Selective affective response to a parent in a 6-month-old infant

CASE. At her 6-month health supervision visit, Julie is accompanied by both her mother and father. Their main concern is persistent "colicky" behavior with "uncontrollable" episodes of crying and night wakening every 2 to 3 h ours. The pediatrician discussed persistent crying and various soothing tec hniques at each previous health supervision visit. Julie's mother could not hold back tears as she described the baby's behavior and her own sleep dep rivation. The parents portrayed the crying as "an off/on switch" without va riations in volume. They read a book on sleep problems in infants and follo wed the advice. For a week, they allowed Julie to cry when she awakened. Sh e cried for 1 to 3 hours each time without being able to settle herself. Wh en her mother breast-feeds, Julie settles and then sleeps for a few hours b efore awakening in a crying state. However, her mother is unable to return to sleep quickly. As the pediatrician explored the family and home environment, a new behavio r, beginning about 1 month before the office visit, emerged. Both parents w ere concerned that when Julie looked at her mother, she became agitated and anxious. The pediatrician, somewhat doubtful, then saw Julie smiling while in her father's arms. When she was turned toward her mother, Julie's facia l features became tense and she appeared anxious. This was followed by what the pediatrician described as "fussy vocalizations... as if she was stress ed." Later in the off ice visit, the pediatrician deliberately repeated the same event and the baby had a similar response when turning to her mother. When she was transferred to her mother's arms, she did not console immedia tely but only after about 3 minutes. Julie's mother expressed loving feelin gs for her child alternating with "hating her and counting the days until s he grows up." The father and maternal grandmother, who helps during the day with child care, are supportive but frustrated as the crying persists and the mother's sleep deteriorates. Along with Julie's mother, they are concer ned about what they perceive to be a negative relationship between Julie an d her mother. The parents are in their early thirties and this is their first child. The prenatal and perinatal history is normal. During the first 2 weeks of life, Julie was described as cuddly and easy to feed at breast. Frequent crying and night awakening began after the second week. Both parents work in sales in small retail stores. Julie's mother was planning to return to work 3 mo nths after the birth of the baby, but sleep deprivation altered her plan. T he father attends a community college two nights each week. The parents sta te that they have a good marriage.