Discrete responses of adult subjects during exposure to infant cry sequences

Wiedenmann, Gottfried; Todt, Dietmar

doi:10.1080/0300443900650120

Cited by 15 publications

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“…Other studies into the relation between crying and pain did not consider the various levels of pain, and some analyzed very few neonates (38,39) or only the first few seconds of crying (5,40,41). The present study endeavored to cover all these aspects: we studied only full-term babies, as previous studies showed that crying features change with postconceptual age (37).…”

Section: Discussionmentioning

confidence: 99%

Cry Features Reflect Pain Intensity in Term Newborns: An Alarm Threshold

et al. 2004

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The purpose of this study was to assess differences in sound spectra of crying of term newborns in relation to different pain levels. Fifty-seven consecutively born neonates were evaluated during heel-prick performed with different analgesic techniques.Crying was recorded and frequency spectrograms analyzed. A pain score on the DAN (Douleur Aiguë du Nouveau-né) scale was assigned to each baby after the sampling. Three features were considered and correlated with the corresponding DAN scores: 1) whole spectral form; 2) the fundamental frequency of the first cry emitted (F 0 ); and 3) root mean square sound pressure normalized to its maximum. After emission of the first cry, babies with DAN scores Ͼ8, but not with DAN scores Յ8 (p Ͻ 0.001), showed a pattern ("siren cry") characterized by a sequence of almost identical cries with a period on the order of 1 s. A statistically significant correlation was found between root mean square (r 2 ϭ 89%, p Ͻ 0.01), F 0 (r 2 ϭ 32%, p Ͻ 0.05), siren cry (r 2 ϭ 68.2%, p ϭ 0.02), and DAN score. F 0 did not show significant correlation with DAN score in the subset of neonates with DAN scores Յ8 (r 2 ϭ 1.4%, p ϭ 0.94), and babies with a DAN score Ͼ8 had a significantly higher F 0 than those with lower DAN scores (p ϭ 0.016). An alarm threshold exists between high (Ͼ8) and low (Յ8) DAN scores: crying has different features in these two groups. When pain exceeds a DAN score of 8, usually a first cry at a high pitch is emitted, followed by the siren cry, with a sound level maintained near its maximum. Crying is simultaneously a sign, symptom, and signal (1). It is the infant's earliest form of communication, but the significance and meaning of neonatal crying are still unclear (2) because different crying features do not reflect different causes (e.g. hunger, pain, and fussiness) (3), but different degrees of distress (4 -6), so that gradations of crying may help a listener to narrow down the range of possible causes, but only with the help of contextual information (4, 6 -9). In the last few years, pain scales have been developed to discriminate levels of pain suffered by newborns (10 -15), but when analyzing crying, the level of the pain that provoked it is rarely considered (16). The aim of this study was to investigate to what extent crying features vary with the level of pain. To achieve this goal, we studied cry frequency spectrograms at different pain levels expressed by a validated pain scale. METHODS SubjectsThis report is based on analysis of a cohort of 57 newborns extrapolated from a previous study (17) consisting of 120 healthy term infants who underwent heel-prick for neonatal screening. Inclusion criteria were Apgar score at least 9 at 5 min, gestational age 38 -41 wk, age more than 48 h, and more than 2 h since last meal. During heel-prick, different analgesic procedures were used, namely SS, SS without oral sugar, oral sugar, sucking, and oral sugar plus sucking. These analgesic procedures were chosen to assess whether SS, a multisensorial stimulation consisting of m...

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Section: Discussionmentioning

confidence: 99%

Cry Features Reflect Pain Intensity in Term Newborns: An Alarm Threshold

et al. 2004

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“…First, acoustic properties related to affective and infant care responses were variable and often not replicated, although fundamental frequency, cry duration, dysphonation, and pauses received the most attention (105,106,(108)(109)(110)(111)(112)(113). Second, almost all studies used single cries; brief segments (10-15 s), or, at most (rarely), 4 min (106,(112)(113)(114)(115) of crying, such that responses were based on short segments taken out of context (106,116). Third, only one study (113) related continuous acoustic changes in spontaneous crying to concurrent adult ratings of infant distress (for 4 min).…”

Section: Crying As the Stimulus For Aht/sbs And Infant Physical Abusementioning

confidence: 99%

Preventing abusive head trauma resulting from a failure of normal interaction between infants and their caregivers

Barr

2012

Proc. Natl. Acad. Sci. U.S.A.

100

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Head trauma from abuse, including shaken baby syndrome, is a devastating and potentially lethal form of infant physical abuse first recognized in the early 1970s. What has been less recognized is the role of the early increase in crying in otherwise normal infants in the first few months of life as a trigger for the abuse. In part, this is because infant crying, especially prolonged unsoothable crying, has been interpreted clinically as something wrong with the infant, the infant's caregiver, or the interactions between them. Here, we review an alternative developmental interpretation, namely, that the early increase in crying is a typical behavioral development in normal infants and usually does not reflect anything wrong or abnormal. We also review evidence indicating that this normal crying pattern is the most common trigger for abusive head trauma (AHT). Together, these findings point to a conceptualization of AHT as the consequence of a failure in an otherwise common, iterative, and developmentally normal infant-caregiver interaction. They also imply that there is a window of opportunity for prevention of AHT, and potentially other forms of infant abuse, through a public health primary universal prevention strategy aimed at changing knowledge and behaviors of caregivers and society in general concerning normal development of infants and the significance of early increased infant crying. If effective, there may be important implications for prevention of infant abuse nationally and internationally.infant development | colic | excessive crying | child maltreatment | parenting A busive head trauma (AHT), also known more commonly as shaken baby syndrome (SBS), is a devastating and potentially lethal form of infant physical abuse (1). The outcomes are grim. In recognized cases, AHT typically results in death or extremely damaging injuries. About 18-25% of babies who are shaken and hospitalized die (2-7). As many as 80% of survivors have significant lifelong brain injuries (3,8,9). Although currently under study, there are no published estimates of lifetime costs per victim specific to AHT. However, the conservative estimated lifetime costs per victim is $210,012 for nonfatal child maltreatment or $1,272,900 for a death from child maltreatment (in 2010 dollars) for a total estimated economic burdern in the US for one year of $124 billion (10). Given its relative severity compared to other forms of maltreatment, these per victim estimates are likely to underestimate the lifetime costs for AHT victims. Of course, the "costs" go far beyond financial considerations, and include the destruction of families and the failure of society's moral obligation to protect defenseless infants.Preventing child maltreatment of any kind is challenging (11) because of the lack of specific stimuli for abuse, the density and difficulties of modifying risk factors in which families of maltreated children are often embedded, and the challenges of getting appropriate supports to the families. However, the convergence of our increasing un...

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“…In light of the fact that naturalistic studies are often conducted in samples that vary little in terms of demography (e.g., a middle-class sample of primaparous women in Ainsworth's initial study), differences in response patterns to crying must be due, at least in part, to other individual differences among parents. Further, the short samples of crying employed in most playback experiments have not allowed researchers to explore the timing of intervention (although see Wiedenmann & Todt, 1990, for an exception), considered by many clinicians to be an important component of sensitive response (Bell & Ainsworth, 1972). By relating personality traits to responses to uniform infant distress stimuli, including the timing of intervention in response to a continuous cry sample presented in real time, this study contributes to our understanding of variations in adult responses to infant distress.…”

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confidence: 99%

Predicting adult responses to infant distress: Adult characteristics associated with perceptions, emotional reactions, and timing of intervention

Zeifman

2003

Infant Mental Health Journal

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This study examined adult characteristics associated with different responses to infant distress. One hundred eighty-eight parents viewed four 20-second segments of videotape in which a 4-weekold infant was either (a) fussing mildly, (b) fussing vigorously, (c) crying, or (d) crying vigorously. Participants rated their emotional reactions and perception of cry characteristics following each segment. Participants then viewed a 4-minute videotape depicting the same infant progressing from calm to vigorous crying, and indicated when they would intervene to pick up the infant. Relatively high levels of empathy and extraversion and low levels of conscientiousness were associated with more sensitive responses to infant distress. Infant-rearing attitudes had a strong impact on response patterns as well, suggesting that education may be an effective means of increasing parental sensitivity.RESUMEN: Este estudio examinó las características adultas asociadas con diferentes respuestas a la angustia infantil. Ciento ochentayocho padres/madres vieron cuatro segmentos de vídeo de 20 segundos, en los cuales un infante de 4 semanas de nacido estaba (1) alborotando suavemente, o (2) alborotando fuertemente, o (3) llorando, o bien (4) llorando fuertemente. Los participantes evaluaron sus reacciones emocionales y sus percepciones de las características del llanto a continuación de cada segmento. Los participantes entonces vieron un vídeo de cuatro minutos que presentaba al mismo infante en forma progresiva desde el estado de calma hasta llegar al llanto fuerte, e indicaron cuándo ellos intervendrían para alzar en brazos al infante. Relativamente, los altos niveles de empatía y extroversión, y los bajos niveles de escrupulosidad, fueron asociados con respuestas más sensibles a la angustia del infante. Las actitudes de crianza de infantes también tuvieron un fuerte impacto en las respuestas de los padres, lo cual sugiere que la educación pudiera ser un medio efectivo de incrementar la sensibilidad de los padres.RÉ SUMÉ : Cette étude a examiné les caractéristiques adultes associées à différentes réactions à la détresse des nourrissons. Cent quatre-vingt huit parents ont visionné quatre segments vidéo de vingt secondes dans lesquels un nourrisson de quatre semaines (1) s'agitait modérément, ou (2)

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Discrete responses of adult subjects during exposure to infant cry sequences

Cited by 15 publications

References 15 publications

Cry Features Reflect Pain Intensity in Term Newborns: An Alarm Threshold

Cry Features Reflect Pain Intensity in Term Newborns: An Alarm Threshold

Preventing abusive head trauma resulting from a failure of normal interaction between infants and their caregivers

Predicting adult responses to infant distress: Adult characteristics associated with perceptions, emotional reactions, and timing of intervention

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