Richmond Practice - The crying baby

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The crying baby

Dr Robert Arlt MD, Consultant Paediatrician at +richmond practice offers insight in to the medical and psychological reasons for excessive crying in babies with good practice recommendations.

Published in Baby Surrey, May/June 2015

Crying is a normal vocal expression for a baby, but is also an alarm signal for the parents or carer.

How much crying is acceptable?
On average babies cry around 60 minutes a day.  A healthy baby has an automatic capacity to settle without help from their parents. Studies show that crying often gets worse at about six weeks of age. You should be concerned if your child cries continuously for more than three hours in a row, more than three days a week, over a period of three weeks or more.
Research suggests that up to 30% of babies cry excessively. It usually starts at two weeks and can go on to six months.

What causes excessive crying?
There are a variety of medical causes. The following are examples:
  • Rhinitis – an irritation or inflammation inside the nose
  • Reflux – frequently associated with cow’s milk protein intolerance
  • Urinary tract infections
  • A hernia
  • An intestinal intussusceptions or gut malformation
  • Meningitis
  • Other stomach problems
A crying baby may also induce a vicious circle of interaction. If the baby is unsettled the parent or carer becomes anxious and when they are anxious their intuitive perception of their child’s needs may reduce. This causes insecure behaviour towards the child, who may sense this and in return get even more unsettled.

Sometimes above average crying is due to difficulties in a baby’s automatic capacity to settle, as mentioned above.

Soothing measures
Unfortunately soothing measures such as positioning, moving, massage, homeopathy, even some commonly used medication, lack reliable evidence as a remedy beyond its mainly placebo effect.
 
There is psychotropic medication which has proven to be effective, but with so many side-effects that it is not used any more
Some evidence suggests that babies, who are picked up regularly, will cry less. Responsive and sensitive human touch may help.
A regular routine which creates a predictable secure environment is also important. Breastfeeding and/or a regular feeding schedule also have a settling effect on babies.

You should avoid:
  • Excessive sensory stimulus
  • Letting the carer become over tired and emotionally exhausted (It is important for carers get regular respite)
  • “Misunderstandings”

A typical example of a “misunderstanding” is when the baby turns their head away. This usually just means that the baby has had enough input and needs space. If anxious carers misinterpret this as rejection, they may attempt to play more with the child and the child may start crying. This can also affect the child’s ability to settle. The parents/carer’s may lose confidence and feel inadequate, which may impact their intuitive feel for the situation and the child.

Consult your doctor:
  • To exclude an underlying medical problem
  • If you’ve lost confidence
  • If after implementing the suggested measures your baby is still crying excessively
At +richmond practice we have two specialist children’s doctors who are consultants in Paediatrics. They are available Monday to Saturday, 60 hours per week to help families who are struggling with a crying baby. You will reliably get a follow-on appointment with the same doctor, if needed. We are open for emergencies, developmental checks, vaccinations and we do paediatric ultrasound. Our newly refurbished office has a breastfeeding and baby changing facility and is close to Richmond Station. For more information visit richmondpractice.co.uk or call 0208 940 5009.
 

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