CRYING and COLIC in INFANT

NORMAL DEVELOPMENT

Infant crying can be a sign of pain, distress, hunger, or fatigue and is interpreted by caregivers according to the context of the crying. The cry just after birth heralds the infant’s health and vigor.

Crying is best understood by the characteristics of timing, duration, frequency, intensity, and modifiability of the cry.

Cry Duration

Most infants cry little during the first 2 weeks of life, gradually increasing to an average of 3 hours per day by 6 weeks and decreasing to an average of 1 hour per day by 12 weeks. Cry duration differs by culture and infant care practices.

Cry Frequency

Frequency of crying is less variable than duration of crying. At 6 weeks of age, the mean frequency of combined crying and fussing is 10 episodes in 24 hours.

Cry Intensity

The intensity of infant crying varies, with descriptions ranging from fussing to screaming. An intense infant cry (pitch and loudness) is more likely to elicit concern or even alarm from parents and caregivers. Although pain cries have a higher frequency than hunger cries, when not attended to for a protracted period, hunger cries become acoustically similar to pain cries.

COLIC

Colic often is diagnosed using Wessel’s rule of threes—crying for more than 3 hours per day, at least 3 days per week, for more than 3 weeks. The limitations of this definition include the lack of specificity of the word crying (e.g., does this include fussing?) and the necessity to wait 3 weeks to make a diagnosis in an infant who has excessive crying. Colicky crying is often described as paroxysmal and may be characterized by facial grimacing, leg flexion, and passing flatus

CAUSES

• Digestive system that isn’t fully developed
• Imbalance of healthy bacteria in the digestive tract
• Food allergies or intolerances
• Overfeeding, underfeeding
• Early form of childhood migraine
• Family stress or anxiety
• Faulty feeding
• Air swallowing
• Gastroesophageal reflux
• Food intolerance
• Infrequent burping

SYMPTOMS

• Intense crying that may seem more like screaming or an expression of pain
• Crying for no apparent reason, unlike crying to express hunger or the need for a diaper change
• Extreme fussiness even after crying has diminished
• Predictable timing, with episodes often occurring in the evening
• Facial discoloring, such as reddening of the face or paler skin around the mouth
• Bodily tension, such as pulled up or stiffened legs, stiffened arms, clenched fists, arched back, or tense abdomen
• Sometimes there is relief in symptoms after the infant passes gas or has a bowel movement. Gas is likely the result of swallowed air during prolonged crying.

COMPLICATIONS

• Increased risk of postpartum depression in mothers
• Early cessation of breast-feeding
• Feelings of guilt, exhaustion, helplessness or anger

TREATMENT

• Exclusive breast feeding
• Walking around with or rocking your baby
• Adequate burping
• Don’t over feed
• Wrapping infants in blankets or similar cloths so that movement of the limbs is tightly restricted.
• Giving your baby a warm bath
• Rubbing your infant’s tummy or placing your baby on the tummy for a back rub
• Avoid formula ,artificial feed

PARENT SELF-CARE

• Maternal diet. If you’re breast-feeding, you may try a diet without common food allergens, such as dairy, eggs, nuts and wheat. You may also try eliminating potentially irritating foods, such as cabbage, onions or caffeinated beverages.
• Express your feelings. It’s normal for parents in this situation to feel helpless, depressed, guilty or angry. Share your feelings with family members, friends and your child’s doctor.
• Remember that it’s temporary. Colic episodes often improve after age 3 to 4 months.
• Don’t judge yourself. Don’t measure your success as a parent by how much your baby cries. Colic isn’t a result of poor parenting, and inconsolable crying isn’t a sign of your baby rejecting you.
• Take care of your health. Eat healthy foods. Make time for exercise, such as a brisk daily walk. If you can, sleep when the baby sleeps — even during the day. Avoid alcohol and other drugs.

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