Crying and fussing in an infant

Definition

All babies cry and fuss. Many infants spend a considerable amount of time being fussy. Young infants cry between one and five hours out of 24. Crying is important for babies; it is the baby's first way of communicating and an important way to release tension. Constant crying, though, can be a symptom of colic or a sign that something else is wrong.

Description

The baby's cry is a perfect signal of life. It has three features:

• The newborn's cry is automatic and reflexive. The infant senses a need, which triggers a sudden inspiration of air followed by a forceful expelling of that air through vocal cords, which vibrate to produce the sound called a cry.
• The baby's cry is disturbing, even ear-piercing, loud enough to catch the caregiver's attention but not so disturbing as to make the listener want to avoid the sound altogether.
• Third, the cry can be personalized as both the sender and the listener learn ways to make the signal more precise. Each baby's cry is as unique as his or her fingerprints.

Infancy

Crying in infants is a normal, healthy means of expression and communication. The average six-week-old baby cries for two-and-a-half hours every day. Infants cry because they are hungry, uncomfortable, in pain , overstimulated, tired, or just bored. A new mother can distinguish her infant's crying from that of other babies within three days, and some fathers can make this distinction as well. A hungry cry begins softly and then becomes loud and rhythmic; an angry cry is similar to a hungry cry but louder. A cry of pain has a distinctive pattern, beginning with a single shriek followed by a short silence and then continuous loud wailing. Neglected or abused infants have a high-pitched cry that is difficult for adults to tolerate. This cry is characteristic of babies born to crack-addicted mothers and has been linked to abnormalities in the central nervous system. An infant's crying patterns and ability to be comforted are important indicators of temperament , both in infancy and even in later years.

The most common way to comfort a crying infant is to hold him or her close to the chest. Some infants are soothed by the motion of a cradle, rocking chair, stroller, swing, or automobile. Sucking on a pacifier is another comfort. Other methods include a warm bath, a massage, music, or some background noise, such as the sound of a hair dryer, a washing machine, or fan. There are also special recordings that reproduce sounds similar to those the infant heard while in the mother's womb. Some infants are hypersensitive to stimuli, and their crying will get worse if they receive any more than a minimum of comforting, such as parental holding or cuddling. A sign of healthy emotional development is the degree to which an infant learns to comfort him- or herself, either with the aid of an object such as a stuffed toy or blanket, or by certain patterns of behavior, such as sucking on a thumb.

Another cause of excessive crying is hypersensitivity. Hypersensitive infants cry in response to new experiences that do not normally upset other babies; ordinary comforting measures, such as holding, rocking, feeding, or swaddling do not work and may even make the crying worse. Hypersensitivity can be a matter of temperament, and it may be influenced by the behavior and attitude of the parents. Some children get into the habit of excessive crying as a way of demanding parental attention. The parents of such children may be overprotective, not giving them the chance to develop independence and resourcefulness by solving problems on their own.

Common problem

Many new parents are not prepared for the amount of time a newborn spends crying. Infants typically cry an average of two hours of every 24 for the first seven weeks of life. The duration peaks at about six or seven weeks. Almost all infants have a period during the day when they are fussy. New parents need to recognize this as normal and not worry. Parents might use this fussy time for bathing or playing with the infant. The most typical time for fussy times is between 6 p.m. and 11 p.m., often when parents are tired and less able to tolerate crying.

A common cause of persistent crying in infants is colic, which is caused by gastrointestinal distress. Colicky infants may have a hard abdomen, get red in the face, and curl their legs up. Often times the colic begins in the evening after the baby's last meal before bedtime. Rocking or walking around with the baby held up against the shoulder can sometimes soothe the infant. Holding the infant face-down across the lap puts pressure on the belly that can sometimes ease the distress.

Among the most common physical reasons for excessive crying are earaches, viral illnesses, and other causes of low-grade fever . Teething also causes increased crying. Medical attention may be necessary if an infant is crying more than usual or if the cries themselves sound different, for example, the cries are weaker or more high-pitched than usual.

Different kinds of cries

As parents get to know their baby, they become experts in understanding the baby's cries. Cries are the baby's form of communication. Following are several common reasons babies cry:

• Hunger: If three or four hours have passed since the last feeding, if the infant has just awakened, or if he or she had just had a full diaper and begins to cry, the baby is probably hungry. Most babies eat six to ten times in a 24-hour period. For a least the first three months, babies usually wake for night feedings.
• Tiredness: The baby has decreased activity, loses interest in people and toys , rubs eyes, looks glazed, and yawns. If the infant cries, he or she may just need to take a nap.
• Discomfort: If babies are uncomfortable, too wet, too hot, or too cold, they will squirm or arch their back when crying, as they try to get away from the source of discomfort. The distress of gas or indigestion can cause the baby to cry, as can wet or soiled diapers and uncomfortable positions. Parents should try to find the source of the child's distress and solve the problem.
• Pain: A sudden shrill cry followed by a brief silence and then more crying communicates pain. The parents should examine the baby carefully to locate the source of pain and remove it.
• Overstimulation: When overtired or overstimulated, babies cry to release tension. If the room is noisy and people are trying to get the baby's attention, the baby may close his eyes, turn his head away, and cry. The parent should find a quiet, dark room and hold the baby until he or she is calmer.
• Illness: When babies are sick, they may cry in a weak, moaning way. If the baby seems ill, parents should take their temperature and call the healthcare provider.
• Frustration: Some babies cry out of frustration because they cannot do what they want to do. Sometimes they want a toy but cannot control their arms and hands enough to reach it. Taking note of the baby's attention to an object and putting it within reach may solve the problem.
• Loneliness: Babies who fall asleep feeding and are placed in a crib may wake soon afterwards crying. These babies are signaling that they miss the warmth of their parent's embrace and do not like being alone. A baby seeking such comfort may calm down simply with the assuring sight of mother, hearing her voice, feeling her touch, cuddling, or being offered something to suck.
• Worry or fear : When the baby suddenly finds himself in the arms of a stranger and cannot see the parent, the baby may begin to cry. Some babies need more time than others to warm up to someone new.
• Boredom: If the baby has been left to play while a parent is busy with another task, boredom may set in. The child is not tired, hungry, or uncomfortable, but starts a whiny, fussy cry. A new position or different toy may help.

Parental concerns

Responding to baby's cry is biologically correct. Mothers are biologically programmed to give a nurturing response to their newborn's cries and not to restrain themselves. Biological changes take place in a mother's body in response to their infant's cry. On hearing the baby cry, the blood flow to the mother's breast increases, with a biological urge to nurse. The act of breastfeeding itself causes a surge of prolactin. Hormones that cause a mother's milk to let down brings feelings of relaxation and pleasure; it is a pleasant release from the tension built up by the baby's cry. These biological responses help mothers to connect with and meet their babies' needs.

New parents sometimes feel guilty when their babies cry. It is not the parent's fault that babies cry. Parents should be responsive to their babies and try to help them feel secure in their world. The parent's job is to create a sympathetic environment that lessens the baby's need to cry, to offer a set of caring and relaxed arms so the baby does not need to cry, and to do as much detective work to figure out why the baby is crying as possible.

There are many times when parents cannot tell why their baby is crying. Some things to try include:

• Hold the baby. No matter the reason for the baby's crying, holding offers security and may calm the baby.
• Breastfeed. Nursing the baby is as much for comfort as food. Most babies calm easily when offered the breast.
• Provide motion. Babies enjoy repetitive, rhythmic motion such as rocking, swinging, swaying, and jiggling. Many parents sway when they are holding a fussy baby because it soothes the baby.
• Turn on some white noise. The womb was a noisy place. Sometimes the baby can be calmed by white noise that is continuous and uniform, such as that of a heartbeat, the rain, static between radio stations, and the vacuum cleaner. Some alarm clocks even have a white noise.
• Let music soothe the baby. Soft, peaceful music calms some babies.
• Give the baby a massage. Babies love to be touched and stroked, so a massage is one way to calm a fussy baby. A variation of massage is the baby pat; many babies love a gentle rhythmic pat on their backs or bottoms.
• Swaddle the baby. During the first three or four months of life, many babies feel comforted if they are held tightly in a way the reminds them of the womb.
• Distract the baby. Sometimes a new activity or change of scenery is calming. Maybe a walk outside, a dance with a song, or a splashy bath can be helpful in turning a fussy baby into a happy one.
• Let the baby have something to suck on. The most natural pacifier is mother's breast, but pacifiers and teething rings also may work. It is important for everything to be clean that goes into the baby's mouth.

When to call the doctor

Parents should call the healthcare provider if there are concerns about why the baby continues to cry. It is important not to misdiagnose a serious condition and call it colic. If the baby's behavior or crying pattern changes suddenly or if the crying is associated with fever, forceful vomiting, diarrhea , bloody stools, or other abnormal spasms or symptoms, call the doctor immediately. Parents should not hesitate to seek help immediately if they feel overwhelmed and are afraid that they will hurt or neglect their baby.

See also Colic .

Resources

BOOKS

Jones, Sandy. Comforting Your Crying Baby: Why Your Baby Is Crying and What You Can Do about It. New York: Innova Publishing, 2005.

Lester, Barry M. Why My Baby Is Crying: The Parent's Survival Guide to Copying with Crying Problems and Colic. London: Harper Information, 2005.

Nelson, Judith Kay. Crying, Caregiving, and Connection: An Attachment Perspective. Florence, KY: Brunner-Routledge, 2005.

WEB SITES

Nissi, Jan. "Crying: Age 3 and Younger." PeaceHealth , March 3, 2003. Available online at http://www.peacehealth.org/kbase/topic/symptom/crybb/overview.htm (accessed December 14, 2004).

Aliene S. Linwood, RN, DPA, FACHE