Maternal knowledge and practices regarding infantile colic in Palestine: a need for enhanced education and awareness | BMC Pregnancy and Childbirth

Infant colic, characterized by excessive crying in otherwise healthy infants, can be a source of anxiety and psychological distress for parents. Adequate knowledge about IC’s nature and management strategies can help mothers implement effective interventions, potentially reducing infant crying episodes and distress. Moreover, it can contribute to enhanced maternal mental health by alleviating the stress and the risk of postpartum depression.

This study investigated maternal knowledge and practices regarding IC in the Northern area of Palestine. The findings revealed a diverse spectrum of knowledge among mothers, ranging from limited understanding to a more comprehensive grasp of the condition. This variability was evident in their responses to questions about IC causes, management strategies, and sources of information.

For instance, the spectrum of mothers’ understanding of common causes like gastrointestinal issues was wide, with some demonstrating a comprehensive grasp while others had limited awareness of potential factors such as immature nervous system development or psychological factors. This variability extended to their knowledge of effective management strategies, with some favoring behavioral techniques and others exploring dietary changes or pharmacological interventions. The diverse sources of information they relied on, from healthcare professionals to family, friends, or personal experience, further underscored the need for a more personalized approach in healthcare.

While a significant proportion of mothers (55.6%) reported prior knowledge of IC episodes, this percentage is lower than the 75.4% reported in a previous Saudi study by M. Mustafa et al. (2023) [12]. It is important to note that both studies relied on self-reported data, which can be subject to recall bias and other limitations. This discrepancy could be attributed to several factors, including differences in cultural contexts, healthcare access, and the specific population studied.

Interestingly, mothers in this study relied heavily on their relatives and friends as the primary source of knowledge, followed by their own experiences with previous children. These findings agreement agreed with previous to prior studies conducted in Iraq and Saudi Arabia (where the majority of Iraqis (76.2%) and Saudi mothers (36.5%) reported their source of knowledge being from their family and friends [10, 12]. Notably, these results contrast with a Turkish study that found mothers most frequently sought information from healthcare professionals, followed by online resources [11]. In this study, mothers were less likely to turn to physicians for guidance about IC, suggesting a potential gap in communication and education within the healthcare system. This finding highlights the need for healthcare involvement in educating mothers and families facing this challenging condition.

Mothers with more than one child were better informed about colic pain. Our analysis revealed a statistically significant association (p = 0.008) between the number of children and maternal knowledge about infantile colic (IC). This suggests that mothers with more than one child are likely to have higher expertise, possibly due to their previous experience with their first child.

The majority of mothers believed in the multifactorial nature of the condition, attributing it to a combination of factors, including: lactose intolerance, gastroesophageal reflux, feeding reflux, and behavioral issues. Mothers (81.6%) held the belief that gender plays no role in the cause of IC. These results, along with most previous studies [9, 10], reveal no significant gender bias in colic presentation.

Formula feeding emerged as a contributing factor to the development of colic in infants. In this study, 30% of mothers identified bottle feeding as a triggering factor for IC, highlighting a potential link between feeding methods and IC. Similarly, another study conducted in Saudi Arabia found that nearly half (49.8%) of mothers agreed that bottle feeding could lead to colic [12].

Despite the evidence from previous reports suggesting an elevated risk of IC among babies exposed to maternal smoking, the majority of surveyed mothers (95.6%) dismiss a direct link between colic and smoking. These findings are in contrast to Reijneveld’s (2000) study, which demonstrated an association between smoking during pregnancy and a higher prevalence of infant colic [14].

Several reports have identified mother-infant interaction and maternal anxiety as key factors in colic development. A previous study found that mothers with high anxiety scores were twice as likely to have infants with colic compared to those with low scores [15]. The current study demonstrated a significant knowledge gap regarding the potential influence of maternal mental health on colic, with the majority (93.6%) of mothers surveyed reporting no perceived impact of their mental well-being on their infants’ colic episodes. This finding deviates from prior research that has established a positive correlation between maternal anxiety and IC [16].

The mother employed several soothing strategies to manage IC, with baby massage being the most popular technique. In this study, (77.3%) of participating mothers utilized massage therapy to reduce crying episodes, highlighting the popularity and potential effectiveness of this method. Similarly, previous reports have demonstrated a positive impact of massage therapy on infants with colic. The findings align with the Unal et al. (2021) study, where 89.3% of mothers preferred abdomen massage to reduce colic attacks in their babie [11]. Moreover, massage therapy was shown to soothe crying episodes, promote relaxation, improve sleep patterns, and strengthen the bond between parent and child. Other frequently used practices were: avoiding flatulent foods and drinks, experimenting with different positioning, and applying warmth therapy [17, 18].

In the absence of definitive conventional treatment for IC, many mothers turn to alternative herbal medicine (36.0%) and complementary interventions to manage their babies’ distress. Anise tea was shown to be the most popular herbal drink. This finding aligns with previous research conducted in Saudi Arabia, where 27.4% of mothers reported using herbal remedies for the same purpose [9]. The participating mothers were less likely to favor pharmacological medications: the use of probiotics(6%) was minimal despite their demonstrated effectiveness in managing colic. This contrasts with a Turkish study where 36% of mothers reported using probiotic drops for colic [11].

The findings revealed a concerning trend of self-treatment practices, with only 18.9% of mothers seeking medical advice regarding their baby’s well-being. This highlights a potential need for increased awareness and education regarding the importance of consulting medical professionals before implementing treatment strategies. The findings suggest the need for healthcare providers to play a more active role in educating mothers about IC.

Parental support is crucial in managing IC. Healthcare providers can offer guidance and advice on management strategies, and support groups can provide a platform for parents to share experiences, connect with others, and receive emotional support.

This study offers valuable insights into maternal knowledge and practices regarding infantile colic in Palestine. As the first investigation of this nature in the region, it fills a crucial gap in the literature and provides valuable perspectives on the unique context of Palestine. The study’s substantial sample size provides a robust foundation for the findings. However, it is essential to consider the limitations inherent in self-reported data and the potential for recall bias. Additionally, the focus on specific regions in Palestine might constrain the generalizability of the results nationwide due to potential variations in cultural and socio-demographic factors.