4.1 FUSSY INFANT
Jane JE David, Mukesh Agrawal
Development of behavior in children is a complex process, influenced by inherent temperament as well as exogenous influences, e.g. family/social environment and organic brain disorders, e.g.
genetic or chromosomal disorders (Table 4.1). Consequently, all children, like all adults, have unique behavioral traits, usually within the acceptable limits of deviance. It is important to differentiate these benign aberrations from more serious behavioral or psychopathic disorders, which require detailed evaluation, expert referral and intensive management.The term quot;behavioral disordersquot; denote a spectrum of abnormal behavior patterns in children, ranging from transient, minor and essentially benign habit disorders to chronic and debilitating psychiatric illnesses. While termed as disorders, many of these problems in children are mere aberrations in normal behavior, which may disappear with age. Some important and common behavioral problems are discussed in this chapter.
TABLE 4.1: Determinants of child behavior
• Biologically inherent temperament, e.g.
- Easy vs. difficult (fussy) babies
• Organic causes:
- Chromosomal: e.g. Klinefelter or Fragile X chromosome
- Genetic: Phenylketonuria
- Organic brain injury
#9830; Prenatal: CNS anomalies, substance abuse
#9830; Perinatal: Birth asphyxia
#9830; Postnatal: Infections, epilepsy
- Physical/mental handicaps
• Environmental causes
- Family factors:
#9830; Parental personality, intelligence, education
#9830; Parent-child bonding (love, rejection, indifference)
#9830; Child-caring behavior: Overprotection/discipline
#9830; Inconsistent parental behavior (confusion)
- Extra-family factors:
#9830; Social/economic discrimination
#9830; Frequent change of schools/ residence
#9830; Stressful school environment
#9830; Peer-pressure
#9830; Effect of mass media, role models
• Learning and conditioning influences Fussy infant, while difficult to define, is an infant who tends to be more demanding or difficult to please. These babies are often irritable and inconsolable even for minor matters.
Each baby has a different temperament and occasional fussiness is not uncommon, which might be their way to express pain, discomfort or frustration. However, persistent fussiness might be an early sign of more serious underlying problem.
Thomas and Chess classified babies in terms of temperament as follows:
• Easy babies (40%) who adjust easily to new situations and quickly establish routines. These babies are generally cheerful and easy to calm.
• Difficult babies (10%), who are slow to adjust to new experiences and likely to react negatively and intensely to stimuli and events.
• Slow-to-warm-up babies (15%), who are somewhat difficult at first but become easier over time.
Temperament of each baby is inherently determined though can be modified to some extent by parents and child rearing practices.
Etiology: All infant may be occasionally fussy due to: (a) Physical discomfort, e.g. hunger, wet diapers or diaper rash, lack of sleep, unpleasant hot/cold or noisy environment, (b) Emotional stress or frustration, e.g. loneliness, separation from mother, stranger anxiety, or (c) Feeding difficulties, e.g. low milk output or nipple confusion often make baby irritable (Table 4.2).
However, persistent fussiness may be a warning signal of more serious underlying health problem and needs to be investigated further before labeling him/her as a fussy infant/child.
Management: Most infants are usually little fussy during early infancy (1-3 months) and no specific intervention is required except: (a) identification and removal of physical discomforts, e.g. hunger, wet diapers, unpleasant environment, etc; (b) exclusion of serious
TABLE 4.2: Causes of fussy infant