Effects of a Mobile-Based Intervention for Parents of Children With Crying, Sleeping, and Feeding Problems: Randomized Controlled Trial

Abstract

Background Excessive crying, sleeping, and feeding problems in early childhood are major stressors that can result in parents feeling socially isolated and having low self-efficacy. Affected children are a risk group for being maltreated and developing emotional and behavioral problems. Thus, the development of an innovative and interactive psychoeducational app for parents of children with crying, sleeping, and feeding problems may provide low-threshold access to scientifically based information and reduce negative outcomes in parents and children. Objective We aimed to investigate whether following the use of a newly developed psychoeducational app, the parents of children with crying, sleeping, or feeding problems experienced less parenting stress; gained more knowledge about crying, sleeping, and feeding problems; and perceived themselves as more self-effective and as better socially supported and whether their children’s symptoms decreased more than those of the parents who did not use the app. Methods Our clinical sample consisted of 136 parents of children (aged 0-24 months) who contacted a cry baby outpatient clinic in Bavaria (Southern Germany) for an initial consultation. Using a randomized controlled design, families were randomly allocated to either an intervention group (IG; 73/136, 53.7%) or a waitlist control group (WCG; 63/136, 46.3%) during the usual waiting time until consultation. The IG was given a psychoeducational app that included evidence-based information via text and videos, a child behavior diary function, a parent chat forum and experience report, tips on relaxation, an emergency plan, and a regional directory of specialized counseling centers. Outcome variables were assessed using validated questionnaires at baseline test and posttest. Both groups were compared at posttest regarding changes in parenting stress (primary outcome) and secondary outcomes, namely knowledge about crying, sleeping, and feeding problems; perceived self-efficacy; perceived social support; and child symptoms. Results The mean individual study duration was 23.41 (SD 10.42) days. The IG reported significantly lower levels of parenting stress (mean 83.18, SD 19.94) after app use compared with the WCG (mean 87.46, SD 16.67; P=.03; Cohen d=0.23). Furthermore, parents in the IG reported a higher level of knowledge about crying, sleeping, and feeding (mean 62.91, SD 4.30) than those in the WCG (mean 61.15, SD 4.46; P<.001; Cohen d=0.38). No differences at posttest were found between groups in terms of parental efficacy (P=.34; Cohen d=0.05), perceived social support (P=.66; Cohen d=0.04), and child symptoms (P=.35; Cohen d=0.10). Conclusions This study provides initial evidence of the efficacy of a psychoeducational app for parents with child crying, sleeping, and feeding problems. By reducing parental stress and increasing knowledge of children’s symptoms, the app has the potential to serve as an effective secondary preventive measure. Additional large-scale studies are needed to investigate long-term benefits. Trial Registration German Clinical Trials Register DRKS00019001; https://drks.de/search/en/trial/DRKS00019001

Mind-mindedness in mothers of infants with excessive crying/sleeping/eating disorders

“…Theoretical models argue that persistent RPs or clinically relevant disorders such as sleep onset or night waking disorder or excessive crying disorder (24) are best described and understood in a relational context: They are frequently embedded in a family system with high psychosocial stress and problems in the parent-child relationship/interaction (2). Indeed, studies showed that having an infant suffering from RPs puts parents under enormous stress (9,25). Moreover, parents of infants with RPs report lower levels of self-efficacy, more social isolation (2,26,27) and more symptoms of depression and anxiety (28, 29).…”

“…Also, infants with RPs tend to show more difficult temperamental features, such as fussiness (66) and negative emotionality (28). Moreover, it is well known that high stress, which is common in parents of infants with RPs (2,25), is likely to lead to a break-down of mentalizing abilities (67). Caregivers of infants with RPs might also be inconsistently attuned to infants, comparable to caregivers of children with a resistant attachment style (41).…”