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Background During the pandemic, parenting stress and mental health challenges for both parents and children have increased. However, the lasting repercussions for families remain largely unexplored. Additionally, young families currently face stressors such as economic inflation, the Russia-Ukraine War, and the climate crisis, whose impacts on families are not yet understood. The primary aim of the study is therefore to evaluate parenting stress as well as child and parent mental health problems in the postpandemic era. Additionally, the study seeks to identify potential predictors of parenting stress and mental health issues in parents. Methods From February 2023 to March 2024, we conducted a digital cross-sectional study involving families ( N  = 17,333) with children aged 0–9 years in Bavaria (Southern Germany) to examine parenting stress and mental health issues among both parents and children in light of current societal challenges. Validated questionnaires were used to gather data, and potential factors contributing to parenting stress were investigated. Results We found that 53.7% of parents scored above the cut-off value, indicating that they experienced moderate to high levels of parenting stress. Additionally, 13.5% showed signs of anxiety symptoms, while 14.6% exhibited indications of depression according to cut-off values. Additionally, 34.9% of the infants (0–24 months) had crying and/or sleeping difficulties, whereas emotional and behavioral problems were observed in 8.7 of the toddlers (2–4 years) and 10.4% of the pre- and primary schoolers (˃ 4 years). Economic inflation was perceived as stressful or very stressful for 59.3% of parents, with radicalization and social division (49.3%), the Russia–Ukraine War (37.9%), and the climate crisis (31.8%) also cited as sources of stress. For 31.6% of families, the lingering effects of the pandemic continued to be a (major) burden. Across all age groups, children’s mental health issues and societal challenges were the primary predictors of parenting stress. Conclusion Our study underscores that psychosocial stressors for families with children remain pronounced even postpandemic. Moreover, our findings highlight the impact of broader societal trends, such as economic inflation and social division, on family well-being. Addressing these stressors and promoting the mental health of infants while bolstering parental resilience by alleviating parenting stress should be key priorities for healthcare initiatives in the aftermath of COVID-19.

ObjectiveTo study regulatory problems (RPs) of feeding, sleeping and excessive crying in infancy, and explore the influence of maternal mental health problems and parent–child relationship problems.Design and settingData were collected in the general child health surveillance delivered to infant families by community health nurses (CHNs). Information on CHNs’ assessments and conclusions were obtained on 2598 infants and merged with data from national registers. Descriptive statistics and logistic regression models were used to study RPs in early and late infancy, and the influences due to child, family and parent–child relationship problems.ResultsCombined RPs (C-RPs), defined as two or more simultaneous problems of feeding, sleeping or excessive crying, was identified in 2.9% and 8.6% of the population between age 2–6 and 8–11 months, respectively. Low maternal schooling and immigrant parents were associated with an increased risk of late C-RPs, but RPs in early infancy stand out as the main predictor of late C-RPs OR 3.4 (95% CI 1.8 to 6.6), and the effect of early maternal mental health problems and parent–child relationship problems seem to be mediated by early C-RPs.ConclusionsCombined problems of feeding, sleeping or excessive crying may exist throughout infancy independently of exposures to maternal mental health problems and parent–child relationship problems. The results indicate that infants with RPs exceeding age 2 months need special attention, in clinical as well as community settings. Suggested intervention includes specific guidance to the parents to help them understand and regulate their infant’s sensitivity and reactions.

Physiological regulatory problems in infancy (i.e., problems with sleeping, feeding, and tactile reactivity) have been associated with impairing Functional Somatic Symptoms (FSS) at ages 5–7. We aimed to extend this finding by examining not only the association of physiological regulatory problems but also other infancy factors (i.e., emotion dysregulation and contact problems) with FSS in pre- and late adolescence. Standardized behavioral assessments and self-report questionnaire data from assessment waves at 0–1, 11–12, and 16–17 years of the population-based Copenhagen Child Cohort (CCC2000) were linked with Danish register data on maternal postpartum psychiatric illness and family adversity as covariates. Multiple linear regression analyses were performed to examine the association between infancy factors and FSS in pre- and late adolescence. Only infancy physiological regulatory problems significantly predicted preadolescent FSS ( b  = 0.38, 95% CI [0.14, 0.62]), also when accounting for maternal postpartum psychiatric illness and family adversity. The association was attenuated for late adolescent FSS. Conclusion : Infancy physiological regulatory problems may represent early signs of a dysregulated stress system and were found to significantly predict FSS in pre- but not late adolescence. Implications for early FSS prevention could include testing interventions promoting infants’ regulation of sleep, feeding, and tactile reactivity. What is Known: • Functional Somatic Symptoms (FSS) are common in adolescence. • Explanatory models of FSS emphasize a multifactorial etiology involving interactions between early child-related vulnerabilities and contextual factors. • Infancy physiological regulatory problems (i.e., problems in the area of sleeping, feeding, and tactile reactivity) might represent early signs of a dysregulated stress system, and have been shown to predict impairing FSS in preschool childhood . What is New: • This study investigated the association between infancy factors, namely physiological regulatory problems with feeding, sleeping, and/or tactile reactivity, emotion dysregulation, and contact problems, and FSS in pre- and late adolescence . • Only a combination of infancy physiological regulatory problems significantly predicted preadolescent FSS, with the association attenuating for FSS in late adolescence . • Implications for early FSS prevention could include parent-mediated interventions aiming to promote infants’ physiological regulatory skills .

Whether infant regulatory behavior problems already in the first month of life indicate an increased risk of childhood neurobehavioral problems, and whether maternal depression in the postpartum and early childhood underpins these associations remain unclear. Altogether, 2049–2364 mothers from the Prediction and Prevention of Pre-eclampsia and Intrauterine Growth Restriction (PREDO) study completed the Neonatal Perception Inventory on regulatory behavior problems at the infant’s age of 15.6 days (SD 3.2, range 1–30), the Infant Behavior Questionnaire-Revised on temperament at 6.5 months (SD 0.9, range 4.2–12.4), and the Ages and Stages Questionnaire-3 on developmental milestones and the Child Behavior Checklist on behavioral problems at 3.5 years (SD 0.7, range 1.9–6.0). Maternal depressive symptoms were measured by the Center for Epidemiological Studies Depression Scale (infancy follow-ups) and Beck Depression Inventory-II (childhood follow-up). Father-rated infant temperament and paternal depressive symptoms were also available (n = 1474). Higher levels of infant regulatory behavior problems predicted higher levels of mother- and father-rated negative affectivity temperament (0.13 SD units per SD unit, 95% confidence interval 0.09–0.17; and 0.09, 0.04–0.14, respectively), lower levels of mother-rated orienting/regulation temperament (− 0.09, − 0.13 to − 0.05) and problem-solving skills (− 0.12, − 0.21 to − 0.04), and higher levels of Externalizing (0.07, 0.03–0.11) and Total behavioral problems (0.07, 0.03–0.11). Regulatory behaviors partially mediated the effect of maternal depressive symptoms. Regulatory behavior problems already during the first month of life predict neurobehavioral outcomes, and partially mediate the effect of maternal depressive symptoms. Our study may inform design of interventions aimed at timely prevention in children at risk.

Co-occurring regulatory problems in infancy, RPs, including excessive crying, feeding–eating and sleeping, have been found associated with mental health problems in school ages. Still, an overview is needed on trajectories of co-occurring or combined RPs, and mental health problems in early childhood. The aim of this review is to systematically review the literature on longitudinal community-based studies of combined RPs measuring mental health outcomes in early childhood. Following the PRISMA guideline, we systematically reviewed the literature published 2000–2020, in which combined RPs are assessed in infancy, and mental health is examined using standardised measures at ages 1–7 years. The search was performed in four databases MEDLINE, EMBASE, PsycINFO and Scopus. A protocol is published on PROSPERO. Based on 1978 screened articles, 42 papers were screened for eligibility, of which six were included, comprising data on two or more RPs investigated among a total of 20,675 children. Assessment of risk of bias in the studies showed overall good quality in five of the six papers. The literature reviewed suggests that combined RPs in infancy are early markers of mental health problems during early childhood, and highlights that community studies exploring the longitudinal associations of combined RP and mental health problems in preschool and early school age are still scarce. Overall, the review points to the need of research into preventive intervention targeting early manifestations of childhood dysregulation, such as RPs.

This study investigates the temporal patterning of infant self-regulatory behaviors (crying/fussing, sleeping) in relation to both infant (age, sex, regulatory problems) and maternal variables (soothing behaviors, mood). Self-regulatory and soothing behaviors were assessed in 121 mother-infant dyads (4–44 weeks) by the Baby’s Day Diary at 5 min intervals over 3 days. Further infant characteristics and maternal mood were assessed by questionnaires (DASS, CES-D, STAI) and the Diagnostic Interview for the Assessment of Regulatory Problems in Infancy and Toddlerhood. Data were analyzed using generalized additive mixed models. Negative maternal mood was associated with a deviant course of crying/fussing during the day. Body contact was associated with reduced variability in the 24 h course of sleep. Mother-infant transactional processes—above and beyond known relationships with overall levels of crying/fussing and sleeping—might play out on the temporal dimension of infant regulatory behaviors.

PurposeThe postnatal period is a vulnerable time for parents and children but epidemiological and health care utilisation data for Germany on parental mental health during early childhood is scarce. This protocol describes the rationale, aim and study design of a population-based cohort study to assess the occurrence and determinants of psychosocial stress and mental health disorders, as well as the use and cost of health care and social services in early childhood.MethodsAs part of the collaborative SKKIPPI project, we will contact a random sample of 30,000 infants listed in the residents’ registration offices of three German towns and we expect to include 6,000 mother–child pairs. Both parents are invited to fill out an online screening questionnaire. Mothers with indications of psychosocial stress will be interviewed to assess mental health disorders, regulatory problems of their children, as well as health care and social services utilisation, with a follow-up assessment after 6 months.ResultsAfter description of sociodemographic and health data, we will analyse occurrences, patterns, and potential determinants (maternal age, social status, household factors, migration status etc.) of psychosocial stress and mental health disorders in the mothers and their children in early childhood.ConclusionsOur study will identify potential risk and protective factors for postnatal mental health and health care utilization of psychosocially burdened families. This will help to improve prevention and treatment strategies to strengthen the parent–child relationship, to reduce persisting vulnerability of children, and to improve health care and social services.Trial registrationThe study has been registered in the German Clinical Trial Registry on February 8th 2019 (DRKS-ID: DRKS00016653).

Background Perinatal depression affects 10–15% of mothers and approximately 5% of fathers. However, only a small number of affected individuals seek treatment. If left unrecognized and untreated, it can have negative long-term consequences for the family’s health, leading to subsequent high costs. Early treatment is crucial, yet there is a notable underdiagnosis and undertreatment. Affected individuals are often seen during this time, e.g. in paediatric practices, but not by specialists in mental health. Consequently, this study aims to increase detection and treatment rates of affected individuals by implementing a screening for depression and psychosocial stress in perinatal and postpartum parents within routine obstetric and paediatric care with subsequent advice and—if necessary—further referral to a mental health specialist. Methods UPlusE is a prospective, cluster-randomized controlled trial conducted in an outpatient setting. Obstetric and paediatric practices will be randomized into an intervention and control group (1:1 ratio). Practices and enrolling patients will be required to use specific smartphone apps (practice apps) for interaction. The screening will occur with the apps at each paediatric checkup up to the child’s age of 12 months, using the Edinburgh Postnatal Depression Scale (EPDS), KID-PROTEKT questionnaire, and the scale 1 (impaired bonding) of the Postpartum Bonding Questionnaire (PBQ-1). The goal is to screen 10,000 patients across Germany. Gynaecologists and paediatricians will receive certified training on peripartum depression. Participants in the intervention group with scores above cut-offs (EPDS ≥ 10, KID-PROTEKT ≥ 1, PBQ-1 ≥ 12) will receive counselling through their treating gynaecologists/paediatricians and will be provided with regional addresses for psychiatrists, psychotherapists, and “Frühe Hilfen” (early prevention) as well as family counselling centres, depending on symptom severity. At each screening, participants will be asked whether they sought support, where, and with whom (utilization). Utilization is the primary outcome. Discussion The screening is designed to reduce underdiagnosis to enable suitable support at an early stage (especially for those often overlooked, such as individuals with “high-functioning depression”) and hence to avoid manifestation of mental health problems in the whole family, especially infants who are exceptionally dependent on their parents and their well-being will benefit from this program. Trial registration German Clinical Trials Register, DRKS00033385. Registered on 15 January 2024.

Background/Objectives: Infant regulatory problems (RPs), i.e., crying, sleeping, and feeding problems, are associated with unfavorable outcomes in later childhood. RPs increased during the pandemic; however, their occurrence in the face of today’s societal challenges remains unclear. RPs are strongly linked to parenting stress and less positive parenting behaviors, but their interplay is less investigated. Methods: In this cross-sectional, questionnaire-based study (ntotal = 7039), we compared the incidences of crying, sleeping, and feeding problems in infants (0–2 years) in pandemic (npandemic = 1391) versus post-pandemic (npost-pandemic = 5648) samples in Germany. We also investigated the relationship between post-pandemic infant RPs and parenting behaviors with parenting stress as a potential mediator for fathers and mothers. Results: Crying/whining/sleeping problems (34.8%) and excessive crying (6.3%) were significantly more prevalent in the post-pandemic sample. In both mothers and fathers, infant RPs were significantly associated with less positive parenting behaviors. Parenting stress partially mediated this relationship. Conclusions: RPs in the post-pandemic era are even more prevalent than during the pandemic, highlighting the imperative for health care professionals to focus on infant mental health. Parenting stress emerges as an entry point for addressing the cycle of infant RPs and maladaptive behaviors in both fathers and mothers.

Background According to the principles of infant mental health care, young children’s gradual attainment of self-regulation is closely tied to co-regulation provided by the caregiver(s). Sometimes, these co- and self-regulatory processes are not seamless and regulatory problems (RP) can arise, which manifest themselves according to age and developmental stage of the child. Parents of children with RP often face prolonged periods of seeking specialized care and become entangled in a cycle of ineffective health-seeking behaviors. The present study aims to understand parental health-seeking behavior in response to their infant’s RP, and the missed opportunities therein, by retrospectively analyzing the healthcare journey of families. Methods Respondents were sampled in collaboration with child psychiatrists from two tertiary care infant mental health day clinics, using extreme case study sampling. Semi-structured interviews were conducted with 14 families (10 fathers and 15 mothers). The mean age of the infants at the time of admission was almost 11 months. The research interviews were qualitatively analyzed via reflexive thematic analysis in NVivo, within the design of a qualitative descriptive study. Results Four main themes are identified. (1) ‘The need for answers’ highlights the fact that parental concerns about what is normal infant behavior, and about possible underlying causes, are significant triggers for seeking (professional) help. (2) ‘The search for recognition and understanding’ identifies the profound impact on parents of being validated by their social network, but also by healthcare providers, in order to obtain timely referrals to specialized care. (3) ‘The lack of a broader approach’ discusses the importance of a holistic approach, which considers not only the physical but also the socio-emotional health of the infant, along with the well-being of parents. (4) ‘Lost in a healthcare maze’ emphasizes how parents feel abandoned by healthcare providers during their search for help. Conclusions The complex and fragmented nature of parents’ search for help often results in delayed referrals to specialized care. Parents believe that the care pathway for families with infants experiencing RP could be improved by addressing the identified missed opportunities.