Spanking is common in the United States but less common in many European countries in which it has been outlawed. Being spanked has been associated with child abuse victimization, poor self-esteem, impaired parent–child relationships, and child and adult mental health, substance abuse, and behavioral consequences. Being spanked as a child has also been shown to increase the likelihood of abusing one's own children or spouse as an adult. Spanking of very young children less than two is almost never recommended even among experts that consider spanking as reasonable in some circumstances. Using a cross-sectional anonymous telephone survey, we describe spanking rates among a representative sample of North Carolina mothers of children less than 2 years old and the association of spanking with demographic characteristics. A substantial proportion of mothers admit to spanking their very young children. The rate of spanking in the last year among all maternal respondents was 30%. Over 5% of the mothers of 3-month olds reported spanking. Over 70% of the mothers of 23-month olds reported spanking. Increased spanking was associated with higher age of the child and lower maternal age. With every month of age, a child had 27% increased odds of being spanked. Early spanking has been shown to be associated with poor cognitive development in early childhood. Further, early trauma has been shown to have significant effects on the early developing brain. It is therefore critical that health and human services professionals address the risk of corporal punishment as a method of discipline early in the life of the child. The spanking of very young children may be an appropriate locus for policy and legislative debates regarding corporal punishment.

Background

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.

Methods

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.

Results

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).

Interpretation

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.)

Gas-fluid levels in the colon observed in radiographs are abnormal and usually indicate serious gastrointestinal disease. Colonic gas-fluid levels associated with concurrent abdominal pain and malabsorption of lactose, documented by lactose breath hydrogen testing, were observed in five children. Incomplete lactose absorption is a relatively benign condition that can be added to the differential diagnosis of gas-fluid levels in the colon and may account for some cases of spontaneous resolution of clinical and radiologic signs in children presenting with acute recurrent abdominal pain.

Images

Background

Infant colic, characterised by excessive crying/fussing for no apparent cause, affects up to 20% of infants under three months of age and is a great burden to families, health professionals and the health system. One promising approach to improving its management is the use of oral probiotics. The Baby Biotics trial aims to determine whether the probiotic Lactobacillus reuteri DSM 17938 is effective in reducing crying in infants less than three months old (<13.0 weeks) with infant colic when compared to placebo.

Methods/Design

Design: Double-blind, placebo-controlled randomised trial in Melbourne, Australia. Participants: 160 breast and formula fed infants less than three months old who present either to clinical or community services and meet Wessel’s criteria of crying and/or fussing. Intervention: Oral once-daily Lactobacillus reuteri (1x108 cfu) versus placebo for one month. Primary outcome: Infant crying/fussing time per 24 hours at one month. Secondary outcomes: i) number of episodes of infant crying/fussing per 24 hours and ii) infant sleep duration per 24 hours (at 7, 14, 21, 28 days and 6 months); iii) maternal mental health scores, iv) family functioning scores, v) parent quality adjusted life years scores, and vi) intervention cost-effectiveness (at one and six months); and vii) infant faecal microbiota diversity, viii) infant faecal calprotectin levels and ix) Eschericia coli load (at one month only). Analysis: Primary and secondary outcomes for the intervention versus control groups will be compared with t tests and non-parametric tests for continuous data and chi squared tests for dichotomous data. Regression models will be used to adjust for potential confounding factors. Intention-to-treat analysis will be applied.

Discussion

An effective, practical and acceptable intervention for infant colic would represent a major clinical advance. Because our trial includes breast and formula-fed babies, our results should generalise to most babies with colic. If cost-effective, the intervention’s simplicity is such that it could be widely taken up as a new standard of care in the primary and secondary care sectors.

Trial Registration

Current Controlled Trials ISRCTN95287767