Problem Crying in Infancy
29 October 06 Up to 20% of parents report a problem with infant crying or irritability in the first 3 months of life.
Crying usually peaks at 6 weeks of age and abates by 12-16 weeks.
For most irritable infants, there is no underlying cause.
CAUSES OF EXCESSIVE CRYING
For most infants, excessive crying is part of a normal spectrum whereby these babies have not yet learned to self-soothe'.
Less than 5% of babies with problem crying have an identifiable cause.
1. Mother-Infant Interactions
Infant factors
emotional reaction to normal' physical sensations (e.g. bowel spasms)
overwhelmed by environmental stimuli (loud noises, parental interactions)
traumatic birthing & postnatal experiences
immature sleep/wake cycle, digestion processes
over-handling, overtired, poor feeding
Mother factors
anxiety, exhaustion, stress
personal beliefs regarding infant's behaviour and own parenting abilities
postnatal depression
own attachment relationships in childhood
previous perinatal or neonatal loss
high stakes pregnancies (IVF, threatened miscarriage)
marital/relationship problems and tensions
poor social supports and social isolation
Other medical causes of excessive crying are rare.
2. Infections/Illness
Infections such as urinary tract infections and other illness should be ruled out.
3. Gastro-oesophageal reflux (GOR)
frequent vomiting (more than five times a day)
silent reflux' without frequent vomiting rarely occurs
blood in vomit, poor weight gain
if GOR is diagnosed, non-drug treatments or medications may be prescribed
4. Food allergy/intolerances
especially in infants with a personal or family history of allergic disorders (eczema, asthma, true food allergies or anaphylaxis)
food allergens commonly implicated are cow's milk protein and soy protein
vomiting, blood or mucous in stools, poor weight gain, signs of allergic disease (e.g. eczema, wheezing)
a trial of elimination cows milk by modifying mother's diet or formula is the best diagnostic test
under medical supervision, mother's of breastfed infants may try completely eliminating dairy proteins from their diet (with appropriate calcium supplementation)
formula fed babies may be tried on a soy-based formula initially (although 50% of dairy sensitive infants will also be sensitive to soy and goat's milk proteins)
if no response, various hydrolysed (partially digested) formulas may be prescribed.
any change should be trialed for 2 weeks prior to deciding its success or failure
5. Lactose intolerance
true deficiency in lactase (the enzyme that breaks down lactose milk sugar is rare)
excess lactose is fermented in the gut producing lactic acid and hydrogen gas
the resultant gas production may cause bowel spasm and acidic faeces may cause burning and redness of the anal area
a stool test may help in the diagnosis
under medical supervision, formula fed infants can be trialed on soy-based or other lactose-free formulas.
under medical supervision, breast fed babies may be fed with lactase-treated breast milk
6. Bowel spasm or gas
may occur in normal infants early on if mother's have an overwhelming breast milk supply, until the infants digestion processes mature a little more to cope with the large milk supply.
studies have found that simethicone drops have no effect compared to placebo
INTERVENTIONS FOR PROBLEM CRYING
keeping a behaviour diary may be useful to recognise crying patterns and adequacy of sleep through the day.
ensure that the infant has a predictable routine of sleep, feed, wake times. Consistency is vital to establish proper predictable routines & to reduce stress
infant settling techniques aim to help infants to learn how to self-soothe and fall asleep by themselves (an important skill for later childhood and adulthood)
most settling techniques recommend that the parent pats or rocks the infant until he/she is quiet but not asleep. The parent then leaves the room to allow the infant to fall asleep by themselves.
if the baby starts crying, after a moment, the parent returns and repeats the above process to resettle the baby. The process continues until the baby falls asleep.
some babies need to held by their mothers more constantly. They may not settle with the above technique. These babies may settle better if kept near the mother more continuously or if put into a pouch or sling. Sleeping in the same room (but not the same bed) is an acceptable technique in some infants
introduction of a transitional object' (a doll, teddy, blanket or shock horror even a dummy if older than 4 weeks) may gradually come to represent maternal care and help the baby to self-soothe
fathers are an invaluable source of practical and emotional support for mothers and babies during this time. Allow and encourage fathers to work out their own ways of interacting with the infant, which may be different, but equally as effective
for most babies, problem crying and irritability settle spontaneously by 3-4 months of age.