Parental responses to infant crying and colic: the effect on breastfeeding duration.

CONTEXT: Infant crying can cause parental distress, and colic is associated with low maternal self-efficacy and heightened risk for depression. Breastfeeding is recognized as an effective method of calming infants, but the relationship of colic and the use of breastfeeding to remedy infant crying have not been tested for any effects on breastfeeding duration.
OBJECTIVE: To evaluate the effects of infant colic (colic analysis) and breastfeeding as a method of infant calming (calming analysis) on breastfeeding duration.
DESIGN: The authors followed 700 healthy breastfeeding mother-baby dyads from birth to 1 year. Maternal interviews were conducted postpartum, and at 2, 5, 10, 16, 24, 38, and 52 weeks to ascertain demographic factors, infant crying patterns, comforting practices, physician-diagnosed colic, and breastfeeding behaviors. Cox survival analyses were used to evaluate the independent effects of: (a) physician diagnosed colic; and (b) breastfeeding as a comforting practice on breastfeeding duration. Data from all 700 breastfeeding dyads were used in the colic analyses. In the calming analyses, to assure that breastfeeding was appropriately established, data were used from the 617 couplets that had breastfed for at least 2 weeks. Using a stepwise process, models, adjusted for typical predictors of breastfeeding duration, were developed for exclusive, full and partial breastfeeding duration. Variables of interest (i.e., colic diagnosis, breastfeeding for comfort) were then forced into the baseline models to determine any independent effects.
RESULTS: In the first 16 weeks, parents found that holding (87%), breastfeeding (82%), walking (67%), and rocking (63%) were highly effective calming practices. Mothers who rated breastfeeding as highly effective had a higher frequency of breastfeeding at all contacts (p < 0.05). In adjusted analyses the use of breastfeeding to comfort infants was a significant predictor of longer partial (overall) ([hazard ratio] HR = 0.6, 95% CI 0.4 to 0.9; p = 0.02) but not exclusive or full breastfeeding duration. By 6 months, 44 mothers (6.3%) reported a diagnosis of colic. Mothers of infants with a diagnosis of colic were less likely to report breastfeeding as effective method of infant comforting (p = 0.03). In adjusted analyses the authors found that a diagnosis of colic predicted shorter full breastfeeding duration (HR = 2.4, 95% CI 1.4 to 4.2; p = 0.001) but not exclusive or partial duration.
CONCLUSIONS: Breastfeeding to comfort a crying infant is a strong predictor of partial (overall) duration and is rated as a highly effective calming method by parents. These data suggest that parents may benefit from education about normal infant crying patterns and effective methods of infant comforting, including breastfeeding. However, mothers of infants diagnosed with colic are at risk for shortened duration of full breastfeeding. Although the reasons for this are unclear, it may be helpful to specifically address the subject of colic and infant feeding and encourage mothers to fully breastfeed for the recommended 6 months.