|Year : 2015 | Volume
| Issue : 3 | Page : 172-180
The effect of two different swinging methods upon colic and crying durations among the infants
Gamze Yilmaz1, Duygu Arikan2
1 Department of Child Health Nursing, Ağrı İbrahim Çeçen University, School of Nursing, Ağrı, Turkey
2 Department of Child Health Nursing, Health Sciences of Faculty, Atatürk University, Erzurum, Turkey
|Date of Web Publication||21-Sep-2015|
Department of Child Health Nursing, Health Sciences of Faculty, Atatürk University, Erzurum
Source of Support: None, Conflict of Interest: None
Context: Swinging "repetitive and rhythmic" movements are helpful because these provide a continuous stimulus. These methods are reported to be effective upon decreasing baby's pains or cry. Aim: The purpose of this study was to determine the factors of the two different methods (rhythmic rocking of infants in the arm and rhythmic rocking infants on a blanket) on crying duration and colic as well as the factors affecting duration of crying with colic. Materials and Methods: A pre-test post-test quasi experimental model was used. Subjects included 72 infants (1-3 months) who had colic and their mothers. The infants were healthy and were delivered after full-term gestation. Results: It has been determined that as the duration of application increased (at the end of the second week), the crying duration of babies who were in each of the two groups decreased. Conclusion: It has been found that swinging ( rhythmic rocking) the infants on a blanket and in arm, decreased the colic and crying duration of infants.
Keywords: Baby, colic, crying, nursing, rhythmic rocking, swinging
|How to cite this article:|
Yilmaz G, Arikan D. The effect of two different swinging methods upon colic and crying durations among the infants. Indian J Pain 2015;29:172-80
| Introduction|| |
Colic is a condition which is seen among the infants during the first 4 months after birth and sometimes may last until the 6 th month, occurs in the evenings and is mainly characterized with incessant crying without any reason.  It is considered normal for babies to cry for a long time but children with colic cries excessively. , Wessel has the most accepted definition of colic as an otherwise healthy baby aged 0-3 months that has paraoxysms (outbursts) of crying, irritability and fussiness lasting for more than 3 hours per day, more than 3 days per weeks for a period of 3 weeks.  İt is reported that the prevalence of colic is between 10-40 %  and that between 10-17 % of these infants are brought to hospitals. , It is thought that particularly gastrointestinal, psychosocial and neurologic factors play key role in the occurrence of colic. Such factors as immature neurologic system, lactose intolerance, poor or excessive feeding of the baby, aerophagia or inability to relieve the colic are seen as neurological factors and gastrointestinal causes. ,,, Among the psychological factors infant's removal from the warm and protective environment the mother's womb, traumatic delivery and poor mother and baby attachment may play a role in the occurence of incessant crying. 
Approaches to managing colic include; pharmacological treatment, diet therapy and behavioral therapy. , It is emphasized that behavioral approaches are the most accepted practice for the elimination of colic.  Some of the behavioral approaches are cuddling the infants, swinging (rhythmic rocking), using rhythmic sounds, using pacifier, swaddling, decreasing stimulation of the baby and parental training. 
Infants may be rhythmically swung in arms, pushchairs, beds, hammocks and in automatic baby swings.  If they are older than 6 weeks or on blanket if they are excessively active.  Swinging defined as "repetitive and rhythmic" movements are helpful because these movements provide a continuous stimulus.  Swinging makes infants asleep by stimulating the vestibular system. At the same time; swinging, as a behavioral method, comforts infants by stimulating endorphin secretion and thus enabling them to feel more comfortable and relaxed.  It is stated that cuddling, hugging, swinging on a blanket may be helpful in an outburst of cry. 
Some infants are able to sleep if they are laid and swung from side to side on knees and calm down when they are swung back and forth. When infants are swung to different directions, their reactions should be checked and caution must be paid because swinging fast may harm their necks.  In the studies conducted, it is seen that mothers use swinging methods to soothe their infants. ,, These methods are reported to be effective upon decreasing baby's pains or cry. ,,,
Colic, one of the most commonly seen problems during suckling period, is a syndrome that has not been solved yet and may sometimes put parents and health care personnel into troubles and cause many financial and intangible damages. 
Colic may lead to unnecessary hospitalization of the infants, conflicts in parent-baby relation, problems in marriage and baby may be abused.  It is observed that shaken baby syndrome (SBS) and even death may occur among the infants who are subjected to intentional or unintentional traumas.  Basic sense of security is improved among the infants whose needs are properly met; which affects their lives positively in the future. 
Pediatric nurse is responsible for not only consoling pains of the infants but also teaching the ways whereby the family members learn what to do and how to comfort if these pains are recurrent and how to provide a life of quality.  Mothers should be assisted in coping with stressful situations, their anxiety levels should be decreased, their knowledge levels should be increased and their support mechanisms should be identified.  Therefore; it is very important to eliminate or to alleviate symptoms because they may have negative effect on the family and attachment.  Thus; it is significant that there be different strategies designed.
| Materials and Methods|| |
Setting and sample
The study was designed in pre-test, post-test model and semi-experimental model.
Population of the study was composed of mothers and their infants who were born at Maternity and Children Hospital a province in Turkey between July 2012 and February 2013. The sample of the study consisted of mothers and 72 infants who were born at the above mentioned hospital, complied with selection criteria and were determined using power analysis (minimum sample size = 18 with 80 % power). Infant who were aged between 1 and 3 months, were born mature, whose birth weight ranged from 2500-4000 g, demonstrated a regular growth and development, were healthy, had paraoxysms of crying lasting for more than 3 hours per day, more than 3 days per weeks for a period of 3 weeks according to the Rule of 3's, whose mothers lived in city center, were literate, open to communication and collaboration were included in the study.
For the data collection; a questionnaire form which examined socio-demographic characteristics of the mothers and infants with colic; Infants' Colic Scale (ICS) and Duration of Cry Registration Form were used.
The infant colic scale
The Infant Colic Scale is used to diagnose colic and to determine factors that cause colic. The Infant Colic Scale was developed by Ellet et al., 2003  to help health care professionals diagnose colic in infants. The tool has a total of 22 items in five subscales:
- Cow's Milk/Soy Protein Allergy/Intolerance (2 items),
- Immature Gastrointestinal System (4 items),
- Immature Central Nervous System (8 items),
- Difficult Infant Temperament (4 items) and (e) Parent-Infant Interaction + Problem Infant (4 items). The Infant Colic Scale items are evaluated on a 6-point Likert-type scale. The responses range from 1 (strongly disagree) and 6 (strongly agree).
A low total score from the tool is positive for showing colic, and a high score indicates a negative state. The Cronbach's alpha coefficients were 0.55-0.89 for the subscales, and .73 for the total scale.  The scale was adapted to Turkish by Çetinkaya and Başbakkal in 2006.  The infant colic scale comprises of 19 questions. The test-retest correlation coefficient for the total scale was found to be .65. The Cronbach Alpha for the Infant Colic Scale in this study was 0.73.
In the pre-interviews made with the mothers who approved to participate in the study; questionnaire forms and ICS were administered. The authors told the mothers not to carry or swing their infants in their arms unless they were crying for long periods. Duration of Cry Registration Forms were provided to the mothers so that they could take notes in the registry forms about duration of crying for 7 days during the interventions when colic of the infants started. Data collection and explanation, demonstration and instruction of the interventions lasted nearly 40 minutes for each mother. Interventions made in the group of swinging (rhythmic rocking) infants in arm and group of swinging (rhythmic rocking) infants on blanket continued for 15 days. After the pre-interview; both groups were followed twice in total every other week. In the first week; follow-up data were gathered with home visits of nearly 10 minutes and Duration of Cry Registration Forms on which information about cry was written for seven days were gathered and new Duration of Cry Registration Forms were left. At the end of the second week; again the second Duration of Cry Registration Forms on which information about cry was written for seven days were collected and ICSs of final follow-up were administered and the interventions were finished.
Information on infants and telephone numbers of the mothers was obtained from hospital registries so that infants with colic should be discovered. Mothers of the infants who complied with research criteria were called on the phone. The mothers who told that their infants cried were requested to take notes about crying duration only due to colic for seven days. At the end of 7 days; the mothers were visited at home by researchers and their notes were examined and it was found out that 80 baby's cried lasting for more than 3 hours per day, more than 3 days per weeks for a period of 3 weeks. Eight mothers declared that they wanted to drop off the study of their own accord and the study was completed with 72 mothers and their infants. The first group that was included constituted the group of the mothers who swung their infants in arm (N = 38) while the second group made up the group of the mothers who swung their infants on blanked (N = 34). The order of the group was determined by drawing lots and using simple randomization. By drawing lots, it was decided which infants would be assigned to the group of the mothers who swung their infants in arm and which infants to the group of the mothers who swung their infants on blanket. When the infants started crying due to colic the mothers who were included in the group of those who swung their infants in arm were told to hold their infants and to swing them rhythmically by always supporting head and neck, no matter the direction, without accelerating the swinging (rhythmic rocking) speed in a quiet setting as long as infants cried and until they calmed down. Mothers of this group were warned about the fact that infants needed to be held in arm when they cried; yet, they should not be held in arm when they did not cry and that mothers should not fear that infants may get accustomed to holding in arm. They were explained that swinging should be rhythmic and particularly slow. Mothers who belonged to the group of those who swung their infants on blanket were told to swing their infants on a soft and thin blanket applying soft movements together with an assistant as long as infants cried and until they calmed down. Mothers were explained that rhythmic rocking would become a habitual activity if they always swung the infants to make them sleep and therefore, in order to prevent it, infants should be put in bed when they got sleepy and did not cry and mothers should not swing their infants if they did not cry. Mothers should hold the corners of the blanket and gently swinging the blanket. The mothers of both the groups were instructed to take notes in the registry form about how long it took for infants to stop crying after mothers had started to swing in arm or on blanket due to the cry due to colic. Mothers were requested to do nothing in order to decrease colic except swinging (rhythmic rocking) during these interventions and their assurance about it was gained. After mothers of both groups were explained what to do by the researcher, the practices were demonstrated and the mothers were made to perform the practices under the guidance of and as explained by the researcher. Duration of swinging (rhythmic rocking) was left to mothers and they were told to swing until the infants calmed down. Mothers were warned against the possibility that swinging (rhythmic rocking) hard may lead to neck injuries . It was explained to the mothers that soft swinging would do no harm to infants. Mothers were informed and provided support about this issue and SBS was kept under control. It was explained to the mothers that colic were normal part of growth, no sign of diseases and the most beneficial help could be produced without shaking and giving any damage to infants no matter how long the cry lasted. , It was told to the mothers that they could give infants to fathers or somebody else who could take care of the baby; when they could not soothe infants and became nervous or felt any kind of tension.  In this way; it was aimed that mothers' anxiety be reduced and their stress be controlled.
In order to conduct the study, legal permissions were obtained from the relevant institutions. This study was reviewed and approved by the research ethics committee of the author's institution. Mothers of the infants who complied with the research criteria were informed of the aim of the study and their questions were answered and written informed consents were obtained. The study was initiated with the approval document of ethical committee with issue-number 2012.2.46 and date 08.05.2012
The data were assessed using SPSS (Statistical Package for Social Science) 18.0 using proper statistical analyses. For the statistical analyses; percentages, means, standard deviations, Chi-square test, t-test for dependent and interdependent samples, Kruskal Wallis H test, Dunnet's T3 Post Hoc test, Mann Whitney U test, Cronbach Alpha analysis were employed.
Among the infants who belonged to the group of (rhythmic rocking) in arm; mean daily crying duration (hour/day) was 3.71 ± 0.83 before the intervention, 1.57 ± 0.66 at end of the first week and 1.29 ± 0.55 at end of the second week after the intervention. Among the infants who belonged to the group of swinging (rhythmic rocking) on blanket; mean daily crying duration (hour/day) was 3.67 ± 0.72 before the intervention, 1.71 ± 0.85 at end of the first week and 1.33 ± 0.67 at end of the second week after the intervention. When crying durations recorded before and after the intervention among the infants who belonged to the both groups were compared; it was found out that there was a significant decrease in crying durations and there was a statistical significance on behalf of post-tests as long as intragroup crying durations were concerned [Table 1]. Although there was a bigger decrease in crying durations of the infants who belonged to the group of swinging (rhythmic rocking) in arm as compared with the infants who belonged to the group of swinging on blanket; there was not a statistically significant difference between the two groups. This finding indicated that there was not a statistically significant difference between the two groups in terms of the decrease crying durations. When ICS total scores were investigated; among the infants who belonged to the group of swinging (rhythmic rocking) in arm; mean pre-test score was 69.89 ± 9.26 while their mean post-test score was 62.07 ± 5.87 whereas among the infants who belonged to the group of swinging on blanket; mean pre-test score was 70.35 ± 7.39 while their mean post-test score was 61.64 ± 4.54. It was found out that age, sex, birth weight, the birth order whether or not it was an intended pregnancy and type of delivery did not affect crying duration and ICS scores, among the infants who belonged to the group of swinging in arm whereas type of feeding affected crying duration and ICS scores. It was seen that crying durations and colic among the infants who belonged to the group of swinging in arm and who were fed with breast milk were lower. It was found out that age, sex, birth weight, whether or not it was an intended pregnancy, type of delivery and type of feeding did not affect crying duration and ICS scores among the infants who belonged to the group of swinging on blanket. However; the birth order (whether or not they were the first, second or third child etc.) affected crying duration, but not affected ICS scores. This finding indicated that the second child among the infants who belonged to the group of swinging on blanket had shorter crying duration. It was noted that family type affected their crying duration and ICS scores (P < 0.05). This finding pointed out that crying durations and colic of the infants whose mothers lived in the extended family type and who belonged to the group of swinging in arm were as more intense. On the other hand; it was seen that educational status, income status and social security status of the mothers who belonged to the group of swinging on blanket did not affect crying duration and ICS scores of the infants (P > 0.05).
|Table 1: Comparisons of intragroup and intergroup crying durations and mean ICS pre-test and post-test scores before and after the interventions (1 st Week and 2 nd Week) among the infant who belonged to the group of swinging in arm and on blanket|
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| Discussion|| |
It was established that crying duration of the infants with colic was reduced among the infants who belonged to group of the swinging (rhythmic rocking) in arm. As the length of intervention increased crying duration of the infants reduced. Researchers were of the opinion that the decrease in colic and crying duration was obtained by the fact that mothers' arm/hug comforted infants, infants felt safe when they were in mothers' arm and they were in continuous physical contact with mothers. It may be argued that the soothing effect of rhythmic movements and swinging decrease crying. In literature it is emphasized that hugging and swinging are helpful and beneficial because hugging produces safety feelings among infants  and swinging when performed as a "rhythmic and recurring movements" provides a constant stimulation.  The study of Ourth and Brown  and the study of Gordon and Foss  suggested that swinging infants in arm was effective upon decreasing infants' cry. In the study of Swandling and Griffiths  it was reported that parents, instead of leaving infants with colic alone when they cried, who attempted to feed, hug and do something to calm infants down were more successful in decreasing crying. Our study findings were in agreement with these studies. In another study done, too; it was understood that mothers used swinging methods to console their infants. ,, In literature; it is explained that hugging infants, holding them in arm and swinging infants in arm during crying caused by colic reduced pains of the infants.  Our study finding was in line with literature. It was found out that swinging (rhythmic rocking) on blanket decreased intragroup crying duration of infants who belonged to the group of swinging on blanket. These findings highlighted that intervention of rhythmic rocking on blanket was effective. It was seen that swinging on the blanket reduced ICS total score. This finding indicated that intervention made through swinging on the blanket was effective and reduced colic of the infants. This reduce in the colic and crying durations among the infants who belonged to the group of swinging on the blanket may have caused by the comfort produced by the rhythmic movements and relaxing effect of swinging. It is concluded that feeling of void infants get when they are lifted above on the blanket makes them feel like inside uterus and safe; which will eventually console them. Because the position infants get on the blanket is like fetal position and infants get a stabilized position on the blanket; they are consoled by the swinging on the blanket. In literature, it is emphasized that swinging is beneficial because it provides continuous stimulus through "repetitive and rhythmic" movements,  makes infants feel relaxed and safe because they stimulate endorphin secretion  and swinging on blanket is helpful.  In the study of;  30 % of those who swung their infants on the blanket to soothe colic became successful. The study of Mathai et al.,  reported that swinging in cradle reduced crying and pains of the infants. Because it was thought that swinging on the blanket and swinging in cradle had the same mechanism; the result of this study was mentioned and it was found to be in line with our study finding. When intergroup crying durations before and after the interventions (1 st week and 2 nd week) among the group of swinging in arm and the group of swinging on blanket were examined, it was noted that there was decrease in crying durations in both groups after the interventions. When the age (in months), sex, birth weight, whether or not they were born as the result of intended pregnancy and type of delivery; and crying duration and mean ICS total scores among the infants who belonged to the group of swinging in arm as compared with the infants who belonged to the group of swinging on blanket were investigated; no statistical difference existed between the groups [Table 2]. In the studies conducted; no statistically significant difference was found among the infants in terms of age (in days), sex, birth-weight being born as an intended pregnancy, type of delivery colic. ,,,,,,, The finding of the present study was similar to the findings of these studies.
|Table 2: Comparisons of cyring durations and mean ICS total scores in terms of socio-demographic characteristics among the infant who belonged to the group of swinging in arm and on blanket|
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It was seen that the birth order (whether or not they were the first, second or third child etc.) did not affect crying durations and ICS total scores among the infants who belonged to the group of swinging in arm while it was effective upon crying durations but not effective upon ICS scores among the infants who belonged to the group of swinging on blanket [Table 2]. This finding pointed out that crying duration among the second born infants who belonged to the group of rhythmic rocking on blanket was shorter; which may have been caused by the fact that mothers had already gained experience in the care of the second born children. Unlike some studies conducted; , it was seen that there was a significant difference between birth order and colic in other studies. ,, It was understood that crying duration and ICS total scores of the infants who were breastfed were lower than those who were fed with formula and breast milk + formula. Literature reported that infants who were breastfed cried less than those who were fed with formula or baby food.  At the same time; it was reported that breastfeeding had a relaxing effect upon crying.  Our study finding concurred with the findings in literature. It was found out that type of feeding did not affect crying duration and ICS total scores among the infants who belonged to the group of swinging on blanket [Table 2]. In a number of studies, no significant difference was found in terms of the type of feeding. ,, This finding discovered in the group of swinging on blanket was in line with the findings of other studies. When crying duration and ICS total scores of the infants were compared according to the socio-demographic characteristics relating to mothers; it was understood that age of the mothers did not affect crying duration and ICS total scores of the infants who belonged to the group of swinging in arm [Table 3]. In the studies conducted,it was explored that there was no statistically significant difference between mothers' age and colic. ,,,, This finding of our study was in line with the findings of other studies. However; it was understood that age of the mothers did not affect crying duration but ICS total scores of the infants who belonged to the group of swinging on blanket and that colic of the infants whose mothers were younger ≤20 years were higher. We thought that this result may have been caused by the inexperience of the mothers in baby care. In the study of Yalçın,  it was found out that colic of the infants whose mothers were younger ≤ 20 years were 3 times higher. In the study of Canivent et al.,  it was seen that risk for colic were more commonly encountered among the infants of mothers who gave birth at an early age. Our study finding was in agreement with the findings of these studies. It was seen that educational level, employment status, income status and social security coverage did not affect crying durations and ICS total scores among the mothers of the infants who belonged to the group of swinging in arm and on blanket [Table 3]. In the studies conducted, too, it was seen that there was no statistically significant difference between colic and mothers' educational status and income status. ,, Our study finding agreed with the findings of these studies. Yet, family type affected crying durations and ICS total scores of the infants who belonged to the group of swinging in arm. This finding demonstrated that crying durations and ICS total scores of the infants whose mothers lived in extended families were higher; which meant that their colic were higher. It was explored in this group that ICS total scores of the infants whose mothers lived in extended families were higher; which meant that their colic were higher. It was interpreted that this finding related to the group of swinging in arm and on blanket was caused by the fact that mothers who lived in the extended families were not able to spare enough time for their infants. In some of the studies , carried out, there was no statistically significant difference in points of family type and colic. Our study finding did not agree with the findings of the above mentioned studies.
|Table 3: Comparisons of cyring durations and mean ICS total scores among the infant who belonged to the group of swinging in arm and on blanket in terms of mothers' socio-demographic characteristics|
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| Conclusion|| |
It may be advised that these interventions be used for a longer time and efficacy of these interventions be tested using other studies. It was discovered that colic were seen more among the infants whose mothers were aged ≤20 years and infants who lived in extended families whereas colic were seen less among the infants who were breastfed. These findings will help staff to educate parents about colic and how to manage the infant with colic.
This article was based on the Doctoral thesis of the first author under the supervision of the second author. We also express our thanks to the women who participated in the study.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3]