Supporting families with unsettled babies - development of a digital intervention

Abstract

Background Unsettled baby behaviours, such as crying and vomiting, are common but distressing for families. Unsettled behaviours are increasingly attributed to medical causes such as reflux or cows’ milk allergy. When inaccurate, this causes unnecessary harm to families and healthcare systems. Existing interventions to support parents managing unsettled babies are costly and often biased by conflicts of interest from the formula milk industry. Aims To co-design a person-, theory- and evidence-based behavioural intervention supporting families with unsettled babies. Method Qualitative interviews and the person-based approach (PBA) were combined with innovative methods including partnership working with underserved communities. Firstly, a systematic review and thematic synthesis explored parent experiences of unsettled babies, with an emphasis on parents’ thoughts and feelings about medical labels. An explanatory, conceptual model was proposed summarising parent experiences when faced with a baby they perceive as unsettled. Next, a qualitative interview study aimed to deepen understanding of parent attitudes to medical labels using an ethnically diverse sample of 25 mothers. Hybrid inductive & deductive analysis was used, including reflective thematic analysis, negative case analysis and framework analysis. Themes were presented and the conceptual model was refined. Finally, an intervention was developed using behaviour change theory and the PBA. This was optimised through qualitative ‘think-aloud’ interviews with 22 parents, analysed through thematic analysis and a table of changes. Findings Key findings from the systematic review and qualitative interviews offer a new insight into the thoughts, feelings and motivations of parents with unsettled babies. Findings suggest parents report a sense of guilt or failure, driving a search for an external, medical cause of unsettled behaviour. A novel intervention was developed. This aims to help parents distinguish normal baby behaviour from medical red flags; increase parent self-efficacy and give tools to self-manage unsettled behaviours. Discussion The results of this work are put in the context of wider literature on medically unexplained symptoms, the transition to parenthood, parenting self-efficacy and bonding. Limitations and strengths of the research, suggestions for future research and clinical practice are discussed. Conclusion The resulting intervention, if nested within a wider system of support, may provide help to families of unsettled babies, reducing unnecessary medicalisation