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The Crying Baby - Paediatrics

Babies cry their most at 6 weeks – just when the honeymoon period is over and all the supports have gone back to work/gone home

The Crying Baby


·        A multifactorial problem

·        Normal crying:

o  Babies cry their most at 6 weeks – just when the honeymoon period is over and all the supports have gone back to work/gone home

o  Range for ½ to 7 hours per day

o  It‟s their only means of communications 

o  May be hungry, overfeed, tired, pain, bored, hot, cold, inadequate burping, switching breasts too soon (® low fat feeds), solids before 3 months. 

o  Note especially babies cry when they‟re tired – common mistake is to stimulate and sooth them when they need to sleep 

o  Not due to parental stress. Crying leads to stress not the other way round. Harder for older women and professional who worked up to delivery to cope with (® ­sense of isolation post delivery)


·        Colic: definitions vary from crying lots to “well thriving baby who develops muscle spasms, flushing face, pulls up legs, screams. On and off every few minutes for several hours, loud tummy rumbles, relieved by flatus or passage of stool” 

o  Theories: 

§  Gut immaturity ® disordered intestinal motility ® GI pain 

§  CNS immaturity ® immature, disorganised response to stimuli ® response to most things is to cry 

§  Very unlikely to be lactose intolerance (rare before 3 months) or maternal cows milk consumption

·        History:

o  Clarify what the parent wants to know – address their issues

o  HPC: How often, when, associated behaviours, timing, pattern

o  Vomiting and bowel patterns

o  Feeding and sleep patterns


o  Maternal social history: attitude to baby, supports, PND, drugs and alcohol

·        Exam and investigations:

o  Check growth

o  Exclude physical causes:

§  Acute: otitis media, intestinal cramping/diarrhoea, corneal abrasion, incarcerated hernia

§  Chronic: gastro-oesophageal reflux

§  Nutritional intolerances from mother‟s diet (rare)

·        Issues:

o  Baby‟s safety: Is mum is at breaking point?

o  Feeding problems: sore nipples, nipple infection (eg thrush)

o  Maternal mental state: depression, lacking support, sleep deprived, anxious

o  Maternal nutrition: is she eating well?

·        Management:

o  Acknowledge strain 

o  Reassurance: “I have looked carefully for physical causes and there are none that I can see”. “Baby is growing well so is getting the food they need”

o  Things to try: rocking, pram, vacuum cleaner, ride in car, dummy, massage, warm bath 

o  Feeding: not too often, burp well, having enough?, no solids till 4 – 6 months, maternal diet (¯caffeine, cabbage, onions, experiment with what causes baby to cry)

o  Optimistic outlook: from 6 weeks to 3 – 4 months amount of crying normally reduces significantly

o  Active advice: plan what mum can do to make it easier

o  Referral to Plunket nurse or Plunket Karatane centre and/or lactation consultant


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Medicine Study Notes : Paediatrics

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