Is your baby’s excessive crying making you sob like one too? Find out what the causes could be, and how you can deal with them so that Baby can stay calm longer.

First things first: crying is a common symptom in the first few months of life. It is so common that it is responsible for approximately 20 per cent of all pediatric consultations. Excessive crying, however, can cause concerns, especially for caregivers who have to face the ‘distress‘ day in, day out.

What is Excessive Crying?

There is no single definition for excessive crying. American paediatrician Morris Arthur Wessel used a “rule of three” criteria to describe newborns up to four months of age with this condition — crying spells at least three hours a day, three times a week for three consecutive weeks, and lasting three months.

Recently, more importance is given to the severity of the crying itself than the time limit — an infant’s prolonged, hard-to-soothe, and unexplained nature of the crying behaviour which causes distress in parents.

Why is it Important to Deal with Excessive Crying?

Recurrent unexplained symptoms in young children can cause concerns for caretakers. This is especially so because young children are unable to verbally express their emotions or the pain that they feel. Hence a medical review is necessary to ensure that the child is not ill, and to have a better understanding of their well-being.

What are the Long-term Concerns for Child who has Excessive Crying?

Some studies have found that babies with excessive crying and difficulties in sleeping and eating in the first few months of life go on to have problems adapting when they go to school. Do take these results with caution though, as there are concerns in the way the studies were designed.

Why is My Baby Crying So Much?

In general, babies cry more after birth. This increase in crying reaches a peak around five to six weeks of gestational age, and then declines at three months. In less than five per cent of children who have inconsolable crying, there could be an underlying disease causing the tears. However, for the majority of young infants, excessive crying does not indicate a disease or anything to be overly concerned about.

Why is your baby crying so much then? Perhaps it could be because of one of these reasons:

• Functional Gastro Intestinal Disorders (FGIDs) — This is often seen in infants who cry excessively. FGIDs are common worldwide in infants and toddlers. They are associated with chronic, recurrent symptoms.

• Environmental factors — These play a major role in a child’s excessive crying. It includes family disruptions, psychosocial problems, and domestic violence.

• Stress during pregnancy — A study has found that stress during pregnancy is strongly related to excessive crying spells in infants during the first six months of life.

• Pathological causes (pointing towards a disease) – This can include:
(i) infections involving the ear/brain/urinary tract
(ii) gastrointestinal disorders such as gastroesophageal reflux disease/constipation/intestinal intussusception/ lactose intolerance/allergy to cow’s milk
(iii) drug reactions such as reactions to vaccines/drugs used during pregnancy (narcotics)
(iv) certain blood-related disorders
(v) cardiovascular disorders such as rhythm issues and heart failure
(vi) trauma to eye/digits and foreign body in the eye, and
(vii) violence/abuse leading to long bone fractures/bleeding inside eye and brain

INFANT COLIC

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Infant colic is a behavioral phenomenon in infants aged one to four months. It involves long periods of inconsolable crying and hard-to-calm behavior. The term “colic” refers to abdominal pain that is acute and which cannot be explained. Prevalence rates for infant colic vary widely, with a recent review reporting a median rate of 17.7 per cent. It has been suggested that alteration in the type of bacteria seen in the intestine affects the intestinal movement and gas production, leading to colicky behaviour.

How do Doctors Diagnose Colic?

According to the Wessel criteria, the “rule of three” can help:
(1) No apparent cause
(2) Healthy infant
(3) Gaining weight

When parents can offer a focused history of their baby’s behaviour, this can provide valuable information to the doctor. The way parents arrive and describe the complaint, how they hold and receive their babies, as well as the strategies they use to calm their babies, are important sources of observation for the doctor. This is not only diagnostic but can also be used therapeutically during the consultation.

Generally, it is not common to find abnormal signs during the physical examination. However the doctor will generally perform a complete examination as part of the assessment and as a management strategy. This is to reassure parents that the infant does not suffer from any disease.

Dealing with Infant Colic

Colic is a self-limiting disease. In the absence of other alarming symptoms, it is usually treated with education and reassurance. One of the most important goals of treatment for infant colic is to help caregivers cope with their infant’s symptoms and to provide support for the infant-family relationship.

Here, simply remember another “rule of three” set:

(1) Infantile colic is not a disease
(2) Nothing will happen to the infant because of the pain
(3) Colic passes on its own and “it is a problem that the baby will learn to solve”

What parents can do is to learn methods to solve the crises, clarifying the meanings of the infant’s crying, dispelling myths, relieving feelings of guilt and the need to share the burden, while the other parent rests.

Techniques to Help with Infant Colic

• Wrapping the infant. This has shown benefits in some studies, where wrapping is more efficient up to eight weeks of age compared to infants who were not wrapped.

• Calming the child in a parent’s arms, with a warm cloth touching the child’s abdomen.

• In one study, the use of sleep hygiene and the establishment of a routine, organising the infant’s and the parents’ day, reduced crying by 42 per cent.

• The use of teas, such as fennel, licorice, chamomile and peppermint. Some encouraging results were shown using fennel, and since teas do not have side effects, they can be used as a therapeutic aid.

• The medicine Simethicone shows no benefit. Its efficacy could be due to the calming effect of its sweet taste.

• A recent analysis confirms that a probiotic (L reuteri DSM17938) is effective for breastfed infants with colic. However, further research needs to be done to confirm whether it works as well in formula-fed infants with colic.

INFANT REGURGITATION

Gastroesophageal reflux (GER) happens when stomach contents move back into the esophagus, mouth, and/or nose involuntarily. The term “regurgitation” describes cases when gastric contents can be seen. This is part of an infant’s normal development and nothing to worry about if there are no other complications. Generally, the management of regurgitation does not require medical interventions. The most important part of treatment is to give reassurance to caregivers. Other treatments include thickened feedings, anti-regurgitation formulas, and left lateral (only when supervision is there during day time) positioning after meals.

If Baby is Still Crying…

The thing to remember is that all babies cry. But when a baby has excessive crying, it is a cause for concern and you should bring your little one to the paediatrician for a check-up. A focused history and detailed examination by a doctor is essential to eliminate worrying causes of excessive crying. Environmental factors and parents’ emotions play important role in managing excessive crying. Reassurance, education, and support for parents and caregivers will help all in the family get through this trying time together.

To learn more about Raffles Children Centre or make an appointment with a paediatrician, visit: https://www.rafflesmedicalgroup.com/specialist-centres/services-by-centre/children

Expert Resource

Dr Vidya Ramasamy is a paediatrician and was accredited as a Specialist in Paediatric Medicine in Singapore in 2014. Prior to joining Raffles Hospital, she was an Associate Consultant specialising in Neonatology. She manages neonatal care, childhood vaccinations, developmental assessment and common paediatric illnesses. Dr Vidya’s main areas of interests are managing pre-term neonates and their developmental follow-up post-discharge. She also has experience in performing procedures related to the neo-natal intensive care unit.

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