Early Infant Crying: What We Know and What Can Help Marsha Baker, OTR/L, MA, M.Ed

“It’s like getting on the fast track to personal growth and you can’t get off.” Becoming a Parent

(Als, 1983)

All babies cry…

Crying is a Biological Alarm Graded signal Alerts parent/caregiver Does not tell source of distress Parents respond to level of emotion in cry and context of cry (Barr, Hopkins, & Green, 2000; Gustafson, Wood, & Green,2000)

Importance of Crying Increases lung capacity Increases motor activity Generates heat & helps regulate temperature Triggers social interaction Ensures survival *“Acoustical umbilical cord” (Lester, 2006)

Early Crying Peaks at six to eight weeks Wide variability in crying amounts across individuals and cultures Parental responsiveness to early crying correlates with positive toddler behavior

Normal Crying Curve Peaks at 4-6 weeks First documented in Brazelton’s practice Replicated in 15 studies Across cultures True for preemies and full-terms 12 weeks 6 weeks

Every Baby Is Different

What is Colic? RULE OF 3’s Crying in otherwise healthy infant that lasts: More than 3 hours per day More than 3 days per week More than 3 weeks (Wessel, 1954)

Excessive Crying Plus: Sudden onset *Paroxysmal *Unpredictable Cry quality *Higher pitch, reaches peak quickly *Like a pain cry Physical signs *Clenched fists *Grimace/flushing *Gas/distention Inconsolable (Lester, Boukydis, Garcia-Coll, & Hole, 1990) “Late afternoon fist-shaking rage”

Begins early:  100% by 3 weeks End varies:  50% by 2 months  80% by 3 months  90% by 4 months (Weissbluth, 1998) Colic is Crying of Infancy

Medical Conditions to Consider in Infants with Excessive Crying Medical conditions account for <5% of infants with excessive crying But it’s important to identify them so they can be treated!

When Crying Is Not a Medical Concern Doctors often unsure how to help “It will go away” “It’s just colic”

Why There’s Nothing “Just” About Colic? Excessive crying may be a risk factor for: –Parent/infant relationship distress –Child abuse –Developmental/behavioral concerns –Maternal depression

Excessive Crying and Abusive Head Trauma Age in Weeks 2.75 hrs. (Holliday-Hanson, Barr, & Trent, 2001)

It’s Hard to Trust Your Instincts

Crying of normal development Regulatory problems, neurological hyper- sensitivity Immaturity of the digestive system Excessive gas Post Partum Depression Temperament Colic Environmental Stressors (Smoking) Underlying medical condition Over-Tired Reflux or Milk Protein Allergy Reflux or Milk Protein Allergy Excessive Crying in Infancy

Start With What You Know What is your baby’s day like? How do you know when your baby is tired or stressed? How is feeding going? Sleeping? What helps soothe your baby? What developmental changes is your baby experiencing? What is your level of distress around your baby’s crying?

Common Soothing Strategies Containment Rhythmic back and forth movement Rhythmic sounds Sucking/feeding Warm or neutral temperature Reducing amount of stimulation Natural light Parent support

Plan for Stressful Moments Sometimes babies are unsoothable When you’re at the end of your rope: –Put the baby down –Take a break –Connect with someone

Call Anytime Fussy Baby Network