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Crying and Feeding Problems in Infancy and Cognitive Outcome in Preschool Children Born at Risk: A Prospective Population Study

Wolke, Dieter PhD*; Schmid, Gabriele MSc; Schreier, Andrea PhD*; Meyer, Renate Dipl-Psych*

Journal of Developmental & Behavioral Pediatrics: June 2009 - Volume 30 - Issue 3 - p 226-238
doi: 10.1097/DBP.0b013e3181a85973
Original Article

Objective: To investigate whether regulatory problems, i.e., crying and feeding problems in infants older than 3 months of age, predict cognitive outcome in preschool children born at risk even when controlled for confounding factors.

Methods: A prospective longitudinal study of children born in a geographically defined area in Germany. N = 4427 children of 6705 eligible survivors (66%) participated at all 4 assessment points (neonatal, 5, 20, and 56 months of age). Excessive crying and feeding problems were assessed at 5 months. Mental development was measured with the Griffiths Scale at 20 months, and cognitive assessments were conducted at 56 months. Neonatal complications, neurological, and psychosocial factors were controlled as confounders in structural equation modeling and analyses of variance.

Results: One in 5 infants suffered from single crying or feeding problems, and 2% had multiple regulatory problems, i.e., combined crying and feeding problems at 5 months. In girls, regulatory problems were directly predictive of lower cognition at 56 months, even when controlled for confounders, whereas in boys, the influence on cognition at 56 months was mediated by delayed mental development at 20 months. Both in boys and girls, shortened gestational age, neonatal neurological complications, and poor parent–infant relationship were predictive of regulatory problems at 5 months and lower cognition at 56 months.

Conclusion: Excessive crying and feeding problems in infancy have a small but significant adverse effect on cognitive development.

From the *Department of Psychology and Health Sciences Research Institute, University of Warwick, Coventry, United Kingdom; †Department of Psychology, University of Basel, Basel, Switzerland.

Received August 2008; accepted April 2009.

The Bavarian Longitudinal Study was supported by grants PKE24 and JUG14 (01EP9504) from the German Ministry of Education and Science (BMBF). This specific work is part of the National Centre of Competence in Research (NCCR) Swiss Etiological Study of Adjustment and Mental Health (sesam). The Swiss National Science Foundation (SNF) (project no. 51A240-104890), the University of Basel, the F. Hoffmann-La Roche Corp. and the Freie Akademische Gesellschaft provide core support for the NCCR sesam.

Address for reprints: Dieter Wolke, PhD, Department of Psychology and Health Sciences Research Institute, The University of Warwick, Warwick Medical School, Coventry CV4 7AL, United Kingdom; e-mail:

© 2009 Lippincott Williams & Wilkins, Inc.