Infant crying

Last updated
Excessive crying
Baby yelling.jpg
An infant crying
Specialty Pediatrics
Symptoms crying for three or more hours per 24 hours [1]
Complications parental sleep deprivation
Usual onsetat birth
Durationdiffers due to cause
Diagnostic method report by caregivers and differential diagnosis
Differential diagnosis colic
Prognosis later developmental delays

Infant crying is the vocalizations of infants as a response to an internal or external stimulus. Infants cry as a form of basic instinctive communication. [2] Essentially, newborns are transitioning from life in the womb to the external environment. [3] Up to 27% of parents describe problems with infant crying in the first four months. Up to 38% identify a problem with their infant crying within the first year. Parents can be concerned about the amount of time that their infant cries, how the infant can be consoled, and disrupted sleeping patterns. [4] [1] Colic is used as a synonym for excessive crying of infants, even though colic may not be the cause of excessive crying. [5] [6]

Contents

Physiology

Crying may elicit the Valsalva reflex. This reflex negatively impacts sucking pressures and results in poor feeding. The cortisol levels will rise along with blood pressure. Increased blood pressure will have an effect on cerebral blood flow, cerebral blood flow velocity and intracranial pressure. Increased pressures and velocity can lead to intracranial hemorrhage. Prolonged exhalation may also cause some adverse effects. Obstructed venous return and quick inspiratory gasp can occur. Foramen ovale shunting can occur. [3] Adults can often determine whether an infant's cries signify anger or pain. [7] Most parents can distinguish their own infant's cries from those of a different child. [8] Babies mimic their parents' pitch contour. French infants wail on a rising note while German infants favor a falling melody. [9] Overstimulation may be a contributing factor to infant crying and that periods of active crying might serve the purpose of discharging overstimulation and helping the baby's nervous system regain homeostasis. [10] [11]

Although crying is an infant's mode of communication, it is not limited to a monotonous sound. There are three different types of cries apparent in infants. The first of these three is a basic cry, which is a systematic cry with a pattern of crying and silence. The basic cry starts with a cry coupled with a briefer silence, which is followed by a short high-pitched inspiratory whistle. Then, there is a brief silence followed by another cry. Hunger is a main stimulant of the basic cry. An anger cry is much like the basic cry; in this cry, more excess air is forced through the vocal cords, making it a louder, more abrupt cry. This type of cry is characterized by the same temporal sequence as the basic pattern but distinguished by differences in the length of the various phase components. The third cry is the pain cry, which, unlike the other two, has no preliminary moaning. The pain cry is one loud cry, followed by a period of breath holding. [12]

Misconceptions

Misconceptions regarding the purpose of crying in the infant are common among caregivers and medical personnel. These are usually determined by cultural mores and not by evidence-based explanations. Infant crying is regarded by some to be normal. [13] [14] The belief that infants have a need to cry to expand or exercise their lungs is not supported by research. This is because a healthy newborn infant lung's are able to contain a sufficient amount of air plus a reserve. [3] Birth trauma is related to the amount of crying. Mothers who had experienced obstetrical interventions or who were made to feel powerless during birth had babies who cried more than other babies. [15] Babies who had experienced birth complications had longer crying spells at three months of age and awakened more frequently at night crying. [16] [17] [18] When infants cry for no obvious reason after all other causes (such as hunger or pain) are ruled out, the crying may signify a beneficial stress-release mechanism, although not all sources agree with this. The "crying-in-arms" approach is a way to comfort these infants. [19] [20] [21] Another way of comforting and calming the baby is to mimic the familiarity of the mother's womb. [22] Consistency and promptness of maternal response is associated with a decline in frequency and duration of crying by the end of the first year, and individual differences in crying reflect the history of maternal responsiveness rather than constitutional differences in infant irritability. [23]

Causes

Most infants cry in response to something, although it may be difficult to identify the cause. Sometimes there may be no apparent reason. [24]

Some possible reasons include: [25] [24]

Excessive crying in infants may indicate colic or another health problem. [25] Some health problems are listed below:

Colic

The term 'colic' was defined in 1954 as: "crying for more than three hours per day, for more than three days per week, and for more than three weeks in an infant that is well-fed and otherwise healthy." [13] Colic and excessive crying by infants is synonymous to some clinicians. [6] Colic is attributed to gastrointestinal discomfort like intestinal cramping. [26] Clinicians often admit that colic cannot be treated or that alternative treatments are ineffective. [27] The protocol followed by clinicians to treat colic is described as "treating the parents" with reassurance. [13]

Maternal responses

Crying in infants is associated with high stress levels and depression in mothers. [28] [29] [1] [4] Excessive crying has also been linked to maternal "physical aggression" and "angry speaking." Mothers without assistance in caring for the infant, are more prone to physical aggression. [1] During evaluations of maternal depression responses to infant crying, sleeping problems are closely associated with excessive crying. It is not always clear that when sleeping problems are associated with infant crying, whether the sleeping problems are descriptive of the mother or the infant or both. [29] Maternal stress is associated with excessive crying. [30]

Effects on young children

One definition used to study excessive crying in infants (colic) is crying for three or more hours per 24 hours. Excessive infant crying has been associated with a twofold increased risk of the overall problem behavior, conduct problems, hyperactivity, and mood problems at the age of 5–6. Excessive infant crying doubles the risk of behavioral, hyperactivity, and mood problems at the age of 5–6, as reported by their mother. Excessive crying is not the only factor in later childhood difficulties. Behavioral problems in childhood include the so-called regulatory problems, such as excessive crying, sleeping, and feeding problems, which occur in 20% of infants in multiproblem families. Excessive crying, whining and sleeping problems at 4–6 months are associated with decreased social development at 12 months. [1]

Several factors may contribute to, and partly explain, an association between excessive infant crying and later behavioral and emotional problems. During early infancy, the quality of the mother–child dyad can be considered to be a crucial vehicle for child's healthy mental development. Both early maternal and early paternal reciprocity in infancy are predictive of social competence and lower aggression in preschoolers. [1]

Compared to other infants, excessive crying infants had a slightly lower birth weight and a slightly younger gestational age. Excessive crying infants more often had a single, lower educated mother, originating from a non-industrialized country, who reported more depression, a higher burden of infant care, and more aggressive behavior and had an authoritarian parenting style. Excessive crying was associated with a higher risk for hyperactivity/inattention problems, emotional symptoms, conduct problems, peer relationship problems, and overall problem behavior at the age of 5–6, as well as a higher risk for decreased pro-social behavior as reported by the mother. Excessive crying was also associated with mood problems as well as generalized anxiety problems at the age of 5–6. [1]

Abuse

Shaken baby syndrome

A common type of physical abuse in infants, shaken baby syndrome, is often a reaction to infant crying. [31] Infant crying is a leading risk factor for shaken baby syndrome and other infant abuse. [32] [33]

Related Research Articles

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A time-out is a form of behavioral modification that involves temporarily separating a person from an environment where an unacceptable behavior has occurred. The goal is to remove that person from an enriched, enjoyable environment, and therefore lead to extinction of the offending behavior. It is an educational and parenting technique recommended by most pediatricians and developmental psychologists as an effective form of discipline. During time-outs, a corner or a similar space is designated, where the person is to sit or stand. This form of discipline is especially popular in Western cultures.

<span class="mw-page-title-main">Infant</span> Very young offspring of humans

In common terminology, a baby is the very young offspring of human beings; while infant is a formal or specialised synonym. The terms may also be used to refer to juveniles of other organisms. A newborn is, in colloquial use, a baby who is only hours, days, or weeks old; while in medical contexts, a newborn or neonate is an infant in the first 28 days after birth.

<span class="mw-page-title-main">Attachment parenting</span> Parenting philosophy

Attachment parenting (AP) is a parenting philosophy that proposes methods aiming to promote the attachment of mother and infant not only by maximal parental empathy and responsiveness but also by continuous bodily closeness and touch. The term attachment parenting was coined by the American pediatrician William Sears. There is no conclusive body of research that shows Sears' approach to be superior to "mainstream parenting".

Co-sleeping or bed sharing is a practice in which babies and young children sleep close to one or both parents, as opposed to in a separate room. Co-sleeping individuals sleep in sensory proximity to one another, where the individual senses the presence of others. This sensory proximity can either be triggered by touch, smell, taste, or noise. Therefore, the individuals can be a few centimeters away or on the other side of the room and still have an effect on the other. It is standard practice in many parts of the world, and is practiced by a significant minority in countries where cribs are also used.

<span class="mw-page-title-main">Kangaroo care</span> Technique of newborn care

Kangaroo mother care (KMC), which involves skin-to-skin contact (SSC), is an intervention to care for premature or low birth weight (LBW) infants. The technique and intervention is the recommended evidence-based care for LBW infants by the World Health Organization (WHO) since 2003.

<span class="mw-page-title-main">Maternal bond</span> Relationship between mother and child

A maternal bond is the relationship between a biological mother/caregiver and her child or baby. While typically associated with pregnancy and childbirth, a maternal bond may also develop in cases later on in life where the child is unrelated, such as in the case of an adoptee or a case of blended family.

<span class="mw-page-title-main">Baby colic</span> Medical condition

Baby colic, also known as infantile colic, is defined as episodes of crying for more than three hours a day, for more than three days a week, for three weeks in an otherwise healthy child. Often crying occurs in the evening. It typically does not result in long-term problems. The crying can result in frustration of the parents, depression following delivery, excess visits to the doctor, and child abuse.

The Ferber method, or Ferberization, is a technique invented by Richard Ferber to solve infant sleep problems. It involves "sleep-training" children to self-soothe by allowing the child to cry for a predetermined amount of time at intervals before receiving external comfort.

<span class="mw-page-title-main">Swaddling</span> Practice of wrapping infants so as to restrict movement

Swaddling is an ancient practice of wrapping infants in blankets or similar cloths so that movement of the limbs is tightly restricted. Swaddling bands were often used to further restrict the infant. Swaddling fell out of favour in the 17th century.

<i>On Becoming Baby Wise</i> 1993 Christian parenting book by Gary Ezzo and Robert Bucknam

On Becoming Baby Wise: Giving Your Infant the Gift of Nighttime Sleep is a Christianity-based infant management book written by Gary Ezzo and pediatrician Robert Bucknam in 1993. Baby Wise presents an infant care program which the authors say will cause babies to sleep through the night beginning between seven and nine weeks of age. It emphasizes parental control of the infant's sleep, play and feeding schedule rather than allowing the baby to decide when to eat, play and sleep.

<span class="mw-page-title-main">Attachment in children</span> Biological instinct

Attachment in children is "a biological instinct in which proximity to an attachment figure is sought when the child senses or perceives threat or discomfort. Attachment behaviour anticipates a response by the attachment figure which will remove threat or discomfort". Attachment also describes the function of availability, which is the degree to which the authoritative figure is responsive to the child's needs and shares communication with them. Childhood attachment can define characteristics that will shape the child's sense of self, their forms of emotion-regulation, and how they carry out relationships with others. Attachment is found in all mammals to some degree, especially primates.

<span class="mw-page-title-main">Breastfeeding difficulties</span> Medical condition

Breastfeeding difficulties refers to problems that arise from breastfeeding, the feeding of an infant or young child with milk from a woman's breasts. Although babies have a sucking reflex that enables them to suck and swallow milk, and human breast milk is usually the best source of nourishment for human infants, there are circumstances under which breastfeeding can be problematic, or even in rare instances, contraindicated.

<span class="mw-page-title-main">Crying</span> Shedding tears due to emotion or pain

Crying is the dropping of tears in response to an emotional state or physical pain. Emotions that can lead to crying include sadness, anger, joy, and fear. Crying can also be caused by relief from a period of stress or anxiety, or as an empathetic response. The act of crying has been defined as "a complex secretomotor phenomenon characterized by the shedding of tears from the lacrimal apparatus, without any irritation of the ocular structures", instead, giving a relief which protects from conjunctivitis. A related medical term is lacrimation, which also refers to the non-emotional shedding of tears. Various forms of crying are known as sobbing, weeping, wailing, whimpering, bawling, and blubbering.

Attachment-based therapy applies to interventions or approaches based on attachment theory, originated by John Bowlby. These range from individual therapeutic approaches to public health programs to interventions specifically designed for foster carers. Although attachment theory has become a major scientific theory of socioemotional development with one of the broadest, deepest research lines in modern psychology, attachment theory has, until recently, been less clinically applied than theories with far less empirical support. This may be partly due to lack of attention paid to clinical application by Bowlby himself and partly due to broader meanings of the word 'attachment' used amongst practitioners. It may also be partly due to the mistaken association of attachment theory with the pseudo-scientific interventions misleadingly known as attachment therapy. The approaches set out below are examples of recent clinical applications of attachment theory by mainstream attachment theorists and clinicians and are aimed at infants or children who have developed or are at risk of developing less desirable, insecure attachment styles or an attachment disorder.

Pain in babies, and whether babies feel pain, has been a large subject of debate within the medical profession for centuries. Prior to the late nineteenth century it was generally considered that babies hurt more easily than adults. It was only in the last quarter of the 20th century that scientific techniques finally established babies definitely do experience pain – probably more than adults – and developed reliable means of assessing and of treating it. As recently as 1999, it was widely believed by medical professionals that babies could not feel pain until they were a year old, but today it is believed newborns and likely even fetuses beyond a certain age can experience pain.

The effects of domestic violence on children have a tremendous impact on the well-being and developmental growth of children witnessing it. Children can be exposed to domestic violence in a multitude of ways and goes beyond witnessing or overhearing, although there is disagreement in how it should be measured. Children who are exposed to domestic violence in the home often believe that they are to blame, live in a constant state of fear, and are 15 times more likely to be victims of child abuse. Close observation during an interaction can alert providers to the need for further investigation and intervention, such as dysfunctions in the physical, behavioral, emotional, and social areas of life, and can aid in early intervention and assistance for child victims.

Sleep training is a set of parental intervention techniques with the end goal of increasing nightly sleep in infants and young children, addressing “sleep concerns”, and decreasing nighttime signalling. Although the diagnostic criteria for sleep issues in infants is rare and limited, sleep training is usually approached by parents or caregivers self identifying supposed sleep issues.

<span class="mw-page-title-main">Parental brain</span>

Parental experience, as well as changing hormone levels during pregnancy and postpartum, cause changes in the parental brain. Displaying maternal sensitivity towards infant cues, processing those cues and being motivated to engage socially with her infant and attend to the infant's needs in any context could be described as mothering behavior and is regulated by many systems in the maternal brain. Research has shown that hormones such as oxytocin, prolactin, estradiol and progesterone are essential for the onset and the maintenance of maternal behavior in rats, and other mammals as well. Mothering behavior has also been classified within the basic drives.

Separation anxiety disorder (SAD) is an anxiety disorder in which an individual experiences excessive anxiety regarding separation from home and/or from people to whom the individual has a strong emotional attachment. Separation anxiety is a natural part of the developmental process. It is most common in infants and little children, typically between the ages of six to seven months to three years, although it may pathologically manifest itself in older children, adolescents and adults. Unlike SAD, normal separation anxiety indicates healthy advancements in a child's cognitive maturation and should not be considered a developing behavioral problem.

<span class="mw-page-title-main">Breastfeeding and mental health</span>

Breastfeeding and mental health is the relationship between postpartum breastfeeding and the mother's and child's mental health. Research indicates breastfeeding may have positive effects on the mother's and child's mental health, though there have been conflicting studies that question the correlation and causation of breastfeeding and maternal mental health. Possible benefits include improved mood and stress levels in the mother, lower risk of postpartum depression, enhanced social emotional development in the child, stronger mother-child bonding and more. Given the benefits of breastfeeding, the World Health Organization (WHO), the European Commission for Public Health (ECPH) and the American Academy of Pediatrics (AAP) suggest exclusive breastfeeding for the first six months of life. Despite these suggestions, estimates indicate 70% of mothers breastfeed their child after birth and 13.5% of infants in the United States are exclusively breastfed. Breastfeeding promotion and support for mothers who are experiencing difficulties or early cessation in breastfeeding is considered a health priority.

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Bibliography

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