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Mums with unsettled babies seek emergency help

More focus needed to be placed on teaching new parents practical, evidence-based strategies to deal with unsettled behaviour, say researchers.

Mothers trying to cope with babies who cry persistently and wake frequently during the night are turning to hospital emergency departments for support.

A new study by the Jean Hailes Research Unit at Monash University with the University of Melbourne, found that mothers whose babies had unsettled behaviour were more likely to attend a hospital emergency department. Mothers (875 in total) were surveyed while attending immunisation clinics with their four month old babies; 23 per cent of these mums had been to an emergency department.

Since their baby's birth, around 36 per cent of parents had called a parenting telephone helpline for support, and 45 per cent of parents consulted specialised services including paediatricians and obstetricians.

"Unsettled infant behaviour is a significant problem for parents with young infants and it's usually not one that we are prepared for," said Professor Jane Fisher, the Jean Hailes professor of women's mental health at Monash University.

"Our fantasy is often that looking after a baby is not a difficult thing to do. But behaviours like persistent and inconsolable crying, difficulties settling to sleep, and frequent overnight waking can lead parents to feel helpless and desperate."

"The fact that parents are using emergency department services indicates how distressing their baby's behaviour is and when parents feel there is nothing they can do to stop their baby crying they seek emergency help. This suggests parents are being driven to this extreme because they don't really know where else to turn for help, or that help from local services has not been effective."

The study, published in the Journal of Paediatrics and Child Health, found parents with persistently waking and crying babies used multiple health services in the first four months after their baby's birth. Some mothers used up to eight different services. The study involved 875 women with four-month-old infants attending immunisation clinics in five local government areas in Melbourne.

The women completed a short self-report survey that included questions on which health services they used and about their baby's unsettled behaviour.

The study also included questions on maternal mental health. Importantly the research found while women with mental health problems were more frequent users of mental health services, their mental condition did not influence their use of emergency department services.

"It was a baby's unsettled behaviour - not the mother's mental health - that was the driver for women to go to an emergency department," Fisher said.

Dr Sonia McCallum, lead author and Research Fellow at the Jean Hailes Research Unit, says it's concerning that parents are turning to emergency departments.

"These families need to be supported by services such as early parenting services that offer specialised skills to manage unsettled behaviour," she said.

Fisher said the use of overburdened hospital emergency departments by parents with unsettled babies was an issue that needed serious consideration.

"Emergency departments can probably reassure a parent that their baby is well, but they are not equipped with the skills to train people in soothing and settling strategies," said Fisher.

"Emergency departments are highly skilled and therefore expensive services and having parents attend there for something best treated in the primary healthcare setting is probably not a good use of the health dollar either."

McCallum saids more focus needed to be placed on teaching new parents practical, evidence-based strategies to deal with unsettled behaviour. These include showing parents how to securely wrap a baby, recognising an infant's tired cues, and learning how to settle a baby into bed while they are awake.

"I think this education needs to be delivered within the first four to six weeks of a baby's birth. And it needs to be delivered in the first instance by maternal child health practitioners, those working in general practice settings, and paediatricians because these are the places families first go to with this problem," said McCallum.

"We need effective early interventions for families to teach them how to manage unsettled infant behaviour - so they are not having to go to hospital emergency departments."

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