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Fussiness in infancy may predict future behavior problems, study finds

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By COURTNEY HUTCHISON
ABC News Medical Unit

"He would cry all the time. It was all about him. I couldn't shower, couldn't eat. I lost 15 pounds. I couldn't do anything. My baby was driving me crazy," one mother told workers at the Fussy Baby Network, a support center for parents of infants with crying and sleeping problems.

"Just doing the simplest things, it is just not possible," said another. "I could not get my baby and my dog out the door at the same time. I simply could not do it."

Most parents are familiar with the sleepless nights and the pull-your-hair-out frustration that can come with having a fussy baby. But there might be something more to worry about. Researchers from the U.K. have found that infants with persistent crying, sleeping and eating problems were more likely to have behavioral problems, such as attention deficit hyperactivity disorder, depression, anxiety and aggression, later on.

This doesn't mean that a fussy baby is doomed to a troubled life, only that the warning signs for later problems can appear in the first months of life, pediatricians say.

"I don't suggest that parents worry per se, but I do suggest that they pay very close attention to these important developmental tasks, and interrelational achievements, characteristic of the first year of life," says Dr. Rahil Briggs, director of New York's Montefiore Medical Center's parenting program, Healthy Steps.

"The next step," says says Dieter Wolke, a professor of developmental psychology at the University of Warwick and co-author of the study, "is understanding what is causing this link, [be it] parenting style, genetic predispositions, or some other factor ... and then understanding what kind of interventions might help address this issue before the infant reaches childhood."

Although many babies are fussy in the first few months of life, the cause is often colic, and the tempermental behavior goes away in a few months. Wolke and colleagues studied babies who continue to cry persistently , have disturbed sleep and difficulty feeding beyond these first months. About one in five infants will show signs of these types of behaviors and become easily upset or overstimulated, according to the study, which was published online Wednesday in the Archives of Disease in Childhood,

"It's not that the children cry more often. It's that they can't stop crying. They can't settle themselves. It's an undercontrol problem that makes it difficult for these infants to calm themselves," Wolke says.

Researchers analyzed 22 studies from 1987 to 2006 that looked at the link between this early "undercontrol" and later behavioral problems. They found that infant "control" problems were associated with a higher risk of depression, anxiety, aggression, and ADHD in children under age 9.

Aggression, temper tantrums and ADHD (called externalizing behaviors) were the most likely childhood outcomes among the children studied, and those infants with more than one regulatory problem (sleep problems and crying, for instance) were the most likely to have later behavioral problems.

Parenting a Fussy Child -- Interventions for a Less Fussy Future?

There are various factors influencing later behavioral problems, ranging from a genetic predisposition to parenting style to stress experienced while still in the womb. Exactly how these factors interact and play out during a child's development is not well understood, but researchers have noted that childhood environment, including parenting style, in combination with infant fussiness are powerful predictors of future problems.

"The vast majority of infants are born completely disregulated. They have no ability to self-soothe, they adhere to no schedule of sleep or elimination, and they must learn how to feed. The infant becomes regulated only via the infant-care giver relationship, and is therefore quite dependent on a reliable and empathic care giver," says Briggs.

The question becomes, how can caregivers parent in a way that enables children to learn good emotional and physical regulation skills?

What these children need is a great deal of structure, Wolke says: "They need predictable patterns for eating and sleeping. They need to be allowed to calm themselves or they will always depend on [the crutch] of being held or fed or whatever is used to soothe them."

Babies who are difficult to soothe often spur parents to resort to soothing "tricks," such as rides in the car, feeding the baby into submission, or constant holding. Though these techniques work in the short-term, the fussy infant never learns how to soothe themselves.

Parents shouldn't take a child's fussiness personally, but they should take a personal interest in learning special skills that will equip them to deal with their child's needs, says Judith Myers-Walls, professor emerita of child development and family studies at Purdue University.

"Having a child like that is not necessarily a result of anything the parents did or didn't do, [but] parents can always improve their responses to the child," she says.

Seeking the counsel of the child's pediatrician is also a wise move if a fussy baby remains difficult to soothe well into the first year of life.

"It takes more to adequately parent a child who presents behavior challenges. So the entire process can become a spiral downward when an infant is difficult to care for. It is critical for professionals to help families deal with these difficult situations in order to break the cycle," says Myers-Walls.

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