Dr Khoo Boo Aik
M.D. (UKM) MRCPCH (UK)
Consultant Paediatrician and Neonatologist
Sunway Medical Centre
All babies cry and some babies do cry more than the other. On average, newborn babies cry for about 2 hours a day. Most of the time they cry for a specific reason and parents normally know how to handle them. But sometime their crying can be very prolong and intense despite all the attentions that parents gave and this can be a very anxious moment both for the parents and caregivers. By understanding why babies cry, we can be more focus on finding the solution for each episodes of crying especially to indentify the one that needs special medical attentions.
Why babies cry?
Most of the time, the reasons why babies cry and normally consolable are:
- Hungry or thirsty
- Wet or dirty diapers
- Uncomfortable, either too hot or too cold or may be uncomfortable with their clothing
- Tiredness especially before they fell asleep
- Frustration of not being able to do something such as reaching for toys or their hand got stuck while they learn to roll over
- Need attention and accompany
Possible reasons of why babies cry became inconsolable and intense?
- Excessive wind in their tummy (colic)
- Milk regurgitation or reflux
- Unwell due to fever, cough, cold or in pain
How to deal with crying babies?
Most of the time, parents can settle their babies by indentifying their needs and fulfill them. They may be crying for specific needs such as:
- I need food – offer your babies some milk especially breastfeed them. They may continue to cry for a moment during the feeding time but once their stomach is full, they may just settled on their own. We advise feeding your baby more frequently but with lesser amount so as to avoid regurgitation or stomach discomfort due to over feeding.
- I need to be comfortable – make sure your baby is comfortable with her clothing as not to overdress her with too many layers or tight fitting dress that may make her feels uncomfortable and therefore she may cry in protest. Soiled nappy may irritate the tender skin of your baby and by changing her nappy may just solve her crying episode.
- 3. I need to be held to feel secure – Some babies need more physical contact than the other to feel warm and secure. So, if your baby is still crying for attention after changing her nappy or feeding her, you may want to cuddle her for a short period of time before putting her to sleep. Infant massage can be very soothing and effective way to make your baby feels secure.
- 4. I need a rest – Overstimulation by her surrounding such as toys, visitors or noise from other children can be overwhelming to your baby. This may cause her to find it difficult to settle down. Try to gradually withdraw her from the stimulation by bringing her to a quiet room and calm her down by rocking, humming with soft and soothing music. She may express her feeling by crying for a while but eventually will settle to sleep.
Important thing to note is that nobody understanding your baby as well as you do. So if you think there is something wrong with your baby despite the above tips, bring him/her to medical attention.
How to deal with babies who cry inconsolably?
Babies who cry inconsolably may be due to:
- abdominal colic
- pain cause by acid reflux or
- Unwell or sickness
Sometime the crying episode will become too intense and prolonged that seeking medical attention is required to make sure your baby is not suffering from serious illnesses.
1. Abdominal Colic
What is colic?
Colic or abdominal pain/cramps are sudden attacks of gut irritation, bloatedness and discomfort. It may present as prolonged crying i.e. unsettled baby. It stops as suddenly as it started. Crying often starts in the evening especially before bed time. The infants seem to be in pain in which they may stretch, arch or lifting their legs. The abdomen may be distended and the infants may pass a lot of wind.
What causes colic? Is it real?
The exact causes are unknown but the pain is real. However, there are some factors identified which may contribute to the symptom.
- Overfeeding without burping
- “Emotional stress” of both baby and parents
- Food intolerance/allergy
What I can do when my baby has colic?
There is no specific treatment for colic and the management of colic is just a matter of “trying out”. Sometimes whatever you try may just go in vain. However, colic pain can be enlightened by comforting the child by holding him/her in an upright position to facilitate burping or by massaging the baby’s abdomen. Make sure you don’t overfeed or underfeed your baby. Treat the underlying constipation if any. Probiotic which is a good and friendly bacteria to your baby’s intestine may be helpful.
When to bring my “colicky baby” to see the doctor?
Inconsolable/irritating cry coupled with abdominal distension and refusal to feed should alert you to bring your baby for medical attention. Your baby’s doctor will then make sure that nothing serious happen to your baby and most of the time will reassure you with some good advise/tips of good feeding techniques. If the symptoms worsen, your baby’s doctor may prescribe colic drops to ease the pain or probiotic drops to facilitate digestion and gut motility. Your baby’s doctor will also try to exclude any possibility of food allergy/intolerance in your baby which may require further dietary modification.
2. Gastro-esophageal Reflux (GOR)
What is reflux?
Sudden and effortless return of small volumes of gastric content into the esophagus and mouth, also called regurgitation.
What causes reflux?
The main reason for GOR is an underdeveloped or weak lower esophageal sphincter. It may also be caused by large meal with relatively small stomach, short esophagus and increase abdominal pressure due to straining or excessive crying.
Should I worry if my baby has reflux?
Uncomplicated reflux is common and physiological. A lot of babies will regurgitate certain amount of milk after feeding. However, if the reflux is accompanied by other symptoms such as excessive crying due to pain (esophagitis), failure to gain weight or projectile/forceful vomiting, you should bring your baby to doctor’s attention immediately for further assessment and evaluation.
What I can do if my baby has reflux?
You can try feeding your baby with smaller amount of milk but more frequent feeds and give time for him/her to burp. Handle your baby carefully especially when the stomach is full.
Nurse your baby slightly upright position about 30-45 degrees during feeding and for about ½ hour post feeding. Thickening the milk (thickened or anti-reflux formula) is recommended as a treatment for regurgitation and proven to benefit most infants with significant GOR.
Can my baby recover from reflux?
Majority of the uncomplicated reflux will resolve spontaneously, normally by 6-12 months of age. With proper feeding technique, slightly upright position and thicken feeds, reflux will be self limiting. Those associated with complication and more severe presentations, your doctor may need to prescribe some medications to facilitate the gastric emptying and suppress the gastric acidity.
3. Excessive cry in baby who is unwell or sick
Babies often cry when they are unwell due to fever, cough/flu and block nose. Apart from crying, they may refuse feeding with occasional vomiting and often become less active and less interactive with their surroundings. It is advisable to bring your baby to medical attention to make sure that your baby does not suffer serious illness. Sometime, simple intervention such as relieving your baby’s block nose by using normal saline nasal spray will just stop your baby from inconsolable cry.
In conclusion, baby uses cry as one of the ways to communicate with parents or caregivers. Over a period of time as she grows, she will learn new ways of communicating her needs to you and her surroundings and eventually her cry will become more predictable. But at times when the crying episodes became more intense and frustrating, try to remain calm by going through the above checklists and strategies. A short period of break from your crying baby will really help you to reenergize and revitalize yourself to handle your crying baby more effectively. Always remember that you are not alone and be ready to call for help from your relatives, friends, doctor or counselor during this difficult period which will eventually come to a pass.
Sleep challenges in babies
Newborn babies spend a great deal of their time sleeping, often as much as 16-18 hours per day. But their sleep is more interrupted by feeding and by their wet or dirty nappy. New parents will find it difficult to adjust to this unpredictable schedule and often find themselves stress up with sleep deprivation. Fortunately by 3 months of age, their sleep pattern is more predictable and some babies can sleep through the night. Parents can help to establish consistency by attempting to adhere to a regular routine and establishing set nap times. Not only will this help baby to get the idea of when it is time to sleep, it will also help parents to get the rest they need.
What are the common sleep problems in babies?
- Difficulty or refuse to fall asleep due to excessive crying episodes – please refer to the coping with crying babies section above.
- Disturbed sleep due to unwell or sickness – bring to medical attention immediately
- Sudden infant death syndrome (SIDS)
What is SIDS?
As the name implies, SIDS is the sudden and unexplained death of an infant who is younger than 1 year old. It is frightening because it can strike without warning, usually in seemingly healthy babies. Most SIDS deaths are associated with cessation of breathing during sleep (hence the common reference to “crib death”) and infants who die of SIDS show no signs of suffering.
What causes SIDS?
SIDS is a diagnosis of exclusion, made only after all other possible causes of death have been ruled out such as accidents, abuse, and previously undiagnosed conditions, such as cardiac or metabolic disorders.
The cause of SIDS is yet to be determined. However, there are many theories as to the cause, including genetic factors, poor bonding or nurturing, chaotic home environments, and drug or alcohol use.
Who are at risk of SIDS?
Most deaths due to SIDS occur between 2 and 4 months of age, and incidence increases during cold weather especially in places that experience winter month. More boys than girls fall victim to SIDS. When considering which babies could be most at risk, no single risk factor is likely to be sufficient to cause a SIDS death. Rather, several risk factors combined may contribute to cause the at-risk infant to die of SIDS.
What are the risk factors of SIDS?
– smoking, drinking, or drug use during pregnancy
– poor prenatal care
– prematurity or low birth-weight
– mothers younger than 20
– tobacco smoke exposure following birth
– overheating from excessive sleepwear and soft/puffy bedding
– co-bedding with parents
– stomach sleeping (prone position)
How to reduce the risk of SIDS?
– Sleep baby on his/her back (supine position). Do not sleep baby on the side or tummy
– Keep head and face uncovered
– No soft or puffy bedding.
– Babies should always sleep on firm mattress
– Make sure no pillow, lamb wool, soft toy, fluffy blanket or comforter inside the baby cot
– Cover the baby only with a light blanket that reaches no further than the shoulders
– Do not co-bed with parents. Safest place for baby to sleep is in a safe cot next to parents’ bed
– No smoking before or after birth
– Make sure your baby has regular well-baby checkup with doctor
Always keep sleep safety in mind. The American Academy of Paediatric (AAP) recommends that healthy infants be placed on their backs to sleep, not on their stomachs. The incidence of SIDS has decreased by more than 50% since this recommendation was first made in 1992. It is now also recommended that premature infants sleep only on their backs. Do consult your local paediatrician if you have any issue related to your baby’s sleeping pattern or for further sleep safety tips and advice.