Contribution: P N Mohanty, Minakshi Sharma [Print/Download]
Management of crying among newborns and young infants
Cry at birth an announcement of arrival in this world
Crying is an important means of communication for the newborn babies. It is the key sign of life at the time of birth. It gives a lot of happiness and comfort to the mother after experiencing the pain of childbirth. The birth attendants in the labour room feel relieved. The near and dear ones waiting outside feel very pleased. Crying at birth helps expand the lungs and is useful in removing any aspirated secretions at the time of birth. In many ways it contributes to intact survival of the child.
Crying after birth
Usually young infants (before 3 months age) cry a lot. This may be between one to three hours a day. Some babies cry a lot others cry less. Crying is a means of expression and communication of needs and feelings of hunger, discomfort, pain, insecurity, need for sleep, seeking attention, etc. However, if an infant cries too often or for too long, it can become a serious concern for the parents. The first time parents can become very stressed and feel helpless if they are not able to control the crying of their child. So the question is whether the baby should be responded to crying without any delay or let him/her cry it out. Let the baby ‘cry it out’ is an idea that has been debated since around 1880s when the field of medicine was in an uproar about germs and transmission of infection. The notion was that babies should rarely be touched. In the 20th century, behaviourist John Watson applied the mechanistic paradigm of behaviourism to child rearing, warning about the dangers of too much maternal love. Too much kindness to a baby would result in a whiney, dependent, failed human being. The behaviourist saw the baby as an intruder into the life of the parents or care givers, and that should be disciplined by different means, so that the adults can live their normal life without too much worry and discomfort. Now it is believed that there is nothing like too much love. Love can never be excessive.
There are two methods practiced to let the baby cry it out. The ‘extinction method’ in which parents or care givers are advised not to attend to the crying of the baby, but to leave the baby to cry it out until s/he has absolutely no energy left to continue crying. The second one is known as the ‘graduated extinction’ method. It is also known as controlled crying in which parents alternate between attending and not attending during crying spells, at increasingly longer intervals. It is considered to be better over the first method. Tracy Cassels, a Clinical and Developmental Psychologist is of the opinion that though it sounds better, in reality, it works on the same principles. The second method can be more frustrating for the infant or the child. Parents who checks their baby at an interval of 5 or 10 minutes does not really respond to the crying of the baby, but tantalize him/her by showing a ray of hope that his/her cry is attended to which is transitory. This arousal of expectations that are repeatedly abandoned leaves the baby with the feeling of only discomfort, disappointment, loneliness, fear, and sadness which can be very painful and traumatizing. On the other hand caregivers who habitually respond to the needs of their baby before the baby gets distressed, attending and preventing crying, are more likely to have children who are independent than the opposite ( Stein & Newcomb, 1994). Soothing care is the best right from the beginning. Once patterns of distress get established, it’s very difficult to change them. That is why responsiveness is the key in parenting. Responding to children in distress is paramount in building a sense of security and later independence for our children. It is important to be aware that it is not possible for any caregiver to give too much love to their child. There is no limit to giving of love and children will never get spoilt by giving their excessive love.
“Remember, all babies will eventually sleep through in their own time, so with provision of love and guidance from care givers sleep needn’t be traumatic for mother or baby”, claims Australian Association of Infant Mental Health. It further says,” But before you consider cry it out ask yourself this: in a society already brimming with anxiety, depression, low self esteem, co-dependency, narcissism and other mental disorders, do you think it’s acceptable to continue this widespread experiment on infant mental health? When we don’t respond to our babies, what sort of future are we paving the way for?” According to Dr. Margot Sunderland, a well-known psychotherapist,“ the infant brain is so vulnerable to stress — after birth, it’s not yet finished! In the first year of life, brain cells (neurons) are still moving to where they need to be, a process known as migration. Migration is hugely influenced by uncomforted stress”. In the first year of life, there are adverse stress-related changes to the gene expression of key emotion neuro transmission systems (chemical and hormonal) that are responsible for emotional well-being and the ability of the individual to be calm so that they can handle stress well in later life. In addition, the level of stress caused to the infant brain by prolonged uncomforted distressed crying is so toxic, it can result in: elevated blood pressure, elevated cerebral pressure, erratic fluctuations of heart rate, breathing, temperature, suppressed immune and digestive systems, suppressed growth hormone, apnoeas and extreme pressure on the heart, resulting in tachycardia. Any unattended, unresponded and uncomforted infant mammal will eventually stop crying. It is a process called ‘Protest-Despair-Detachment.’ Arguing on similar lines Dr Howard Chilton, a consultant Neonatologist says that “Cry it out makes absolutely no biological sense. Like other primates, humans are a ‘continuous contact’ species, but we humans are even more than that — we are born the most immature of all placental mammals. The important point to be made is that in the early months, our fetus-like babies have to embark upon massive amount of brain development. They have to lay down life-long brain connections and embed fundamental beliefs about how safe and secure their world is, how reliable their parents are, and how valued and loved they are. This is a vital time during which they are learning from their parents (but their mother in particular) new things about the world around them and how to deal with stress. So it makes no sense at the darkest, scariest time of the day to abandon them to a regime of nocturnal neglect! Cry it out also contradicts the very basic parental instincts of nurturing and caring for those we love the most in our lives. It truly makes no sense. Professor Helen Ball, Professor in Anthropologist opines that “From an evolutionary anthropological view point, human infant crying is an identical behaviour to the separation distress call displayed by infants among other primate species. Crying is the infant’s only means of attracting their mother’s (carer’s) attention once separated, in order to ensure their own survival”. Responding to their infant’s cry is an instinctive behaviour of human mothers. To resist the urge to approach his/her crying infant is emotionally and physiologically stressful for mothers. Leaving an infant to cry is therefore evolutionarily inappropriate and biologically detrimental to both mother and baby. Dr Frans Plooij is of the opinion that not only can cry it out or other sleep training methods have an adverse impact on a baby’s brain development, but on the whole breastfeeding relationship too. This is because breast milk production works on a supply equals need basis. So if a baby’s needs are ignored by them being left to cry it out, then a mother’s milk supply can suffer. According to Penelope Leach crying for long enough will eventually stop not because the baby has learnt to go to sleep happily alone, but because he’s exhausted and has despaired of getting any help. Crying hard is stressful, and continued acute stress sets up a hormonal chain reaction that ultimately stimulates the adrenal glands into releasing the “stress hormone” cortisol. Long continued or oft-repeated crying can produce so much cortisol that it can damage a baby’s brain, Professor James McKenna labels the practice of ‘crying it out’ is “entirely a western, cultural construction, and nothing less than a form of abuse” Leaving the baby to cry and not attended amounts to neglect that if repeated and for prolonged periods of time can damage the rapidly developing brain at this age.
We should understand the fact that the mother and child are a mutually responsive dyad. They are a symbiotic unit that make each other healthier and happier in mutual responsiveness. This principle applies to other caregivers too.
Reasons for crying
All babies cry, some more than others. It’s not crying that is bad for babies but crying that gets no response. Therefore, the mother or the care giver should attend to the crying child, try to understand the reasons for crying and respond accordingly. Prominent reasons why an infant cries are as follows:
- Hunger: – Most probably this is the first thing mother thinks when her baby cries. A sensitive mother recognizes the early signs of hunger and responds to it in a timely manner. Some of the cues of hunger include rooting, fussing, smacking of lips, putting hands to mouth, etc. Mother should recognize these signs of hunger and feed the baby before s/he cries.
- A dirty diaper: – When the diaper is dirty and wet, the baby feels discomfort and starts crying.
- Needs sleep: – Many babies when sleepy can be cranky. Instead of nodding off, they may fuss and cry especially if they are exhausted.
- Wants to be held: – Babies need a lot of cuddling. They like to see the face of their mother the most, hear her voices, listen to her heartbeats which s/he was used to hearing in utero and even can detect the unique smell of the mother. Crying can be a way of expressing his/her desire to be held close.
- Tummy troubles: – If the baby often fusses and cries after feeding, it may be s/he is feeling some pain and discomfort in the tummy. Tummy troubles, very often are associated with gas or colic which can lead to lots of crying. In fact, the rather mysterious condition called colic is defined as inconsolable crying for at about three hours a day, three days a week, three weeks in a month for a period of 3 months. A good burp after each feeding may be all s/he needs. Babies swallow air when they are breastfed or suck from a bottle, and if the air isn’t released it may cause some discomfort. Babies are always lying down and the air in the gastro intestinal tract does’nt get expelled easily. This can cause a lot of discomfort and crying. Crying can also be associated with swallowing of air and this can worsen the situation.
- Feels too hot or too cold:- When babies feel too cold ( while removing clothes, less clothing, changing diapers, cleaning bottom in cold water or cold swipe) or too hot (over clothed and covered) , they may protest by crying. Babies are more likely to complain about being too cold than being too warm. They are less likely to cry vigorously under these circumstances.
- Wants more/less stimulation: – A “demanding” baby may be outgoing and eager to see the world. Often the only way to stop the crying and fussing is to stay active. They learn from the stimulation of the world around them (the lights, the sounds, being passed from one hand to the other), but sometimes they have a hard time in processing it all. Crying can be a baby’s way of saying, “I’ve had enough”, and “I am no more interested”.
Not well: – If the basic needs of the baby have been met and possible measures to comfort him/her have been taken and the baby is still crying, it indicates that s/he might have some medical problems. Mother or care giver may measure the temperature to rule out fever or hypothermia and look for other danger signs. The cry of a sick baby tends to be distinctly different from one caused by hunger or frustration. If you find your baby’s crying “just doesn’t sound right,” trust your instincts and contact a health care provider immediately Do not delay care seeking.
What to do if the baby is still crying?
Babies have their own reasons to cry. Even the sensitive and learned parents can’t say why their baby is crying and the baby is not capable of expressing to him/her verbally what is wrong with him/her. Moreover, two babies are never alike. One formula that works well with one may not work with other. However, there are certain tried and trusted methods which can be applied. Paediatrician Harvey Karp advises parents to use 5 Ss when their babies are crying when reasons are not known. These 5 Ss recreate a womb like environment and activate baby’s calming mechanism. These are as follows:-
- Swaddling: – Newborns like to feel warm and secured as s/he was in utero. Create a situation so that the baby can have that feeling by swaddling the baby in a soft blanket, clothing the baby adequately, and holding the baby in your shoulder. However swaddling should not be tight and not prolonged.
- Side or stomach position: – Hold your baby so he is lying on his side or stomach. This will help in releasing air/gas. But always put the baby on his/her back at sleep. A baby should never be kept on its stomach when sleeping This can choke the baby.
- Shushing: – Many babies are calmed by a steady flow of “white noise” that drowns out other noises – much like the constant whoosh of bodily sounds they heard in the womb. Run the vacuum cleaner, hair drier fan, clothes drier,etc. It helps to hold the baby on your shoulder so the baby can hear the heart sounds and simply produce a continuous humming sound.
- Swinging: – Hold your baby in your arms and gently rock, get your baby in motion by sitting in a rocking chair, putting the baby in a pram or carrier and gently moving it would help
- Sucking: – Give something to your baby to suck. Sucking can steady a baby’s heart rate, relax his stomach, and calm flailing limbs. The finger or the object that the baby sucks on should be clean to prevent an infection.
In addition, other methods that can be tried out are as follows:-
- Music and Rhythm: – Play soft music or sing a lullaby or a song slowly. You can experiment by playing different songs and find out for yourself what works and what does not. Soft and sweet music would soothe and relax the little one. Avoid putting the TV on loud.
- Fresh air: – Open the door of your house and step out with your baby. Look at your surroundings, look at the sky and talk to your baby slowly. Sometimes this helps to stop the baby crying.
- Warm Water: – Just like fresh air, warm water can soothe and relax the baby and stop the baby from crying. Hold him/herb in your arms under a slowly running shower and make sure that your shower is slip proof.
- .Massage: – Babies love to be touched. So, gentle touch stroking the baby or a gentle massage is a good idea. Slowly and gently massage the baby or stroke the baby from head to toe. This would comfort your baby.
Physical, mental, or emotional challenges at birth, or soon after, are often traumatic to an infant and can cause your baby’s nervous system to get “stuck.” A nervous system that is stuck will probably have difficulty with regulation, which means the baby will have a hard time settling down. Special or traumatic circumstances that might cause problems include premature birth, difficult or traumatic birth, medical problems or disability and adoption or separation from primary caregiver. The physical illness or depression in the care giver can be quite stressful for the baby. Remember, if you have tried out various methods to calm and soothe the baby but these are of no avail, don’t delay in consulting a health care provider. Your baby might be in need of medical care. A sensitive mother can differentiate a cry for hunger or it is cry due to illness. The care givers (mothers) can become sensitive through ongoing interaction with their babies.
How to cope with a crying baby who is non-responsive?
When the baby is crying nonstop and not responding whatever you do can be a very painful and stressful situation for the mother. She gets exhausted, frustrated and sometimes angry and may cause harm to herself or the baby. Mother should recognise her own limits and needs to develop some strategy to take care of her own self. Unless the mother is stable, calm, relaxed and focused, she can’t find out what is going on with her baby and can’t do something positive to calm the baby. So, she should take a break and seek support of others. Extra support is required when parents or care takers particularly mother is depressed, suffering from major illness or having chronic health problem, exhausted due to sleeplessness, feeling neglected, unsupported and isolated. Post partum depression affects 10-20% mothers during the first few months after child birth. Maternal depression adversely affects some aspects of infant development and behaviour particularly difficulty soothing, irritability and crying behaviour. Arguably, excessive infant crying is a signal waiting for a response. Consequently, it may be a useful target to use for interventions in mothers with depression that improves the outcomes for infants and their mothers. Some of the strategies you can consider are as follows:-
- Put the baby in a safe place and let him cry for a while
- Take the help of a trusted person to take care of the baby at this time The baby should never be left unattended.
- Seek the advice of a person on whom you have faith
- Listen to music or view a TV show that you like.
- Have a cup of tea or coffee if you feel so.
- Think that crying is not going to harm your baby
- Think that time is in your side. This phase will go. Crying follows a developmental pattern known as ‘crying curve’. It increases at the age of 2-3 weeks, peaks between 6 – 8 weeks then slows down after that and generally hitting its lowest around 4 months of age.
- Don’t worry about perfection. Parenting is not all about perfection. Experts estimate that meeting your infant’s needs at leastone third of the time is enough to support healthy bonding and secure attachment.
Never shout at your baby or get upset. It neither helps you nor your baby. Never shake the baby to blow out your frustration and anger. It will neither help in soothing your baby nor stop him from crying. Rather it will cause long lasting psychological and emotional problem. Baby will feel insecure, helplessness and fearful. According to American Academy of Paediatricians, ‘Shaken Baby Syndromes’ occurs when the baby is shaken which happens when parents or care givers become frustrated and angry and are not able to cope up with the situation when the baby is crying and nonresponsive. Adverse outcome that may result from shaking a baby includes brain damage, mental retardation, blindness, seizures and even death.
- Cry it out-six educated professional who advice against it www.bellybelly.com.au//baby –sleep //cry-it-out//accessed October 2016 (Dr Margot Sunderland, Prof James McKenna, Dr Howard Chilton, Prof. Helen Ball, Tracy Cassels, Dr Frans Plooij).
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