Infant Crying

One of life's certainties is that babies cry. Infants cannot talk, so crying and body language are the only ways they can communicate. In addition, each baby is different, and cries in her or his own particular way for each need. Some infants cry a lot, some only a little. It is important to realize that crying means something is wrong and must be addressed. Caregivers also must give careful attention to learning each baby's particular signals and the best ways to respond. It helps for caregivers to talk with the parents about interpreting their babies' cries, and what works best to meet their needs. There are many reasons that infants cry; this article outlines some of them.

Hunger Babies may cry when they are hungry, usually every three-four hours. Some babies cry quietly when hungry, usually rooting around or sucking on a fist. Often, these babies will take a bottle quietly and easily. On the other hand, some babies become frantic when hungry, crying very loudly and flailing their arms and legs. They then may gulp the bottle, swallowing extra air, causing spitting up or gas pains. If this occurs, try calming the baby before feeding, and burp him often during the feeding; or feed on a schedule, before the baby becomes frantic.

Discomfort Infants cry when they are uncomfortable. It may be a wet diaper, or the baby may be too cold or too hot. She may want to be in a different position, such as out of the swing, or maybe it is time for a burp. Check all these possibilities, relieving discomfort as needed.

Loneliness Babies need to interact with caregivers and may cry simply due to loneliness or boredom. Babies should not be left alone, just lying in a crib or in a swing or seat without attention from caregivers. If you use a swing or bouncy seat for short times, place the baby so that he can see you and the other babies, and talk to the baby. If the baby becomes fussy, take him out of the seat, holding, talking to, and singing to him. Sometimes, a baby may feel alone after waking from a nap. Lift the baby from his crib, hold him, and rock, talk, or sing; reassure him that he is not alone.

Fatigue Some babies cry when they are tired or overstimulated. When this occurs, provide a quiet, peaceful environment. Soothing music or "white noise" can be helpful. Some babies can then be rocked gently to calm them, while others may need to lie in a crib to go to sleep. An infant should not be left to cry herself to sleep for more than five-10 minutes. If the baby continues to cry after a few minutes, then pick her up, rock and reassure her in a calm, soothing manner.

Illness Infants' cries can be the first signs of illness. Babies cannot tell us what is wrong or where it hurts, so they cry. If a baby is crying more than usual and just does not seem to be acting like his usual self, let the parents know so they can contact the doctor. If you provide childcare for babies who are sick, expect them to be fussy and more difficult to console. Give them extra attention, soothing and reassuring them often.

Premature Babies Infants who are born prematurely ("premies") are sometimes harder to comfort than full-term babies. These babies may require extra patience from caregivers because their cries are usually more difficult to understand. Some premies prefer a busy environment, with bright lights and background noise, while others prefer quiet. Some prefer to be held and cuddled, while others would rather spend time on the floor or in a seat, watching things around them. Solutions are found by trial and error.

Colic Babies sometimes cry for long periods of time every day, regardless of the comfort caregivers and parents try to give. This is called "colic" if it lasts for more than three hours a day, three-four days a week, and the crying episodes typically occur at the same time every day. If an infant is crying excessively and cannot be comforted, a doctor should be consulted to rule out any medical problems or illnesses.

Sometimes a baby with colic has a stomach ache due to gas or food allergies. A doctor may prescribe medicine for gas or a change in the baby's formula. Often no cause for colic is found. The only way to find comfort measures for a colicky baby is by trial and error, often after trying many different things before finding something that works. Colic usually ends by three months of age.

When caring for fussy babies, first make sure that they are not hungry, uncomfortable, lonely, bored, sick, or overstimulated. If meeting these needs does not stop the crying, try the following:

• Give the baby a pacifier (with the parent's approval).
• Try to bring up a burp by holding the infant upright and gently patting her back.
• Try holding her in different positions:
  - Lay her on her stomach on your lap.
  - Carry her in a football hold, lying on her stomach on your forearm with her head supported by your hand.
  - Carry her in a sling-type carrier.
• If the mother is providing expressed breast milk, let her know that the baby is fussy. She may want to keep a food diary, checking for foods she eats that upset the baby.
• Gently rub infant's abdomen. The warmth of your hand may feel good.
• Rock or walk with the infant, providing gentle movement.
• Provide quiet music or "white noise." Sound machines that provide white noise are available at retail stores.
• Talk, sing, or simply hum to the baby.

Sometimes, nothing works, and a baby who is not sick just cries excessively. Remember, infants are not trying to make you angry by crying; they are not capable of manipulative behavior. While crying is normal for babies, constant crying can be frustrating and difficult to deal with. It is okay to be frustrated, but it is not okay to take out that frustration on the infant. Never spank, scold, or shake a baby. Instead, when you are frustrated, place the crying baby in a safe place, such as a crib, and get another staff member to keep watch. Walk away for a few minutes and take a break. Staff members who are more experienced in infant care can mentor newer staff members, demonstrating calmness and ways to deal with fussy babies.

When a baby cries, it means that the baby needs something. Responding quickly and calmly to a baby's cries will not spoil her or him. Instead, it will help to build a trusting relationship and promote healthy development. When caring for infants, you can expect that they will cry; and sometimes cry a lot. With patience, time, and careful attention to the babies, caregivers can comfort and nurture the babies in their care.

By Kay Lyles, RN, BSN

American Academy of Pediatrics, PO Box 747, Elk Grove Village, IL 60009-0747; 888-227-1770; www.aap.org

National Center on Shaken Baby Syndrome, 2955 Harrison Blvd., #102, Ogden, UT 84403, 888-273-0071; www.dontshake.com

Johnson & Johnson Pediatric Institute, PO Box 579, Calverton, NY 11933-0579; 877-JNJ-LINK; www.jjpi.com

Zero to Three, National Center for Infants, Toddlers and Families, 2000 M Street, NW, Ste. 200, Washington, DC 20036; 202-638-1144; www.zerotothree.org

INTERNET RESOURCES

CNN Health Library: www.cnn.com/HEALTH/library/PR/00037.html

Kids Healthworks: www.kidshealthworks.com/topic.asp?topic_id=128