Regulatory disorders in infancy

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Classification according to ICD-10
F98.2 Feeding disorder in early childhood
F93.8 Other childhood emotional disorders
F43.2 Adjustment disorder
F51.9 Unspecified inorganic sleep disorder
ICD-10 online (WHO version 2019)

A regulatory disorder in infancy (formerly sometimes also called three-month colic) describes the extraordinary difficulty of an infant in adequately regulating its behavior in one, but often in several, interactive and regulatory contexts (self-soothing, screaming , sleeping , feeding, paying attention ).

Infants and young children are only able to regulate their behavior in interaction , i. In other words, they can only do this in direct exchange with their parents. For this reason, regulatory disorders are often found together with stress or disorders in early parent-child relationships .

Prevalence

The occurrence of early regulatory disorders is sometimes assessed quite differently. In the case of excessive crying , this is between 16 and 29% in the first three months. In 8.3% of these infants, crying persisted beyond the third month of life.

The criteria for a sleep disorder have not been uniformly defined. But if one assumes waking up at least three times per night for at least five nights per week for at least three months, the prevalence is around 15-20%

Serious persistent feeding problems were found in 3 to 10% of the cases. Light to medium problems in 15-20%. In addition, failure to thrive could be found in 3 - 4% of the cases.

causes

Screaming infant

The early mother-child relationship consists of complex non-verbal communication, which is mainly based on eye contact, sounds and touches of both interaction partners, i.e. the infant and his caregiver . One of the purposes of this social interaction is that the infant can regulate itself, its behavior and its affects . The infant is dependent on the intuitive, co-regulatory support of their caregivers. Even comparatively minor disturbances in this interaction can have a major impact on the development of the infant. If this interaction fails and the infant cannot be reassured, the parents often experience helplessness, powerlessness, frustration , anger, fear of rejection, depression, aggression, etc. In this context, unfavorable psychosocial factors often increase the level of suffering on the part of the parents. A vicious circle arises because the intuitive skills of the parents are even less effective. This can be aggravated by an unfavorable temperament in the children.

It has been shown that negative psychosocial factors on the mother's side, coupled with socio-economic stress factors, increase the risk of developing a regulatory disorder. Frequent psychosocial stresses include: a. specified:

  • pre- and postnatal stress
  • severe pregnancy and / or childbirth,
  • Couple conflicts,
  • Conflicts in and with the family of origin and
  • mental illness

diagnosis

Guiding symptoms

Excessive screaming

  • Acute, insatiable episodes of screaming or restlessness without an identifiable cause,
  • Failure to respond to appropriate tranquilizers
  • Short daytime sleep phases (usually <30 minutes) with pronounced problems falling asleep,
  • Increased occurrence in the evening hours with cumulative overstimulation / fatigue in the evening,
  • Possibly. distended abdomen, bright red skin and hypertension of the muscles (clinical syndrome of so-called "infant colic").

Here one can adhere to the so-called rule of three from Wessel et al. (1954): average screaming / restless duration of more than 3 hours per day on an average of at least 3 days a week for at least 3 weeks.

sleep disorders

  • Problems falling asleep with protracted (= delayed) sleep duration
  • Falling asleep in the evening / at night only with parental sleep and regulation aids
  • Repeated waking up at night with phases of screaming and restlessness
  • Sleep in the parents' bed if this is perceived by the parents as disturbing
  • Phase shift in the circadian distribution of the sleep-wake phases

Feeding disorder

  • Refusal to eat with or without fear-tinged defense
  • Rumination / vomiting
  • Eating behavior perceived as provocative by parents
  • Eating behavior that is grossly inappropriate for age
  • Bizarre eating habits regarding the type and number of foods accepted
  • Age-inappropriate context of feeding (e.g. with regard to feeding position, feeding time)
  • Chewing, sucking and swallowing problems.

Diagnostic survey

Diagnosis is primarily made by observing the interaction between the infant and its mother. A physical illness must be excluded. An attempt is made to identify problematic situations in the daily routine by taking a careful anamnesis or diaries, for example about the distribution of screaming or the food intake.

Further necessary steps are:

  • Pediatric developmental neurological / psychological anamnesis to assess a possible developmental retardation,
  • Survey of the behavioral development of the infant in the context of the development of parent-child relationships,
  • Qualitative assessment of the parental couple relationship including coping with the transition to parenthood,
  • Recording of biological and psychosocial stresses on the child and parents,
  • Assessment of parental previous experience with phases of crying and restlessness in one's own childhood / previous history,
  • In the case of sleep disorders, also: family sleeping habits, bedtime rituals,
  • In addition, in the case of feeding disorders: nutritional / breastfeeding history.

The psychosocial accompanying circumstances of the parents must also be recorded in order to be able to offer help with possible stress.

Exclusion diagnoses, i.e. other diagnoses for which no regulatory disorder should be diagnosed, are:

Excessive screaming:

  • Organic brain damage, which is associated with a resulting increased tendency to cry and restless in the infant.
  • Child abuse as a cause of excessive crying.

For sleep disorders:

  • Sleep apnea syndrome
  • Organic brain disorders (e.g. cerebral seizures) that can be associated with a disruption in sleep-wake regulation, provided that the sleep disorder is clearly causally related to this disorder.

classification

The existing diagnostic manuals, especially the ICD-10 and the DSM-IV, are not based on the current state of research. For this reason, the regulatory disorders cannot be correctly classified. In most cases, diagnoses are available for the corresponding disorders that are not geared towards the disruption of the parent-child relationship.

Comes from the English-speaking world, the diagnostic manual " Zero-to-Three " of the National Center for Infants , which in German as " Diagnostic Classification 0 - 3. Mental health and developmental disorders in infants and young children " is available. A multi-axis assessment, i.e. the assessment of the disease on several levels, is possible here. The different axes are:

  1. Primary classification of the child's clinical disorder
  2. Classification of the parent-child relationship
  3. Medical-neurological disorders and developmental disorders (according to ICD-10)
  4. Psychosocial stress factors
  5. Emotional and social functional level

The fundamental fault is recorded and named on the first axis. On the second axis, the parent-child relationship is assessed and is classified, for example, as anxious, tense or overly involved or the like. On the third axis, medical disorders are assessed in the same way as the ICD-10. The fourth axis evaluates the stress on the caregiver and the last axis briefly describes the emotional and social functional level.

Comorbidity

The comorbidity referred to the frequent occurrence of a failure in connection with one or more other. Regulatory disorders in infancy occur more frequently with:

However, most parents do not have any mental health problems and do not require treatment on their own.

treatment

Various forms of parent-child counseling / psychotherapy are successful . These mostly focus on the interaction and / or the parents' ideas about the child and usually only require a few sessions. In severe cases, especially if the parents themselves have psychopathology , such as severe postnatal depression , the parents are very exhausted, the mother does not experience any relief from her partner or particularly stressful psychosocial circumstances, an inpatient parent-child Psychotherapy should be indicated. Video-based counseling and psychotherapy approaches are also recommended.

In order to receive help, affected parents can go to one of the “ crying clinics ” available in many cities . These are often attached to socio-pediatric centers . Some child and youth psychotherapists or child and youth psychotherapists also offer appropriate advice and therapy. In the outpatient department of some clinics for child and adolescent psychiatry, advice for parents is offered, which is specifically geared towards disorders in the first three years of life.

If particularly stressful psychosocial circumstances prevail, family-relieving services such as child care or child care can also be used. A socio-educational family assistance can be helpful in stressful psychosocial situations.

An American review has tried to analyze all available studies with the treatment of drugs to determine which treatment of excessive crying, also known as three-month colic, is actually scientifically effective. Among the various drugs used, only dicyclomine , a substance from the group of anticholinergics , showed a measurable effect. However, it is not available in Germany and even in the USA and Canada is not approved for the decisive age group under six months due to isolated serious side effects. Simeticon preparations, which are also widespread in Germany, as well as scopolamine , which also belongs to the anticholinergics, were classified as ineffective .

Web links

literature

  • Mechthild Papoušek , Michael Schieche, Harald Wurmser: Regulatory Disorders of Early Childhood. Early risks and help in the developmental context of parent-child relationships. Verlag Hans Huber, Munich 2004, ISBN 3-456-84036-5 .

See also

Individual evidence

  1. ↑ a b c d e f g Dt. Ges. F. Child and adolescent psychiatry and psychotherapy etc. a. (Ed.): Guidelines for the diagnosis and therapy of mental disorders in infants, children and adolescents. 2nd, revised edition. Deutscher Ärzte Verlag, 2003, ISBN 3-7691-0421-8 .
  2. ^ Ian St James-Roberts, Tony Halil (1991): Infant Crying Patterns in the First Year: Normal Community and Clinical Findings. In: Journal of Child Psychology and Psychiatry. 1991, 32 (6), pp. 951-968.
  3. ↑ L. Lehtonen, T. Korhonen, HJ Korvenranta: Temperament and sleeping patterns in colicky infants during the first year of life. In: J Dev Behav Pediatr. 1994 Dec; 15 (6), pp. 416-420.
  4. ↑ M. Ziegler, R. Wollwerth de Chuquisengo, M. Papoušek: baby colic. In: M. Papoušek, M. Schieche, H. Wurmser (eds.): Regulatory disorders in early childhood. Early risks and help in the developmental context of parent-child relationships. Huber, Bern 2004, pp. 111-143.
  5. ↑ M. Schieche, C. Rupprecht, M. Papoušek: Sleep disorders: current results and clinical experience. In: M. Papoušek, M. Schieche, H. Wurmser (eds.): Regulatory disorders in early childhood. Early risks and help in the developmental context of parent-child relationships. Huber, Bern 2004, pp. 145–170.
  6. ↑ N. von Hofacker, M. Papoušek, H. Wurmser: Feeding disorders and failure to thrive in infants and toddlers. In: M. Papoušek, M. Schieche, H. Wurmser (eds.): Regulatory disorders in early childhood. Early risks and help in the developmental context of parent-child relationships. Huber, Bern 2004, pp. 171–199.
  7. ↑ Martin Dornes: The competent infant. The preverbal development of man. Fischer, Frankfurt am Main 1993.
  8. ↑ medicine.uni-tuebingen.de
  9. ↑ a b Martin Dornes : The emotional world of the child. Fischer, Frankfurt am Main 2000.
  10. ↑ Guideline of the German Society for Social Pediatrics and Adolescent Medicine eV. (DGSPJ) Quality Circle Physiotherapy for cerebral motor disorders in social paediatrics
  11. ↑ Nina Sandleben: Regulatory disorders in early childhood . GRIN Verlag, 2006, ISBN 3-638-53953-9 ( Google Books ).
  12. ↑ Diagnostic classification: 0 - 3. Mental health and developmental disorders in infants and young children. Springer, Vienna 1999.
  13. ↑ M. Garrison, D. Christakis: A Systematic Review of Treatments for Infant Colic. In: Pediatrics. 2000, 106, pp. 184–190 full text online (English) ( Memento from January 1, 2009 in the Internet Archive )