted. Infants were randomly assigned to two sequences (Day 1 heel stick in Kangaroo Care [after 30 minutes of prone skin contact upright between maternal breasts] and Day 2 heel stick in incubator [inclined, nested and prone] or the opposite sequence) was conducted. Video tapes of Baseline, Heel Warming, Heel Stick, and Recovery phases were independently scored for audible and inaudible crying times by two research assistants. The audible and inaudible crying times for each subject in each phase were summed and the mean between the scorer's values was analyzed by repeated measures ANOVA.
Subject characteristics did not differ between those in the two sequences. Crying time differed between the study phases on both days (p ≤ 0.001). When in Kangaroo Care as compared to the incubator, crying time was less during the Heel stick (p = 0.001) and Recovery (p = 0.01) phases.
Because Kangaroo Care reduced crying in response to heel stick in medically stable preterm infants who were 2-9 days old, a definitive study is recommended.
BACKGROUND. The incidence and prevalence of non-specific symptoms in a group of normally healthy infants have not previously been investigated. The relationship of such symptoms to the risk of sudden unexplained infant death has been explored. AIM. This study set out to assess the usually unreported minor morbidity occurring in infants under the age of two years in a defined community. METHOD. Diary cards were completed by mothers for 323 infants on a daily basis for up to two years from birth. Analysis of the diary card data allowed the incidence and prevalence of behavioural changes and non-specific symptoms to be determined, together with the duration of the episodes of symptoms and the frequency and timing of consultations with health visitors and doctors. RESULTS. Non-specific symptoms and behavioural changes occurred commonly in this age group. Upper respiratory symptoms were especially prevalent. Episodes of symptoms relating to particular body systems tended to be of longer duration while behavioural changes tended to be of shorter duration. Parents managed 67% to 99% of infants' health problems without requiring a consultation. Parents often delayed four or five days before consulting their doctor for symptoms in conditions which could be judged to be 'normal' for the child such as some respiratory conditions, but behavioural changes and fever led to consultations on the second day on average. CONCLUSION. The prevalence of the symptoms reported here should provide the setting for any discussion of their use as indicators of serious illness in infancy or the risk of sudden unexplained infant death.
studies suggest that recurrent episodes of coughing and wheezing occur
in up to 75% of infants after acute viral bronchiolitis.
AIM—To assess the
efficacy of budesonide given by means of a metered dose inhaler,
spacer, and face mask in reducing the incidence of coughing and
wheezing episodes up to 12 months after acute viral bronchiolitis.
the age of 12 months admitted to hospital with acute viral
bronchiolitis were randomised to receive either budesonide or placebo
(200 µg or one puff twice daily) for the next eight weeks. Parents
kept a diary card record of all episodes of coughing and wheezing over
the next 12months.
RESULTS—Full follow up
data were collected for 49 infants. There were no significant
differences between the two study groups for the number of infants with
symptom episodes up to six months after hospital discharge. At 12 months, 21 infants in the budesonide group had symptom episodes
compared with 12 of 24 in the placebo group. The median number of
symptom episodes was 2 (range, 0-13) in those who received budesonide
and 1 (range, 0-11) in those who received placebo. Because there is no
pharmacological explanation for these results, they are likely to be
caused by a type 1 error, possibly exacerbated by there being more boys
in the treatment group.
administration of budesonide by means of a metered dose inhaler,
spacer, and face mask system immediately after acute viral
bronchiolitis cannot be recommended.
Newborns’ crying in response to the cry of another newborn has been called an empathetic response. The purpose of this study was to determine whether newborns of depressed mothers showed the same response. Newborns of depressed and non-depressed mothers were presented with cry sounds of themselves or other infants, and their sucking and heart rate were recorded. The newborns of non-depressed mothers responded to the cry sounds of other infants with reduced sucking and decreased heart rate. In contrast, the newborns of depressed mothers did not show a change in their sucking or heart rate to the cry sound of other infants. This lesser attentiveness/responsiveness to other infants’ cry sounds may predict their later lack of empathy.
Newborns of depressed mothers; Discrimination Cry sounds
Origins of mothers’ and fathers’ beliefs about infant crying were examined in 87 couples. Parents completed measures of emotion minimization in the family of origin, depressive symptoms, empathy, trait anger, and coping styles prenatally. At 6 months postpartum, parents completed a self-report measure of their beliefs about infant crying. Mothers endorsed more infant-oriented and less parent-oriented beliefs about crying than did fathers. Consistent with prediction, a history of emotion minimization was linked with more parent-oriented and fewer infant-oriented beliefs about infant crying for both mothers and fathers either as a main effect or in conjunction with the partners’ infant-oriented beliefs. Contrary to expectation, parents’ own emotional dispositions had little effect on parents’ beliefs about crying. The pattern of associations varied for mothers and fathers in a number of ways. Implications for future research and programs promoting sensitive parenting are discussed.
Parental beliefs; infants; crying; family of origin; parental sensitivity
Links between maternal emotional reactions to crying (anger and anxiety) and infant attachment security were examined in 119 mother-infant dyads. Mothers rated the intensity of their emotional responses to videotapes of crying infants prenatally. Maternal sensitivity was observed during infant exposure to emotion eliciting tasks at six and 16 months postpartum and mothers’ self-reported on their responses to their infant’s negative emotions at 16 months. Infant attachment security was assessed using the Strange Situation at 16 months postpartum. Results indicated that observed sensitivity was associated with fewer avoidant and resistant behaviors and prenatal maternal anger and anxiety in response to infant crying predicted the developing attachment system independent of observed sensitivity, but in different ways. Maternal anxiety in response to crying was positively associated with resistant behaviors as a direct effect. Maternal anger in response to crying was associated with avoidant behaviors indirectly through mothers’ self-reported punitive and minimizing responses to infant distress at sixteen months. Theoretical, applied and methodological implications are discussed.
attachment; infant crying; maternal emotions; maternal sensitivity
BACKGROUND: Fewer than 20% of all illnesses that occur in the home require the attention of a general practitioner (GP). Whether specific illnesses in children are more likely to need the attention of a GP is poorly understood, as is the influence of various other factors. Health diaries are the most suitable method of collecting comprehensive information about children's health problems at home and in general practice simultaneously. AIM: To investigate the occurrence of, and consultation rates for, specific symptoms in childhood in relation to age, sex, birth order, and place of residence of the child, and season of the year. METHOD: The parents of 1805 children kept a health diary over three weeks and recorded symptoms and consultation behaviour. The symptoms were later combined into illness episodes. RESULTS: Over three weeks, colds/flu (157/1000 children) and respiratory symptoms (114/1000 children) occurred most frequently. More young children (0-4 years) suffered from illness generally. Eleven per cent of all illness episodes required the attention of a GP. Consultation rates differed greatly according to symptoms. A GP was consulted most often for ear (36%) and skin (28%) problems, and least often for headaches (2%) and tiredness (1%). Regardless of symptoms, young children (0-4 years) were taken to a GP twice as often as older children (10-14 years). CONCLUSIONS: This study emphasizes the enormous amount of illness that occurs in children and the fact that more than 80% of all illnesses are dealt with by parents without reference to the professional health care system.
To compare coital diaries and face‐to‐face interviews (FFIs) in measuring sexual behaviour among women at high risk of HIV. To assess the effect of differing levels of support from researchers on reporting in coital diaries and FFIs.
Three groups of 50 women were randomly selected from a cohort of food and recreational facility workers participating in a microbicide trial feasibility study and received differing levels of researcher support. Minimum support involved delivering and collecting coital diaries weekly; medium support included a weekly FFI and discussion of concerns; intensive support also included an unscheduled mid‐week visit when diaries were checked and concerns addressed. All respondents participated in an exit FFI, including questions on sexual behaviour over the four‐week study period and study acceptability.
Sexual behaviours were generally reported more frequently in coital diaries than weekly or exit interviews. Vaginal and anal sex, male and female condom use, vaginal cleaning and lubrication, sex during menstruation and sex with irregular and regular partners were reported more frequently in coital diaries than exit interviews. In coital diaries, level of support was associated with reporting of vaginal sex and cleaning. In exit interviews, support level was associated with reporting of vaginal sex, vaginal cleaning and sex with regular, irregular and commercial partners. Women with minimum support reported least satisfaction with the research process. Women with intensive support were most likely to report that they informed someone about their study participation and that they completed diaries daily.
Compared with FFIs, coital diaries resulted in higher reporting of socially stigmatised activities, and sexual behaviour reporting varied less by level of support. More researcher support enhanced study acceptability.
sexual behaviour research methods; microbicides; diaries; HIV; developing countries