“There must be something wrong, or else I’m just a terrible parent”: Systematic review of experiences parenting unsettled babies

Problem

Parents often feel intense distress in the transition to parenthood over baby unsettled behaviours. There is concern that these behaviours are increasingly attributed to medical causes such as reflux or cows’ milk allergy. When inaccurate, this can cause harm to parents and babies, may have negative consequences for their breastfeeding journey and increase costs for healthcare systems. This study explores parent experiences of unsettled babies, with emphasis on thoughts and feelings about medical labels.

Approach

Systematic review of primary, qualitative research into parents’ experiences of unsettled babies (<12months age). ‘Unsettled’ was defined as perception of excessive crying with additional feature(s) such as vomiting, skin or stool problems. Structured searches were completed in CINAHL, Medline, Embase, PsychINFO and Cochrane Clinical Trials on 23.03.2022 and rerun on 14.04.2023. The Critical Appraisal Skills Programme (CASP) checklist assessed trustworthiness of included studies. Analysis utilised inductive thematic synthesis and resulted in the development of a conceptual model summarising parents’ experience.Public Involvement and Engagement (PPIE) included a series of four in-depth ‘listening cafes’ with eight low-income parents of unsettled babies; informal drop-in engagement at parent playgroups and children’s centres; digital 1:1 conversations with families of diverse cultural heritage and ad-hoc engagement with healthcare professionals working in areas of relative affluence and deprivation. These activities contributed to the choice of the term ‘unsettled’, supported themes emerging from the systematic review and gave insight into parent experience from perspectives of underserved communities.

Findings

Ten eligible studies conducted in high (n=8) and middle income countries (n=2) were included, contributing data from 103 mothers and 24 fathers. Two analytical themes and 8 descriptive themes were developed. Firstly, parents described strategies to construct an “Identity as a ‘Good Parent’”. Within this, descriptive themes included parents experiencing “Transition from ‘me’ to ‘me as a parent’” where reality contrasts with idealised perfection. Parents reported feelings of “Guilt and failure” about infant unsettled behaviours and “Feeling responsible and wanting control” The second analytical theme “Searching for an explanation” captures parents seeking external (medical) causes for babies’ unsettled behaviours. Descriptive themes illustrated parents’ “Expectations” of themselves and their baby. “Feeding is linked to unsettled behaviour” and is frequently changed. Repeated “Help seeking” leaves parents feeling ignored and experiencing a “Lack of certainty”. Parents reported “Hypervigilance and desperation” during the search.

Consequences

Parents can become trapped in a cycle of ‘searching for an explanation’ for their baby’s unsettled behaviours, experiencing considerable distress, exacerbated by feelings of guilt and failure. Primary care professionals could support a positive parenting identity by managing expectations, normalising the continuum of infant behaviours, reducing feelings of guilt or uncertainty and helping parents regain feelings of control. Insight gained from this systematic review will inform interventions to support parents, reducing harm caused by inaccurate medicalisation.