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The unsettled baby: crying out for an integrated, multidisciplinary primary care approach
Author(s) -
Douglas Pamela S,
Hiscock Harriet
Publication year - 2010
Publication title -
medical journal of australia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 131
eISSN - 1326-5377
pISSN - 0025-729X
DOI - 10.5694/j.1326-5377.2010.tb04039.x
Subject(s) - crying , medicine , breastfeeding , population , pediatrics , anxiety , disease , depression (economics) , intensive care medicine , poor feeding , psychiatry , environmental health , economics , macroeconomics
Abstract Unsettled behaviour in the first few months of life is a common clinical problem, with the associated risks of postnatal depression, premature cessation of breastfeeding, long‐term psychological disturbance, and child abuse. Parents of new babies complain of difficulty accessing appropriate care and receiving conflicting advice. Although organic disturbance is implicated in only 5% of cases, gastro‐oesophageal reflux disease, food allergies and lactose intolerance are often mistakenly diagnosed in unsettled babies. There is no evidence that acid‐suppressive medications help in treating unsettled behaviour and, until the hypothesis that proton‐pump inhibitors may predispose to food allergies has been properly investigated, treatment with acid‐suppressive medications should be avoided in this population. Although unsettled behaviour in infants is commonly a transient neurodevelopmental phenomenon that peaks at 6 weeks of age, failure to diagnose other correctable problems, including breastfeeding difficulty and cows milk allergy, risks entrenching anxiety and disrupted mother–infant interactions in the long term. In the current climate of health system reform, the design and evaluation of an integrated, evidence‐based, multidisciplinary primary care approach to management of unsettled babies and their mothers is a priority.