All babies cry, and most babies spend quite a lot of their early life crying. This is normal, reassures consultant paediatrician Dr Keith Bolton, the former chief paediatrician at Rahima Moosa Mother and Child Hospital in Johannesburg, who has a special interest in infant crying and its impact on the mother-child relationship.
Normal crying, he points out, is one of the most common reasons for mothers to take their babies to the doctor in the first three months of life. This is mostly because mothers’ expectations and tolerance levels vary widely. However, this underscores an important point – a crying baby can be hugely upsetting, especially if you’re unsure whether the crying is normal or a symptom of ill health.
What your baby’s cries are telling you
Your baby is completely dependent on you for soothing and protection, so she is born with a set of survival techniques to cue your care. Take note of grimacing, yawning, fussing, fists and fingers in the mouth, or wide eyes. If these cues are missed, crying is your baby’s next resort and usually her strongest signal of discomfort, explains Jacqui Jorge, a paediatric occupational therapist whose practice treats ‘fussy’ infants.
Crying of this nature doesn’t usually begin at birth. While babies may niggle in their first few days, they usually begin their lives quite sleepy. They tend to become more alert between 10 days and two weeks, when their crying will increase.
“The crying will peak around six weeks, and start to improve around eight weeks. By 14 weeks, it has usually subsided, according to Conny Fraser, a registered nurse, midwife and owner of the Baby Grow Clinic in Cape Town.
How to soothe your baby
The best soothing strategies are those that come from learning to read your baby’s cues and finding which inputs are most soothing, suggests Jacqui. Some strategies can be more powerful than others. To settle a baby quickly, try letting her suckle (breast, bottle or dummy) while subtly rocking her backwards and forwards. If your baby is in a full-throttle cry, try deep-pressure tactics such as swaddling and firm pressure when handling her. Try bringing her hands to her midline, let her suck her fingers, and create a soothing environment including dim lights and slow movements.
Some babies cry more than others
The amount of time your baby spends crying is the result of a complex mix of factors, says Jacqui. Temperament, birthing history, a parent’s sensitivity and responsiveness to the baby’s needs, the baby’s capacity to process sensory input, medical conditions such as reflux, allergies and lactose intolerance, as well as the environment all influence how much a baby cries. Dr Bolton explains that within this complex matrix of factors are those babies with wonderfully responsive parents, who’ve had normal birthing conditions and who grow up to be well-adjusted children, but start to cry excessively at around two weeks of age.
Medical science is yet to determine the exact reasons why these infants cry more than others, and they’ve become known as ‘colicky babies’ after US paediatrician Dr Morris Wessel identified (in 1953) that some infants cried for longer than three hours per day, on more than three days per week and for more than three weeks in a row. This is often referred to as the Rule of 3s.
The colic cry
A number of studies across cultures have subsequently confirmed Dr Wessel’s criteria for colic. These infants, explains Dr Bolton, will cry excessively, screaming inconsolably hour after hour.
These babies often pull their legs up to their stomachs, clench their fists, go blue or red from the effort of crying, and look as if they are in pain. This is why mothers believe their babies are in pain and that the source of pain is the abdomen. However, although the word colic implies colon, there is little evidence that colicky babies actually experience intestinal pain or spasm, Dr Bolton explains. “I’m not saying these babies don’t experience pain. About 5% of colicky babies are allergic to the protein in milk and get better if you put them on a hydrolysed formula. Studies have also found that before they start crying, colicky infants have normal amounts of stomach and intestinal gas. It’s after crying that they have gas. Additionally, all the paediatric drugs useful for cramping don’t bring relief unless paired with a sedative.”
Recent studies show that colicky babies tend to have more migraines as adults than non-colicky babies and that the condition may have more to do with the brain than the gut. Some research also points to sensory processing difficulties.
The silent scream
The toll that incessant and excessive crying can take on parents is often overlooked. “It is very difficult for a mother to remain calm and ‘in love’ with her baby when all her efforts to console her baby, the one job she feels she should be able to do, are unsuccessful,” says Jacqui.
The incessant crying can also produce bizarre and panicked thought processes, with a significant percentage of mothers fantasising about infanticide. “This is not to say that these mothers harm their babies. Child abuse is less common among mothers to colicky babies. Rather, feeling utterly beside themselves, these mothers may find themselves cooking supper while trying to placate their screaming baby when thoughts like ‘I would like to boil you with the butternut’ arise. Horrified, they often feel too guilty to tell anyone,” says Dr Bolton.
This can leave them feeling not only hopeless and guilty, but isolated, too, since studies have shown that mothers with colicky babies tend to have a disrupted family life.
At your wits’ end?
Many healthcare professionals overlook parental concern about baby crying. Mothers are told to bite the bullet and that the crying will go away in time. However, Dr Bolton found that what helped his patients most was acknowledging their desperation. “It helped mothers that they could cry in my office and be reassured that their disturbed thought patterns were a normal response to an extreme situation,” he says.
Jacqui urges parents who feel they can’t cope with their baby’s crying to seek out a professional who takes their concerns seriously. Moms who need support may find it from either a group of parents in a similar situation, or a specialist in mental healthcare. Postnatal depression and colic often go hand in hand.
As for baby treatment, Dr Bolton prescribes a mild sedative. You can’t sedate a baby during the first few months of his life as this is when he learns the most. However, sometimes it helps for parents to know that there’s an option should the situation become unbearable.
When is crying a symptom of ill health?
“Colicky babies are almost always thriving,” says Dr Bolton. Regular healthcare checks at your local baby clinic can help you to determine if your baby is gaining weight. If not, then incessant crying can be a sign of an underlying illness. If you suspect ill health, rather seek medical help.