On April 11, 2012, we hosted a live Q-and-A on Seattle Children's Facebook page with experts from our staff (Drs. Kenneth Feldman, Frederick Rivara and Wendy Sue Swanson) as well as a world expert on infant crying, Dr. Ron Barr. Below are the questions that were asked and the answers provided by our team.
Dr. Frederick Rivara: Hello, I have been a general pediatrician at Seattle Children's for more than 25 years. I have two grown kids, one of whom had his share of crying as a young infant. I am glad to be here answering your questions.
Dr. Ron Barr: Hi everyone, this should be great. I am a pediatrician at BC Children's Hospital in Vancouver. Great to join you. I have spent probably too many years trying to understand infant crying, including studies of other cultures, and especially how frustrating it can be to parents and caregivers. I have two sons, neither of whom had "colic" (thank goodness). But I also have 7 grandchildren, with another one expected. Looking forward to this chat.
Dr. Kenneth Feldman: Hi, I've been a general pediatrician for nearly 40 years. I also have been a consultant for child abuse for 30 years. As, a result I've dealt with a lot of fussy infants in my office practice and have seen the unfortunate injury consequences of caretaker frustration with fussy babies. I also have 2 children of my own who are now adults. Also, my grandson and his family were living in our home for his first 2 years. So I've had plenty of opportunity to see how difficult it is to console infants, as would any parent.
Dr. Wendy Sue Swanson: I'm a mom and general pediatrician. I have 2 boys, one who was fussy during early infancy and then again around 6-9 months (!!) and one who was not. I'm a community pediatrician in Mill Creek and talk with families every single day while I'm in clinic about crying, fussiness and the hard-work of raising young children. Delighted to be here!
Does a newborns cry change if they have a sore throat?
Dr. Frederick Rivara: I get this question often. Newborns rarely get the same sore throats that older children get. Mothers frequently tell me that their infant's voice becomes more hoarse if they get a sore throat, and this can make their cry more hoarse as well.
We'll be at swim lessons at 6:30 (at the hospital), so here is my question... My 3.5 year old has been waking up crying almost every night at regular intervals for about 6 months. It seems to be at the end of her REM sleeping maybe? She goes down at 7:30, and wakes up at 11 ish, 2 ish, and 5 ish. She is not in pain or scared or ill, but she won't stop crying and yelling for us until we come into her room. She'll carry on for 45 minutes or longer. She requests water or a tissue or sometimes nothing when we do come in to check on her. We've tried to ignore her and let her cry it out. We've tried to reason with her. We've tried all sorts of comfort mechanisms from music to a nightlight to animals and blankies etc. Nothing works. HELP!
Dr. Wendy Sue Swanson: Toddler and preschool awakenings are unfortunately very common. At first thought, it sounds to me like your daughter is awakening at regular intervals (it's not unexpected for children to awaken 5 times at night) that could be very normal with her sleep cycle like you mention, however she may be having a bit of separation anxiety when she awakens. If she calms when you enter the room that's reassuring and likely helpful to confirm she is experiencing separation anxiety. Your consistency is key. Here's what I would do: make a plan with your daughter so she is clear what you'll do. Make a verbal contract (i.e. we'll be in only once in the middle of the night, the other times you'll need to get yourself back to sleep). Stick to your plan. Reward her for nights she sticks to the plan. If she is unable to self-soothe over time with your strict plan, talk with her pediatrician. Further, to improve her hygiene at bedtime try to avoid any screen time before bed, no other activities in her bed other than sleeping or books, same bed time every night, no napping after 3pm. Stay strong, be consistent and provide rewards. If no improvement, talk to your pediatrician about next step for a work up. Some children do have sleep challenges like restless leg syndrome, etc. and can be screened in the office. Also here's a blog post I wrote on toddler overnight awakenings.
My 10month old will not sleep through the night. She will go to bed at 9pm, wake up around 2am and 6am very hungry. She will drink 6oz of formula each time she wakes up. She will cry and scream until she gets a bottle. Comforting her and letting her cry it out will not work. Is there any hope for a full nights rest?
Dr. Wendy Sue Swanson: Yes, hope is always something to maintain! You will sleep again, but it will take consistency and a little discomfort first, I suspect. Your 10 month old is not doing anything uncommon, she's accustomed to getting fed prior to sleep as part of her routine for soothing. Babies become "trained night feeders" meaning they demand feeds as a part of getting back to sleep. It is safe to try to gradually discontinue what you provide her. I would work to move from providing a bottle to only providing comfort in picking her up and rocking, etc, to then only rubbing her back in the crib to then not going in. Some families feel better gradually stepping back from the care they provide for babies who awaken and cry until being fed. Letting her cry it out is also an option but you may not be ready. I'll link to a few posts I've written about sleep as well. Never too late to start putting babies down and letting them learn to self-soothe.
I understand that not all crying is soothable. Why?
Dr. Ron Barr: Yes, you are completely right...it is true that not all crying is soothable. In the first 3-4 months of life, about 5 to 10% of bouts of crying that infants do are UNSOOTHABLE. Interestingly, this experience of unsoothable crying bouts is pretty much unique to the first 3-4 months of life. As you can imagine, these crying bouts (as compared to "fussing" and "crying") is the most frustrating form of crying for caregivers. It is unfortunately also the most likely form of crying to trigger an abusive episode if caregivers lose their cool. So, it is very important to be aware of them, and not let these episodes "get to you" as a caregiver. These unsoothable crying bouts are part of the normal crying behavior that infants do in the first month of life, and do not indicate that you are a bad caregiver if your infant has them.
I have a 3 1/2 year old boy who is very whiny. He seems to whine all the time over nothing. I don't get it. He wasn't a colic baby either and didn't cry much. But for the past couple years he whines over everything.
Dr. Kenneth Feldman: A lot of toddlers go through periods when they are more insecure or are seeking more attention. Sometimes you can recognize changes in their life that have caused this, but sometimes there is no obvious cause. Whatever the cause, responding positively when you son does things right and avoiding fussing over him when he is winy or inappropriate can help reduce the behaviors that bother you. It's important to pick your battles on important issues, but then set consistent limits.
Since I have started my path to fight child abuse, I get a lot of questions about how to handle situations they encounter. I refer to Period of Purple information that I have learned, but are there other resources that you doctors find helpful for people? Also, what is a safe amount of time for a baby to cry when a parent is taking their "timeout" while the baby cries and they are trying to calm down?
Dr. Ron Barr: So thrilled to hear that you are helping to fight child abuse. You have two questions: are there other resources that doctors find helpful, and what is a safe amount of time for a baby to cry when a parent is taking their "time out"? With regard to the first, you may or may not know that the PURPLE DVD has just added a second video (released in late January) on the same DVD that is called "Crying, Soothing and Coping: Doing What Comes Naturally." It provides advice on strategies to calm infants that are research-based as well as strategies on how to cope with crying IF SOOTHING IS NOT SUCCESSFUL. All parents who now receive the PURPLE materials at birth in the hospital get both the PURPLE Crying video and the "Soothing" video. Second, the National Center has a web site for parents called purplecrying.info that has a lot of additional information about crying, but also about sleeping, suggestions for fathers, swaddling, and so on.
As for the amount of time that parents take for their "time out", that depends mostly on how frustrated they are when they put the baby down for their "time out." The main thing is for the parent to be able to be calm. They won't be much help if they come back to check on the baby if they are still furious. However, if they have calmed down, we usually say coming back to check in about 10 to 15 minutes is usually fine. If they are put down safely in their crib (on their back, of course), the crying won't hurt them.
I am interested in infant crying around two months. We had two babies seriously injured in our community due to shaking baby.
Dr. Kenneth Feldman: It makes us all sad when we hear that children have been injured due to caretaker frustration. Most babies begin to cry more in the weeks after they are born and cry the longest when they are about 6-8 weeks old. Fortunately this is about the time they learn to smile socially, so they can start to give parents some positive feedback for your attention. If parents make it over that hump, they can expect the crying to slowly improve.
Unfortunately, when caretakers are pushed to their limits of frustration, they may do harmful things like shaking their baby. We can help by trying to recognize the needs of new families and providing some support and relief to them.
Dr. Swanson, You said you had one baby who was fussy and another who wasn't. My daughter - now almost 1 - was super-fussy for about four months, but then ultimately settled down. Does this mean there's a possibility the second - if there's a second - won't be fussy?
Dr. Wendy Sue Swanson: ABSOLUTELY! One of the wonderful gifts of having more than one child is the reality that they truly are different - in looks, in behavior, in personality, and in temper. Many families notice the profound difference between their children during infancy. Let's cross our fingers your second isn't an excessive crier.
There are a lot of people that say "Babies don't cry from crying, but the cry from being shaken" though I agree with this to some extent, is it true that a baby won't die from crying? Cause this also leads me to wonder about the theory of letting them cry it out when parents try teaching their babies to self soothe.
Dr. Ron Barr: So, let me be very clear. IF the baby is crying, it is true to say that babies will not die from crying. The very, very rare possible exception might be if there is another serious pathological (illness) condition such as a severe cardiac abnormality or something like that. But, in an "otherwise healthy baby" they will not cry from crying. However, you quotation raises a different question; namely, will infants cry from being shaken. There are two parts to the answer to that. First, if a baby is crying and then is shaken, they typically go quiet and stop crying. This is in a way VERY unfortunate, because sometiems caregivers think that the shaking "works" as a way to soothe infants, and this encourages (unfortunately) some caregivers to repeat the shaking the next time the infant cries. This is one of the most dangerous aspects of shaking...that it is misinterpreted as a good way to sooth infants. The second part of the answer is this: IF an infant is shaken but recovers from that episode with a "little bit" of brain damage, this little bit of brain damage may reduce the infant's ability to "regulate" itself, and after a few episodes like this, it may cry more. But the crying more is coming from the shaking (espeically repeated shaking), not from the crying. Does that answer your question? Finally, I am sceptical that babies "learn" to self soothe in the first few months of life; later they do when they are older.
I really appreciate the discussion on toddler crying/ whining. I have a 20 month old daughter and she goes on crying/screaming/whining jags that, in the moment, seem to last forever! It can be so incredibly frustrating. In fact, I often find it harder to cope with than her infant crying. I sometimes have to take a "time out" myself.
Dr. Wendy Sue Swanson: Yup, yup yup. Taking a time-out for yourself sounds perfect. Whining is very frustrating and can really irritate us, especially when we're tired. Here's a blog post I wrote about whining that you might find helpful as well.
I have a 3 1/2 month almost 4 month old boy. He has been fussy and I assume colic since he was about 3 weeks old. His doctor has him on acid reflux medicine. It seems to be helping somewhat. But he still has a few fussy times during the day. Anything else you doctors suggest I can do? I thought by now the colic would be gone. And he's also still waking up about 3-4 times a night. Need advice. I'm a first time mom.
Dr. Wendy Sue Swanson: First off, the overnight awakenings at this age are not too uncommon. I usually help families try to get down to only 1-2 overnight awakening by 6 months by providing less and less for babies each time they awaken to help them learn to self-soothe. However, most 4 month olds will sleep 4 hours or so and then awaken every 2 hours or so naturally with their sleep cycle. And it's helping them learn how to get them back to sleep all on their own that can be really helpful.
In regards to reflux (GERD), many babies are treated for spitting up/regurgitation and fussiness with antacids. If there are typical times of day that are worse, try to devise a way to improve their positioning, reduce volume of feedings, keeping them upright AND getting out of the house. Crying is much easier to deal with outside while on a walk and with friends than when you're alone at home. Hopefully you'll see great improvements in the next few months. Many babies start to outgrow their GERD around 7 months of age. Talk with your pediatrician about timing of a wean off meds.
Our son is 5 months old, and diagnosed with laryngomalacia. He is really fussy, and will cry a lot through the day. Is there any relation to the crying and laryngomalacia? His naps are not great due to snoring. Thanks!
Dr. Frederick Rivara: I don't know of any direct relationship between laryngomalacia and crying or being fussy. On the other hand, if he is not napping well, he may be tired a lot of the time which could account for the fussiness. It might be good to take him back to his pediatrician.
I am not a parent but I have friends who are new parents and would like to know how I can support them. They have a baby that cries a lot.
Dr. Wendy Sue Swanson: Of course it does take a village so you ask an incredible question. First off, providing a sounding board for frustrated parents is a great start. Check in with them, ask them how they feel with their crying baby. Can you offer to come over one night a week and provide respite? Even an hour of coverage during a fussy time of day (often in the evening) can be an incredible gift. Further, can you provide things for mom and dad who are stressed and tired? A meal, a load of laundry, or just a chat on the couch. All this can be entirely life-changing to an exhausted, stressed new parent with a fussy baby.
Also, don't just do this once. Do this and then hit repeat until your friends are past the months of major overwhelm. Keep checking in and keep providing help if they will let you. Even a text message can be a buoy for an overwhelmed new parent.
Hi all, I lead groups for new fathers. One issue that comes up for many of the new dads is that they get angry when baby is fussy. Many have talked about using earplugs which they say help de-intensify their emotion. But my concern is that this only partially deals with the problem. Most of the time I think it is a frustration that there is nothing that you can do for your baby or a misreading of cues. Anyhow wondering if you have any good resources about how dads (or moms) can cope with this.
Dr. Kenneth Feldman: Conscious Fathering was designed by a dad who recognized the toll on dads of fussy babies and the risks to their infants. They have some great training and resources at parenttrust.org.
Dr. Wendy Sue Swanson: I think you're right about the source of frustration coming from an inability to make crying go away. Some books and some sleep experts talk about making ALL crying go away. Something to remember and talk about is that CRYING IS NORMAL in infancy, particularly in the first 3 months. Although swaddling and shoooshing and walking and strolling helps, sometimes all of our efforts don't stop the crying. SOMETIMES we all just need a break. It's always okay to place a baby in a safe crib on their back and step away for 10-15 minutes. Taking a break before you escalate in anger is a great way to calm down.
Dr. Ron Barr: I am so impressed that you lead groups for new fathers. What a great contribution. To get to your question, first about ear plugs. That suggestion comes up often. And, frankly, it is fine. Anything that helps caregivers calm down and bit and not hit their "threshold" (whatever it is for them) to do anything bad is helpful. But I do agree that it is just a partial answer to the problem. There is no question that there is frustration when nothing you do works. That is a completely normal response. The key is to understand that it is not "you" who are at fault here, but a well-recognized and completely normal part of the challenges of infant crying in the first few months of life. Something like 5-10% of the crying is going to be "unsoothable" crying. Also, the new PURPLE DVD has a second video on it called "Crying, Soothing and Coping: Doing What Come Naturally" that includes suggestions about what to do when soothing DOESN'T work, and includes some really astute stories from dads about how they coped.
How often is excessive newborn crying indicative of underlying disease?
Dr. Kenneth Feldman: Some babies get fussy, because something is wrong with them. It is very appropriate to look for the usual culprits: I'm hungry, my diaper is bothering me, I have a burp I can't get up or a BM I can't get out, I'm tired, to much noise/action/change is occurring around me. However, crying usually is just a normal infant activity. If there is nothing wrong, it's hard to fix it. So you shouldn't be surprised if nothing you try settles your infant.
Even though colicky crying sounds awful and painful, it usually isn't caused by any illness. Although many people worry about belly problems or allergies, most crying infants are just normal and don't have diseases such as these. Often parents and doctors will try things like changing formulas, but don't be surprised is this doesn't change the crying.
Question for all of our doctors here tonight: can we soothe all infant crying?
Dr. Kenneth Feldman: Some things like swaddling, gentle repetitive motion, soothing sounds (talking quietly to or reading to your baby), feeding or changing to fresh diapers can settle some children. Some children are soothed by a car ride (of course, using an appropriate infant car seat).
If you can't settle your baby, even though you've tried everything, you're not a bad or ineffective parent. (It's pretty frustrating though.) That situation occurs to everyone. Crying is always un-soothable for some babies. In that case your baby may just be overstimulated or exhausted. It's OK to put your baby down in a safe place and walk away to get yourself settled down.
Dr. Wendy Sue Swanson: The quick answer is NO. All babies cry, just not the same amount. When it's difficult to make the crying go away you're not failing! And it isn't "perfect" parenting that stops crying. Some babies will cry over 3 hours a day while others only a few minutes every day. Our job as parents is to do our best to soothe and then acknowledge at times that crying is a normal part of fatigue, over-stimulation, and maturation for newborns. Surround yourself with family and friends who can support you when it's difficult to get the crying to stop. And know that although we can soothe most crying there will be some periods, particularly around 6-8 weeks of age, that it's hard to stop the crying entirely. Go outside (drying much less irritating), go on a walk with a baby, take a break and put your baby in the crib for 10 minutes. And then start again.
Dr. Frederick Rivara: NO! It is very important for parents to understand that, while most of the time they can soothe a crying baby, there will definitely be times that they cannot soothe a baby. It does not mean something is wrong with the baby and it also does not mean something is wrong with you as a parent. It is important to understand this, not be frustrated by your inability to always console your child, and be able to hand off the baby to someone else, or place the baby in the crib and walk away for a few minutes.
Dr. Ron Barr: Great question. Maybe the most important one. My answer: NO. A really, really important thing to recognize is that, in the first few months of life (first 3 or 4 months) about 5-10% of the crying bouts that infants have will be unsoothable, or inconsolable crying bouts. They are not due to dirty diapers, lack of food, or anything else in the environment. AND, it is not because the parent is a bad caregiver! It is part of the normal properties of crying in the first few months of life. Unfortunately, these unsoothable bouts are also the most frustrating for parents. Unfortunately, some of the parent advice out there "promises" that, if only you do it right, you can have a calm baby. I am very sad to hear such claims, because when a parent tries the calming techniques and they don't work, the caregiver can get even more frustrated, with the increased risk of doing something to their baby that they will regret.
Our (former) pediatrician called it colic when my daughter cried 20 hours a day. Allergist realized she had food intolerances. Once she was on a formula that agreed with her (I didn't breastfeed as she's adopted), she became mellow and happy. In my experience, "colic" just means "We can't figure out what is wrong". I think it's worth it to keep trying to figure out what is wrong if a baby cries a lot.
Dr. Wendy Sue Swanson: Not all pediatricians "believe" in colic and use it as a diagnosis, particularly because crying is a normal part of infancy. However, for excessive criers (like yours it sounds like) there sometimes are things like diet restrictions that can help. Often, I have moms restrict dairy in their diet if they are breastfeeding for 10-14 days to see if any fussiness improves. To prove it does, I then have them do a big DAIRY day where they go nuts. If crying recurs or fussiness spikes again, restriction of dairy may be a great intervention. Dairy, followed by soy, egg, wheat and nut are some of the most common intolerances in infancy but are hard to diagnose at best. But it is often very worth a trial off dairy to see if it improves. Thanks for your comment.
How can a parent take care of themselves when they have a colicky baby and when they feel judged by others?
Dr. Wendy Sue Swanson: New moms and dads often talk about feeling judged or feeling inadequate when they can't stop the crying. First off, find support with your baby's pediatrician and from friends who understand how hard you are working. Take breaks, split childcare duties at night with your spouse or partner, take a shower when baby is napping, let neighbors and friends help you around the house, and do your best to plan a night out to dinner and away during a cranky period to just have a break. Taking care of yourself, surrounding yourself with supportive (non-judging) family members will always be in your child's best interest.
Dr. Kenneth Feldman: It's pretty awkward when your baby cries in public and you can't settle them. Just remember that most people around you have had the same experience and have only sympathy for your situation.
It's very important to have friends or family who can provide you with support and a break from child care. You might be surprised how much your neighbor, who you don't know very well, would be glad to sit and talk with you or give you a little time on your own to recover. Children are great, but it helps to also have interaction with other adults.
Whatever else, if you are frustrated with your infant, it's OK to put them down in a safe place, walk away far enough that the crying doesn't stir you up and catch your breath. Never, ever shake your baby or lifelong injuries or death may result.
Dr. Ron Barr: Right, parents absolutely need to attend to their own needs too, especially when frustrated by a crying baby. Having a friend to call (someone suggested that in an earlier post) is really helpful. "Respite" of any kind that works for you (all parents have their own thoughts about what works for them) is key. Having a great health care provider who is supportive and understands what you are going through helps. Taking your baby to your health care provider to make sure there are no "organic" or "disease" problems is always worthwhile, so that you can be assured that you are just dealing with the normal increases and decreases in crying in the first few months of life helps. For those with the most recent PURPLE DVD there is a new video on it called "Crying, Soothing and Coping." The last section deals with what you can do to calm yourself if your attempts at soothing your baby don't work.