Baby crying

All babies cry. All babies cry more in the first 3 months of life than at any other time. Many studies have shown that during the first three months of life, the crying of babies follows a developmental pattern. This pattern is called the crying curve (see Figure 1 below). Crying begins to increase at two or three weeks of age, peaks at around six to eight weeks of age, and gradually declines to the age of 12 weeks. Some other studies have shown different peaks of crying, but all studies agree that maximum crying occurs in the first three months of life. Much crying in the first three months is unexplained, in the sense that it starts and ends without warning and may not respond to comforting or feeding.

• During their first few weeks of life, most babies cry for about a total of 1 hour over the course of a day.
• At about 6 weeks of age, they may cry for up to 2 hours per day.
• At 8 weeks, most go back to about 1 hour of crying a day.
• All babies fuss and cry most in the late afternoon or early evening.
• Some babies cry more than others.

At 6-8 weeks age, a baby cries on average 2-3 hours per 24 hours. Babies who cry more than the averages listed above might have colic, a condition in which an otherwise healthy baby cries for more than 3 hours per day, more than 3 days per week for at least 3 weeks. Basically, colic is infant crying for long periods each day for what seems like no reason. “Colic” is an out-dated term used to describe excessive crying. The parents are often distressed, exhausted, and confused and often have received conflicting advice. Parents of babies with colic say their infants’ cries sound more like screams. It sounds as if babies are in pain when in fact, they check out as perfectly healthy in the clinic.

Babies use crying to communicate, it is your baby’s way of saying, “Something is not right. Care is needed, please!”. The baby is telling his/her mom and dad that something is wrong — for instance, an empty belly, a wet bottom, cold feet, being tired, or a need to be held and cuddled.

Sometimes, crying can be due to a problem that might need medical attention, such as an infection, an injury, or other health condition that causes discomfort or pain. In these cases, the crying is usually more severe or prolonged, and the baby often has other symptoms, such as fever, extreme irritability or tiredness, trouble breathing, coughing, vomiting, diarrhea, a rash, or worsening of the crying when the baby is picked up or moved. Call your doctor if you’re worried that your crying baby might be ill.

Taking care of whatever is upsetting a baby is the easiest way to address crying. If the baby has napped, been fed, burped, diapered, or held, he or she will probably settle down.

It can be hard to stay calm when a very upset baby can’t be consoled. Unfortunately, this can sometimes lead to abusive behavior that can cause serious damage to a baby and even death. Abusive head trauma injuries happen when someone (most often a parent or other caregiver) cannot get a baby to stop crying and, out of frustration or anger, shakes the baby or strikes the baby’s head against a surface. It’s important to tell anyone caring for a baby to never shake the baby.

Experts often divide overall crying into fussing, crying and inconsolable crying. Inconsolable crying is the most difficult, because (as the name implies) nothing that you do will calm your infant. For some infants, more of the overall crying will be fussing; for other infants, more of the overall crying will be inconsolable. These are all individual differences from one infant to another, and the range is pretty wide. These differences in crying behavior are very similar to differences between infants in height or weight; some are taller or heavier, and some are shorter or lighter.

But why is this crying feature so frustrating? There are two main reasons. The first is that there is probably nothing more frustrating than the fact that it gets worse and worse (as crying does in the first couple of months) when there is nothing that you can do about it; even if it is normal! The second is that most parents do not know that this basic peak pattern will occur. If they knew ahead of time that it would get worse before it gets better, it would be easier to deal with even though it was not much fun while it was getting worse.

The first feature that really frustrates parents is that the amount of crying that happens in a day tends to increase and increase in the first two (or sometimes three) months of life. Then it reaches its highest point, and begins to decrease. This is the basic peak pattern of crying in infants. However, although they all do it, there are lots of differences between one infant and another.

For example, some infants might have their “peak” at 3 weeks of age, while others have it at 8 weeks of age. For some infants, the amount of crying that infants do at the peak might be 1 hour a day; for others, the amount of crying might be 5 hours.

The second feature that parents don’t expect is that some of these crying times start and stop for no apparent reason at all. They are unrelated to anything the parent does, either to begin the crying or to bring it to an end. Consequently, your baby can be completely happy and content one minute, and then a minute later can be crying out loud for minutes or even hours before it comes to an end. We are all very uncomfortable with behaviors that happen when there is no apparent reason for them happening. We like to have explanations. And we especially like to think we can influence when crying starts or, especially, stops. For many crying times, you can do that; but for some of them in the first few months of life, you can’t.

The third frustrating feature is that some of these crying times include crying that is unsoothable, no matter what you do. That isn’t true of all crying. But about 10% of the time, the crying can go on and on no matter what you do. If we use the distinction we made before among fussing, crying and unsoothable crying, it helps us to understand why things that you do to soothe your infant can work sometimes, and not at other times. If a baby is fussing (even for half an hour), doing something soothing will often work; but if a baby is in a period of unsoothable crying, then nothing that you do is likely to work. Alternatively, some things (like feeding your baby) may work for a few minutes, but as soon as you are finished, the crying begins again. Here is a general way of thinking about soothing: some things work some of the time, but nothing works every time.

This unsoothability feature of early infant crying is one of the most misunderstood parts of the experience for parents. It is very important for parents to realize that, for some of the crying times, they will not be able to soothe their infants. But that is OK; their baby (and they) are still acting normally.

The fourth feature is that crying infants look like they are in pain, even when they are not. No wonder this is frustrating to parents. If the infant is in pain because you prick its heel, or if the infant is hungry but not in pain, the crying will look and sound similarly. Of course, if you see the infant being pricked, it is easy to understand that the infant is in pain. But if you don’t see the pin prick — which is what happens most of the time — and the infant is just crying, it is very difficult to know the cause. Unfortunately, despite lots of misleading suggestions in the advice literature, there is nothing in the cry sound, in the facial expression or in the baby’s activity that lets you know whether or not the infant is in pain.

The fifth feature is that crying can go on and on for long periods of time. In fact, infants cry more and for longer periods in the first three or four months than they ever do again. In one study, the average length of crying times was 35 minutes. However, the “average” includes both very long and very short crying times. In this study, the lengths of crying times were often 5 minutes and sometimes over 2 hours. As with all other features of crying, this can vary a lot between one infant and the other. But in all infants, they are likely to cry more and for longer in the first few months than they ever do again.

The sixth unexpected feature is that the increased crying tends to happen in the late afternoon and the evening. In fact, any of the features that we have talked about can occur at any time of day or night. Some infants (but not most) have a particular time of day when the increased crying seems to occur; like clockwork. However, for most infants on most days, most of the increased crying will occur in the late afternoon or evening.

This can be frustrating and misinterpreted by both mothers and fathers. Mothers or fathers may think that it has something to do with coming home from work. Mothers may feel that the infant is getting tired or bored with them; fathers may feel that their infant is doing it “on purpose.” But they are not. This occurs whether or not parents work, and whether or not parents are doing everything they can think of that is right for their baby.

These are features of crying that can make parents very frustrated. However, it is worth pointing out that not all parents will experience all of these features. If they have a relatively “quiet” baby, then they might not notice that the overall amount of crying follows a peak pattern. Some babies cry a lot for one or two days, and then not so much for the next three. Over weeks, it gradually increases, but it does not increase in a straight line. If they are lucky, and their infant only cries for one hour when it reaches its peak, then they may not have noticed the gradual increase before it goes down. They may notice some unsoothable crying, some evening clustering, and some crying that reminds them of pain, but they may not notice the peak or the prolonged crying as much. That’s fine. Any one of these features, or any combination of them, can be frustrating if parents do not expect them. The main thing is to understand that they happen, that they differ from infant to infant and that, most of all, having these crying features are a completely normal part of infant behavior in the first few months of life.

Baby crying key points:

• Crying is normal physiological behavior in young infants.
• If the history is typical and examination normal, no investigations are required.
• Parental education and close follow-up are vital to managing the unsettled or crying infant. It is often helpful to explain to caregivers the potential causes of crying that have been excluded and the reasons for excluding each condition.
• Excessive crying is associated with higher rates of parental post-natal depression.
• You can deal with a baby’s crying by remaining calm, touching or holding your baby, following your baby’s schedule, taking a break from your baby, getting some sleep and taking your baby for a walk or a drive.
• Follow your instincts when it comes to responding to your baby’s crying, regardless of what other people tell you to do.

Figure 1. Normal crying curve

What is colic?

Colic also called infant colic or baby colic, is the medical term for excessive, frequent crying in a baby who appears to be otherwise healthy and well fed. Colic is very common, affecting about 1 – 2 in 5 babies (10% to 40% of infants worldwide) ¹⁾. However it is still poorly understood.

All newborns cry and get fussy sometimes. During the first 3 months of life, they cry more than at any other time. But when a baby who is healthy cries for more than 3 hours a day, more than 3 days a week, a doctor may say the baby has colic.

Colic doesn’t mean a baby has any health problems. With time, colic goes away on its own.

In most cases, the intense crying occurs in the late afternoon or evening and usually lasts for several hours.

You may also notice that your baby’s face becomes flushed, and they may clench their fists, draw their knees up to their tummy, or arch their back.

If your baby has colic, they may appear to be in distress. However, the crying outbursts are not harmful and your baby will continue to feed and gain weight normally. There is no clear evidence that colic has any long-term effects on a baby’s health.

• Colic is defined as crying for more than 3 hours a day, for more than 3 days a week, for at least 3 weeks ²⁾. But doctors may diagnose a baby as having colic before that point.
• Most of this crying and fussing seems to happen in the late afternoon and evening, although this can change from day to day.
• Colic is not dangerous, although it can be frightening, frustrating and upsetting for parents.
• Colic usually doesn’t point to any health problems and eventually goes away on its own.
• The incidence of infantile colic is equal between sexes, and there is no correlation with type of feeding (breast vs. bottle), gestational age, or socioeconomic status.
• Colic causes considerable stress for parents and for their health care providers ³⁾. Indeed, in the first 3 months of a baby’s life, crying is the No. 1 reason for pediatric visits ⁴⁾. Parents often perceive—incorrectly—that the inconsolable crying is either a sign of serious illness or a result of poor parenting skills ⁵⁾.

Crying is normal in babies. At six to eight weeks, babies normally cry for two to three hours a day. But babies with colic will cry inconsolably for more than three hours at a time on at least three days each week, and this cycle tends to last for more than three weeks.

Doctors aren’t sure what causes colic. It may be due to digestion problems or a sensitivity to something in the baby’s formula or that a nursing mom is eating. Or it might be from a baby trying to get used to the sights and sounds of being out in the world.

Some colicky babies also have gas because they swallow so much air while crying. But it’s not the gas that causes the colic.

Here are some key facts about colic baby:

• Colicky babies have a healthy sucking reflex and a good appetite and are otherwise healthy and growing well. Call your doctor if your baby isn’t feeding well, isn’t gaining weight, or doesn’t have a strong sucking reflex.
• Colicky babies may spit up from time to time just as non-colicky babies do. But if your baby is actually vomiting and/or losing weight, see your doctor. (Vomiting is a forceful throwing up of stomach contents through the mouth, whereas spitting up is an easy flow of stomach contents out of the mouth.) Vomiting repeatedly is not a sign of colic.
• Colicky babies typically have normal stools (poop). If your baby has diarrhea or blood in the stool, see your doctor.

If your baby has colic, there are things you can do to try to avoid possible triggers. There are also things you can try to soothe them and reduce crying.

There’s no treatment to make colic go away. But there are ways you can help:

• Make sure your baby isn’t hungry.
• Make sure your baby has a clean diaper.
• Try burping your baby more often during feedings.
• If you bottle-feed, try other bottles to see if they help your baby swallow less air.
• Ask your doctor if changing formula could help.
• Some nursing moms find that cutting caffeine, dairy, soy, egg, or wheat from their diet helps. Talk to your doctor before doing this and stop only one thing at a time.
• Rock or walk with the baby.
• Sing or talk to your baby.
• Offer your baby a pacifier.
• Take your baby for a ride in a stroller.
• Hold your baby close against your body and take calm, slow breaths.
• Give your baby a warm bath.
• Pat or rub your baby’s back.
• Place your baby across your lap on his or her belly and rub your baby’s back.
• Put your baby in a swing or vibrating seat. The motion may be soothing.
• Put your baby in an infant car seat in the back of the car and go for a ride. Often, the movement of the car is calming.
• Play music — some babies calm down with sound as well as movement.

Some babies need less stimulation. Babies 2 months and younger may do well swaddled, lying on their back in the crib with the lights very dim or dark. Make sure the swaddle isn’t too tight. Stop swaddling when the baby is starting to be able to roll over.

When does colic start?

Colic usually begins within the first few weeks of life – colic usually starts between the 3rd and 6th week after birth and peaks at around six to eight weeks ⁶⁾ and gets better by the time the baby is 3–4 months old. Any baby can have colic.

How long does colic last?

Colic often stops by the time the baby is four months old and by six months at the latest.

If the baby is still crying excessively after that, another health problem may be to blame.

How do I know if it’s colic or normal crying?

Colic is a special pattern of crying. Babies with colic are healthy, and eating and growing well but cry in spells. The spells happen at the same time of day. Most often, the crying starts in the early evening.

During a colic spell, a baby:

• has high-pitched crying or screaming
• is very hard to soothe
• can have a red face or pale skin around the mouth
• may pull in the legs, stiffen the arms, arch the back, or clench fists.

What if a baby won’t stop crying?

Caring for a colicky baby can be hard. If your baby won’t stop crying:

• Call a friend or family member for support or to take care of the baby while you take a break.
• If nothing else works, put the baby on his or her back in a crib without loose blankets or stuffed animals, close the door, and check on the baby in 10 minutes. During that 10 minutes, do something to try to relax and calm down. Try washing your face, eating a snack, deep breathing, or listening to music.

Don’t blame yourself or your baby for the crying — colic is nobody’s fault. Try to relax, and know that your baby will outgrow this phase.

If you ever feel like you might hurt yourself or the baby, put the baby down in the crib and call for help right away. Never shake a baby.

Why do babies cry?

All babies cry and get fussy sometimes. It’s normal for a baby to cry for 2–3 hours a day for the first 6 weeks. During the first 3 months of life, they cry more than at any other time.

Hunger is the most common reason babies cry, but certainly not the only reason. Usually, if a newborn has been fed and burped within the last hour and a half, chances are she needs something else. Maybe she wants to be held, maybe she is cold, or maybe she just needs to be reminded that you are there for her.

You may think that as a parent you are somehow supposed to magically know what each cry means. You won’t. No parent does. At least, not at first. As you and your baby get to know each other, you will learn to read her cues and her cries. Child development experts agree: you cannot spoil your newborn by responding to her cries.

There may be times when you feel like your new baby is trying to control you with her crying. However, scientists now know that it is not until later in the first year of life when babies learn that they have the power to get you to behave in certain ways. For babies six months or younger, your quick and loving response – as much as food – is a comfort to her if she is upset.

New parents often are low on sleep and getting used to life with their newborn baby. They’ll quickly learn to find out if their crying baby:

• is hungry
• is tired
• needs to be burped
• is overstimulated
• has a wet or dirty diaper
• is too hot or cold

Often, taking care of a baby’s needs is enough to soothe a baby. But sometimes, the crying goes on longer.

Common non-pathological causes of crying

• Excessive tiredness – consider if the infant’s total sleep duration per 24 hours falls more than an hour short of the “average” for their age
• Average sleep requirements
  • at birth: 16 hours
  • at 2-3 months: 15 hours
  • a 6-week-old baby generally becomes tired after being awake for 1.5 hours
  • a 3-month-old baby generally becomes tired after being awake for 2 hours
• Hunger – more likely if there is poor weight gain.

Other causes of crying

• Non-IgE cow milk / soy protein allergy
  • Both can be found in human breast milk if in the mother’s diet
  • Goat milk protein is as allergenic as cow milk protein
  • Suspect if there is:
    • significant feeding problems that persist day and night
    • frequent vomiting
    • diarrhea with blood or mucus
    • poor weight gain
    • wide-spread eczema (atopic dermatitis)
  • Clinical diagnosis by trialling eliminating cow / soy milk for 2 weeks
    • modifying the mother’s diet
    • or changing to an extensively hydrolyzed formula (requires pediatrician consultation)
    • and requires resolution of symptoms or re-emergence of symptoms on rechallenge
• Lactose overload / malabsorption
  • Consider lactose overload if infant has very frequent breastfeeds and frothy, watery diarrhea with perianal excoriation
  • Primary lactose intolerance is extremely rare
• Gastro-esophageal reflux disease (GERD)
  • No causal relationship between gastro-esophageal reflux (GER) and infant crying and irritability has been demonstrated
  • Gastro-esophageal reflux disease is rare
  • Proton pump inhibitors have been shown to be ineffective in reducing crying

Do different cries mean different things?

There is some difference of opinion among scientists about whether different types of early cries have different meanings. However, there is emerging consensus that babies’ cries are a graded signal, with increased pitch or intensity indicating greater distress, but not the precise cause.

Nevertheless, you will find that you are usually able to correctly guess your baby’s needs based on the sound of their cry. At about three months of age, crying becomes much more interactive, and your baby will use different cries to mean different things. This change coincides with the baby’s growing social competence. Here are some general guidelines about types of crying.

Hunger

Your baby’s hunger cry can begin quietly and slowly, but it builds in volume, becoming loud and rhythmic. Unless you have fed your baby recently and are certain they had enough to eat, try feeding your baby.

Pain

The typical pain cry is high-pitched, tense, harsh, non-melodious, sharp, short, and loud.

Fussiness

Your baby may cry in a mild, intermittent way when they are upset. Most babies have a “fussy time,” usually in the late afternoon or early evening. The sound of fussy crying differs from a hunger cry, but like the hunger cry, it can grow in volume. Some of the reasons for this type of crying can include:

• Your baby wants to be held. This is often an effective technique to quiet your baby. Newborn babies have just emerged from a confined space and may find the wide open spaces of a crib frightening.
• A wet or soiled diaper is causing discomfort.
• Your baby is tired. Sometimes babies become frustrated when they cannot fall asleep.
• Your baby is over- or under-stimulated. Use the context to decide whether to reduce or increase interaction or environmental sources of stimulation such as music or light.

Remember, during the first three months of life, fussy crying may be unexplained as noted above, and may start and stop regardless of what a parent does.

What is considered normal baby crying?

While all babies cry, the amount depends on the baby. It is common for babies to cry on average for a total of one hour over the course of a day during the first few weeks. This may increase to as much as two hours total a day when the baby is six weeks old. Then, after about eight weeks or so, that amount may go back down to about an hour a day total.

Remember, these are averages. That means that some babies cry more than this, some cry less. Babies who are held several hours a day, cry less overall. If your baby cries a lot more than the average, he could have colic.

Of course, five minutes of crying can feel like an hour if you have only had a couple hours of sleep! Use a crying diary to track how much your baby is really crying. It may be less than it seems.

Clinical characteristics of normal baby crying:

• Increases in the early weeks of life and peaks around 6-8 weeks of age and usually improves by 3-4 months of age
• Usually worse in late afternoon or evening but may occur at any time
• May last several hours
• Infant may draw up legs as if in pain, but there is no good evidence that this is due to intestinal problems

Late afternoons are common times for babies to get fussy and cry a lot. As they grow, babies spend more and more time awake and so, by the afternoon, they can get cranky. The same thing can happen with parents, too. Try putting your baby down for naps at the same time every day. And take a nap yourself too. Keep the lights low and sounds quiet as evening approaches.

Figure 2. Crying diary

Crying diary

Track your baby’s crying for one week. Note when sleeping and feedings happen too. The baby’s crying diary can help you notice crying patterns. Add up the total number of minutes each day that your baby cries and share this with your baby’s health care provider. Experts recommend waiting until your baby is at least 4 weeks old before you start tracking crying time because that is when
patterns begin to become clear.

For each day of the week, put down the time that your baby sleeps, eats, or cries. For sleeping and crying, you might keep track of how many minutes or hours she does each. Add up the total at the end of the day (see Figure 2 above).

Do you see any patterns in your baby’s sleeping, crying, and eating habits?

• Do crying periods happen before or after feedings?
• Are late afternoons common crying periods?
• When do the worst episodes occur?

Share this information, along with total sleeping and crying amounts with your baby’s health care provider. Charting how much your baby cries can be helpful if you think she may have colic. The important thing to remember is that the crying patterns of all babies change over time. They often get worse before they get better, but they will get better.

Abnormal crying

Very high-pitched crying, up to three times higher than a normal infant cry, that persists, or in some cases very low-pitched crying that persists, can be associated with severe or chronic illness. This type of crying is markedly dissimilar from any normal infant cries, and is not to be confused with the excessive crying often identified as colic.

What can help a crying baby?

Having realistic expectations about how much your baby might cry can help you prepare — including asking for help from a partner, friend, or other caregiver if you need a break. You also can look online for sites and support groups that can offer tips to help you soothe your baby — and manage your own frustration. Keeping calm will likely contribute to making a considerable impact on how much your baby cry. Try your best to keep calm. If you are able to keep calm while your baby is crying, you will be better able to read your baby’s signals. Try to maintain your composure and speak to your baby in a soft, soothing voice when they cry.

Taking care of a baby who has colic can be exhausting. Don’t blame yourself or your baby for the constant crying — colic is nobody’s fault. Try to relax, console your little one, and remember that your baby will eventually outgrow it.

Regardless of how much crying your baby does, it can wear on your nerves, especially when you are tired. Below are some tips on what you can do when your baby is crying.

You can’t spoil your baby with too much attention. To soothe a crying baby:

• First, make sure your baby doesn’t have a fever. In a baby, a fever is a temperature of 100.4°F (38°C). See the doctor right away if your baby does have a fever.
• Make sure your baby isn’t hungry and has a clean diaper.
• Realize the power of touch. When babies are distressed, they often need human touch in order to relax and calm down. Touching your baby helps to reduce their stress level, and teaches them that they are safe. When they feel safe, they will be better able to calm down and relax. Try carrying your baby more, as this can reduce normal bouts of crying. Consider using a baby carrier or sling so that you can go about your routines as your newborn snuggles close to you.
• Hold your baby close against your body and take calm, slow breaths.
• Rock or walk with the baby.
• Sing or talk to your baby.
• Offer the baby a pacifier.
• Take the baby for a ride in a stroller.
• Take your baby outdoors for a walk in a carriage or stroller, or for a drive in the car
• Give the baby a warm bath.
• Pat or rub the baby’s back.
• Place your baby across your lap on his or her belly and rub your baby’s back.
• Put your baby in a swing or vibrating seat. The motion may be soothing.
• Put your baby in an infant car seat in the back of the car and go for a ride. Often, the vibration and movement of the car are calming.
• Play music — some babies respond to sound as well as movement.
• Follow your baby’s schedule. For example, if your baby has a specific time each evening when the crying and fussiness peaks, try not to schedule activities at that particular time. Consider having your evening meal at an earlier time.
• Take a break from your baby. Find a neighbor or friend who can watch your baby for a few minutes while you escape for a walk around the block. Don’t worry that your friend will find it difficult to take care of a crying baby for that amount of time. If you are alone and you feel like you are becoming too frustrated or agitated, try placing your baby in a safe place such as their crib, and escaping to the backyard for a few minutes.
• Get some sleep. Try to grab a nap when your baby sleeps during the day, especially if your baby fusses and cries at night. If you can, ask a friend to come over for an hour or two, to watch your baby while you catch up on your sleep.
• Some babies need less stimulation. Babies 2 months and younger may do well swaddled, lying on their back in the crib with the lights very dim or dark. Make sure the swaddle isn’t too tight. Stop swaddling when the baby is starting to be able to roll over.

Undoubtedly, you will receive a lecture or two from older, well-meaning relatives who think you are spoiling your baby by responding to their every cry. Rest assured that you cannot spoil a newborn baby. When you respond quickly to your newborn baby’s cries, you are teaching them to feel secure, safe in the knowledge that you are there to take care of them. When you pick up your newborn baby to console them, be proud that you followed your parental instincts, and don’t fall victim to the opinions of others who do not know what your baby really needs.

Comforting your baby

There is no one right way to comfort a crying baby, but there are lots of different strategies that work. Consider them all tools in your toolbox. When one does not work, try the next one. Ask your parents or grandparents what soothing techniques they used with you. The same ones may comfort your baby. With time and practice, you will find what works best for you and your baby. Just keep trying.

Swaddling

Swaddling is another word for snuggly wrapping your baby. Swaddling is a technique of wrapping a blanket snuggly around your baby’s body in order to resemble the mother’s womb and help soothe a newborn baby. While it may seem strange to grown ups, babies really like being wrapped up so that it’s hard for them to move their arms or legs. When they were in the womb, they did not have much wiggle room. So being swaddled feels like home to them.

Research shows that swaddling, a technique that mimics the coziness of the womb — can keep your baby warm and secure, as well as possibly calm a baby with colic. New parents often learn how to swaddle their infant from the nurses in the hospital. Some experts feel that swaddling in the early weeks can help newborns sleep more comfortably on their backs. This can help minimize the startle reflex and ease colic symptoms in some babies. If you choose to swaddle, take time to learn how to swaddle properly before you leave the hospital. When swaddling isn’t done properly, however, it can pose risks for your baby. Take care not to swaddle too loosely, as the blanket can come loose and accidently suffocate your baby. Take care not to swaddle too tightly as this can compress your baby’s chest and make it difficult to breathe. Tight swaddling can also cause problems with your baby’s hips and legs. Once your baby starts to wiggle around during sleep, it is probably time to stop swaddling.

Is swaddling safe?

The American Academy of Pediatrics says that when done correctly, swaddling can be an effective technique to help calm infants and promote sleep ⁷⁾. It is fine to swaddle your baby. However, make sure that the baby is always on his or her back when swaddled. The swaddle should not be too tight or make it hard for the baby to breathe or move his or her hips. When your baby looks like he or she is trying to roll over, you should stop swaddling.

The 2 most important things to remember about safe sleep practices:

1. Healthy babies are safest when sleeping on their backs at nighttime and during naps. Side sleeping is not as safe as back sleeping and is not advised.
2. Tummy time is for babies who are awake and being watched. Your baby needs this to develop strong muscles.

If you plan to swaddle your infant at home, you need to follow a few guidelines. To reduce the risk of Sudden Infant Death Syndrome (SIDS), it’s important to place your baby to sleep on his back, every time you put him to sleep. This may be even more important if your baby is swaddled. Some studies have shown an increased risk of SIDS and accidental suffocation when babies are swaddled if they are placed on their stomach to sleep, or if they roll onto their stomach.

Pacifiers are safe

For babies younger than two years old, pacifiers are okay and will not hurt their future teeth. In fact, pacifiers can be a source of comfort to babies.

Breastfeeding experts recommend that you wait until four weeks of age before trying a pacifier so your baby only needs to get used to one nipple.

Soothing strategies

For many babies, using a combination of several comfort strategies all at once is what soothes them best. For example, you might swaddle your baby, change her position (try laying her on her side, across your forearm), give her a pacifier, gently bounce her, and then make shushing sounds. For centuries, parents and grandparents have learned to be creative in order to discover what soothes their baby best. Many parents find that trying a little bit of everything is the best way to go.

You may find that some comfort strategies work like a charm right away, and others not at all. Babies grow quickly, and their preferences change as they grow. What doesn’t work today may well work tomorrow.

When a baby won’t stop crying

If a baby in your care won’t stop crying:

• Call a friend or relative for support or to take care of the baby while you take a break.
• If nothing else works, put the baby on their back in an empty crib (without loose blankets or stuffed animals), close the door, and check on the baby in 10 minutes. During that 10 minutes, do something to try to relax and calm down. Try washing your face, breathing deeply, or listening to music.

See your doctor if nothing seems to be helping the baby, in case there is a medical reason for the fussiness.

Self-care tips for parents

Parenting can be one of the hardest (and most rewarding) jobs you will ever have. You are learning “on the job” and are getting a lot less sleep than you are used to. There may be days when you love every minute, and you may also have days when you wish your baby came with a mute button and volume control.

5 steps for parents to self-care

Step 1. Remind yourself that uncomfortable feelings when caring for a crying baby are normal. It is normal to have bad days

If your baby has been crying nonstop for a long time, you may have thoughts that scare you or make you feel helpless or anxious. You may even question if you are a good parent. It might feel awful, but you would be amazed how many experienced parents will tell you they have felt exactly the same way.

But, there is a big difference between having scary thoughts (which is common) and acting on those thoughts (which is not okay). Thinking “I just want to run away from home today” and actually packing a suitcase are two different things. Remember the difference between thinking and doing and let yourself off the hook for occasional thoughts that worry you.

If your bad days outnumber the good ones or if they affect your ability to get out of bed or take care of your baby, this could be a sign of depression. If you are ever worried that you might act on “scary thoughts” or afraid you might hurt your baby, it is important to talk to your doctor right away. One out of five women has postpartum blues or depression. Dads can get the blues, too.

Talk with your doctor if you have any of the following:

• feeling agitated or moody
• less interest in food or lowered appetite
• constant anxiety or worry about the baby
• frequently unable to sleep when you have the chance
• difficulty concentrating or thinking
• feelings of worthlessness or guilt
• feeling withdrawn, socially isolated, or unconnected
• no pleasure or interest in all or most activities
• less energy
• negative feelings toward the baby
• thoughts of death or suicide
• trouble sleeping

Step 2. When you need to, put some distance between you and the sound of crying

All jobs come with coffee breaks. Parenting should too. So put the baby in her crib and take a few minutes for yourself – you will feel better for it.

Some ways to get relief:

• use foam earplugs or headphones (they will help reduce the sound of the crying but you can still hear your baby)
• lower the volume of the baby monitor
• listen to music you love
• make yourself a cup of tea
• go into another room for a few minutes
• do some deep breathing exercises
• put the baby in a front pack or stroller and go for a walk
• if there is someone else around you trust, hand off the baby for a little while

Sometimes partners have different parenting styles, and that is okay! In fact, those differences help your baby learn how to handle new situations and people. You and your partner may deal with the baby’s crying in your own ways. It may bother one of you more. One of you may need more frequent breaks. That is also okay.

Work at accepting each other’s limits and differences. No way is the “right way” or the “wrong way.” Remember to trade off. Just because one of you is good at rocking the baby to sleep or singing a lullaby should not mean that it is always your job to calm the crying baby. Try not to let one of you become more of an “expert” on your baby. You are both learning as you go.

Step 3. Identify signs that you are becoming stressed

Every parents all have limits on their ability to handle change and stress. When you are new to parenting, you may find that you get upset or stressed out more easily than before – probably because you have not had enough sleep or time for yourself. It is important to know when you are reaching your limit so you can take care of yourself. So, learn to notice your personal signs of
stress. They might include:

• clenched teeth
• sweating
• heart racing
• faster breathing
• pacing or walking back and forth
• repeating movements
• swearing
• moving faster in general
• being accident prone
• having changes in your eating habits
• upsetting or disturbing thoughts

These behaviors can be signs from our bodies telling us we are stressed and need to step back. When you notice any of these happening to you, take a break. If you are caring for your baby alone, it is perfectly okay to spend a few minutes by yourself in another room, away from the sound of baby crying.

Step 4. Figure out what you can do to reduce stress and soothe yourself

Taking care of yourself is one of the most important things you can do to take care of your baby. If you make time to sleep, eat, see friends and family, and get a break, you will feel better and your baby will notice. So take care of you: it’s worth the effort.

• Make getting sleep a priority. Getting as much sleep as possible is the single most important thing new parents can do for themselves. Nap whenever your baby naps.
• Remember to eat well. Eat plenty of fruits and veggies, whole grains and protein. They will give you the energy you need.
• Find time for exercise. You do not have to go to the gym to exercise. Floor exercises, yoga, stretches, dancing, aerobics, and even running in place are easy to do at home. Going for a walk is also a great way to beat stress and get some fresh air.
• Let go around the house and limit guests for a while. Having a tidy house may make you feel a little more in control of things. But it may not be worth the added stress. Your baby will never know if the house is messy. But she will know if you are stressed out. So, if you can, let go of the house and enjoy your time with your baby instead.

Step 5. Get the help you need and take time off

If you have a partner, work together and take turns doing baby care and house chores. Ask friends for recommendations for a good babysitter – you will be glad for a break and your baby will get the benefit of being with someone new. Single parents especially need breaks. Identify a network of support for yourself so you can have some time to yourself as often as you can.

Your baby’s crying will not bother other people the way it bothers you. Outsiders can take it a lot longer than you can. They know they will be able to go home after babysitting.

Practice asking for help

For many people, asking for help is hard to do. But ALL new parents need support and most don’t ask nearly enough for an extra hand. Keep a running list of things you need help with. Be direct and specific when you make requests. Asking for help from family and friends actually makes them feel truly useful.

Here’s a running list of “to dos”:

• shop for groceries
• clean the laundry
• drop off/pick up clothes for dry cleaning
• babysit while I sleep
• babysit while I run errands/socialize/work
• take an older child to daycare or school
• bring a meal over (home-cooked or take out)
• clean the bathroom/kitchen
• do the dishes
• take the car in for a tune up/inspection
• help with yard work.

Don’t go it alone

Make sure you have someone to talk to on days when the stress that can come with crying feels like too much. It could be a friend, sibling, parent, or neighbor. Maybe that person can come over and give you a hand. Maybe you can just talk to them on the phone when you need it. You can also develop a “code word” or phrase (even something silly like “peanut butter sandwiches”) that can be your way of telling this person that you need them to come over, no questions asked.

Practice reaching out to friends and family. Join a new parents group – either in person or online. Share your joys AND frustrations with people who care about you or who are going through the same experience as you. Talking to other people who know what it is like to be a new parent can help you not feel so alone.

You may need extra special care if you:

• have a baby who was born prematurely
• are parenting alone
• are a teen parent
• are taking care of other children while caring for a newborn
• have a change in your living situation (such as a move, job change, financial stress, etc.)
• use drugs or alcohol
• have a history of depression or anxiety
• have a physical illness (either you or the baby)
• have relationship struggles
• have a history of family violence
• have an especially fussy or colicky baby

What does NOT work to calm a baby?

• NEVER feed your baby anything other than breast milk or formula until your health care provider says so. Many old wives’ tales say to give babies solid food or even alcohol to help them settle down or sleep. This is absolutely not true and can cause harm to your baby. A newborns digestive system is not able to handle anything but breast milk or infant formula.
• NEVER hit, shake, or yell at your baby. Shaking or hitting a baby can cause permanent brain damage or death. It can keep your baby’s trust in you from growing. What’s more, it usually makes crying even worse.

Medications and other treatment options that do NOT work:

• Anti-reflux medications – ineffective in reducing crying compared with placebo
• Anticholinergic medications – due to risk of serious adverse events e.g. apneas, seizures
• Colic mixtures (e.g. gripe water) – no proven benefit
• Simethicone (e.g. Infacol Wind Drops / Degas Infant Drops) – no effect on crying compared with placebo
• There is limited evidence to support probiotic use
  • Only in exclusively breastfed infants under 3 months, the probiotic Lactobacillus reuteri DSM17938 (BioGaiaTM) has been shown to be effective with excessive crying (colic)
  • To be given as 5 drops per day orally to the infant for 21 days only.
  • It should not be given to formula-fed infants
  • The probiotic has not been shown to be effective in both breastfed and formula-fed infants.
  • Probiotic effects are strain-specific; Lactobacillus reuteri DSM17938 is the only probiotic strain with some evidence of efficacy in exclusively breastfed infants with excessive crying (colic)
• Formula changes are usually not helpful unless there is proven cow milk allergy. Weaning from breast milk has no benefit
• Spinal manipulation is not indicated and has associated risks

NEVER shake your baby

If you are angry or very upset, put your baby safely in her crib and walk away. Babies can sense our stress and often it makes them more fussy. Take a break from the sound of the crying. Then, come back and check on her every few minutes. You will both be better off if you take a break instead. And remember: all new parents need help now and then. Don’t hesitate to ask when you do.

What is Shaken Baby Syndrome?

Shaken baby syndrome also known as abusive head trauma, shaken impact syndrome, inflicted head injury or whiplash shake syndrome, is a serious brain, head or neck injury from physical child abuse. Shaken baby syndrome is a dangerous form of child abuse. Shaken baby syndrome happens when someone forcefully shakes a baby or hits the baby against something hard. Most cases happen when a parent or caregiver is angry, tired, or upset because a baby won’t stop crying or the child can’t do something they expect, like toilet train. People should never shake a baby for any reason.

Shaken baby syndrome or abusive head trauma can occur from as little as 5 seconds of shaking during which an infant’s still-developing brain bounces back and forth against the skull. This can cause bruising, swelling, pressure, and bleeding in the brain. It might also lead to permanent brain damage or death.

Shaken baby syndrome destroys a child’s brain cells and prevents his or her brain from getting enough oxygen. Shaken baby syndrome is a form of child abuse that can result in permanent brain damage or death. At least one of every four babies who are violently shaken dies from shaken baby syndrome ⁸⁾.

Shaken baby syndrome is preventable. Help is available for parents who are at risk of harming a child. Parents also can educate other caregivers about the dangers of shaken baby syndrome.

All babies cry and do things that can frustrate caregivers; however, not all caregivers are prepared to care for a baby.

Babies especially babies ages 2 to 4 months, newborn to one year and toddlers younger than 2 years old, are at greatest risk of injury from shaking. Rarely, it can happen in children up to 5 years old. It can happen to boys or girls in any family. At special risk for abuse are children who have a lot of special needs or health problems that make them cry a lot, like colic and gastroesophageal reflux.

Shaking them violently can trigger a “whiplash” effect that can lead to internal injuries, including bleeding in the brain or in the eyes. Often there are no obvious external physical signs, such as bruising or bleeding, to indicate an injury.

In more severe cases of shaken baby syndrome, babies may exhibit the following ⁹⁾:

• Unresponsiveness
• Loss of consciousness
• Breathing problems (irregular breathing or not breathing)
• No pulse

Babies suffering lesser damage from shaken baby syndrome may exhibit some of the following ¹⁰⁾:

• Change in sleeping pattern or inability to be awakened
• Vomiting
• Convulsions or seizures
• Irritability
• Uncontrollable crying
• Inability to be consoled
• Inability to nurse or eat

Shaken baby syndrome can potentially result in the following consequences:

• Death
• Blindness
• Mental retardation or developmental delays (any significant lags in a child’s physical, cognitive, behavioral, emotional, or social development, in comparison with norms) ¹¹⁾ and learning disabilities
• Cerebral palsy
• Severe motor dysfunction (muscle weakness or paralysis)
• Spasticity (a condition in which certain muscles are continuously contracted—this contraction causes stiffness or tightness of the muscles and may interfere with movement, speech, and manner of walking) ¹²⁾
• Seizures

Emergency treatment for a baby who has been shaken usually includes life-sustaining measures such as respiratory support and surgery to stop internal bleeding and bleeding in the brain. Doctors may use brain scans, such as MRI and CT, to make a more definite diagnosis.

In comparison with accidental traumatic brain injury in infants, shaken baby injuries have a much worse prognosis. Damage to the retina of the eye can cause blindness. The majority of infants who survive severe shaking will have some form of neurological or mental disability, such as cerebral palsy or cognitive impairment, which may not be fully apparent before 6 years of age. Children with shaken baby syndrome may require lifelong medical care.