Around 15 to 25 percent of all infants show abnormal behavior in the first months and years of life. These include excessive crying or restlessness. These are known as regulatory disorders.
An infant with regulatory disorders cannot regulate their behavior appropriately. This can lead to extraordinary stress for the caregivers.
Common situations in which regulatory disorders manifest themselves include
- Crying
- sleeping
- Feeding
- Talking and playing
- brief separation
- Setting limits
The child is then unable to calm himself down sufficiently.
After birth, an infant gradually breaks away from the initial symbiotic relationship with the mother. It begins to develop an increasingly independent regulation of physical, emotional and social functions. In the process, the infant adapts its behavior to the existing environmental conditions.
One speaks of "developmental tasks" that the child has to solve. For example, it learns to crawl, walk and speak at certain ages. The developmental tasks also include
- adapting the sleep-wake rhythm to day and night,
- food intake and digestion,
- immune defense, and
- the ability to self-soothe.
The child therefore learns to regulate itself in various areas of development. Regulation of arousal and attention control are added later.
Towards the end of the first year of life, these are the areas of closeness-distance regulation and attachment-separation. In the second year of life, the child learns
- the regulation of dependence and autonomy and
- the acceptance of rules and boundaries.
Crises in the adaptation and development process of infants and toddlers
Short-term "crises" can occur as part of these above-mentioned adaptation and development processes. The child reacts with
- Displeasure and restlessness,
- crying or
- sleep disorders.
For the infant, crying is the elementary, natural means of expression and communication. Crying therefore does not always have anything to do with "distress" in need of care.
Such "crises" are transitional phases. The child uses them to initiate a further developmental step by means of adaptation and learning processes. They are therefore normal and temporary in nature, but can cause parents to worry about their child's well-being.
Every 5th family suffers from the crying behavior of their infant in the first months of life.
The three types of infant crying
Not all infant cries are the same. A distinction is therefore made between
- physiological crying due to physical and emotional needs, e.g. hunger, wet diaper, attention
- pathological crying due to organic causes, e.g. acute illnesses
- non-specific crying without a recognizable cause
Non-specific crying is based on the developmental processes described above. It occurs in almost all infants. The crying episodes begin in the 2nd week of life and reach their peak in the 6th week of life. They level off again by the 3rd month of life.
This difficult time used to be referred to as "three-month colic". This was based on the assumption that the reason for the crying fits was to be found in gastrointestinal disorders (e.g. cramps, flatulence).
However, studies have shown that digestive disorders are only rarely the cause of crying spells. In most cases, unspecific crying can be seen as an expression of physiological arousal.
Synchronization with the caregiver
Infants and toddlers can only regulate their behavior in direct exchange with their caregiver. A constant, secure "counterpart" is the prerequisite for regulating tension or developing an appropriate sleep rhythm, for example.
The infant needs permanent synchronization with its caregiver in order to develop an appropriate sleep rhythm via
- Eye contact,
- affective resonance,
- physical contact,
- care and
- rhythm
to find their inner balance.
Ideally, the caregiver will be able to respond appropriately to the infant's phase-related restlessness and crying fits. This creates a positive feedback loop:
Crying of the infant -> care and nurturing behavior of the caregiver -> the child calms down -> the caregiver also calms down and the parental sense of competence is strengthened.
This sense of competence is important for the caregiver in the long term for coping with further crisis situations. As a result, they gain the feeling that they understand the child better and better and feel more confident in dealing with the child.
Causes of non-functioning synchronization with the caregiver
Minor disruptions to this interaction with the caregiver can tip the infant's inner balance. This can lead to massive behavioral problems.
Psychosocial stress often plays a significant role here, putting the caregiver under stress:
- Stress before and during pregnancy
- Difficult circumstances of the birth
- relationship problems
- own psychological problems
- Problems in the wider family environment
- Everyday stress, restlessness and hectic pace
Excessive crying can be an expression of a regulatory disorder © Ilka Burckhardt | AdobeStock
The infant appears overexcited, fussy and restless. The crying attacks occur in fits and starts for no apparent reason. The infant can hardly regulate itself. This is referred to as "insatiable crying", as even the caregiver's attempts to calm the baby down are unsuccessful. Children who cry excessively are also known as cry babies.
The main symptoms of excessive crying are
- sudden restlessness and episodes of crying
- lack of response to soothing aids
- short daytime sleep times with pronounced problems falling asleep
- Reduced total sleep
- Frequent occurrence in the evening hours
- Possibly distended abdomen, bright red skin coloration, hypertonia of the muscles
The rule of thumb for excessive crying is the so-called rule of three: an average duration of crying/restlessness of
- more than 3 hours a day
- at least 3 days a week
- for at least 3 weeks
The mutual regulatory coordination described above no longer works. The parents lack a sense of competence in dealing with the child and can no longer safely classify the crying. They try all kinds of calming attempts until they themselves are on the verge of exhaustion.
As a result, parents come under increasing pressure: the constant failure of attempts to calm them down leads to helplessness and powerlessness, but also anger and aggression. "I did everything for him," reports one mother, "but all he did was scream - I could no longer understand my child!"
This leads to further problems. The caregiver has the feeling that they no longer have access to their child. This can give them the feeling that the child's behavior is directed against them: As rejection, defense and deliberate annoyance.
The experienced helplessness and feelings of failure can turn into anger and aggression towards the child. Excessive crying is therefore a frequent trigger for child abuse, such as
- Shaking,
- hitting or
- neglect.
The problem can spread relatively quickly to other regulatory areas. Disruptions to the sleep-wake rhythm and feeding problems then occur. In the long term, this can mean that there is hardly any relaxed interaction in everyday family life.
A vicious circle develops that leads to extreme psychological stress on both sides and ultimately to exhaustion. The relationship between parents and child changes negatively, as the parents hardly experience any positive interactions with their child. They themselves almost inevitably fall into an overload syndrome caused by
- lack of sleep,
- stress caused by the child's crying,
- feelings of failure
- powerlessness,
- aggressive impulses towards the child and
- depression
is characterized.
Early childhood regulatory disorders are extremely complex. This is why the doctor takes the family constellation and all family stress factors into account when making a diagnosis. To do this, he takes a detailed medical history, i.e. he talks to the caregivers and asks for details about the symptoms.
The first step is to rule out organic factors, such as
Further anamnesis relates to the identification of associated factors:
- Child-related factors
- Interaction and relationship factors
- Parent-related factors
This is recorded as part of the medical history. For a more differentiated diagnosis of the problem, behavioral observations in the relevant contexts on site or via
- video documentation,
- protocols and
- diary records of the parents and
the use of standardized questionnaires and scales if necessary.
Child-related factors:
- Onset, duration and development of the problem
- Contexts in which the disorder occurs
- Biological and psychosocial stress and resources
Interaction and relationship factors:
- Daily structure and family framework conditions
- Type and manner of care for the child
- problematic, but also well-functioning interactive areas
- The child's relationships with other people (grandparents, siblings, etc.)
- Parental attitudes and feelings towards the child
- Parental explanatory models for the child's behavior
Parent-related factors:
- subjective experience of stress
- Biological and psychosocial stress and resources
- own childhood experiences and traumatization
Couple and family-related factors:
- Organization of the parental partnership
- Coping with the transition to parenthood
- Quality of the relationship between parents and their parents
Parents are often uncomfortable admitting to themselves or others that they cannot cope with their child at the moment. They therefore try to manage everything on their own - which is likely to reinforce the vicious circle processes described above. Parents should seek help especially when they feel a loss of competence and powerlessness.
The regulatory disorder cannot simply be attributed to educational, emotional or moral failure. Numerous factors must be considered in order to
- identify the exact causes and triggers of the crying,
- as well as to recommend a solution to the situation.
Professional help often brings significant relief and improvement to the problem within a short time.
The pediatrician is the first point of contact for parents. He clarifies the physical condition of the child and, as a first step, the psychosocial background to the disorder. They can then provide advice or refer the child to further treatment options.
Outpatient counseling and therapy for regulatory disorders
Outpatient counseling and therapy (e.g. in so-called "crying outpatient clinics") takes place via regular parent-teacher conferences. This is supplemented by interaction-centered sessions with the child. These include observation as well as behavioral exercises for the parents with the child in play and challenge situations. Video recordings made by the parents at home can also be analyzed.
As part of the therapy, parents receive practical tips and rules of conduct.
Depending on requirements, the sessions are
- in shorter intervals as crisis intervention or
- at regular intervals for supportive guidance.
The aims of the treatment are
- to improve the regulation problem,
- to relieve the parents and
- the (re)establishment of a positive parent-child relationship.
Partial inpatient therapy for regulatory disorders
Partial inpatient therapy also includes the caregiver. It is appropriate if the parents are no longer able to implement the agreements and rules of conduct made at home.
Experts support the parents directly in dealing with the relevant disorder-specific situation. In this way, misperceptions can be reduced and safe, appropriate ways of dealing with difficult situations can be developed.
Inpatient parent-child therapy for regulatory disorders
In severe cases, the caregiver-child system can be so disturbed that the physical and emotional well-being of the child is threatened. Those affected should then consider full inpatient parent-child therapy.
Such psychosomatic inpatient complex therapy is also necessary if
- lack of success of outpatient counseling and
- massive exhaustion of the caregiver as a result of the perception of powerlessness.
Full inpatient therapy completely removes the caregiver from the home environment. This offers the best chance of breaking the vicious circle of regulatory disorders and the perception of powerlessness as quickly as possible.
In the clinic, the parents can be relieved in the short term through intensive nursing and therapeutic care. As a rule, the child also quickly settles into an age-appropriate rhythm under structured, relaxed conditions. As a result, the seizure-like crying fits and emotional outbursts subside.
In the further course of therapy, relevant situations from the everyday context are discussed and new behavioral patterns are practiced. The caregiver' s sense of competence is gradually reinforced. The positive mutual feedback enables her to deal with the child independently and safely again.
One mother reports: "I feel like I have a connection with my child again. I can now classify his behavior again".
As part of the inpatient complex therapy
- Behavioral medicine,
- developmental psychology,
- systemic,
- attachment theory and
- psychodynamic aspects
are given equal consideration.
At the same time, various situations are treated therapeutically, such as
- Feeding disorders,
- sleep disorders,
- restlessness,
- separation anxiety etc.
Inpatient complex therapy and contact with a team experienced in dealing with these disorders has the best effects.
