Objective: To investigate whether regulatory problems, i.e., crying and feeding problems in infants older than 3 months of age, predict cognitive outcome in preschool children born at risk even when controlled for confounding factors.
Methods: A prospective longitudinal study of children born in a geographically defined area in Germany. N = 4427 children of 6705 eligible survivors (66%) participated at all 4 assessment points (neonatal, 5, 20, and 56 months of age). Excessive crying and feeding problems were assessed at 5 months. Mental development was measured with the Griffiths Scale at 20 months, and cognitive assessments were conducted at 56 months. Neonatal complications, neurological, and psychosocial factors were controlled as confounders in structural equation modeling and analyses of variance.
Results: One in 5 infants suffered from single crying or feeding problems, and 2% had multiple regulatory problems, i.e., combined crying and feeding problems at 5 months. In girls, regulatory problems were directly predictive of lower cognition at 56 months, even when controlled for confounders, whereas in boys, the influence on cognition at 56 months was mediated by delayed mental development at 20 months. Both in boys and girls, shortened gestational age, neonatal neurological complications, and poor parent-infant relationship were predictive of regulatory problems at 5 months and lower cognition at 56 months.
Conclusion: Excessive crying and feeding problems in infancy have a small but significant adverse effect on cognitive development.