This post is based off of a midwifery school assignment.
Crying is a communication tool, one of the few that babies have. It is vital to understand that newborns and babies do not have the rational capacity to perform manipulative behavior; train your mind and heart to accept their crying for what it is, a cry.
For most infants, crying is normal and is fairly easy to soothe. Not so long ago, your baby was warm, hugged and held (by the womb), hearing the soothing sounds of his mother’s heart beat and whooshing water around his ears, muted voices. He never experienced hunger or uncomfortable diapers or clothing, injections, loud noises, feeling cold, alone, or even something as simple as an itch somewhere on the skin.
They are also developing awareness and brain development at a stunningly rapid pace. This causes its own good and bad stresses for the baby.
Let’s think of some common reasons a baby might cry. He feels hunger (breastmilk digests quickly), his diaper is dirty, he’s tired and can’t control his limb movement; he instinctively understands that he should not be alone and needs to be held, a loud noise or a jostle scares him, he has an earache or other sickness that causes pain.
With observation, parents learn to differentiate why their baby is crying—one type of cry is for hunger, another for sickness, another for fear. It’s helpful to learn the pre-crying cues that baby is hungry—turning head to the side, sucking on fist, and mouthing sucking motions are common hunger signals. Responding quickly to babies’ cries can minimize crying and facilitate good communication skills between the parent and their child that can last a lifetime.
Holding your baby actually induces a state of calm in the baby. His heartbeat automatically slows down and it physically relaxes his muscles and nervous system.
We’ll discuss colic below, but first, here are cries and conditions that should be immediately evaluated by a doctor:
- A high-pitched, catlike wail (especially when the baby is also jaundiced)
- Any strangely high-pitched or low-pitched crying
- Persistently weak crying
- Crying that doesn’t stop for 2 hours no matter how you try to soothe, feed, or comfort
- Crying when you hold, touch or move the baby
- If your baby looks or acts in a way that is abnormal
- If your baby has a temperature over 38.0
- If your baby won’t feed (or only very little) for 8 hours or more
- If you baby vomits in a way that is unusual, persistent, or projectile
- If the baby has a bulging or swollen soft spot or a swollen groin area
These can be emergency situations. When there are crying questions that are non-emergency, check the baby’s weight gain, that it is normal. Observe if the baby is spending long periods of the day content and alert (rather than lethargic, overly sleepy, weak, and fussy). Observe any inconsolable crying if it occurs more than 3 times a day, or if you can comfort the baby but it’s unclear why the baby is crying. It’s best to write down the date, time, describe the crying, how long it lasts, and any activities or “symptoms” that accompany the crying, so you and the pediatrician can look for patterns or possible causes.
Colic
Colic is hard to define, and its cause is still unknown, though we are still guessing and trying to find ways to soothe these babies and provide parents with relief. Advice for treating colic is contradictory, so open yourself up to learning possible relief methods and trying them safely to see if they work or don’t work for you and your baby. Colic is a frustrating topic for parents and caregivers alike, so let’s take a deep breath and calm ourselves, especially if we have a colicky baby or if we’re around someone who does. Even if our own baby is not colicky, let’s give understanding and support to parents who experience this.
How colic is defined:
- The infant is less than five months old;
- The infant has prolonged (3 or more hours consecutively or in a 24-hour period) repeated (at least 3 times in a 7-day period) times of crying/fussiness that is not soothe-able nor preventable and has no other symptoms or obvious cause;
- The infant has no other symptoms like fever, illness, failure to thrive, etc.
The pediatrician needs to rule out underlying illnesses or conditions that could be causing the crying (gastroesophageal reflux, allergies, etc). If the crying is due to an underlying problem, there will be other signs other than just crying.
Colic is common in the first 6 weeks of life, typically decreases around 3 months, and is resolved by 4-6 months. It’s still unknown as to what causes colic. The current theory that holds some promise is that it is due to discomfort caused by the infant’s gastrointestinal microbiome and in breastfed infants, probiotic supplementation (Lactobacillus reuteri DSM 17938) might be helpful (in formula-fed babies, the same results were not noted). Another current theory is that colic is due to gut permeability and dead or tyndallized bacteria might help this. Older theories are things like gas/air in the gastrointestinal tract, the mother’s diet/allergies, and too much stimulation.
REMEMBER: The most important part of colic treatment is reassuring and supporting the parents. Like babies, parents are different; some handle crying easier than others, and colicky baby needs large amounts of patience and love. It’s key for the provider to rule out other possible causes or complications causing the crying and help the parents be confident of this, too, then to support the parents in coping with the crying and developing a healthy relationship with each other and their child.
Any intervention done to soothe the crying needs to have no adverse effects; doing something that utilizes the placebo effect is fine. Soothing skills are valuable for all parents to know: swaddling, shushing, sucking, stomach position, swinging (see Dr. Harvey Karp’s site in the resource section to learn these skills—he’s probably on YouTube, too; I especially recommend this for fathers, as they do not have a breast to soothe the baby and needs other ways of interacting with and soothing their small kids).
Things that have been tried but are of questionable effectiveness for colic: maternal dietary changes (no dairy, for example), simethicone, formulas (for formula-fed babies) that break down the allergens in cow’s milk (extensive hydrolysate formulae). These have been tries. Medical studies seem to show that they are not effective, but there are parents for whom they are effective. DON’T USE THESE PRODUCTS due to their side effects: Dicycloverine or cimetropium bromide.
Trying 2 weeks of oral lactase is recommended in the UK along with prebiotics; this does show some promise. Trying a maternal diet of no dairy for 2 weeks can be tried. Sears has an elimination diet (see recommended reading).
Long term, it’s possible that babies with colic have more gastrointestinal pains and disorders as adults, but the immediate emotional effects on the family are even more pronounced—parents are frustrated, depressed, anxious, visit the pediatrician more often, and even child abuse is more likely.
Here’s a Recommended Reading List for colic and baby soothing:
NOTE: Lots of ideas and products to try for colic. However, these are not all categorized as medical recommendations. PLEASE USE YOUR COMMON SENSE; remember, any treatment tried for colic should have no bad effects on the baby.
Ask Dr Sears: “Colic Relief: 10 Tips for Comforting Colicky Babies”
Dr. Harvey Karp The 5 s’s for soothing babies.
Resources I used to write this paper:
AskDrSears.com. (n.d.). 5 possible hidden medical causes of colic. Ask Dr Sears: A trusted resource for parents. https://www.askdrsears.com/topics/health-concerns/fussy-baby/coping-with-colic/5-possible-hidden-medical-causes-colic/
Daelemans, S., Peeters, L., Hauser, B., & Vandenplas, Y. (2018). Recent advances in understanding and managing infantile colic. F1000Research, 7, F1000 Faculty Rev-1426. https://doi.org/10.12688/f1000research.14940.1
Davis, E. (2004). Heart & hands: A midwife’s guide to pregnancy and birth (4th ed.). Ten Speed Press.
Gianluca Esposito*, Sachine Yoshida*, Ryuko Ohnishi, Yousuke Tsuneoka, Maria del Carmen Rostagno, Susumu Yokota, Shota Okabe, Kazusaku Kamiya, Mikio Hoshino, Masaki Shimizu, Paola Venuti, Takefumi Kikusui, Tadafumi Kato and Kumi O. Kuroda. “Infant calming responses during maternal carrying in humans and mice”. Current Biology, 2013.doi：10.1016/j.cub.2013.03.041