Excessive crying
An infant crying
SpecialtyPediatrics
Symptomscrying for three or more hours per 24 hours[1]
Complicationsparental sleep deprivation
Usual onsetat birth
Durationdiffers due to cause
Diagnostic methodreport by caregivers and differential diagnosis
Differential diagnosiscolic
Prognosislater developmental delays

Infant crying is the crying of infants as a response to an internal or external stimulus. Infants cry as a form of basic instinctive communication.[2] Essentially, newborns are transitioning from life in the womb to the external environment.[3] Up to 27% of parents describe problems with infant crying in the first four months. Up to 38% identify a problem with their infant crying within the first year. Parents can be concerned about the amount of time that their infant cries, how the infant can be consoled, and disrupted sleeping patterns.[4][1] Colic is used as a synonym for excessive crying of infants, even though colic may not be the cause of excessive crying.[5][6]

Physiology

Crying may elicit the Valsalva reflex. This reflex negatively impacts sucking pressures and results in poor feeding. The cortisol levels will rise along with blood pressure. Increased blood pressure will have an effect on cerebral blood flow, cerebral blood flow velocity and intracranial pressure. Increased pressures and velocity can lead to intracranial hemorrhage. Prolonged exhalation may also cause some adverse effects. Obstructed venous return and quick inspiratory gasp can occur. Foramen ovale shunting can occur.[3] Adults can often determine whether an infant's cries signify anger or pain.[7] Most parents also have a better ability to distinguish their own infant's cries than those of a different child.[8] Babies mimic their parents' pitch contour. French infants wail on a rising note while German infants favor a falling melody.[9] Overstimulation may be a contributing factor to infant crying and that periods of active crying might serve the purpose of discharging overstimulation and helping the baby’s nervous system regain homeostasis.[10][11]

Misconceptions

Misconceptions regarding the purpose of crying in the infant are common among caregivers and medical personnel. These are usually determined by cultural mores and not by evidence-based explanations. The crying of an infant is regarded by some to be normal and good.[12][13] The belief that infants have a need to cry to expand or exercise their lungs is not supported by research. This is because a healthy newborn infant lung's are able to contain a sufficient amount of air plus a reserve.[3] Birth trauma is related to the amount of crying. Mothers who had experienced obstetrical interventions or who were made to feel powerless during birth had babies who cried more than other babies.[14] Babies who had experienced birth complications had longer crying spells at three months of age and awakened more frequently at night crying.[15][16][17] When infants cry for no obvious reason after all other causes (such as hunger or pain) are ruled out, the crying may signify a beneficial stress-release mechanism, although not all sources agree with this. The "crying-in-arms" approach is a way to comfort these infants.[18][19][20] Another way of comforting and calming the baby is to mimic the familiarity of the mother’s womb.[21] Consistency and promptness of maternal response is associated with a decline in frequency and duration of crying by the end of the first year, and individual differences in crying reflect the history of maternal responsiveness rather than constitutional differences in infant irritability.[22] There is online training to address the educational needs of the parents of the infant and caregivers in the understanding and handling of infant crying.[23]

Causes

Most infants cry in response to something, although it may be difficult to identify the cause. Sometimes there may be no apparent reason. [24]

Some possible reasons include:[25][24]

  • Hunger
  • Sleepiness (Normally just yawns or rubs eyes)
  • Gas pain (for example, if the baby has not burped)
  • Discomfort (for example, a wet diaper)
  • Temperature (for example, feeling too hot or too cold)
  • External stimulus (for example, too much noise or light)
  • Boredom or loneliness
  • Pain (for example, teething)

Excessive crying in infants may indicate colic or another health problem.[25] Some health problems are listed below:

Colic

The term 'colic' was defined in 1954 as: "crying for more than three hours per day, for more than three days per week, and for more than three weeks in an infant that is well-fed and otherwise healthy."[12] Colic and excessive crying by infants is synonymous to some clinicians.[6] Colic is attributed to gastrointestinal discomfort like intestinal cramping.[26] Clinicians often admit that colic can't be treated or that alternative treatments are ineffective.[27] The protocol followed by clinicians to treat colic is described as "treating the parents" with reassurance.[12]

Maternal responses

Crying in infants is associated with high stress levels and depression in mothers.[28][29][1][4] Excessive crying has also been linked to maternal "physical aggression" and "angry speaking". The burden of care of the mother, that is, mothers without assistance in caring for the infant, are more prone to physical aggression and angry speaking.[1] During evaluations of maternal depression responses to infant crying, sleeping problems are closely associated with excessive crying and may confound the conclusions of such research. Also, it is not always clear that when sleeping problems are associated with infant crying, whether the sleeping problems are descriptive of the mother or the infant or both.[29] Maternal stress is associated with excessive crying.[30]

Effects on young children

One definition used to study excessive crying in infants (colic) is crying for three or more hours per 24 hours. Excessive infant crying has been associated with a twofold increased risk of the overall problem behavior, conduct problems, hyperactivity, and mood problems at the age of 5–6. Excessive infant crying doubles the risk of behavioral, hyperactivity, and mood problems at the age of 5–6, as reported by their mother. Excessive crying is not the only factor in later childhood difficulties. Behavioral problems in childhood include the so-called regulatory problems, such as excessive crying, sleeping, and feeding problems, which occur in 20% of infants in multiproblem families. Excessive crying, whining and sleeping problems at 4–6 months are associated with decreased social development at 12 months.[1]

Several factors may contribute to, and partly explain, an association between excessive infant crying and later behavioral and emotional problems. During early infancy, the quality of the mother–child dyad can be considered to be a crucial vehicle for child’s healthy mental development. Both early maternal and early paternal reciprocity in infancy are predictive of social competence and lower aggression in preschoolers.[1]

Compared to other infants, excessive crying infants had a slightly lower birth weight and a slightly younger gestational age. Excessive crying infants more often had a single, lower educated mother, originating from a non-industrialized country, who reported more depression, a higher burden of infant care, and more aggressive behavior and had an authoritarian parenting style. Excessive crying was associated with a higher risk for hyperactivity/inattention problems, emotional symptoms, conduct problems, peer relationship problems, and overall problem behavior at the age of 5–6, as well as a higher risk for decreased pro-social behavior as reported by the mother. Excessive crying was also associated with mood problems as well as generalized anxiety problems at the age of 5–6.[1]

Abuse

Normal crying

The physical abuse of infants is related to crying.[31] Crying may be related to the abusive head trauma in infants. This is the most common cause of child abuse death. Fathers are often the ones who shake the infant. Shaking may occur many times. This shaking can cause serious injuries almost 50% of the time. Some caregivers are unaware that shaking the baby can seriously harm or kill the infant. This type of abuse is being addressed by efforts to educate parents and caregivers with educational flyers and videos.[32]

Prevention and treatment

Infant crying is most excessive in the first several months of life, but lessens as the infant develops. A baby can sometimes be calmed by rocking gently, offering a pacifier, singing or talking softly, taking a walk with a stroller, or going for a drive in the car. If a baby won’t stop crying, it can be sick and seen by a doctor. Frustration and stress can be overwhelming for those with an infant that cries for hours on end. If caregivers feel as if they may lose control there are preventative measures that can be taken. The caregiver may benefit by calling a friend, relative, neighbor, or parent helpline for support. Another suggestion is to put the baby in a safe place and walk away. The baby can be checked every 5 to 10 minutes. Babies may be in danger if a person who is easily irritated, has a temper or a history of violence cares for or watches the baby.[33]

When "normal" causes of excessive crying are ruled out, some caregivers adopt alternative and complementary treatments for excessive crying. Those practices include:

  • Eliminating milk products, eggs, wheat, and nuts from the diet of breastfeeding mothers
  • Feeding infants fiber-enriched formula; not proven to be of benefit for most infants
  • Counseling parents about specific colic-management techniques; not proven to be effective for most infants
  • Infant massage; not proven to be effective or recommended[12]

Those who realize that an infant can be in a situation where abuse is a possibility, support can be offered to give a parent or caregiver a break when needed. Education and understanding can let the parent know that dealing with a baby that is crying excessively can be very frustrating—especially when they are tired or stressed, however crying is a normal behavior in infants and will subside at some point. Parents can be encouraged to take a calming break if needed while the baby is safe in the crib. Others can be sensitive and supportive in situations when parents are trying to calm a baby that is crying continuously. [33]

References

  1. 1 2 3 4 5 6 7 Smarius, Laetitia Joanna Clara Antonia; Strieder, Thea G. A.; Loomans, Eva M.; Doreleijers, Theo A. H.; Vrijkotte, Tanja G. M.; Gemke, Reinoud J.; Eijsden, Manon van (1 March 2017). "Excessive infant crying doubles the risk of mood and behavioral problems at age 5: evidence for mediation by maternal characteristics". European Child & Adolescent Psychiatry. 26 (3): 293–302. doi:10.1007/s00787-016-0888-4. PMC 5323467. PMID 27422707.
  2. ↑ Chicot, Dr Rebecca (2015-12-03). The Calm and Happy Toddler: Gentle Solutions to Tantrums, Night Waking, Potty Training and More. Random House. ISBN 9781473527591.
  3. 1 2 3 Walker 2011, p. 210.
  4. 1 2 Cook, Fallon; Seymour, Monique; Giallo, Rebecca; Cann, Warren; Nicholson, Jan M.; Green, Julie; Hiscock, Harriet (2015). "Comparison of methods for recruiting and engaging parents in online interventions: study protocol for the Cry Baby infant sleep and settling program". BMC Pediatrics. 15 (1): 174. doi:10.1186/s12887-015-0502-9. PMC 4640160. PMID 26556032.
  5. ↑ Kaley, Fiona; Reid, Vincent; Flynn, Emma (1 September 2011). "The psychology of infant colic: A review of current research". Infant Mental Health Journal. 32 (5): 526–541. doi:10.1002/imhj.20308. PMID 28520254.
  6. 1 2 Domino, Frank J.; Baldor, Robert A.; Golding, Jeremy; Grimes, Jill A., eds. (2014). The 5-minute clinical consult premium (23rd ed.). St. Louis: Wolters Kluwer Health. p. 251. ISBN 9781451192155.
  7. ↑ Zeskind, P. S.; Klein, L.; Marshall, T. R. (Nov 1992). "Adults' perceptions of experimental modifications of durations of pauses and expiratory sounds in infant crying". Developmental Psychology. 28 (6): 1153–1162. doi:10.1037/0012-1649.28.6.1153.
  8. ↑ Santrock, John W. (2007). "Crying". A Topical Approach to Lifespan Development (4th ed.). McGraw-Hill Humanities/Social Sciences/Languages. pp. 351–2. ISBN 978-0-07-338264-7.
  9. ↑ Mampe, B.; Friederici, A.D.; Christophe, A.; Wermke, K. (December 2009). "Newborns' cry melody is shaped by their native language". Curr. Biol. 19 (23): 1994–7. doi:10.1016/j.cub.2009.09.064. PMID 19896378. S2CID 2907126.
  10. ↑ Brazelton, T.B. (1985). "Application of cry research to clinical perspectives." In B.M. Lester and C.F.Z. Boukydis (Eds.), Infant Crying: Theoretical and Research Perspectives. New York: Plenum Press.
  11. ↑ Brazelton, T.B. (1992). Touchpoints. New York: Perseus.
  12. 1 2 3 4 5 6 7 Roberts, Donna M.; Ostapchuk, Michael; O'Brien, James G. (15 August 2004). "Infantile Colic". American Family Physician. 70 (4): 735–40. PMID 15338787. Retrieved 26 August 2017.
  13. ↑ "It's OK to be a cry baby at bedtime, study says." Age [Melbourne, Australia], 26 May 2016, p. 11. Opposing Viewpoints in Context, link.galegroup.com/apps/doc/A453306793/OVIC?u=pitt92539&xid=ffe1df14. Accessed 23 Aug. 2017.
  14. ↑ Kitzinger, S. (1989). The Crying Baby. New York: Viking.
  15. ↑ de Weerth, C; Buitelaar, JK (2007). "Childbirth complications affect young infants' behavior". European Child & Adolescent Psychiatry. 16 (6): 379–388. doi:10.1007/s00787-007-0610-7. PMID 17401610.
  16. ↑ de Weerth, C. & Buitelaar, J.K. (2007). "Childbirth complications affect young infants' behavior." European Child and Adolescent Psychiatry, 16 (6): 379–388.
  17. ↑ Keller, H., Lohaus, A., Volker, S., Cappenberg, M. & Chasiotis, A. (1998). "Relationships between infant crying, birth complications, and maternal variables." Child: Care, Health and Development, 24 (5): 377–394.
  18. ↑ Solter, A. (1995). "Why do babies cry?" Pre- and Perinatal Psychology Journal, 10 (1), 21–43.
  19. ↑ Solter, A. (1998). Tears and Tantrums: What to Do When Babies and Children Cry. Goleta, CA: Shining Star Press.
  20. ↑ Solter, A. (2004). Crying for comfort: distressed babies need to be held." Mothering, Issue 122 January/February, 24–29.
  21. ↑ "How To Calm A Crying Baby Tips for Parents and Babysitters". NannySOS. 30 November 2016. Retrieved 23 December 2016.
  22. ↑ Bell, Silvia M.; Ainsworth, Mary D. Salter (23 August 1972). "Infant Crying and Maternal Responsiveness". Child Development. 43 (4): 1171–1190. doi:10.2307/1127506. JSTOR 1127506. PMID 4643768.
  23. ↑ Cook, Fallon; Seymour, Monique; Giallo, Rebecca; Cann, Warren; Nicholson, Jan M.; Green, Julie; Hiscock, Harriet (10 November 2015). "Comparison of methods for recruiting and engaging parents in online interventions: study protocol for the Cry Baby infant sleep and settling program". BMC Pediatrics. 15: 174. doi:10.1186/s12887-015-0502-9. PMC 4640160. PMID 26556032.
  24. 1 2 "Crying in infancy: MedlinePlus Medical Encyclopedia". medlineplus.gov. Retrieved 2021-10-13.
  25. 1 2 "Excessive crying in infants: MedlinePlus Medical Encyclopedia". medlineplus.gov. Retrieved 2021-10-13.
  26. 1 2 Shamir, Raanan; St James-Roberts, Ian; Di Lorenzo, Carlo; Burns, Alan J.; Thapar, Nikhil; Indrio, Flavia; Riezzo, Giuseppe; Raimondi, Francesco; Di Mauro, Antonio (2013-12-01). "Infant crying, colic, and gastrointestinal discomfort in early childhood: a review of the evidence and most plausible mechanisms". Journal of Pediatric Gastroenterology and Nutrition. 57 (Suppl 1): S1–45. doi:10.1097/MPG.0b013e3182a154ff. PMID 24356023. S2CID 30840225.
  27. ↑ Biagioli, E; Tarasco, V; Lingua, C; Moja, L; Savino, F (16 September 2016). "Pain-relieving agents for infantile colic". The Cochrane Database of Systematic Reviews. 2016 (9): CD009999. doi:10.1002/14651858.CD009999.pub2. PMC 6457752. PMID 27631535.
  28. ↑ Johnson, JD; Cocker, K; Chang, E (1 October 2015). "Infantile Colic: Recognition and Treatment". American Family Physician. 92 (7): 577–82. PMID 26447441. Retrieved 22 July 2017.
  29. 1 2 Petzoldt, J.; Wittchen, H.-U.; Einsle, F.; Martini, J. (1 March 2016). "Maternal anxiety versus depressive disorders: specific relations to infants' crying, feeding and sleeping problems". Child: Care, Health and Development. 42 (2): 231–245. doi:10.1111/cch.12292. PMID 26490836.
  30. ↑ Iacovou, M; Ralston, RA; Muir, J; Walker, KZ; Truby, H (August 2012). "Dietary management of infantile colic: a systematic review". Maternal and Child Health Journal. 16 (6): 1319–31. doi:10.1007/s10995-011-0842-5. PMID 21710185. S2CID 8404014.
  31. ↑ Reijneveld, Sijmen A.; van der Wal, Marcel F.; Brugman, Emily; Sing, Remy A. Hira; Verloove-Vanhorick, S. Pauline (2004). "Infant crying and abuse". Lancet. 364 (9442): 1340–1342. doi:10.1016/S0140-6736(04)17191-2. PMID 15474137. S2CID 23342520.
  32. ↑ Simonnet, Hina; Laurent-Vannier, Anne; Yuan, Wenlun; Hully, Marie; Valimahomed, Sakil; Bourennane, Malek; Chevignard, Mathilde (1 December 2014). "Parents' behavior in response to infant crying: Abusive head trauma education". Child Abuse & Neglect. 38 (12): 1914–1922. doi:10.1016/j.chiabu.2014.06.002. PMID 25043922.
  33. 1 2 https://www.cdc.gov/violenceprevention/childmaltreatment/abusive-head-trauma.html Public Domain This article incorporates text from this source, which is in the public domain.

Bibliography

  • Walker, Marsha (2011). Breastfeeding management for the clinician : using the evidence. Sudbury, Mass: Jones and Bartlett Publishers. ISBN 9780763766511.
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