The Screaming Infant
We all know that parenting newborns and infants is extremely hard, even when the baby has no additional health challenges. Babies cry—a lot—to communicate each and every one of their needs. Sometimes, however, infants with complex medical issues cry—or even scream—significantly more than other babies, especially if they have any type of neurological impairment.
In this article, I will take a look at what “normal” crying is in an infant, and when the crying or screaming likely is abnormal. The article will also cover causes of crying and potential solutions.
Normal Crying Versus Abnormal Crying
Abnormal crying can take one of several forms:
- The infant who cries normally but excessively
- The infant who cannot be consoled and cries nonstop
- The infant who screams in seeming agony frequently
The average infant cries as much as 1-3 hours a day, depending on age and temperament, peaking at around 6-8 weeks of age. By age 3 to 4 months, most babies begin to learn to calm themselves, and the amount of crying gradually decreases over time. If your baby is less than 4 months old and crying for three hours a day, that could be developmentally appropriate. However, if your 8-month-old is still crying three hours a day, there might be something more going on.
Similarly, certain babies are very difficult to console, and may cry despite trying every trick in the book. Many of these babies have cyclical patterns of crying each day, usually peaking around the same time of day. This is also considered developmentally normal. What is not normal is when the infant can never be consoled, or when inconsolable crying happens in older infants.
Finally, as all parents know, babies cry in different ways to communicate different needs, and each infant has different types of cries. Most parents learn to identify these different cries, such as a hunger cry or a tired cry. Some babies, however, may scream in agony, as if they are in horrible pain. In some cases, these babies actually ARE in terrible pain. Some babies may also be experiencing discomfort due to oversensitivity of their nervous system to stimuli, including sounds, light, digestion, or even touch. They also may be exhibiting what is sometimes called “neuro-crying,” when their neurological system is so overwhelmed or over-sensitive that they can only respond by crying. This cry is often high-pitched and especially grating on the ears.
While still in its infancy, researchers at Brown University have developed a computerized tool that analyzes a baby’s cry to help determine why a baby may be crying, or if the baby is at risk for certain conditions such as autism.
Causes of Abnormal Crying
If you think your child’s crying is excessive, inconsolable, or is indicative of a larger problem, the first step is to try to determine the cause of the crying.
If the pattern of crying suddenly changes and your baby begins crying inconsolably out of the blue, there is likely an acute or new problem, which should be immediately evaluated in any baby. Your baby may have a hair wrapped around a toe or finger, a broken bone, a burn, an infection, or some other serious injury or medical condition. The best bet is to try to determine what area of the body is affected, and if the situation cannot be resolved, bring the baby to the doctor or the ER.
On the other hand, if your baby is crying excessively or inconsolably all the time, it may be more difficult to pin down the cause. Common causes include the following:
- Reflux, especially acid reflux
- Vomiting, gagging, and swallowing problems
- Pain with digestion, including hypersensitivity of any part of the gut
- Pain while pooping or excessive gas
- Food allergies or intolerances
- Other GI-related pain
- Pain with urination, either chronic pain from hypersensitivity or a medical condition, or acute pain from infection
- Ear infections, chronic or acute
- Certain syndromes or genetic conditions
- Fatigue or overtiredness
- Sensory overload
- Neurological immaturity
- Chronic stress or post-traumatic stress due to multiple painful or invasive procedures as a newborn/infant
Many infants may experience a combination of factors. For example, children with brain injuries around the time of birth may have extra-sensitive neurological systems that make everything from bright lights to abdominal spasms painful. They may also have undergone multiple life-saving and painful procedures in the NICU that have caused them to develop a kind of post-traumatic stress that makes it more difficult for them to deal with every day life. They may also have reflux and vomiting, adding to their discomfort.
Handling and Improving Crying
In almost all cases, crying can be improved, but it may take time and attention from the right doctors and therapists. Below are a few suggestions for improving crying. Note that some of these are simple strategies useful in all situations, while others are more appropriate for children with complex medical conditions.
Carrying Your Baby
All babies cry less if they are carried, since the closeness of a parent, along with the movement of the parent, is comforting. Baby carriers for all ages and types of babies are widely available. Slings and front carriers, in which the baby’s stomach faces your stomach, are the best options for most babies. Avoid facing your baby outward, as this can be harmful to hip development. In addition, don’t use a backpack if the baby cannot hold up her head and trunk.
Learning infant massage and routinely massaging your baby can help calm crying, especially in babies who have sensory overload or sensory defensiveness. Some early intervention programs will provide a consult with an infant massage therapist, while occupational or physical therapists may be able to assist you in learning the techniques.
Bouncing, Swinging, or Vibrating
Many babies respond to bouncing, swinging, or vibrating, and will calm when placed in a bouncing or vibrating chair or swing. Another method for especially irritable babies is holding the baby while bouncing yourself on an exercise ball. Some babies may handle vertical motion (bouncing) much better than horizontal motion (swinging), especially if their vestibular system is immature. Occupational therapists can help your baby learn to handle various types of movement.
The environment often overwhelms infants with immature nervous systems. Removing stimuli from the environment will sometimes help these babies calm and cope. For example, a quiet dark room may benefit some babies, while others do much better when clothing is removed.
Treating GI Conditions
Most infants who are medically complex have some sort of gastrointestinal condition, and these conditions can be extremely bothersome in infants, who tend to have difficulty tolerating digestive spasms or even normal digestion. Treating conditions such as reflux, vomiting, and gas can dramatically improve crying in many children. There are many potential options for treating GI conditions, including eliminating food allergens, running tube feeds slower, using a GJ tube, switching to a different formula or blenderized diet (in infants over 6 months of age), and using anti-reflux and other GI medications.
Treating Hypersensitivity or Visceral Hyperalgesia
Many infants with excessive crying are simply hypersensitive to everything going on around them. For these infants, who typically have significant neurological conditions, medications such as Neurontin (Gabapentin) or Elavil have been shown to decrease crying and improve quality of life. These medications help to calm the nervous system in babies.
When Nothing Works
Crying can be incredibly stressful for parents, and the type of excessive crying that is common in children with significant neurological conditions is virtually unbearable. As a parent, you need to take care of yourself in order to continue taking care of your baby.
There are times when absolutely nothing works. It is important to note that it is perfectly fine to put your crying baby down and take a break if you are becoming overwhelmed. Finding a respite care provider is also essential to give you breaks from the crying. Many children with complex needs may be able to receive respite care through their Medicaid waivers or through other state programs.
Note that in almost all cases, crying diminishes over time, and most children will stop excessively crying by 12 and 18 months of age. It does get better, I promise!