Crying is a normal behaviour in healthy young infants. Yet as a new parent, or even as an experienced parent, a crying baby can be confusing as to its cause and it can simply wear you down. We spoke with A/Prof David Coman; Medical Director of Paediatrics at The Wesley Hospital to get more information about what is normal and when you might need to get further support and intervention.
At 6 – 8 weeks of age, a baby cries on average 2 – 3 per 24 hours. Excessive crying is defined as crying greater than 3 hours/day for greater than 3 days/week. Crying is often at its peak in the evening i.e. “the witching hour”. Excessive crying can be very distressing for parents, many of whom will be exhausted from the rigours of caring for a newborn baby.
Why do babies cry?
There are three more common reasons why babies cry. Go through this mental checklist to determine if any of these could be the problem:
Sleep is an essential component of life. Sleep deprivation can have a profound impact on an adult’s ability to function adequately in our day to day lives. The same is true of infants and children. The average sleep requirements for infants vary with age;
- birth ~ 16 hours/day, a 6 week-old baby generally becomes tired after being awake for 1.5 hours
- 2-3 months ~ 15 hours/day, a 3 month-old baby generally becomes tired after being awake for 2 hours
This is a very common cause of infantile irritability. Clues to suggest inadequate milk supply (breast milk and formula) are requiring frequent feeds i.e. less than 3 hours. Inadequate milk supply is more likely if a mother reports her baby has frequent feeds, and poor weight gain.
This is a commonly used term, but the cause is not well understood. It usually begins at about 2 weeks of age and goes away by the fourth month. About one in five babies develop colic. Common symptoms include;
- Kicking and drawing pulls legs into a “ball”
- Loud noises heard from the babies stomach
- Burping and flatulence
- Often worse after feeding
Less common causes of excessive infant crying
Cow milk/soy protein allergy (CMPA)
This type of food allergy occurs in breast milk, goat’s milk, and formula. Infants with CMPA frequently have eczema rashes and occasionally wheezing. Important clues to suggest this diagnosis include, vomiting, poor weight gain, and especially blood and mucous stained diarrhoea. There is often a family history of CMPA.
Gastro-oesophageal reflux (GOR)
This is an over diagnosed cause of infantile irritability. Symptoms of GOR disease include, persistent vomiting, blood stained vomiting, back arching during feeds, and “rumination”. GOR may be secondary to CMPA.
In breast fed babies, the fore milk is proportionately high in lactose. If your baby switches breast feeding sides quickly or if the mother has very rapid milk let down, the baby may be getting too much lactose and/or not be absorbing it adequately. An adult analogy is drinking 3 litres of fruit juice per day.
Medical-Surgical Health issues
Red flags to suggest that there is a potentially significant health issue with your infant include:
- a sudden onset of irritability
- blood stained vomit
- bile stained vomit
- blood stained stool
- poor weight gain
If any of these signs are evident contact your doctor.
What can I do to help my crying baby?
Addressing the difficult issue of excessive infant crying can be very challenging, and is often a journey of trial and error. Excessive infant crying has the potential to cause significant stress in the family, including increasing the risk for post-natal depression.
Simple non-medical intervention options
1) Establish pattern to feeding/settling/sleep.
2) Avoid excessive stimulation
3) Baby massage/rocking/patting
4) Gentle music
5) Ask for help, especially from your immediate family members who have walked a mile in your shoes. The baby’s grandmothers can be helpful in this regard.
Medications and other treatment options
Medication is rarely prescribed for irritability alone. Medical studies examining the effects of colic mixtures have demonstrated no proven effect on infant crying when compared to placebo, however many parents note an improvement. Anti-reflux medications can be used for infants diagnosed with GOR disease. You may also consider formula changes if there is proven CMPA. Paediatricians do not recommend spinal manipulation for infants.
Where can I get help?
- Maternal and Child Health Nurse
- Lactation Consultants
- General Practitioner
- Parent Groups
- Unsettled babies clinics & consultants (see our article on sleep and settling on pages 20 & 21)
- Useful links
A/Prof David Coman MBBS MPhil FRACP
Medical Director of Paediatrics, The Wesley Hospital
Academic Lead for Paediatrics, UnitedCare Health Clinical School
This article was published in Issue 3 of our print magazine, April/May 2014.