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 hours. The pediatrician discussed persistent crying and various soothing techniques 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 deprivation. The parents portrayed the crying as “an off/on switch” without variations in volume. They read a book on sleep problems in infants and followed the advice. For a week, they allowed Julie to cry when she awakened. She cried for 1 to 3 hours each time without being able to settle herself. When her mother breastfeeds, Julie settles and then sleeps for a few hours before 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 behavior, beginning about 1 month before the office visit, emerged. Both parents were 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 facial features became tense and she appeared anxious. This was followed by what the pediatrician described as “fussy vocalizations . . . as if she was stressed.” Later in the office 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 immediately but only after about 3 minutes. Julie’s mother expressed loving feelings for her child alternating with “hating her and counting the days until she 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 concerned about what they perceive to be a negative relationship between Julie and 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 months after the birth of the baby, but sleep deprivation altered her plan. The father attends a community college 2 nights each week. The parents state that they have a good marriage.