An article published in Family Physicians Association Magazine, Rajkot

Introduction

Excessively crying baby is often a serious problem for physician as well as the parents. All babies cry. It is an attachment behaviour needed for the development of social bond.

Babies usually cry about two hours a day. About 15% of them cry more than three hours a day. Usually it is more in the evening. But can occur any time of the day. It is a sign of distress. Babies cry when they are unhappy or uncomfortable. It is a process of adaptation to the extra uterine stimuli like sound, light, temperature changes and handling.

When to define it as an excessive crying?

As such any crying that is beyond parental tolerance is excessive. And parental tolerance is dependent on their own psychology, education, and social support. For physicians it can be defined as paroxysms of crying lasting for more than three hours a day and occurring on more than three days a week.

What are the causes of crying?

1) General causes

Trauma, rashes, corneal abrasions, mouth ulcers, otitis media, stuffy nose, pharyngitis, anal fissures, DPT reaction,

2) Serious causes

glaucoma, meningitis, hydrocephalus, intussusceptions, GI reflux, cow’s milk protein intolerance, testicular torsion, UTI, obstructive uropathy, CCF, fractures, scurvy, osteomyelitis, septic arthritis, septicemia etc.

3) Infantile colic (evening colic)

Colic can be defined as intermittent, unexplained crying during the first three months of life that reaches a point where the parents complain about it.

Colicky babies are well fed, healthy and happy between crying spells. Colic usually begins in the first month of life.

The clinical features of infantile colic are;

1) Attacks occur suddenly, usually in the evening.

2) Loud continuous cry.

3) Lasting for 30 minutes to 2 hours.

4) Flushing of face with occasional circumoral pallor.

5) Distended tense abdomen.

6) Legs drawn up to the abdomen and cold feet.

7) Fingers clenched

8) Relief often noted after passage of flatus or feces.

9) No relief with feeding

10) Attack usually terminates from apparent exhaustion.

Contributing factors;

1) Mother; Inexperienced and anxious, sleep deficit, excessive housework, job stress, depression

2) Environment; Father absent or marital discord, lack of family support, critical neighbors

Management of excessive crying baby

1) Role of a physician.

• First eliminate the medical causes of irritability before labeling it as colic.
• Take detailed history of the infant’s crying, sleep, feeding.
• Ask parents about their concerns and strategies tried.
• Stop inappropriate medications for the baby.
• Parental counseling is the mainstay in the treatment of colicky babies.

Explain parents that;

Normal crying peaks at 6 weeks and mostly disappears by 3 to 4 months.

All babies are different regarding normal sleep requirement.

Some babies find it difficult to cope with the sensations of normal reflux, elimination, tiredness or hunger. They become irritable and cannot soothe themselves.

Discuss with parents the ways of calming the baby.

Provide gentle motion and   physical contact. Apply quiet and gentle approach while routine procedures like nappy changing or bathing. Set a predictable schedule for naps and sleep and feeding. Continue breast feeding and avoid weaning at this stage. Keeping a dairy can help identify the causative factor or help monitoring the response to a strategy.

Father’s role

The role of a father is often neglected. Father is often an invaluable source of practical and emotional support for the mother and their baby during this time.

When to refer?

Baby to the pediatrician if;

Continued sleeping and feeding problems beyond three months of age

Avoids gaze

No response to parents when not crying

Does not enjoy play

Remains distressed beyond three months of age

Mother to the psychiatrist if;

Lacks empathy, makes hostile statement

Not feel ‘bonded’ to the baby

Unable to follow advice

Reports symptoms of depression or anger and anxiety

Outcome  

Most babies settle down by 3 to 4 months of age.

Irritable babies are more likely to develop behaviour and sleep problems in toddler and preschool years.

Families of irritable babies are less likely to have subsequent siblings than families of non-irritable babies!!!!

PS: The article was written for FPA times, 2010

DR NEEMA SITAPARA

MD (Ped), PGDip. (Adolescent Pediatrics)